Background Increasingly patients referred to community specialist palliative care (SPC) have multiple co-morbidities including psychiatric and mental health needs in addition to physical disease. Access to psychiatric services is variable. There is no national standard for community-based shared care in this context and both palliative and psychiatric professionals report challenges.
Methods This prospective audit aimed to:
establish local need for community psychiatric liaison/shared working;
identify unmet needs for quality improvement. Patients discussed in a SPC community multidisciplinary team meeting were screened for three months.
SPC staff had concerns about managing mental health needs; contact with psychiatric services within last year; current medication prescription for psychiatric disorder. Exclusion criteria: not meeting inclusion criteria and dementia if SPC considered this appropriately managed without psychiatric input.
Results In 182 case discussions (May–July 2017), 35 patients (new n=19/96, complex n=16/86) with unmet mental health needs were identified. 26 had a formal psychiatric diagnosis; 12 had on-going psychiatric care. 20 had never had contact with a local community mental health team, 3 were previously discharged. SPC attempted shared care with mental health services in 10 cases (3 via GP, 1 patient refused, 1 via oncology psychology services, 4 received psychiatry services and 1 was accepted but died before being seen). Four patients‘ needs were first identified by psychiatric liaison teams during hospital admissions. SPC records demonstrate a further 17 patients whose current needs exceeded SPC expertise but no shared care or referrals were attempted. The remaining 4 patients‘ needs were met directly by SPC. Exemplar vignettes with further learning will be shared.
Conclusions This demonstrates significant unmet mental health needs in our community SPC population. Addressing needs requires proactive liaison between SPC and mental health services with identification of best practice models that also integrate specialist services with general practice.
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