Liaison psychiatry

Liaison psychiatry, also known as consultative psychiatry or consultation-liaison psychiatry is the branch of psychiatry that specialises in the interface between general medicine and psychiatry, usually taking place in a hospital or medical setting. The role of the consultation-liaison psychiatrist is to see patients with comorbid medical conditions at the request of the treating medical or surgical consultant or team. Liaison psychiatry has areas of overlap with other disciplines including psychosomatic medicine, health psychology and neuropsychiatry.

Liaison psychiatry usually provides a service to patients in a general medical hospital, either inpatients, outpatients or attenders at the Emergency Department. Referrals are made when the treating medical team has questions about a patient's mental health, or how that patient's mental health is affecting his or her care and treatment. Typical issues include:

The psychiatric team "liaises" with many other services, including the treating medical team, other mental health services, social services, and community services. There is increasing interest on extending liaison psychiatry to primary care, for the management of long-term medical conditions such as diabetes mellitus.

An evaluation of the Rapid Assessment, Interface and Discharge (RAID) model of liaison psychiatry — employed at City Hospital, Birmingham — estimated that the service saved between 43 and 64 beds per day through reduced lengths of stay and prevention of readmission. In 2011 the Centre for Mental Health published an economic evaluation of the service, estimating savings of around £3.5 million. This was followed in 2012 by the publication of a report recommending that every NHS hospital should have a liaison psychiatry service as standard.

The history of liaison psychiatry is partly a history of psychiatry and medicine. Galen was highly influential for over 1500 years in medicine particularly advocating the use of experimentation to advance knowledge. The polymath physician Avicenna produced many insights into medicine but only became influential in Western medicine when William Harvey's elucidation of the circulatory system forced a re-evaluation of Galen's work. The French philosopher René Descartes began the dualistic debate on the division between mind and body. Johann Christian August Heinroth is credited with the origination of the term psychosomatic illness. At the beginning of the 19th century Johann Christian Reil created the term psychiatry whilst the polymath Benjamin Rush wrote Diseases of the Mind. The philosopher Spinoza's concept of conation, Mesmer's development of hypnosis together with Charcot's refinement of this technique influenced Sigmund Freud whose development of psychoanalytic theory was to have a profound impact on the development of liaison psychiatry. Under the guidance of Alan Gregg, psychoanalysis impacted on hospital medicine through figures such as Franz Alexander, Stanley Cobb and Felix Deutsch.

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