Louth County Hospital's in-reach team combines mental and physical healthcare for older patients, to reduce pressure on hospital beds and promote independence.

Louth County Hospital is in a rural area of Lincolnshire with a population over 65 of almost 18,000 people.

A traditional bed-based service was provided by the Lincolnshire Partnership trust for 14 older adults with mental health needs. In addition, the general hospital wards were admitting older adults who had physical care needs plus secondary mental health needs.

The specialist ward frequently had delayed transfers due to lack of community alternatives. Patients requiring physical care were often transferred to general care and back again.

It was clear that teams needed to work together to address physical and mental health needs through one holistic assessment. After considering various models of liaison and support, an in-reach service was developed, bringing together physical and mental healthcare.

Core aims of the new service are to:

  • provide in-reach support, wherever the patient is within the acute inpatient service, including accident and emergency;
  • reduce transfers between different acute services through one streamlined assessment process;
  • work across a range of partners, including statutory and third-sector providers;
  • offer an increased range of options for assessment and treatment;
  • provide timely mental health and social care to reduce length of stay and enable more people to return home with individual care programmes;
  • help agencies work together, remove organisational boundaries, and share resources including knowledge and skills;
  • enable a transfer of knowledge between mental healthcare staff and acute general hospital staff to provide holistic care;
  • develop a service to meet the growing needs of an above-average elderly population.

A real alternative
In the first six months the new in-reach team has seen 270 referrals. The team is involved from admission to discharge, and the vast majority of patients are returning to their own homes. Where ongoing mental health assessment or treatment is required, this can be provided as part of the discharge plan for up to four weeks by the in-reach team.

Follow-on support, if required, is provided by the long-term conditions arm of the enhanced community services. The length of stay is based on the patient's physical care requirements and generally falls within 14 days or less.

A recent survey of patients and carers showed that carers rated the service as either good or excellent. Staff within the acute general wards said that they felt supported and more aware of the needs of older people with mental health needs.

For more information contact Janet Toynton at Lincolnshire Partnership trust at janet.toynton@lpt.nhs.uk