Abstract
BackgroundMechanisms by which liaison mental health services (LMHS) may bring about improved patient and organisational outcomes are poorly understood. A small number of logic models have been developed, but they fail to capture the complexity of clinical practice.MethodWe synthesised data from a variety of sources including a large national survey, 73 in-depth interviews with acute and liaison staff working in hospitals with different types of liaison mental health services, and relevant local, national and international literature. We generated logic models for two common performance indicators used to assess organisational outcomes for LMHS: response times in the emergency department and hospital length of stay for people with mental health problems.ResultsWe identified 8 areas of complexity that influence performance, and 6 trade-offs which drove the models in different directions depending upon the balance of the trade-off. The logic models we developed could only be captured by consideration of more than one pass through the system, the complexity in which they operated, and the trade-offs that occurred.ConclusionsOur findings are important for commissioners of liaison services. Reliance on simple target setting may result in services that are unbalanced and not patient-centred. Targets need to be reviewed on a regular basis, together with other data that reflect the wider impact of the service, and any external changes in the system that affect the performance of LMHS, which are beyond their control.
Highlights
Mechanisms by which liaison mental health services (LMHS) may bring about improved patient and organisational outcomes are poorly understood
The logic models we developed could only be captured by consideration of more than one pass through the system, the complexity in which they operated, and the trade-offs that occurred
Our findings are important for commissioners of liaison services
Summary
Mechanisms by which liaison mental health services (LMHS) may bring about improved patient and organisational outcomes are poorly understood. Liaison mental health services (LMHS) in England have become a focus of the Department of Health’s plans to develop key areas of mental health provision [1]. LMHS have the potential to improve both the quality of care and overall outcomes for people with mental and physical health problems [2], and there is an expectation that liaison services in Liaison services should reflect to a certain degree the size and acuity of the acute hospital they serve, but there is great heterogeneity in the composition, purpose, size and activity of liaison services [5], which is not fully explained by hospital variation. Programme theories explain how interventions or services are understood to contribute to intended outputs and outcomes. They are useful ways to bring together
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