OPMH LIASION TEAM BASINGSTOKE & WINCHESTER

OPMH LIASION TEAM BASINGSTOKE & WINCHESTER

Initial Challenges Resources Information from referrers Diagnosis: delirium or dementia Training all clinical staff about behavioural management Appropriate use of drugs Liaising with CMHTs/ GPs

Reports Economic Evaluation of Liaison Psychiatry Service: Report, Centre for Mental Health (2011) Long-Term Conditions and Mental Health: Cost of Co-morbidities, The Kings Fund & Centre for Mental Health (2012) Liaison Psychiatry in the Modern NHS, Centre for Mental Health, (2012) Psychiatric Liaison Network Accreditation Network Standards, 3 rd Edition (2011-2012) Liaison Psychiatry Services for Older People Project, National Institute for Health Research Service Delivery and Organisation Programme, (2010)

The challenge Disorder Prevalence in General Hospital Dementia 31% 5% Depression 29% 12% Delirium 22% 1-2% Anxiety Disorder 8% 3% Alcohol misuse 3% 2% Prevalence in Community

Impact of comorbidities mortality length of stay poor outcomes related to physical health loss of function institutionalisation readmission knowledge, attitude and skills of staff experience for patients and carers cost 13.5 billion pounds to the NHS

Team Basingstoke Winchester Consultant 0.2PA 0.2PA Nurse 2 1.6 Administrator 0.6 0.6

What we do?

Mar 14- Aug 14 Sep 14- Feb 15 Mar 15- Aug 15 Sep 15- Feb 16 Referrals 151 159 197 199 194 Mar 16- Aug 16 Age>80 109 108 139 143 137 Average time to initial assessment Average length of stay 2 1.6 2.5 1.9 1.9 33 34 41 43

Vignette 1 Mr H is an elderly gentleman admitted about 9 PM following an ambulance call, presenting with confusion and possible UTI. He is very disturbed and had scratched a HCA when she was trying to provide personal care. His hearing aid seems to have been lost. Mr H is refusing antibiotics. His son when contacted says that Mr H had been noticeably forgetful and had not been to memory clinic due to his forgetfulness.

Diagnosis

Diagnosis Mar 14- Aug 14 Sep 14- Feb 15 Mar 15- Aug 15 Sep 15- Feb 16 Mar 16- Aug 16 Dementia (N) 30 24 40 41 30 Functional (N) 11 3 11 5 16

Appropriate Drug Treatment

Treatment Mar 14- Aug 14 Sep 14- Feb 15 Mar 15- Aug 15 Sep 15- Feb 16 Mar 16- Aug 16 Cognitive enhancers 16 19 21 14 7

Vignette 2 Mrs C had been admitted to hospital with breathlessness late in the evening. This is the 3 rd such time since she had lost her husband a year back. She appeared to be disinterested and lacking in motivation. OT and phsyio have expressed concerns about her motivation to engage in assessments and activities.

Mental Health Act/ Assessments of Mental Capacity

Mar 14- Aug 14 Sep 14- Feb 15 Mar 15- Aug 15 Sep 15- Feb 16 Admission to SHFT 9 2 5 11 Discharge to home 78 66 102 89 CMHT followup 65 54 85 73

Experiential Learning

Vignette 3 Mr G had been admitted to hospital with UTI. This is the 3 rd such time in a year back. OT and phsyio have expressed he is suitable for discharge home with package of care. No evidence of dementia. Daughter wants Mr G in placement. Writes to PALS.

Feedback from families team in [hospital] was on the ball with everything. Wonderful people and so helpful.

Feedback from HHFT staff

Feedback from HHFT staff Improvement of clinical staff in managing mental health symptoms (score of 9 /10 on staff feedback). Good interactive sessions, Learnt about management - feedback on training. It provides the support that both patients and staff need for the care of older patients with dementia and mental health issues. Your continued input into staff education around the issue of dementia is also vital for developing a dementia strategy within the Trust and fulfils part of the national initiative towards better dementia understanding and care as seen in the National Dementia Strategy

Creating psychiatry training posts

Challenges Delirium pathway follow up in community Dementia follow up in care homes Functional discharges with risk time to follow-up in community Continuing education and training transitory staff Resources: Between Basingstoke and Winchester 750 referrals per year! Equal to a CMHT!

Discussion/ Questions

Cure sometimes, treat often, comfort always.