mental health

Bringing together physical and mental health
1 2 3 4
5 6 7
Priority 7: Supporting mental health in acute hospitals
The problem
Mental health problems are highly prevalent in inpatient wards, outpatient clinics
and emergency departments, and can profoundly affect outcomes of care for acute
physical illnesses. However, they often go unidentified and unsupported (Joint
Commissioning Panel for Mental Health 2013b). For example, two-thirds of NHS beds
are occupied by older people, up to 60 per cent of whom have or will develop
a mental health problem during their admission (Anderson et al 2005). Other
conditions such as eating disorders can significantly complicate the management
of hospitals patients. In recognition of this problem, there has been some growth in
liaison mental health services in recent years, but there remains significant variation
in approach across the country. Only 16 per cent of acute hospitals in England
currently have access to a comprehensive liaison service (Mental Health Taskforce
2016). Acute hospital staff often lack the necessary training, knowledge and skills
related to the recognition and management of common mental health problems
affecting acute hospital care (Royal College of Psychiatrists 2013a; Parsonage and
Fossey 2011).
Impact on people
The failure to consistently support the mental health needs of people using acute
hospital services has an important effect on both patient experience and care
outcomes. For example, in approximately 50 per cent of cases, acute care staff fail to
identify delirium in older inpatients, with significant negative consequences for the
people affected (NHS Confederation 2009). Patients with dementia are still prescribed
antipsychotics on some inpatient wards, despite guidance indicating that this is
often inappropriate (McIlroy et al 2015). Under-treatment of other mental health
problems such as depression leads to people spending longer in hospital than may
otherwise have been necessary (see below).
Impact on the health system
Mental health problems have an important effect on costs in the acute sector. For
example, general hospital inpatients with co-morbid depression have a longer
length of hospital stay than patients who are not depressed (Prina et al 2015;
Simon et al 2007; Aoki et al 2004). For older people, mental health problems
The case for change: 10 areas where integration is needed most 34