Internationalization and integration of the “C-L” psychiatry field

Before 1990, professional organizations of consultation–liaison (C-L) psychiatry were primarily nationally based. In the United States, no single organization had yet defined itself as the national organization of C-L psychiatry. Although some psychiatrists attended meetings in other countries, there was no formal exchange between professional organizations. As a result of two meetings in the 1980s for key leaders in the United States,1 the Academy of Psychosomatic Medicine (APM) united C-L psychiatrists by redefining itself as the US national organization of C-L psychiatry and assumed the ultimately successful task of achieving subspecialty status for the field [1], [2].

In Europe, prior to the 1990s, C-L psychiatry was primarily modeled after C-L psychiatry in the United States, with the exception of the German psychosomatic movement in which internists trained in psychoanalysis treated the medically ill with related emotional disorders [3]. Following the successful second Brook Lodge meeting in the United States in 1989, the Upjohn Company expressed an interest in also supporting the development of a European C-L network [4].

Participating European countries concluded that they needed to unite around a European organization in order to develop a roadmap that was congruent with the research initiatives of the European Union (EU) and to effectively compete for EU research funds. This European Consultation Liaison Workgroup collected three collaborative grants supported by the EU, which focused on (a) the extent and quality of C-L psychiatric and psychosomatic services across Europe [5], (b) the development of models to improve the quality of care in C-L psychiatry and psychosomatics [6], and (c) the development of integrative models that would include early detection and integrative care for patients with multiple comorbidities in the medical system—the complex medically ill [7], [8]. This research collaboration gave rise to the European Association of Consultation-Liaison Psychiatry and Psychosomatics (EACLPP). The INTERMED group of the EACLPP has continued to study and promote the efficacy of the integrative model in a multinational workgroup, involving institutions, among others, from the Netherlands, Switzerland, Germany, Spain, the United States, and Japan (www.intermedfoundation.org) [8].

While both the APM and the EACLPP initially promoted statistical research into epidemiology, medical utilization, and the economics of treating medical patients with comorbid psychiatric disorders, the organizations differed in their approach to exploring the value of treating the complex medically ill. While the APM pursued subspecialization to stabilize the field, the EACLPP embarked on research initiatives focused on the development of models of integrated care.

In the past decade, members of the APM and the EACLPP have explored areas of synergy and cross-fertilization. These efforts have resulted in collaborative research, and the inclusion of each other's members on the governing councils and key committees including the program planning committees, with an increase in presentations and participation at each others meetings. Reduced attendance fees for scientific meetings and access to each other's Web sites have further enhanced international collaboration. Since 2000, the EACLPP has also organized annual scientific meetings, combined every second year with the meeting of the European Conference on Psychosomatic Research. The first attempt at a combined meeting between the APM and the EACLPP, hosted by the Spanish Society of Psychosomatic Medicine in Barcelona, was planned but seemed a bridge too far at this point, but remains a viable option for the future.

The developments in Europe and the United States have been closely followed by representatives of C-L psychiatry organizations in Japan, [9] Australia [10], and other countries as members from around the world collaborate around common interests and have expressed the need for growing informal and formal links. The international C-L/Psychosomatic Medicine community now stands poised, ready, but uncertain about how, to take the next step in structuring forums for collaboration, at a time when models of integrative care are demanded by the needs of the complex medically ill. These are the two great challenges now facing our discipline. How we solve them will determine how well we carry out our responsibilities to the populations of the complex medically ill. Has the time come to create a formal umbrella organization that can encourage and support the potential synergies that exist between and among our national and regional organizations?