mental health

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Bringing-together-Kings-Fund-March-2016_1

Bringing together physical and mental health

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have been indicated as a predictive factor for longer hospital stays and higher

institutionalisation rates (NHS Confederation 2009). Patients with dementia often

experience delays in discharge, even when there is no substantive medical reason

for delay (Parsonage and Fossey 2011; National Audit Office 2007). There is evidence

linking untreated or under-treated mental health problems among general hospital

inpatients to higher rates of re-attendance at A&E after discharge (Joint Commissioning

Panel for Mental Health 2013b). Self-harm accounts for more than 150,000 A&E

attendances per year in England (NICE 2004) and can require significant staff time

to manage.

What would a more integrated approach look like?

An integrated approach would mean all acute hospital professionals having the

necessary skills and confidence to manage mental health appropriately. Professionals

working in emergency departments and inpatient wards would understand how

to identify and respond to dementia, delirium, self-harm and acute psychosis.

Outpatient teams would have the capability to help people make psychological

adjustments to illness, or to manage medically unexplained symptoms. Liaison

psychiatry or psychological medicine services would be instrumental in achieving

these aims, performing an important educational function across the hospital. Liaison

services would be age-inclusive, operate seven days a week, and would be available

in every acute hospital, in line with current policy commitments (Department of Health

2014a). They would also offer outreach services to primary care.

Further guidance

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Guidance for commissioners of liaison mental health services to acute hospitals

(Joint Commissioning Panel for Mental Health 2013b)

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Liaison psychiatry in the modern NHS (Parsonage et al 2012)

Case study examples

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Oxford Psychological Medicine Service (Appendix D)

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Psychological medicine services in Hull (Appendix E)

The case for change: 10 areas where integration is needed most 35

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