For the next week, we have a doctor thought she was going to be talking about crossing boundaries and work as a
consultant in psychological medicine and psychiatry at Oxford University Health and Foundation Trust.
And she has a particular interest in the care of older adults in complex conditions,
in institutionalised settings, and is set up interesting trials in that area.
So she got pretty much there are absolutely no difference, whatever.
But this is from an all age service.
This is not surprising for us because only 17 percent of all admissions actually ended up with an intervention from psychological medicine.
There was a lot more data that that did prove really quite useful for us,
a hint of a of an increase in of a reduction in the number of delayed transfers of care.
But the numbers are relatively modest. But the real the real issue here was, first of all, this was this was feasible.
It was acceptable. The medicks brought us I and my colleagues have spent a good year and a half building up relationships,
and they had to allow us to make decisions which were really the remit of medicks before the issue of medical fitness if you run the junior.
So I think this one's medically fit. Can we let them go? They would be likely to say, yes, I think it is.
You're then discharging the patient. You're talking about medical issues.
You're making all the liaison with the full range of staff that are needed to get this person out of hospital.
This is not just to save money or increase throughput. This is because hospitals are toxic places for old people, especially confused elderly people.
They are, on average, likely to get worse in hospital, which is a rather perverse situation.
So we're targeting particularly those older age people.
We believe this could be a cost effective and effective intervention and those are currently the final stages.
Who knows if it'll be funded, but a very large controlled trial,
what we're now calling proactive liaison's here with Michael Sharp as the lead applicant.
These things take years and cost millions of pounds, but they're the only real way forward.
Evidence, which is not in randomised controlled trials, is to be strongly suspected.
There are many examples in medicine and in our field psychiatry of conventional
treatments being shown in proper controlled trials to be not effective.
So I must say for me, it's an intellectual challenge. Crossing the divide, crossing the boundary from psychiatry, which is my background.
I was an old age psychiatrist for many years, like Philip, like who is going to speak after I've moved into what we call liaison psychiatry.
The move is a bit weird. As a psychiatrist,
you get used to one particular culture and coming to work somewhere like Podgorica before the job because I'm not in the mental health trust.
It's quite strange. Here's one of the things, something that happened in psychiatry four, five, ten years ago.
New ways of working through a dilution of medical authority,
a belief that a multidisciplinary team needed to be very democratic and traditional models of medical leadership were not appropriate.
Now, for better or worse, that that has caught on for a lot of young people coming to a community mental health team.
It's pretty weird if you go to a certain, you know, surgery to theatre, it's clear who's in charge.
There's a team. The authoritarianism can be a problem.
I wouldn't work in psychiatry.
If you go to a community mental health team meeting, it's often really a bit you know, it is just not clear who's in charge.
It's all very democratic. It's not for everybody. There's none of that in the setting that we work in.
We only have consultants in the team anyway. So it's literally in charge. It's all generals and no troops, but there's no new ways of working.
Their medical opinion is really valued. They really want an expert opinion on what is wrong with this patient and this kind of typical example of us,
um, a well-intentioned diagnosis of delirium made by the community psychiatric nurse.
But in fact, the diagnosis was wrong.
This was an 86 year old who's had a first episode of schizophrenia and we were able to discharge him home quickly.
And that's not to say we are clever. It's just to say that they really value the opinion of somebody with clinical expertise.
We could skill the staff. There was no I mean, in the past, most psychiatry is clearly done by non psychiatric staff in the general hospital.
And this is the sort of thing that we would get where they might go.
Well, what's the point in thinking about what does this guy, you know, this psychiatry on top in the hospital?
And this is the sort of conversation that we have from time to time where people perhaps don't actually know what question they're asking.
They don't really know why they're referring. Patient is a bit mental.
So let's refer to psychiatry, which is actually unhelpful for the referrer, because they don't have to train themselves to think at all.
Managers, politicians, really quite interesting, weird psychiatrists who are a bit strange,
we talk strange language does a kind of alien aspect to us, which they really rather like.
We're seen as having some magical quality of dealing with difficult people or having some unusual terminology.
Mustn't underestimate that. That has a considerable appeal to, you know, you Hajj.
Conclusion, most people in general.
Well, everyone has a physical disorder. Most of them have a psychiatric disorder if you're old in general hospital.
It's a kind of second from a second asylum. It's an alternative provider of old age mental health care.
And our discipline, which is actually working as part of medicine, but on the psychological side, can work directly with them.
There's a lot of things that we can do where I think it's not just about giving a decent opinion quickly on the patient,
where I think we can begin to look at altering a system to make a difference.
Thank you.