Liaison mental health services

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The development of an outcome measure for liaison mental health services

The development of an outcome measure for liaison mental health services

Items included in the measure were determined using a modi- fi ed version of the mini-Delphi method. 6 We ran three cycles of the mini-Delphi process using panels of clinicians (nurses and psychiatrists) working in di ff erent types of liaison mental health services in the North West of England, including acute hospital wards, emergency departments, out-patient and community liaison services, and liaison services for older adults. A pool of potential items (64 items) was initially gener- ated, and a prototypic measure was produced which then underwent 6 months of fi eld testing in a Manchester liaison mental health service. Following this, the measure underwent a series of modi fi cations, including the exclusion and reword- ing of many items. A subsequent 12-month testing period gen- erated further minor revisions.
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A programme theory for liaison mental health services in England

A programme theory for liaison mental health services in England

Seventy three individual in-depth, qualitative interviews were conducted with staff from 11 different hospitals chosen to represent hospitals with the 4 different types of liaison service. As services had diverse configurations and sizes, there was a significant range in the number of participants interviewed from each service, so between 4 and 11 interviews were conducted at each hospital. Liaison staff (i.e. mental health practitioners working in liaison mental health services) and acute hospital staff, who had experience of referring to liaison LMHS, were included in the interview sampling. The methods are de- scribed in more detail in a separate paper, which focuses upon the barriers to integration of liaison services into acute hospital services (Keeble J, Walker A , Guthrie E , Trigwell P , Quirk A , Hewison J, House A. Integrated li- aison psychiatry services in England: a qualitative study of the views of liaison practitioners and acute hospital staffs from four distinctly different kinds of liaison ser- vice. Submitted to BMC Health Services Research).
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A programme theory for liaison mental health services in England

A programme theory for liaison mental health services in England

Seventy three individual in-depth, qualitative interviews were conducted with staff from 11 different hospitals chosen to represent hospitals with the 4 different types of liaison service. As services had diverse configurations and sizes, there was a significant range in the number of participants interviewed from each service, so between 4 and 11 interviews were conducted at each hospital. Liaison staff (i.e. mental health practitioners working in liaison mental health services) and acute hospital staff, who had experience of referring to liaison LMHS, were included in the interview sampling. The methods are de- scribed in more detail in a separate paper, which focuses upon the barriers to integration of liaison services into acute hospital services (Keeble J, Walker A , Guthrie E , Trigwell P , Quirk A , Hewison J, House A. Integrated li- aison psychiatry services in England: a qualitative study of the views of liaison practitioners and acute hospital staffs from four distinctly different kinds of liaison ser- vice. Submitted to BMC Health Services Research).
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Evaluation of a new mental health liaison team in a general hospital  Part 1: background and literature review

Evaluation of a new mental health liaison team in a general hospital Part 1: background and literature review

Fossey and Parsonage (2014) claim that liaison psychiatry provision is patchy in geographical terms, and of variable quality where it does exist, while the Mental Health Taskforce (MHT) (2016) notes that 'comprehensive liaison mental health services are currently available in only one in six (16%) of England’s 179 acute hospitals'. The MHT makes several recommendations, as part of a five- year strategy to improve the care and treatment of people with mental health problems, including that all acute hospitals should have all-age MHL services in EDs, and inpatient wards, by 2020/2021. This suggests that the question is not whether such initiatives are worthwhile, but rather how they should be implemented.
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Service Users’ Experiences of Liaison Mental Health Care

Service Users’ Experiences of Liaison Mental Health Care

From study inception to submission the interest and quality of policy, guidance and reports into LMHC has increased and improved. However, national guidance such as the current Government Mental Health strategy (HM Government, 2011) attest LMHC has yet to become integrated within the acute hospital setting. There is a clear conflict between the tentative evidence base for only offering high impact work and education (Parsonage et al, 2012) and the good practice guidance for commissioning (Fernandes, 2011; JCPMH, 2012), policy implementation (Aitken, 2007) and patient experiences (NICE, 2011). Further research and evaluation is required to add to the evidence base for the effectiveness of LMHS provision. There remains a debate about the function and role of LMHC. Adoption of a more integrated approach to mental and physical health care is currently recommended which will place LMHC higher up the agenda in non-mental health settings. The current interest in ensuring all hospitals have a LMHS offers the opportunity to evaluate services as they develop.
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Integrated liaison psychiatry services in England: a qualitative study of the views of liaison practitioners and acute hospital staffs from four distinctly different kinds of liaison service

Integrated liaison psychiatry services in England: a qualitative study of the views of liaison practitioners and acute hospital staffs from four distinctly different kinds of liaison service

Liaison psychiatry is the sub-specialty of psychiatry that focuses upon the interface between psychiatry and non- psychiatric clinical services [1]. Most commonly this in- volves psychiatric provision to the acute general hospital but can include other specialist hospitals and also pri- mary care [2]. Several different models of liaison psych- iatry exist with differing degrees of penetration into the general hospital and different styles of working [3]. The most common types of service in the UK are hospital based teams that provide on demand consultation and treatment for patients in acute hospital settings, with some also providing out-patient work or specialist in- reach to specific medical teams/specialties. The term psychosomatic medicine has been used to refer to liaison services, although this term is now used more specific- ally to refer to services that provide treatment for patients who have physical and mental co-morbidities. Liaison services provide treatment for all patients in the acute hospital with mental health problems including those with physical and mental co-morbidities, self- harm, dementia, alcohol and drug related problems, behavioural disturbance etc., There is growing, although still somewhat limited, evidence that liaison psychiatry services are effective [4] and may lead to cost reductions in healthcare [5].
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Adult Mental Health Hospital Liaison Service Evaluation

Adult Mental Health Hospital Liaison Service Evaluation

The provision of a mental health focused nursing presence to provide psychiatric liaison within general hospitals is not new. In the US, Nelson and Schilke (1976) saw it as a clinical specialism in which appropriately qualified nurses would use their skills to develop a 'framework within which the [general] nursing staff can understand the patient's experience of illness and hospitalisation and their own experience of caring for patients' (1976:64). Later, and in the UK, in a review of practice, the Department of Health (1994) described new roles which might be available to mental health practitioners such as, 'liaison nursing with accident and emergency services and general hospitals' (1994:4). Roberts (1997) then describes what he sees as the development of the role when he says 'liaison MH nurses will need to work collaboratively with their general colleagues in clarifying how best to share mental health knowledge and skills' (1997:106).
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Consultation liaison in primary care for people with mental disorders

Consultation liaison in primary care for people with mental disorders

Consultation liaison, in its broadest sense, is a model of mental health care in which there is an interface between mental health specialists and other health care providers. There is a strong his- tory of consultation liaison within the hospital setting (Huyse 2000; Ilchef 2006) but the consultation liaison services required by hospital patients can be quite different from those in primary care (Ruddy 2005). Hospital patients are more likely to be acutely physically unwell and more likely to receive short-term interven- tions compared to patients in primary care (Ruddy 2005). In more recent years, the potential advantages of consultation li- aison in the primary care setting have been recognised (Harmon 2000; Sved Williams 2006), and the World Health Organization (WHO 2001; Kohn 2004) identified primary care as essential to improving the delivery of mental health care because of its greater accessibility (Parslow 2000; WHO 2001). Primary care, such as general or family physician practices, provides general commu- nity-based health care which links people to specialist services for specific health needs. In mental health consultation liaison, the primary care provider maintains a central role in the delivery of mental health care with the mental health care specialist typically assessing the person with a mental disorder and providing consul- tation to the primary care provider (Berardi 2002; Bower 2005; Ruddy 2005). The mental health specialist may also directly treat and refer consumers (Berardi 2002; Ruddy 2005). The mental health specialist is often a psychiatrist, but can also be a men- tal health nurse, psychologist, social worker, or a team of men- tal health care providers (Gunn 2009; Kisely 2007; McNamara
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Organisation and delivery of liaison psychiatry services in general hospitals in England: results of a national survey

Organisation and delivery of liaison psychiatry services in general hospitals in England: results of a national survey

Measures Data included the location, service structures and staffing, working practices, relations with other mental health service providers, policies such as response times and funding. Model 2-based clustering was used to characterise the services. Telephone interviews identified the range of additional liaison psychiatry services provided. results Most hospitals (141, 79%) reported a 7-day service responding to acute referrals from the emergency department and wards. However, under half of hospitals had 24 hours access to the service (78, 44%). One-third of hospitals (57, 32%) provided non-acute liaison work including outpatient clinics and links to specialist hospital services. 156 hospitals (87%) had a multidisciplinary service including a psychiatrist and mental health nurses. We derived a four-cluster model of liaison psychiatry using variables resulting from the electronic survey; the salient features of clusters were staffing numbers, especially nursing; provision of rapid response 24 hours 7-day acute services; offering outpatient and other non-acute work, and containing age-specific teams for older adults. Conclusions This is the most comprehensive study to date of liaison psychiatry in England and demonstrates the wide availability of such services nationally. Although all services provide an acute assessment function, there is no uniformity about hours of coverage or expectation of response times. Most services were better characterised by the model we developed than by current classification systems for liaison psychiatry.
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An Evaluation of the Role of the Traveller Mental Health Liaison Nurse in Carlow and Kilkenny

An Evaluation of the Role of the Traveller Mental Health Liaison Nurse in Carlow and Kilkenny

Several studies have outlined the activities which MHLNs perform. Reet & Brendon (2001) found that liaison nurses engaged mostly in clinical work but also administration, supervision, audit, research and education (cited in Callaghan et al. 2003). A study by Sharrock et al. (2001) examining the role and functions of a Psychiatric Consultation Liaison Nurse (PCLN) within a general hospital setting found that the PCLN mainly provided a range of interventions to patients experiencing mental health problems but also performed a consultative service by inputting into broader hospital issues, and provided education and support to colleagues, including guidance on support services to refer patients to. In a later study, Sharrock et al. (2008) again found that PCLNs provided consultation and education to colleagues, a finding that was echoed elsewhere (Roberts and Whitehead 2002). Johnston & Cowman’s (2008) exploration of the role and services provided by the PCLN at a rural general hospital in Ireland found that while the PCLN engaged in clinical work, providing mental health interventions to patients and coordinating referrals to other services, the education and de-stigmatization roles alluded to in the literature did not emerge in any distinctive way. Brinkman et al. (2009) described and evaluated a MHLN service based in a rural health centre in Canada. Similar to the other MHLN roles described, the role comprised education, indirect and direct client intervention, and follow up. However other core functions of the role identified included advocacy and building a collaborative culture between the local hospital, medical and mental health clinics, and local community agencies, a form of relationship-building and bridging, referred to as culture brokering. The aforementioned studies and other studies highlighted that patients who self-harmed, attempted suicide, were at risk of self-harm or suicide, or had mood disorders, such as depression, accounted for most of the MHLN’s caseload (Tunmore 1994; Sharrock et al. 2001; Roberts and Whitehead 2002; Callaghan et al. 2003; Sharrock et al. 2008; Johnston & Cowman 2008).
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Young people, mental health practitioners and researchers co produce a Transition Preparation Programme to improve outcomes and experience for young people leaving Child and Adolescent Mental Health Services (CAMHS)

Young people, mental health practitioners and researchers co produce a Transition Preparation Programme to improve outcomes and experience for young people leaving Child and Adolescent Mental Health Services (CAMHS)

Dedicated transition peer support workers (TPSW) with CAMHS experience should guide and support young people through their preparation period, individually and in small groups, to identify and reach their transi- tion goals by: accompanying a young person to their first AMHS appointment; organising visits to AMHS and other third sector organisations; answering questions and fact-finding; advocacy and liaison; sourcing, main- taining and distributing information; organising and fa- cilitating small group activities some of which may include visiting speakers to advise on specific, relevant topics such as legal rights, benefits or housing, according to individual needs and interests.
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Clinical outcome and predictors of adverse events of an enhanced older adult psychiatric liaison service: Rapid Assessment Interface and Discharge (Newport)

Clinical outcome and predictors of adverse events of an enhanced older adult psychiatric liaison service: Rapid Assessment Interface and Discharge (Newport)

Comorbid mental disorders affecting older people in general hospitals are amenable to prevention and treatment. In this study, we have observed this in terms of reduced LoS, better recovery, more successful rehabilitation, and less transfer to institutional care, leading to an overall annualized bed savings of 44 days. This study highlights that improved outcomes can be achieved in routine clinical practice by an enhanced partnership with acute front door teams and psychiatric liaison services. There are several liaison service models to provide comprehensive mental health assess- ment to patients above the age of 16 years. Considering aging population and financial constraints, service models need to be modified to meet the needs of the local popula- tion. Newport RAID model was adapted from a 24 hours a day, seven days a week, Birmingham RAID model. 33 The
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The Rapid Assessment Interface and Discharge service and its implications for patients with dementia

The Rapid Assessment Interface and Discharge service and its implications for patients with dementia

Abstract: The rising prevalence of dementia will have an effect on acute care hospitals around the world. At present, around 40% of patients older than 70 years with acute medi- cal admissions have dementia, but only half of these patients have been diagnosed. Patients with dementia have poorer health outcomes, longer hospital stays, and higher rates of read- missions and institutionalization. Worldwide, health care budgets are severely constrained. National Institute for Health and Care Excellence (NICE) has listed ten quality standards for supporting people in living well with dementia. NICE resource implications and com- missioning support to implement these guidelines and improve dementia services have been recently published. Although most of the frail elderly patients with dementia are cared for by geriatricians, obstacles to making a diagnosis and to the management of dementia have been recognized. To provide a timely diagnosis of dementia, better care in acute hospital settings, and continuity of care in the community, services integrating all these elements are warranted. Extra resources also will be required for intermediate, palliative care, and mental health liaison services for people with dementia. The Birmingham Rapid Assessment Interface and Discharge service model uses a multiskilled team that provides comprehensive assess- ment of a person’s physical and psychological well-being in a general hospital setting. It has been shown to be an effective model in terms of reducing both length of stay and avoiding readmission. The aim of this review is to discuss the implications of the Rapid Assessment Interface and Discharge model in people with dementia and to critically compare this model with similar published service provisions.
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SUPPORTING VULNERABLE PEOPLE IN CUSTODY AND AT COURT An update for the voluntary and community sector

SUPPORTING VULNERABLE PEOPLE IN CUSTODY AND AT COURT An update for the voluntary and community sector

There are currently over 100 adult Criminal Justice Liaison and Diversion schemes operating across England. The majority of these schemes are based in magistrates’ courts, although as previously outlined, some also cover police custody. When they were first established in the early 1990s, the focus of these services was often concentrated on diverting offenders with mental health problems out of the criminal justice system and into secure mental health facilities 22 . Many of these services have since evolved

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Mental health services in rural India: challenges and prospects

Mental health services in rural India: challenges and prospects

Proposed decentralization and synchronization of Na- tional Mental Health Programme (under 11th Five Year Plan, 2007-2012) with National Rural Health Mission is a good opportunity and has a wider prospect [41]. We can hope that this will ensure Primary Health Centre (PHC) based mental health services to the rural popula- tion. Involving and training village level Accredited So- cial Health Activists (ASHA) is another opportunity. Adding a module on community mental health and train- ing ASHAs will definitely help in early detection, treat- ment, and rehabilitation of patients in the community in the rural areas. Presently, most of the rural people ap- proach traditional healers (religious saints, tantriks (black magicians), unregistered medical practitioners, and quacks) for treating mental health problems. Considering peo- ple’s faith in them and lack of trained professional, training these traditional healers could help in alleviating mental illness in rural areas. Developing short-term spe- cial curriculum based training for medical officers is another prospect which will help in providing clinical services at block level.
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Beyond evidence-based interventions: implementing an integrated approach to promoting pupil mental wellbeing in schools with pyramid club

Beyond evidence-based interventions: implementing an integrated approach to promoting pupil mental wellbeing in schools with pyramid club

a non-judgemental, supportive environment; encouraging mutual trust. Art and craft activities are designed to be fun whilst simultaneously facilitating task-based and social skills practice with peers and adults. Similarly, club games allow children to engage in the type of activities they will encounter in the playground in a ‘safe and controlled manner’ (Pyramid, 2011:12). Snack time plays a significant part in Pyramid club, encouraging sharing, turn taking and prompting conversation. The normal school day offers limited opportunities for relaxed, uninterrupted conversations and Pyramid club is a space where unresolved issues can be brought up, perhaps for the first time. According to Lyubomirsky and Layous (2013), simply participating in pleasurable and fun activities increases mental wellbeing by providing an escape from daily stressors.
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Managing the link and strengthening transition from child to adult mental health Care in Europe (MILESTONE): background, rationale and methodology

Managing the link and strengthening transition from child to adult mental health Care in Europe (MILESTONE): background, rationale and methodology

disorders and those with emerging mood, psychotic, personality-related or substance abuse disorders slip through the care net at the transition boundary [29, 45–48]. With insufficient support in place, many disen- gage from mental health services altogether only to present to adult services subsequently, with more severe and enduring mental health problems [24, 49, 50]. Such occurrences may have been prevented or better con- trolled had better transition arrangements been in place. Young people who undergo a planned and purposeful transition process that addresses their psychosocial and medical needs, experience an improvement in their mental health and functioning [29, 47]. Yet, due to a policy-practice gap [28], few of those who do transition from CAMHS to AMHS experience ‘optimal transition’ , which has been characterised by a period of parallel care between CAMHS and AMHS, at least one transition planning meeting, adequate information transfer and continuity of care [27]. Studies carried out in the Repub- lic of Ireland [23, 51] and France [52] suggest that prob- lems of the same nature and magnitude at the CAMHS-AMHS interface are occurring in other European countries. This poses a major health, socioeco- nomic and societal challenge for the care and wellbeing of young people with mental health needs within the European Union (EU), which is exacerbated by the dif- ferent mental health care service structures and provision in the member states [53–55]. The develop- ment of solutions is made harder by the lack of system- atic and robust evidence on the nature and severity of transition-related problems across the differing health care contexts in Europe and on their impact upon the health and wellbeing of young people.
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School-Based Mental Health Services

School-Based Mental Health Services

example, schools should provide students with mul- tiple and varied curricular and extracurricular activ- ities, thereby increasing the chances that each stu- dent will feel successful in some aspect of school life. Schools also should provide numerous opportunities for positive individual interactions with adults at school so that each student has positive adult role models and opportunities to develop a healthy adult relationship outside his or her family. Schools can provide families with support services and should implement “prevention” curricula (eg, curricula that decrease risk-taking behaviors). Behavioral expecta- tions, rules, and discipline plans should be well pub- licized and enforced school-wide. A recent review of
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Outcomes Framework for Mental Health Services

Outcomes Framework for Mental Health Services

It is suggested that services using this framework should only record outcomes against the indicators when the service has been involved in successfully supporting an individual to make the relevant change in their lives. Therefore an outcome for beginning voluntary work in a mainstream organisation should only be recorded when the service user has begun the work, rather than when they receive the support.

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Recommendations for the transition of patients with ADHD from child to adult healthcare services: a consensus statement from the UK adult ADHD network

Recommendations for the transition of patients with ADHD from child to adult healthcare services: a consensus statement from the UK adult ADHD network

In order to facilitate further discussion about the transi- tion from child to adult services and develop more expli- cit and comprehensive recommendations for clinicians, commissioners and policy makers, an expert workshop – “ADHD: Transition from Adolescence to Adult” – was convened in June 2012 in London by the UK Adult ADHD Network (UKAAN) [29]. UKAAN is an organisa- tion founded in 2009 by a group of mental health spe- cialists in response both to the NICE guidelines [19] and to recommendations from the British Association for Psychopharmacology (BAP) [21] that aims to provide support, education, research and training for mental health professionals working with adults with ADHD. The workshop was attended by experts in the field of ADHD, working across services, together with allied professionals and patients. The workshop consisted of a series of presentations summarising the transition process from the perspective of these experts. The work- shop first considered the findings of the TRACK study [27] which sought to identify factors that facilitate or im- pede effective transition more generally within the healthcare system. The National Institute for Health and Care Excellence,[19]) guidelines for transitioning young people with ADHD and the extension to these recom- mendations proposed by Young et al. [33] were reviewed, and consideration was given to the broader clinical, educational, occupational, and social needs of young people in this age group. There followed an in
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