Shouldn’t mental health units be part of general hospitals?

I’ve been working in liaison psychiatry for the last six months. For those of you who haven’t heard of it before, it’s the branch of psychiatry that see patients who are in hospital with physical health problems. Some hospitals have a dedicated liaison department, some have a team that only visit if they’re called, some have no service at all.

There’s a very instructive video about the speciality by CNWL NHS Trust available here.

Anyway, I’ve enjoyed my job, and think that every hospital should have a liaison psychiatry service – but I got to wondering, why should we need to liaise in the first place? Why should every speciality except psychiatry have their patients under one roof, with psychiatry visiting from outside to help out, while people with mental health problems are usually admitted to separate hospitals often miles away?

I tweeted about it:

Having mental health wards as part of general hospitals is something that already happens in other countries. There appear to be positives and negatives to it.

On the plus side, patients would get a higher quality of physical health care. So many patients who have a mental health problem also have physical health problems, and many need treatment for both simultaneously. Sometimes the cause of the mental health problem is a physical health problem. Being seen by doctors from a range of specialities would be easy; so would getting all the relevant tests. It would be a far better situation than currently, when patients who are unlucky enough to have both a mental and a physical health problem are often shuttled back and forth between hospitals in a time consuming, inefficient, untherapeutic and potentially risky game of musical beds.

Furthemore, some might argue that having mental health units as part of general hospitals might lower the stigma of being admitted. I’ve met so many patients who were quite happy to come into a general hospital but not into a mental health hospital, just because of the negative connotations. Having mental health patients and indeed psychiatrists mixing in the general hospital environment might serve to demonstrate that we are deserving of respect and equality and do not live up to our distorted stereotypes.

On the negative side, perhaps it would reinforce what some feel is already too ‘medical’ a model. Maybe having our mental health hospitals physically separate from general hospitals enables, or at least encourages, us to treats our patients less like disease-bearing entities and more like people. Personally I’m not sure I agree though. I don’t see why a mental health ward placed on a general hospital site couldn’t still have a holistic, non-biological ethos, and I’m not sure our mental health units are even slightly holistic currently as a result of being separate. In fact, I might argue the opposite – that by isolating mental health units, we stagnate in comparison to our forward-thinking relatives in other specialities, hide away our deficits and struggles and encourage insular practice.

So those are my initial thoughts, but there is so much left to be said. What do you think?

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