Ralph Chananda, Mental Health Practitioner, Royal Berkshire NHS FoundationTrust

Background

The older people mental health liaison team was established in line with the 2009 National Dementia Strategy and with 'Who cares wins' (Royal College of Psychiatrists 2005). Our aim is to provide a first class, specialist service by assessing and treating older people with mental health problems within the general hospital. This is achieved through the multidisciplinary team (MDT) approach. We provide advice, education and support to health care professionals, older people and their carers in the general hospital on mental health problems. The team attends MDT meetings on the wards and we have Registrars attending our ward rounds ensuring medical and psychiatric services are joined.

Aims

To signpost and enable users to access appropriate on-going care or treatment from mental health services, and achieve this through the following activities.

• Provide advice and collaborative management plans on issues involving mental health to acute wards at RBH.
• Provide a rolling education programme to RBH staff.
• Promote and develop links with other non-mental health services within West Berkshire.
• Work cohesively as part of the trust’s wider mental health services and non-statutory services.
• Support/advice and information to carers/families.
• A proactive approach to people admitted on three occasions within a six month period, who often have complex physical and mental health needs by working in parallel and in collaboration with RBBH staff.
• Provide a system of communication to ensure that information on potential attendees "alerts" and clients with agreed care/management plans, are accessible to both mental health and RBBH staff.
• Provide advice and support around The Mental Health Act 1983 and its application.

An audit of how the service has improved patient care and outcomes is due.

What did you do?

We have an MDT approach instead of one or two community psychiatric nurses (CPNs) which enables the team to provide a wider service. The team offers training to dementia champions and on the wards as we have the expertise that the general hospital doctors do not have. Having a big team allows us to invest in training and collaborating with practice educators.

The team consists of:

• team leader - staff nurse back ground
• 0.5 consultant psychiatrist - consultant ensures there is a senior medical support during the day
• two band 6 liaison nurses - both dual trained
• team administrator ANC band 4
• senior social worker- provides specialist complex capacity assessments and training
• 0.5 speech and language therapist - provides swallowing assessment, frontal –temporal dementia assessments and advice on diet.

Except for the team leader, the consultant and the administrator, the team is made up of only mental health practitioners.

What changed?

We have provided comprehensive assessment and/or treatment to older people, who are 65 or over and who are experiencing mental health difficulties; or patients presenting with dementia regardless of their age, who are admitted to in-patient wards at RBBH.

There are now: rapid complex capacity assessments done within a day; diagnosis of dementia; referrals to memory clinics, community mental health teams and home treatment teams for follow up; we arrange for rapid sectioning of acutely unwell patients; anti-cholinesterase inhibitors are now being prescribed due to availability of a consultant psychiatrist in the team.

We recently put out questionnaires for staff and referrer feedback, and referrers and patients were very satisfied with the quality of service provision. The service was initially set up with expected contacts of 250 patients but at the end of the first year the service received 650 referrals. The team expected delayed discharges to be reduced as part of its remit but in the last financial calendar year we did not meet that target due to reasons outside the team's control.

Advice for others

The practice is sustainable as there is an increasingly aging population and the home counties is one of the favourite areas for people to retire to. The service has been well received by the acute hospital consultants as they have seen the benefits of a liaison service specific to older people. There has been debate in the past about merging the two liaison services but the idea has not succeeded due to funding arrangements in place. The service has needed both specialist mental health staff from a variety of backgrounds and office equipment. An initial business case established the cost benefit analysis of the service for the whole of West Berkshire.