In 2014, University Hospitals Bristol NHS Foundation Trust extended the operating hours of its liaison psychiatry service in the emergency department (ED), as part of a national initiative to increase access to liaison psychiatry services.
The liaison psychiatry service provides care for people who come to ED with mental health problems and for people who develop mental health problems while being treated in hospital. UK guidelines recommend that everyone who presents to healthcare services because of self-harm should be offered a psychosocial assessment, which includes an evaluation of the factors leading to self-harm and a full mental health and social needs assessment.
Most patients who present at ED due to self-harm, do so outside of ‘office hours’, so are less likely to receive specialist care.
The increase in hours, from 40 hours over five days to 98 hours over seven days a week, cost an additional £250,000 per year.
Our previous evaluation of the short-term impact of the service change showed that in the three months following the service change, compared to the three months before:
Building on these findings, this study focused on the impact of the service change on patients who had presented at ED after self-harming in the three years after it was introduced.
It is important to understand this longer-term impact, because people who visit the emergency department due to self-harm:
With their consent, they also shared detailed data about their care through a local self-harm register. It was this detailed data that made this evaluation possible.
We used data from the three years before the change in operating hours to predict what would have happened if the service change hadn’t been put in place. We then compared it to what actually happened in the three years after the service change.
We looked at:
Staff from the liaison psychiatry service were central to the success of this project. They helped us to design the evaluation, access and use the data available, and interpret the results.
Our analysis found that, following the extension of the liaison psychiatry team’s operating hours:
The findings also showed an increase (likely due to extra staffing costs), although there was little evidence of an increase in the average hospital costs for a self-harm attendance overall. However, a larger study would be needed to provide stronger evidence that the service change resulted in any costs or savings for the health system.
Our study will help commissioners across England decide if further investment in liaison psychiatry services represents value for money.
This study didn’t look at whether the service change led to improvements in patients’ health, or how frequently patients used other services after involvement with the liaison psychiatry service. The service extension is also likely to benefit other patient groups, but we were only able to look at data for patients who had self-harmed, who make up only 40 per cent of referrals to the liaison psychiatry team.
Further research that included these aspects would provide a more complete picture of the impact of an enhanced liaison psychiatry team, and generate more robust results.
University Hospitals Bristol and Weston NHS Foundation Trust is a dynamic group of hospitals in the heart of Bristol and Weston-Super-Mare, with over 100 clinical services across ten sites. They offer care to the people of Bristol, Weston-Super-Mare and the South West, and have an international reputation for cardiac surgery, paediatric services, oncology and bone marrow transplantation. They are the largest centre for medical training and research in the South West.