Initiatives in the CMHTOP

1
Initiatives in the CMHTOP
Liaison Nurses for the East Kent Acute Hospitals

• Reasons for the service
• What we do
• Outcomes
• Future Challenges

2
Reasons for the services

• Between two stools Leeds University 2002
• A survey of 450 old age psychiatrists in
  conjunction with the RCPSYCH
• Lack of shared organisational aims between mental
  health/PCT/acute Trusts
• Services often geographically isolated and
  community orientated

• Slow response time 71 of consultant
  psychiatrists believing the service to general
  hospitals was poor
• 30 of the 65yrs in DGH have dementia
• 20-25 of referrals to old age psychiatry are
  from general hospitals
• 20-30 of AE attendees have co-existing mental
  health problems
• Co-morbidity increases stay, mortality and
  severity of illness

3
Role of the Liaison Nurse

• Office hours service available by phone, pager,
  written referral, e-mail
• Dedicated whole time nurse on each of the three
  main sites with weekly supervision from
  consultant psychiatrist and access to SHO
• Provide psychiatric assessment, advice and
  information regarding medication, placement,
  risk, nursing care and how to access further
  services
• Formal and informal teaching sessions for acute
  hospital staff focusing on core knowledge, skills
  and attitudes related to the care and treatment
  of older people with a mental illness
• Work with the hospitals as requested on matters
  of procedure, policy and delayed discharge

4
Outcomes

• Difficult to quantify but perceived to be
• More rapid access to psychiatric services within
  two hours in an emergency and most patients seen
  within 48 hours
• Preventing inappropriate admissions to
  psychiatric beds or facilitating/prioritising
  transfer if required
• Facilitating most appropriate placement or home
  care package with quicker access to CMHT if
  required
• Expediting discharge by reducing time waiting for
  psychiatric input
• Raising the profile of old age psychiatry and the
  knowledge and understanding of staff dealing with
  older people with mental health problems

5
Future Challenges

• Growing numbers of people with dementia in local
  population, fewer mental health beds available,
  more people admitted to DGHs
• The shape of things to come organic service
  only or 75
• Increasing expectations of the service
  multi-disciplinary input
• More treatments offered on the general ward? E.g.
  CBT for chronic illness, introduction of shared
  care wards
• Education for the liaison nurses genuine
  speciality?