slide1 l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Plan PowerPoint Presentation
Download Presentation
Plan

Loading in 2 Seconds...

play fullscreen
1 / 27

Plan - PowerPoint PPT Presentation


  • 135 Views
  • Uploaded on

Liaison Psychiatry for Older People: a new service development with opportunities for research Dr Mick Dennis, Reader & Honorary Consultant in Liaison Psychiatry for Older People. Plan. Background: mental health problems in the general hospital NSFOP & Who cares wins Service models

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Plan' - mieko


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide1

Liaison Psychiatry for Older People: a new service development with opportunities for researchDr Mick Dennis, Reader & Honorary Consultant in Liaison Psychiatry for Older People

slide2
Plan

Background: mental health problems in the general hospital

NSFOP & Who cares wins

Service models

Evidence base

The new team in Swansea

Research opportunities

slide3
The complex challenge of providing mental health care for physically ill older people in the general hospital setting
  • Older people occupy 2/3 of NHS beds
  • Approximately 60% have, or will develop mental disorder
    • Depression mean prevalence = 29%
    • Dementia mean prevalence = 31%
    • Delirium mean prevalence = 20%
  • Mental disorder is frequently missed (>50%)
  • 25-30% of all referrals to older peoples mental health services come from general hospitals
slide4
A typical district general hospital with 500 beds:

• Will admit 5000 older people each year.

• 3000 of these will have or develop a mental disorder

In an average day:

• 330 beds will be occupied by older people.

• 220 will have a mental disorder

• 96 will have depression

• 66 will have delirium

• 102 will have dementia

• 23 will have other major mental health problems.

consequences of mental health problems on older people in the general hospital 1
Consequences of mental health problems on older people in the general hospital - 1
  • Untreated and poorly managed mental health reduces quality of life for patients and carers Co-morbid mental disorder has an adverse effect on outcomes:
    • Increased length of hospital stay
    • Increased mortality
    • Poor quality of life
    • Increased carer strain
    • Institutionalisation
consequences of mental health problems on older people in the general hospital 2
Consequences of mental health problems on older people in the general hospital - 2
  • Other effects of unrecognised and poorly managed mental health problems in the general hospital:
  • Disengagement with therapy
  • Poor treatment adherence
  • Complaints
  • Increased staff stress, staff sickness, recruitment and retention problems
  • Inappropriate use of psychotropic medication
national service framework for older people nsfop standard 4 general hospital care
National Service Framework for Older People (NSFOP, Standard 4, General Hospital Care)
  • Clear guidelines for involving specialist mental health services in the general hospital
  • ‘Older people who have complex co-morbidities associated with old age are best treated by a dedicated specialised team’
  • ‘Staff on wards to be trained to recognise and manage behavioural problems appropriately’
  • ‘to have completed a skills profile…and to have in place education and training programmes to address gaps identified’
relevance of older people s liaison psychiatry to implementing the rest of the nsfop
Relevance of older people’s liaison psychiatry to implementing the rest of the NSFOP
  • Standard 1: Address age discrimination
  • Standard 3: no intention to exclude people with mental illness from intermediate care
  • Standard 5: psychological input to stroke, depression post-stroke, Vascular dementia
  • Standard 6: MH issues in the aetiology of falls
  • Standard 7: Endorses the early detection and management of mental illness no matter what the setting
  • Standard 8: MH promotion
who cares wins 2005
Who Cares Wins (2005)
  • Neglected problem.
  • Underdeveloped services.
  • Multi disciplinary team the most appropriate model
  • Liaison approach is proactive with a focus on education and training.
service models for mental health care in the general hospital setting
Service models for mental health care in the general hospital setting
  • Standard sector model
  • An enhanced sector model
  • The liaison nurse
  • Outreach from psychiatric wards
  • Shared care
  • Hospital mental health team
levels of evidence
Levels of evidence
  • Level 1
      • Systematic review of RCTs
    • Level 2
      • At least one well designed RCT
    • Level 3
      • Evidence obtained from non-randomised controlled trials
    • Level 4
      • Evidence from case series
evidence base for liaison services for older people
Level 2

Reduce LOS

Reduce costs

Improvement in depression

Patient satisfaction

Level 4

Improved physical functioning

Decreased nursing home transfers

Advice on suitability of psychotropic medication reduces adverse events and improves QOL

Evidence base for liaison services for older people
shared care wards
Shared care wards
  • Level 4
    • Reduce LOS
    • Reduce mortality
swansea 2007 the hospital liaison psychiatry team for older people
Swansea 2007: The Hospital Liaison Psychiatry Team for Older People
  • John Coffey
  • Bev Saunders
  • Dr Mick Dennis
referrals
Referrals
  • Urgent referrals seen within 1 working day
  • Routine referrals within 4 working days
  • All Swansea hospitals (Morriston, Singleton & Community Hospitals)
  • Out of county (but not Neath/Port Talbot)
what does a liaison service provide
What does a liaison service provide?
  • Daily presence
  • Speedy response
  • Collaborative approach
  • Assessment and management advice
  • Advise on medication
  • Regular reviews
  • Liaise with family/carers/other agencies
  • Arrange mental health follow up where indicated
  • Training & education
slide21

DEPARTMENT OF OLD AGE PSYCHIATRYHOSPITAL MENTAL HEALTH LIAISON SERVICE FOR OLDER PEOPLE

Dr Mick Dennis, Liaison Consultant Psychiatrist

Tel: Direct line 01792 516517 Fax: 01792 516579

(secretary: Trudi Poole ext 6517)

John Coffey, Hospital Liaison Nurse Manager

Tel. 01792 561155 ext 8606

Bev Saunders, Hospital Mental Health Liaison Nurse

Tel. 01792 561155 ext 8607

NB If the patient is currently known to Mental Health Services

for Older People, the referral should be faxed to the relevant

Consultant Psychiatrist.

FaxNumbers

Dr S Albuquerque 01792 516433

Dr E Clarke-Smith/Dr M Ellis 01792 222919

Dr T Crownshaw 01792 841461

Dr J Rule 01792 516433

If the patient resides in Neath 01639 862881

or if resides in Port Talbot 01639 862475

REFERRAL CRITERIA

Dementia

Difficult behaviour

Diagnostic difficulty

Risk to self and others

Abuse

New, distressing or disabling psychotic symptoms

Sleep disturbance, not responding to usual measures

Depression

Risk of harm to self or others

Risk of self-neglect

Adverse effect on physical health

(including poor nutrition and fluid intake)

Psychotic depression and more severe depression

Compliance difficulties

Diagnostic problems

More complex management issues (i.e. resistive depression,

discharge planning, etc)

  • Delirium
  • Difficult behaviour
  • aggression/agitation/anti-social/significant risk to others/wandering
  • Diagnostic difficulty
  • - aetiology/complicating other mental disorder

Other referrals

Alcohol/substance misuse, which is complicating a

mental health problem

Late onset schizophrenia

Mania

Organic personality change

Acute paranoid psychosis

Problematic abnormal reaction to physical ill health

Mental Capacity Assessment

For advice where there are uncertainties concerning

capacity after the treatment team’s assessment

the future the liaison mental health team for older people liaison mhsop
The future: The liaison mental health team for older people (Liaison MHSOP)

Multidisciplinary

Psychiatrist

Psychiatric nurses

O.T.

Social worker

Operates like a sector CMHT but the population is the general hospital

the liaison mhsop how does it work 1
The Liaison MHSOP – how does it work? (1)

Consultation & liaison i.e. proactive as well as reactive

Referrals from general hospital staff, including A&E & MAU

Rapid response

Accurate, skilled assessment, monitoring, and treatment of mental disorder – particularly for the complex case

Targets areas where morbidity is high i.e. rehabilitation facilities, orthopaedic wards, geriatric medical wards

the liaison mhsop how does it work 2
The Liaison MHSOP– how does it work? (2)

Advise and supervise on non-specialist screening and management

Assessment of all cases of self-harm

Development and introduction of treatment protocols and care pathways

Educational: prevention, identification, and management

Good communication

Data for research and audit purposes

the liaison mental health team for older people important links
The Liaison Mental Health team for Older People– important links

Community mental health teams for older people

General adult liaison services

Educational institutions

General hospital stakeholders

Patients and carers

research opportunities
Research Opportunities
  • Service evaluation
  • Liaison MHSOP
  • Integrated Liaison MHSOP & Community Care
  • Disorder specific outcome evaluation
  • Identification of mental disorder
  • Screening tools
  • Introduction and evaluation of training packages
  • Collaboration in other areas of general hospital-based research of mental disorder in physically morbid populations