Abstract:
AIM: To characterise and understand the scope of referrals made to a consultation-liaison psychiatry (CLP) service at Waitemata DHB (WDHB), Auckland, New Zealand which encompasses two general hospital campuses that serve a population of 600,000 people. METHOD: This is a retrospective observational study that involved analysis of referrals (n=1,100) made to the CLP service for those ≥18yo at WDHB over a 6-month timeframe (from November 1st 2017). Descriptive statistics were summarised for demographic variables and features of referrals, assessment and intervention. Data sources included electronic patient record systems for both physical and mental health services respectively. RESULTS: 78% of referrals were for those between the ages of 18-65 and 22% for those over the age of 65. Approximately 80% of referrals were for individuals who had a pre-existing mental illness and 40% of referrals were regarded as urgent. A minority of patients were from outside the catchment area (10%). The ED was the largest user of the service (approximately 66%). The main reasons for referral were self-harm/suicidal ideation (40%), mood disorder (8%), adjustment disorder (6%) or staff support (6%). The main diagnoses made by the CLP team were mood disorder (18%) followed by an adjustment or grief reaction (7%). The most common interventions offered by the CLP service was medication advice, risk or decision-making capacity assessments, psychotherapy, psychoeducation for patients/staff, recruitment of other services (e.g. social worker, addiction services) and legal advice (e.g. mental health act). CONCLUSION: The results highlight the diversity of CLP input with a large demand for acute assessment at the ED. Although largely adults of working age were seen, a significant minority were elderly, and a small proportion were from outside the catchment area which has implications for optimal service funding and delivery.
