Academic journal article East Asian Archives of Psychiatry

Consultation-Liaison Service in a Regional Hospital in Hong Kong

Academic journal article East Asian Archives of Psychiatry

Consultation-Liaison Service in a Regional Hospital in Hong Kong

Article excerpt

Abstract

Objective: To examine consultation-liaison psychiatric services in a general hospital in Hong Kong.

Methods: All records of Tseung Kwan O Hospital psychiatric consultations from 1 July 2012 to 30 June 2013 were extracted from the database. Patients' demographic data, sources and reasons of referral, psychiatric and suicidal histories, current suicidal attempt, psychiatric diagnoses, psychiatric outcomes, as well as waiting times were analysed accordingly.

Results: A total of 1392 psychiatric consultations were received, of which 82% were attended to within the same working day when the referral was received, and 99% were attended to by the end of the next working day. The commonest reasons of consultation were unstable emotion followed by suicidal / deliberate self-harm and aggression. There were 246 consultations with actual suicidal attempt. Overall, 270 (19%) patients who received consultation-liaison psychiatric services were admitted to the psychiatric wards. Follow-up in the psychiatric outpatient department was arranged for 691 (50%) patients while 57 (4%) required referral to the community psychiatric nursing service in addition to outpatient department arrangement.

Conclusions: Management of suicidal attempters and provision of risk assessment continue to be the major tasks of consultation-liaison psychiatrists and nurses. A readily available on-site consultationliaison psychiatric service is an essential component of services provided in acute general hospitals.

Key words: Hong Kong; Mental disorders; Referral and consultation

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Introduction

Consultation-liaison (CL) psychiatric services operate at the interface between physical health and mental health, and address the mental needs of people who are being treated primarily for physical health problems or symptoms. The scope includes psychiatric collaboration or integration into mental health care services provided in primary care and specialty care settings.1 Consultation-liaison psychiatrists also need to be equipped with relevant legal knowledge related to health care, informed consent, and privacy. At present, liaison mental health services are mostly provided to patients attending general and acute hospitals. The prevalence of mental illness among people with physical health conditions is 2 to 3 times higher than that in the rest of the population.2 Prevalence is particularly high in the hospital setting, where around half of all inpatients suffer from a mental health condition such as depression, dementia, or delirium.2 Many of these co-morbid mental health problems typically go undiagnosed and untreated. In the absence of effective intervention, they lead to poor health outcomes, including increased rates of mortality and morbidity. Mental health co-morbidities also substantially increase the costs of physical health care.

In 2011, the Centre for Mental Health of the UK published an economic evaluation of the award-winning liaison psychiatry service at the UK's Birmingham City Hospital. As well as improving health, the financial savings generated by the service significantly outweighed the costs of running it; annual savings were estimated to be £3.5 million.3 This was followed in 2012 by the publication of a report recommending that every National Health Service hospital in the UK should have liaison psychiatry as a standard service.2 This highlights the changing status of liaison psychiatry in public health care services. It needs to be recognised as an essential ingredient of modern health care and not an optional extra, which is merely nice to have.2

Most general hospitals in Hong Kong have different levels of CL psychiatric services which are provided by the psychiatric team within the same cluster. Some have round-the-clock coverage, especially to the Accident and Emergency Department (AED), while some have only limited services. …

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