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Hopkins J, Skudder E, Sundram F, Vroegop P. A survey of the psychiatric care provided for children and young people in general hospital settings in New Zealand. Australas Psychiatry 2024:10398562241282743. [PMID: 39298649 DOI: 10.1177/10398562241282743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2024]
Abstract
OBJECTIVE The aim of this study was to conduct an in-depth survey of psychiatric care provided for children and young people (CYP) in general hospital settings in New Zealand (NZ). METHOD As part of a larger national survey of Consultation-Liaison Psychiatry (CLP) services across the lifespan, a 44-question survey was emailed to clinicians who were involved in providing psychiatric care for CYP at each of the 24 public general hospitals with specialist paediatric services. RESULTS Responses were obtained from all four paediatric CLP teams that cover the four specialist children's hospitals, and 16 of the 23 child and adolescent community mental health services that provide hospital inreach. These services were found to be under-resourced, utilise variable service models, and rely heavily on inreach. CONCLUSION Escalating presentation rates for young people and increasingly complex paediatric presentations pose major challenges for the psychiatric care of CYP in general hospital settings. Utilising international staffing standards and service models, proposals are made to evolve more consistent and effective paediatric CLP services in NZ.
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Affiliation(s)
| | | | - Frederick Sundram
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
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Hopkins J, Skudder E, Vroegop P, Sundram F. Broadening the state of play - the second national survey of Consultation-Liaison Psychiatry services in New Zealand, 2021. Australas Psychiatry 2023; 31:635-645. [PMID: 37632731 DOI: 10.1177/10398562231191689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/28/2023]
Abstract
OBJECTIVE The original national survey of Consultation-Liaison Psychiatry (CLP) services in New Zealand (NZ) that was undertaken in 2018 (CLPSNZ-1) established a baseline but was limited in scope. The aim of the current study was to conduct a more in-depth national survey. METHOD A 44-question survey was emailed to clinicians at each of the 16 general hospitals in NZ with specialist adult CLP services in 2021. RESULTS Responses were obtained from all 16 CLP services. These services were found to be under-resourced (with mean total full-time equivalents of 0.26 psychiatrists and 1.10 clinicians per 100 inpatient beds, respectively), operate with highly variable service models (with major variations in operating hours and coverage of age groups, the Emergency Department and outpatients) and provide a predominantly consultation service. CONCLUSION While many of the findings from CLPSNZ-1 remain relevant, the current survey has extended our understanding of the circumstances, achievements and challenges of this psychiatric subspecialty in NZ.
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Affiliation(s)
- John Hopkins
- Liaison Psychiatry, Middlemore Hospital, Auckland, New Zealand
| | | | | | - Frederick Sundram
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
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Hopkins JR, Skudder E, Sundram F, Cullum S. A survey of the psychiatric care provided for medically ill older adults in general hospitals in New Zealand. Australas Psychiatry 2023; 31:485-493. [PMID: 37386900 DOI: 10.1177/10398562231186132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
OBJECTIVE The aim of this study was to conduct an in-depth survey of the psychiatric care provided for medically ill older adults in general hospitals in New Zealand (NZ). METHOD As part of a larger survey of Consultation-Liaison Psychiatry (CLP) services for all ages in NZ (CLPSNZ-2), a 44-question survey was emailed to clinicians who were involved in providing psychiatric care for medically ill older adults at each of the 16 general hospitals with designated CLP services. RESULTS Responses were obtained from 22 services at 16 hospitals - 14 CLP services and eight Psychiatry of Old Age (POA) in-reach services. These services were found to be under-resourced, operate with highly variable service models, and predominantly provide inpatient consultations. Services could be conceptualised as six prototypes with variations of POA in-reach to hospitals, scope of CLP cover and collaboration between services. CONCLUSION The heterogeneity in the psychiatric care for medically ill older adults in NZ means that there is an urgent need to develop more consistent CLP service models that better serve the specialist needs of older adults, and establish the policies, resources and standards needed to support them.
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Affiliation(s)
- John R Hopkins
- Liaison Psychiatry, Middlemore Hospital, Auckland, New Zealand
| | | | - Frederick Sundram
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Sarah Cullum
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
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COVID-19-related consultation-liaison (CL) mental health services in general hospitals: A perspective from Europe and beyond. J Psychosom Res 2023; 167:111183. [PMID: 36801662 PMCID: PMC9912022 DOI: 10.1016/j.jpsychores.2023.111183] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 02/06/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVE The COVID-19 pandemic posed new challenges for integrated health care worldwide. Our study aimed to describe newly implemented structures and procedures of psychosocial consultation and liaison (CL) services in Europe and beyond, and to highlight emerging needs for co-operation. METHODS Cross-sectional online survey from June to October 2021, using a self-developed 25-item questionnaire in four language versions (English, French, Italian, German). Dissemination was via national professional societies, working groups, and heads of CL services. RESULTS Of the participating 259 CL services from Europe, Iran, and parts of Canada, 222 reported COVID-19 related psychosocial care (COVID-psyCare) in their hospital. Among these, 86.5% indicated that specific COVID-psyCare co-operation structures had been established. 50.8% provided specific COVID-psyCare for patients, 38.2% for relatives, and 77.0% for staff. Over half of the time resources were invested for patients. About a quarter of the time was used for staff, and these interventions, typically associated with the liaison function of CL services, were reported as most useful. Concerning emerging needs, 58.1% of the CL services providing COVID-psyCare expressed wishes for mutual information exchange and support, and 64.0% suggested specific changes or improvements that they considered essential for the future. CONCLUSION Over 80% of participating CL services established specific structures to provide COVID-psyCare for patients, their relatives, or staff. Mostly, resources were committed to patient care and specific interventions were largely implemented for staff support. Future development of COVID-psyCare warrants intensified intra- and inter-institutional exchange and co-operation.
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Flavel MJ, Holmes A, Ellen S, Khanna R. Evaluation of consultation liaison psychiatry in Australian public hospitals (AU-CLS-1). Australas Psychiatry 2023; 31:95-98. [PMID: 36461947 DOI: 10.1177/10398562221143930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
OBJECTIVE This study aimed to determine whether consultation liaison psychiatric service (CLS) staffing within Australian public hospitals meet national and international minimum staffing standards. METHOD Semi structured interviews were conducted with CLS Directors across Australia from August to December 2021. Data were collected on demographics, staffing, funding, hospital size and admissions. RESULTS The majority of services did not meet minimum standards for CLS staffing. Non-medical staff outnumbered medical staff with increasing rurality. Psych-oncology CLS had the greatest resources, skill mix and service breadth. CONCLUSION Although CLS are heterogeneous, most services are inadequately resourced to provide baseline specialist mental health care in Australian hospitals. Establishing national minimum standards for CLS staffing will facilitate uniform service development and quality care provision.
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Affiliation(s)
- Mary-Jo Flavel
- Psychiatry, Consultation Liaison Psychiatry, 213116University of Melbourne, Parkville, VIC, Australia
| | - Alex Holmes
- Department of Psychiatry, 213116University of Melbourne, Royal Melbourne Hospital, Parkville, VIC, Australia; and Consultation Liaison Psychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Steve Ellen
- Psychiatry, University of Melbourne, 3085Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Rahul Khanna
- Psychiatry, 2281University of Melbourne, Melbourne, VIC, Australia; and Austin Health, Heidelberg VIC, Australia
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Helingoe KE, Cullum S, Ng L. Stigma in Consultation Liaison Psychiatry: A Qualitative Study of Trainee Psychiatrists. Australas Psychiatry 2022; 30:658-662. [PMID: 35139666 DOI: 10.1177/10398562211064221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Stigma related to mental illness can impact service-user care and clinician wellbeing. The aim of this study was to explore experiences of stigma in consultation-liaison psychiatry from the perspectives of trainee psychiatrists and suggest interventions to tackle stigma within a hospital environment. METHOD Ethics approval and consent were obtained for the study. In-depth interviews were conducted by telephone with six participants in four New Zealand district health boards. De-identified data was analysed using thematic analysis. An independent co-coder was employed to enhance analytic rigour. RESULTS Participants experienced stigma during their consultation-liaison rotations. Some felt isolated and undervalued. Education, intergration and role clarification within the hospital environment were identified as ways to reduce stigma. CONCLUSIONS Stigma experienced by trainee psychiatrists completing consultation-liaison rotations may lead to them feeling devalued and perceiving service-users to experience poorer care. Multidisciplinary education may potentially combat stigma and contribute to improved integration of services.
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Affiliation(s)
| | - Sarah Cullum
- Psychiatrist, Department of Psychological Medicine, 1415The University of Auckland, Auckland, New Zealand
| | - Lillian Ng
- Psychiatrist, Department of Psychological Medicine, 1415The University of Auckland, Auckland, New Zealand
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Schaefert R, Stein B, Meinlschmidt G, Roemmel N, Huber CG, Hepp U, Saillant S, Fazekas C, Vitinius F. COVID-19-Related Psychosocial Care in General Hospitals: Results of an Online Survey of Psychosomatic, Psychiatric, and Psychological Consultation and Liaison Services in Germany, Austria, and Switzerland. Front Psychiatry 2022; 13:870984. [PMID: 35815043 PMCID: PMC9270003 DOI: 10.3389/fpsyt.2022.870984] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/27/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic was accompanied by new challenges for psychosocial health care to enable the support of affected patients, their families, and staff in general hospitals. In this study, we aimed to describe the structures and procedures put in place by psychosomatic, psychiatric, and psychological consultation and liaison (CL) services in German, Austrian, and Swiss general hospitals, and to elucidate the emerging needs for cooperation, networking, and improvement. METHODS We conducted a cross-sectional online survey between December 2020 and May 2021, using a 25-item questionnaire derived from relevant literature, professional experience, and consultation with the participating professional societies. The survey was disseminated via national professional societies, relevant working and interest groups, and heads of the above-mentioned CL services. RESULTS We included responses from 98 CL services in the analyses, with a total response rate of 55% of surveyed hospital CL services; 52 responses originated from Germany, 20 from Austria, and 26 from Switzerland. A total of 77 (79%) of the 98 responding CL services reported that "COVID-19-related psychosocial care" (COVID-psyCare) was provided in their hospital. Among these, 47 CL services (61%) indicated that specific cooperation structures for COVID-psyCare had been established within the hospital. A total of 26 CL services (34%) reported providing specific COVID-psyCare for patients, 19 (25%) for relatives, and 46 (60%) for staff, with 61, 12, and 27% of time resources invested for these target groups, respectively. Regarding emerging needs, 37 (48%) CL services expressed wishes for mutual exchange and support regarding COVID-psyCare, and 39 (51%) suggested future changes or improvements that they considered essential. CONCLUSION More than three-quarters of the participating CL services provided COVID-psyCare for patients, their relatives, or staff. The high prevalence of COVID-psyCare services targeting hospital staff emphasizes the liaison function of CL services and indicates the increased psychosocial strain on health care personnel during the COVID-19 pandemic. Future development of COVID-psyCare warrants intensified intra- and interinstitutional exchange and support. TRIAL REGISTRATION ClinicalTrials.gov NCT04753242, version 11 February 2021.
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Affiliation(s)
- Rainer Schaefert
- Department of Psychosomatic Medicine, Faculty of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Barbara Stein
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical Private University, Nuremberg General Hospital, Nuremberg, Germany
| | - Gunther Meinlschmidt
- Department of Psychosomatic Medicine, Faculty of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.,Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland.,Department of Clinical Psychology and Cognitive Behavioral Therapy, International Psychoanalytic University, Berlin, Germany
| | - Noa Roemmel
- Department of Psychosomatic Medicine, Faculty of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian G Huber
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | - Urs Hepp
- Integrated Psychiatric Services Winterthur - Zurcher Unterland, Winterthur, Switzerland
| | - Stéphane Saillant
- Department of General and Liaison Psychiatry, Neuchâtel Psychiatry Center (CNP), Neuchâtel, Switzerland
| | - Christian Fazekas
- Department of Medical Psychology and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Frank Vitinius
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
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Gabet M, Grenier G, Cao Z, Fleury MJ. Implementation of three innovative interventions in a psychiatric emergency department aimed at improving service use: a mixed-method study. BMC Health Serv Res 2020; 20:854. [PMID: 32917199 PMCID: PMC7488576 DOI: 10.1186/s12913-020-05708-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/02/2020] [Indexed: 11/16/2022] Open
Abstract
Background Emergency department (ED) use is often viewed as an indicator of health system quality. ED use for mental health (MH) reasons is increasing and costly for health systems, patients, and their families. Patients with mental disorders (MD) including substance use disorders (SUD) and suicidal behaviors are high ED users. Improving ED services for these patients and their families, and developing alternatives to ED use are thus key issues. This study aimed to: (1) describe the implementation of three innovative interventions provided by a brief intervention team, crisis center team, and family-peer support team in a Quebec psychiatric ED, including the identification of implementation barriers, and (2) evaluate the impacts of these ED innovations on MH service use and response to needs. Method Using mixed methods with data triangulation, the implementation and impact of the three above-named ED interventions were studied. Quantitative data were collected from 101 participants (81 patients, 20 family members) using a user questionnaire and patient medical records. Qualitative data were gathered from focus groups (n = 3) with key intervention staff members (n = 14). The user questionnaire also included open-ended questions. Descriptive, comparative and content analyses were produced. Results Key implementation issues were identified in relation to system, organizational and patient profiles, similar to results identified in most studies in the ED implementation literature aimed at improving responsiveness to patients with MD. Results were encouraging, as the innovations had a significant impact for improved patient MH service use and adequacy of care. Services also seemed adapted to patient profiles. Family members were grateful for the help received in the ED. Conclusions Before implementing innovations, managers need to recognize the basic issues common to all new healthcare interventions: the need for staff training and strong involvement, particularly among physicians, development of collaborative tools especially in cases of potential cultural clash between staff and organizations, and continuous quality assessment. Future research needs to confirm the pertinence of these interventions, especially use of family-peer support teams in ED, as a highly innovative intervention. Broader ED strategies could also be deployed to improve MH services and decrease ED use for MH reasons.
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Affiliation(s)
- Morgane Gabet
- Management, Evaluation and Health Policies Department, School of Public Health, Université de Montréal, 7101 av. du Parc, Montreal, QC, H3X1X9, Canada.,Research Center, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Guy Grenier
- Research Center, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Zhirong Cao
- Research Center, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Marie-Josée Fleury
- Management, Evaluation and Health Policies Department, School of Public Health, Université de Montréal, 7101 av. du Parc, Montreal, QC, H3X1X9, Canada. .,Research Center, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada. .,Department of Psychiatry, McGill University, 1033, Pine Avenue West, Montreal, QC, H3A 1A1, Canada.
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