Who Cares Wins - Royal College of Psychiatrists

3: Models and Styles of
Service
3.1 There are several potential service models that would improve the delivery of mental health services
for older people in general hospitals. Several factors may influence which particular model is
chosen, as discussed later in this section. It is also possible to have more than one model
operating simultaneously. Whatever model is chosen for a particular setting, it must be able to
deliver the core functions of a liaison mental health service.
3.2 That is, a consultation-liaison service, whatever model is chosen, must be in a position to raise
awareness of the importance of mental health in the general hospital and facilitate the acquisition of
basic skills of assessment and treatment of mental disorder by general hospital staff. The service
will need to champion the cause of older people with mental disorder who find themselves under
general hospital care.
3.3 The ultimate aim is to see mental health care assimilated into the routine care of older people
admitted to general hospitals.
3.4 The mental disorder co-morbidity is so great (see Section I) that mental health services cannot and
need not evaluate all cases if general staff are sufficiently skilled. The majority of older people with
simple and mild mental disorder should receive a competent response from the general hospital
care team.
3.5 Some disorders are of such a degree or complexity that they require the mental health service.
Consultation-liaison services need to develop an approach that will ensure that older people
needing specialist mental health care are referred and seen promptly while those with simple
mental health needs receive an appropriate response to their problems from the general care team.
This will require clear policy, process, education and training.
• Liaison services must promote the importance of mental health and facilitate
competent assessment and treatment skills of general staff.
Consultation or liaison?
3.6 Most older peoples mental health services offer consultation to general hospitals (131) This
approach responds to referrals on a case-by-case basis offering diagnosis and advice on
management with limited review. It is essentially reactive.
3.7 This is in stark contrast to services for working age adults where liaison mental health is a
developed speciality with at least 93 funded consultants in liaison psychiatry in the British Isles
(132). These services have an established multidisciplinary model of service delivery with
recommended staffing levels and training programmes.
3.8 The liaison approach is proactive and not limited to direct patient contact. It aims to integrate the
assessment and treatment of mental disorder into routine general hospital practice. This requires a
physical presence in the general hospital, close collaboration with general departments, shared
care and the development of education and training programmes. Reported benefits of the liaison
approach are described in Section 2.
3.9 The assessment of mental health should be part of general hospital care (2). Mental health will only
become part of general hospital practice if mental health is part of the general hospital. As long as
mental disorder is referred to a geographically and organisationally distant mental health service on
a consultation basis it will remain the responsibility of the mental health service and not the general
hospital.
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