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For the next week, we have a doctor thought she was going to be talking about crossing boundaries and work as a

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consultant in psychological medicine and psychiatry at Oxford University Health and Foundation Trust.

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And she has a particular interest in the care of older adults in complex conditions,

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in institutionalised settings, and is set up interesting trials in that area.

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So she got pretty much there are absolutely no difference, whatever.

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But this is from an all age service.

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This is not surprising for us because only 17 percent of all admissions actually ended up with an intervention from psychological medicine.

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There was a lot more data that that did prove really quite useful for us,

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a hint of a of an increase in of a reduction in the number of delayed transfers of care.

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But the numbers are relatively modest. But the real the real issue here was, first of all, this was this was feasible.

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It was acceptable. The medicks brought us I and my colleagues have spent a good year and a half building up relationships,

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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.

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So I think this one's medically fit. Can we let them go? They would be likely to say, yes, I think it is.

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You're then discharging the patient. You're talking about medical issues.

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You're making all the liaison with the full range of staff that are needed to get this person out of hospital.

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This is not just to save money or increase throughput. This is because hospitals are toxic places for old people, especially confused elderly people.

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They are, on average, likely to get worse in hospital, which is a rather perverse situation.

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So we're targeting particularly those older age people.

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We believe this could be a cost effective and effective intervention and those are currently the final stages.

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Who knows if it'll be funded, but a very large controlled trial,

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what we're now calling proactive liaison's here with Michael Sharp as the lead applicant.

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These things take years and cost millions of pounds, but they're the only real way forward.

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Evidence, which is not in randomised controlled trials, is to be strongly suspected.

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There are many examples in medicine and in our field psychiatry of conventional

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treatments being shown in proper controlled trials to be not effective.

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So I must say for me, it's an intellectual challenge. Crossing the divide, crossing the boundary from psychiatry, which is my background.

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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.

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The move is a bit weird. As a psychiatrist,

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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.

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It's quite strange. Here's one of the things, something that happened in psychiatry four, five, ten years ago.

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New ways of working through a dilution of medical authority,

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a belief that a multidisciplinary team needed to be very democratic and traditional models of medical leadership were not appropriate.

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Now, for better or worse, that that has caught on for a lot of young people coming to a community mental health team.

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It's pretty weird if you go to a certain, you know, surgery to theatre, it's clear who's in charge.

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There's a team. The authoritarianism can be a problem.

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I wouldn't work in psychiatry.

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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.

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It's all very democratic. It's not for everybody. There's none of that in the setting that we work in.

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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.

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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,

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um, a well-intentioned diagnosis of delirium made by the community psychiatric nurse.

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But in fact, the diagnosis was wrong.

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This was an 86 year old who's had a first episode of schizophrenia and we were able to discharge him home quickly.

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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.

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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.

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And this is the sort of thing that we would get where they might go.

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Well, what's the point in thinking about what does this guy, you know, this psychiatry on top in the hospital?

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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.

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They don't really know why they're referring. Patient is a bit mental.

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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.

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Managers, politicians, really quite interesting, weird psychiatrists who are a bit strange,

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we talk strange language does a kind of alien aspect to us, which they really rather like.

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We're seen as having some magical quality of dealing with difficult people or having some unusual terminology.

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Mustn't underestimate that. That has a considerable appeal to, you know, you Hajj.

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Conclusion, most people in general.

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Well, everyone has a physical disorder. Most of them have a psychiatric disorder if you're old in general hospital.

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It's a kind of second from a second asylum. It's an alternative provider of old age mental health care.

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And our discipline, which is actually working as part of medicine, but on the psychological side, can work directly with them.

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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,

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where I think we can begin to look at altering a system to make a difference.

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Thank you.