The effectiveness of mental health consultation and referral in ambulatory primary care: a research lacuna

Psychiatric liaison consultations of patients without psychiatric illness in a general hospital in Germany: a retrospective analysis

The aim of the study was to explore the utilization of consultation-liaison psychiatric (CLP) service among nonpsychiatric patients in a general hospital. A retrospective analysis was conducted on all patients seen by the CLP in 2013. In 66 (5.9 %) of these 1112 consultations, no psychiatric diagnosis could be identified. These cases were analyzed by department of referral, assumed psychiatric symptoms, consensus with the symptoms found by the CLP, and recommended procedures. Assumed depressive symptoms, suicidal ideations and "difficult" behavior were the predominant reasons for CLP referrals. As the results suggest, CLP service was mostly "overprovided" because of uncertainty about the working areas of psychiatrists or overestimation of the severity of symptoms. These findings emphasize the importance to develop more precise guidelines for CLP services and that it could be worth striving for a more profound psychiatric training for nonpsychiatric physicians to achieve an optimal treatment for patients.

The mental health professions: workforce supply and demand, issues, and challenges

The U.S. mental health (MH) workforce is comprised of core disciplines: psychology, psychiatry, social work, psychiatric nursing, and marriage and family therapy. A broader group of practitioners also deserves recognition. Diverse professions provide significant services in a variety of settings, extending the de facto mental health workforce. A tally of key disciplines estimates there are 537,857 MH professionals, or 182 per 100,000 U.S. population. This article provides an overview of the need and demand for mental health services and summarizes the MH professions (e.g., training, educational credentials, workforce estimates). It also discusses a range of challenges confronting MH professionals and the need for greater understanding of the workforce and integration of services. Methodological factors that confound estimates of the magnitude of the MH workforce are reviewed.

A systematic review of studies of the cost-effectiveness of mental health consultation-liaison interventions in general hospitals

A systematic review of cost-effectiveness analyses of mental health consultation-liaison interventions in general hospitals was conducted. Few studies have evaluated the cost-effectiveness of consultation-liaison interventions, and only two articles met the criteria for inclusion in the review. The comparable variable was length of the hospital stay. It could not be concluded that psychiatric consultation had an effect on the duration of hospital stays. In one of the studies, the group that received psychiatric consultation showed improvement in depressive symptoms. Additional studies would have been relevant to this review if they had replicated clinical practice by using a naturalistic research design.

Sharing mental health care. Training psychiatry residents to work with primary care physicians

Overcoming problems in communication between psychiatry and primary care requires new models of collaboration. Their success will depend upon the ability of participants to work productively with each other, which will require psychiatry residency programs to offer appropriate preparation for future graduates in working with primary care physicians. This article, based on the training at McMaster University in Hamilton, Ontario, describes a brief curriculum for training psychiatry residents to work effectively with primary care physicians that can be easily integrated with current training rotations and looks at adjustments academic departments need to make to support such programs.

Supervised integrated screening of low-back pain patients by a neurologist. A randomized clinical trial

In a randomized, controlled design, the effect of psychiatric consultation intervention in medical outpatients with low-back pain (N = 104) was assessed for the patients' subjective well-being and satisfaction of general practitioners (GPs) in their cooperation with the neurologists. The goal of the intervention was an integrated approach towards the patients' symptoms and the improvement of the cooperation between primary and secondary medical health services. The intervention was designed at the health care provider level; the psychiatrist did not see or examine the patient. The 104 patients were subdivided into an intervention group (N = 50) and a control group (N = 54). The major outcome measures were the psychological status of the patient and degree of the GPs' satisfaction concerning the cooperation with the medical specialists. After 6 months follow-up, there was a greater overall decline of symptoms in the patient intervention group compared with the control group. However, it was not possible to specify this effect. Contrary to the hypotheses, GPs in the control group were as satisfied about the cooperation with the neurologist as their colleagues in the intervention group. Yet, the information in the specialists' letters of the intervention group was more often in agreement with the integrated model carried out. It is concluded that great diversity of the target group of patients and the focus on the neurologists' behavior may explain the lack of hypothesized effects. It is recommended that the target group be more specifically defined, and that a more intensive intervention might prove to be more effective.

A review of randomized trials of psychiatric consultation-liaison studies in primary care

The field of consultation-liaison (C-L) psychiatry has developed a variety of research interventions to try to improve the recognition and treatment of mental disorders in primary care. The authors review the results of three generations of randomized trials of mental health interventions developed by C-L psychiatrists. In general, these trials have been more successful in improving detection of mental illness and increasing the application of mental health treatments by primary care physicians than in changing patient outcomes. The results of these randomized trials are interpreted by using models developed in the health services field.

Psychiatric consultations in medical outpatients with abdominal pain: patient and physician effects

OBJECTIVE

The purpose of the study was to assess the effect of a psychiatric consultation intervention in terms of changes in 1) the patients' psychological symptoms, and 2) satisfaction of general practitioners (GPs) concerning their cooperation with the internists.

METHOD

In a randomized controlled design, the effect of a psychiatric consultation intervention in medical outpatients with abdominal pain (n = 106) has been assessed. The goal of the intervention was 1) a holistic approach toward the patients' symptoms, and 2) the improvement of the cooperation between primary and secondary medical health services. The intervention was designed at the health care provider level; the psychiatrist did not see or examine the patient. The 106 patients were subdivided in an index group (N = 49) and a control group (N = 57). The major outcome measures were the psychological status of the patient and degree of satisfaction of the GPs about the cooperation with the medical specialists.

RESULTS

At six months follow-up, there was a significantly greater decline in depressive symptoms assessed by SCL-90 in the patient index group compared with the control group. The GPs of the index group were significantly more satisfied with the cooperation and communication with the internists compared with the control group.

CONCLUSIONS

An experimental psychiatric consultation intervention did effect the patients' well-being to a certain degree, and especially the GPs were affected in terms of satisfaction. The relevance of improving the communication between health care providers in the management of somatizing patients is discussed.

Depression assessment and management: evaluating a community-based mental health training program for nurses

This mental health training program was designed to increase primary care nurses' knowledge and skills about depression. The program emphasized criteria for assessing depression, presented psychopharmacologic and psychotherapeutic content, discussed care coordination among several agencies and providers, and addressed referral resources. Cultural and developmental issues were highlighted. The 237 participants had significant knowledge gains after the program on comparison of pretest and posttest measures. Client record audit found significant increases in the assessment of and intervention with depression. The training program successfully increased primary care nurses' abilities to use knowledge about depression in clinical practice.

Assessment and management of depression: an imperative for community-based practice

The purpose of this mental health training program was to increase primary care nurses' knowledge and skills about depression. The program emphasized criteria for assessing depression, presented psychopharmacological and psychotherapeutic content, discussed care coordination among multiple agencies and providers, and addressed referral resources. Highlighted were cultural and developmental issues for Native Americans, Mexican-Americans, the elderly, and adolescents. The training program successfully increased primary care nurses' knowledge about depression and their abilities to use this knowledge in clinical practice.

Psychotherapy and general practice

The authors review the development of liaison psychotherapy in general practice, and argue that a 'skill-sharing' approach, where the general practitioner retains the treatment role, is a more efficient model than a 'consultation' approach. Skill-sharing models are reviewed, and the need for psychiatrists and psychotherapists to be more directly involved in teaching basic psychotherapeutic skills to general practitioners is emphasised.

Anxiety and depression in the medical setting: an overview

Many physicians fail to correctly diagnose, treat, or refer their patients with anxiety and depression. These are common and costly disorders, but many barriers often prevent effective care for them in medical settings. Greater knowledge about these disorders and closer working relationships with mental health specialists should lead to decreased morbidity and mortality.

Ambulatory mental health liaison research: a review and preview

Mental health liaison in primary care is a complex technology requiring scientific study and validation if we are to know when, where, and how to utilize it. Earlier studies have raised as many questions as they have resolved. Recommendations for future research are presented in relation to such issues as: How should mental health consultation/liaison be defined? How should consultation/liaison studies be prioritized? What aspects of consultation/liaison should be studied? What methodologies are appropriate?

Patient-oriented models for linking primary care and mental health care

Although there has been much importance attached to the relationship between mental health care and general health care, there have been few attempts to systematically describe the nature of the relationships between these two domains of health care. The author reviews other attempts to develop models of interaction between the two systems, describes the dimensions of a patient-oriented set of models for the linkage between mental health and general health care providers, and suggests how these models fit into the overall context of clinical services research at the interface between these two systems of care.