Mental health and substance misuse: joined-up services
How joining up mental health, alcohol and drug misuse services in a Derby hospital provided better support for people with addiction and mental health problems.
Background
Co-existing substance misuse and mental health issues are very common. Having a team that can treat both of these helps them to provide better integrated care and allows a person’s substance misuse to be considered alongside their wider mental, physical and social health.
Derbyshire Healthcare NHS Foundation Trust set up a liaison psychiatry team at the Royal Derby Hospital in 2013 using the Core 24 model based on the Rapid Assessment Interface and Discharge (RAID) model of liaison psychiatry.
The liaison psychiatry service works with patients in the Royal Derby Hospital who have mental health and substance misuse needs. The service ensures that mental and physical health problems are treated equally and not separately. The team replaced 3 smaller services within the hospital.
This service was set up after an economic evaluation of a similar model in a Birmingham hospital showed reduced hospital stays and a cost to benefit ratio of more than 4 to 1.
The service involves:
- 24/7 rapid response to requests for help
- quick response targets - 1 hour for the emergency department, 24 hours for hospital wards
- having a comprehensive range of specialist knowledge including mental health, substance misuse, self-harm, suicidal thoughts, dementia and delirium
- working with around 600 adult patients a month
What they’ve done
In the first year of operation, the number of contacts recorded by the team rose to over 8,000 compared to around 5,000 recorded by the 3 former services in the previous year. The number of contacts then fell in the second year to around 6,500 (in line with what was reported by the original RAID service) and it has stayed constant.
Over the first 2 years of the team’s operation, the average length of stay in hospital significantly decreased by 1.16 days for nearly all patient groups with mental health or substance misuse related diagnoses. Although the team has not been able to prove that the new service has directly reduced hospital stays, it is likely that the service played a significant role in reducing them.
Main learning points
Close working relationships between liaison, acute and community teams were essential to helping people receive appropriate community care, reduce readmissions to hospital, and cut delays to hospital discharges.
The liaison team has developed a good relationship with the community substance misuse service, to create a quick referral process and data sharing agreements. The team also hosts volunteers from the community team twice a week, to talk to patients and support them to continue seeking help if they need it after they are discharged from hospital. This engagement team from the substance misuse service also reaches out to patients who are in regular contact with the liaison team.
The team has a research post to help continually evaluate everyday practice and ensure the service is efficient, high quality and sustainable.
When the new service was created, some clinicians were apprehensive about what reconfiguring the service meant for their specialties. But as the new service has developed, clinicians have been able to retain their specialties while developing a core set of generic skills and an ability to provide integrated care, resulting in a better quality of care for patients.
The link between substance misuse and mental health problems is becoming more widely recognised as the liaison team has become more integrated with the care happening on the hospital wards and the mental health and substance misuse training for hospital staff has improved. There is also a greater sense that mental health and substance misuse is everybody’s business.
Further information
Please contact lesley.fitzpatrick@nhs.net or jennifer.ness@nhs.net for more information.