Thursday 30 November 2006

Hospices fall well below NICE guidance on psychiatric support for end of life care

Patients in hospices in the UK and the Republic of Ireland may not be receiving appropriate psychiatric services as recommended by the National Institute of Clinical Excellence (NICE) guidelines.

The study, published in the Journal of the Royal Society of Medicine, has found 45 per cent of hospices do not have access to psychiatric or psychological care; however, 86 per cent did have access to complementary therapists.

Dr Max Henderson, a psychiatrist and one of the study’s authors, said there was a clear gap between the recommended level of service and the psychiatric care available in hospices.

“Hospices are doing the best they can in alleviating distressed patients, many of whom are dying from cancer, however, increasingly threatened funding to liaison psychiatry means the care of patients with advanced stages of the disease is being compromised by limited resources,”

said Dr Henderson.

“The NHS must not focus on those with severe and enduring mental health problems such as schizophrenia to the detriment of patients with advanced disease,”

he said.

The authors assessed the availability of psychological care to hospices in accordance with NICE guidelines. All 224 hospices in the UK and Republic of Ireland were contacted. With a response rate of 74 per cent (166 hospices) they found that only 30.1 per cent had access to a psychiatrist, 41.2 per cent a clinic psychologist, 51.2 per cent a creative therapist and 86.1 per cent a complementary therapist.

“There is an increasing awareness within palliative care that the mental wellbeing of a patient is an important aspect of their care. While many hospices provide that support, the very end of a patient’s life is a very difficult time, the NICE guidelines reflect this and it is crucial that these guidelines are met,”

said Dr Henderson.

“Nationally, liaison psychiatry services still fall well short of the recommendations agreed by most Royal Colleges and this may be a particular problem for patients at the end of their life who should not have to go without the level of care required.”

[ends]

Psychological services in hospices in the UK and Republic of Ireland [PDF 57k]

Notes

Liaison psychiatry is the multi-disciplinary approach to managing the psychological aspects of physical health problems. The importance of psychological factors is increasingly recognised at many stages on the patient journey and liaison psychiatry teams have expertise in both managing and advising other medical teams on the management of often complex clinical problems.

‘Psychological services in hospices in the UK and Republic of Ireland’ by A Price, M Hotopf, IJ Higginson, B Monroe and M Henderson is published in the December 2006 issue (Vol. 99) of the Journal of the Royal Society of Medicine.

JRSM is the flagship journal of the Royal Society of Medicine. It has been published continuously since 1809. Its Editor is Dr Kamran Abbasi.

The article is available free at www.jrsm.org on 1 December.