Consultation liaison psychiatry in Sweden, 2006

Between the years 1976 and 1980, a number of articles on consultation liaison psychiatry (CLP) were published in Läkartidningen, the journal of the Swedish Medical Association. The tone was optimistic, and liaison projects with many medical specialties were described. In the beginning of the 1990s, the CLP Association was founded in Gothenburg by two enthusiasts. The expectations proved to be overoptimistic. In the year 2000, a national survey, which documented activity in the field, was undertaken; however, as a whole, the majority of the earlier described projects were dissolved without a trace [1]. What were the reasons for this? In Sweden, reforms in psychiatry in the 1970s and 1980s left the specialty disrupted and, for the most part, with its back turned on general hospitals. The attractiveness of psychiatry to young colleagues was, for many years, low, and Swedish CLP has subsequently lacked a prominent academic figurehead.

However, the survey of 2000 showed some interesting features, which, according to the Nordic survey of CLP psychiatry in 2005, have now stabilized [2].

In spite of the fact that almost the entire health care system in Sweden is under the control of public services, the overall picture of CLP is a patchwork of different organizational structures and reimbursement schemes. In most hospitals, on-demand urgent referral is the only existing form. In some moderately sized general hospitals and in all university hospitals, there are liaison activities to a variable extent. These are significantly often driven by the ambitions of individual liaison psychiatrists and often lack an organizational bond with psychiatric departments. Psychiatric liaison teams in Sweden are exclusively composed of psychiatrists; however, in some major hospitals, there are larger independent bodies of social workers and clinical psychologists doing varying degrees of what is, properly, liaison psychiatry.

Research is not a regular concern of existing CLP units, although, in recent years, academic dissertations dealing with, for example, Wilson's disease, fibromyalgia, psychiatric disorder after cerebral bleeding, tinnitus, and psychiatric illness in primary care have been produced [3], [4], [5], [6], [7]. English is the publishing language of the scientific community in Sweden. There is still a need for smaller-format CLP literature written in the Swedish language, which is being met increasingly.

The Swedish Association of Liaison Psychiatry, with its current president Anders Lundin, has been affiliated with the Swedish Psychiatric Association since 2003. With activeness in consultation psychiatry as a statutory requirement, 35 members qualified. Meetings are held annually. New and developing trends in Swedish consultation psychiatry will be focused on in the next annual conference, which will be held in autumn 2006. It will be jointly organized with the Association of Primary Care Physicians with the theme “psychiatry in primary care.”