Quality Standards for Liaison
Psychiatry Services
Fourth Edition 2014
Editors: Lucy Palmer, Rohanna Cawdron, Eleanor Pollock, Jim Bolton
and Jenna Spink
A manual of standards written primarily for:
Professionals who deliver liaison psychiatry services
Commissioners
Managers
Also of interest to:
People with physical and mental health problems
Carers of people with physical and mental health problems
Non-mental health professionals in the general hospital
Crisis Resolution/Home Treatment Teams
Out-of-hours mental health services
Researchers
Policy makers
Fourth Edition: January 2014
Publication number: CCQI163
Correspondence:
Lucy Palmer, Rohanna Cawdron or Ella Pollock
Psychiatric Liaison Accreditation Network
Royal College of Psychiatrists’
Centre for Quality Improvement
21 Prescot Street, London, E1 8BB
Tel: 020 3701 2523/2730
Email: plan@rcpsych.ac.uk
This document can be downloaded from our website
©Royal College of Psychiatrists 2014
1
Contents
Section
Page
How to use these standards
3
Introduction
4
Domain 1: Core Standards for all Adult Teams
9
Core Commissioning and Resources
9
Referral Procedures
10
Mental Health Assessment and Care Planning
11
Involving Patients and Carers
15
Collaborative Working in the General Hospital
18
Interfaces with Other Services
20
Staffing, Support and Communication
21
Quality, Audit and Governance
27
Domain 2: Providing Emergency Mental Health Care to Adults of all Ages
29
Domain 3: Providing Routine Mental Health Care to Working Age Adults
30
Domain 4: Providing Routine Mental Health Care to Older People
31
Domain 5: Providing Interventions
33
Domain 6: Providing Training to Hospital Colleagues
34
Appendix 1: Examples of Training Provided to Acute Colleagues
36
Appendix 2: Examples of Liaison Psychiatry Staffing Levels
37
Appendix 3: Examples of assessment rooms
42
Appendix 4: Examples of Interventions Recommended by NICE
44
Appendix 5: Examples of Interventions Recommended by SIGN
45
Appendix 6: Key to References
46
Appendix 7: Acknowledgements
48
2
How to use these standards
Below is an explanation of the various terms used throughout this document.
For further information, please contact the PLAN team on 020 3701 2523/2730.
No.: this
relates to the
criterion
number.
Criterion: a more specific
statement explaining what needs
to happen. Please note, in order
to pass a standard, a team must
meet the majority of criteria
within it.
Standard: this
describes the
overarching aim or
value of a particular
group of criteria.
Standard 1: Liaison psychiatry services to general hospitals
are adequately planned and commissioned
No. Type Criterion
1.1 2
Liaison services are explicitly commissioned/contracted against
agreed service standards
Ref.
ACAD
1.2
2
Liaison services are planned, developed and reviewed by a joint
planning forum
JOINT
1.3
2
Commissioning includes provision for local advocacy services
GPP
Re
Type: this relates to the rating of
the standard i.e.
Type 1: Failure to meet these criteria would result in a
significant threat to patient safety, rights or dignity
and/or would breach the law.
Ref: this refers to the source
that inspired or relates closely to
the criterion in question. Please
see Appendix 5 on page 46 for
full details of the references.
Type 2: Criteria that an accredited service would be
expected to meet.
Type 3: Criteria that an excellent service should meet.
Some criteria, though very important, are not the
direct responsibility of the liaison team and therefore
cannot be rated as Type 2 or 3.
Please note
o
o
Where there are notes underneath some criteria (in italics) these are for
additional guidance.
The standards and criteria in this document exist to guide best practice
and do not override the individual responsibility of a professional to make
appropriate decisions on a case-by-case basis.
3
Introduction
What is the Psychiatric Liaison Accreditation Network (PLAN)?
PLAN is a network of mental health liaison psychiatry services run by a central
project team at the Royal College of Psychiatrists’ Centre for Quality
Improvement (CCQI). PLAN facilitates quality improvement and development in
liaison psychiatry services through a supportive peer review network. PLAN is
open to all liaison psychiatry services in the United Kingdom and Ireland. To
speak to a member of the PLAN team, please telephone 020 3701 2523 or email
plan@rcpsych.ac.uk
Each year, mental health liaison teams are evaluated against the PLAN service
standards. Members are expected to take part in self review every year and peer
review every two/three years.
What are the benefits of PLAN?
The network enables communication between services and the sharing of best
practice. PLAN supports members in their endeavors to improve and develop, at
a pace which suits the individual service. By applying standards developed from
literature reviews and consultations with experts, and using proven quality
improvement methods, PLAN:




Recognises achievement and identifies areas for improvement;
Raises awareness of the value of liaison services;
Encourages services to constantly strive for improvement;
Provides funders with the confidence to invest in accredited services.
The PLAN cycle
7. Annual
Members’
Meeting
1. Agree
standards
6. Action
planning
2. Self
review
3. External
peer review
5.
Accreditation
decision
4. Local
reports
compiled
4
How have the PLAN standards been developed?
The standards were initially developed following a review of the literature and a
period of consultation with various experts, including:






Patients and carers;
Liaison mental health professionals, including nurses, psychiatrists, social
workers, therapists and psychologists;
Experts from voluntary sector organisations;
Healthcare professionals from emergency departments and general
hospital wards;
Managers and directors;
Individuals with expertise in quality improvement research and audit.
The consultation process involved a written consultation exercise, expert group
meetings, telephone and email discussions and an exercise where people
independently rated the standards. The standards are updated every two to
three years to reflect changes in policy and legislation.
How are the standards measured?
The standards are measured in two stages; the self and peer review.
The self review
During the self review period (8-10 weeks), PLAN members are provided with
brief, anonymous questionnaires (either online or on paper) to be completed by:



All members of the liaison team;
Professionals who refer patients to the liaison team;
Patients and carers who have recently been seen by the liaison team.
The liaison team also reviews a number of case notes and completes a checklist.
Liaison teams are provided with bespoke tools and guidance notes.
Members are also given an action planning document, and support to make
improvements to the service where needed. These changes may be based on the
PLAN standards or may have already been in the pipeline.
The peer review
The peer review is a one-day visit from a review team made up of other liaison
staff as well as a patient or carer. It offers an opportunity for multi-disciplinary
and multi-agency discussions, and gaining an insight into other services.
The aim of the peer review is to validate the data from the self review and
record any changes that have taken place since the self review. Liaison
professionals, referrers, patients and carers are all invited to reflect on the
achievements of the liaison team and discuss how the service could be improved
or developed in the future.
5
How is accreditation decided?
Data from the self and peer review are compiled by the central PLAN team into a
summary report of the service’s strengths and areas for improvement. This
report is then considered by the PLAN Accreditation Committee (AC), which
makes a recommendation about accreditation status. The liaison team in
question is provided with ample opportunity to comment on their report and
inform the committee of any new developments to support the decision.
How many standards must be met to gain accreditation?
There are four categories of accreditation status
Category 1: “accredited with excellence”. The service would:
 meet all Type 1 standards;
 meet at least 95% of Type 2 standards;
 meet at least 80% of Type 3 standards, with a clear plan for how to
achieve the others;
 excel in other areas, such as research, audit or teaching.
Category 2: “accredited”. The service would:
 meet all Type 1 standards;
 meet at least 75% of Type 2 standards;
 meet at least 60% Type 3 standards.
Category 3: “accreditation deferred”. The service would:
 fail to meet one or more Type 1 standards but demonstrate the
capacity to meet these within a reasonable period of time;
 fail to meet a substantial number of Type 2 standards but
demonstrate the capacity to meet the majority within a reasonable
period of time.
Category 4: “not accredited”. The service would:
 fail to meet one or more Type 1 standards and not demonstrate the
capacity to meet these within a reasonable period of time;
 fail to meet a substantial number of Type 2 standards and not
demonstrate the capacity to meet these within a reasonable period
of time.
6
What happens if a team is not meeting sufficient numbers of
standards?
In cases where accreditation cannot be awarded at the first attempt, the AC
would normally defer the team for an agreed period of time and the central PLAN
team will provide the service in question with advice on how to meet the
standards that need to be addressed. The team will be offered time and support
to develop an action plan and make positive changes, giving teams the best
chance of meeting the standards required. After an agreed period of time, the
PLAN team will follow this up with the service to determine if the service now
meets sufficient standards to be accredited.
Which standards will teams be measured by?
PLAN recognises that functions differ between liaison teams. The standards in
this document are therefore laid out in different domains according to the
different functions that liaison teams perform. When teams sign up to PLAN they
are asked to inform us which areas of service they provide. Teams are then
measured against the domains which apply to them and exempt from those
which are not. The domains are as follows:





Core standards for all liaison teams
Providing routine mental health care to working age adults
Providing routine mental health care to older people (aged 65 and above)
Providing interventions to patients
Providing training to hospital colleagues
Accreditation certificates and details on the PLAN website will state which
domains each team has and has not been measured against. They will also state
that accreditation is for the liaison team, and not any other services, such as
out-of-hours services.
7
Notes about the standards
 Psychiatric liaison services differ widely in their function, organisation,
funding, staffing and levels of service, even within the same Trust or
organisation. The standards therefore focus on function rather than any
particular model of service delivery.
 Where standards relate to the satisfaction level of patients, carers,
referrers or liaison staff, the AC expects at least 75% of responders to
respond positively if the standard is to be considered met. For example, if
20 referrers have been surveyed about a standard, 15 of them will need to
give positive responses.
 Where measurement against the standard is based on the judgment of
reviewers, this means that the evidence will be looked at by the PLAN
central team, the peer reviewer visitors, the PLAN Accreditation
Committee, or any combination of the above.
 Many of the standards relating to patient involvement assume that the
patient in question has the required capacity to engage in their treatment
and understand the information being provided. In some situations, this
may not be the case and the PLAN process will take this into account.
 In order to meet these standards, teams operating across multiple sites
must be able to demonstrate a consistently high service on all sites. For
example, the standards around assessment facilities need to be met at all
sites with emergency departments that the team operates at.
 The standards and criteria in this document exist to guide best practice and
do not override the individual responsibility of a professional to make
appropriate decisions on a case-by-case basis. Healthcare professionals
should adhere to the code of conducts established by their own governing
professional body (for example the Nursing and Midwifery Council, the
General Medical Association etc).
 Organisational and personal interests must never be allowed to outweigh
the duty to be honest, open and truthful.
8
Domain 1: Core standards for all Liaison
Services (Working-age and Older Adults)
Core Commissioning and Resources
Standard 1: Liaison psychiatry services to general hospitals are
adequately planned, commissioned/contracted and managed
No.
Type.
Criterion
Ref.
1.1
2
Liaison services are explicitly commissioned/contracted
against agreed service standards.
ACAD
Note: This is detailed in the Service Level Agreement (SLA)
Operational Policy, or equivalent document and has been
agreed by funders.
1.2
2
The liaison service is commissioned/contracted to provide GPP
emergency/urgent assessment and treatment to adults of
all ages throughout the hospital.
Note: If care is only provided to one age group then PLAN
members will be asked to specify who provides care to the
other age group.
1.3
2
The liaison service is commissioned/contracted to provide
emergency/urgent care to all patients, regardless of the
patient’s address.
GPP
Please note:


Standards relating to the commissioning of mental health care for working
age adults can be found on page 29.
Standards relating to the commissioning of mental health care for older
people can be found on page 30.
Standard 2: The liaison team has access to essential facilities and
resources
No.
Type.
Criterion
Ref.
2.1
1
The liaison team has office space which is fit for purpose,
with essential facilities such as computers, telephone and
the internet.
GPP
2.2
2
The liaison team has an additional breakout room for
confidential activities such as supervision.
PIG
9
Referral Procedures
Standard 3: The liaison team provides an effective service to referrers
No.
Type.
Criterion
Ref.
3.1
1
The liaison team provides referrers with information on
how to refer patients to the liaison team (and if
applicable, who to contact out-of-hours).
GPP
3.2
2
Referrers are satisfied with the communication
provided by the liaison team between initial referral
and assessment.
GPP
Note: This includes updates on waiting times and any delays
and telephone advice to the referrer.
3.3
2
Referrers are satisfied with the information provided
by the liaison team after the assessment.
GPP
3.4
2
Referrers are satisfied with the time it takes to receive
a senior opinion from the liaison team when required.
GPP
3.5
2
Referrers are satisfied with the amount of mental
health input provided within the liaison team’s working
hours.
GPP
3.6
3
Liaison professionals proactively seek referrals and
raise awareness of the liaison function, for example
through visiting wards, providing staff training and
promoting the liaison team at multi-disciplinary
meetings.
JOINT
Note: It is acknowledged that this is not practical for small
or over stretched teams but this should be a long term
aspiration.
3.7
1
There is a clear pathway for referrers to access advice
from a consultant psychiatrist, where needed, during
the liaison team’s normal working hours.
ACAD
Note: This may be through the liaison team or through
another mental health service.
3.8
2
Referrers are satisfied with the referral process.
10
GPP
Mental Health Assessment and Care Planning
Standard 4: Mental health assessments take place in an appropriate and
safe environment
 Teams operating across multiple sites must have access to acceptable facilities at
all sites.
 Sufficient private space should exist to ensure that patients and liaison staff do not
have to travel far through the hospital to find a room suitable for assessment.
 The use of a curtain around a patient’s bed does not ensure privacy and should
only be used rarely, and as a last resort, i.e. if there is significant risk and no safe
alternative room, or if it is not physically possible for the patient to be moved to a
more private setting.
No.
Type.
Criterion
Ref.
4.1
1
The liaison team, patients and reviewers agree that
assessment rooms are sufficiently private.
PIG
Note: Facilities should be private enough so that
conversations cannot be easily overheard and that some
visible privacy is provided. Large windows that have no cover
and are in full view of passers-by do not offer sufficient
patient privacy. (See Appendix 3 for examples of PLAN
compliant assessment rooms).
4.2
1
The liaison team has a procedure for estimating the
level of risk involved in conducting an assessment (i.e.
checking past notes, liaising with other colleagues).
GPP
4.3
1
The liaison team has a clear procedure for managing
‘high risk’ assessments.
GPP
Note: Written guidance should include:
 A description of suitable facilities for high risk
assessment in the emergency department/medical
assessment unit (see 4.4);
 Arrangements for alerting acute colleagues that the
assessment is taking place, including where it is taking
place;
 Guidance on the frequency of checks and observations,
depending on the nature of the concern;
 Agreements about more experienced liaison or acute
staff being present during the assessment, if
appropriate;
 Agreements for involving security staff where needed;
11
4.4
1
The liaison team has access to facilities and equipment
for conducting high risk assessments. Facilities should:
a) Be located within the main emergency department;
b) Have at least one door which opens outwards and is
not lockable from the inside;
c) Have an observation panel or window which allows
staff from outside the room to check on the patient or
staff member. A common and effective approach is to
use windows with built-in adjustable blinds, which allow
partial viewing of the room and the option for staff to
view the room fully if a situation requires it, whilst still
offering a degree of patient privacy. Another approach is
to use obscured glass to provide privacy, in which case a
small section of this must be clear so that staff can still
look in if needed.
d) Have a panic button or alarm system (unless staff
carry alarms at all times);
e) Only include furniture, fittings and equipment which
are unlikely to be used to cause harm or injury to the
patient or staff member. For example, sinks, sharpedged furniture, lightweight chairs, tables, cables,
televisions or anything else that could be used to cause
harm or as a missile are not permitted;
f) Not have any ligature points.
Note: Whilst not mandatory for accreditation, PLAN highly
recommends that assessment facilities should have two doors
to provide additional security. All new assessment rooms must
be designed with two doors.
12
ASS’T
Standard 5: Mental health assessments are comprehensive, supportive
and focus on patient needs
No.
Type.
Criterion
Ref.
5.1
2
Liaison staff and patients are satisfied with the length of
time spent on mental health assessments.
PIG
GPP
5.2
1
Reviewers agree that patients’ plans of care or discharge
are well constructed and clearly documented.
PIG
Note: Plans should:
 Demonstrate that the assessor has made efforts to
access past notes;
 Include a clear formulation or diagnosis;
 Indicate a care/discharge plan which aims to address
problems and needs, and builds on the patient’s (and
carer’s) protective factors and strengths.
5.3
1
Reviewers agree that patients’ plans of care or discharge
are communicated to other services in a timely manner.
PIG
Note: I.e. for high risk cases, on the same day; for others,
within 7 working days.
5.4
2
If the patient presents with a companion, the patient is
offered the choice of them being present during the
assessment.
SH
Note: If involving carers, it is good practice for the assessor to
spend time alone with the patient first, to ensure that the
patient can speak privately. In other cases, where the carer
wishes to speak to the assessor in private, this should also be
facilitated (with the patient’s permission).
5.5
1
The liaison team is able to conduct dementia
assessments, or signpost patients to a service that can do
so.
Note: People who are assessed for the possibility of dementia
should be asked if they wish to know the diagnosis and they
should be asked with whom the outcome should be shared.
13
NICE1
GPP
Standard 6: Assessment includes consideration of issues around risk
and mental capacity
No.
Type.
Criterion
Ref.
6.1
1
Assessment of the patient’s risk (to self and others) is
judged by reviewers to be clearly documented.
PIG
GPP
CWP
Note: The risk assessment may include some of the following:







6.2
1
Harm to self - i.e. current suicidal intent, hopelessness,
ability to resist suicidal thoughts, depression and selfneglect;
Vulnerability - e.g. risk factors for older people and the
protection of vulnerable adults, including people with
learning disabilities;
Triggers to symptoms and behaviours;
Deterioration;
Absconding;
Non-adherence to treatment;
Harm to others, including child protection issues.
The liaison team has a written policy on managing
different levels of risk.
GPP
Note: This is likely to include:


Developing a risk management plan;
Procedures and timescales for communicating the plan
to relevant colleagues.
6.3
1
Where risk has been established, the assessor records a
risk management plan in the case notes and
communicates this with colleagues.
GPP
6.4
1
Liaison professionals are available to advise colleagues on
issues around mental capacity.
PIG
Note: It is not the sole responsibility of the liaison team to
assess mental capacity; this should be undertaken by the
medical professional proposing the action being taken.
However, in complex or borderline cases, the liaison
professional may be able to offer valuable insight, and should
endeavour to do so.
6.5
1
The liaison team can access advocacy services, including
PALS, Independent Mental Health Advocates, Independent
Mental Capacity Advocates and Mental Health Act
advocates.
14
GPP
Involving Patients and Carers
Note: The default position should be to involve the patient as fully as possible. It is
acknowledged that there are occasions where patients cannot be fully involved and
informed (i.e. where it would cause distress, or where the patient lacks the capacity to
understand what is being said or written, even with support). Carers should also be
involved when it is in the patient’s best interest.
Standard 7: Patients are fully involved in the assessment and care
planning process
No.
Type.
Criterion
Ref.
7.1
1
Patients report that they were involved in discussions
about their problems and the different treatment options
available.
NICE
Note: This includes encouraging individuals to express
preferences and involving them as fully as possible in decisions
about discharge or onward care. For patients with emergency
care plans, crisis cards or advance directives, the contents of
these should be taken into account.
7.2
1
Patients report that liaison staff treated them with dignity,
respect and understanding.
NICE
7.3
1
Patients are offered a written summary of the assessment
and what will happen next.
NICE
Note: This may be in the form of a handwritten summary, or
information filled in on a patient leaflet, or a copy of a letter to
another professional. PLAN will look for evidence in the case
notes that this information was offered to patients.
7.4
2
Patients are offered the choice of receiving copies of
letters between the liaison team and other services,
unless there is a good reason not to do so.
DH
Note: This guidance derives from Department of Health
guidance for services in England and Wales. Services in other
jurisdictions should have similar means of informing patients of
their rights to view their records. PLAN will look for evidence in
the case notes that patients are being offered the choice of
receiving letters.
7.5
1
Patients are told how to access emergency help, where
needed.
Note: Where appropriate, this might include helping the patient
draw up an action plan for future mental health crises if this has
not already been undertaken.
15
PIG
7.6
2
The liaison team offers patients a leaflet describing the
role of the liaison service.
GPP
7.7
2
The liaison team offers patients written information about
any mental health problem the patient is experiencing.
GPP
Note: This might be in the form of a leaflet from the
trust/organisation, or leaflets from mental health charities,
Royal College of Psychiatrists etc.
7.8
1
The liaison team offers patients information on how to
access support through other health services, social
services, advocacy and voluntary sector services.
PIG
7.9
2
Patients are satisfied with the information provided to
them by the liaison team.
GPP
Note: For example, information about the liaison team, any
relevant mental health problems, how to access different
services etc.
7.10
1
The Trust/organisation has a policy on confidentiality and
information sharing.
GPP
Note: This should provide the liaison team with guidance on
informing patients about where information about them is being
sent, and why.
Standard 8: The liaison team involves carers in discussions about
assessment and treatment
Note: Subject to the patient giving consent, and/or carer involvement being in
the best interest of the patient
No.
Type.
Criterion
Ref.
8.1
2
Carers report that they were involved in discussions about
the patient’s care and treatment.
JOINT
8.2
2
The liaison professional offers carers written information
explaining what had been discussed in the assessment.
NICE
Note: Designated carers should be involved as fully as possible.
8.3
2
The carer is offered the choice of being copied into written
communication between the liaison team and other
services if appropriate.
DH
8.4
2
Carers who had contact with the liaison team reported
that liaison staff were supportive and helpful.
NICE
8.5
2
The liaison team supports carers to be involved in the
patient’s care whilst she/he is in hospital.
GPP
Note: For example, this may include re-orientation or
stimulation for patients with dementia.
16
Standard 9: The liaison team can communicate effectively with a range
of patients and carers
No.
Type.
Criterion
Ref.
9.1
1
The liaison team can access information in a range of
formats to suit individual patient needs.
JOINT
GPP
Note: The hospital should be able to access key information in
languages other than English, and for people with sight,
hearing, learning or literacy difficulties.
9.2
1
Liaison professionals have timely access to professional
interpreters/signers through the provider
Trust/organisation.
CQI1
GPP
Note:
 Relatives should not be used as sole interpreters;
 Where appropriate, telephone interpreters can be used,
but ideally should not be used for initial assessments;
 The Trust/organisation should have agreed timescales
for providing these.
9.3
1
Liaison professionals can access equipment to facilitate
communication with people with visual and/or hearing
impairments, cognitive impairment or learning disability.
Note: this might include a white board, marker pen and other
visual aids, a hearing amplifier and similar aids.
17
GPP
Collaborative Working in the General Hospital
Standard 10: There is effective collaboration between the team and
general hospital staff
No.
Type.
Criterion
Ref.
10.1
1
Liaison and acute staff have effective systems in place
to alert each other to potentially at-risk patients.
CR118
10.2
1
If the liaison team provides a service to the emergency
department, a member of the liaison team meets with
emergency department staff at least quarterly.
GPP
10.3
2
If the liaison team provides a service to the general
hospital, a member of the liaison team meets with
hospital staff at least quarterly.
GPP
10.4
1
Liaison professionals can access the physical health
records of their patients.
JOINT
10.5
2
Members of the liaison team can access both mental
health and acute information systems.
GPP
10.6
3
Liaison and acute managers ensure that there is a
mechanism which allows the liaison team and acute
staff to discuss differences of clinical opinion.
PIG
10.7
1
If members of the liaison team prescribe drugs, there is
a policy regarding the use of medication.
GPP
Note: This should be in line with local medicines management
and include:
 The team’s agreed use of different medication;
 Mechanisms for checking contraindications between
different medications being taken for mental and
physical problems, including over-the-counter
products, that may adversely affect cognitive
functioning;
 Mechanisms for monitoring side effects and advising
the patient on self-monitoring, where appropriate;
 The different responses to medication in different age
groups;
 Mechanisms for the safe administration of medication;
 Guidance on how to access a pharmacist;
 The use of honorary contracts for the liaison team.
10.8
2
Liaison professionals attend joint case reviews with
medical teams to advise on complex cases.
18
CR183
Standard 11: Unless the liaison team provides 24 hour cover, there is
effective collaboration between the liaison team and out-of-hours
services (e.g. Crisis Resolution Home Treatment teams, on-call staff etc)
No.
Type.
Criterion
Ref.
11.1
1
Joint protocols for out-of-hours cover are in place
between the liaison and out-of-hours service(s).
ACAD
PIG
GPP
Note: A written summary should be developed in consultation
with out-of-hours staff and is likely to include guidance on:
 The working hours and days of the liaison service and
the out-of-hours team(s);
 The clinical responsibilities of each service;
 The handover responsibilities of each service.
11.2
2
The liaison team and out-of-hours services work together
to share notes and develop joint plans for patients who
frequently attend the general hospital.
GPP
11.3
1
The liaison team has written working arrangements
detailing who is responsible for assessing patients who
may need to be detained under mental health legislation.
CR118
Note: E.g. Approved Mental Health Professionals and/or
Section 12 (England) and Section 20 (Scotland) doctors, or the
Crisis Resolution Home Treatment Team. Details of how to
contact Independent Mental Health/Mental Capacity Advocates
should also be included.
19
Interfaces with Other Services
Standard 12: The liaison team has an operational policy or written
guidance that explains how to refer patients to services including:
No.
Type.
Criterion
Ref.
12.1
2
Local mental health services (i.e. Community Mental
Health Teams, inpatient units, Home Treatment Teams,
Improving Access to Psychological Therapies Services).
GPP
12.2
2
Local primary care health services.
GPP
12.3
2
Specialist mental health services for older people.
JOINT
Note: A decision to refer someone to services for older people
should be based on need and not just age.
12.4
2
Local social services departments.
PIG
12.5
2
Local child or adolescent services, including details of
when it is appropriate for child or adolescent patients to
be seen by the working age adult liaison team.
GPP
Note: This should be based on need and not just the person's
age. A written summary should be developed in consultation
with Child and Adolescent Mental Health Services (CAMHS).
This may include guidance regarding referral/discharge to
CAMHS, if appropriate.
12.6
2
Liaison professionals take steps to check that referrals
to other services have been received.
20
GPP
Staffing, Support and Communication
Standard 13: The service is adequately staffed by a skilled team and can
access specialist skills where needed
No.
Type.
Criterion
Ref.
13.1
1
The liaison team comprises a number of staff to ensure
that it can perform its core functions safely.
PIG
GPP
13.2
2
The liaison team comprises a number of staff that is
proportional to national best practice guidance (see
appendix 2).
CR187
MSS
13.3
2
In the event of staff absence (i.e. sickness, maternity or
annual leave), there is a mechanism in place to bring in
additional staff to cover core work.
CCQI1
Note: In cases where cover is insufficient, the service has an
acceptable contingency plan, such as minor and temporary
reduction in non-essential services. This should be in the
form of a written summary which is agreed with other
services, if appropriate.
13.4
2
The liaison team has access to a drug and alcohol
worker.
MSS
13.5
2
The liaison team has access to a learning disability
nurse or similar specialist.
MSS
13.6
2
The liaison team has access to a mental health
pharmacist.
CR187
13.7
3
The liaison team has access to a support, time and
recovery worker (STR).
MSS
13.8
3
There has been a review of the staff and skill mix of the
liaison team within the past 12 months to identify gaps
in the team.
GPP
Note: The review should result in an action plan or business
plan being submitted to the managing organisation. This plan
should then be used to inform decisions on recruitment and
staff training.
21
Standard 14: Structures are in place to provide clear lines of
accountability, support and supervision
No.
Type.
Criterion
Ref.
14.1
2
There are up-to-date documents which state the
managerial and clinical responsibility and accountability
of staff.
CCQI3
14.2
2
All staff receive an annual appraisal.
CCQI1
14.3
1
All staff are able to contact a senior clinical and
managerial colleague at any time.
CCQI2
14.4
1
All staff are able to meet with their peers for support.
CCQI3
14.5
1
There are debriefing/reflection opportunities for staff
following traumatic incidents.
GPP
14.6
1
Members of the liaison team are offered regular clinical
supervision.
CCQI1
Note: Frequency of supervision should be in line with national
guidance for the person’s particular professional group. Staff
should have some choice in who supervises them, including
access to an external supervisor if preferred.
14.7
1
Liaison staff are satisfied with the frequency of
supervision they receive.
GPP
14.8
1
Liaison staff are satisfied with the quality of supervision
they receive.
GPP
14.9
1
Liaison professionals can access advice when necessary
(i.e. on the use of legal frameworks, confidentiality,
capacity and consent issues etc).
JOINT
Standard 15: There is clear communication within the liaison team
No.
Type.
Criterion
Ref.
15.1
1
The liaison team meets regularly (i.e. daily contact and
weekly meetings).
PIG
Note: For larger liaison teams which operate across various
sites and shifts, arrangements are in place to ensure that staff
from each group are represented in core team meetings and
all staff receive regular updates.
15.2
2
The liaison team has one core set of liaison health care
records.
PIG
15.3
2
The liaison team agree that communication within the
team is effective.
GPP
22
Standard 16: Structures are in place to ensure that the liaison team has
access to training, education and guidance
No.
Type.
Criterion
Ref.
16.1
2
Liaison staff are asked about their training needs at least
annually by their line manager.
GPP
16.2
2
Staff are not routinely denied relevant training due to a
lack of funding or staff cover.
CCQI2
16.3
3
There is a rolling training programme for liaison
professionals which is repeated to account for staff
rotation and changes.
GPP
HE
Note: Training programmes should include regular updates for
long-term staff, not just new staff. A list of core competencies
for liaison nurses can be accessed by emailing
S.Eales@city.ac.uk
16.4
1
All liaison staff know how to access the team’s policies,
procedures and written guidance relevant to their role.
CCQI1
16.5
2
Liaison staff can access the intranet and relevant shared
drives of their provider Trust or organisation.
CCQI2
16.6
2
Liaison staff can access online journals, reference guides
or text books.
CCQI2
16.7
2
There are opportunities for liaison staff to shadow
colleagues or attend placements in other areas of the
hospital (e.g. emergency department, general medical
wards, elderly wards etc).
PIG
16.8
3
There are opportunities for liaison staff to shadow mental
health colleagues from outside of the hospital.
GPP
16.9
2
The liaison service provides an induction to new liaison
team members which is based on an agreed list of core
competencies.
GPP
HE
Note: An induction checklist can be used to list the
competencies which new staff are expected to demonstrate,
with timescales attached.
23
Standard 17: Clinical and non-clinical members of the liaison team have
access to training and education in:
No.
Type.
Criterion
Ref.
17.1
1
A basic awareness of common mental health problems.
SH
17.2
1
A basic awareness of risk.
SH
Note: Including safety issues relating to the hospital
environment, such as ensuring that patients are not isolated
for long periods and staff knowing when to alert colleagues to
potential hazards.
17.3
1
Information sharing and confidentiality.
CCQI1
17.4
2
Culturally sensitive practice, disability awareness and
other diversity and equality issues.
CCQI1
17.5
2
Mental health and stigma.
GPP
17.6
2
Ageism and stigma.
GPP
17.7
2
Recognising special needs and knowing how to
provide/access support for people with visual, hearing,
literacy or learning disabilities.
GPP
24
Standard 18: Clinical members of the liaison team have access to advice,
training, and development opportunities appropriate to the patients
they work with, in order to allow them to perform their core role
No.
Type.
Criterion
Ref.
18.1
1
Clinical liaison staff have access to advice, training and
development in all of the following areas:
 Working with 16-18 year olds, if relevant.
 Working with older people, including the detection
and management of dementia, delirium and
depression.
 Conducting mental health assessments of acute
hospital patients.
 Assessing and managing a patient’s risk to self
and others.
 The use of legal frameworks, such as conducting
assessments, deprivation of liberty, assessing
capacity and providing medico-legal advice to
colleagues.
 Detecting and managing acute disturbance in
physically ill people of all ages (e.g. delirium,
psychosis etc) including the use of rapid
tranquilisation, if used.
 The protection of vulnerable adults and child
protection issues, including responding to
suspected abuse or domestic violence.
 Understanding why people self-harm and the
difference between self-harm acts and acts of
suicidal intent (for working age adults and for
older people).
 Suicide awareness, prevention techniques and
approaches.
 Preventing and managing challenging behaviour.
 Detecting the misuse of alcohol and knowing
where to signpost if necessary.
 Detecting the misuse of drugs and knowing where
to signpost if necessary.
GPP
PIG
CCQI1
SH
25
18.2
2
Clinical liaison staff have access to advice, training and
development in at least 60% of the following areas,
appropriate to their role:
 Understanding the interface between complex
physical and psychological problems.
 Recognising and managing emotional responses to
trauma.
 Recognising and managing medically unexplained
symptoms.
 Recognising and managing organic mental health
disorders.
 Person-centred care planning.
 The use of therapeutic approaches in the
assessment process, such as psychotherapeutic
theories.
 Awareness of the processes involved in adjusting to
illness, including issues of non-adherence and
phobic responses to illness.
 Working with people diagnosed with personality
disorder.

The impact of cultural differences on mental health
and use of services.
 The needs of people with learning disabilities.
 Awareness of the liaison team’s role following major
incidents.
 The role of nutrition and diet in liaison psychiatry
patients.
 Eating disorders.
 Pain management.
26
Standard 19: Training provided to the liaison team is planned and
delivered in collaboration with key partners
No.
Type.
Criterion
Ref.
19.1
2
Patients or carers are actively involved in the planning or
delivery of training to liaison professionals.
PIG
Note: This might be through a Trust/organisation or third
sector and may include developing a training session,
developing materials, DVDs and so on.
19.2
2
Liaison and acute staff work together to deliver joint
training to the liaison team.
ACAD
Note: For example, a geriatrician and liaison nurse could
jointly provide dementia training to the rest of the liaison
team.
Quality, Audit and Governance
Standard 20: The performance of the liaison service is monitored
No.
Type.
Criterion
Ref.
20.1
1
The liaison team has reviewed its performance in the
past twelve months.
PIG
Note: For example using clinical audit, service evaluation,
performance indicators or clinical outcome measures.
20.2
2
The liaison team has a written document detailing key
performance indicators.
GPP
Note: Examples include, response times to referrals, reduction
in mental health related 4-hour Emergency Department
breaches, number of people who have self-harmed being
offered a psychosocial assessment etc.
20.3
1
Written information is offered to patients and carers
about how to give feedback to the team, including
compliments, comments, concerns and complaints.
PIG
20.4
1
There is evidence of action and feedback from any
negative comments and complaints made about the
liaison team.
CCQI2
20.5
3
The liaison team uses findings from service evaluation to
support or inform business cases and changes to the
service.
GPP
27
20.6
2
An integrated governance/joint planning group (or
similar) involving senior clinicians and managers from the
liaison service and acute hospital meet at least quarterly.
CR183
Note: The group should: Review matters relevant to clinical and organisational
risk and quality;
 Co-ordinate planning of service developments;
20.7
1

Co-ordinate plans for high risk clinical scenarios
especially where these are likely to involve several
services or organisations;

Report through locally determined management
structures.
The managing Trusts/organisations have an agreed
protocol in place for reporting and responding to safety
concerns raised by staff from either Trust or organisation.
GPP
Note: This should link to governance structures.
20.8
2
Liaison professionals are involved in Trust/organisational
meetings which address critical incidents, near-misses
and other adverse incidents, where relevant to the liaison
team.
28
GPP
Domain 2: Providing Emergency Mental Health
Care to Adults of all Ages
Definitions of ‘emergency’ and ‘urgent’ referrals
Emergency: An acute disturbance of mental state and/or behaviour which
poses a significant, imminent risk to the patient or others.
Urgent: A disturbance of mental state and/or behaviour which poses a risk to
the patient or others, but does not require immediate mental health
involvement.
Standard 21: People with mental health needs are assessed within the
appropriate timescales
Important notes:
 The following standards relate to the responsiveness of the liaison team within its
usual operating hours and not the response of other services such as out-of-hours
teams.
 When standards relating to response times are being measured, the process will
take into account legitimate reasons for delayed assessment (such as patients not
being fit for assessment).
 The definitions of ‘emergency’ and ‘urgent’ referrals above are provided for the
purpose of the standards. It is not being suggested that teams must necessarily
adopt this system of classification.
No.
Type.
Criterion
Ref.
21.1
1
Patients referred for emergency mental health care are
seen within 60 minutes.
CR118
GPP
Note: If the liaison team is not based on site and are unable to
respond to emergency assessments, there are clear
arrangements regarding whose responsibility it is to do so.
There should also be clear arrangements for immediate
telephone advice to the referrer.
21.2
1
Patients referred for urgent mental health care are seen
within the same working day.
GPP
21.3
2
Referrers are satisfied with the liaison team’s speed of
response to emergency referrals.
GPP
21.4
2
Referrers are satisfied with the liaison team’s speed of
response to urgent referrals.
GPP
29
Domain 3: Providing Routine Mental Health
Care to Working Age Adults
Definitions of referral type
Emergency: An acute disturbance of mental state and/or behaviour which
poses a significant, imminent risk to the patient or others.
Urgent: A disturbance of mental state and/or behaviour which poses a risk to
the patient or others, but does not require immediate mental health
involvement.
Routine: All other referrals, including patients who require mental health
assessment, but do not pose a significant risk to themselves or others, and are
not medically fit for discharge.
Standard 22: Liaison psychiatry services for the routine care of working
age adults are adequately planned and commissioned/contracted
Note: ‘Routine’ refers to all cases which are not emergency or urgent referrals.
No.
Type.
Criterion
Ref.
22.1
2
The liaison service is commissioned/contracted to provide
routine assessment and care to working age adults
throughout the hospital.
GPP
22.2
2
The liaison service is commissioned/contracted to provide
routine assessment and care to all working age adults,
regardless of the patient’s address.
GPP
Standard 23: People with non-urgent mental health needs are assessed
within the specified timescales
No.
Type.
Criterion
Ref.
23.1
1
Patients referred for routine mental healthcare are seen
within two working days.
GPP
23.2
2
Referrers are satisfied with the liaison team’s speed of
response to routine referrals for working age adults.
GPP
23.3
3
For teams that are striving for an ‘excellent’ accreditation
status: the two day target for non-urgent referrals is
consistently exceeded.
GPP
23.4
2
All older patients under the care of the liaison team who
have a diagnosis of dementia have a review of
antipsychotic medication during their hospital stay.
MSS
30
Domain 4: Providing Routine Mental Health
Care to Older People
Please note: these standards are not the only standards relating to the care of
older people; all of the other standards relate to the provision of emergency
mental health care to older people. This section relates to services which also
provide routine mental health care to older people.
Definitions of referral type
Emergency: An acute disturbance of mental state and/or behaviour which
poses a significant, imminent risk to the patient or others.
Urgent: A disturbance of mental state and/or behaviour which poses a risk to
the patient or others, but does not require immediate mental health
involvement.
Routine: All other referrals, including patients who require mental health
assessment, but do not pose a significant risk to themselves or others, and are
not medically fit for discharge.
Standard 24: Liaison psychiatry services for older people are adequately
planned, commissioned/contracted and managed
No.
Type.
Criterion
Ref.
24.1
2
The liaison service is commissioned/contracted to provide
routine assessment and care to older people throughout
the hospital.
GPP
24.2
2
The liaison service is commissioned/contracted to provide
routine assessment and care to all older people,
regardless of the patient’s address.
GPP
24.3
2
A designated lead for older people’s mental health attends WCW
a forum which meets quarterly, and includes the
discussion of key operational, clinical and governance
issues including safety.
31
Standard 25: The liaison team responds promptly to routine referrals for
older people
No.
Type.
Criterion
Ref.
25.1
1
Patients referred for routine mental healthcare are seen
within two working days.
GPP
25.2
2
Referrers are satisfied with the liaison team’s speed of
response to routine referrals for older people.
GPP
25.3
3
For teams that are striving for an ‘excellent’ accreditation
status - the two day target for routine older adult
referrals is consistently exceeded.
GPP
Standard 26: Liaison teams working with older people have access to
advice, training and development opportunities appropriate to their core
role, including:
No.
Type.
Criterion
Ref.
26.1
1
Detecting and managing dementia in older people.
GPP
26.2
1
Detecting and managing delirium in older people.
GPP
26.3
1
Detecting and managing depression in older people.
GPP
26.4
1
Undertaking specialist assessment of a patient with
cognitive impairment.
GPP
Note: This might include:
• Examination of attention and concentration, orientation,
short and long-term memory, praxis, language and
executive function;
• Formal cognitive testing using a standardised
instrument, e.g. the Mini Mental State Examination
(MMSE);
• Arranging for more in-depth neuropsychological testing
as indicated, e.g. for early onset or complex dementia;
• Talking to carers/family members;
• Assessing the impact on daily living and mental health
well-being.
26.5
2
The roles of the different health and social care
professionals, staff and agencies involved in the delivery
of care to older people.
GPP
26.6
2
Referral pathways and joint working arrangements with
local health services for older people.
GPP
32
Domain 5: Providing Interventions
Guide to timescales for interventions:
Brief interventions: up to six sessions.
Longer term interventions: more than six sessions.
Standard 27: The liaison team is able to provide effective interventions,
where needed
No.
Type.
Criterion
Ref.
27.1
2
The liaison service is commissioned/contracted to
provide brief, time-limited follow-up care to
patients.
NIMHE
27.2
2
The liaison team provides brief, time-limited,
evidence based interventions.
PIG
GPP
Note: See Appendix 4 for evidence-based interventions
recommended by NICE.
27.3
3
The liaison team is commissioned/contracted to
provide longer term interventions in the general
hospital.
NICE
GPP
27.4
3
The liaison team provides longer term therapeutic
interventions.
NICE
27.5
2
The liaison team can access sufficient space in the
hospital to deliver interventions safely.
GPP
NICE
27.6
2
The majority of patients were satisfied with the
length of time it took them to receive an
appointment with the outpatient team.
GPP
27.7
2
The majority of patients were satisfied with the
number of follow-up sessions that are offered to
them.
GPP
27.8
2
The majority of patients and peer reviewers agree
that the outpatient facilities are safe.
GPP
27.9
2
The majority of patients and peer reviewers agree
that outpatient facilities are private.
GPP
27.10 2
Liaison professionals actively follow up nonattenders who have missed an appointment with the
liaison team.
NICE
27.11 1
The liaison team or service manager has ensured
that liaison staff have received sufficient training in
any therapeutic interventions they provide.
PIG
27.12 1
Liaison professionals receive supervision relating to
any therapeutic interventions they provide.
GPP
33
Domain 6: Providing Training to Hospital
Colleagues
Standard 28: The liaison team provide training to hospital colleagues
No.
Type.
Criterion
Ref.
28.1
2
The liaison service is funded to deliver mental health
training to staff in the emergency department.
ACAD
NHSC
28.2
2
The liaison service is funded to deliver mental health
training to staff in the general hospital (wards and so
on).
ACAD
NHSC
28.3
3
The liaison team has a rolling programme of training for
general hospital staff which is repeated to account for
staff changes.
CR183
28.4
3
The liaison team regularly provides induction training to
junior doctors.
CEM
28.5
3
The liaison team records details of the training it
provides, such as the curriculum, a list of attendees and
a summary of feedback.
GPP
28.6
3
The liaison team has developed the training programme
in consultation with training participants.
GPP
28.7
3
The liaison team evaluates the effectiveness of its
training.
CR183
28.8
2
Acute colleagues are satisfied with the amount of training
provided by the liaison team.
28.9
2
Acute colleagues are satisfied with the quality of training
provided by the liaison team.
Standard 29: The liaison team has provided a range of training to
hospital professionals in the past 12 months, including topics such as:
No.
Type.
Criterion
Ref.
29.1
2
How to make an initial mental health assessment of an
acute hospital patient.
CR118
29.2
2
Working with adults aged over 65, including the
detection and management of dementia, delirium and
depression.
GPP
29.3
2
How to assess and manage the patient’s risk to self and
others.
CR118
29.4
2
The use of mental health legislation.
CR118
29.5
2
Detecting and responding to acute disturbance in
physically ill people of all ages e.g. delirium, psychosis
etc.
CR118
29.6
2
Understanding why people self-harm and the difference
between self-harm and acts of suicidal intent (including
for older people).
NICE
34
29.7
2
Suicide awareness, prevention techniques and
approaches.
PIG
29.8
2
Preventing and managing challenging behaviour.
PIG
29.9
2
Recognising and responding to organic mental health
disorders.
GPP
29.10 3
Detecting the misuse of alcohol.
JOINT
29.11 3
Detecting the misuse of drugs.
JOINT
29.12 3
Recognising and responding to emotional responses to
trauma.
JOINT
29.13 3
Recognising and responding to medically unexplained
symptoms.
GPP
29.14 3
Awareness of the processes involved in adjusting to
illness, including issues of non-adherence and phobic
responses to illness.
GPP
29.15 3
The impact of cultural differences on mental health and
use of services.
ACAD
SH
29.16 3
Mental health and stigma.
GPP
29.17 3
Ageism and stigma.
GPP
29.18 3
Working with people diagnosed with personality
disorder.
GPP
See Appendix 1 overleaf for suggested approaches to training acute
colleagues.
Standard 30: The liaison team provides support and supervision to acute
colleagues, including:
No.
Type.
Criterion
Ref.
30.1
2
Providing informal supervision, such as case reviews,
multi-disciplinary discussions etc to acute colleagues.
CR118
30.2
3
Providing formal regular supervision to acute colleagues.
GPP
30.3
3
Providing formal regular supervision to trainee
psychiatrists and doctors.
JOINT
30.4
3
The liaison team has a rolling programme of training for
Emergency Department staff which is repeated to
account for staff changes.
CR118
30.5
2
Acute staff are satisfied with the amount of support and
supervision provided by the liaison team.
CR118
30.6
2
Acute staff are satisfied with the quality of support and
supervision provided by the liaison team.
CR118
35
Appendix 1: Examples of Training Provided to
Acute Colleagues
The following approaches to training are suggested by the report Liaison
psychiatry for every acute hospital: Integrated mental and physical healthcare.
College report from the Royal College of Psychiatrists (CR183). The brief
extracts below should be read in conjunction with the full report, which
can be found on the Royal College of Psychiatrists website
Examples of tailored education include greater emphasis on:


Self-harm and alcohol use disorders for staff in the emergency
department and acute medical unit.
Dementia for staff in elderly medicine, the acute medical unit and trauma
services.
Organic mental disorders and medically unexplained symptoms for staff in
neurosciences services.
Examples of tailoring training about depression and mental capacity includes
emphasis on:


Nutrition, self-care, activity and medication refusal for ward-based staff
Diagnosis, medication, treatment refusal and the role of mental health
legislation for senior medical staff.
Specific communication skills and simple techniques to improve mood and
behavioural activation for all staff.
The following level of formal educational sessions should be regarded as
minimum for all services. Some services may achieve the educational objectives
through on-line modules supplemented by face to face training.



Two sessions per year, per hospital, on communication and other
psychological skills to discuss and manage common emotional and
behavioural reactions to physical illness in an acute hospital, including
adjustment reactions.
Three sessions per year, per hospital, regarding depression, self-harm,
dementia, medically unexplained symptoms and challenging behaviour;
including the influence of personality disorders, psychosis, alcohol
withdrawal and delirium on acute hospital care.
One session per year, per hospital, on the application of legislation related
to mental and physical health care tailored to an acute hospital setting,
including treatment refusal and detention for the patient’s health or safety
(in England this relates to the Mental Health Act and its interface with the
Mental Capacity Act).
36
Appendix 2: Examples of Liaison Psychiatry
Staffing Levels
The following excerpt is taken from: Liaison psychiatry for every acute
hospital: Integrated mental and physical healthcare. College report from
the Royal College of Psychiatrists (CR183). These examples should be read
in conjunction with the full report, which can be found on the Royal College of
Psychiatrists website
Staffing numbers: Development of liaison psychiatry services needs to match the
number and skills of staff to the number and type of referrals, the latter being
significantly affected by the age of patients and the number of beds and
complexity of services in the acute hospital.

Due to the level of need and complexity of physical and mental health
interactions, hospitals with tertiary care centres and services for younger
adults tend to require more input at the consultant psychiatrist level
(Parsonage et al 2010)
Table 1 and 2 (see page 37 of these standards) indicate staffing requirements
for a core service to a 650 bedded general hospital and to a 100 bedded general
hospital with tertiary centres, operating 7 days a week with only emergency and
urgent referrals being seen at weekends and on bank holidays. Although services
must not discriminate on age, there needs to be appropriate skills and service
design to meet the specialist requirements of different ages. Therefore staffing
levels in tables 1 and 2 are given according to current mental health training
with expertise in managing adults 18-65 years and >65 years of age.

It would be expected that even with age-specialist subteams, there would
be flexibility to ensure patients are seen by the subteam with skills most
appropriate to their individual needs.
The overall staffing number would still be expected to meet those outlined in
Tables 1 and 2 even if some team functions were provided across the age range,
thereby affecting the distribution of staffing in the sub-teams. For example,
extended out-of-hours cover for the emergency department and acute medical
unit may be solely provided by staff from the younger adults sub-team and a
dementia service solely from the older adults sub-team.
37
Table 1: For a service providing to the emergency department and wards of a
650 bedded general hospital.
Profession
Working Age (Ages 18-65)
Older People (65 years & older)
Medical
1.5 Consultant Liaison
Psychiatrist
1.0 Staff grade or specialist
trainee
1.0 junior trainee
1.0 band 7/8 Lead nurse*
2.0 band 7 nurses**
4.0 band 6 nurses**
1.0 Consultant Liaison
Psychiatrist
0.5 Staff grade or specialist
trainee
0.5 junior trainee
0.5 band 7/8 Lead nurse*
1.0 band 7 nurse**
4.0 band 6 nurses**
1.0 band 6 nurse with a lead for
learning disabilities++
0.5 band 6 social worker
0.5 band 5 occupational
therapist
0.2 band 7 clinical or health
psychologist
1.0 band 3/4 administrator
Nursing
Other health
professionals
0.5 band 7 clinical or health
psychologist
0.4 band 7 mental health
pharmacist+
Administrative 1.5 band 3/4 administrator
Table 2: For a service providing to the emergency department and wards of a
1000 bedded general hospital with tertiary centres
Profession
Working Age (Ages 18-65)
Older People (65 years & older)
Medical
3.0 Consultant Liaison
Psychiatrist (including
expertise in substance
misuse)
1.0 Staff grade
1.0 Specialist trainee
1.0 Junior trainee
1.0 band 7/8 Lead nurse*
3.0 band 7 nurses**
4.0 band 6 nurses**
1.5 Consultant Liaison
Psychiatrist
0.5 Staff grade
1.0 Specialist trainee
1.0 junior trainee
Nursing
Other health
professionals
1.0 band 7 clinical or health
psychologist
1.0 band 7 mental health
pharmacist+
Administrative 2.5 band 3/4 administrator
38
0.5 band 7/8 Lead nurse*
2.0 band 7 nurses**
4.0 band 6 nurses**
1.5 band 6 nurse with lead for
learning disabilities++
1.0 band 6 social worker
0.5 band 5 occupational
therapist
0.5 band 7 clinical or health
psychologist
2.0 band 3/4 administrator
*Lead Nurse is expected to undertake clinical duties as well as nursing line
management duties in the team and would be expected to be a band 7 or 8
depending on their role in wider management/development of the service
**If nurses work as independent practitioners then they will usually require
being graded at band 7
+
Dedicated mental health pharmacist does not replace usual ward pharmacist
responsibilities and may be part of the hospital pharmacy service rather than the
Liaison Psychiatry service
+
Dedicated mental health pharmacists and
will work across all adult ages
++
Lead nurse for learning disabilities
If fewer staff are provided than shown in tables 1 and 2, the service will not be
able to meet all the core clinical, educational and clinical governance
requirements.

Not all functions of the liaison psychiatry service need to be provided
across all hours of service functioning. More routine core functions of the
service - such as service development, clinical governance, case
conferences, education and routine assessments and follow-up-may be
provided on a more restricted basis than rapid response to emergency and
urgent referrals.
The level of staffing and skill mix of staff may justifiably vary at different hours
of operation of the service. The details of variation in staffing should be
influenced by functions of the service and other local resources.
Four base models of liaison psychiatry service
The extracts and diagrams below are taken from Model Service Specifications
for Liaison Psychiatry Services - Guidance (first edition). These extracts
should be read in conjunction with the full report which can be found at the
Mental Health Partnerships website
Four models of hospital based liaison psychiatry service are described each with
their own colour code to help the commissioner follow the text relevant to that
model through the document (see diagram on page 39).




Core Liaison Psychiatry Services
Core 24 Liaison Psychiatry Services
Enhanced 24 Liaison Psychiatry Services (Enhanced with adjustments to
fill local gaps in service and some outpatient services)
Comprehensive Liaison Psychiatry Services (Enhanced with inpatient and
outpatient services to specialties at regional and supra regional level)
39
Table 3: High-level summary of differences between models
From the report, Model Service Specifications for Liaison Psychiatry Services –
Guidance (first edition).
Core
Core 24
Enhanced 24
Comp
c 500
c 500
c 500
c 2000
2
2
4
5
0.6
2
2
2
2 Band 7
6 Band 6
6 Band 7
7 Band 6
3 Band 7
7 Band 6
2 Band 8b
17 Band 6
10 Band 5
Other Therapists
0
4
2
16
Team Manager Band 7
1
1
1
3
Clinical Service manager
Band 8
0.2
0.2 – 0.4
0.2 - 0.4
1
Admin Band 2, 3 and 4
2.6
2
2
12
0
1
1
1
Total Whole Time
Equivalent
14.4
25.2 - 25.4
22.2 – 24.4
69
Hours of Service
9-5
24/7
24/7
24/7
Age
16+
16+
16+
16+
Older Person
Yes
Yes
Yes
Yes
Drug and Alcohol
No
Yes
Yes
Yes
Out Patient
No
No
Yes
Yes
Specialities
No
No
No
Yes
£0.7M
£1.1M
£1.4M
£4.5M
Example Number of Beds
Consultants
Other Medical
Nurses
Business support (band 5)
Approx Costs
Detailed descriptions on these models and their differences in terms of staff size
and skill mix can be found in document 3, ‘Developing Models for Liaison
Psychiatry Services - Guidance for Commissioning Support’. An example of
further defining the optimal service for your local context can be found in
appendix 3 of document 2, ‘An Evidence Base for Liaison Psychiatry Services –
Guidance for Commissioners’.
40
Diagram 1: Scaling models to meet local need.
From the report Model Service Specifications for Liaison Psychiatry Services Guidance (first edition).
41
Appendix 3: Examples of Assessment Rooms
Many liaison teams initially struggle to meet the standard around assessment rooms
and PLAN is keen to support teams to make the changes required. PLAN can send
supportive letters to senior managers in a Trust or organisation to help persuade them
to finance changes to the room – this has resulted in numerous rooms being improved.
The guidance below is intended to help teams make changes to their rooms. Please
contact PLAN if you would like us to support you or provide further information.
Rooms need to be furnished so that furniture cannot easily be used as a weapon. The
seating should be sturdy and comfortable. Ideally the room needs to be big enough to
allow four people to sit comfortably in, and when the peer review team visit your
hospital and room, they need to agree that the facilities are safe and private. Because
of these requirements some people feel the assessment room can look too stark and
unfriendly. Canvas pictures which are secured tightly to the wall are a way of
brightening up the room, as is painting the walls.
Points to consider









Are there any ligature points?
Can the furniture be easily picked up?
Are any windows in the room made of toughened glass?
How big is the observation panel or window? Privacy is also important and
frosted film can be purchased cheaply to ensure privacy of patients.
Is there a strip alarm if staff do not carry personal alarms?
Can the door open outwards and ideally both ways?
Are there two doors?
Are any pictures on the wall made of canvas and securely fastened?
Is there any other furniture other than seating? If so this needs to be removed.
If your room is unsuitable (for example if it is also used as a medical room and
contains a sink, bed etc) PLAN can contact commissioners and managers on a team’s
behalf to highlight the inadequacy of the room. We will send a letter which emphasises
the positive work the team is doing, and we will outline the achievements of the team,
and inform the Trust(s) that the standard regarding the assessment room needs to be
met to achieve accreditation. PLAN gives teams time to make these changes and offers
advice on the recommendations that need to be met. In our experience, this is almost
always effective in making the changes happen. Although it might take longer for a
team to be accredited, it does result in a room that is safer for patients and staff.
On the next pages are some good examples of assessment rooms which meet PLAN
standards.
42
Sturdy seating and a door which opens outwards.
Two doors, privacy shutters and a strip alarm.
Bright sofas which can seat four people make a room more welcoming.
43
Appendix 4: Examples of Interventions
recommended by NICE: National Institute of
Health and Clinical Excellence
Anxiety: http://publications.nice.org.uk/generalised-anxiety-disorder-and-panicdisorder-with-or-without-agoraphobia-in-adults-cg113


Cognitive Behavioural Therapy (CBT)
Structured problem solving
Dementia: http://www.nice.org.uk/nicemedia/pdf/CG042NICEGuideline.pdf
For those who have depression and/or anxiety:
 CBT
 Reminiscence therapy
 Multisensory stimulation
Depression: http://www.nice.org.uk/nicemedia/pdf/CG23fullguideline.pdf





Structured problem solving (mild-moderate depression)
Brief CBT
Counselling
Interpersonal therapy (IPT) (moderate –severe depression)
Psychodynamic therapy (complex co-morbidities)
Depression with a chronic physical health problem–guideline in development:
http://www.nice.org.uk/CG91



Group-based CBT or individual CBT for patients who decline group-based CBT or
for whom it is not appropriate, or where a group is not available
Couples therapy
For patients with initial presentation of severe depression and a chronic physical
health problem, consider offering a combination of individual CBT and an
antidepressant.
Drug misuse: http://guidance.nice.org.uk/CG51/NiceGuidance/pdf/English




Group based psycho-educational interventions
Contingency management
Behavioural couples therapy
CBT for co-morbid depression and anxiety
Schizophrenia: http://www.nice.org.uk/nicemedia/pdf/CG82FullGuideline.pdf


Cognitive Behavioural Therapy
Arts therapy
Self-harm: http://guidance.nice.org.uk/CG16/Guidance/pdf/English
 Behavioural Therapy
44
Appendix 5: Examples of Interventions
recommended by SIGN: Scottish Intercollegiate
Guidelines Network
Dementia: http://www.sign.ac.uk/pdf/sign86.pdf






Behaviour management
Caregiver intervention programmes
Cognitive stimulation
Multi sensory stimulation and combined therapies
Recreational and physical activities
Reality orientation therapy
Depression: http://www.sign.ac.uk/pdf/sign114.pdf











Psychological therapies
Behavioural Activation
Cognitive Behavioural Therapy
Interpersonal Therapy
Mindfulness Based Cognitive Therapy
Problem Solving Therapy
Psychodynamic Psychotherapy
Self help
Guided Self Help
Computerised Self Help
Exercise
Alcohol misuse: http://www.sign.ac.uk/pdf/sign74.pdf




Referral and follow up to:
NHS services
Lay services (e.g. Alcoholics Anonymous)
Patient’s family should be helped by the Primary Care Trust to support them to
make positive choices regarding their recovery
Schizophrenia: http://www.sign.ac.uk/pdf/sign131.pdf




Cognitive Behavioural Therapy
Cognitive remediation
Family Intervention
Social skills training
45
Appendix 6: Key to References
The documents listed below demonstrate those which inspired, or those which closely
relate to, the various PLAN criteria. Although many of the PLAN criteria map closely to
these documents, some criteria have been adapted and revised slightly, and should
therefore not necessarily be interpreted as direct quotes from the source documents.
ACAD
Academy of Medical Royal Colleges (2008). Managing urgent mental health
needs in the acute trust. A guide by practitioners, for managers and
commissioners in England and Wales.
http://www.rcpsych.ac.uk/pdf/ManagingurgentMHneed.pdf
ASS’T
Royal College of Psychiatrists (2004) Assessment following self-harm in adults.
Council report CR122
http://www.rcpsych.ac.uk/workinpsychiatry/qualityimprovement/qualityandacc
reditation/liaisonpsychiatry/plan/membersarea/resources.aspx
CCQI1
Royal College of Psychiatrists (2009). Inpatient services for people with
learning disabilities standards.
http://www.rcpsych.ac.uk/pdf/LD%20standards_Pilot%20version.pdf
CCQI2
Royal College of Psychiatrists (2009). Standards for Acute Inpatient Wards –
Working Age Adults.
http://www.rcpsych.ac.uk/pdf/AIMS%20%20National%20Report%20for%20Working%20Age%20Acute%20Wards.pdf
CCQI3
Royal College of Psychiatrists (2008). Quality Improvement Network for MultiAgency CAMHS: Service Standards (second edition).
CR118
Royal College of Psychiatrists and British Association for Accident and
Emergency Medicine London (2004). Psychiatric services to accident and
emergency departments. Council report CR118.
CR183
Royal College of Psychiatrists (2013). Liaison psychiatry for every acute
hospital: Integrated mental and physical healthcare.
https://www.rcpsych.ac.uk/files/pdfversion/CR183.pdf
GPP
‘Good Practice Principle’: established by expert consensus, July 2009 and
August 2010 (see acknowledgements on page 45 for details of those who
contributed).
HE
Hart, C. and Eales, S. (2004). A Competency Framework for Liaison Mental
Health Nurses. Unpublished and accessible from S.Eales@city.ac.uk
JOINT
Royal College of Psychiatrists and the Royal College of Physicians (2003).The
psychological care of medical patients: A practical guide. College report
CR108.
http://www.rcpsych.ac.uk/files/pdfversion/cr108.pdf
The Strategic Clinical Network for Mental Health, Dementia and Neurological
Conditions South West (2013). Model Service Specifications for Liaison
Psychiatry Services - Guidance for Commissioning Support (first edition)
http://mentalhealthpartnerships.com/resource/model-service-specificationsfor-liaison-psychiatry-services
National Institute of Clinical Excellence (NICE) and the National Collaborating
Centre for Mental Health (2004). The short-term physical and psychological
management and secondary prevention of self-harm in primary and secondary
MSS
NICE
46
care.
http://www.nice.org.uk/nicemedia/pdf/CG16FullGuideline.pdf
NICE1
National Institute for Health and Clinical Excellence (2006). Dementia: The
NICE-SCIE guideline on supporting people with dementia and their carers in
health and social care.
http://www.nice.org.uk/nicemedia/pdf/CG42Dementiafinal.pdf
NO-H
Royal College of Psychiatrists and Academy of Medical Royal Colleges (2009).
No health without mental health: the supporting evidence.
http://www.rcpsych.ac.uk/pdf/No%20Health%20%20%20the%20evidence_%20revised%20May%2010.pdf
PIG
Aitken, P (2007). Mental health Policy Implementation Guide: Liaison
psychiatric and psychological medicine in the general hospital.
http://www.rcpsych.ac.uk/pdf/PIG2.pdf
SH
Royal College of Psychiatrists (2006). Better services for people who selfharm: Quality standards for healthcare professionals.
http://www.rcpsych.ac.uk/PDF/Self-Harm%20Quality%20Standards.pdf
47
Appendix 7: Acknowledgements
We would like to thank the following people for their continued advice and support on
PLAN:
The PLAN Accreditation Committee (AC)
o
Jim Bolton, Consultant Liaison Psychiatrist and PLAN AC Chair, South West
London and St George’s Mental Health NHS Trust.
o
Richard Brownhill, Deputy General Manager and Associate Lecturer, Royal
College of Nursing.
o
Peter Byrne, Consultant Liaison Psychiatrist, East London NHS Foundation Trust.
o
Alison Cobb, Senior Policy and Campaigns Officer, Mind (National).
o
Sarah Eales, Programme Manager Mental Health Nursing and Senior Lecturer in
Mental Health at City University, London.
o
Anne Hicks, Emergency Medicine Consultant, College of Emergency Medicine.
o
Steve Hood, Consultant Gastroenterologist, Royal College of Physicians.
o
Satveer Nijjar, PLAN Patient Advisor.
o
Richard Pacitti, Chief Executive of Mind in Croydon and Deputy Chair of the PLAN
AC.
o
Chris Roseveare, Consultant Physician, Royal College of Physicians.
o
Amrit Sachar, Consultant Liaison Psychiatrist, Imperial College Healthcare NHS
Trust.
o
Chris Wright, PLAN Patient Advisor.
Other contributors to the standards revision
o
Julie Armstrong PLAN Patient Advisor
o
Paul Chrichard, Senior Mental Health Practitioner, Devon Partnership NHS Trust
o
Jenny Cook, Clinical Lead, University Hospitals Coventry and Warwickshire NHS
Trust
o
Dru Cherry, Team Manager, South West London and St George’s Mental Health
NHS Trust
o
Jo Fisher, Service Manager, Humber NHS Foundation Trust
48
o
Vicky Glen-Day, Service Lead, Guys and St Thomas NHS Foundation Trust
o
Mandy Haddock, Clinical Team Leader, Devon Partnership NHS Trust
o
Brian Hills, PLAN Carer Advisor
o
Nick Holdsworth, Nurse Consultant, Northumberland Tyne and Wear NHS
Foundation Trust
o
Chloe Hood, Programme Manager, National Audit of Dementia and the Quality
Mark for Elder- Friendly Hospital Wards
o
Eliza Johnson, Consultant Clinical Psychologist, Birmingham and Solihull Mental
Health NHS Foundation Trust
o
Joseph Jones, Mental Health Liaison Clinician, Worcestershire Health and Care
NHS Trust
o
Melanie King, Team Manager, East London NHS Foundation Trust
o
Jennifer Luchoomun, Nurse Practitioner, University Hospitals Southampton NHS
Foundation Trust
o
David McDowell, Psychiatric Liaison Nurse, South West London and St George’s
Mental Health NHS Trust
o
Nick Nalladorai, PLAN Carer Advisor
o
Ayan Nayak, Consultant Psychiatrist, Sheffield Health and Social Care NHS
Foundation Trust
o
Elizabeta B. Mukaetova-Ladinska, Senior Lecturer and Consultant in Old Age
Psychiatry, Northumberland Tyne and Wear NHS Trust
o
John Murphy, Mental Health Nursing Adviser and Service Manager, Central and
North West London NHS Foundation Trust
o
Renata Souza, Deputy Programme Manager, National Audit of Dementia
o
Keith Waters, Team Leader/Clinical Nurse Specialist, Mental Health Liaison
Team, Derbyshire Healthcare NHS Foundation Trust
49
Psychiatric Liaison Accreditation Network (PLAN)
Royal College of Psychiatrists
21 Prescot Street
London
E1 8BB
Registered Charity
Number 228636
50