Every day Rishi Seeruthun relishes the challenges of being a psychiatric nurse in one of the busiest mental health trusts in the country. Sometimes he may have to assess up to 13 patients in crisis who come through the doors of A&E during a single 12-hour shift. These assessments will generally take between 30 and 60 minutes, with some taking substantially longer than that. “We are at the frontline of acute mental health care. It can be adrenaline-driven sometimes and we have to be very well coordinated,” he says. “But you do get job satisfaction because we are a team working together to support each other with the common aim of working in the best interests of the patient. This is our aim and it’s good teamwork.”
Seeruthun works in Tooting as part of the nurse-led liaison service at South West London and St George’s Mental Health NHS Trust. The trust has three liaison teams that fit into the wider urgent and acute care services.
The teams – based at St George’s University Hospital NHS Foundation trust, Epsom and St Helier University Hospitals NHS trust, and Kingston Hospital NHS Foundation trust – work alongside their emergency departments but they also take referrals from hospital inpatient wards and outpatient clinics. “We are the gatekeepers of the NHS acute psychiatric beds,” says Seeruthun. “We do an assessment then make a working diagnosis, which we discuss with the consultant. We then signpost patients to other services.”
The trust’s liaison model is not unique – indeed, it reflects government ambition for every emergency department in England to have a service designed to care for people turning up in mental health crisis.
But what sets it apart from others is that it is a well-established service in a busy London teaching hospital – ranked “good” by Care Quality Commission (CQC) inspectors. The mental health trust, which inspectors say encourages innovation to deliver better patient care, and is “outward looking”, also has a national role looking after deaf adults and children with eating disorders who have additional serious mental illness.
“All three acute trusts have a 24-hour A&E, and St George’s is a major trauma centre with a number of tertiary services, so it’s a very busy and interesting site to work,” says Sarah Adams, the trust’s clinical services lead for liaison psychiatry.
The well-established liaison services also boast a number of clinicians with national reputations, including Jim Bolton, chair of the Royal College of Psychiatrists’ (RCPsych) Faculty of Liaison Psychiatry. Within the mental health trust more widely, there is also Catherine Gamble, head of the trust’s nursing practice, education and research, and the Royal College of Nursing’s professional lead for mental health.
The liaison teams based at St George’s and St Helier are both accredited to the RCPsych psychiatric liaison accreditation network, while Kingston – the smallest of the teams – is just about to begin the process. “It’s quite unusual to have all liaison services accredited from a single trust,” says Adams, adding: “but it confirms we are meeting the standards set by the Rcpsych in terms of how we should be operating in an acute trust.”
Adams, who began her career at the trust as a psychiatric nurse, is testament to the value that the trust puts in its nursing workforce. Currently, three of its nurses are completing the prestigious Darzi Fellowship leadership programme. “We want to think ‘legacy’ and are committed to people’s learning and development,” she says.
Adams agrees with the CQC that the trust is an innovator. Its Lotus suite – a 48-hour assessment centre that acts as a halfway house between an inpatient ward and community services – is unique to London. A new unit – which will provide 24-hour mental health assessment – being built at Kingston hospital as part of the liaison service, is also breaking new ground. “It creates a more comfortable space for people to be assessed in their own time, rather than ours,” she says.
While Kingston may be the smallest of the liaison units it is increasingly busy, offering nurses the chance to support people with diverse mental health needs. “The service has become busier and busier as the demographic of the local Kingston population has changed,” says Adams. “It used to be a predominantly older population but now there are more young people and young families living locally.”
That has changed the case mix of people coming through liaison services: “It means staff are dealing with more complex cases, which makes it more interesting, and it’s about what we can do to use the skills of our mental health nurses,” she explains.
The liaison service now wants to expand the skills of the nurse-led teams and is keen to attract occupational therapists (OTs). There are also plans to recruit social workers. “We recognise that nurses are not the only profession in mental health services, and that OTs and social workers bring different skills and different views,” says Adams. “I think historically nurses have felt slightly unsure [about a new skills mix], but our feeling is that what the OTs and social workers bring with them far outweighs what nurses feel they might lose.”
Find out more at swlstg.nhs.uk
