Centre for Mental Health

Liaison Psychiatry

Psychiatric liaison services provide mental health care to people being treated for physical health conditions in general hospitals. The co-occurrence of mental and physical health problems is very common among these patients, often leading to poorer health outcomes and increased health care costs. An effective liaison psychiatry service offers the prospect of saving money as well as improving health.

People who have a long term physical health condition are more than twice as likely to have a mental health problem as the general population. This can have a huge effect on a patient's chances of recovery. For example, someone with chronic heart failure is eight times more likely to die within 30 months if they also have depression. Altogether, there are over 4.6 million people with a long term physical health condition and co-morbid mental health problem, all of whom would benefit from more integrated physical and mental health care.

Half of all hospital inpatients have mental health conditions such as depression and dementia. Identifying and managing these conditions quickly and effectively helps people to recover and reduces their length of stay in hospital.

Liaison Psychiatry in the modern NHS

The report, Liaison Psychiatry in the Modern NHS, finds that liaison psychiatry services can save an average hospital £5 million a year by reducing the number and length of admissions to beds. It adds that even bigger savings could be achieved in future if liaison psychiatry services were extended to work in the community to prevent crises from happening at all.

There is a wide variation in the way liaison psychiatry services work and who they help. Many offer training and support to other clinical staff as well as providing mental health care themselves.

The report concludes that well-run liaison psychiatry services can be highly cost-effective, saving more money than they cost. The greatest immediate impact can be achieved by supporting older patients in hospital but liaison psychiatry services also have the potential to offer better care at potentially lower cost to many other groups, both in hospital and in the community.

The report highlights the following points:

• Every general and acute hospital should have a dedicated liaison psychiatry service, set up according to local needs.
• Every service should be established on a sustainable basis.
• Liaison psychiatry services should seek to integrate psychiatry and psychology fully into medical care.
• In hospitals where liaison psychiatry support is currently limited or non-existent, the initial priority should be to set up a rapid-response generic service.
• A generic service should wherever possible provide liaison psychiatry support on an all-ages, all-conditions basis.
• A liaison service should therefore focus mainly on complex and costly cases.
• The training and supervision of acute hospital staff should be a core function of all liaison psychiatry services.
• Outpatient treatment clinics should focus particularly on conditions which are not generally well managed in the community, for example medically unexplained symptoms and self-harm.

The way ahead for liaison psychiatry

The way ahead for the long-term development of liaison psychiatry is likely to lie primarily in the expanded provision of community-facing services. The biggest area for the development of community-based liaison psychiatry is in contributing to the management and treatment of mental health problems among people with long-term physical conditions

An evaluation of a liaison psychiatry service
in Birmingham

The Economic Evaluation of a Liaison Psychiatry Service examines the costs and benefits of the award-winning Rapid Assessment Interface and Discharge (RAID) psychiatric liaison service in City Hospital, Birmingham.

The service offers comprehensive, round-the-clock mental health support to all adult patients in the hospital.

The report finds that the financial savings RAID generates within the hospital significantly outweigh the costs of running the service. Since expanding from a small liaison psychiatry team to its current form in 2009, RAID is estimated to have cut the costs of bed use within the hospital by some £3.5 million a year.

Most of the savings the service generates come from shorter lengths of stay and reduced readmissions to the hospital among elderly patients. But further savings are also likely to be generated by an increase in the number of older patients being discharged to their own homes rather than residential care.

Liaison psychiatry both cuts costs in the NHS and improves people's quality of life. By even the most conservative analysis, the RAID service creates savings that are four times bigger than the extra cost of expanding the service it replaced.

Further information

For more information about liaison psychiatry, contact Michael Parsonage on 020 7827 8317 or email him.