Consultation liaison psychiatry in Turkey
Article Outline
Turkey is a rapidly developing country. It covers an area of 817,578 sq km, with a population of 70 million; it is located in two continents and bridges East and West [6]. Turkish psychiatry dates back to the mid-1800s, but the integration of mental and physical care can be seen as early as the 12th and 14th centuries, when “houses of healing” were common throughout the country. What characterized these institutions was the integration of mental and physical care. Early forms of therapy used in the treatment of mentally ill patients included music therapy and water therapy. In general, Turkish society has approached the mentally ill with protection and kindness, not with discrimination and stigma [1], [2]. Turkish thinkers such as Mevlana and İbn-i Sina (Avicena) spotlighted the integrity and interaction between body, brain, and mind, thus the wholeness.
The first mental health hospital was opened during the Ottoman Empire days toward the end of the 19th century (1872). Presently, there are five state-run psychiatric hospitals. The total number of psychiatric beds in the country is around 6000, with still about 5000 of them in mental hospitals [2]. The first psychiatric department in a general hospital in Turkey was established in 1955 at the Istanbul University Faculty of Medicine. In the 1960s, psychosomatic and psychotherapy units were established within psychiatry departments in Istanbul and Ankara. However, up until the 1980s, psychiatric consultation in university hospitals was haphazard and mostly limited to emergencies (e.g., attempted suicides and psychotic excitation), as well as to cases where “no organic pathology” was detected. The establishment of medical schools has paved the way for the integration of psychiatric departments into general hospitals and has acted as a corner stone for psychiatry to be taken as a functional discipline by the medical and surgical departments. Today, there are 50 medical faculties with psychiatric departments; two thirds have psychiatric beds.
The first consultation liaison psychiatry (CLP) unit was formally established in 1989 at the Istanbul University Faculty of Medicine. Consultation liaison psychiatry was officially approved as a distinct academic branch in 1997 by the National Board of Higher Education. It is currently awaiting recognition as a subspecialty. Today, CLP in Turkey is a rapidly and enthusiastically developing area of practice and research [3]. Psychiatric services in the general hospital are promoted, but our main deficiencies are (a) the lack of standardized widespread graduate and postgraduate training programs, and (b) the fact that basic health and mental health services are not integrated into primary health settings [7].
The state and governmental institutions favor implementing psychiatric services in the general hospital, and any such hospital having more than 50 beds is expected to have a psychiatric service. In the Psychiatric Association of Turkey, there is general acceptance that CLP should be an integral part of basic residency training (4–6 months), and studies are in progress to develop standard programs. Medical students are taught about psychosomatic medicine and CLP issues.
National CLP congresses have been organized every 2 years by the Department of CLP of Istanbul Faculty of Medicine. Now it is institutionalized under the national organization of CLP and psychosomatic medicine. Consultation liaison psychiatry symposia have flourished in the country, including sessions at nonpsychiatric congresses. In recent years, one third of all the psychiatry-related papers published in the country were on CLP and related subjects. There is a CLP working group in the Psychiatric Association in Turkey. There is also a national CLP and Psychosomatic Association with more than 100 members. Approximately one third of psychiatrists in the country are working in general hospitals.
During 14 years (1989–2003), the Department of CLP of Istanbul Faculty of Medicine has seen a consistent and gradual increase in the rate of consultation (1.8% in 1991 to 4.70% of all patients in 2003) [4], [7]. Over this period, general hospital cases of comorbidity have increased substantially. Consultation liaison psychiatry has been established as a separate unit, and a larger multidisciplinary team has been developed. We have developed training programs for nonpsychiatric physicians (and nurses) in the general hospital to aid recognition of psychiatric problems in medical settings and to encourage appropriate referrals to CLP. All these have contributed to the wider recognition of psychological disorders in the medically ill, willingness for collaboration, increase in requests for consultation, and rational utilization of psychiatric services [5].
References
- . Ruh sağlığı ve hastalıkları. Ankara: Hacettepe; 1987;
- Göğüs AK. Türkiye'de psikiyatrik hizmetler. Ruh Sağlığı Bülteni, Yaz, 1988.
- Özkan S. Psikiyatrik Tıp: Konsültasyon Liyezon Psikiyatrisi Tanımı, Kavramları, Hizmet Alanı, Eğitim ve Araştırma Objektifleri İle Dünyada gelişimi ve Bir Bilim Dalı ve Uzmanlık Alanı Olarak Kurumsallaşması. Konsültasyon Liyezon Psikiyatrisi Kongre Kitabı 1994–1995. İstanbul, 1996.
- . The development of psychiatric medicine at Istanbul Faculty of Medicine and evaluation of 889 psychiatric referrals. Gen Hosp Psychiatry. 1995;17(3):216–223
- . Psychiatric liaison: benefits of an “active” approach. Psychosomatics. 1979;20(9):598–611
- DİE http://cografya.dostweb.com/nufus.htm.
- Özkan S. Türk Psikiyatrisinin Tarihi Ve Çağdaşlaşma Süreci İçinde Konsültasyon Liyezon Psikiyatrisinin Gelişimi Ve İstanbul Tıp Fakültesi Psikiyatri Anabilim Dalında Konsültasyon Liyezon Psikiyatrisinin Klinik, Eğitim, Araştırma Ve Eğitim Objektifleri İle Gelişimi, Konsültasyon Liyezon Psikiyatrisi Kongre Kitabı 1998-1999, Istanbul, 1999.
PII: S0022-3999(05)00472-1
doi:10.1016/j.jpsychores.2005.10.015
© 2005 Elsevier Inc. All rights reserved.
