Service innovations: Is there a market for neuropsychiatry? A year in the life of a district-based neuropsychiatry service

Neuropsychiatry in the UK: national survey of existing service provision

Aims and Method

To elucidate and describe current neuropsychiatry service provision in the UK. A questionnaire was developed and posted to members of the Royal College of Psychiatrists who had expressed an interest in neuropsychiatry. the responses were tabulated and analysed using descriptive statistics and SPSS version 11.0 for Windows. the neuropsychiatry services provided, sources of referrals, setting of the services and funding streams are described.

Results

Out of 251 respondents, 70 reported providing a neuropsychiatry service, 21 having been principally appointed as neuropsychiatrists.

Clinical Implications

Neuropsychiatry services in the UK are currently based in a few regional centres, representing a patchy and inadequate service provision.

Neuropsychiatry in the UK: planning the service provision for the 21st century

Some believe that Cartesian dualism of mind and body in the 19th century and the rise of psychoanalysis by the turn of the 20th century was what led to the separation of neurology and psychiatry. More recently, conceptualisations of the mind/brain paradigm have helped rediscover the relationship between the mind and the brain, bringing renewed synergy between neurology and psychiatry (Cunningham et al, 2006). However, division is still apparent in current service planning and provision in the UK for individuals whose presentation lies in the no-man's-land between these two historical domains.

Provision of neuropsychiatry services: variability and unmet need

Aims and method Neuropsychiatry services remain underdeveloped and underprovided. Previous studies have shown variability in service provision in the UK. In this survey we approached all mental health and neuropsychiatric service providers within London to map current neuropsychiatric service provision and explore perceived barriers. Results All the specialist mental health service providers responded. There was huge variability in neuropsychiatric service provision within different parts of London. There was evidence of significant unmet need and variability in service pathways. Lack of earmarked funds for neuropsychiatry and disjointed funding stream for such services were identified by providers as a barrier. Clinical implications This study provides further evidence of an ongoing lack of adequate neuropsychiatric service provision. Reasons for variability and unmet need are discussed. Adoption of a previously proposed hub-and-spoke model of service provision and the removal of commissioning barriers through uniform national commissioning may help deal with this problem.

Implication of rates of referral to a specialised inpatient neuropsychiatry team

OBJECTIVES

This study examined and compared the number and pattern of referrals from neurosurgery and neurology specialist services to the inpatient liaison neuropsychiatry service in the years 2002 and 2005. We estimated the prevalence of psychiatric illness and evaluated the results of subsequent psychiatric assessment and follow-up of all patients reviewed by the neuropsychiatry service.

METHODS

The medical notes of those patients referred to the neuropsychiatry team were retrospectively examined to obtain appropriate information on assessment and management of these cases.

RESULTS

There were 544 referrals over the two years selected for study. Rates of referral to the inpatient neuropsychiatry service increased overall by 35% between 2002 and 2005. Overall, referrals from neurology comprised 85%, neurosurgery 15%. Patients with epilepsy comprised the majority of referrals (36%). A total of 378 (73%) had an acute psychiatric disorder and this group had a significantly higher rate (p = 0.01) of past psychiatric disorder (40%) than that in those with no acute mental illness (33%). Depressive episode was the most frequent acute psychiatric diagnosis (38%), followed by anxiety and organic psychiatric disorder (both 15%). Overall, 21% of patients diagnosed with acute mental illness were referred on discharge to the neuropsychiatry outpatient clinic for specialist follow up and the remainder followed-up by either local mental health teams or their GP.

CONCLUSIONS

These findings provide clear evidence that further resources should be allocated to expanding neuropsychiatry mental health services to improve detection and management of mental illness in this vulnerable patient group.