Deployment of the consultation-liaison model in adult and child-adolescent psychiatry and its impact on improving mental health treatment

Background

Little information exists on the perceptions of psychiatrists regarding the implementation and various impacts of the consultation-liaison model. This model has been used in Quebec (Canada) through the function of specialist respondent-psychiatrists (SRP) since 2009. This study assessed the main activities, barriers or facilitators, and impact of SRP in adult and child-adolescent psychiatry on the capacity of service providers in primary care and youth centers to treat patients with mental health disorders (MHD).

Methods

Data included 126 self-administered questionnaires from SRP and semi-structured interviews from 48 SRP managers. Mixed methods were used, with qualitative findings from managers complementing the SRP survey. Comparative analyses of SRP responses in adult versus child-adolescent psychiatry were also conducted.

Results

Psychiatrists dedicated a median 24.12 h/month to the SRP function, mainly involving case discussions with primary care teams or youth centers. They were confident about the level of support they provided and satisfied with their influence in clinical decision-making, but less satisfied with the support provided by their organizations. SRP evaluated their impacts on clinical practice as moderate, particularly among general practitioners (GP). SRP working in child-adolescent psychiatry were more comfortable, motivated, and positive about their overall performance and impact than in adult psychiatry. Organizational barriers (e.g. team instability) were most prevalent, followed by system-level factors (e.g. network size and complexity, lack of resources, model inflexibility) and individual factors (e.g. GP reluctance to treat patients with MHD). Organizational facilitators included support from family medicine group directors, collaboration with university family medicine groups and coordination by liaison nurses; at the system level, pre-existing relationships and working in the same institution; while individual-level facilitators included SRP personality and strong organizational support.

Conclusion

Quebec SRP were implemented sparingly in family medicine groups and youth centers, while SRP viewed their overall impact as moderate. Results were more positive in child-adolescent psychiatry than in adult psychiatry. Increased support for the SRP function, adapting the model to GP in need of more direct support, and resolving key system issues may improve SRP effectiveness in terms of team stability, coordination among providers, access to MH services and readiness to implement innovations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-021-01437-5.

La collaboration interprofessionnelle comme modalité pour résoudre les impasses thérapeutiques en pédopsychiatrie : une revue de littérature

L’intervention auprès des enfants et des adolescents en clinique de pédopsychiatrie génère un risque d’impasses thérapeutiques élevé pour les cliniciens. L’alourdissement des difficultés des jeunes qui y sont référés et l’obligation pour les professionnels qui y travaillent de collaborer avec les différents acteurs présents auprès de cette clientèle contribuent à cette situation. Les recherches démontrent toutefois qu’il existe un lien positif entre la collaboration interprofessionnelle et l’efficacité des services en santé, et ce, même si son implantation demeure difficile. D’Amour et coll. ont développé un modèle de structuration de la collaboration interprofessionnelle qui permet d’en comprendre les processus. La revue de littérature qui constitue le sujet du présent article explore comment, en extrayant les indicateurs de ce modèle, il serait possible d’aider les professionnels travaillant en clinique de pédopsychiatrie à dénouer les impasses thérapeutiques qu’ils rencontrent.