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

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

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

2011 2011 2012 2012 2013 2014

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.

2014 Feb 2015 Oct 2015

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.

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.”

What’s the baseline?

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

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

Core 24 skill mix Consultants: 2; other Medical: 2 Nurses: 6 Band 7, 7 Band 6 Other Therapists: 4 Team Manager Band 7: 1 Clinical Service Manager Band 8: 0.2 - 0.4 Admin Band 2, 3 and 4: 2 Business support (Band 5): 1 Total Whole Time Equivalent: 25.2 - 25.4 COST: £1.1M

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.

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

What about other models?

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

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)

What about under 16s? ?

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

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

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

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

Thank you

References and resources http://mentalhealthpartnerships.com/resource/model- service-specifications-for-liaison-psychiatry-services/ http://www.crisiscareconcordat.org.uk/wp- content/uploads/2015/10/2a-Report-of-the-2nd-Annual- Survey-of-Liaison-Psychiatry-in-England-20-.pdf https://www.england.nhs.uk/wp- content/uploads/2015/02/mh-access-wait-time- guid.pdf http://www.kingsfund.org.uk/sites/files/kf/field/field_ publication_file/long-term-conditions-mental-health- cost-comorbidities-naylor-feb12.pdf