The. British Psychological. Society. Society. Prof Jamie Hacker Hughes CPsychol CSci FBPsS. President, British Psychological Society

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1 British Psychological Society The British Psychological Society Prof Jamie Hacker Hughes CPsychol CSci FBPsS President, British Psychological Society

2 Psychology and Psychiatry in Liaison

3 Numbers with LTCs

4 Excess cost of co-morbidities (1)

5 Excess cost of co-morbidities (2)

6 The general case for liaison mental healthcare - high proportions of people with physical health conditions also have co-morbid mental health problems, including 30-65% of inpatients in acute hospitals - many of these problems go undiagnosed and untreated leading to poorer health outcomes and higher costs of care - mental health co-morbidities increase hospital costs by c. 6 billion a year in total, or by c. 25 million a year in a typical 500- bed DGH - a well-run liaison mental health service can improve health outcomes and reduce costs (in the region of 20% or 5 million)

7 Liaison Mental Health Services to Acute Hospitals The mental health needs of a patient in a physical health care setting often remain undiagnosed and therefore untreated. To optimise the physical health care of patients, it is essential that their mental health and wellbeing are addressed at the same time. Liaison Mental Health Services to Acute Hospitals (2012)

8 The RAID Service Birmingham City Hospital - Internal evaluation of service showed showed value for money(tadros et al) - Qualified by external evaluation - Parsonage and Fossey (2011) The RAID report - total bed-days saved are estimated at 14,500 a year (which would allow the hospital s capacity to be reduced by beds) - the value of savings is estimated at 3.55m a year, to be set against the incremental cost of RAID of 0.8m a year. - these figures imply a benefit : cost ratio of more than 4:1, i.e. every 1 invested in RAID yields a financial return of over 4. - the service is clearly good value for money, particularly as benefits are assessed on a conservative basis and are over and above any improvements in health and quality of life

9 Further Qualification for the need for Liaison Mental Health - Liaison Psychiatry in the Modern NHS (2012) - commissioned by the NHS Confederation and SHA Mental Health leads - follow-up to report on the RAID service in Birmingham - remit: to identify the key components and characteristics of a good liaison psychiatry service in the QIPP context - Review of literature - Consideration of 5 different services

10 Liaison mental healthcare in the general hospital (1) - every hospital should have a dedicated in-house liaison mental health service - the scale and nature of operations should be geared to local needs - sustainability is important (critical minimum size and level of expertise; secure funding) - service should include all relevant services, I.e. psychiatry, clinical psychology, addictions services etc.) - integrate within the hospital

11 Liaison mental healthcare in the general hospital (2) - start with a rapid-response generic service, then consider add-ons - core work in medical wards and A&E - an all-ages service; work with older inpatients should be a top priority - focus on complex and costly cases - emphasise education, training and supervision of general hospital staff - change the hospital culture

12 Liaison mental healthcare beyond the hospital - Liaison mental healthcare needs to reflect and reinforce wider trends in health care, especially more care closer to home - this means more provision of community-facing liaison mental health services across the primary/secondary care boundary - main area of development is in supporting integrated care for people with long-term physical conditions and co-morbid mental health problems - other options include (i) outpatient treatment clinics for MUS, self-harm etc, and (ii) perinatal mental health services

13 MODEL FOR DELIVERY OF LIAISON MENTAL HEALTHCARE SERVICES

14 Innovo Consultancy Ltd 2013 LA Dementia Services District Nursing Ambulance IAPT Acute Trust Liaison Psychiatry Service Community Training and Education Community Services Acute ward work ED, Admissions etc. Outpatient Clinics: Primary Care Dementia Delirium ED LTC+

15 MUS? What s in a name? Fibromyalgia Irritable Bowel Syndrome Chronic Fatigue Temporomandibular Joint (TMJ) dysfunction Atypical facial pain Non-Cardiac l chest pain Hyperventilation Chronic Cough Loin Pain Haematuria syndrome Functional Weakness / Movement Disorder Dissociative (Non-epileptic) Attacks Chronic pelvic pain Dysmenorrhoea Syndrome Stone, J., Wojcik, W., Durrance, D., Carson, A., Lewis, S., MacKenzie, L., Warlow, C.P., Sharpe, M. What should we say to patients with symptoms unexplained by disease? The "number needed to offend". BMJ 2002;325; Creed, F., Henningsen, P., & Fink, P. (2011). Medically unexplained symptoms, somatisation and bodily distress. Cambridge: Cambridge University Press.

16 Emotional and psychological wellbeing for patients with long-term conditions. In the face of multi-morbidity, personalised planning of care, including a collaborative care approach, is required to facilitate meaningful management plans. To ensure meaningful access to effective services, and to maximise the efficiency of those services, a well coordinated and collaborative journey between physical, psychological and psychiatric components of diseasespecific pathways is required, as well as cross-cutting pathways where common co-morbidities exist. Mental Health Network: NHS Confederation (2012)

17 How others do it Training in Medically Complex Psychology Post-Doctoral Programmes in Health Psychology Admitting and medication management in conjunction with nurse and medical prescribers

18 Key points - Recap - liaison psychiatry/psychological medicine is one of the few services in the NHS operating at the interface between physical health and mental health - long-term aim should be to contribute to integrated care for all patients with physical and mental health co-morbidities, whether in hospital or in the community - integrated care in hospitals is critical because that is where the sickest patients are - but integrated care in the community is at least as important because of the much larger numbers - the status of liaison mental healthcare needs to change froman optional extra to essential ingredient in modern health care - Using a framework for collecting and measuring outcomes is essential

19 Key References: The College of Emergency Medicine. (2013). Mental Health in Emergency Departments: A Toolkit for Improving Care. London: CEM. Fossey and Parsonage (2014) Outcomes and Performance in Liaison Psychiatry: Developing a Measurement Framework London: Centre for Mental Health IAPT. Medically Unexplained Symptoms / Functional Symptoms: A Positive Practice Guide Joint Commissioning Panel for Mental Health. (2012). Guidance for commissioners of liaison mental health services to acute hospitals. London: JCPMH. Mental Health Network: NHS Confederation (2012). Investing in emotional and psychological wellbeing for patients with long-term conditions. Naylor et al (2012) Long term conditions and the cost of co-morbidities London: The Kings Fund Parsonage and Fossey (2011) The Economic Evaluation of a Liaison Psychiatry Service London: Centre for Mental Health Parsonage, Fossey and Tutty (2012) Liaison Psychiatry in the Modern NHS London: Centre for Mental Health Psychiatric Liaison Accreditation Network. (2010). Quality Standards for Liaison Psychiatry Services: 2nd Edition. London: Royal College of Psychiatrists. Tadros, G et al. (2013). Impact of an integrated rapid response psychiatric liaison team on quality improvement and cost savings: the Birmingham RAID model. The Psychiatrist, 37(1), doi: /pb.bp

20 British Psychological Society The British Psychological Society Prof Jamie Hacker Hughes CPsychol CSci FBPsS President, British Psychological Society