The North West London Optimal Model is a liaison mental health service designed to operate in acute general hospitals in the area, providing care for people with significant mental health needs. It also provides training for non-mental health clinicians and hospital staff in supporting people with mental health needs. The model integrates GPs, specialist mental health teams, out-of-hospital care providers and housing services.
The Integrated Care Pathway in North West London was established in 2012 with the initial goal of integrating the management of diabetes with the care of people over 75 years old. Building on the evidence for the Rapid Assessment Interface Discharge (RAID) model (see Section 2.6), the service modified the skill mix and staffing ratios of that model to put together a 24-hour service that reflected the local urban demand, and later became the ‘core 24’ model (as described in Section 3.4.1 of the implementation guidance). The service provides a single point of contact for all people with diagnosed or suspected mental health problems, providing rapid response in emergency departments (EDs) and hospital wards.
The North West London Optimal Model is a liaison mental health service designed to operate in acute general hospitals in the area, providing care for people with significant mental health needs. It also provides training for non-mental health clinicians and hospital staff in supporting people with mental health needs. The model integrates GPs, specialist mental health teams, out-of-hospital care providers and housing services.
The service is delivered by a multidisciplinary team made up of clinical staff from a range of disciplines, including psychiatry, nursing and social work. The team is made up of two consultant psychiatrists, one team manager, 12 band 6 and 7 team nurses, two therapists (one generic and one occupational therapist). The service also provides one substance misuse nurse, two specialist registrars, one social worker and two staff to provide business and administrative support.
An interim evaluation of the liaison mental health service piloted at the four acute trusts was undertaken in September 2012 to measure the service’s impact. The evaluation found that from March to September 2012, the liaison mental health team saw 4,102 people. Two- thirds of people seen were between 16 and 65 years old, and one-third was over 65. The four most frequently diagnosed conditions were depression, alcohol dependence, schizophrenia and dementia.
The new model has led to important pieces of work, one of which has been looking at ways to reduce the number of attendances by frequent attenders at acute hospitals. Frequent attendance was reduced and improvements in care were achieved through face-to-face interventions (such as psychoeducation) with service users and carers, and a review identifying gaps and duplications within primary, secondary and community care to allow for appropriate referrals to be made. Another piece of work looked at how breaches in EDs are recorded across acute trusts. That resulted in the creation of a work validation tool, used to define any breaches and why they were occurring. Common reasons included waiting for Mental Health Act assessments or beds; another factor was medical teams not referring a person to the liaison mental health team until the four-hour target was almost breached.
