Who Cares Wins - Royal College of Psychiatrists

4.10 The liaison team will operate in a number of different clinical and training forums (Table 4.4). The
clinical areas covered by a consultation-liaison team will be linked to the local organisation of
services and the composition of the team. It is likely that all consultation-liaison teams will cover
the inpatient wards of a general hospital. Ideally, they should cover Accident and Emergency and
Medical Assessment Units where patients are assessed before admission. The advantage of
working with these assessment units is the opportunity to influence admissions to hospital when
some older people with mental disorder might be better managed by diversion to an alternative
service. The impact on avoiding admission may, however, be limited by the paucity of services
providing alternatives to admission for older people with mental health problems.
4.4: Forums for liaison activity
Clinical:
• Wards
• Case conferences
• Pre-discharge meetings
• Multidisciplinary team meetings
• Medical assessment units
• Discharge coordinators
4.11 Some hospitals will have specialist units that could benefit from a closer liaison with mental health
services, for example, oncology, neurology and orthopaedics. Some working age adult liaison
mental health services have developed out patient clinics either as an extension of the inpatient
service or for patients with particular disorders, notably, medically unexplained symptoms (see
Section 3). These are developments that would require extra resources.
4.12 The majority of consultation-liaison services for older people will operate during normal working
hours. There will need to be a clear arrangement to provide mental health consultation out of
hours and to bring patients to the attention of the consultation-liaison team for continued
assessment and to monitor activity.
4.13 Consultation-liaison teams would expect to deal with the full range of mental and behavioural
disorders. A particular note should be made of self harm. While older people only account for 5-
15% of all cases of self harm admitted to general hospitals they represent a group at high risk of
completed suicide. The majority have a mental disorder and all cases of self harm involving an
older person should receive a specialist mental health assessment (135).
Administering liaison services
Management:
Teaching:
• Clinical areas
• Grand Rounds
• Local postgraduate education programmes.
• Staff induction programmes eg. PRHO, SHO,
nursing staff, PAMS
• Rolling programmes single or multidiscipline
4.14 If liaison teams are to function effectively and develop they need clear lines of management. Line
managers should have an understanding of the nature of liaison work and the special aspects of
providing mental health services in the general hospital environment. The clinical problems and
their resolution are not the same as community mental health and the priorities and demands for
liaison teams are not those of community mental health teams. Managers must appreciate these
differences.
4.15 It is advisable for teams to have a clinical lead with some managerial responsibility to be sure that
management decisions are properly informed and relevant to the operation and development of
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