Specialist mental health presence in emergency and general hospital departments

December 21, 2016

Consultation Liaison (CL) mental health services to general hospitals have been running in Australia from the 70’s and also started in Hong Kong in the early 80’s.  This means for developing best practices, international exchanges are very valuable.  This month, Kwai Chung Hospital CL nurse Lam Yiu Chau spent some time with the St. Vincent’s Mental Health CL team.  Here in the hustle and bustle of a busy workplace, Lam found a few differences but some familiar territory.

 Broadly, a CL clinician provides support for the mental health care of people in non-psychiatric (generalist) settings, with co-morbid mental health problems such as depression, anxiety, dementia or delirium contributing to poor health outcomes, including increased rates of mortality and morbidity.   It is also a feature of modern emergency departments, for teams needing to provide expert assistance with a wide range of mental health and psychiatric needs.  CL clinicians advise and assist general hospital staff on management of patients as well as directly providing assessment and counselling.

 After 10 days of activities and observations, Lam Yiu Chau was surprised to note the CL team at St. Vincent’s had only one nurse, and was staffed mainly by psychiatrists and training psychiatrists, compared to his Hong Kong team which is made up of psychiatric nurses.  The St. Vincent’s multidisciplinary team had a strong collaborative model, and while the assessments often followed similar lines of enquiry to Hong Kong, the treatment and community liaison reflected the greater availability of resources in Australia.  The local and district- based supports appeared to be more developed and more accessible for people experiencing mental illness, than Lam had experienced with his work. 

 The CL team in Australia welcomed the opportunity to host their Hong Kong colleague and felt that the visit gave them also the opportunity to reflect on the key aspects of the consultation and liaison role, and how their capacity to deliver best practice care can be impacted by complexity and high demand for services.

 Specialist roles like the CL team in general hospitals are developing throughout our region, working in primarily in general wards and emergency departments to positively influence hospital care by addressing physical and mental health issues.  Whether considered as a subspecialty as in the US, or as a special interest group, there is growing recognition of the skills and benefits of addressing the impact of psychosocial factors and improving holistic care by integrating general and mental health.