Response to “The guideline ‘consultation psychiatry’ of the Netherlands Psychiatric Association”

The Dutch Psychiatric Association is to be applauded for the development of the “Guideline for Consultation Psychiatry.” The most helpful aspect of this document is that is draws together current evidence on a variety levels regarding the effectiveness of Liaison Psychiatry.

It is crucial for the continuing development of Liaison Psychiatry that the evidence base continues to grow as there remain many gaps, particularly in the area of liaison services to acute hospitals.

There are a myriad of technical problems in designing studies to evaluate the efficacy of liaison services and the Dutch Guidelines helpfully address some of these issues. However, one important point is the diversity and complexity of patient problems that present to liaison services which can include assessment of depression or anxiety in the physically ill, psychological reaction to physical trauma (e.g., post traumatic stress disorder), substance misuse, assessment for capacity to give informed consent for medical treatment, management of acute disturbance, self harm, acute psychosis, frequent attendance, treatment of delirium, detailed discharge planning for patients with dementia, medically unexplained symptoms, etc.

Although evaluation is a challenge, the diversity of problems that present to liaison services is also a strength, as only Liaison Psychiatry services have the professional expertise to manage such a wide range of problems and link effectively with hospital and primary care services.

In the United Kingdom, the Royal College of Psychiatrists is developing a system of accreditation for liaison services, which should drive up standards of service delivery and quality, when it is implemented in 2009. The Dutch Guidelines are a welcome resource as the standards for accreditation are currently being agreed.

There is an enormous amount of work involved in developing guidelines, and all of the Dutch members of Guideline group should be thanked for their enormous efforts. The guideline will extremely useful in the drive to develop liaison services in the United Kingdom.