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Guidance for commissioners of liaison mental health services to acute hospitals 1 Joint Commissioning Panel for Mental Health www.jcpmh.info Guidance for commissioners of liaison mental health services to acute hospitals Volume Two: Practical mental health commissioning
2 Practical Mental Health Commissioning Contents Executive Introduction What are Why is acute summary acute liaison liaison important services? to commissioners? 04 05 05 What do we What would Supporting Resources know about the a good liaison the delivery and references current provision service look like? of the mental of acute liaison health strategy services? 07 09 12 14
Guidance for commissioners of liaison mental health services to acute hospitals 3 Executive summary • Physical and mental health are • A liaison service should be an integral inextricably intertwined. Long-term part of the services provided by acute conditions (LTCs), such as diabetes, hospital trusts – trusts that have are associated with high rates of mental incorporated a liaison service have illness. Some 70% of NHS spend goes demonstrated much better cost- on the treatment of LTCs, a great deal effectiveness. of which currently involves treatment • Commissioning of acute liaison in acute hospitals. services should be universally included • Psychological stress is often expressed in contracts for the provision of as physical symptoms, which are an acute hospital services and concord example of medically unexplained to standards set by professional and symptoms (MUS). regulatory authorities. • The mental health needs of a patient • Acute liaison services should have the in a physical health care setting often resources and skills needed to support remain undiagnosed and therefore all age groups. untreated. To optimise the physical • Liaison services may, over time, extend health care of patients, it is essential their remit to help primary mental health that their mental health and wellbeing care to manage people with LTCs and are addressed at the same time. MUS, in order to avoid unnecessary • Liaison services should be provided admissions to secondary care. throughout the acute hospital, including in A&E departments. Services should be provided to meet the needs of patients with a mental disorder secondary to their physical disorder, or a physical disorder alongside their mental disorder, and for patients (particularly those with MUS) where it is impossible to separate the two. • Acute liaison services operate within existing (often ad hoc) local networks of other generic and disorder-specific clinical health psychology and multidisciplinary services. This should be mapped out by commissioners so that acute liaison becomes a primary partner in the effective management of the emotional and adjustment/ behavioural needs of all patients presenting to acute services.
4 Practical Mental Health Commissioning Introduction The Joint Commissioning Panel The JCP-MH has two primary aims: How will this guide help you? for Mental Health (JCP-MH) • to bring together service users, carers, This guide has been written (www.jcpmh.info) is a new clinicians, commissioners, managers and by a group of acute liaison collaboration co-chaired by others to work towards values-based experts in consultation with commissioning the Royal College of General patients and carers. Practitioners and the Royal • to integrate scientific evidence, service user and carer experience and viewpoints, The content is primarily evidence-based but College of Psychiatrists, ideas deemed to be best practice by expert and innovative service evaluations in which brings together leading order to produce the best possible advice consensus have also been included. By the organisations and individuals on commissioning the design and delivery end of this guide, readers should be more with an interest in commissioning of high quality mental health, learning familiar with the concept of acute liaison for mental health and learning disabilities, and public mental health and better equipped to: disabilities. These include: and wellbeing services. • understand what a good quality, The JCP-MH: modern, acute liaison service looks like • Service users and carers • understand why a good acute liaison • Department of Health • has published Practical Mental Health service delivers the objectives of the • Association of Directors Commissioning,2 a briefing on the key mental health strategy and the Quality, of Adult Social Services values and principles for effective mental Innovation, Productivity and Prevention • NHS Confederation health commissioning (QIPP) challenge – not only in itself but • Mind • provides practical guidance and a also by enabling changes in other parts of • Rethink Mental Illness developing framework for mental health the system. • National Survivor User Network • will support commissioners of public This guide also addresses issues relating • National Involvement Partnership mental health to deliver the best to the commissioning of acute liaison • Royal College of Nursing possible outcomes for community services. It describes: • Afiya Trust health and wellbeing • British Psychological Society • the benefits of liaison services • has published a series of short guides • Representatives of the English • the optimum liaison psychiatry team describing ‘what good looks like’ in Strategic Health Authorities • the mental health needs in acute care various mental health service settings. • Mental Health Providers Forum settings that a liaison service addresses • New Savoy Partnership Who is this guide for? • why a liaison service is important for • Representation from commissioners of acute hospital services. Specialised Commissioning This guide describes what This guide draws on, and refers to, • Healthcare Financial ‘good looks like’ for a modern previously published guidance including: Management Association. acute liaison service. It • the Royal College of Psychiatrists The JCP-MH is part of the implementation should be of value to Clinical College Centre for Quality Improvement arm of the government mental health Commissioning Groups (who PLAN standards3 strategy No Health without Mental Health.1 will be commissioning secondary • the Royal College of Psychiatrists services, both specialist mental CCQI Mental Health Policy and acute). Implementation Guide for Liaison Psychiatry and Psychological Medicine in the General Hospital4 • the Royal College of Psychiatrists briefing No Health without Mental Health: the Supporting Evidence5 • the NHS Confederation briefing Healthy Mind, Healthy Body.6
Guidance for commissioners of liaison mental health services to acute hospitals 5 What are acute Why is acute liaison important liaison services? to commissioners? An acute liaison service The problems acute liaison Mental and physical health are closely linked is designed to provide addresses are common: services for: • mental disorder accounts for around Mental illness increases risk • people in acute settings (inpatient or five per cent of A&E attendances, 25% of physical illness and outpatient) who have, or are at risk of primary care attendances, 30% of complicates its management. of, mental disorder acute inpatient bed occupancy and 30% Depression is associated with: of acute readmissions7 • people presenting at A&E with urgent • reduced life expectancy of 10.6 years mental health care needs • self-harm accounts for between in men and 7.2 years in women12 150,000 and 170,000 A&E attendances • people being treated in acute settings • increased risk of coronary heart disease13 per year in England8 with co-morbid physical disorders such • MUS may account for up to 50% of • four-fold increased risk of myocardial as long-term conditions (LTCs) and acute hospital outpatient activity9 infarction (MI) and four-fold increased mental disorder risk of death within six months of • people being treated in acute hospital • 13–20% of all hospital admissions and myocardial infarction14 settings for physical disorders caused up to 30% of hospital admissions via A&E at weekends are related to alcohol10 • two-fold increased risk of type 2 by alcohol or substance misuse diabetes15 • people whose physical health care is • in England, alcohol-related hospital admissions doubled in the 11 years up • three-fold increased risk of non- causing mental health problems to 2007, and alcohol-related deaths also compliance with treatment • people in acute settings with medically recommendations.16 doubled in the 15 years to 200611 unexplained symptoms (MUS). • one quarter of all patients admitted to Schizophrenia is associated with: The service aims to increase the detection, hospital with a physical illness also have recognition and early treatment of • reduced life expectancy of 20.5 years a mental health condition that, in most in men and 16.4 years in women17 impaired mental wellbeing and mental cases, is not treated while the patient is disorder to: • three-fold increased death rate from in hospital6 respiratory disease18 • reduce excess morbidity and mortality • most patients who frequently re-attend associated with co-morbid mental and • two-fold increased risk of obesity, two A&E departments do so because of an physical disorder to three-fold increased risk of smoking, untreated mental health problem6 two-fold increased risk of diabetes, • reduce excess lengths of stay in acute • two thirds of NHS beds are occupied two to three-fold increased risk of settings associated with co-morbid by older people, up to 60% of whom hypertension, five-fold increased risk mental and physical disorder have or will develop a mental disorder of dyslipidaemia and two to three-fold • reduce risk of harm to the individual and during their admission.6 increased risk of metabolic syndrome.19 others in the acute hospital by adequate risk assessment and management Substance use disorder is associated with 13.6 year reduced life expectancy • reduce overall costs of care by reducing for men and 14.8 years for women.12 time spent in A&E departments and general hospital beds, and minimising Smoking is the main cause of preventable medical investigations and use of death in the general population. People medical and surgical outpatient facilities with a mental disorder smoke much more • ensure that care is delivered in the than people without a mental disorder: least restrictive and disruptive manner they consume 42% of all tobacco possible. consumed in England.20
6 Practical Mental Health Commissioning Why is acute liaison important to commissioners? (continued) Physical illness increases the risk of Integrated mental Liaison services are important in facilitating mental illness. Depression is more common and physical health care collaborative care approaches to both in those with a chronic physical illness.21 mental and physical health conditions. The close links between Risk of depression is doubled for people Closer working between primary and with diabetes, hypertension, coronary mental and physical health secondary care staff is particularly artery disease and heart failure, and highlight the importance of important in improving the confidence tripled in those with stroke, end-stage an integrated approach to of specialist mental health staff in renal failure and chronic obstructive treating physical and mental identifying, preventing and intervening pulmonary disease.22 illness. However, traditionally early with physical health problems, and vice versa (see the companion primary Depression is more than seven times mental and physical health mental health care commissioning guide). more common among people with two care have been commissioned or more chronic physical conditions.23 separately; it is rare that the The quality and productivity One in five people newly diagnosed with challenge (QIPP) cancer or first hospitalised with a heart needs of patients with mental attack will develop depression or anxiety and physical health problems Commissioners are required within one year.24 are provided for through a to improve quality while Children with physical illness are at single funding stream. at the same time increasing increased risk of emotional or conduct Mental health and physical health productivity (QIPP). Liaison disorder.25 are closely linked. Liaison services services provide an excellent provide commissioners with a means to opportunity to do this by: address this in the acute hospital setting. • improving clinical outcomes Liaison services can significantly reduce incidence of mental illness associated • reducing admissions to and lengths of with physical illness and vice versa, stay in acute settings thereby reducing the burden on both • ensuring patients with co-morbid long- primary and secondary care. The focus term conditions receive better treatment of Improving Access to Psychological while using fewer health care resources Therapies (IAPT) has been extended to • treating and reducing costs for patients cover psychological interventions for with MUS LTC co-morbidity and MUS. • reducing psychological distress following Mental illness can frequently cause self-harm, and reducing suicide. or aggravate physical disorder. These disorders are seen and treated in acute hospital settings. The commissioners of acute hospital services should therefore be responsible for commissioning acute liaison services to meet this need.
Guidance for commissioners of liaison mental health services to acute hospitals 7 What do we know about the current provision of acute liaison services? There is currently no single, • participation in Mental Health Act • assessment, management and uniform model for liaison services and Mental Capacity Act assessments, signposting of patients with alcohol and and performing risk assessments for substance misuse disorders. across the country. Where such harm to self and others services exist, they are often The service could bring the • expert advice on capacity to consent following benefits: provided by the local mental for medical treatment in complex cases health trust within the estate of involving both physical and mental • increased mental health care capacity the acute hospital trust, which health problems within the acute hospital through collaboration may present logistical and • acting as a Responsible Clinician operational challenges. under the Mental Health Act for people • improved wellbeing of staff in acute detained under the Act, and receiving hospital settings, by relieving the anxiety Liaison services are commonly these staff sometimes feel when dealing care in the acute hospital commissioned by the commissioners of with patients with complex needs – mental health services (rather than the • rapid response to requests for this may in turn help reduce levels commissioners of acute hospital care). assessment in the A&E department and of sickness absence This is despite the fact that the acute trust on acute hospital wards (assessment and management of people who have self- • improved patient self-management should be providing them, and the quality harmed forms a significant proportion of their care and productivity benefits that derive from the service are realised within the acute of this responsibility) • improved physical care of people hospital setting. • development of care plans with mental disorder post-assessment • reduced stigma associated with Most acute liaison services • arranging appropriate follow-up mental health care. could provide the following: post-discharge • advice, training and coaching on • assessment of people with MUS the management of mental health • management of people with MUS problems to other professionals in who require a higher level of input the acute hospital than can be provided by lower • biopsychosocial assessment, intensity services such as IAPT – in formulation and diagnosis for people association with primary care, specialist identified by acute hospital staff medical teams and other specialist as experiencing impaired mental multidisciplinary teams (eg. chronic wellbeing or whose physical symptoms fatigue syndrome/ME services) are unexplained • contributing to the management • brief interventions, advice and of people with long-term physical signposting to services in a range conditions in collaboration with primary of agencies for patients in acute care and specialist physical health hospital settings multidisciplinary teams (eg. diabetes psychology and dietetics) • assistance with the management of people with long-term physical conditions
8 Practical Mental Health Commissioning What do we know about the current provision of acute liaison services? (continued) Models of acute liaison service • chronic pain management teams and vary greatly, from those that chronic fatigue teams, operating over a wider area than a single acute hospital provide a ‘core’ adult mental • cancer network of psychosocial support health liaison service to those professionals, organised to support that cater for more complex sophisticated training arrangements for needs (learning disability, medical and nursing oncology staff (and dementia, children and young often including liaison psychiatrists) people). However there is a • cardiac and pulmonary rehabilitation considerable body of work that teams. describes what liaison services Existing liaison services tend typically to should do, how they should be be for adults with mental health needs, organised and what standards and not for children and young people. they should achieve. An important development would be for commissioners to commission liaison Liaison psychiatry provision is often patchy, services that are age-inclusive. The liaison despite its core role in risk management needs of children and young adults may and in facilitating good physical health differ in some respects from those of care. The picture is further complicated by adults and older people but the principles the range of other services that provide and benefits are applicable across all ages. behavioural input to physical health This all-age approach will present care. Liaison services have a unique and challenges to the way in which services essential role in providing broad cover are currently organised but is important across health care settings, and in their if the ambition of the English mental capacity to handle the most severe and health strategy is to be realised through risky mental health problems. However, the commissioning process. commissioners will also need to consider the range of other services that provide Furthermore, the current patchy nature evidence-based talking therapies and of liaison services commissioning leads rehabilitation for physical health problems, to patchy provision. There should be including MUS and LTCs. These include: universal agreement to commission liaison services as part of the acute hospital care • clinical health psychology embedded commissioning process. in medical teams, such as oncology, diabetes, renal, rheumatology or respiratory teams and providing specialist talking therapies, assessment, consultation, training and research
Guidance for commissioners of liaison mental health services to acute hospitals 9 What would a good liaison service look like? Model of service delivery Key components of the service • broad capacity building across the health and social care system so that mental A good liaison service functions A comprehensive liaison service health is much more readily recognised best as a discrete, specialised, will have the following features: as a concomitant to physical health fully integrated team comprising • ability to work closely with the acute (liaison clinicians should be able to assess multi-professional health care hospital through integrated governance, physical health as well as mental health, staff, under single leadership open (pre-referral) discussion with the manage mental health issues, recognise the remit of their capabilities, and refer and management. hospital’s principal referring units, a single point of referral and the capacity to psychiatric services when appropriate) A core service should be based on the to serve the agreed hospital population • provision of supervision, liaison and following principles: direct clinical activity outside the acute • provision of comprehensive assessment • staff members sole (or main) and formulation, including risk setting and into primary care when care responsibility is to the acute liaison team assessment and joint assessment where pathways for patients with MUS, LTCs appropriate, using recognised formal or other issues require consistency of • the team includes adequate skill mix instruments to provide diagnosis and care in order to avoid deterioration or • the team has strong links with specialist re-admission formulation that leads to an agreed plan mental health services and good general that is communicated in a timely manner • all-age inclusive services, including knowledge of local resources • capacity to engage effectively with liaison services for children, older people • there is clear and explicit responsibility and adults with dementia the patient in a safe place that allows for all patients in the acute hospital a positive therapeutic relationship to • holistic and culturally responsive setting be built services. • there is one set of integrated • provision of a range of interventions multi-professional healthcare notes including signposting, support, • consultant medical staff are fully psychosocial interventions, therapeutic integrated. interview, brief psychotherapeutic interventions, and pharmacotherapy • effective liaison with other parts of the health system, including general practice, crisis and in-patient teams, specialist mental health teams, social services, emergency services and non- statutory agencies
10 Practical Mental Health Commissioning What would a good liaison service look like? (continued) Standards Table 1: Examples of levels and skill mix for a team serving a general hospital with 650 beds and 750 new self-harm patients per year. Commissioners will need to (Mental Health Policy Implementation Guide, 2008) commission liaison services that can demonstrate that they role grade time comment meet the recognised standards for the service. Medical Consultant Whole time Consultant involvement is essential, including managing risk, providing These are set out in the Royal College supervision and training, and offering of Psychiatrists College Centre for expertise on psychopharmacological Quality Improvement (CCQI) Plan treatment, complex patients, capacity standards,3 against which liaison services and the Mental Health Act. may be accredited. These are not Nursing Band 8 Whole time One of the nursing roles should be as currently mandatory. It is suggested team leader. that the PLAN accreditation process becomes a commissioning requirement, Nursing Band 7 3x The nurses operate as autonomous with the joining fee included in the whole time practitioners, undertaking assessments, commissioning process. and brief treatment interventions, and liaising with mental health teams in The optimum liaison team primary care. Those working with older adults will become involved in detailed To provide the breadth discharge planning. of services set out above, Clinical Band 8 1 May be provided from health a range of staff operating Psychology psychology team, but should be within a multidisciplinary an integral part of a liaison team team is essential. to provide supervision, training and delivery of brief psychological Table 1 sets out the absolute minimum treatments. staff requirements to provide an adult Team PA Band 4 1.5 x Core to referral management, care liaison service working office- whole time information gathering and hours within an acute hospital with 650 communication. beds, as described in the Royal College of Psychiatrists Mental Health Policy Implementation Guide.4 • adults with complex needs The model of acute liaison services additional staffing requirements outlined in this guide will require a number • older-age adults –all senior staff will need experience in older people’s mental health, of additional therapists with experience If liaison professionals are to and all teams should have the necessary of working with people with MUS. These provide teaching, training and requirements to allow training of juniors therapists may come from a variety of support to colleagues within and students for all professional groups backgrounds, including social work, occupational therapy and physiotherapy their team and throughout the • CAMHS – child and adolescent mental general hospital, the staffing health services to general hospitals should For examples of guidance on appropriate ratios above would need to be be provided by specialist multidisciplinary staffing levels for older-age adults and CAMHS liaison teams, but current other population groups please see increased to allow for this. provision is patchy and further investment references26-31,as well as the existing Similarly, a greater number of staff will be is required. JCP-MH series of guides on commissioning needed to provide a comprehensive office (www.jcpmh.info). hours liaison service for:
Guidance for commissioners of liaison mental health services to acute hospitals 11 Outcomes RAID is a new model for acute liaison Quality indicators have confirmed good services developed by Birmingham and patient feedback on improved holistic care The quality outcomes of Solihull Mental Health Foundation Trust in acute care settings. Staff feedback has liaison services include: and the University of Staffordshire. It confirmed that the team is popular and has • improved service user experience has been piloted at Birmingham’s City built capacity and confidence in managing and care outcomes Hospital, an inner city general hospital patients with mental health issues, with some 600 beds.31 reduced violence and improved morale (as • improved access to mental health care evidenced in the annual staff survey). for a population with high morbidity The service offers consultation and liaison • reduced emergency department waiting to A&E, the medical assessment unit and In terms of hospital efficiency, waiting times for people with mental illness the medical, maternity and surgical wards, times for mental health patients in A&E with response targets of one hour for A&E have been reduced by 70%, which is • reduced admissions, re-admissions and 24 hours for inpatients. reflected in an overall improvement in and lengths of stay A&E waiting times. • reduced use of acute beds by patients RAID builds on existing liaison services, with dementia adding health and social care capacity to The service is to expand across the the liaison team, plus specialist skills in Birmingham acute care health economy • reduced risk of adverse events older adults and addictions – as such, it is to cover five acute hospitals with 3,600 • enhanced knowledge and skills of a complete, all-age mental health service beds in total. Throughout this expansion acute hospital clinicians within an acute trust. it will be subject to ongoing evaluation. • improved compliance of acute trusts RAID is viable at a cost of circa £1 million with legal requirements under the for a hospital of circa 600 beds. Mental Health Act (2007) and Mental Capacity Act (2005) Economic evaluation of RAID, undertaken • improved compliance with NHS by the London School of Economics, has Litigation Authority Risk Management demonstrated that it can achieve the Standards and the Clinical Negligence following outcomes, over and above Scheme for Trusts (CNST). traditional liaison services: • reduce admissions, leading to a RAID: an example of reduction in daily bed requirement service innovation of 44 beds per day, saving the NHS The Rapid Assessment Interface £3.55 million per annum through and Discharge (RAID) service is decommissioning acute beds an age-inclusive, drugs/alcohol • reduce discharges to institutional care inclusive, consultant-led service for elderly people by 50%, saving local authorities £3 million per annum in that is fully integrated into the contributions to residential care structure and function of an • produce a consequent cost-to-return acute hospital in Birmingham. It ratio of £1 to £4. has shown dramatic reductions in bed use,particularly use of acute/elderly ward beds by patients with dementia.
12 Practical Mental Health Commissioning Supporting the delivery of the mental health strategy The JCP-MH believes that Shared objective 4: commissioning that leads to More people will have a positive good acute liaison services, experience of care and support. as described in this guide, By addressing both physical and mental will support the delivery of health needs together, acute liaison the mental health strategy1 services can improve the likelihood of in a number of ways. patients experiencing more holistic and positive care in acute hospital settings. Shared objective 1: More people will have Shared objective 5: good mental health. Fewer people will suffer avoidable harm. Commissioning acute liaison services will increase the number of people receiving One of the key components of a appropriate care and support and reduce good liaison service is to assess the the number developing mental illness. This risk of self-harm and harm to others. is because they provide early identification, Commissioners should look to a liaison diagnosis, and either treatment or referral, service to both provide short-term for people with mental health needs interventions and appropriate onward admitted to acute hospital. referral and signposting. Reducing outpatient attendance, hospital admissions Shared objective 2: and readmissions protects patients from avoidable harm. More people with mental health problems will recover. Shared objective 6: A patient’s road to recovery is often Fewer people will experience made more difficult by the co-morbidity stigma and discrimination. of physical and mental health needs. By commissioning a liaison service that By commissioning services that recognise addresses both physical and mental mental and physical health as inseparable health needs together, the prospects and inter-related, commissioners will be of recovery are enhanced. actively addressing the stigma that derives from the artificial separation of physical Shared objective 3: and mental health and increasing public and professional understanding of their More people with mental frequent coexistence. health problems will have good physical health. Ensuring that a person’s mental health needs are also addressed when they are in an acute hospital for treatment for their physical health needs removes one of the potential barriers to provision of good physical health care. Liaison services can reduce the risk of self-harm and suicide while also addressing the long-term conditions and medically unexplained symptoms with which many patients present.
Guidance for commissioners of liaison mental health services to acute hospitals 13 Liaison Expert Reference Group Members • Paul Gill (ERG Chair) • Rebecca Harrington Development process Consultant Psychiatrist Assistant Director This guide has been written by a group Sheffield Liaison Psychiatry Service (Strategic Planning and Joint of liaison care experts, in consultation Sheffield Health and Social Care Commissioning) with patients and carers. Each member NHS Foundation Trust London Borough of Camden of the Joint Commissioning Panel for & Camden PCT Mental Health received drafts of the guide • Jonathan Campion for review and revision, and advice was Consultant Psychiatrist • Lance McCracken sought from external partner organisations South London and Maudsley Consultant Clinical Psychologist and individual experts. Final revisions NHS Foundation Trust Bath Centre for Pain Services to the guide were made by the Chair Royal National Hospital for of the Expert Reference Group in • Mike Clarke Rheumatic Diseases collaboration with the JCP’s Editorial Board London School of Economics (comprised of the two co-chairs of the and Political Science • Stella Morris JCP-MH, one user representative, one Consultant Psychiatrist carer representative, and technical and • Chris Fitch Humber NHS Foundation Trust project management support staff). Research and Policy Fellow Royal College of Psychiatrists • Kieron Murphy Director of Delivery • Jeremy Gauntlett-Gilbert Joint Commissioning Panel Senior Clinical Psychologist for Mental Health Bath Centre for Pain Services Royal National Hospital for • Chris Naylor Rheumatic Diseases Fellow (Health Policy) King’s Fund • Annemarie Smith Carer Representative
14 Practical Mental Health Commissioning Resources References The Joint Commissioning Panel Healthy Mind, Healthy Body 1 HM Government (2011). for Mental Health (JCP-MH) NHS Confederation (2009) No health without mental health: www.jcpmh.info a cross-government mental health www.nhsconfed.org/Publications/ outcomes strategy for people of all ages. This website describes the function Documents/Briefing_179_ London: Department of Health. and intended outputs of the JCP-MH Healthy_mind_healthy_body_MHN.pdf This briefing explains how liaison 2 Bennett, A., Appleton, S., Jackson, C. Quality standards for liaison psychiatry services can transform (eds) (2011). Practical mental health psychiatry services (2nd ed). quality and productivity in acute commissioning. London: JCP-MH. Royal College of Psychiatrists settings. It sets out some good practice www.rcpsych.ac.uk/pdf/JCP-MH%20 College Centre for Quality Improvement examples together with academic -%20Vol%20One%20(web%20 Psychiatric Liaison Accreditation evidence to build a business case for 11_04_05).pdf Network (PLAN) (2010) liaison psychiatry services. 3 Palmer, L., Dupin, M., McGeorge, www.rcpsych.ac.uk/pdf/ M., Soni, M. (eds) (2010). Quality PLANStandards%202nd%20Edition Managing Urgent Mental standards for liaison psychiatry services %20Final.pdf Health Needs in the Acute Trust (2nd ed). London: Royal College of This report sets out standards for Academy of Medical Royal Psychiatrists College Centre for Quality acute liaison services. Colleges (2008) Improvement. www.rcpsych.ac.uk/pdf/ www.rcpsych.ac.uk/pdf/ PLANStandards%202nd%20Edition%20 Mental Health Policy Implementation ManagingurgentMHneed.pdf Final.pdf Guide: Liaison Psychiatry and This report outlines the case for 4 Aitken, P. (2007). Mental health policy Psychological Medicine in the investing in liaison mental health implementation guide: liaison psychiatry General Hospital services and sets out a set of and psychological medicine in the Royal College of Psychiatrists (2008) recommendations and standards general hospital. London: Royal College www.rcpsych.ac.uk/pdf/PIG2.pdf that should underpin these services. of Psychiatrists. www.rcpsych.ac.uk/pdf/ This report focuses on the key components PIG2.pdf Department of Health that should be in place in a liaison team if 5 Royal College of Psychiatrists (2007). mental health website the service is to operate effectively. No health without mental health: the www.dh.gov.uk/en/Healthcare/ supporting evidence. London: Academy No Health without Mental Health: Mentalhealth/MentalHealthStrategy/ of Medical Royal Colleges/Royal College the ALERT summary report. index.htm of Psychiatrists. Academy of Medical Royal Colleges National Institute for Health 6 NHS Confederation (2009). (2009) and Clinical Excellence (NICE) Healthy mind, healthy body: how liaison www.rcpsych.ac.uk/pdf/ALERT%20 psychiatry services can transform quality www.nice.org.uk print%20final.pdf and productivity in acute settings. London: This report, produced by the PLAN NHS Confederation. www.nhsconfed.org/ team with the Royal College of Publications/Documents/Briefing_179_ Psychiatrists Liaison Faculty highlights Healthy_mind_healthy_body_MHN.pdf the importance of liaison services and 7 Royal College of Psychiatrists and British argues that every hospital should have Association for Accident and Emeregency access to these services. Medicine, 2004, Psychiatric services to accident and emergency departments (CR118) London, Royal College of Psychiatrists. 8 Yeo, H.M. (1993). The cost of treatment of deliberate self-harm. Archives of Emergency Medicine, 10(1), pp. 8–14.
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Guidance for commissioners of liaison mental health services to acute hospitals 17 A large print version of this document is available from www.jcpmh.info Published February 2013 Produced by Raffertys
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