Current and Future Perspectives of Liaison Psychiatry Services: Relevance for Older People’s Care
Abstract
:1. Introduction
2. Mental Health in Medically Ill: Review of Policies
3. Provision for Liaison Psychiatry Teams Working in General Medical Setting
4. The Future of Liaison Psychiatry Services
5. Conclusions
- being not well researched area (incomplete and inconclusive evidence based);
- being not easy for evaluative research (e.g. heterogeneous groups, complex interventions, lack of quality data and absence of metrics to measure relative performance) and
- having wide diversity of service models (assessment/management, various treatment).
Acknowledgments
Conflicts of Interest
References
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1 | Early detection of dementia |
2 | Behavioural and psychological symptoms of dementia (BPSD) |
3 | Detection and management of delirium |
4 | Mood disorders (depression, bipolar disorder) |
5 | Anxiety |
6 | Insomnia |
7 | Suicidality |
8 | Anorexia |
9 | Advocates/social issues |
10 | Pharmacological and non-pharmacological treatments of psychiatric syndromes |
11 | 24-h care |
12 | Ethical issues (e.g. competence and capacity decisions) |
13 | Medico-legal assessments |
14 | Education and training |
Models | Characteristics |
---|---|
Core | Working or extended hours only; serves acute health care systems with or without minor injury or emergency department environments where there is variable demand across the week. |
Core 24 | 24 h, seven days a week; hospital based in urban or suburban areas with a busy emergency department. This model mainly serves emergency and unplanned care pathways. |
Enhanced 24 | 24 h, seven days a week, with extensions to fill local gaps in service and some outpatient services; additional expertise in addictions psychiatry and the psychiatry of intellectual disability. Demography and demand may suggest additional expertise with younger people, frail elderly people or offenders, crisis response or social care. This may extend to support for medical outpatients. This model mainly serves emergency and unplanned care pathways but extends to support elective and planned care pathways where mental health problems co-exist. |
Comprehensive | 24 h, seven days a week, enhanced with inpatient and outpatient services to specialties at major centres. Required at large secondary care centres with regional and supra-regional services. Additional specialist consultant liaison psychiatry, senior psychological therapists, specialist liaison mental health nursing, occupational and physiotherapists. They support inpatient and outpatient areas such as neurology, gastroenterology, bariatric surgery, plastic and reconstructive surgery, pain management and cancer services. They may support other condition specific elements such as chronic fatigue / ME and psychosexual medicine. They may include specialist liaison psychiatry inpatient beds. This model serves emergency and unplanned care pathways as well as elective and planned care pathways where mental health problems co-exist. |
New Services | Old (Established) Services |
---|---|
Start with a rapid response generic service, and then consider add-ons. | Consider add-ons (e.g., multidisciplinary outpatient clinics, substance misuse clinics, etc.). Long hours provision only for Accident and Emergency and Deliberate Self-Harm activity. |
Focus on complex and costly cases. | Further develop outpatient liaison and multidisciplinary clinics, e.g., delirium clinics, dementia/behavioural problems follow-up, links with community services, etc.). |
Core work in medical wards and Accident and Emergency. | Extend work to Accident and Emergency for all ages |
An all ages service | Integrated Liaison service, to include children, adults and older adults |
Work with older inpatients should be a top priority. | Expand on Liaison teams for older adults to expand on core clinical work, teaching and multidisciplinary and outpatient liaison clinics. |
Emphasize education, training and supervision of general district staff - Spend half of time on education and training. | Expand on Liaison teams to incorporate teaching and training as part of their core professional activity. |
Change culture of local care health system to response to and support development of Liaison psychiatry services | Ongoing assistance from local care health system(s) to support Liaison services. |
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Mukaetova-Ladinska, E.B. Current and Future Perspectives of Liaison Psychiatry Services: Relevance for Older People’s Care. Geriatrics 2016, 1, 7. https://doi.org/10.3390/geriatrics1010007
Mukaetova-Ladinska EB. Current and Future Perspectives of Liaison Psychiatry Services: Relevance for Older People’s Care. Geriatrics. 2016; 1(1):7. https://doi.org/10.3390/geriatrics1010007
Chicago/Turabian StyleMukaetova-Ladinska, Elizabeta B. 2016. "Current and Future Perspectives of Liaison Psychiatry Services: Relevance for Older People’s Care" Geriatrics 1, no. 1: 7. https://doi.org/10.3390/geriatrics1010007
APA StyleMukaetova-Ladinska, E. B. (2016). Current and Future Perspectives of Liaison Psychiatry Services: Relevance for Older People’s Care. Geriatrics, 1(1), 7. https://doi.org/10.3390/geriatrics1010007