1. Liaison Psychiatry Service Models ‘Core 24’ and more
Dr Sarah Brown
Consultant Liaison Psychiatrist
Newcastle

2. The story of liaison 2009-present
Models of liaison services
Which model where?
A reminder of the benefits
The way ahead?

3. Rapid Assessment Interface & Discharge Team
City Hospital Birmingham
4:1 savings by reducing length of stay
Before: 2 Drs, social worker, 6 nurses, admin
After: 5 Drs, 11 nurses, psychologist, social worker, 3 admin

4. 2011
2011
2012
2012
2013
2014

5. 5 year forward view
Over the next five years, the NHS will do far better at organising and simplifying the system. This will mean:
Proper funding and integration of mental health crisis services, including liaison psychiatry.
….towards an equal response to mental and physical health, and towards the two being treated together….to achieve genuine parity of esteem between physical and mental health by 2020.

6. 2014
Feb 2015
Oct 2015

7. New Standard for Access and Waiting times for Mental Health
£30m investment in effective models of liaison psychiatry
by 2020, all acute trusts will have in place liaison mental health services for all ages appropriate to the size, acuity and specialty of the hospital.

8. Pump prime funding
“……ensuring that all acute hospitals are operating at ‘Core 24’ service grading, which is the minimum service grading that the evidence shows will bring benefit to patients whilst generating savings….
….investing in liaison mental health for children and young people, as well as working age and older adults.”

10. What’s the baseline?

12. Key findings 2015 survey 179 hospitals with A&E
approx 200 Consultant Liaison Psychiatrists in England
~200 more needed to reach Core
~500 more need for ‘adequate’ services in every area
Bigger gap for nurses
Very little paediatric liaison
Lots of variation in service provision

13. So what is ‘Core 24’?
North West London ‘Optimal Liaison Psychiatry Model’
built on the evidence from RAID by modifying the model skill mix and staffing ratios to provide an effective core service twenty four hours a day, seven days a week reflecting their urban demand.
16+
Inpatient and A&E
24/7 support to unplanned care pathways

15. Core 24 skill mix Consultants: 2; other Medical: 2
Nurses: 6 Band 7, Band 6
Other Therapists: 4
Team Manager Band 7: 1
Clinical Service Manager Band 8:
Admin Band 2, 3 and 4: 2
Business support (Band 5): 1
Total Whole Time Equivalent: COST: £1.1M

16. What are ‘Core’ services?
3 main areas of work:
Direct patient care (assessment, diagnosis and provision of mental healthcare for patients referred to the team).
Support and training to general hospital staff relating to mental health needs.
Interfacing with other parts of the health and social care system.

17. Core 24 activity A&E 1 hour; inpatients 24 hours.
See patients, right place, right time:
Assess, Diagnose, Treat, Manage risk
Brief evidence-based interventions, short-term follow up
Liaison with multiple professionals and agencies
Advice, support, expertise to referrers

18. What about other models?

19. Models of liaison Core – basic model to A&E & wards, Mo-Fri, 9-5 only
Core 24 – 24/7 hour cover
Enhanced 24 – (e.g. RAID) 24/7 with follow up, and other specialist enhancements inc o/p referrals
Comprehensive – specialty/condition - specific liaison service

20. Which model is needed where?
Working age adults have traditionally been the main patient group for liaison psychiatry services. However, although they make up 45% of inpatient admissions, they only make up 30% of bed-days. Older adults, by contrast, make up 65% of total bed-days, and they make up 80% of hospital bed days taken up by people with mental and physical problems (Parsonage et al, 2012)
From: Model service specifications for liaison psychiatry services – Guidance. Mental Health Partnerships (2014)

21. What about under 16s? ?

22. Benefits of adequate liaison services
Savings of £4 for every £1 invested (RAID)
Improved service user experience
Increased knowledge and understanding of mental health issues amongst general hospital staff
Improved care outcomes
Reduced emergency department waiting times

23. Benefits Reduced admissions, re-admissions and lengths of stay
Reduced use of acute bed by patients with dementia
Reduced risk of adverse events
Improved compliance of acute trusts with legal requirements under the Mental Health Act (2007) and Mental Capacity Act (2005)
Reduced psychological distress following self-harm, and reducing suicide

24. Challenges ‘Ageless’ services
Single point of access with multiple providers
Staffing
Evaluation
Outcomes data
Research

25. Liaison psychiatry: the way ahead…
Integration with other resources
Training and recruitment
Innovative roles – physician assistant, nurse practitioners, peer support workers, Clinical training fellows
Integration with other resources e.g. dementia teams, joint clinic provision, health psychology

26. Thank you

27. References and resources
service-specifications-for-liaison-psychiatry-services/
content/uploads/2015/10/2a-Report-of-the-2nd-Annual- Survey-of-Liaison-Psychiatry-in-England-20-.pdf
content/uploads/2015/02/mh-access-wait-time- guid.pdf
publication_file/long-term-conditions-mental-health- cost-comorbidities-naylor-feb12.pdf