Journal Article

A programme theory for liaison mental health services in England

House, Allan, Hewsion, Jenny, Trigwell, Peter, Tubeuf, Sandy, Crawford, Mike, Murray, Carolyn Czoski, Martin, Adam, Walker, Andrew, Hulme, Claire, Guthrie, Elspeth, Fossey, Matt, Brennan, Cathy, Quirk, Alan

2018

Overview

Background Mechanisms by which liaison mental health services (LMHS) may bring about improved patient and organisational outcomes are poorly understood. A small number of logic models have been developed, but they fail to capture the complexity of clinical practice. Method We synthesised data from a variety of sources including a large national survey, 73 in-depth interviews with acute and liaison staff working in hospitals with different types of liaison mental health services, and relevant local, national and international literature. We generated logic models for two common performance indicators used to assess organisational outcomes for LMHS: response times in the emergency department and hospital length of stay for people with mental health problems. Results We identified 8 areas of complexity that influence performance, and 6 trade-offs which drove the models in different directions depending upon the balance of the trade-off. The logic models we developed could only be captured by consideration of more than one pass through the system, the complexity in which they operated, and the trade-offs that occurred. Conclusions Our findings are important for commissioners of liaison services. Reliance on simple target setting may result in services that are unbalanced and not patient-centred. Targets need to be reviewed on a regular basis, together with other data that reflect the wider impact of the service, and any external changes in the system that affect the performance of LMHS, which are beyond their control.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Ambulatory care / Consultation-liaison psychiatry / Cost control / Emergency Service, Hospital - organization & administration / England / Health Administration / Health Informatics / Health services / Hospitals / Humans / Intersectoral Collaboration / Interviews as Topic / Length of Stay / Liaison mental health services / Logic models / Medicine / Medicine & Public Health / Mental disorders / Mental Disorders - therapy / Mental health / Mental health care / Mental health services / Mental Health Services - organization & administration / Models, Organizational / Nursing Research / Organization / Patient-centered care / Programme theory / Psychiatry / Public Health / Referral and Consultation / Research Article / structure and delivery of healthcare / Surveys and Questionnaires / Theories of change