Woodall et al (Psychiatric Bulletin, June 2006, June 2006, 30, 220–222) highlight the potentially adverse effects on the clinical experience of psychiatric trainees of increased reliance on liaison nurses to conduct emergency psychiatric assessment. As members of the liaison team in the hospital in Wrexham where the study was conducted, we would like to respond.

Liaison psychiatry, in particular the assessment of patients after self-harm, offers excellent opportunities for trainees to develop a range of clinical skills, including rapport in difficult circumstances, comprehensive history-taking and mental state examination, case formulation, risk assessment, negotiating a management plan with the patient and communicating effectively with all parties.

We wholeheartedly support the development of the role of liaison nurses because it increases capacity and improves service delivery. However, we are concerned about the effect that this might have on the clinical experience of psychiatric trainees. Hence for some time we have invited trainees to voluntarily undertake psychosocial assessments jointly with liaison nurses. However, the uptake of this offer has been variable and this latest study has underlined the need for a new approach.

With the consensus of consultant colleagues, all junior psychiatrists will now be required to complete ten joint psychosocial assessments every 6 months in addition to their on-call work. They will observe the first few assessments while the liaison nurse takes the lead, and then take the lead on the remaining assessments. Trainees will also continue to receive weekly supervision of all liaison cases they see while on call.