Liaison and Emergency Psychiatry: The Role of the Psychiatry Liaison Nurse

Liaison Psychiatry

Liaison psychiatry, also known as consult-liaison psychiatry, bridges the gap between physical and mental health. Its primary objective is to address acute psychiatric symptoms and disorders experienced by patients with medical and/or surgical conditions. This is achieved through a multidisciplinary approach involving various professionals’ input from the respective point of view.

This field of medicine is relatively new and has been gaining recognition in recent years as more attention is being given to the importance of mental health in overall health and well-being. In the UK, the NHS Long Term Plan has identified liaison psychiatry as a priority area for development, with plans to increase funding for liaison psychiatry services and expand the workforce (NHS England, 2019).

Liaison psychiatry in medical-surgical care

Liaison psychiatry is effective in a variety of medical and surgical settings and has been used to improve the management of chronic medical conditions such as diabetes, cardiovascular disease, and chronic pain. These conditions are typically accompanied by psychiatric comorbidities such as depression and anxiety, which can negatively impact patients’ physical health outcomes. By addressing these psychiatric comorbidities, liaison psychiatry can help to improve the patient’s quality of life (Katon & Unützer, 2013).

Liaison psychiatry in neurological care

Liaison psychiatry plays a critical role in providing mental health support and care within the context of neurological care. In addition, liaison psychiatry has also been effective in the management of medically unexplained symptoms (MUS), also known as ‘conversion’. MUS are a common problem in medical settings, and they can be difficult to manage as there is often no clear physical cause for the symptoms. Liaison psychiatry can help to identify or rule out any underlying psychiatric issues that may be contributing to the symptoms and provide appropriate treatment and management strategies (Kroenke, Sharpe, & Sykes, 2007).

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Gary Brincat RMN May 2023

Liaison psychiatry in psychogeriatric care

Liaison psychiatry consults are important in psychogeriatrics, especially in conducting capacity assessments, incapacitations, managing symptoms of neurodegenerative illnesses and administering cognitive screening tests. Liaison psychiatry delivers guidance and support in evaluating a patient’s decision-making capacity, assisting in determining incapacitations, and ensuring appropriate care and support for patients.

Liaison psychiatry in palliative care

Palliative care is focused on the management of patients with advanced or life-limiting illnesses. Liaison psychiatry in palliative care involves the assessment and management of psychiatric symptoms such as depression, anxiety, and delirium. The goal of this type of consult is to improve patients' quality of life and ensure that their end-of-life care is as comfortable and supportive as possible.

Liaison psychiatry in alcohol dependence and substance use disorders

Consultation for alcohol and substance use disorders involves the assessment and management of patients with substance use disorders who are also receiving medical or surgical treatment. The goal of this type of consult is to provide comprehensive care that addresses both the physical and psychiatric aspects of substance use disorders.

Emergency psychiatry

Emergency psychiatry is a sub-speciality which is also covered by the liaison psychiatric team. These department consults involve patients who present to the emergency department in crisis, with acute psychiatric symptoms or who require emergency psychiatric assessment and treatment. Psychiatric consultation in the emergency department is focused on the assessment and management of acute psychiatric conditions, such as suicidal ideation, psychosis, and severe anxiety. The goal of this type of consult is to provide rapid assessment and intervention to stabilize the patient's condition and determine the appropriate next steps.

What is a Psychiatric Liaison Nurse?

Psychiatric Liaison Nurses (PLNs) are specialised psychiatric nurses, also known as Registered Mental Health Nurse (RMN), who work within the liaison psychiatry team and work closely with medical/surgical teams to ensure that patients with psychiatric disorders receive appropriate and timely care. They play a vital role in the assessment, management, and treatment of patients with psychiatric conditions, particularly those with comorbid medical and/or surgical comorbidities.

PLNs facilitate communication and collaboration between the psychiatric and medical teams. They serve as a liaison between the psychiatric and medical teams, communicating the patient’s psychiatric status and treatment plan to the medical team and vice versa. This ensures that patients receive comprehensive care that addresses both their medical and psychiatric needs.

Psychiatry liaison nurses within the liaison psychiatry team

Central to the provision of an array of liaison psychiatry services are PLNs. They are integral members of the liaison psychiatry team, playing a crucial role in delivering a range of liaison psychiatry services.

These nurses have proven to be influential in reducing healthcare costs by shortening hospital stays, decreasing readmission rates, enhancing patient satisfaction, preventing deterioration and relapses, and reducing suicide rates (Vos et al., 2015). Their contributions are essential in achieving these positive outcomes and improving overall patient care within the field of liaison psychiatry.

In each of these types of consults, the PLN plays a crucial role in ensuring that patients receive timely and appropriate psychiatric care. PLNs are trained to assess and manage psychiatric disorders in medical and surgical settings, and they work closely with the team to provide coordinated care that addresses patients' unique needs.

The Role of the Psychiatric Liaison Nurse

One of the key members of the liaison psychiatry team is the PLNs. The PLN plays an important role in supporting and working closely with the liaison psychiatrists in the assessment, diagnosis, and management of psychiatric comorbidities in patients with medical and surgical conditions.

The primary role of the PLN is to conduct initial assessments of patients referred to the liaison psychiatry service, gathering relevant information about their medical and psychiatric history, presenting symptoms, and psychosocial context. They are also crucial in conducting comprehensive psychiatric assessments of patients.

The extensive and specialised role of the PLN can be summed up in the following:

● Mental state examinations,

● Risk assessments,

● Capacity assessments,

● Triaging

● Crisis and emergency,

● Mental welfare officers,

● Advocating, educating and training

● Liaising and referring

● Documentation

● Service development

Mental State Examinations

Mental state examinations are used to evaluate a patient's current mental state, including their mood, thought process, verbal and non-verbal behaviour, and cognitive functioning.

Risk Assessments

Risk assessments are a critical component of psychiatric care, particularly in medical and surgical settings. PLNs work with the multidisciplinary team to assess a patient's risk for self-harm, harm to others, and other possible psychosocial risks. This information is used to develop a risk management plan that aims to minimize the risk of harm to the patient and others and is essential in formulating a safety plan.

Capacity Assessments

PLNs also play a role in conducting capacity assessments. Capacity assessments are performed to determine a patient's ability to make decisions about their medical treatment, (long-term) care, and other important life decisions. They also work closely with the team to assess a patient's capacity, provide support and advocacy, and develop a management plan that respects the patient's autonomy and best interests.

Triaging

Psychiatry liaison nurses play a pivotal role in triaging calls and consultations through the liaison pager. They serve as a primary point of contact, receiving incoming inquiries, urgent requests, and consults from healthcare professionals. By efficiently assessing the urgency and nature of each call, these nurses prioritise and direct the appropriate resources and interventions, ensuring that critical situations are addressed promptly and efficiently. Their expertise in psychiatric care and knowledge of available services enable them to make informed decisions, provide immediate support, and facilitate timely access to mental health resources. Through their role in triaging calls and consults, PLNs ensure that patients receive the necessary care, support, and interventions based on their unique needs and circumstances.

Crisis and Emergency Department

PLNs play a major role in the emergency department as they provide crisis intervention and support to patients who are experiencing acute mental health issues, provide psychological first aid, administer medications, gather collateral histories from relatives, and provide support and reassurance to patients and their families. Furthermore, PLNs are essential in utilizing their expertise and experience to offer rapid advice and guidance on complex cases to the psychiatrist and emergency staff. Additionally, they are crucial in providing continuity of care and bridging the gap between clinic hours and duty hours. They ensure continuity of care and support for patients during times when direct access to mental health providers may be limited.

Mental Welfare Officers

PLNs are instrumental both in the presence or absence of a responsible carer, to determine whether patients require sectioning under the Mental Health Act. Acting as Mental Welfare Officers, they carefully evaluate a person's mental state and risk status and work collaboratively with other healthcare professionals to determine whether an involuntary admission to the state's psychiatric facility is necessary. Moreover, they ensure the well-being and rights of patients, adhering to the guidelines of the Act.

Advocating, Educating and Training

Apart from conducting assessments, the PLN is also involved in the implementation and coordination of treatment plans. This may involve recommending and administering psychotropic medication, training nursing staff in administering depot injections and recognising and responding to common mental health issues.

Furthermore, they also provide education and support to patients and their families, such as providing information about psychiatric diagnoses, treatment options, management of psychiatric symptoms and information about mental health services.

In addition, PLNs act as advocates for patients, ensuring that their needs are met and their rights are respected, receiving appropriate treatment and care, facilitating communication between patients and medical teams, and ensuring that patients are involved in decisions about their care.

Liaising and Referring

In addition to being advocates for patients, PLNs also collaborate with community mental health services to ensure that patients receive appropriate and timely follow-up care and support after discharge from the general hospital or emergency department. This includes liaising with the psychiatric hospital admission nurse to provide essential admission details, liaising with community mental health teams to arrange outpatient appointments, providing information on local support services, and ensuring that patients are connected with appropriate community resources. Furthermore, PLNs are crucial in receiving information from community mental health services about patients who are referred to the hospital and/or emergency department.

Documentation of reviews

Documentation of psychiatric reviews provides essential information when patients are admitted to the state psychiatric hospital or discharged to outpatient settings. By maintaining comprehensive notes, liaison nurses facilitate seamless transition of care, ensuring accurate communication among healthcare providers and enabling outpatient teams to understand the patient's psychiatric background, ongoing treatment needs, and recommended follow-up services. This meticulous documentation enhances patient safety, quality of care, and effective communication throughout the psychiatric care continuum.

Service Development

PLNs are also responsible for conducting research and quality improvement initiatives to help improve the delivery of liaison psychiatry services. They collect and analyse data on patient outcomes, develop new interventions or approaches to care, develop care pathways or protocols, and share best and modern policies and practices with other healthcare professionals.

Conclusion

Overall, the role of the PLN is critical in providing comprehensive psychiatric care to patients with medical and surgical conditions. By working closely with the multidisciplinary team and using their expertise and skills, PLNs help to ensure that patients receive appropriate and timely care that addresses their mental health needs. Their unique combination of clinical expertise, advocacy skills, and as well as their ability to facilitate communication and collaboration between medical teams, makes them an essential and unique part of the liaison psychiatry team.

Written by Mr Gary Brincat