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Liaison services for older adults

Published online by Cambridge University Press:  02 January 2018

Matthew Rowett
Affiliation:
Teeswide Liaison Psychiatry, Tees, Esk, Wear Valleys NHS Foundation Trust, UK. Email: Matthew.Rowett@nhs.net
Itoro Udo
Affiliation:
Teeswide Liaison Psychiatry, Tees, Esk, Wear Valleys NHS Foundation Trust, UK
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Abstract

Type
Columns
Copyright
Copyright © Royal College of Psychiatrists, 2014 

We have read with interest the editorial by Sharpe. Reference Sharpe1 Recognition of liaison psychiatry as valuable to patients, general hospitals and commissioners has been a long time coming.

We agree that the crisis of identity in psychiatry may have indeed resulted from the many decades of isolation from the rest of medicine. As such, there may be a temptation to redefine psychiatry based on the path of least resistance which is one left by the ‘compassion’ vacuum highlighted by the Francis inquiries. 2 Psychiatry does indeed ‘retain strengths in humane social and psychological care’, Reference Sharpe1 although it has much to learn from the involvement of patients in the design of care Reference Nettle3,Reference Russo and Rose4 and often struggles with the interface between physical and mental healthcare itself.

There is indeed a need to ‘enhance the patient’s experience of medical care’ and for medicine to move away from purely ‘disease-focused medical care’. Reference Sharpe1 However, we differ on the opinion that liaison psychiatry or psychological medicine ‘aims to put these skills back into medical care’. Reference Sharpe1 We may be at risk of medicalising the distress that is prevalent in healthcare settings. Reference Dowrick and Frances5 Healthcare professionals have a duty to improve the experience of people they care for and to respond to their distress in a humane and compassionate manner. 6,Reference Balducci7 From our experience of delivering training and support in general hospital settings, there are many barriers to liaison psychiatry being able to achieve this kind of change, not least the sheer scale of the task. This may actually be a strength of the current trend of psychiatric superspecialisation occurring in general hospital settings - more psychiatrists advocating and modelling change.

In the article, an excellent point is made that the current approaches to commissioning liaison psychiatry may be less than ideal. Reference Sharpe1 It is unlikely that teaching from another specialty, let alone another organisation, will address these issues to a satisfactory extent or in a timely manner. We could avoid the temptation of calling for more training. Instead, perhaps each specialty and organisation could take seriously the responsibility of creating the right culture and putting patients first.

Indeed, it may be that lessons can be learned from psychiatry, but we have many lessons to learn ourselves. The key to medicine rediscovering its humanity may be more likely to lie in re-engaging with its patients and carers than looking to another medical specialty.

References

1 Sharpe, M. Psychological medicine and the future of medicine. Br J Psychiatry 2014; 204: 91–2.CrossRefGoogle Scholar
2 The Mid Staffordshire NHS Foundation Trust Public Enquiry. Report of The Mid Staffordshire NHS Foundation Trust Public Enquiry Volume 3. TSO (The Stationery Office), 2013.Google Scholar
3 Nettle, M. Time to Change campaign through the eyes of a service user. Invited commentary on … Evaluation of England's Time to Change programme. Br J Psychiatry 2013; 202 (suppl 55): s1023.CrossRefGoogle Scholar
4 Russo, J, Rose, D. ‘But what if nobody's going to sit down and have a real conversation with you?’ Service user/survivor perspectives on human rights. J Public Ment Health 2013; 12: 184–92.CrossRefGoogle Scholar
5 Dowrick, C, Frances, A. Medicalising unhapppiness: new classification of depression risks more patients being put on drug treatment from which they will not benefit. BMJ 2013; 347: F7140.CrossRefGoogle Scholar
6 General Medical Council. Good Medical Practice. GMC, 2013.Google Scholar
7 Balducci, L. Communication as the heart and the art of person-centered medicine: making a case for qualitative research. J Med Person 2014; doi: 10.1007/s12682-014-0164-7.CrossRefGoogle Scholar
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