Faculty of Liaison Psychiatry Annual Conference 2018 - Conference Booklet Wednesday 16 - Friday 18 May 2018
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Faculty of Liaison Psychiatry
Annual Conference 2018
Wednesday 16 - Friday 18 May 2018
Marriott Hotel, Liverpool
Conference BookletContents Page
CONFERENCE PROGRAMME 1
USEFUL INFORMATION 5
PRESENTATION ABSTRACTS AND BIOGRAPHIES 7
Wednesday 16 May 7
Thursday 17 May 9
Friday 18 May 14
POSTER EXHIBITION (ALPHABETICALLY BY SURNAME) 25
SAVE THE DATES FOR 2019 70
NOTE PAPER 71
Please note a presentation link (with non-editable pdf versions) will be emailed
shortly after the conference to all delegates after obtaining the authorisation of
the authors of the presentations.
NB this can take up to 3 weeks.
Unfortunately, it is not always possible to supply presentations due to some items
being unpublished and copyright issues.Programme
For room allocation see the Useful Information page
Wednesday 16 May 2018
12:00-12:55 Registration and lunch
12:55-13:00 Welcome from Chair
Jim Bolton, Chair, Faculty of Liaison Psychiatry
13:00-13:30 Expansion of liaison mental health services in England: progress update and
future policy questions
Bobby Pratap
13:30-14:00 Sleep disorders
Ivana Rosenzweig
14:00-14:30 ADHD in Adults
Dene Robertson
14:30-14:40 Q&A
14:40-15:10 Afternoon refreshments, exhibition and poster viewing
Chair: Annabel Price
15:10-15:40 Transplant psychiatry – assessing recipients
Roger Smyth
15:40-16:10 Transplant Psychiatry – assessing donors
Stephen Potts
16:10- 16:20 Q&A
16:20 – 16:50 Drugs and alcohol in old age
Tony Rao and Cathy Symonds
16:50-17:20 Eating disorders in old age
William Rhys Jones
17:20-17:30 Q&A
17:30 Close
17:30 Trainees, New Consultants, Nurses & Allied Health Professionals (TNC-
Room: Walker, NAHP) AGM
ground floor
17:30-18:00 Drinks reception
18:30 Beatles inspired walking tour of Liverpool
Meeting point: Hotel reception at 18:15
RCPcych Faculty of Liaison Psychiatry Annual Conference 2018 1Thursday 17 May 2018
08.30 -09.00 Registration & refreshments
Chair: Peter Aitken
09:00-09:35 LP Maestro
Allan House
09:35 - 10:10 More or Less? Findings from the 4th Liaison Psychiatry Survey of England
William Lee
10:10-10:40 Morning refreshments, exhibition & poster viewing
Chair: Khalida Ismail
10:40-11:15 Primary Care Psychological Medicine Service
Chris Schofield
11:15-11:50 Liaison psychiatrists in diabetes: supernumerary or super
Partha Kar
11:50-12:30 Training Psychiatrists for Collaborative Care: Leveraging both Consultation
and Liaison Skills
Anna Ratzliff
12:30-13:40 Lunch, exhibition & poster viewing
12:30-13:40 Additional lunchtime meeting
Room: Meeting of Diabetes Working Group
Conference
Lounge, ground
floor
Chair: Sarah Burlinson
13:30-14:15 Integrating Psychological Medicine in a Transforming NHS
Peter Aitken
14:15-14:50 Nonepileptic seizures: explanations for a ‘medically unexplained symptom
Markus Reuber
14:50-15:25 CAT in Liaison Psychiatry
Alison Jenaway
15:25-15:55 Afternoon refreshments, exhibition & poster viewing
15:55-16:30 Functional Neurological Disorder, the Fragility of recovery
Kate Chartres and Lisa Loftus
The role of spirituality in Resilience
16:30-17:05
Alison Gray
17:05-17:35 Pitfalls of transition –services for all age
Birgit Westphal, Luke Solomons and Simon Thacker
17:35 Close and AGM
19:00 Conference dinner
RCPcych Faculty of Liaison Psychiatry Annual Conference 2018 2Friday 18 May 2018
08:30–09.00 Registration, exhibition & refreshments
Chair: Peter Byrne
09:00-09:30 Repeated self-harm in adults
Allan House
09:30-10:00 Suicide: research, policy and practice
Nav Kapur
10:00-10:30
Child mental health service responses to self-harm – is there anything of
relevance to adult services?
David Cottrell
10:30-10:40
Q&A
10:40-11:05 Morning refreshments, exhibition & poster viewing
Chair: Geraldine Swift
11:05-11:35 Organic Psychiatry of Cancer & Cancer Treatments
Andrew Hodgkiss
11:35-12:05 Better Conversations-Better Care
Alison Coackley
12:05-12:35 Palliative care in ITU
Laura Chapman
12:35-12:40 Q&A
12:40-14:05 Working Lunch with workshops, exhibition & poster viewing
Room: Walker Workshop 1:
First do no harm: the science behind the approach to Medically
unexplained symptoms
Philippa Bolton
Room: Lever Workshop 2:
New Examination Questions for MRCPsych Paper B
Shez Khan
Room: Hornby Workshop 3:
Getting Education into the Acute Trust- Making it Vital
Sarah Eales and Kate Chartres
Room: Workshop 4:
Merchant Suite
Epilepsy; Sleep disorders and NEAD: Video cases
Manny Bagary
14:05-14:35 Afternoon refreshments, exhibition & poster viewing
RCPcych Faculty of Liaison Psychiatry Annual Conference 2018 3Chair: Jim Bolton
14:35-15:10 Psychostimulants in Palliative and End of Life Care
Anthony Thompson
15:10-15:50
New research presentations
Collaborative care of self-harm frequent attenders; clinical re-audit of the
South Tees Liaison Psychiatry pathway of care for repeat attenders to
A&E
Madelaine Eddleston
Delivering EMDR for PTSD in Post-ICU Patients
Tom Hulme
Less is More?: Pilot Study of Liaison Psychiatry 10-minute Tutorials in an
Acute Hospital
Nora Sawan Alawam and Mariam Alexander
Atypical antipsychotic medications in treatment of delirium: a systematic
review
Abhishek Shastri
Care Plans for patients with complex medically unexplained symptoms in
liaison psychiatry: a pilot project service evaluation
Alje Van Hoorn
15:50-16:25 Paediatric Liaison in the Liaison Faculty – an update
Birgit Westphal
16:25-16:45
Closing remarks and prizes
16:45 Close6
RCPcych Faculty of Liaison Psychiatry Annual Conference 2018 4Useful information
Rooms:
The Merchant suite is situated on the 1st floor. All plenary sessions will take
place here.
Walker, Hornby and Lever are situated on the ground floor. These will be used
as workshop rooms on the 18 May.
Refreshments will take place in the Merchant corridor and bar on the 1 st floor.
Lunch will be served in the Olivier's Restaurant, 1st floor.
Additional meetings:
Wednesday 16 May
Trainees, New Consultants, Nurses & Allied Health Professionals (TNC-NAHP) AGM:
17:30 in the Walker room, ground floor
Thursday 17 May
Meeting of Diabetes Working Group
12:30-13:40 in the Conference Lounge, ground floor
Workshops:
All workshops are on a first come first serve basis.
There will be a working lunch, please collect your lunch and take it to the workshop rooms.
Certificates of attendance
Certificates of attendance will be emailed to delegates within one week of the conference. This
conference is eligible for up to 6 CPD hours on Wednesday, Thursday and Friday respectively,
subject to peer group approval.
Speaker presentations
A link to all the speaker presentations we have permission to share will be emailed to registered
attendees after the meeting.
Feedback
A detailed online feedback form can be found at https://www.surveymonkey.co.uk/r/Liaison18
All comments received will remain confidential and are viewed in an effort to improve future
meetings. This link will be emailed to all delegates after the conference.
RCPcych Faculty of Liaison Psychiatry Annual Conference 2018 5Cloakroom
There will be a staffed cloakroom outside of the Merchant Suite in the Foyer.
Multi-faith room
Please ask a member of staff at the registration desk.
Fire exit
No fire drills scheduled for today, so if alarm sounds it is a real fire! Fire exits are to the rear of
the Merchant Suite or out of the main doors, down the main set of stairs. The assembly point
is the Princess Diana Memorial Steps outside of the hotel.
Wi-fi
There is free wi-fi available through-out the building. The WIFI Code is Liverpool.
Mobile phones
Please turn off or switch to silent.
Toilets
Toilets are located on the ground and 1st floor.
Twitter @RCPsych #LiaisonConf
RCPcych Faculty of Liaison Psychiatry Annual Conference 2018 6PRESENTATION ABSTRACTS AND BIOGRAPHIES
(LISTED BY PROGRAMME ORDER)
Wednesday 16 May
Welcome from Chair
Jim Bolton, Chair, Faculty of Liaison Psychiatry
Dr Jim Bolton is a Consultant Liaison Psychiatrist at St Helier Hospital.
Expansion of liaison mental health services in England: progress update and future policy
questions
Bobby Pratap
Bobby Pratrap has been leading in setting up and implementing NHS England’s national adult crisis &
acute mental health programme since June 2015. Prior to that, he worked at the Department of Health
for 9 years covering a range of policies. Bobby also served as Private Secretary to three Health
Ministers (Norman Lamb, Paul Burstow and Phil Hope) which included work on mental health. In his
spare time, Bobby is studying for an MSc in Health Policy at Imperial College and is a season ticket
holder at Liverpool FC.
Sleep disorders
Ivana Rosenzweig
Dr Ivana Rosenzweig is a Sleep Physician & Consultant Neuropsychiatrist at the Sleep Disorders
Centre, Guy's and St Thomas Hospital, GSTT NHS Trust, London. She is also Head of the Sleep and
Brain Plasticity Centre, Department of Neuroimaging at the IoPPN, King’s College London.
ADHD in Adults
Dene Robertson
Dr Dene Robertson is a Consultant Psychiatrist at the National Autism Unit and the Behavioural
Genetics and Autism Assessment Clinic, South London & Maudsley NHS Foundation Trust.
Transplant psychiatry – assessing recipients
Roger Smyth
Drs Smyth & Potts plan a double act: two speakers will present two cases, involving two organs,
covering two sides of the transplant transaction, in order to introduce two protocols, and to leave the
audience with two dilemmas.
RCPcych Faculty of Liaison Psychiatry Annual Conference 2018 7Our intention is to provide relevant background to liaison psychiatrists who do not routinely work
alongside transplant units but may be asked to undertake assessments of suitability to give or receive
an organ.
Dr Roger Smyth is Consultant Psychiatrist in the Department of Psychological Medicine at the Royal
Infirmary of Edinburgh and Honorary Senior Lecturer at the University of Edinburgh. He is a lead
author and editor of the Oxford Handbook of Psychiatry.
Transplant Psychiatry – assessing donors
Stephen Potts
Drs Smyth & Potts plan a double act: two speakers will present two cases, involving two organs,
covering two sides of the transplant transaction, in order to introduce two protocols, and to leave the
audience with two dilemmas.
Our intention is to provide relevant background to liaison psychiatrists who do not routinely work
alongside transplant units but may be asked to undertake assessments of suitability to give or receive
an organ.
Dr Stephen Potts trained in medicine in Cambridge, Oxford and the United States, and then in
psychiatry at the Maudsley and in Edinburgh. in 1996 he was appointed as a Consultant in Liaison
Psychiatry at the Royal Infirmary of Edinburgh, where he took up a new role as a Consultant in
Transplant Psychiatry in 2014.
For many years he has worked part time to pursue a parallel career as a writer, initially of childrens’
fiction and latterly of screenplays. Go to www.stephenpotts.net for more information.
Drugs and alcohol in old age
Tony Rao and Cathy Symonds
This presentation is designed to improve knowledge and skills in the public health and clinical aspects
of substance misuse in older people. It will focus on the relevance of these competencies to the
detection of drug and alcohol misuse in liaison psychiatry settings.
Dr Tony Rao has worked as a consultant old age psychiatrist for 20 years in an inner-city area of
London with a high rate of alcohol misuse in older people. After completing an MSc in the clinical and
public health aspects of addiction in 2004, he has led a Trust strategy for alcohol misuse in older
people at South London and Maudsley NHS Foundation Trust. Dr Rao has been Visiting Professor at
London South Bank University and is currently Visiting Lecturer at the Institute of Psychiatry. He has
continued to develop an evidence base to develop training, research and clinical services to meet the
needs of older people with substance misuse. He was previously involved with medical education for
RCPcych Faculty of Liaison Psychiatry Annual Conference 2018 8over 10 years as Royal College Tutor, Training Programme Director and Associate Dean at London
Deanery and the Royal College of Psychiatrists
Eating disorders in old age
William Rhys Jones
Not available at time of print
********************************
Thursday 17 May
LP Maestro Repeated self-harm in adults
Allan House
Professor Allan House is Professor of Liaison Psychiatry at the Leeds Institute of Health Sciences.
More or Less? Findings from the 4th Liaison Psychiatry Survey of England
William Lee
Dr William Lee is Clinical Associate Professor in Psychiatry at the University of Plymouth.
Primary Care Psychological Medicine Service
Chris Schofield
Dr Chris Schofield is a Consultant Liaison Psychiatrist, Lead Consultant DPM, Payments and Pricing
lead (Faculty of Liaison Psychiatry RCPsych), Clinical lead – East Midlands Clinical Networks (Liaison
and CRHT) and Clinical Lead – Primary Care Psychological Medicine MCP Vanguard pilot.
Liaison psychiatrists in diabetes: supernumerary or super
Partha Kar
Dr Partha Kar has been a Consultant in Diabetes & Endocrinology at Portsmouth Hospitals NHS Trust
since 2008. He has been the Clinical Director of Diabetes from 2009-2015, being part of a multiple
national award-winning department (HSJ Awards / BMJ Awards) due to its services and care provided.
One of his main areas or passion is in helping to redesign diabetes care in an attempt to integrate
chronic disease management across primary and secondary care. He is the pioneer of the Super Six
Diabetes Model which aims to deliver diabetes care differently. He is an avid user of social media such
as twitter (@parthaskar) to engage with patients - and been recognised as a "Social media Pioneer" by
HSJ in 2014. Recent innovations have involved the Hypoglycaemia Hotline, which was recognised in the
Guardian Healthcare Awards 2013.
RCPcych Faculty of Liaison Psychiatry Annual Conference 2018 9He is also the co-creator of TAD talks (Talking About Diabetes) and the Type 1 Diabetes comic
(“Origins”)- while also involved in setting up a Type 1 Diabetes information portal (T1resources.uk)
He is also Associate National Clinical Director, Diabetes with NHS England leading on developing the
NHS RightCare Diabetes pathway; leading on Freestyle Libre being available on NHS tariff and helping
to coordinate the development of the Diabetes “Language Matters” document
Training Psychiatrists for Collaborative Care: Leveraging both Consultation and Liaison Skills
Anna Ratzliff
Psychiatrists are in a unique position to help shape mental health care delivery in the current rapidly
evolving healthcare reform landscape using integrated care approaches, in which mental health is
delivered in primary care settings. In this model of care, a team of providers, including the patient’s
primary care provider, a care manager and a psychiatric consultant, work together to provide
evidence-based mental health care. Lessons learned in a large scale effort of the American Psychiatric
Association to train 3,500 psychiatrists in collaborative care, a specific integrated care model will be
presented. Although psychiatrists must to learn how to adapt their clinical skills to leverage their
psychiatric expertise through a team, it is equally important to provide training in liaison skills for
success in this new role.
Dr Anna Ratzliff is a national expert on collaborative care and specifically, on training teams to
implement and deliver mental health treatment in primary care settings. Her passion for translating
complex research ideas into practical real-world applications began when she received her MD and PhD
in Anatomy and Neurobiology as part of the Medical Scientist Training Program at the University of
California at Irvine. She currently is an Associate Professor in the Department of Psychiatry and
Behavioral Sciences at the University of Washington where she has developed expertise in suicide
prevention training, mental health workforce development, adult learning best practices, and
mentorship. Dr. Ratzliff is the Director of the AIMS Center (Advancing Integrated Mental Health
Solutions), is the Director of the UW Integrated Care Training Program for residents and fellows, and
leads a national collaborative care training program for the American Psychiatric Association’s
Transforming Clinical Practices Initiative grant. For more information on collaborative care please visit
the AIMS Center Website (aims.uw.edu), the UW Integrated Care Training Program (ictp.uw.edu).
Integrating Psychological Medicine in a Transforming NHS
Peter Aitken
Dr Peter Aitken is Director of Research & Development, Devon Partnership NHS Trust and Honorary
Associate Professor, University of Exeter Medical School.
RCPcych Faculty of Liaison Psychiatry Annual Conference 2018 10Nonepileptic seizures: explanations for a ‘medically unexplained symptom
Markus Reuber
Nonepileptic Seizures (NES) superficially resemble epileptic seizures but have a different cause. Unlike
epilepsy, NES are not associated with epileptic discharges in the brain, and are widely considered
‘medically unexplained’. Patients with NES vary widely in terms of background, personality profiles,
comorbidities, response to treatment and outcomes. Previous accounts interpreting these seizures as
the activation of dissociated material, a physical manifestation of emotional distress, hard-wired reflex
responses, or learned behaviours cannot explain key features of the phenomenon. Drawing on our
current understanding of the literature on aetiology, associated neurobiological changes and
phenomenology of NES, I will demonstrate that an Integrative Cognitive Model (ICM) can provide an
explanation which transcends a traditional dualistic interpretation dividing symptoms or disorders into
“psychological” or “physiological”. The ICM suggests that the central feature of NES is the automatic
activation of a mental representation of seizures (the “seizure scaffold”) in the context of a high level
inhibitory processing dysfunction. This often arises in response to elevated autonomic arousal, and may
disrupt the individual’s awareness of distressing material, but can become divorced from abnormal
autonomic and emotional activity. This model accounts for existing findings and the heterogeneity of
patients with PNES, whilst leading to a number of novel hypotheses against which it can be evaluated.
It also facilitates the explanation of the disorder to patients (as a conditioned reflex-like response
triggered by internal or external triggers perceived as threatening) and it can provide a basis for
psycho- and pharmacotherapeutic treatment formulations.
Markus Reuber is a Professor of Clinical Neurology at the University of Sheffield and Honorary
Consultant at the Sheffield Teaching Hospitals NHS Foundation Trust in Sheffield, United Kingdom. He
is particularly interested in the phenomenology and treatment of epileptic and non-epileptic seizure
disorders and in communication between doctors and patients.
He has been involved in research projects examining a wide range of clinical issues in epileptology and
general neurology. For instance, he has helped to investigate the use of new functional imaging
techniques in patients with epilepsy, the long-term effects of epilepsy surgery on memory and the
effects of epilepsy or anticonvulsant drugs on sex hormones. Most of my research, however, has
concentrated on improvements of the diagnosis of epilepsy and similar disorders, especially
nonepileptic seizures. His most recent studies have focussed on the psychological treatment of patients
with functional neurological symptoms, the involvement of the autonomic system in epileptic and
nonepileptic seizures and the interaction between doctors and patients using the methodology of
Conversation Analysis (CA). He has been particularly interested in exploring the use of CA as a
supplementary diagnostic method.
RCPcych Faculty of Liaison Psychiatry Annual Conference 2018 11CAT in Liaison Psychiatry
Alison Jenaway
Cognitive Analytic Therapy was developed by Tony Ryle in the 1980’s as an accessible, integrative
therapy for complex cases, who might not be accepted for longer term psychotherapy. It draws on
ideas from object relations theory, how our early relationships become the template for how we expect
relationships to be and how we relate to ourselves, and those trying to help us. Combining these with
a more cognitive description of these patterns through visual mapping. It is being used increasingly in
physical health settings and Alison will describe how it is being used in Cambridge University Hospital,
particularly with patients presenting with medically unexplained symptoms and those with poor
adherence to treatment, for example after transplantation. Using the relationship ideas from CAT can
be helpful to carers and staff in helping them make sense of complex patients, and remain in a helpful
relationship, without being pulled into problematic responses. Alison will briefly introduce the theory of
relationship roles in CAT and then present some clinical cases to illustrate it’s use in these different
areas.
Dr Alison Jenaway is a consultant psychiatrist in medical psychotherapy in the Liaison psychiatry
department of Cambridge University Hospital. She is a CAT therapist and supervisor and has
presented CPD days, and written about, using CAT with patients with physical health problems and
medically unexplained symptoms. She started a national special interest group “PhysCAT” which
meets yearly to exchange ideas about using CAT in physical health settings, she is also currently Chair
of ACAT, the national Association for Cognitive Analytic Therapy.
Functional Neurological Disorder - the Fragility of recovery
Kate Chartres and Lisa Loftus
This is a personal account of the experience of having and being treated for a Functional Neurological
Disorder, detailing the experience from both the patient’s and the therapist’s perspective over an 18-
month period.
Kate Chartres is educated to Masters level and hold an MSc in Healthcare Leadership. She is in the
role of Nurse Consultant in Psychiatric Liaison. The Sunderland Team is a comprehensive psychiatric
liaison team working across the Acute Trust and in Outpatients. My previous experience has included
extensive time within Crisis Services, work in Primary Care, EIP and the Clinical Management of a
range of diverse Psychiatric Liaison Teams across Northumberland Tyne and Wear. She has undertaken
further development in a variety of therapeutic modalities which enables me to develop innovative
treatment packages for people presenting with complex clinical difficulties utilising an eclectic approach
which she believes is necessary within this specialist field. Her interests include mentoring and
coaching nursing staff to enable them to be the best that they can, developing truly integrated services,
engagement and developing the body of evidence to underpin future Psychiatric Liaison practice.
RCPcych Faculty of Liaison Psychiatry Annual Conference 2018 12This month has been busy clinically utilizing EMDR with a complex clinical caseload and fitting in
research/ teaching and influence around that; though she is delighted to say that this is what brings
me true joy!
She is enormously proud of my achievements to date and feel that I have both been in the right place
at the right time and made opportunities for myself, her previous dream had been to become a Nurse
Consultant, having achieved this now with a significant period of my career left to experience it is
difficult to know what the next dream ought to be.
The role of spirituality in Resilience
Alison Gray
Dr Alison Gray is a Consultant in Liaison Psychiatry at the Stonebow Unit, Hereford.
Pitfalls of transition –services for all age
Birgit Westphal, Luke Solomons and Simon Thacker
Full integration between mental and physical healthcare requires a person centred approach and
seamless transfer of care across specialties. Defining service provision by age cut offs creates artificial
barriers in a fast changing healthcare environment especially when we are dealing with some the most
complex patient groups with physical and mental health comorbidity.
Old Age Psychiatry offers a valuable skill-set to Liaison Psychiatry whilst joint working with colleagues
who work mainly with younger people can broaden the horizons of psychogeriatricians. The risk of the
needs of older adults being muted by more dramatic presentations in younger people requires
acknowledgement.
Dr Birgit Westphal MD MRPsych is a Consultant Child & Adolescent Psychiatrist leading the Paediatric
Liaison Team at the Royal London Children's Hospital since 2008. Birgit is the Joint-Chair of the
Paediatric Liaison Network and together with Elaine Lockhart she has been working on national
paediatric liaison standards (for PLAN) as well as consolidating effective collaboration with the
Paediatric Psychology Network (PPN). Birgit has been elected as Paediatric Liaison Rep in the Liaison
Dr Luke Solomons is a consultant in psychological medicine/ psycho-oncology at Oxford University
Hospitals NHS Foundation Trust, the first fully integrated psychological medicine department in the
country. He trained in liaison psychiatry and neuropsychiatry at Guys and St. Thomas’ Hospitals, then
moved to the Thames Valley to set up the liaison psychiatry service at the Royal Berkshire Hospital
before taking up his current role. He has been involved with research into models of service delivery in
liaison psychiatry/ psychological medicine and am currently part of the team working on the HOME
study, proactive psychological medicine.
https://oxfordpsychologicalmedicine.org/research/thehomestudy/
RCPcych Faculty of Liaison Psychiatry Annual Conference 2018 13Dr Simon Thacker is an Old Age Psychiatrist who did a traditional community-inpatient job for 17
years until moving to an age-inclusive Liaison Team 5 years ago. He is currently Clinical Director for
ward-based services and acute adult pathway in Derby and Southern Derbyshire.
**************************
Friday 18 May
Repeated self-harm in adults
Allan House
Biography as above.
Suicide: research, policy and practice
Nav Kapur
Professor Nav Kapur is Professor of Psychiatry and Population Health at the University of Manchester,
UK, and an Honorary Consultant Psychiatrist at Greater Manchester Mental Health NHS Foundation
Trust. He is Head of Research at the Centre for Suicide Prevention in the University of Manchester and
leads the suicide work programme of the National Confidential Inquiry into Suicide and Homicide which
collects data on all suicide deaths among people in contact with health services in the UK. He was
Chair of the Guideline Development Group for the National Institute for Health and Clinical Excellence
(NICE) self-harm guidelines (longer term management) and also chaired the Quality Standards for self-
harm. He is currently chairing the NICE guidelines for depression in adults and is topic expert on the
NICE guidelines for suicide prevention in the community. He also chairs the Health Education
England/Royal College of Psychiatrists group developing core competencies for clinical staff in the
assessment of self-harm and suicidal ideas. He is a member of the Department of Health’s (England)
National Suicide Prevention Strategy Advisory Group. He has published extensively on suicide and self-
harm with much of his research focussing on how health services might best contribute to suicide
prevention.
Child mental health service responses to self-harm – is there anything of relevance to adult
services?
David Cottrell
Dr David Cottrell was appointed Foundation Chair in Child & Adolescent Psychiatry at Leeds in 1994
and from 2008 -2013 was Dean of Medicine. He was Associate Medical Director for Child & Adolescent
Psychiatry in Leeds for many years and has a wide experience of the development, management,
delivery and evaluation of services for children in the community.
RCPcych Faculty of Liaison Psychiatry Annual Conference 2018 14His research interests are in the evaluation of psychological interventions and CAMH services. He was a
co-author of the NICE guidelines on management of depression in children and young people. He is
Chief Investigator of a large multi-centred randomised controlled trial of systemic family therapy
following teenage self-harm funded by the NIHR, and co-investigator on a second large multi-centred
randomised controlled trial evaluating multi-systemic treatment for teenagers at risk of care or custody,
funded by DH.
Organic Psychiatry of Cancer & Cancer Treatments
Andrew Hodgkiss
Organic psychiatry of cancer has been a relatively neglected area of the wider discipline of psycho-
oncology. Yet cancers, and all modalities of cancer treatment, can provoke psychopathology through
numerous and varied direct biological mechanisms.
This lecture offers a brief overview of how certain tumours can cause psychiatric phenomena through
paraneoplastic endocrine effects, structural disruption of the brain, release of pro-inflammatory
cytokines and production of onconeuronal antibodies. Then the adverse psychiatric effects of cancer
treatments - including surgery, radiotherapy, conventional chemotherapy, hormone deprivation
therapy and molecularly-targeted agents (including cancer immunotherapies) - are described.
The aim of the lecture is not to suggest that organic psychiatric issues are more prevalent than
psychopathology due to the many psychosocial and existential threats and losses experienced by
people with cancers. But as liaison psychiatrists we need to be able to consult fluently with oncology
colleagues about the organic psychiatry of cancer.
Dr Andrew Hodgkiss MD FRCPsych
Consultant Liaison Psychiatrist, CNWL at The Royal Marsden NHS Foundation Trust, London & Honorary
Clinical Senior Lecturer at IoPPN
Dr Andrew Hodgkiss studied medicine at Trinity College, University of Cambridge and Guy's Hospital
Medical School, University of London. His postgraduate training in psychiatry was on the Guy's rotation,
including 3 years as Clinical Lecturer in Biological Psychiatry at the National Unit for Affective
Disorders. He then trained as a Lacanian psychoanalyst and, with a Wellcome Fellowship at University
College London, wrote an MD thesis about the history of chronic pain, later published as a single-
author monograph, From Lesion to Metaphor (Rodopi, 2000). He was elected a Fellow of the Royal
College of Psychiatrists in 2008.
Dr Hodgkiss has worked clinically with people affected by cancer for over twenty years. He was a
Consultant Liaison Psychiatrist at St Thomas' Hospital for 17 years before moving to The Royal Marsden
Hospital in 2014 to specialise in the psychiatry of cancer. Dr Hodgkiss recently co-chaired the mental
health & psychology pathway group at London Cancer Alliance. His book Biological Psychiatry of Cancer
and Cancer Treatment (OUP, 2016), written for oncologists and psychiatrists, reviews the aetiology,
RCPcych Faculty of Liaison Psychiatry Annual Conference 2018 15prevention, assessment and treatment of psychiatric symptoms arising from cancers and their
treatment.
Better Conversations-Better Care
Alison Coackley
Dr Alison Coackley is a Consultant in Palliative Medicine at the Clatterbridge Cancer Centre NHS
Foundation Trust.
Palliative care in ITU
Laura Chapman
The Intensive Care Unit is a unique environment within the hospital, guaranteed to create a feeling of
discomfort in all who are unfamiliar with its sights and sounds – patients, families and staff alike.
A high proportion of people, particularly those with end-stage long-term conditions, will spend time in
the ICU in the months and weeks prior to their death.
I will examine how the delivery of end of life care in the ICU is influenced by its culture and processes,
and discuss ways for health care professionals to provide support to patients families and staff at this
challenging time.
Dr Laura Chapman Medical Director and Consultant in Palliative Medicine, Marie Curie Hospice
Liverpool
I have been a consultant in Palliative Medicine since 2006, initially working as part of the hospital
palliative care team in a busy acute trust and more recently as medical director of the Marie Curie
Hospice in Liverpool. End of Life Care in the Critical Care environment is one of my interests and I have
previously been the clinical lead for an action research project to map the processes around end of life
care in Critical Care, and develop tools to enable staff to deliver the best care possible to their dying
patients.
Workshop 1:
First do no harm: the science behind the approach to Medically unexplained symptoms
Philippa Bolton
Medically unexplained symptoms are not medically unexplained. Once we understand some of the
science behind medically unexplained symptoms, we can then formulate evidence based approaches
and explanations for patients. And stop causing patients harm. This presentation will provide you with
the knowledge and skills to do this, linking to recent research from the North East Academic health
Science Network on what constitutes a valid explanation for patients.
RCPcych Faculty of Liaison Psychiatry Annual Conference 2018 16Dr Philippa Bolton is a consultant liaison psychiatrist working in Durham. Half of the time she works
in a multidisciplinary team for patients with medically unexplained symptoms. This team has been
established for 5 years. Dr Bolton also works with the clinical network in the North East and Cumbria to
promote mental health across the region, in particular liaison and Medically unexplained symptoms.
Workshop 2: New Examination Questions for MRCPsych Paper B
Shez Khan
This is a unique opportunity to contribute to the question writing of the MRCPsych Examination. No
previous question writing experience is necessary and full instruction will be provided. The focus of the
workshop will be on the writing of liaison psychiatry questions but contributions to any section of the
syllabus will be welcomed. All submissions will be forwarded to the MRCPsych Clinical Topics Panel for
possible inclusion in future MRCPsych examinations.
Workshop 3: Getting Education into the Acute Trust- Making it Vital
Sarah Eales and Kate Chartres
An interactive workshop sharing practice and innovation in ensuring that training is integrated into all
that we do as Liaison Teams.
An overview of some ideas from teams in the North East, then an opportunity to interact with others
attending the workshop to share ideas.
Dr Sarah Eales is a Senior Lecturer in Mental Health Nursing, Bournemouth University. Having been
involved in clinical and academic work in the field of Liaison Mental Health Care for eighteen years
Sarah represents the Royal College of Nursing in regard to Liaison Mental Health Care. Sarah is a
member of the Executive Committee of the Faculty of Liaison Psychiatry and a member of the PLAN
Accreditation Panel.
Kate Chartres is educated to Masters level and hold an MSc in Healthcare Leadership. She is in the
role of Nurse Consultant in Psychiatric Liaison. The Sunderland Team is a comprehensive psychiatric
liaison team working across the Acute Trust and in Outpatients. Her previous experience has included
extensive time within Crisis Services, work in Primary Care, EIP and the Clinical Management of a
range of diverse Psychiatric Liaison Teams across Northumberland Tyne and Wear. She has undertaken
further development in a variety of therapeutic modalities which enables me to develop innovative
treatment packages for people presenting with complex clinical difficulties utilising an eclectic approach
which she believes is necessary within this specialist field. Her interests include mentoring and
coaching nursing staff to enable them to be the best that they can, developing truly integrated
services, engagement and developing the body of evidence to underpin future Psychiatric Liaison
practice.
RCPcych Faculty of Liaison Psychiatry Annual Conference 2018 17This month has been busy clinically utilizing EMDR with a complex clinical caseload and fitting in
research/ teaching and influence around that; though she is delighted to say that this is what brings
me true joy!
She is enormously proud of my achievements to date and feel that she has both been in the right place
at the right time and made opportunities for myself, my previous dream had been to become a Nurse
Consultant, having achieved this now with a significant period of my career left to experience it is
difficult to know what the next dream ought to be.
Workshop 4: Epilepsy; Sleep disorders and NEAD: Video cases
Manny Bagary
Dr Manny Bagary is a Consultant Epileptologist, Somnologist and Neuropsychiatrist. He graduated
from Imperial College Medical School, London and completed his training in psychiatry on the Charing
Cross (Junior) and Maudsley (Senior) Rotations in London. He has held research posts at The MRC
Cyclotron Unit, Imperial College, London, Institute of Psychiatry, King’s College London and completed
a PhD in Neurological Sciences at the Institute of Neurology, UCL, Queen Square, London.
His epilepsy training was at The National Hospital for Neurology and Neurosurgery, Queen Square,
London and at the National Centre for Epilepsy, Chalfont Centre. He is experienced in the assessment
and management of complex epilepsies, complex sleep disorders and Non Epileptic Attack Disorders
(NEAD). Since 2004 he has worked in Birmingham as a consultant in a regional service specialising in
Epilepsy, Sleep Medicine and Neuropsychiatry. He is lead consultant for the epilepsy and sleep service.
He specialises in second opinions for complex epilepsy, video telemetry assessments for diagnostics
and epilepsy surgery, vagal nerve stimulation clinic, modified ketogenic diet in adults with drug
resistant epilepsy, novel treatments including phase II, III and IV trials of new anticonvulsants,
epilepsy with mental health comorbidity and NEAD.
Dr Bagary is a Council Member and Treasurer of the UK Chapter for the International League against
Epilepsy and a medical advisor to the charity, Epilepsy Action.
Psychostimulants In Palliative and End of Life Care
Anthony Thompson
Dr Anthony Thompson works as a Consultant in Palliative Medicine at St Helens and Knowsley
Teaching Hospitals NHS Trust, based at Whiston Hospital. He also works across the Integrated locality
in Willowbrook Hospice and has a Community role.
Dr Thompson is a Liverpool Medical School Graduate, who has worked across Liverpool area , and then
did his GP training in Cornwall. He worked as GP for 3 years in Southport before moving into Palliative
Care in 1998.
RCPcych Faculty of Liaison Psychiatry Annual Conference 2018 18He completed his CESR 2 years ago and left Willowbrook Hospice after 17 years and moved the huge
¾ mile to Whiston Hospital as a Consultant.
He lives in Southport with his wife, 3 sons and the beloved family Labrador Teddy.
He, Dr Thompson not Teddy, has just completed the London Marathon and enjoys running and
Manchester United FC!
His clinical interests are wide but include helping to deliver timely and high quality palliative and end of
life care across acute medical specialities in acute Hospitals.
New research presentations
Chairs: Sira Mahalingappa Sridevi and Aditya Hosakere
Collaborative care of self-harm frequent attenders; clinical re-audit of the South Tees Liaison
Psychiatry pathway of care for repeat attenders to A&E
Madelaine Eddleston
BACKGROUND:
A Rapid Process Improvement Workshop held in March 2016 by the South Tees Liaison Psychiatry
Team led to the development of a care pathway for repeat attenders to A&E. This aimed to identify
unmet needs and reduce re-attendance. The pathway introduced an individualised Frequent Attenders
Care Plan meeting involving the patient and services involved in their care.
AIMS & OBJECTIVES:
An initial audit covered the ten month period immediately following implementation of the new
pathway and identified an initial reduction in the mean number of A&E attendances post Care Plan
meeting.
The aim of this re-audit was to assess current adherence to the pathway, in addition to evaluating
service outcomes by identifying if the reduction in A&E re-attendance had been sustained.
RESULTS:
In the initial Audit cycle (11/3/16-12/1/17) the pathway was triggered 188 times. This resulted in 82
patients having a Frequent Attenders Care Plan meeting. The remaining 106 patients did not have a
meeting, as this was not deemed to be clinically necessary. The mean number of attendances for
patients in the year preceding the Frequent Attenders Care Plan meeting was 2.4. This reduced to 1.7
during the following 12months.
However, for the 106 patients who did not have a meeting, the mean number of attendances also
reduced; from 2.7 in the year prior to the pathway being triggered to 1.7 in the following 12months.
RCPcych Faculty of Liaison Psychiatry Annual Conference 2018 19CONCLUSIONS:
Although there was a reduction in the average number of A&E attendances in the 12months following
the pathway being triggered, the reduction was the same in both groups, regardless of whether a
meeting was held or not. It is possible that this reflects the natural history in this patient group with
presentations increasing with crises and waning again following crisis resolution.
This project remains topical with the recent introduction of the National CQUIN targets to reduce repeat
attendance at A&E due to mental health presentations. It also raises interesting questions regarding
the use of substantial resources to try and reduce A&E re-attendance.
Dr Eddleston is a Core Psychiatry Trainee working in Liaison Psychiatry at The James Cook University
Hospital in Middlesbrough. Her main interest outside work is exhibiting her dogs at Championship
Shows, including Crufts. She is interested in pursuing a carer in Liaison Psychiatry and is currently
involved in a number of service improvement projects in collaboration with The South Tees NHS
Foundation Trusts Treat As One group.
Delivering EMDR for PTSD in Post-ICU Patients
Tom Hulme
This pilot project was requested by our ICU colleagues after they had been given £11,000 by a drug
company to deliver an improvement in their delirium pathway. The aim was to assess, support and
treat patients with delirium and those likely to suffer post-traumatic stress disorder as a consequence
of their in-patient stay at University Hospitals Bristol NHS Foundation Trust. We also wanted to support
ICU staff with education and training to care for this group of patients. This pilot aimed to address this
issue from three perspectives: identifying, assessing and treating patients whilst in ICU; ‘watchful
waiting’ for signs and symptoms of post-traumatic stress disorder in the weeks following their
admission; and following up patients as necessary to ensure that they had no lasting psychological
effects from their ICU stay. The 10 patients who completed eye movement desensitization and
reprocessing (EMDR) therapy showed significant improvements. Their mean IES-R score reduced from
62 (severe PTSD) to 16, indicating minimal symptomology. Their mean Beck Depression Inventory II
score reduced from 25 (moderate depression) to 9 (normal symptomology). The mean number of
treatment sessions was 5.
Tom Hulme is qualified as an RMN in 1996 and spent the first 3 ½ years working in a medium secure
forensic unit in Bristol. He then spent a year on a PICU before working in a Crisis Team for 5 years.
During this time, he completed a Thorn Diploma in psychosocial interventions for psychosis at
Gloucester University and a BSc (Hons) in community mental health nursing at the University of the
West of England.
He joined the Liaison Psychiatry team in the Bristol Royal Infirmary in 2005 as a Clinical Nurse
Specialist. Over the last 13 years he has helped to set up a self-harm follow-up clinic for patients
RCPcych Faculty of Liaison Psychiatry Annual Conference 2018 20attending A&E following an episode of self-harm and a hepatology liaison service for assessing, treating
and supporting patients with hepatitis C through their Interferon treatment.
He has also been able to train as a BABCP accredited cognitive behaviour therapist, having completed
an MSc in CBT at Derby University in 2012. This enabled me to set up a specialist CBT out-patient clinic
within the liaison psychiatry service. In 2016 I also qualified as an EMDR therapist which he also use in
an out-patient clinic to treat trauma and medically unexplained symptoms. This then led to setting up
an 11 month pilot offering EMDR to post-ICU patients with PTSD.
He has lived in Bristol all of his life and he is married with 4 children aged 13, 15, 18 and 20.
he fills any spare time he has with running, watching Manchester United, collecting vinyl records and
playing the drums.
Publications:
• Hulme, T. (2018). Using eye movement therapy to reduce trauma after intensive care.
Nursing Times. 114 (3), pp18-21.
• Hulme, T. (2018). Eye movement desensitisation and reprocessing therapy for medically
unexplained symptoms: a case study. Mental Health Nursing. 38 (1), pp10-13.
• Quinlivan, L., Cooper, J., Meehan, D., Longson, D., Potokar, J., Hulme, T., Marsden, J.,
Brand, F., Lange, K., Riseborough, E., Page, L., Metcalfe, C., Davies, L., O’Connor, R.,
Hawton, K., Gunnell, D. & Kapur, N. (2017). Predictive accuracy of risk scales following self-
harm: multicentre, prospective cohort study. British Journal of Psychiatry. 210 (6), pp429-
436.
• Hulme, T. (2009) A nurse-led self-harm clinic in a liaison psychiatry service. Mental Health
Nursing. 29 (5). pp16-18.
Less is More?: Pilot Study of Liaison Psychiatry 10-minute Tutorials in an Acute Hospital
Nora Sawan Alawam
AIMS AND HYPOTHESIS This pilot aims to address some of the challenges faced by Liaison Psychiatry
when providing teaching to the Acute Hospital by introducing an innovative teaching concept of ‘10
minute tutorials’.
BACKGROUND In 2016, the Psychiatric Liaison Accreditation Network demonstrated that 1 in 6 of acute
hospital colleagues feel dissatisfied with teaching provided by Liaison Psychiatry.
Locally, our Liaison Psychiatry Service has found it difficult to provide teaching to the Acute Hospital
due to clinical staff having limited protected time for educational purposes.
Consequently, we developed an innovative teaching concept of ’10 minute tutorials’. These are
PowerPoint based tutorials which have been designed to be delivered within 10 minutes at the end of a
variety of clinical meetings with the aim of ‘drip feeding’ mental health knowledge to Acute Hospital
staff in a way that is engaging, flexible and accessible.
RCPcych Faculty of Liaison Psychiatry Annual Conference 2018 21METHODS We designed a 10-minute tutorial about legal frameworks in clinical settings and delivered
this at multiple clinical meetings and teaching sessions throughout a one-week period. Attendees were
asked to fill out a questionnaire about their confidence and competence on this topic pre and post
tutorial in addition to quantitative and qualitative data regarding the concept of ’10 minute tutorials’.
RESULTS 40 questionnaires were completed: acute hospital staff felt 50% confident and competent at
using legal frameworks in the clinical setting pre 10-minute tutorial, this increased to 70% confidence
and competence post 10-minute tutorial. 80% of attendees preferred the concept of 10-minute
tutorials to the conventional 1-hour lecture and 80% felt the tutorial would lead to an improvement in
their clinical practice. 91% of respondents would like to receive further 10-minute tutorials.
CONCLUSIONS This pilot has demonstrated that 10-minute tutorials are an effective method for Liaison
Psychiatry Services to provide meaningful and engaging teaching for Acute Hospital staff.
Based on our findings, we plan to expand the 10-minute tutorial teaching programme as part of a
wider strategy to improve the teaching and training that we are able to offer our Acute colleagues.
Nora Sawan Alawam is currently a FY1 Doctor working at Ealing Hospital. She is interested in
cardiology with a particular interest in the interface between cardiology and mental health. She has a
passion for teaching and developing innovative methods to optimise the teachers and learners
experiences.
Atypical antipsychotic medications in treatment of delirium: a systematic review
Abhishek Shastri
AIMS/HYPOTHESIS: This systematic review was conducted to assess effectiveness of atypical
antipsychotics in treatment of delirium.
BACKGROUND: Delirium is an acute medical emergency with high mortality rate if untreated.
Haloperidol has been the drug of choice when treating delirium. Over the years, atypical antipsychotics
are being increasingly used in management of delirium.
METHODS: A literature search on PubMed and Cochrane database using the following search strategy
was conducted: (antipsychotics OR atypical antipsychotics OR amisulpride OR aripiprazole OR
asenapine OR clozapine OR lurasidone OR olanzapine OR paliperidone OR quetiapine OR risperidone OR
ziprasidone) AND delirium AND (random OR randomised OR randomly).
Prospective, randomised controlled studies in adult patients (more than or equal to 18 years of age)
with delirium; specifically, studies that compared atypical antipsychotics with placebo, haloperidol or
another atypical antipsychotic were included. Only studies in English language were included, and
those that used established rating scales such as Delirium Rating Scale (DRS), Memorial Delirium
Assessment Scale (MDAS), Delirium Index (DI) or DRS Revised 98 (DRS-R-98), to measure
RCPcych Faculty of Liaison Psychiatry Annual Conference 2018 22improvement in severity of dementia were included in the review. We excluded studies where
antipsychotic medications were used to prevent delirium.
RESULTS: We identified 238 articles, out of which 43 were duplicated and excluded. Further screening
excluded 149 articles based on title or abstract. Full text articles were retrieved from 46 remaining
articles and 38 were excluded as they did not meet inclusion criteria. A total of 8 studies were included
in the qualitative syntheses. Atypical antipsychotics are effective and safe in delirium. Risks of bias has
also been considered and presented.
CONCLUSION: Atypical antipsychotics appear to be as effective as conventional antipsychotics, better
than placebo and also present with lower side effect profile. The limitations of the study include small
sample sizes in studies, heterogeneity in samples including etiology of delirium, and only English
language articles being considered. In order to reach definitive and firm conclusions, larger sample
sizes, with well-controlled randomised trials are indicated. In addition, it is also important to consider
hypoactive form of delirium in future studies, which is often undiagnosed due to its clinical presentation.
Dr Abhishek Shastri is a Specialist Registrar in Older Adult & General Adult Psychiatry, currently
training at Westminster Adult Community Mental Health Team in London. He has an interest in
neuropsychiatry and dementias. He completed his MPhil in Biological Sciences from Brunel University,
London working in the field of neuro-inflammation & went on to gain his Membership of Royal College
of Psychiatrists while training in Dorset. He has published well-cited articles in the field of neuro-
inflammation and has presented posters at several conferences in the UK. He is also closely involved in
supervision of undergraduate students and clinical research at Imperial College, London.
Care Plans for patients with complex medically unexplained symptoms in liaison psychiatry:
a pilot project service evaluation
Alje Van Hoorn
Introduction There is very little published evidence about the best approach to take with patients with
complex, chronic and often medically unexplained symptoms. General hospital approaches are often
extrapolated from work in other settings like general practice. In Cornwall a project was set up using
care plans specifically designed for this patient group.
The key aspects of a care plan:
- Involving the patient and the general hospital consultant in an agreed formulation
- A written Care Plan to include specific action points for all those involved to maintain health and
manage an exacerbation
- Wide dissemination of the Care Plan to include the patient, their medical notes and psychiatric
records, general practice, Accident and Emergency, the ambulance service, and other agencies
like social services if appropriate
RCPcych Faculty of Liaison Psychiatry Annual Conference 2018 23Methods Data were collected for the year before and the year after the care plan. There were 16
patients suitable for the study. 1 patient was excluded because she had left the area before 1 year
follow-up could be completed. Data for 15 patients were analysed. Parameters measured were:
- Outpatient appointments
- Admissions
- Total Length of Stay
- Total tariff cost
- Emergency Department attendances
The data were collected with the help of the Information Services Department at the Royal Cornwall
Hospital
Results The results are presented as means. OPD Pre:8.2 OPD Post: 4.5; Admissions Pre: 9.4;
Admissions Post: 5.4; Length of Stay Pre: 29.8; Length of Stay Post: 8.1; ED Attendances Pre: 9.3; ED
Attendances Post: 3.9; Total Tariff Pre: £11,941; Total Tariff Post: £5,964
Discussion This pilot project examined the benefits of a standardised method of planning care and
sharing information in patients with complex (at least partly) unexplained symptoms. Although the
sample size and lack of a control group preclude making causal links, the downward trend in health
utilisation in those patients whose care was delivered in this way is encouraging.
Paediatric Liaison in the Liaison Faculty – an update
Birgit Westphal
RAID: The “all age service” or a service for all ages - Either way, the integration of Old age Psychiatry
seems to have happened naturally (hasn't it?), so what is the story with Paediatric Liaison Psychiatry?
A progress update and the latest on PL -standards, - competencies and PLAN will be covered.
Dr Birgit Westphal MD MRPsych is a Consultant Child & Adolescent Psychiatrist leading the Paediatric
Liaison Team at the Royal London Children's Hospital since 2008. Birgit is the Joint-Chair of the
Paediatric Liaison Network and together with Elaine Lockhart she has been working on national
paediatric liaison standards (for PLAN) as well as consolidating effective collaboration with the
Paediatric Psychology Network (PPN). Birgit has been elected as Paediatric Liaison Rep in the Liaison
faculty in January 2017 and is also a member of the Paediatric Mental Health Association (PMHA) of the
RCPCH (Royal College of Paediatrics & Child health).
**************************
RCPcych Faculty of Liaison Psychiatry Annual Conference 2018 24Poster Presentations
(LISTED BY ALPHABETICAL ORDER)
1. Knowledge of Section 5 Holding Powers (Mental Health Act) Among Foundation
Doctors
Mawada Adam, ST5 Psychiatry Trainee - North West Deanery; Peter Jamieson, Foundation Year
2 – CMFT
Introduction: A small, but significant, number of patients are detained in general hospitals by
use of Section 5 of the Mental Health Act1 , so that a full Mental Health Act assessment can take
place. A Section 5 (2) form is a legal document and incorrect completion presents a risk to
patient safety and opens the detaining trust to legal challenge. Foundation doctors are among
those likely to be asked to complete this paperwork.
Aims: To audit the knowledge of Section 5 of the Mental Health Act among foundation doctors
at Central Manchester University Hospitals Foundation Trust (CMFT).
Methods: We completed a knowledge audit of 32 foundation doctors based at CMFT by use of a
printed questionnaire containing 8 questions. These were filled out between December 2016 and
January 2017. Standards for the audit were drawn from the Mental Health Act 1983: Code of
Practice2.
Results: Knowledge among foundation doctors regarding who can complete a Section 5(2) was
poor, with only 41% aware it should be the consultant in charge of the patient, or a specific
nominated deputy. Only 62% of doctors correctly answered that Section 5 (2) could not be used
in A&E. As few as 6% of doctors knew paperwork must be accepted by the hospital managers in
order to be valid.
Interventions: A number of interventions were carried out following the initial audit results.
These included:
Mental Health Act teaching for foundation doctors, incorporating distribution of the audit
results.
Distribution of audit results in the CMFT Acute (Internal) Medicine Divisional Clinical
Effectiveness Meeting.
Mental Health Act Awareness Session for nursing staff.
Re-Audit: A re-audit of 14 foundation year doctors by use of the same questionnaire in June
2017 demonstrated improvements in knowledge across all standards/questions used.
Conclusions: We discovered large knowledge gaps in foundation doctors at CMFT relating to
Section 5 of the Mental Health Act, with potential patient safety and litigation risks associated
with incorrect use of this legislation. Following a number of interventions focusing on education
of doctors and nursing staff, re-audit demonstrated improvements in knowledge of the subject
RCPcych Faculty of Liaison Psychiatry Annual Conference 2018 25You can also read
