Consultation-liaison psychiatry

Domain IX · Biomedical, neuro & digital

What it is

Consultation-liaison (C-L) psychiatry, called liaison psychiatry in the UK and psychosomatic medicine in parts of Europe, is a service model and specialty, not a single therapy. The US Academy of Consultation-Liaison Psychiatry describes its members as physicians providing "psychiatric care to…

Format

• C-L has no session-numbered protocol. It has (a) a service structure, (b) a consultation episode that repeats for each referral, and (c) a liaison (indirect) function that runs continuously.
• For self-harm presentations, NICE NG225 adds: psychosocial assessment at the earliest opportunity by a trained mental health professional, not unduly delayed by medical treatment, and prompt aftercare (ideally within 48 hours) where safety concerns persist. For psychological treatment after…

Who practises it, and how they are trained or regulated

• Quality standards: the RCPsych Psychiatric Liaison Accreditation Network (PLAN) publishes standards against which liaison services are peer-reviewed and accredited. The current edition number and the exact wording of individual PLAN standards are; check the edition your service is reviewed against.
• Advice to acute teams on individual patients; joint planning; teaching ED and ward staff local protocols, legal frameworks and mental health awareness, ideally co-produced with people with lived experience; supporting ED triage staff to spot mental health problems; links and data-sharing with community services. CR183 notes that many acute staff lack training to recognise and manage these problems.
• Core idea of how change happens. Change happens at two levels. For the patient: psychological and psychiatric problems that complicate physical illness (self-harm, depression, delirium, dementia, alcohol-related problems, distress about illness, functional symptoms) are recognised, assessed and treated during the medical episode rather than missed or deferred. For the system: the acute team is helped, through…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• : reassuring a patient about a symptom you cannot assess. Working: concerns are passed on with a clear description and a named recipient.
• : family conflict, safeguarding concerns, the carer at their own breaking point. Working: carers feel informed and know how to raise concerns.
• : problems that belong to other professions (refer to social work, welfare advice); overload. Working: one problem has a named next step and owner.
• : referrals that bounce between services; follow-up offered only if the person rings. Working: a named service has accepted the person and a date exists.
• : your team's own service specification may define the psychologist's role more narrowly (for example planned-care pathways only, not ED work). Follow it.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.