Patient feedback on liaison mental health care in A&E

Standard 4 of the National Service Framework for Mental Health states that all mental health service users should have access to services at all times. Liaison mental health services in A&E departments across the country are central to the realization of this objective. This article reports on a study carried out in an East London A & E departments to evaluate the effectiveness of liaison mental health nursing. Quantitative data was collected on referrals made to the service and qualitative data was collected through interviews with clients and a postal questionnaire to determine client satisfaction.     

The development of a nurse-led liaison mental health service for older people in Chesterfield, Derbyshire, UK

Mental health problems are very common among older people in general hospitals. They are independent predictors of poor outcomes. Research indicates that appropriate interventions can improve outcomes. It is increasingly recognized that liaison mental health services have a key role in meeting the needs of older people in the general hospitals and educating and supporting staff. This paper describes aspects of the developmental and clinical work of a consultant nurse in developing a nurse-led liaison mental health service for older people in Chesterfield, Derbyshire, UK. It describes the impact of this service on referral rates. It also details the results of an audit of 206 referrals assessed by the consultant nurse in the second year of the service. The analysis of data collected provides a profile of aspects of the role of a liaison nurse including reasons for referral, psychiatric diagnosis and interventions recommended. This paper also, uniquely, documents mental health liaison into a community hospital. Implications for the development of services are discussed.     

A collaborative approach to urgent mental health referrals

The National Service Framework for Mental Health was launched in October 1999 and detailed the standards required for an effective and robust service (DoH 1999). Within North Solihull, a quick response initiative for urgent referrals to the mental health team has been in operation for the past five years. It is a nurse-led service that appears to meet some of the standards set, including collaboration with primary care and suicide prevention. This article identifies the benefits of a nurse-led service to combat the growing need for urgent assessment. It also discusses the need for specific mental health practitioner involvement at the point of referral. Particular reference is made to clients in crisis and with suicidal ideation. Important liaison at the interface between primary and secondary care is presented, for the benefit of this client group and effective alleviation of referrer anxiety.     

Impact of the role of senior dual disability coordinator on the perceived self-efficacy and job satisfaction of mental health clinicians

Abstract

Purpose: This study aimed to evaluate a new service role in mental health services, namely, the senior dual disability coordinator role (SDDC) for its impact on the perceived self-efficacy of mental health clinicians in managing clients with dual disability (mental illness and acquired brain injury and/or intellectual disability) and their job satisfaction. Method: Mental health clinicians from a health service district in Queensland, Australia who contacted the SDDC for clinical consultation and liaison between July 2011 and July 2013 were asked to complete a questionnaire assessing perceived self-efficacy in working with clients with dual disability as well as their job satisfaction, prior to (T1) and following (T2) their contact with the SDDC. Results: Twenty-five clinicians completed and returned pre- and post-measure questionnaires. Self-reported knowledge of dual disability, clinical skills in dual disability, service knowledge in dual disability as well as perceived self-efficacy, and job satisfaction increased significantly from T1 to T2. There were no significant differences across professional discipline or years of service. Conclusions: The delivery of a clinical consultation liaison service as part of the role of SDDC may assist mental health clinicians with self-efficacy and job satisfaction, regardless of the number of years they have worked in the service or their professional discipline. Mental health clinicians with improved self-efficacy for working with clients with dual disability may be more likely to consider the client suitable for services through mental health and follow-up with treatment and linking the client with other identified suitable services.

• Implications for Rehabilitation

• Dual disability (mental illness and acquired brain injury and/or intellectual disability) presents specific challenges for mental health services Specific strategies are needed to build capacity among mental health practitioners in order to meet the needs of people with dual disability and provide appropriate services.

• Introducing dual disability coordinators as a specific position within a health service district may assist to improve self-efficacy and job satisfaction of mental health practitioners assisting people with dual disability.

     

The multidisciplinary approach to mental health crisis management: an Australian example

Changes within the Australian health care system have led many people with mental health disorders to use emergency departments as the point of access to mental health services. Staff in emergency departments are not necessarily equipped to assess the needs of such clients. This paper briefly describes the development of a multidisciplinary mental health liaison team, within the emergency department of one hospital in Sydney, which was designed to assist both staff and clients. Available evidence suggests the implementation of the team has been a success, however, more research is required to confirm the effectiveness of this approach. Questions are raised about appropriate referral and follow-up for some clients. The study also found deficiencies in the method of routine data collection (Emergency Department Identification System), which makes formal auditing of the team and the services it provides a difficult task.     

Extended hours community mental health nursing service

The Extended Hours Community Mental Health Nursing Service is an innovative service introduced within Milton Keynes following the success of an earlier project. The service operates every day and provides an on-call Community Mental Health Nurse (CMHN) who is available 1700-0100 h for people aged 17 years and over, in support of other health services. The function of the service is to offer: Immediate assessment/intervention to people presenting, with any mental health problem, to the out of hours GP service or the local Accident and Emergency department. CMHN support out of normal working hours to patients from the Community Mental Health Teams. Outreach to patients on leave from the wards. Professional support to consultant psychiatrists undertaking home assessments outside normal working hours. Better service to patients in Accident and Emergency by improved liaison between Accident and Emergency and the Mental Health Directorate. This is primarily a nurse-led initiative that has extended the scope of professional practice for all staff involved. The team comprises three G grade mental health nurses, one of whom is the team coordinator, a secretary and a team of 'back up' first level registered nurses who work on-call as and when needed.     

A review of research on the structure,process and outcome of liaison mental health services

Liaison mental health services (LMHS) developed originally to address the mental health needs of people with physical illnesses in general hospitals and more recently to work also with people with mental health problems presenting at non-mental health services. The purpose of the present paper was to review empirical research on the structure, process and outcome of liaison mental health services using systematic review methods. Following a comprehensive search strategy, the authors reviewed 48 papers published between 1975 and 2001. There is an extensive international literature on LMHS, much of which describes the structure and process of liaison work. Studies evaluating the outcomes of liaison mental health services are fewer, and handicapped by methodological flaws, some of which are serious enough to cast doubts on the reported results. Professionals and clients value LMHS. LMHS based in accident and emergency (A & E) departments appear to ease the burden of general A & E staff, help clients access mental health services and reduce re-admission rates of people with mental health problems. There is little evidence supporting one model of configuring LMHS over another.     

Role of a psychiatric liaison nurse in an A & E department

Attendances at Accident & Emergency (A & E) departments by patients with mental health problems are on the increase. An emphasis on care in the community for patients with psychiatric disorders, and a society which is placing increased demands on the vulnerable, has meant that A & E departments are increasingly having to manage patients who have self-harmed and patients with acute mental health problems. Arguably, it is no longer acceptable or necessary for all patients presenting with self-harm to be admitted to hospital or to have a full evaluation by a psychiatrist. Other options exist whereby such patients can be managed in an efficient and appropriate way. One such option is the introduction of a psychiatric liaison nurse to the A & E department, who can liaise with A& E staff and with all available psychiatric services to offer optimal treatment for a patient. Such a service can obviate the need for involving psychiatric services directly on the day a patient presents. This paper describes the role of a psychiatric liaison nurse in an A & E department. It illustrates how effective the role can be by describing two case histories and outlining the psychiatric liaison nurse's work practice in the A & E department.     

One-year outcomes of older adults referred for aging and mental health services by community gatekeepers

One-year outcomes of older adults referred for community aging and mental health services through the Gatekeeper Model were examined in this study. Outcomes included level of social, physical, psychological, and economic isolation, physical health problems, service need, and service utilization. Findings indicate that individuals referred by gatekeepers were more likely to live alone and to be socially isolated but less likely to have physical health problems. They were also less likely to have a physician at referral, but at 1 year this difference was not found. Cognitive problems had a significant impact on the lives of clients referred by gatekeepers at referral but not after one year. At referral, those referred by gatekeepers had greater service needs, but after 1 year they did not use more services than those referred by other sources. Implications of these findings are discussed. The findings from this study indicate that the adoption of the Gatekeepers model does not result in high service utilization. The Gatekeeper model is inexpensive to implement and can benefit communities through increased collaboration among service providers.     

Evaluating a new model of nurse-led emergency department mental health care in Australia; perspectives of key informants

BackgroundMental health nurse services have existed in Emergency Departments (ED) for many years. However, there is considerable variation in the way these services operate, and no standardised model of care has been articulated.AimTo evaluate an extended hours nurse practitioner-led mental health liaison nurse (MHLN) service based in an ED in Sydney Australia.MethodsAs part of a larger mixed-methods study, semi-structured interviews were conducted with a sample of ED patients and nursing, medical and psychiatry staff (N = 46). Newly recruited MHLNs were interviewed at the commencement and conclusion of the study period. This paper presents the qualitative component from the evaluation.ResultsThe new service was met with high levels of approval by patients and staff. MHLN team members were challenged by their new role but considered the service reduced waiting times, provided therapeutic benefits, and enhanced communication and support for emergency staff.ConclusionA nurse practitioner-led extended hours MHLN service embedded within the ED team structure provides prompt and effective access to specialised mental health care for people with ‘undifferentiated health problems’ and removes a significant workload from nursing and medical staff.     

A needs assessment of clients with HIV in a home-based care program in Guyana

ABSTRACT Objective: To assess the needs of clients in a home‐based care (HBC) program aimed at improving the quality of lives of people living with HIV in Region 4 of Guyana (Demerara‐Mahaica region) following their involvement with the HBC program, volunteers, and nurse providers. Design and Sample: A cross‐sectional analysis of a needs assessment conducted through a verbally administered questionnaire. We collected a cross‐sectional sample of 84 HBC clients living with HIV from Region 4 in Guyana. Measures: Respondents were administered a questionnaire that asked questions regarding the demographics; services received; quality of service delivery; and mental health and substance abuse. Results: The services most commonly received by respondents included nutritional assessment and counseling, HIV prevention education, emotional support, hygiene education, support for antiretroviral adherence, and support for HIV disclosure. Respondents reported further need of referrals to income‐generation opportunities, food and nutritional supplement support, and support for children. Forty‐two percent of the respondents screened positive for probable depression, and 37% of respondents screened positive for being at risk for a drinking problem. Conclusions: While a substantial portion of needs were addressed by the HBC program, outstanding needs included linking people living with HIV to income‐generation opportunities, food support, mental health, and services for children. We suggest that mental health and substance use services be factored into HIV programming and that referral systems be strengthened to ensure access to support services for people living with HIV.     

National survey of alcohol treatment agencies in England: Characteristics of clients

Background: To map and contact all alcohol treatment services in England offering Tier 2, 3 and 4 interventions and describe the characteristics of their service-users.

Methods: A national cross-sectional survey of alcohol treatment providers in England, designed to gather information about the characteristics of clients referred, assessed, and treated in the financial 2003/4.

Results: A total of 696 alcohol treatment agencies were mapped, of which 388 (55.7 %) responded to the survey. The majority of clients were men, particularly within residential and non-statutory agencies. A higher proportion of residential clients were highly alcohol dependent, homeless and neurologically impaired, whereas, community clients were more likely to be offenders or to have mental health problems. Non-statutory services were more likely to see homeless clients, offenders, and clients with mental health problems and neurological deficits than statutory services who, typically, see a more dependent population.

Conclusions: Findings support the need for more specialist service provision for severely dependent offenders and dependent drinkers with serious mental illness. To aid future mapping of alcohol services, which allows areas of need to be identified, it is recommended that services have a monitoring system similar to that for drug misuse with the National Drug Treatment Monitoring System.     

Access to primary care services for homeless mentally ill people

Modernisation of mental health services has been a government priority in recent years with new legislation, increased funding and investment and service reforms. The National Service Framework (NSF) for Mental Health defines national standards to meet the mental healthcare needs of adults up to the age of 65. This article considers standards two and three of the NSF regarding access to primary care services for people with a mental health problem. It discusses whether these standards consider homeless people, who continue to experience significant problems gaining equal access to health care.     

A nurse-led service to identify and treat depression in primary care

Setting up a GP mental health liaison service has led to clients at risk of depression being identified earlier, enabling them to access treatments in a primary care setting and easing pressure on other services.     

Mental health service utilization by African Americans and Whites: the Baltimore Epidemiologic Catchment Area Follow-Up.

OBJECTIVE: To compare mental health service utilization and its associated factors between African Americans and whites in the 1980s and 1990s. DESIGN: Household-based longitudinal study with baseline interviews in 1981 and follow-up interviews from 1993 to 1996. SETTING: The Baltimore Epidemiologic Catchment Area (ECA) Follow-Up. SUBJECTS: Subjects included 1,662 adults (590 African Americans and 1,072 whites). MAIN OUTCOME VARIABLE: Use of mental health services, defined as talking to any health professional about emotional or nervous problems or alcohol or drug-related problems within the 6 months preceding each interview. RESULTS: In 1981, crude rates of mental health service use in general medical (GM) settings and specialty mental health settings were similar for African Americans and whites (11.7%). However, after adjustment for predisposing, need, and enabling factors, individuals receiving mental health services were less likely to be African American. Mental health service use increased by 6.5% over follow-up, and African Americans were no longer less likely to report receiving any mental health services in the 1990s. African Americans were more likely than whites to report discussing mental health problems in GM settings without having seen a mental health specialist. They were less likely than whites to report use of specialty mental health services, but this finding was not statistically significant, possibly because of low rates of specialty mental health use by both race groups. Psychiatric distress was the strongest predictor of mental health service use. Attitudes positively associated with use of mental health services were more prevalent among African Americans than whites. CONCLUSIONS: Mental health service use increased in the past decade, with the greatest increase among African Americans in GM settings. Although it is possible that the racial disparity in use of specialty mental health services remains, the GM setting may offer a safety net for some mental health concerns of African Americans.     

Sources of referral to alcoholism treatment from two low-income areas in a core city

In this study the authors compare the patterns of referral to alcoholism treatment from two neighborhoods adjacent to a public mental health facility. The areas are alike in terms of socioeconomic status, but they differ in their racial composition and social organization. They hypothesized that referrals to alcoholism treatment originate from self, family, and friends in the organized neighborhood and from police and social service agencies in the unorganized area. Results support the following conclusions: 1) self, family, and friends account for the majority of referrals to alcoholism treatment from both an organized neighborhood and an unorganized area; 2) race and sex explain more variation in referral to alcoholism treatment than does neighborhood social organization; and 3) white female patients are more likely to be institutionally referred than any other group.     

A comparison of senior nurses and managers views on the development of mental health services in NHS trusts in London

Aims  To assess how lead nurses and senior managers of mental health services differed in their views concerning the drivers and barriers to service development in London.
Background  Since 1997, London managers in Mental Health have been surveyed to assess their views about the drivers and barriers to service development ( Peck et al . 1997 ). Under clinical governance, nurses are likely to have an enhanced decision‐making role. Therefore, in 1998, lead nurses were included in the study to identify differences in views.
Methods Lead nurses and senior managers of mental health services in Trusts in the London area were sent self‐administered questionnaire. Only if responses were obtained from the lead nurse and senior manager in the Trust were they included in the current analysis.
Findings  Few differences were identified in the ratings of drivers and barriers to service development. Reasons why lead nurses and senior managers felt drivers and barriers were important differed: senior mangers focused on organizational‐wide development, lead nurses focused staff expertise and clinical issues.
Conclusion Although areas of potential conflict are revealed, these areas may also be complimentary. Lead nurses highlight issues of concern for the optimum clinical functioning of the Trust, allowing management to incorporate these concerns into strategic planning.     

Service users and other stakeholders' evaluation of a liaison mental health service in an accident and emergency department and a general hospital setting

Liaison mental health care has been an emerging specialism of mental health nursing in the UK since the early 1990s. Studies have so far looked only briefly at service user evaluation. A qualitative study involving 47 interviews with service user and professional stakeholders was undertaken to determine what is important to stakeholders in a liaison mental health-care service. The largest group of stakeholders interviewed were service users. Analysis of the data was undertaken using the service user interviews to guide the development of themes. The majority of the issues identified were raised by both service users and professionals. The three key themes were, the practicalities of the service including waiting time, the staffing profile and receiving the service, which included issues such as the opportunity to talk and outcomes. The findings provide new information regarding what service users and other stakeholders expect from a liaison mental health service and important areas to consider when offering a satisfactory service.     

How effective are mental health nurses in A&E departments?

Background

A&E departments are key points of contact for many people with mental health problems. Various models of care have been developed in A&E departments for delivering mental health services, but few have been assessed for effectiveness. The present study aimed to assess the impact of a dedicated A&E psychiatric nurse service on several outcomes relevant to patients and clinicians.

Methods

A crossover design was used to introduce a dedicated psychiatric nurse service (comprising four experienced community psychiatric nurses) into two busy UK A&E departments. Standardised assessments were completed for each patient, and a random sample of these independently assessed for quality. Data were also collected on the number of patients assessed, psychiatric nurse time employed, waiting times, onward referrals, repeat attendances, patient satisfaction, and staff views.

Results

A&E staff referred about a third of patients judged to have mental health problems to the psychiatric nurse service; approximately half of those assessed had a psychiatric history. On average, assessments took 60 min and over 90% of the formulated management plans were judged appropriate by independent assessors. The psychiatric nurse intervention had little impact on waiting times or satisfaction levels for mental health patients, although there was evidence of a change in onward referral patterns.

Comment

Psychiatric nurse assessment services have been introduced in many A&E departments, although the evidence base for the effectiveness of this development is not well established. This study presents evidence that psychiatric nurses can provide an accurate assessment and referral service with advantages for patient care.     

Mental Health Nurse Incentive Program: contributing to positive client outcomes

Mental health conditions are likely to affect almost half of the population at some stage in their lives. Despite the magnitude and potentially serious consequences of mental illness and disorders, access to services is a significant problem. In 2007, the Mental Health Nurse Incentive Program (MHNIP) was implemented to improve access to mental health care in Australia. Mental health nurses are engaged under the MHNIP to work with general practitioners, psychiatrists, and other mental health professionals to treat clients experiencing a mental health condition. This paper presents findings from a qualitative exploration of nurses working under the MHNIP in Australia. In-depth interviews were conducted with 10 nurses currently working under the MHNIP to gain an understanding of their roles and their perceptions of the effectiveness of this new programme. Data were analysed using NVivo. Four major themes emerged: developing the role, a holistic approach, working collaboratively, and benefits to clients. The findings suggest that mental health nurses have the potential to make a significant contribution to enhancing access to, and the quality of, mental health care through flexible and innovative approaches.