mental health

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Bringing together physical and mental health

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While the outcomes achieved by the RAID model appear to be encouraging, it is

important to state that the full scope of liaison mental health can and should go

wider than this. In some acute hospitals, liaison services also perform a valuable

longer-term rehabilitative function, working in outpatient clinics to help people

address issues concerning the interface between mental and physical health. For

example, liaison psychiatry services in Leeds are divided into several distinct

services – including an ‘acute liaison psychiatry’ service resembling the RAID model

for A&E, and a liaison psychiatry outpatient service that provides ongoing therapy.

Clinical health psychologists often play an important part in delivering this longerterm

therapeutic work, either as members of liaison teams or by being embedded in

specific clinics.

From an integrated care perspective, some of the most significant opportunities for

innovation lie in building community-facing liaison services that stretch beyond

hospital boundaries and work in new ways with community partners (Aitken et al

2014). For example, both of the psychological medicine/liaison psychiatry services

included in our case studies are currently exploring options to extend hospital-based

liaison mental health services into primary care, to provide GPs in the local area

with a service they can refer into directly (see appendices D and E).

The psychological medicine service in Oxford University Hospitals NHS Foundation

Trust provides a distinctive model that differs in two important ways from liaison

services provided in many acute trusts. First, whereas liaison psychiatrists operating

in most acute hospitals are employed by the local mental health provider, the Oxford

Psychological Medicine team is fully integrated with and employed by the acute

trust. Second, the Oxford service is delivered largely by consultant psychiatrists

and senior psychologists, with a relatively smaller role for other professionals such

as liaison nurses. This is seen as being consistent with the culture of the wider

organisation. Further details about the service are provided in Appendix D.

Further progress is needed to ensure that liaison mental health services are able

to support people of all ages, including older people who comprise the majority

of hospital inpatients (Anderson et al 2005). The national audit of dementia care

indicated that most acute hospitals now have access to some form of liaison services

for older people (Royal College of Psychiatrists 2013b), but the sophistication

of these services appears to be variable. An important aspect of integration here

is inclusion of mental health expertise in frailty units. The frailty unit at the

Integrated service models: current developments and trends 54

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