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In the last of our series of blogs about the Mental Health Implementation Plan launched earlier this week, nurse consultant Kate Chartres discusses how the model of liaison at Northumberland, Tyne and Wear NHS Foundation Trust supports patients through specialist clinics for people with co-morbid physical and mental health conditions:
I have the pleasure of being the nurse consultant for the Sunderland Psychiatric Liaison Team, a team enormously passionate about what we provide.
Three years ago we extended hours to cover 24/7 and are consistently delivering on an urgent response within an hour to A&E for 95% to 99% of referrals and our target of less than 24 hours for inpatient wards in around 100% of cases, with little variation.
Positive feedback from service users and acute trust peers indicates the impact we’ve had in being accessible and available to offer expert advice and support.
Initially we signposted or referred to the ‘best fit’ service for ongoing support, so we’d refer people with a long term condition experiencing an associated anxiety or depressive disorder to our local IAPT service, or gave advice to GPs, as appropriate.
Over the first year, however, we increasingly found gaps in services for people who didn’t fit neatly into the system, be that due to the nature or complexity of their physical health problem or the acuity of their clinical presentation.
What we were doing we were doing well, but it wasn’t enough for people trapped in a cycle of admission and discharge when the relationship between their physical and mental health was not addressed.
This meant for someone at a later stage of a progressive illness like COPD (Chronic Obstructive Airways Disease) the local IAPT service might not have the medical expertise to offer treatment; or an individual with frequent attendances to hospital may be invested in getting help for their health condition but unaware of the impact this had on their mental health and, in turn, how that would affect the management of their condition.
We knew it was likely that if we could offer a service linked to the acute hospital, it would mean people would be more able and willing to engage with mental health services.
Supported by our commissioners, we began developing follow up out-patient clinics bespoke to the needs of those patients, people with long term conditions, those going to A&E frequently with self-inflicted injuries, people attending neurology and those with abdominal pain that was poorly managed, etc.
Clinics now include generic liaison psychiatry to offer specialist assessment and prescribing advice for people with complex needs, and innovative nurse-led clinics such as one for COPD which has led to a four-fold reduction in admission rates and, more importantly, reports of substantial improvements in lifestyle quality and experience.
We also launched a pilot stroke service and found a significant previously unmet need for those presenting with a post-stroke depression in around 41% of patients.
Referrals come from all wards and departments including other outpatient clinics. Each patient agrees a bespoke care, treatment and support plan and every element of that is delivered by the most appropriate member of a skilled and dedicated multidisciplinary team.
When we start work around a specific condition, as we are now doing again for cardiac conditions, we draw heavily on the specialist expertise of our acute trust peers. Their input helps to shape the design of any screening programme, as well as the relevant training around the psychological impact of the health problem and how to identify, offer help and support early.
This approach increases awareness and adds to the understanding of mental health for our peers. Crucially, it also ensures patients are treated for an underlying mental health problem at the right time. Over time, we’ve seen that only the most complex people are being referred and there’s an improved experience for all patients as everyone feels more capable and able to support their mental health.
All team members are encouraged to develop their ideas and everyone has a voice and is heard. We challenge each other constantly, consider the impact we are having and try to understand what it is like to be on the receiving end of our service. It’s vital for us that patients have access to staff with the right skills and experience when they need them, and that they and their families feel validated and supported in a manner that’s sensitive, empowering and as destigmatising as possible.
My hope for the future is that we can continue to develop and expand the knowledge and skills of our peers within the hospital to the point we are no longer needed.