London hospitals step up efforts to improve mental health care
People with a physical illness are known to be three to four times more likely to develop a mental health problem than those who are physically well, but these problems often go undiagnosed and untreated.
Over one-quarter of patients in a general hospital bed have a mental health problem. The number is even greater in those aged 65 and over – they occupy 65 percent of hospital beds and 60 percent will have mental health problems, largely dementia, delirium, depression.
Early identification and treatment are key to improving the quality of life for our patients. Liaison psychiatry provides the general hospital with a greater understanding of the patient’s individual needs.
North West London takes the lead
Recognising the scale of the mental health issues, hospitals in North West London have, since January, rolled out special teams of experts who can provide a link between physical and mental health care so that patients receive the care they need without delay. At the start of the year just four hospitals had these ’liaison psychiatry’ teams, but now they operate from all nine major hospitals in North West London. Each team is based on the hospital site allowing for ease of access to the service and a rapid response.
The new liaison psychiatry services work at the interface of physical and mental health in hospitals, with staff working proactively to identify and provide treatment for patients with mental health problems. They also provide training for general hospital staff. "We see patients who present in A&E with a range of mental health problems including self harm. On the wards we will see people with pre-existing problems as well as those who develop mental disorders as a consequence of a physical illness", says Clinical Director for Psychological Medicine at CNWL NHS Foundation Trust Dr Steven Reid. "One of the areas where we really make an impact is in the diagnosis and management of dementia", he says.
Faster access to the right treatment
Untreated mental health issues in hospitals mean patients are more likely to have to stay longer, and have poorer outcomes. For older adults with dementia this includes a greater likelihood that they will be discharged to institutional care rather than going home. They also have an increased risk of dying in hospital. "Once staff recognise that a patient has delirium, dementia or another mental health problem, that person can be treated and quickly referred to a memory clinic or an appropriate specialist", says Dr Reid. "Early identification and treatment are key to improving the quality of life for our patients. Liaison psychiatry provides the general hospital with a greater understanding of the patient’s individual needs".
Improvements to dementia care
Improving the quality of care delivered to patients with dementia is a priority for liaison psychiatry services. One of the main ways of doing this is to reduce the prescription of anti-psychotic medications, which have been associated with side-effects such as sedation and dizziness. Among patients with dementia, the anti-psychotic medications also increase the risk of stroke by nine times. Dr Reid explains, "Liaison psychiatry services work with pharmacists who conduct reviews of medicines prescribed to older adults. They also advise on alternative methods of dealing with agitation or aggression sometimes seen in patients with dementia so there is less reliance on anti-psychotics".
The road ahead
The future of this development looks promising and hospitals in North West London have welcomed the new liaison psychiatry services. Dr Reid says, "Feedback has been extremely positive so far, but London still has some work to do for this service to be available in every hospital".