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The organization of psychiatric services for general hospital departments 

The organization of psychiatric services for general hospital departments
Chapter:
The organization of psychiatric services for general hospital departments
Author(s):

Frits J. Huyse

, Roger G. Kathol

, Wolfgang Söllner

, and Lawson Wulsin

DOI:
10.1093/med/9780199696758.003.0148
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date: 18 August 2019

The organization of psychiatric services for general hospital departments might change in far-reaching ways in the coming decades. Whereas the focus was primarily on reactive services for inpatients on medical and surgical wards, the future should focus on more proactive integrated service delivery for the complex medically ill. The essential difference from other psychiatric services is that the population served is taken care of by medical specialists in the general health setting. Consequently services are delivered in the context of the medical-psychiatric interface. Consult requests are always formulated in this perspective: the patient is treated for a medical illness or physical complaints and there are signs of an interfering psychiatric disorder. Nowadays these patients are referred to as the ‘complex medically ill’. Therefore triage and treatment integrated in the medical context is the area of expertise of consultation-liaison (CL) psychiatrists. The development of this area of psychiatry has been hampered by dysfunctional splits in health care, such as between general and mental health care, both on the level of its organization as well as its reimbursement. Recent reports, such as the report of the joint working group of the United Kingdom Royal College of Physicians and the Royal College of Psychiatrists, which describe the psychological needs of the medically and surgically ill, provide guidance to counteract these dysfunctional splits. As the delivery of care-trajectories for comorbid patients becomes more and more an issue on the health care agenda, CL psychiatrists should seize this opportunity and become advocates for integrated service delivery for the complex medically ill.

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