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Insidious undermining of the utility of the liaison nursing role
- Alexandra L Pitman, José Catalán, Consultant Psychiatrist in Liaison Psychiatry (5 October 2006)
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Alexandra L Pitman, SHO in Psychiatry South Kensington and Chelsea Mental Health Centre, José Catalán, Consultant Psychiatrist in Liaison Psychiatry
Send letter to journal:
alexandra.pitman{at}imperial.ac.uk Alexandra L Pitman, et al.
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Kewley and Bolton’s survey of London liaison psychiatric services raises concerns that government pressures to observe four-hour targets in Accident & Emergency may have compromised liaison input to other general hospital patients1. Almost all teams surveyed fell short of College recommendations regarding service provision2 and the recent threats to liaison services in Oxford and London suggest that resources will not become available to meet these standards. Compounding this issue is the trend towards mergers of Crisis Resolution Teams with Liaison Psychiatric Nursing Teams to cut service costs. Community patients in crisis may tend to be prioritised over patients within the hospital, irrespective of the level of need. This undermines the skills specific to liaison nursing and their unique role in general hospitals. Our recent audit at Chelsea & Westminster Hospital of the provision of psychosocial assessments to A&E patients presenting with suicidal thoughts or behaviours showed that 90% received full assessment by the liaison team or duty psychiatrist with plans for further action communicated to their GP (or CMHT)3. This level of service was achieved with a liaison nursing team managing 85% of out-of-hours clients without medical input, with implications not only for four-hour targets but also for the European Working Time Directive on junior doctors’ working hours. Any further threats to liaison services run counter to the government’s efforts to tackle suicide targets, to address the psychological needs of patients with cancer, HIV, neurological disorders, cardiovascular disease, and diabetes, and its obligation to uphold employment law. References: 1 Kewley T. & Bolton J. (2006) A survey of liaison psychiatry services in general hospitals and accident and emergency departments: do we have the balance right? Psychiatric Bulletin 30; 260-3 http://pb.rcpsych.org/cgi/content/full/30/7/260 2 Royal College of Physicians and Royal College of Psychiatrists (2003) The psychological care of medical patients Report CR108. London: Royal College of Physicians and Royal College of Psychiatrists http://www.rcpsych.ac.uk/files/pdfversion/cr108.pdf 3 Audit report available from authors Alexandra Pitman, SHO in Psychiatry, South Kensington and Chelsea Mental Health Centre, London SW10 9NG Email: alexandra.pitman@imperial.ac.uk José Catalán, Consultant Psychiatrist, Psychological Medicine Unit, South Kensington and Chelsea Mental Health Centre, London SW10 9NG |
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