Consultation liaison psychiatry and emergency medicine in Japan

Abstract

Japanese consultation-liaison (C-L) activities were expanded along with the critical care medical center projects. This might be different from other countries. After the development of critical care centers system, C-L psychiatrists applied “psychiatrists as gatekeepers” for the further development of C-L psychiatry. Two styles became common: liaison settings including a make-rounds style and in-house staff style. Make-rounds style means that C-L team makes rounds on the unit on a regular basis. They see all patients on the unit and play a key role in the total decision-making process which may incorporate psychiatric intervention. In some facilities, the psychiatrists or the C-L team is assigned as in-house staff in the critical care center. In some facilities, 10-15% of patients are due to suicide attempts. Therefore, concurrent psychiatric treatment of the suicidal patients in these units became essential. Furthermore, since all patients admitted to this center have serious illness, many patients become delirious or show mental/behavioral problems. Therefore, effective psychiatric treatment has become very important. For further development of C-L in this field, multidisciplinary team approach with co-medical staffs is necessary to supply efficient and effective care in critically ill patients and suicidal patients. Systematic clinical work and research of the efficient and effective role of C-L psychiatrists is necessary. Presenting the outcome of the work/research would be our next challenge to fully integrate ourselves into the practice of emergency medicine and catch up with the ongoing medical reform in Japan.