NHS reforms

General hospital staff ill-equipped to deal with mental health patients

Hospitals’ failure to integrate physical and mental healthcare is leading patients with incidental mental health conditions to receive poor care, a report has found.

An in-depth review of 552 patient cases by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD), most admitted via A&E, found that less than half of patients (46.3%) received a review by a liaison psychiatry team during their stay in hospital.

Only 95 of the 208 hospitals involved in the study had mandatory training for staff on managing patients with mental health conditions.

Experts warned that general hospital staff are often ill-equipped to deal with patients with mental health conditions, adversely affecting patients’ health as a consequence.

Calling on general hospitals to integrate physical and mental healthcare services as a matter of urgency, report co-author Dr Vivek Srivastava, NCEPOD clinical co-ordinator and consultant in acute medicine, says that general hospital  staff often don’t have the knowledge or confidence to care for people with mental health conditions appropriately: “Good care was only provided to 46% of patients in this study, showing patients who had a mental health condition suffered the double-whammy of both poor physical and mental healthcare.

“The systems don’t exist to train hospital staff appropriately in the care of patients who also happen to have a mental health condition, so immediately there is an issue with having the confidence to care for this group of patients. Once someone is admitted to hospital it is likely to expose any underlying issue such as a mental health problem, and staff need to have the confidence to deal with this, and have access to and know how to refer to mental health services.”

NCEPOD’s report found that only 57.3% of hospitals involved with the study had a policy or protocol specifying which patients should be referred to liaison psychiatry, with 49.1% of patients having an inadequate mental health history taken during consultant review.

“Our report reveals a massive divide between the physical healthcare and mental healthcare people receive in general hospitals,” said Dr Sean Cross, NCEPOD’s clinical co-ordinator in liaison psychiatry and co-author of the report, ‘Treat as One – Bridging the gap between mental and physical healthcare in general hospitals’.

“One in four of us will suffer a mental health condition at some point in our lifetime. General hospitals need to take mental healthcare seriously and understand how to provide holistic care for mind and body.”

Worryingly, only 11% of hospitals shared complete access to a patient’s mental health records from the community, leading to a gap in knowledge about patients’ full healthcare situation.

“For many years mental healthcare in the NHS has been underfunded, and you may rightly conclude from this new NCEPOD report that patients with mental health conditions are seriously disadvantaged when treated for physical disorders in hospital,” said NCEPOD chair Professor Lesley Regan.

“This report should be a clarion call that we have a major problem that will be difficult to untangle, and in the meantime we are failing a significant proportion of our patients.”

In order to tackle the gap, some of NCEPOD’s recommendations included an increase in routine screening for potential mental health conditions, new guidelines for hospital staff on making referrals to psychiatric services and improved record sharing between mental health and general hospitals.

Prof Derek Bell, president of the Royal College of Physicians of Edinburgh (RCPE), praised the recommendations made by the report, saying that they have the potential to improve patients’ experience and should be explored by hospitals.

“[The] recommendations in the report are long term, large in scope and will require major changes to structure, attitudes and practice, but must be addressed if we are to tackle this problem,” Dr Bell said.

At the start of this year the prime minister Theresa May announced new measures to improve the nation’s mental health in her annual Charity Commission lecture, promising an additional £1bn of funding include up to £15m in additional funding for community-led mental health services.

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