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Original papers: Divya Sakhuja and Jonathan I. Bisson Liaison psychiatry services in Wales Psychiatr Bull 2008; 32: 134-136 [Abstract] [Full text] [PDF]

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Electronic letters published:

Developing liaison psychiatry services: a training perspective.

Harinder Bains   (14 April 2008)

Value Your Liaison Psychiatry Service!

Dr Mukesh Kripalani, Dr. Amanda Gash, Consultant Liaison Psychiatrist, Tees, Esk and Wear Valley NHS Trust; Lyn Williams, Nurse Consultant, Liaison Psychiatry, Tees, Esk and Wear Valley NHS Trust.   (23 April 2008)

Developing liaison psychiatry services: a training perspective. 14 April 2008
Harinder Bains, Speciality Registrar (ST4) Department of Psychological Medicine, Frimley Park Hospital, Frimley GU16 7UJ Send letter to journal: Re: Developing liaison psychiatry services: a training perspective. harinder.bains{at}nhs.net Harinder Bains	This study again highlights the gap in the provision of liaison psychiatry services. Despite there being a clear need for the development of liaison psychiatry in the detection and management of mental disorders (Semple, Brown and Irvine 1996), there is lack of clear definition of the role of these services and liaison psychiatry is seen to be a sub speciality which lacks substantial influence (Lloyd and Mayou 2003). Lack of rational planning (Ruddy and House 2003), lack of funding, and difficulty in understanding the role and potential of liaison services (Lloyd and Mayou 2003) have been cited as some of the reasons limiting the growth of liaison services. Talking from a trainee’s point of view, more training opportunities in liaison psychiatry would be an effective way of developing services. Training opportunities in liaison psychiatry remain scarce although recommendations have been made to improve undergraduate education and the psychological and psychiatric aspects of general patient care (Sharpe et al 1996). I had very limited exposure to liaison psychiatry as a SHO apart from seeing patients with deliberate self harm and overdoses in Accident and Emergency settings. Having now been in a liaison psychiatry placement, I have had the opportunity to see an array of medically unexplained symptoms, somatisation symptoms and functional symptoms, which has significantly enriched my abilities as a Psychiatrist. I therefore feel that such training opportunities should be offered to every psychiatry trainee. This would also help create an improved trained workforce and more Consultants. The lack of Consultants is possibly a major limiting factor in service development and this is reflected in the fact that despite the increase in the number of liaison consultants since 1996, the numbers still fall below that recommended by the Royal College of Psychiatrists (Swift and Guthrie 2003). References: Geraldine Swift and Else Guthrie. Liaison psychiatry continues to expand: developing services in the British Isles. Psychiatric Bulletin, Sep 2003; 27: 339 - 341. Geoffrey G. Lloyd and Richard A. Mayou. Liaison psychiatry or psychological medicine?. The British Journal of Psychiatry, Jul 2003; 183: 5 - 7. Margaret Semple, David Brown, and Elizabeth Irvine. Liaison psychiatry in detection and management of mental illness. Psychiatric Bulletin, Aug 1996; 20: 466 - 469 Rachel Ruddy and Allan House. A standard liaison psychiatry service structure?: A study of the liaison psychiatry services within six strategic health authorities. Psychiatric Bulletin, Dec 2003; 27: 457 – 460 Sharpe, M., Guthrie, E., Pevelar, R., et al (1996). The psychological care of medical patients: a challenge for undergraduate medical education. Journal of The Royal College of Physicians of London, 30, 202-204. Declaration of interest: Dr Harinder Bains is currently in a ST4 placement in Liaison Psychiatry
Value Your Liaison Psychiatry Service! 23 April 2008
Dr Mukesh Kripalani, Specialist Registrar Northern Deanery, Dr. Amanda Gash, Consultant Liaison Psychiatrist, Tees, Esk and Wear Valley NHS Trust; Lyn Williams, Nurse Consultant, Liaison Psychiatry, Tees, Esk and Wear Valley NHS Trust. Send letter to journal: Re: Value Your Liaison Psychiatry Service! drmukesh{at}doctors.org.uk Dr Mukesh Kripalani, et al.	Value Your Liaison Psychiatry Service! We completely support the conclusions of the article by Sakhuja and Bisson in the April 2008 edition of the Psychiatric bulletin. The state of Liaison psychiatry services in Wales clearly falls well below the recommendations of the Royal College of Physicians and Psychiatrists, the National Service Framework for Mental Health in Wales and what patients should accept in our National Health Service. With Primary and Secondary care mental health increasingly polarised between those with mild versus those with enduring mental health needs, there is a real risk of those with co-morbid physical and psychiatric disorders failing to get the care they need without Liaison Psychiatry. The question is what does Liaison psychiatry contribute to this group of patients? We would like to share some of our experiences on the ground with our Liaison service that has been established and run successfully over the last 12 years:- • We have managed to reduce psychiatric in-patient admissions following self-harm to 10%, compared to 17% in other areas (data presented as poster in Liaison Psychiatry Conference March 2008). • Acute stress reaction/adjustment disorder (ASR/AR) is the second most common cause of admission at 34.7% following self harm in our unit (data presented as poster in Liaison Psychiatry Conference March 2008). • Moreover of all the patients we see following self-harm, 38% overall fulfil DCR-10 criteria for ASR/AR (data presented as another poster in Liaison Psychiatry Conference March 2008). • We have already shown that we meet all quality standard indicators for self-harm (http://pb.rcpsych.org/cgi/eletters/31/9/345#2990). Moreover Liaison psychiatry has been credited with a role in reduction in rates of hospital admission following self-harm (1). • We get regular referrals from both Community Mental Health Teams and Primary Mental health care wherein one who doesn’t meet the enduring mental health criteria whereas the other too complex medically to handle in primary care. • By providing services for those frequent attendees, somatisers and those suffering with hypochondriacal disorders we manage to reduce inappropriate and costly investigations, excessive use of precious acute beds and reduce frustration in general hospital colleagues. • We provide training to nurses, doctors and allied health care professionals in the acute hospital such as to provide the best patient journey possible in the system. Our team allows psychiatric trainees valuable experience, which is highly sought in the era of the European working time directive! • A successful service level agreement with palliative care continues to underpin the importance of our service and recent invitation to be part of the occupational health team has given a major fillip to expansion plans for our team. There is truly a different expertise and experience in Liaison Psychiatry teams to fulfil the special co-morbid needs of the acute hospital population and provide the seamless interface between secondary medical services, secondary psychiatric services and primary care services of a vulnerable cohort of patients who find themselves doubly disadvantaged. We believe these teams provide excellent value for money but due to stigma may be themselves under-appreciated in their work. There is enough feedback from patients, carers and general hospital colleagues to back the existence and support the expertise of a Liaison Psychiatry team and it’s only a matter of time before patients and their carers stand up and demand appropriate care being made available to them. References: 1. Wilkinson S, Taylor G, Templeton L, et al. Admissions to hospital for deliberate self-harm in England 1995-2000: an analysis of Hospital Episode Statistics. Journal of public health medicine. 2002 24 (3): 179- 183 http://jpubhealth.oxfordjournals.org/cgi/reprint/24/3/179 Authors: Dr. Mukesh Kripalani, SpR Adult Psychiatry, Northern Deanery. Dr. Amanda Gash, Consultant Liaison Psychiatrist, Tees, Esk and Wear Valley NHS Trust. Lyn Williams, Nurse Consultant, Liaison Psychiatry, Tees, Esk and Wear Valley NHS Trust. Acknowledgements: Staff and Patients of the Liaison Psychiatry team in Middlesbrough. Declaration of Interest: All 3 work in the Liaison Psychiatry team.