Liaison Mental Health (LMH)

Acute hospital liaison psychiatry, often termed Liaison Mental Health, provides all age services for people:

• In acute settings (inpatient or outpatient) who have, or are at risk of, mental ill health;
• Presenting at A&E with urgent mental health care needs (particularly relating to: self-harm, dementia, mood disorders, alcohol abuse, psychosis relapse and co-occurring mental health and physical health conditions);
• Being treated in acute settings with co-morbid physical health conditions and mental ill health;
• Being treated in acute hospital settings for physical conditions caused by alcohol or substance misuse;
• Whose physical health care is causing mental health difficulties;
• In acute settings with medically unexplained symptoms (MUS). 

Liaison Mental Health services are multidisciplinary, typically comprising psychiatry, psychology, nursing and specialist substance misuse roles. They aim to increase the detection, recognition and early treatment of impaired mental wellbeing and mental ill health to improve outcomes and:

• Reduce premature mortality associated with co-morbid mental and physical health conditions;
• Reduce excess lengths of stay in acute settings associated with co-morbid mental and physical health conditions;
• Reduce risk of harm to the individual and others in the acute hospital through adequate risk assessment and management;
• Ensure that care is delivered in the least restrictive and best coordinated manner possible.[1]

In January 2016 the Prime Minister pledged £247 million for mental health services in hospital emergency departments, which will be deployed over the next 5 years. The purpose of the pledged money is to make sure that every emergency department has mental health support and, as a global leading effort, will make sure that these services are available 24 hours a day, 365 days a year in at least half of England’s acute hospitals by 2020.

“Achieving better access to mental health services by 2020”[2] set the expectation that, by 2020, all acute trusts will have in place liaison psychiatry services for all ages appropriate to the size, acuity and specialty of the hospital. NHS England is supporting this expectation with the NHS Mandate (2015-16)[3] stating that NHS England will invest in effective models of liaison psychiatry in more acute hospitals during 2015/16. The NHS Mandate (2016-17)[4] does not make specific reference to liaison psychiatry, although there is a deliverable for 2016/17 to implement the agreed actions from the Mental Health Taskforce, which could include Liaison Mental Health.

There is strong evidence that some Liaison Mental Health service models can deliver better outcomes, better patient experience and more cost-effective care to patients with the Centre for Mental Health report, “Liaison Psychiatry in the Modern NHS”[5], suggesting that Liaison Mental Health services could save an average hospital £5 million per annum by reducing the number and length of admissions to beds.

Within Yorkshire and the Humber the Mental Health Network is developing a Liaison Mental Health (LMH) programme of work and has appointed Clinical Lead, Dr Katherine Martin, Consultant Liaison Psychiatrist, to lead on the development of the work programme in conjunction with the Clinical Network team.

The key intention of the programme of work is to support developing Urgent and Emergency Care Networks to manage patients admitted to emergency departments in crisis and provide psychological medicine services to acute providers.