Search results

The purpose of this paper is to examine an audit that was performed of all patients referred to a liaison psychiatry inpatient consultation service which sought to establish a baseline for demographics, type of referral, and management of referrals, with a view to introducing improved evidence‐based treatments. It also aims to examine timeliness of response to referrals benchmarked against published standards.

All inpatient referrals to a liaison psychiatry service were recorded over a six‐month period, including demographics, diagnosis, management and timeliness of response to referrals. The data were retrospectively analysed and compared against international standards.

A total of 172 referrals were received in the six months. Commonest referral reasons included assessments regarding depressive disorders (23.8 per cent), delirium/other cognitive disorders (19.2 per cent), alcohol‐related disorders (18.6 per cent), anxiety disorders (14.5 per cent), and risk management (12.2 per cent). Evidence‐based practices were not utilised effectively for a number of different types of presentations. A total of 40.1 per cent of referrals were seen on the same day, 75.4 per cent by the end of the next day, and 93.4 per cent by the end of the following day.

Use of a hospital protocol for management of delirium may improve outcomes for these patients. Evidence‐based techniques, such as brief intervention therapies, may be beneficial for referrals involving alcohol dependence. Referrals were seen reasonably quickly, but there is room for improvement when compared with published standards.

This paper provides valuable information for those involved in management of liaison psychiatry consultation services, providing ideas for development and implementation of evidence based practices.

The purpose of this paper is to review the findings from an audit of the implementation of a consultation-liaison psychiatry (CLiP) database in all inpatients referred to a CLiP service at the largest hospital in Malaysia with the aim of improving the quality CLiP services.

All inpatient referrals to the CLiP team were recorded over a three-month period and compared to previous audit data from 2017. Four audit standards were assessed: the reporting of referrals, timeliness of response indication of reason for referral and presence of a management plan.

The compliance of reporting using the CLiP form was 70.1 per cent compared to 28 per cent in the audit data from 2017 after interventions were conducted. Analysis of the completed CLiP form reveals that 89 per cent of referrals were seen within the same working day. All referrals included the reason for referral. The most common reason for referral was for depressive disorders, but post-assessment, delirium was the most common diagnosis. In total, 87.8 per cent satisfied the audit criteria for a completed written care plan.

Specialised CLiP services are relatively new in Malaysia and this is the first paper to examine the quality of such services in the country. Interventions were effective in improving the compliance of reporting using the CLiP database. The findings suggest that the CLiP services are on par with international audit standards. Furthermore, data from this clinical audit can serve as a benchmark for the development of national operating policies in similar settings.

A system of care is a function-specific, rather than agency-specific approach defined as a “comprehensive spectrum of mental health and other necessary services which are organized into a coordinated network to meet the multiple and changing needs of children and adolescents with severe emotional disturbances and their families” (Stroul & Friedman, 1986). A system of care provides a mental health delivery system for children with SED with a wide array of accessible, community-based services that focus on children's individual needs, include the family in treatment planning, and provide culturally competent services. System of care services are provided by multiple child serving agencies and are collaborative and coordinated (Stroul & Friedman, 1986).

There is an association between the diagnosis of a mental illness and violent behaviour. Individuals diagnosed with severe and enduring mental health difficulties who display violent behaviour have inferior treatment outcomes when compared with those who do not engage in violent behaviour. Violent behaviour within care settings impacts on general functioning, adherence to treatment plans, and inhibits wider recovery goals. The paper aims to discuss these issues.

This research studied 95 inpatients with a primary diagnosis of severe mental illness, with and without a history of violence, and compared how levels of global functioning and risk impacted on recovery. Patients were divided into two groups: those with and without a previous or current history of violence. The two groups were compared on measures of global functioning, symptomatology, and risk at baseline and 12-month follow up.

Both violent and non-violent groups showed increased global functioning over time, with no significant difference between the groups. Neither group showed significant reductions in risk over time. Patients in the violent group had significantly fewer prior and current symptoms of mental ill-health than non-violent individuals.

Despite evidence suggesting that historical or current violence leads to impaired outcomes amongst people with diagnoses of mental illness, the findings of this study suggest a history of violent behaviour was not a predictor of poor progress within inpatient settings.

Disconfirming previous hypotheses, the paper suggests that in itself, violent behaviour does not always significantly impair outcomes for individuals diagnosed with mental illnesses, and that many other variables contribute to meaningful recovery.

Whilst there are previous studies investigating outcomes for inpatients diagnosed with mental illness who have violent histories, there is a dearth of research comparing equivalent groups in the same facility over the same time period. This study directly compared inpatients with or without a history of violence in the same psychiatric rehabilitation settings.

The purpose of this paper is to describe how an adult liaison psychiatry service was established at a hospital introducing the special interest service provision model, which is a cost‐effective method of developing new services.

The paper describes a step‐by‐step process of setting up a new service. Nearly, 20 months after its introduction, the new service was evaluated using a retrospective survey design that involved reviewing the patient referral forms. The authors looked at the demographical data, reasons for referral and the outcome of assessment for patient assessed by this service.

Results revealed that the majority of the referrals (51 per cent, n=136) were from the medical ward, 56 per cent of the psychiatric assessments were done within 24 hours of the referral, 37 per cent of the assessed patients were provisionally diagnosed with a depressive episode and 24 per cent with substance misuse.

The paper describes a new model of service provision. From the above findings it can be extrapolated that this model of service provision is generalisable and can be replicated anywhere in the UK. This paper would interest clinicians and individuals interested in service development and improving patient care.

The focus of this paper is to consider the findings of a survey, which aims to identify the types of training that acute mental health staff could access, in relation to workforce development and substance misuse issues in acute mental health care.

An electronic survey was developed and distributed using work email lists to all clinicians who worked in acute mental health services across a region in England. Not all NHS organisations agreed to participate.

A total of 89 clinicians responded to the survey, some failed to indicate their consent, therefore the results of the 77 that did are presented. The main finding was that most acute care staff had only accessed mandatory training such as risk assessment. Many staff had not been trained in the use of psychosocial approaches. Drug and alcohol specific activities were performed on the whole only “sometimes”.

It was not possible to determine the total number of potentially eligible staff who were sent the survey, therefore, response rates cannot be calculated. It is possible that the findings may not be generalisable to other services. There may be bias in those who choose to respond to an electronic email, in terms of those who had access to a computer or who were more IT literate. In addition, the survey did not specifically set out to examine substance misuse issues as its main focus.

Acute care staff work with service users with increasingly complex needs. Creative and cost effective ways of facilitating access to training and support must be found as a priority to ensure that staff have the competencies to identify and manage substance users effectively in acute mental health settings.

The findings reinforce previous studies highlighting the deficit in access to psychosocial interventions training for acute care staff.

The purpose of this study is to describe the characteristics of severely psychiatrically impaired adolescents requiring day hospital management and the effectiveness of the service using standardised outcome measures.

The data was collected on adolescents aged 13‐17 years in two London boroughs, attending the day service over a period of one year. Outcome measures were HoNOSCA, CGAS, SDQ and qualitative data from feedback forms from adolescents and parents.

The adolescents (n=22) had varied disorders, but mainly depression, (n=9) and psychosis (n=4). HoNOSCA score on admission was mean 18.14 (SD 3.78) but by discharge it had reduced to mean 15.39 (SD 7.31) (p=0.07), and CGAS reduced from initial mean score of 43.83 (SD 9.90) to 53.17 (SD 12.04) (p=0.003). Attendance for 19 (86 per cent) adolescents was for less than six months. Following discharge 14 (64 per cent) returned to education or employment. Adolescents and their carers reported high levels of satisfaction. The findings indicate substantial improvement and satisfaction with the service. The size of the improvement in outcome scores and the consistency across the HoNOSCA and CGAS associated with high service satisfaction also suggest that the data is reliable.

The small size of the sample and loss of data made it difficult to extrapolate from the results to other groups of impaired adolescents. There was no control group in the study and therefore it was not possible to demonstrate whether the improvement was due to spontaneous changes over time, Tier 3 CAMHS input or the attendance at the day service. It is difficult to demonstrate what proportion of adolescents who were admitted to the day service would have required a Tier 4 in patient admission had the service not been available. A larger study using a more robust design involving randomisation to the day‐service or in‐patient service would provide important comparative data regarding the service benefits.

Currently there is little provision for severely psychiatrically impaired adolescents who require a day treatment programme. Day patient programmes appear to offer a useful and accessible treatment method. The service is much cheaper than an in‐patient service, and may also reduce the demands for or duration of inpatient admission. Unfortunately the service did not obtain continuation funding in view of NHS funding cuts, rather than dissatisfaction by local commissioners, and so needed to close. The data presented here can hopefully be used to support the case for child and adolescent psychiatric day programmes.

The purpose of this paper is to explore the challenges that are experienced by staff responsible for commissioning liaison psychiatry services and to establish if these are shared by other health professionals.

Using a mixed-methods design, the findings from a mental health commissioner workshop (n = 12) were used to construct a survey that was distributed to health care professionals using an opportunistic framework (n = 98).

Four key themes emerged from the workshop, which was tested using the survey. The importance of secure funding; a better understanding of health care systems and pathways; partnership working and co-production and; access to mental health clinical information in general hospitals. There was broad convergence between commissioners, mental health clinicians and managers, except in relation to gathering and sharing of data. This suggests that poor communication between professionals is of concern.

There were a small number of survey respondents (n = 98). The sampling used an opportunistic framework that targeted commissioner and clinician forums. Using an opportunistic framework, the sample may not be representative. Additionally, multiple pairwise comparisons were conducted during the analysis of the survey responses, increasing the risk that significant results were found by chance.

A number of steps were identified that could be applied in practice. These mainly related to the importance of collecting and communicating data and co-production with commissioners in the design, development and monitoring of liaison psychiatry services.

This is the first study that has specifically considered the challenges associated with the commissioning of liaison psychiatry services.

The aim of this article is to examine clinical outcomes in a child psychiatry inpatient unit using dedicated measures. Clinicians completed contextual (Paddington Complexity Scale - PCS) and clinical change (Health of the Nation Outcome Scales for Children and Adolescents - HoNOSCA) questionnaires on admission and discharge for consecutive admissions to the unit between 1999 and 2007 (n=167). Mean changes in HoNOSCA scores were analysed, and the predictors of HoNOSCA mean change were assessed using regression analysis. The results showed that the mean length of stay at the unit was 5.6 months (SD 3.1). PCS ratings identified high total, clinical, and environmental complexity scores. HoNOSCA ratings indicated high levels of psychological problems on admission and significant improvement at discharge (mean change 7.7 (SD 6.7)). Greater positive change was associated with higher initial HoNOSCA scores, diagnoses other than conduct disorder and schizophrenia, and a facilitative parental attitude. The authors conclude that the systematic use of standardised outcome measures in child psychiatric inpatient units is useful to document clinical features, complexity and clinical change.

A high and possibly increasing prevalence of mental disorders in prisoners has been demonstrated in recent surveys. Psychiatric care of prisoners is subject to wide regional variations in Germany, especially regarding inpatient treatment. Although hospitalized psychiatric patients in prison closely resemble those in forensic psychiatric secure hospitals with regard to socio‐demographic (percentage of women, age peak) and forensic characteristics (delinquency, prison experience), marked discrepancies in the diagnostic spectrum necessitate very different treatment planning based on general clinical psychiatry when considering the approach and especially the treatment duration. In Berlin, we try to develop a care structure within the prison system, which addresses inmate‐specific problems and circumstances as well as the possibility of inpatient and outpatient treatment and semihospitalization according to the principle of “equivalence”.