Liaison Psychiatry for Older People

What was the issue you were addressing or working on?

It was recognised that an increasing number of older people with dementia and/or mental health problems are admitted to acute hospital inpatient settings.  These patients often require additional supports and hospital staff are less able to manage these patients within a busy ward environment.  In addition to increasing staff skills through staff training, often individual patients will highlight specific issues which require a more specialist understanding or assessment.  The project sought to provide this additional support and assessment.


What you did?

2 fulltime posts were added to the Community Mental Health Teams to work with the inpatient services and Care Homes.  The staff provide a set number of sessions into the wards and will work closely with the staff and key workers to identify and assess the current concerns and plan for future care needs.  This service works closely with other services such as Medicine for the Elderly and Hospital Social Work Teams.

The following case study demonstrates the supports which can be provided:

Patient was admitted to acute ward following symptoms of breathlessness, feeling dizzy and faint.  Investigations identified no physical cause for this.  Patient was readmitted soon after with similar symptoms and again no physical cause identified.  Medical staff referred patient to liaison psychiatry to determine whether patients’ mental health was the cause of the symptoms.

Patient was assessed by liaison psychiatry and a mental health assessment was carried out.  Using specific tools, severe anxiety was identified.  Liaison was able to access psychiatric notes for patient history and any current psychiatric input (which was not accessible to general ward staff).  Medication was advised for the short term and relaxation sessions were carried out during her stay by liaison.  Patient was discharged with support put in place by liaison.  Liaison provided a transitional visit for further support on discharge and referred to day service for attendance at anxiety management group. Liaison linked with day service to provide a full account of history and presentation.

If similar symptoms were to reoccur the patient was reassured that it would unlikely be a medical issue and could work on managing the anxiety.  This would prevent a potential further readmission to the acute setting.


What were the outcomes - benefits or otherwise?

The Liaison posts actively seek to support older people who are admitted to hospital and to ensure that mental health issues are both identified and managed on ‘general’ wards. As a consequence, staff who come into contact with older people with dementia and other mental health problems feel both empowered to seek advice and are more confident in managing symptoms and behaviours.  Patients receive support during admission, on discharge, and a plan for future treatment is agreed. 


Contacts - to find out more

Melissa Paton, melissapaton@nhs.net