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The Royal College of Psychiatrists Improving the lives of people with mental illness

Liaison psychiatry

Background to liaison psychiatry

Liaison psychiatry is the subspecialty of psychiatry that provides specialist mental health assessment and treatment for patients attending general hospitals. This includes patients who attend outpatient clinics or emergency departments, or who are admitted as inpatients. Liaison psychiatrists work at the interface between physical and psychological health, dealing with a range of problems including self-harm, adjustment to illness and physical and psychological co-morbidities.

Medical and surgical patients have high levels of mental health problems which can be treated with psychological or pharmacological methods, and patients with chronic disease such as diabetes or asthma can benefit from liaison psychiatry input if they are having difficulties managing their condition. Liaison psychiatrists work alongside colleagues from a wide range of medical and surgical specialities; the clinical content of liaison psychiatry practice is amongst the most complex of any medical speciality, and every day brings a new challenge.

A further important role of a liaison psychiatrist is the training and education of general hospital colleagues in order to improve their knowledge, skills and confidence in the basics of management of the common mental health problems (depression, dementia, delirium, anxiety) that they encounter in their day-to-day practice. If you are a skilled clinician who likes a challenge, enjoys working with a wide range of colleagues, and are a good teacher and communicator, then liaison psychiatry may be for you.

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Personal perspective

I am currently an academic specialist registrar (SpR) in liaison psychiatry and I just can’t understand why every student doesn’t want to do psychiatry – but I am biased!

I decided to become a psychiatrist after my fourth year medical student placement. I love the way that you get to know your patients as people and keep up relationships with them, often for many years. I also love the fact that you have to really use your brain in order to make a diagnosis – I find the lack of diagnostic tests a real challenge, and much prefer constructing management plans suited to an individual person rather than going by protocols according to a diagnostic label as so many other specialties do. I suspect that psychiatry will change more that any other specialty over the course of my career given the rate of accumulation of new evidence in neurosciences and psychological interventions.

During my training, I have been lucky to experience a really broad range of subspecialties, including psychiatric intensive care, work with asylum seekers, psychotherapy, learning disabilities, crisis resolution, perinatal psychiatry, addictions, services for gender identity disorder, post-traumatic stress disorder, eating disorders and chronic fatigue. Psychiatry offers so much variety that everyone seems to be able to find a niche somewhere.

I also managed to complete a MSc in psychiatry as a senior house officer (SHO). The course was a great help in preparing for College exams and provided a day a week away from clinical work! Should there be something positive about having protected time away from the clinical job?

By the end of my SHO training, my main interests became teaching, psychotherapy and liaison psychiatry and I secured a SpR post with four weekly teaching sessions and the opportunity to gain accreditation in liaison psychiatry. Liaison psychiatry seemed the perfect solution to use my interests in teaching and psychotherapy in a hospital setting.

Liaison psychiatry is the practice of psychiatry in the general hospital setting – the interface between physical and mental health. The rates of mental health problems (delirium, dementia and depression, for example) are astounding in general hospital inpatients, and are often poorly recognised and managed. It is well known that mental health problems in hospital inpatients increase morbidity, mortality, length of stay and rehabilitation. Education of medical staff coupled with simple interventions can often have a dramatic effect on patient outcomes, which I find incredibly satisfying. I particularly enjoy developing relationships with my medical colleagues and working within the hospital culture (including the mess!) In addition, I have the opportunity to work psychologically with patients adjusting to living with chronic illness, and those who are struggling to make sense of medically unexplained symptoms.

A typical working week would include two out-patient clinics, taking referrals from hospital colleagues (this week included a lady with a body mass index of 9 and a man with dissociative amnesia), supervising juniors and nurses assessments, attending a psychotherapy work discussion group, providing a lunchtime teaching session to medical SHOs, preparing and giving lectures for medical students and MSc students, helping to run a pain management group and providing input to the asthma multi-disciplinary team meeting. 

All SpR on calls are done from home – a big bonus to my social life. Even better is that I am currently expecting my first baby, and have been able to take plan a full year of maternity leave and return to work part-time. I have also been excused from working on call whilst pregnant – we do seem to get treated much better than our medical colleagues in this respect, and I am thus very privileged to do a job I love that also allows me time to enjoy my family.

Dr Charlotte Heaps

SpR, Leeds

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