Abstract
Aims and method To describe the liaison psychiatry services of all 30 general hospitals in Greater London and to determine whether services met national recommendations. The results were compared with a similar survey conducted 8 years previously to determine whether there had been significant service development.Results We identified wide variations in service provision across London. Fifteen hospitals (50%) had 24-hour services and one had no service. There had been a significant increase in services that assessed older adults. Increases in the size of teams and consultant psychiatry staff were not significant.Clinical implications Despite an increasing emphasis on the effectiveness of liaison psychiatry services, no London hospital had staffing levels consistent with national recommendations. Recent evidence for the cost-effectiveness of liaison psychiatry and an emphasis on parity between physical and mental health in National Health Service policy may provide further impetus for growth.
Highlights
Following reconfiguration of acute hospital services between 2004 and 2012, we judged that differences between liaison psychiatry staffing and service provision in these 2 years could be compared at 27 sites.[10]
Information was collected from all 30 hospitals, of which 29 had a liaison psychiatry service
For the 27 comparable sites there was a significant increase in liaison psychiatry service provision for older adults between 2004 and 2012 (P = 0.006), but not for patients with alcohol and substance misuse (P = 0.55)
Summary
Strong similarities exist between the two schemes in the demographic profile of individuals subject to the SOAD process and rates of approval of compulsory treatment. Clinical implications Clinicians may not always favour greater formality or elaborate national structures for administering the Mental Health Act, but there are advantages in promoting clarity and consistency in a mandatory statutory process designed to protect compulsory patients’ rights. In 1992, New Zealand adopted a modified version of the second opinion appointed doctor (SOAD) scheme into its mental health law. As in England, New Zealand law requires the proposals of the treating clinician to be approved by a second psychiatrist in two main situations - for longer-term use of medication, and for electroconvulsive therapy (ECT) where a compulsory patient does not consent.[1] In England, this mandatory second opinion scheme has been managed, funded and periodically reviewed by a national agency, firstly by the Mental Health Act Commission (MHAC), by the Care Quality Commission (CQC). New Zealand’s national guidelines on the Mental Health
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