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Providing a liaison psychiatry service in the absence of a consultant liaison psychiatrist

  • Claire Flahavan (a1) and Claire Flahavan (a1)

Abstract

Aims and Method

Liaison psychiatry services in Ireland are currently unequally distributed. In the absence of a specialist liaison psychiatry team, general adult psychiatrists may provide a consultation service to their local hospital. Demographic and clinical characteristics pertaining to all psychiatric consultations at the Louth County Hospital were collected over 12 months to examine one such local service and to highlight the challenges of this mode of service delivery.

Results

A total of 232 consults were audited. the most frequent reasons for referral were assessment following deliberate self-harm (38%), affective symptoms (28%) and alcohol or substance misuse (25%). This differs from documented referral patterns to specialist liaison teams. Referring physicians had a low diagnostic ‘hit-rate’ with respect to affective disorders. Difficulties in service provision included poor communication by referring teams and time constraints due to other sectoral commitments.

Clinical Implications

Refinements to service delivery may be beneficial in managing the workload more effectively. Priority should be placed on fostering communication with non-psychiatric colleagues.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

References

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Providing a liaison psychiatry service in the absence of a consultant liaison psychiatrist

  • Claire Flahavan (a1) and Claire Flahavan (a1)

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Providing a liaison psychiatry service in the absence of a consultant liaison psychiatrist

  • Claire Flahavan (a1) and Claire Flahavan (a1)
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eLetters

Liaison psychiatry: a Celtic perspective

Schalk W. du Toit, Specialty Registrar ST5
09 October 2008

We were interested to read that the clinical characteristics of liaison psychiatry referrals at the Louth County Hospital (LCH) were very similar to those identified in our recent 12-month activity report of referrals (n=1321) at the Aberdeen Royal Infirmary (ARI).

Diagnosis in the self-harm referral groups:

• Alcohol use disorders (+/- personality disorder) – 38% in ARI& 30% in LCH

•Acute crisis or no formal psychiatric diagnosis – 27% in ARI & 31% in LCH

•Depression – 19% in ARI & 12% in LCH

•Personality disorder – 9% in ARI & 8% in LCH

Diagnosis in the non-self-harm referral groups:

•No formal psychiatric disorder – 9% in ARI & 10% in LCH

•Depression – 18% in ARI & 13% in LCH

•Psychotic illness – 4% in ARI & 2% in LCH

One significant difference was the ratio of total self-harm to non-self-harm referrals – 2.6:1 in ARI & 0.6:1 in LCH. This could be the result of self-harm patients in LCH discharging themselves from A&E, before they could be “admitted for review by a psychiatrist”. In our study, 81% of the self-harm referrals were assessed by psychiatric liaisonnurses. It was not made clear in the paper how independently their psychiatric liaison nurses were working.

In terms of disposals, we referred 9% of the self-harm and 4% of the non-self-harm group to substance misuse services (many patients refused tobe referred). At ARI, we employ a specialist alcohol liaison nurse. Evidence suggests the addition of a specialist alcohol liaison service canimprove engagement in the alcohol rehabilitation process (Hillman A, et al).

References:

Hillman A. McCann B. Walker NP. Specialist alcohol liaison services in general hospitals improve engagement in alcohol rehabilitation and treatment outcome. [Journal Article] Health Bulletin. 59(6):420-3, 2001 Nov.

Declaration of interest: None
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Conflict of interest: None Declared

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