Useful information about working in Psychiatry
Who to call
Liaison Psychiatry reception / e-Referral Liaison Psychiatry
Office hours: For urgent or semi-urgent referrals, or to discuss informally, contact Liaison Psychiatry Registrar
After hours: contact Liaison Psychiatry Nurse Specialist (until 2300h, 7 days a week).
Overnight: the on-call Psychiatric Registrar is available via the switchboard.
Referral process
Information to include in the referral:
Current referral question (be specific, e.g. diagnostic query; advice about management).
A brief outline of reason(s) for admission and relevant medical and/or surgical issues.
A brief psychiatric history that will include current psychiatric symptoms, relevant aspects of past psychiatric history and current mental state examination.
Mental state examination (MSE):
Behaviour (appearance, motor behaviour)
Speech (rate/volume, intonation, quantity of information)
Mood (depressed/euphoric/suspicious)
Affect (restricted/flattened/inappropriate)
Thought form (organised, disorganised)
Thought content (delusions)
Perception (hallucinations)
Orientation and cognition
Insight/awareness of difficulties
Safety concerns
If relevant, a cognitive assessment, e.g. Mini-ACE or ACE-III
Common problems
Consent / Capacity
Refer to
See Managing Patients with Diminished Capacity under the Legal section on the intranet, and the Capacity and Consent Guideline
Clinicians are routinely required to assess a patient’s capacity and ability to give informed consent for medical management during the course of a clinical assessment. It is therefore essential to assess the patient’s ability to give informed consent and the specific context in which it is given.
When is it appropriate to refer to Liaison Psychiatry for an assessment of capacity?
You should complete a capacity assessment, and if you are still unsure whether the person has capacity, discuss this with the Consultant in charge of the patient’s care. If you need a second opinion, a Liaison Psychiatry referral may be appropriate, especially if a psychiatric condition is impacting your capacity.
It is important to remember that a patient is presumed competent unless there are reasonable grounds to believe otherwise. A psychiatric disorder does not necessarily indicate impaired capacity.
Where the capacity issues relate to cognitive impairment, it is assumed that all clinicians would be able to perform a basic bedside cognitive assessment and determine how this relates to a patient’s ability to (1) comprehend, (2) recall, (3) weigh information, and (4) communicate their decision consistently.
In cases where there is diagnostic uncertainty or issues of borderline capacity, it is appropriate to request a second opinion from Liaison Psychiatry.
Mental Health (compulsory assessment and treatment) Act 1992 (MHA)
The MHA allows for the compulsory assessment and treatment of patients suffering from a mental disorder defined in the Act as: "an abnormal state of mind (continuous or intermittent) characterised by delusions or by disorders of mood or perception or volition or cognition".
Experiencing symptoms from a mental disorder is not sufficient grounds for compulsory treatment.
In addition, the patient must either:
Pose a serious danger to their own health or safety or that of others OR
They are seriously diminished in their capacity to care for themselves
The MHA can ONLY be used to treat the psychiatric condition. Patients under the MHA can be detained in a hospital to receive compulsory mental health care.
If you are required to participate in an MHA process, Liaison Psychiatry staff will guide you through it.
If you are aware that a patient is subject to the Mental Health Act in the community, Liaison Psychiatry should be notified when they are admitted to hospital.