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.
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.
What you can do - Commissioning
- Every general and acute hospital should have a sustainable, dedicated in-house liaison psychiatry service that can meet local needs.
- Liaison psychiatry services should seek to integrate psychiatry and psychology fully into medical care and could incorporate related services such as substance misuse services.
- In hospitals where liaison psychiatry support is limited or non-existent, the initial priority should be to set up a rapid-response generic service, focusing on assessment, the day-to-day management of patients and onward referral. The core work is likely to be in inpatient wards and emergency departments.
- A generic service should wherever possible provide liaison psychiatry support on an all-ages, all-conditions basis.
- The training and supervision of acute hospital staff should be a core function of all liaison psychiatry services.
- The next stage of development for a hospital-based liaison psychiatry service is likely to be in the provision of outpatient clinics for the treatment of mental health problems which cannot be resolved during the limited time that most patients spend in hospital.
- The way ahead for the long-term development of liaison psychiatry is likely to be in the expanded provision of community-facing services.
- One way of developing services in this way would be to open up outpatient treatment clinics to referrals from GPs and other community-based providers, where this is not already the case.
- Another possible area for the expansion of community-facing services is in relation to perinatal mental health, particularly during the antenatal period.
- 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 such as diabetes and chronic respiratory or cardiac problems.