Workforce issues threaten continued expansion of liaison psychiatry services

Author: Caroline White
Workforce issues threaten continued expansion of liaison psychiatry services

Specialist psychiatric liaison services to treat people experiencing a mental health crisis now operate in every major A&E department in England, and hospitals are ahead of target on 24/7 provision, the fourth annual survey* of services issued by NHS England, shows.

But the shortage of practitioners poses a major risk to continuation of this good rate of growth, says the report.

Of the eligible 175 hospitals surveyed, the Core 24 standard ─ the availability of services 24/7 staffed by two full-time equivalent consultant psychiatrists and 13 mental health professionals ─ was met by 58 (33%) in mid-2018. This is ahead of the target by this stage of 20%. The first three surveys recorded nine, 16 and 22 Core 24 services, respectively.

The aim is to have at least 50% (88/175) of acute hospitals with emergency departments able to provide liaison psychiatry services 24/7 with the requisite number of staff by 2021.

Most (117, 67%) teams undertake 24/7 working, but many are not staffed to do this in a sustainable way that can consistently meet response time standards and provide a high-quality response, says the report.

England still needs 109.9 additional full-time equivalent consultant psychiatrists and 198.5 additional mental health practitioners to do this, says the report.

Responding to the figures, director of policy and strategy at NHS Providers, Miriam Deakin said: “We are pleased to see the progress that has been made in expanding liaison services to ensure that patients with mental health needs are treated by specialists in emergency departments.

“This is particularly welcome given that our recent report, Mental health services: addressing the care deficit, identified how demand for these services is outstripping supply. There is significant unmet need and expertise is required, not just in acute settings but right across the system.”She continued: “It is vital that these services are adequately resourced. They need the right investment and workforce in order to genuinely meet the needs of mental health patients who seek treatment during a crisis. Capital investment is also needed to ensure the environment in A&E is safe and supports appropriate care, assessment and treatment.

“It is also vital that providers and commissioners work together to ensure joined-up care across all pathways.”

Liaison psychiatry has been growing as a specialty, partly because of the evidence showing that well-resourced services make acute hospitals function more efficiently with shorter admissions and fewer readmissions.

NHS England has invested £45m in 71 sites since 2017, and a further rollout is backed by £48m of new funding over the next two years.

*Report of the fourth survey of liaison psychiatry in England. Prepared for NHS England and the Liaison Faculty of the Royal College of Psychiatrists, July 2019.