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Bringing together physical and mental health 1 2 3 4 5 6 7 Appendix D: Oxford Psychological Medicine Service Overview The Oxford Psychological Medicine Service aims to transform patients’ experiences in Oxford University Hospitals NHS Foundation Trust by integrating psychiatric and psychological support with medical care. The service is distinct from counterparts in other acute hospitals in that the team is employed directly by the acute trust, rather than being delivered by a mental health provider. The service is led by a consultant psychiatrist and a consultant clinical psychologist and largely delivered by consultant psychiatrists and senior clinical psychologists, within a unified team. Service description The team is reported to be considered as much a part of the acute trust’s workforce as the medical and nursing staff. Psychiatrists and psychologists are directly employed by the acute trust and embedded in clinical teams. Working across the hospitals that make up the acute trust, the Psychological Medicine Service is available to inpatients and outpatients receiving care from a number of clinical areas, including: •• acute general medicine and gerontology •• cancer •• children’s services •• chronic pain •• diabetes •• enablement services •• infectious diseases •• neurosciences •• palliative care •• respiratory medicine •• women’s services. Appendices: case study site profiles 83
Bringing together physical and mental health 1 2 3 4 5 6 7 Psychiatrists in the multidisciplinary team work alongside medical consultants, junior doctors, ward nurses and others to offer rapid, senior psychiatric opinions. They can assess suspected mental health, confusion or memory problems, or general risk. They can give advice about managing behavioural disturbance or on medicolegal issues regarding capacity and use of the Mental Health Act. They assist with discharge planning and can facilitate dialogue with mental health services outside of the acute trust for onward management. In palliative medicine, the service’s consultant psychiatrists provide assessment and treatment for patients, as well as training and supervision for palliative care team members. Psychologists in the team work as members of medical teams, adding a psychological dimension to patient management. In respiratory medicine, for example, a clinical health psychologist works with the respiratory team to assess and provide evidencebased treatment to patients with psychological issues that have a negative impact on their physical and mental health. One of the benefits of the service is that it provides an opportunity for team members to teach and train their physical health care counterparts as they work closely together. At the time of writing, this mental health training was a trust-wide requirement for staff in cancer and women’s services. In addition to the Psychological Medicine Service, a separate Emergency Department Psychiatric Service assesses patients presenting with psychiatric issues to the emergency departments at the John Radcliffe and Horton General hospitals. This service is provided by Oxford Health NHS Foundation Trust. Outcomes The Oxford Psychological Medicine Service has been in place for two years and in that time has received highly positive feedback from physicians, surgeons and nursing staff. Acute care staff greatly appreciate a quick response and diagnosis of patients’ mental health issues. The value that acute care staff place in the service is evidenced in the growing number of clinical departments that have commissioned its input over the past two years. One of its most important perceived impacts is that it has challenged pervasive stereotypes about mental illness within the acute care setting, and has helped to change how patients with challenging behaviours Appendices: case study site profiles 84
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