The Society for Acute Medicine (SAM) welcomes the NCEPOD (National Confidential Enquiry into Patient Outcome and Death) report Treat as One – Bridging the gap between mental and physical healthcare in general hospitals. We agree with the comment in the foreword that “it has been acknowledged for many years that mental health services are a cinderella of our NHS, but after reading this report you may rightly conclude that those mental health patients being treated for physical disorders are seriously disadvantaged”. While most people see acute medicine as a specialty devoted to physical disease, SAM has long argued that we need to return to the basic definition of health, namely physical, psychological and social wellbeing. In the same way that we have championed the need for better social care, we also support any efforts that we, and others, can make to improve the care of patients with mental health disorders.
As with other NCEPOD reports, acute medical units again provide care for the majority of patients, in this case 57.8%. Waiting for patients to be ‘medically fit’ or ‘medically cleared’ before any mental health assessment is undertaken needs to stop. Physical and mental health assessments should be carried out in parallel with each other when possible in order to avoid delays in best managing a patient’s mental health alongside their physical needs.
We need to be better at psychiatric medicines reconciliation on admission, especially psychotropic medications, and documentation of psychiatric medication and treatment on discharge. We need to ensure that mental health assessment is a part of all medical patients’ admission process; it should be part of clerking and routinely asked about on post-take ward rounds, forming part of the senior review and management plan.
All staff working with patients with mental health diagnoses should have training in mental health conditions, including support staff such as porters and security staff. Patients with chronic mental health conditions are at increased risk of medical co-morbidities and nearly 40% are current smokers, so we need to offer more smoking cessation advice and intervention. We know when to refer to psychiatry liaison for self-harm and challenging behaviour, but we are less good at referring for support for those patients with chronic mental health problems.
SAM is committed to implementing the recommendations of the NCEPOD report. In the past, issues related to mental health have formed important educational sessions at our conferences and going forward we will incorporate our response to mental health in our soon to be published strategy and governance structure.