Psychiatric Bulletin (2000) 24: 379-381. doi: 10.1192/pb.24.10.379
© 2000 The Royal College of Psychiatrists
Psychiatric Bulletin (2000) 24: 379-381
© 2000 The Royal College of Psychiatrists
Towards the development of a reciprocal liaison service
A survey of attitudes
Mark Davies, Consultant Psychiatrist
Community Mental Health Team, Waterford House, 142 Station Road, New
Milton, Hampshire BH25 6LP
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Abstract
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AIMS AND METHOD
The aim of this survey was to determine attitudes among consultants in
different specialities towards the development of a reciprocal liaison service
providing access for psychiatric patients to medical and surgical liaison
services equal to the access of medical and surgical patients to psychiatric
liaison services. All medical, surgical and psychiatric consultants in a
district health service were surveyed, with a total response rate of 48%.
RESULTS
The mean number of medical and surgical patients requiring a psychiatric
liaison service was 6%. The mean number of psychiatric patients requiring
medical and surgical liaison services was 11%. Ratings overall for various
components of the two types of liaison service were generally similar, with
acute assessments and follow-up being given a high priority for both
types.
CLINICAL IMPLICATIONS
As liaison services are developed, the notion of equity of access for all
patients is paramount.
Commissioning of such services should thereby specify the reciprocal nature
of development. This survey shows that generally there is a positive attitude
to the development of such a service.
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Introduction
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Psychiatric liaison services for medical and surgical patients are a
well-established, although often under-resourced and underdeveloped, feature
of most local health services. Studies consistently show that this type of
service reduces hospital stays and, ultimately, costs
(Smith et al, 1995;
Hall & Frankel, 1996). However, a clearly defined reciprocal service provided by medical and surgical
services for psychiatric patients is poorly researched and developed.
Cooperative intervention between physical and mental health services can
improve detection and management of ‘cross-speciality’ disease
(Saravay, 1996). Comorbidity of
mental and physical health problems can be complex, requiring close working
between mental and physical health professionals
(Buckley et al, 1995;
Rustomjee & Smith, 1996). Confronting stigma towards people with mental illness has taken on a higher
profile recently with the launch of the Royal College of Psychiatrists
anti-stigma campaign (Cowan & Hart,
1998). Part of the process of destigmatising mental illness is to
increase the access of psychiatric patients to appropriate medical and
surgical care. People with mental illnesses are often perceived as requiring
less physical health care than the non-mentally ill
(Dolinar, 1993). Communication
of physical symptoms may be hampered by poor communication skills, and
understanding of physical disease impaired. Mental health units are often
sited away from medical and surgical units, leading to marginalisation of
psychiatric patients and staff. This can lead to inequitable access of mental
health patients to physical health services. One way to overcome this inequity
would be to integrate medical and surgical liaison services for mental health
patients with developments in psychiatric liaison services for medical and
surgical patients. To determine whether such an integration would be feasible,
a survey was undertaken of medical, surgical and psychiatric consultants
asking about their attitudes to the development of a reciprocal liaison
service.
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The study
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All medical and surgical consultants were identified in a large district
general hospital serving a town on the south coast of England with a
population of 160 000 people. Additionally, all consultants in the local
mental health service covering a large proportion of the same population were
identified. Those identified were then sent a questionnaire. Each respondent
was first asked to signify the speciality in which they worked, along with an
estimate of how many of their patients might require a liaison service.
Respondents were then asked to complete two sections, the first containing
components of a psychiatric liaison service for medical and surgical patients
and the second section, components of a physical health liaison service for
mental health patients. Respondents were asked to rate the components on a
five-point scale ranging from necessary (four) to unimportant (zero). It was
emphasised that respondents should complete both sections. For each of the two
types of liaison service, the number of respondents indicating each of the
possible ratings (i.e. 4--0) for a component was calculated. Each of these
totals was then multiplied by the corresponding rating. An average was then
calculated from the resultant values to give an overall ‘priority
value’ for each component. The priority value was intended to indicate
the overall relative preference of respondents for each component of the two
liaison services. The higher the priority value, the higher that component was
rated by each group as a whole. The priority values allocated by medical and
surgical consultants were combined to give average values for ‘physical
health services’.
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Findings
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Of the consultants contacted, 30 were surgical, 36 medical and 20
psychiatric. Of these, surgical consultants returned 12 (40%) questionnaires,
medical consultants 19 (53%) and psychiatric consultants 10 (50%). For the
question on the percentage of their own patients requiring psychiatric liaison
services, surgical consultants quoted a mean of 2% (range 1-5%), two not
indicating a figure. Medical consultants specified a mean of 10% (range
1--33%), with five not indicating a figure. For psychiatric patients requiring
medical or surgical liaison, psychiatric consultants quoted a mean of 11%
(range 5-25%), two not giving a score for this item. The priority values for
each of the liaison services by both the medical and surgical consultants and
the psychiatric consultants are presented in Figs
1 &
2.
Overall, the pattern of relative scoring is similar for the two groups of
consultants for both types of liaison service. For psychiatric liaison
services for medical and surgical patients, medical and surgical consultants
considered acute assessments the most important, with follow-up by a
specialist liaison service the next most important item. Joint case
conferences and routine assessments were considered least important.
Psychiatric consultants felt acute assessments, a designated liaison
consultant, and education for senior house officers (SHOs) were most valuable,
with follow-up by general services or a specialist liaison service being two
of the least valuable components. Medical and surgical consultants regarded
SHO education and a designated consultant as less important.
For medical and surgical liaison services for psychiatric patients,
psychiatric consultants thought acute assessments followed by in-patient
admission were the most important, with follow up by a specialist liaison
service the least important. Surgical and medical consultants agreed that
acute assessments were the most important, followed by advice without formal
assessment. A designated liaison consultant and joint case conferences were
given lower ratings by these consultants.
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Comment
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This survey gives an indication of the attitudes of consultants in both
mental and physical health services to the potential development of a
reciprocal liaison service. The study was undertaken on a relatively small
number of consultants in a single district service. The average return rate of
48%, with only 40% of consultant surgeons responding, meant information on the
views of a majority of consultants was not forthcoming. The relatively low
returns may be explained by the poorly developed area of reciprocal liaison,
along with the prospect of increased workloads for both physical and mental
health services. Future studies in this area may require larger study
populations, with a study design to improve the proportion of respondents.
The average range of 6% of medical and surgical patients requiring a
psychiatric liaison service is just over half the 11% of psychiatric patients
requiring a physical health liaison service. The prioritisation of components
show similar profiles for physical and mental health consultants, with some
important differences. The low rating by medical and surgical consultants for
SHO education regarding psychiatric problems in medical and surgical patients
is of concern in the light of studies demonstrating significant levels of
mental illness missed by medical and surgical services
(Clarke et al, 1995).
Medical and surgical consultants themselves may be keen to improve their
knowledge of psychiatric disorders and their management
(Creed, 1992).
With evidence that liaison services can reduce hospital stays, and
therefore costs, a reciprocal liaison service is conceivably an economically
as well as clinically desirable area for development. The results of this
survey support the viability of such a service. Further, the development of
reciprocal liaison services with improved physical health services for
psychiatric patients will be another step closer to the destigmatisation of
people with mental illness.
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References
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Top
Abstract
Introduction
, medical and surgical
consultants (n=31); 
, psychiatric consultants
(n=10).