scholarly journals Trends in referrals to liaison psychiatry teams from UK emergency departments for patients over 65

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S311-S312
Author(s):  
Sarah Bradbury ◽  
George Crowther ◽  
Manimegalai Chinnasamy ◽  
Laura Shaw ◽  
Sara Ormerod ◽  
...  
Keyword(s):  
Mental Health ◽  
Older People ◽  
Emergency Departments ◽  
Community Mental Health Services ◽  
Service Evaluation ◽  
Liaison Psychiatry ◽  
Convenience Sample ◽  
National Priority ◽  
Health Related ◽  
The Uk

AimsThe number of people over the age of 65 attending Emergency Departments (ED) in the United Kingdom (UK) is increasing. Those who attend with a mental health related problem may be referred to liaison psychiatry for assessment. Improving responsiveness and integration of liaison psychiatry in general hospital settings is a national priority. To do this psychiatry teams must be adequately resourced and organised. However, it is unknown how trends in the number of referrals of older people to liaison psychiatry teams by EDs are changing, making this difficult.MethodWe performed a national multi-centre retrospective service evaluation, analysing existing psychiatry referral data from EDs of people over 65. Sites were selected from a convenience sample of older peoples liaison psychiatry departments. Departments from all regions of the UK were invited to participate via the RCPsych liaison and older peoples faculty email distribution lists. From departments who returned data, we combined the date and described trends in the number and rate of referrals over a 7 year period.ResultReferral data from up to 28 EDs across England and Scotland over a 7 year period were analysed (n = 18828 referrals). There is a general trend towards increasing numbers of older people referred to liaison psychiatry year on year. Rates rose year on year from 1.4 referrals per 1000 ED attenders (>65 years) in 2011 to 4.5 in 2019 . There is inter and intra site variability in referral numbers per 1000 ED attendances between different departments, ranging from 0.1 - 24.3.ConclusionTo plan an effective healthcare system we need to understand the population it serves, and have appropriate structures and processes within it. The overarching message of this study is clear; older peoples mental health emergencies presenting in ED are common and appear to be increasingly so. Without appropriate investment either in EDs or community mental health services, this is unlikely to improve.The data also suggest very variable inter-departmental referral rates. It is not possible to establish why rates from one department to another are so different, or whether outcomes for the population they serve are better or worse. The data does however highlight the importance of asking further questions about why the departments are different, and what impact that has on the patients they serve.

scholarly journals Service innovations

2003 ◽  
Vol 27 (09) ◽  
pp. 346-348
Author(s):  
Chris Simpson ◽  
Prasanna De Silva
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Older People ◽  
High Quality ◽  
The Uk ◽  
Multi Disciplinary Team

The increase in older people in the UK will increase the need for mental health services to run efficient, high-quality services. Multi-disciplinary team assessments, although not new, provide a method of increasing the capacity to see referrals. Two similar systems of multi-disciplinary team assessments from North Yorkshire are reported with evidence of improvement in quality.

scholarly journals Multidisciplinary team meetings in community mental health: a systematic review of their functions

2016 ◽  
Vol 21 (2) ◽  
pp. 119-140 ◽  
Author(s):  
Caoimhe Nic a Bháird ◽  
Penny Xanthopoulou ◽  
Georgia Black ◽  
Susan Michie ◽  
Nora Pashayan ◽  
...  
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Community Mental Health ◽  
Multidisciplinary Team ◽  
Community Mental Health Services ◽  
Content Type ◽  
Team Members ◽  
Team Meetings ◽  
Unwarranted Variation ◽  
The Uk

Purpose – Previous research has identified a need for greater clarity regarding the functions of multidisciplinary team (MDT) meetings in UK community mental health services. The purpose of this paper is to identify the functions of these meetings by systematically reviewing both primary research and academic discussion papers. Design/methodology/approach – Papers relating to adult community mental health teams (CMHTs) in the UK and published between September 1999 and February 2014 were reviewed and appraised using NICE quality checklists. The search was broad in scope to include both general CMHTs and specialist CMHTs such as early intervention psychosis services and forensic mental health teams. A thematic synthesis of the findings was performed to develop an overarching thematic framework of the reported functions of MDT meetings. Findings – None of the 4,046 studies identified directly investigated the functions of MDT meetings. However, 49 mentioned functions in passing. These functions were categorised into four thematic domains: discussing the care of individual patients, teamwork, team management and learning and development. Several papers reported a lack of clarity about the purpose of MDT meetings and the roles of different team members which hindered effective collaboration. Practical implications – Without clearly agreed objectives for MDT meetings, monitoring their effectiveness is problematic. Unwarranted variation in their functioning may undermine the quality of care. Originality/value – This is the first systematic review to investigate the functions of CMHT MDT meetings in the UK. The findings highlight a need for empirical research to establish how MDT meetings are being used so that their effectiveness can be understood, monitored and evaluated.

117 The Impact of Hurricane Sandy on Mental Health-Related Emergency Departments Visits

2014 ◽  
Vol 64 (4) ◽  
pp. S42
Author(s):  
K.C. Frankel ◽  
C.M. Allegra ◽  
B. Eskin ◽  
J.R. Allegra
Keyword(s):  
Mental Health ◽  
Emergency Departments ◽  
Hurricane Sandy ◽  
Health Related ◽  
The Impact

scholarly journals The impact of first COVID-19 peak on patient referrals to Liaison Psychiatry Service and staff perception about service provision in Birmingham and Solihull Mental Health Trust Birmingham - a service evaluation project

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S329-S329
Author(s):  
Saima Jehanzeb ◽  
Muhammad Suleman ◽  
Ella Tumelty ◽  
Joanne Okusanya ◽  
Laxsan Karunanithy ◽  
...  
Keyword(s):  
Mental Health ◽  
Focus Groups ◽  
Quantitative Methods ◽  
Service Evaluation ◽  
Psychotic Symptoms ◽  
Healthcare Provision ◽  
Liaison Psychiatry ◽  
Clinical Databases ◽  
The Impact ◽  
Health Trust

AimsBased on recommendations from the Royal College of Psychiatrists, this project aimed to evaluate the impact of the first peak of the COVID-19 pandemic on referral patterns to the Queen Elizabeth Hospital Birmingham (QEHB) Liaison Psychiatry (LP) service. Additionally, we aimed to explore staff experiences in LP services across Birmingham and Solihull Mental Health Trust (BSMHFT) in order to generate Trust recommendations promoting optimal healthcare provision amidst the on-going pandemic.MethodA mixed method service evaluation was conducted using quantitative and qualitative analysis. Quantitative methods involved reviewing referrals made to the QEHB LP service from March to June 2020, compared with the equivalent time period in 2019. Data were retrospectively extracted from the electronic clinical databases RIO and PICS, and subsequently analysed using Microsoft Office. The number of, and reasons for referrals to LP were identified, whilst focus groups were conducted to explore the subjective experiences of staff working across BSMHFT LP services.ResultBetween 1st March and 30th June 2020, 984 referrals were made to the QEHB LP service, compared to 1020 referrals in 2019, representing a 3.5% reduction. From 2019 to 2020, referrals due to psychotic symptoms and deliberate self-harm rose by 12.8% and 14.1% respectively, whilst referrals for drug and alcohol-related causes reduced by 28.3%. A significant increase (150%) in referrals for medication or management advice was seen. Focus groups indicated that staff perceived an initial reduction in number of referrals, but an increase in the acuity of patient presentations.Staff reported anxiety around contracting and transmitting SARS-Cov-2, exacerbated by uncertainty around patients’ COVID-19 status. In QEHB, sixty-five of the 984 referrals (7%) had a positive SARS-Cov-2 PCR swab, with the remaining 919 referrals being either negative (68%) or unknown (25%). Ninety-six percent of consultations were conducted face-to-face in QEHB. There were conflicting views amongst staff regarding whether more consultations could have been conducted remotely. Furthermore, varying perceptions of support and communication from both the physical and mental health trust were reported.ConclusionQuantitative data indicates that COVID-19 impacted LP healthcare provision in BSMHFT. Whilst referral numbers remained similar between the equivalent period in 2019 and 2020, a change in the nature of referrals to LP at QEHB was seen. This was corroborated by qualitative data which highlighted a perceived change in acuity of referrals. These findings have been disseminated across the Trust and subsequent recommendations are being implemented during the on-going pandemic.

Principles of service provision in old age psychiatry

2020 ◽  
pp. 281-306
Author(s):  
Tom Dening ◽  
Kuruvilla George
Keyword(s):  
Mental Health ◽  
Older People ◽  
Old Age ◽  
Religion And Spirituality ◽  
Liaison Psychiatry ◽  
Memory Assessment ◽  
Challenges And Opportunities ◽  
Recent Developments ◽  
Old Age Psychiatry ◽  
Consultation Liaison Psychiatry

Globally increasing numbers of older people bring both challenges and opportunities for old age psychiatry services. This chapter outlines the history, underlying principles, and policy context for contemporary mental health services for older people. It discusses components of services, including community health teams, memory assessment services, consultation-liaison psychiatry, and in-patient mental health care, as well as newer types of service, such as crisis teams and outreach to care homes. Other recent developments include various models of case management and emphasis on post-diagnostic support. Equally important are issues of equality and access, and the chapter covers several key areas, such as age, gender, sexual orientation, religion and spirituality, and rurality. Major challenges to old age psychiatry come from limited resources and non-recognition of the distinct needs of older adults, as well as the demands of the growing older population, advances in science and technology, and the need to attract talented psychiatrists into this field.

scholarly journals Prevalence of impairing behavioral health problems in ED patients and association with ED utilization.

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Setarah Mohammad Nader ◽  
Paul Musey Jr., MD, MS, FACEP
Keyword(s):  
Mental Health ◽  
Suicidal Ideation ◽  
Behavioral Health ◽  
Emergency Departments ◽  
Mental Health Problems ◽  
Severe Depression ◽  
Health Problems ◽  
Screening Tools ◽  
Convenience Sample ◽  
Severe Anxiety

Background and Hypothesis: It has been observed that patients with poor mental health are relatively frequent users of the Emergency Departments (ED). The objective of this study is to evaluate the prevalence of numerous behavioral health domains (depression, anxiety, PTSD, substance abuse, and suicidality) in patients presenting to the Emergency Department and the association of each of these domains with ED utilization. Experimental Design or Project Methods: This prospective study seeks to enroll a convenience sample of 1000 Englishspeaking adults presenting to IU Health Methodist and Eskenazi Emergency Departments without psychiatric chief-complaints. Patients were assessed for behavioral health problems using the CAT-MHTM, PHQ-8 and GAD-7 screening tools, which were administered via tablet device. Additionally, data on disposition medical history, discharge diagnoses, and ED utilization in the 12 months before and after enrollment from electronic medical records and data from the Indiana Network for Patient Care (INPC) will be reviewed. Results: Over the course of five weeks, 375 patients have been enrolled. Of those 59.4% were female with an overall mean age of 46.1 (SD ± 16.4); 52.9% were white and 39.8% black/African American. Among enrollees 42.2% screened positive for depression, 29.7% for anxiety, and 1.3% for suicidal ideation. Patients who screened positive for depression were predominately females (76.1% vs 23.9%), those who screened positive for anxiety were also predominately females (71.6% vs. 28.4%). However, 3 out of the 5 (60%) patients that screened positive for suicidal ideation were males. The preliminary analysis of GAD-7 showed of those enrolled 215 (57.5%) had no anxiety, 157 (42%) had mild-severe anxiety. PHQ-8 scores showed 194 (51.9%) had no depression, 178 (47.5%) had mild-severe depression. Similarly, CAT-MH results showed 216 (57.8%) had no depression, 158 (42.2%) had mild-severe depression, while 263 (70.3%) had no anxiety and 111 (29.7%) had mild-severe anxiety. Full data analysis including comparative analysis of the CAT-MH with PHQ-8 and GAD-7 scores will take place after 1000 patients have been enrolled and data has been received from the INPC. Conclusion and Potential Impact: In our sample, almost half of patients that visit the ED have screened positive for mental health problems. We believe that early identification and appropriate referral may reduce inappropriate ED utilization.

scholarly journals “Lost between the interface of physical and mental health”: focus groups exploring liaison psychiatry staff's perception about working during the first wave of the COVID-19 pandemic in Birmingham and Solihull Mental Health Foundation Trust

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S329-S329
Author(s):  
Saima Jehanzeb ◽  
Muhammad Suleman ◽  
Ella Tumelty ◽  
Joanne Okusanya ◽  
Laxsan Karunanithy ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Community Mental Health ◽  
Health Services ◽  
Focus Groups ◽  
Working Conditions ◽  
Community Mental Health Services ◽  
Physical And Mental Health ◽  
Liaison Psychiatry ◽  
Mental Health Foundation

AimsAs the COVID-19 pandemic continues, increasing attention is being drawn to the welfare of healthcare providers who have endured many months of sustained exposure to the virus, disrupted working conditions and psychological stress. This project aimed to explore the subjective experiences of staff working in Liaison Psychiatry (LP) in the Birmingham and Solihull Mental Health Foundation Trust, (BSMHFT) during the first wave of the COVID-19 pandemic. These findings have been used to devise recommendations for subsequent waves.MethodData collection occurred as part of a mixed method service evaluation project. We invited all clinical and non-clinical staff from LP departments across BSMHFT to participate in focus groups conducted via Microsoft Teams. The focus groups were video-recorded and facilitated by a moderator and an observer. Subsequent anonymised transcripts were coded and themes were generated by at least two evaluators, using thematic analysis.ResultThe focus groups, which ranged from 21 to 69 minutes, involved consultants, junior doctors and nurses from four hospitals within BSMHFT. Six major themes emerged including an initial reduction in number yet increase in acuity of patients seen by LP, with some perception that this resulted from reduced face-to-face contact with community mental health services. A feeling that LP was lost at the interface between the physical and mental health trusts emerged as another theme. Uncertainty in adapting to unprecedented working conditions, for example, unclear guidance concerning the use of personal protective equipment, was also described alongside anxiety about contracting and transmitting SARS-Cov-2. Additionally, increased pressure was felt due to staff shortages and inadequate inter-departmental communication. Participants reported differential uptake of remote working, as well as conflicting views regarding the feasibility of remote assessments in LP.ConclusionLiaison psychiatry staff within BSMHFT continued to provide a crucial service during the COVID-19 pandemic. Focus groups with thes staff indicate several recommendations for implementation within the Trust and provoke questions for future research. Due to the unique role that LP plays in providing mental health care within general hospitals, clear guidance for LP staff is key for effective service provision and supporting LP staff. Although used widely across community mental health services, the role of remote working in LP is contentious and requires further exploration. However, there are limitations to the use of focus groups and these findings may not fully represent the experiences of LP staff throughout BSMHFT. Different themes may have emerged through the use of anonymous questionnaires.

scholarly journals Reduced Activity in an Inpatient Liaison Psychiatry Service During the First Wave of the COVID-19 Pandemic: Comparison With 2019 Data and Characterization of the SARS-CoV-2 Positive Cohort

2021 ◽  
Vol 12 ◽  
Author(s):  
Matthew Butler ◽  
Afraa Delvi ◽  
Fedza Mujic ◽  
Sophie Broad ◽  
Lucy Pauli ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Structural Changes ◽  
Relative Increase ◽  
Clinical Activity ◽  
Liaison Psychiatry ◽  
Neuropsychiatric Complications ◽  
Neuropsychiatric Manifestations ◽  
Relative Prevalence ◽  
The Uk

Background: The COVID-19 pandemic led to changes in the way that healthcare was accessed and delivered in the United Kingdom (UK), particularly during the peak of the first lockdown period (the “first wave”) beginning in March 2020. In some patients, COVID-19 is associated with acute neuropsychiatric manifestations, and there is suggestion that there may also be longer term neuropsychiatric complications. Despite this, at the time of writing there are only emerging data on the direct effects of the COVID-19 pandemic on psychiatric care.Methods: In this retrospective study we analyzed referrals to an inpatient liaison psychiatry department of a large acute teaching hospital during the first wave of covid-19 in the UK and compared this data to the same period in 2019.Results: We saw a 40% reduction in the number of referrals in 2020, with an increase in the proportion of referrals for both psychosis or mania and delirium. Almost one third (28%) of referred patients tested positive for COVID-19 at some point during their admission, with 40% of these presenting with delirium as a consequence of their COVID-19 illness. Save delirium, we did not find evidence for high prevalence of new-onset acute mental illness in COVID-19 positive patients.Conclusion: Our data indicate decreased clinical activity in our inpatient psychiatry liaison department during the first wave of the COVID-19 pandemic, although a relative increase in relative increase in referrals for psychosis or mania, suggesting less of a relative decrease in more severe cases of mental illness. The reasons for this are likely multifactorial, including structural changes in the NHS and patient reluctance to present to emergency departments (ED) due to infection fears and Government advice. Our data also supports the literature suggesting the high relative prevalence of delirium in COVID-19, and we support integration of psychiatry liaison teams in acute general hospital wards to optimize delirium management. Finally, consideration should be given to adequate staffing of community and crisis mental health teams to safely manage the mental health of people reluctant to visit EDs.

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