A review of research on the structure, process and outcome of liaison mental health services
ABSTRACT Liaison mental health services (LMHS) developed originally to address the mental health needs of people with physical illnesses in general hospitals and more recently to work also with people with mental health problems presenting at non-mental health services. The purpose of the present paper was to review empirical research on the structure, process and outcome of liaison mental health services using systematic review methods. Following a comprehensive search strategy, the authors reviewed 48 papers published between 1975 and 2001. There is an extensive international literature on LMHS, much of which describes the structure and process of liaison work. Studies evaluating the outcomes of liaison mental health services are fewer, and handicapped by methodological flaws, some of which are serious enough to cast doubts on the reported results. Professionals and clients value LMHS. LMHS based in accident and emergency (A & E) departments appear to ease the burden of general A & E staff, help clients access mental health services and reduce re-admission rates of people with mental health problems. There is little evidence supporting one model of configuring LMHS over another.
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ABSTRACT: Bundling is defined as the aggregation of services to increase effectiveness (i.e., creating synergy of effort). The purpose of this commentary is to review the utilization and potential benefits of bundling in its application to HIV prevention. Review of the literature to provide a broad perspective on the concept of bundling and specific examples of bundling in HIV prevention. Benefits, challenges and directions are considered. To be effective, bundling must offer strategic advantage: greater value, less cost. It provides an opportunity to target multiple risk behaviors simultaneously for synergistic gain. Technological advances including rapid HIV tests permit noninvasive sampling in clinical and non-clinical settings. Bundling of HIV prevention provides an opportunity to reach high-risk persons who are asymptomatic and/or may not otherwise seek care by eliminating barriers to prevention. We must implement programs that work and consider innovative approaches to stem the AIDS epidemic; bundling provides one such opportunity to create an efficient paradigm targeting multiple risk behaviors simultaneously.Preventive Medicine 04/2008; 46(3):222-5. DOI:10.1016/j.ypmed.2007.09.006 · 2.93 Impact Factor
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ABSTRACT: Australia, like many other countries that adopted deinstitutionalisation is experiencing increased presentation at emergency departments (EDs) by patients with acute mental health and addiction needs. While different models of psychiatric emergency care have been utilised within EDs little is known about the effectiveness of the care provided or how they work on a day-to-day basis. Psychiatric Emergency Care Centres (PECCs) is one of these new initiatives. PECCs aim to improve patient flow in urban EDs by providing a rapid pathway to specialist mental health assessment and care. St Vincent hospital in Sydney opened a 6 bed PECC service in 2005. It is co-located with ED and staffed 24 hours a day by registered mental health nurses supported by psychiatric and emergency teams. The service has two components - a short term stay unit and an ED liaison role. The nurses work closely with community mental health teams, inpatient units, general practitioners, non-government agencies and other hospitals. This thesis evaluated the organisational and operational aspects of this PECC service using a processimpact evaluation. Documents, existing clinical records and interviews with nurses in the PECC and ED and with a consumer representative were used as data sources to describe the service and identify what was working well and what could be improved. The research found that the service has provided additional resources and collaboration between ED and mental health services. In addition the research found that PECC is an effective service catering to the needs of consumers and providing access to mental health specialist clinicians. Since PECC was established there has been an increase in assessments conducted within the ED and an increase in the numbers presenting to ED for mental health reasons from 2833 in 2006 to 4987 in 2008, but the number of admissions to PECC have remained relatively stable at 693 and 714. Aspects of the service that worked well included the rapid assessment and management of acutely unwell people by the PECC nurses. Aspects that were problematic concerned the ability of the service to address social issues and the management of people with behavioural, alcohol, substance intoxication or selfharm behaviours. Areas for enhancing the service include being more consumers responsive, increasing the skills and knowledge of staff and undertaking further research regarding the needs of people who use the service.
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ABSTRACT: If nurses plan and approach older people with dementia with positive values, and learn from the person's communication through their behaviour, the outcomes for all parties can be improved. The vignette has offered one example, but also demonstrates that there are no failure-proof ways of communicating, and sometimes nurses need to learn through trial and error. Only in this way can they become more skilled in their interventions to facilitate rather than manage challenging behaviours. Avoidance and ignorance do not help in either the short term or the long term. The good news is that single interventions are successful 45 per cent of the time and multiple interventions, as shown in Box 2, are more successful (Bair et al 1999).Nursing older people 06/2001; 13(3):18-20. DOI:10.7748/nop2001.05.13.3.18.c2177