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21 Jan

What is Consultation-Liaison Psychiatry?

In addition to my training in General Adult Psychiatry, I am also board certified in Consultation-Liaison (C-L) Psychiatry by the American Board of Psychiatry and Neurology and practice on the medical-surgical wards at the Philadelphia Veterans Affairs (VA) Hospital. When I tell friends, family, or clients that I am specialty trained in Consultation-Liaison Psychiatry, it is almost always followed up by confusion and the question, “What does that mean?”

According to the Academy of Consultation-Liaison Psychiatry, “Consultation-Liaison Psychiatrists work to help people suffering from a combination of mental and physical illness by consulting with them and liaising with other members of their care team.” In the medical hospital, this generally means that I take calls from my physician colleagues to help care for hospitalized patients who are also exhibiting mental health or behavioral problems that are affecting their care. In my practice at the VA Hospital, some of the more common mental health problems that I assist with include cases of confusion, depression, anxiety, substance use, suicide attempts, or difficulties following hospital rules. The medical problems these patients face can be cardiac, HIV/AIDS, diabetes-related, kidney disease, pain, cancer, and pulmonary disease (to name just a few).

The interventions I provide at the bedside sometimes include medications but ALWAYS include a therapeutic interaction with efforts to ally myself with the patient and tips to help them cope with their current situation. I make it clear that, while it may be their provider who asked me to see them, I am there to help as a support through hospitalization in any way possible. In the moment, this can be something as simple as putting the TV remote within arm’s reach but can also be more complicated like coordinating a multi-disciplinary meeting at the bedside with family in order to make sure everyone is on the “same page.” This is the “Consultation” part of C-L Psychiatry.

Liaison work refers to the ways in which I help my colleagues to improve their interactions with patients. This is particularly useful with the patients who may have difficulty following hospital rules. By liaising with the providers, I can help them make their interactions with the patient more therapeutic, so the care can remain focused on what is undoubtedly the shared goal of improving the patient’s physical and mental health concerns. In the “complicated” example above, I may liaise with the primary team prior to the multi-disciplinary meeting to discuss ways to present information that may be most helpful to the patient and their family.

The next question you may be asking yourself is “Now I understand what a C-L psychiatrist does in the hospital setting, but how does it help in an outpatient/therapy setting like Council for Relationships?” Well, as it turns out, many of the above medical issues are also chronic conditions with frequently co-occurring psychiatric symptoms. Once the patient has left the hospital, both the medical AND mental health issues often require ongoing care. Many patients continue to suffer from mood symptoms surrounding their cancer diagnosis, chronic pain, kidney disease, etc., and benefit from ongoing, specialized mental health care from a C-L trained psychiatrist.

Because of this need for continuing, specialized care, C-L psychiatrists have branched into medical clinics and integrated care settings to bring our expertise in treating psychiatric illness to where those who have co-occurring medical and psychiatric illnesses are most likely to present – at their medical appointments. For example, the patient who is suffering with depression through their cancer treatment no longer needs to search for a mental health provider on their own (which can be a daunting task even without the burdens of chemotherapy); in many places there will be a mental health team embedded in a comprehensive cancer treatment program. The same can be said for the specialized training I have received in providing mental health care on an outpatient basis to those dealing with perinatal issues, neurologic disorders like epilepsy, and gastrointestinal issues, as well as the other medical problems mentioned above.

In summary, I feel fortunate to have the expertise to address complicated psychological and psychiatric symptoms in the medical hospital, but also in the clinic. This is essential for long-term health and wellness, since mental health problems often continue to linger long after an acute hospitalization. Decades of research has shown us the inextricable links between body and mind, which is why a C-L psychiatrist can play such a crucial role in recovery from medical illness and for global wellness. While my general psychiatric training has prepared me for care of common psychiatric problems, my subspecialty training has enabled me to help patients through what can be the long and arduous journey of coping with chronic illness and its often physically and emotionally painful treatments.

Eric Devon, MD is a staff psychiatrist at our University City office; he currently sees clients via online therapy. To set-up an appointment, you can reach him at edevon@councilforrelationships.org or 215-382-6680 ext. 7093.

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