State of Consultation-Liaison Psychiatry in India: Current Status and Vision for Future
Grover, Sandeep, Indian Journal of Psychiatry
Byline: Sandeep. Grover
Over the years Consultation-Liaison (C-L) psychiatry has contributed significantly to the growth of the psychiatry and has brought psychiatry very close to the advances in the medicine. It has also led to changes in the medical education and in the providing comprehensive management to the physically ill. In India, although the General Hospital Psychiatric units were established in 1930s, C-L Psychiatry has never been the main focus of training and research. Hence there is an urgent need to improve C-L Psychiatry services and training to provide best and optimal care to the patients and provide best education to the trainees.
"Consultation-Liaison Psychiatry provides a fit vantage point for watching the changes that permit prediction of future directions in psychiatry as a medical discipline. The kind of psychiatry that the consultants practice and the type of training, skills, and professional attitudes that their work requires represent a model that is likely to prevail in psychiatry in the coming years". [sup]
Consultation-liaison (C-L) psychiatry as a subspecialty has been defined as the area of clinical psychiatry that encompasses clinical, teaching and research activities of psychiatrists and allied mental health professionals in the non-psychiatric divisions of a general hospital. [sup] C-L Psychiatry is derived conceptually from the old tradition, which advocates a ceaseless dynamic interaction between mind and body. It has brought psychiatry out of the mental asylums to the general hospitals and has also contributed significantly to the reduction of stigma that follows mental illness not only among members of the public but within the medical professionals and establishments also. Over the years C-L Psychiatry has contributed significantly to the growth of the psychiatry and has brought psychiatry very close to the advances in the medicine. It has also led to changes in the medical education and in the providing comprehensive management to the physically ill.
Understanding the term consultation-liaison
According to Lipowski, the designation "Consultation-Liaison" reflects two interrelated roles of the consultants. "Consultation" refers to the provision of expert opinion about the diagnosis and advice on management regarding a patient's mental state and behavior at the request of another health professional. The term "Liaison" refers to linking up of groups for the purpose of effective collaboration. In the context of current C-L Psychiatry, liaison involves interpretation and mediation i.e., the consultant psychiatrist mediates between patients and members of the clinical team and between mental health and other health professionals, respectively. [sup],,, Further the consultation and liaison are mutually complementary. A consultation encompass three interlocked foci i.e., the patient, the consultee, and the therapeutic team. Hence for consultation to be most effective the consultant psychiatrist need to have personal contact with both the patient (including his family) and those taking care of him. [sup]
However it, is important to understand the differences between the terms C-L Psychiatry and "Psychosomatic Medicine". Psychosomatic medicine is conceptualized as a non-clinical discipline that is concerned with ideas such as "the interplay of biological and psychosocial factors in the development, course and outcome of all diseases." In fact, the idea of psychological factors play an important role in the etiology of various physical disorders emerged from practice and theory of psychodynamic principles. [sup] Hence, some authors consider C-L Psychiatry as the practical/clinical arm or an applied form of psychosomatic medicine. [sup],
The basic assumption of C-L Psychiatry is to integrate the information so as to provide optimal health care, which is sensitive to people's needs, mindful of prevention, and economically sound. …