Liaison Psychaitric Nursing is a new concept in the Psychiatric field. The effective use of this service will be beneficial for the patients

1. LIAISON PSYCHIATRY-
NURSES ROLE
Sayani Samanta
M.Sc. Nursing 2nd
year
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2. INTRODUCTION:
Holistic patient care is the role of liaison psychiatry
that means meeting client, mental health care need
in general health setting.
Edward Billings first coined the term "liaison
psychiatry”.
 Liaison psychiatry came from the old tradition, which
advocates ceaseless dynamic interaction of mind and
body.
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3. Cont..
 George L. Engel coined the term
"Biopsychosocial Model" which overcame
divisions created by Cartesian Dualism and
was to have wider repercussions on psychiatric
practice.
 It includes the psycho dynamic evaluation of
the of the patient’s personality to their reaction
of illness.
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4. DEFINITION:
 Liaison psychiatry is the sub-specialty which provides psychiatric treatment to patients
attending general hospitals, whether they attend out-patient clinics, accident &
emergency departments or are admitted to in-patient wards. Therefore it deals with
the interface between physical and psychological health.
 Liaison nurse: a nurse specialist with a master's degree who provides psychiatric
nursing services in nonpsychiatric settings. But generally speaking every nurse who
addresses the psychosocial issues of the patient care is a liaison nurse because she /he
play the role of interface between the physical and psychological health.
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5. History
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Phases Years Major events
Preliminary Phase pre 1900-1930 Medical revolution, new role for hospital and medical school.
First true general-hospital psychiatry unit was established at Albany Hospital in 1902.
First clinical consultation psychiatry paper was published in 1929 by Henry.
Organization/ pioneering Phase 1930s to late
1950s
The term “liaison psychiatry” was used for the first time by Billings Academy of
Psychosomatic Medicine founded in 1953.
CL services established in many hospitals, using many different models.
Developmental phase: Conceptual
development phase
1960–1975 Many publications devoted to CL psychiatry Research in CL Psychiatry started
accumulating.
Developmental phase: Rapid-growth
phase
1975–1980s Rapid growth in number of CL services.
Formal organizational models and training programs established.
Lipowski published 3-part review detailing scope and function of a CL service NIMH
training grants for CL programs began.
Consolidation/retrenchment 1980 onwards Consultation vs liaison debates.
Rethinking objectives: No more proselytizing
NIMH training grants reduced, reimbursement limited Liaison nurses and behavioral
medicine

6. NEED FOR LIASON PSYCHIATRIC
NURSING:
 The World Health Organization (WHO) estimates India has only 0.3 psychiatrists, 0.07
psychologists and 0.12 nurses available per 1,00,000 people.
 The National Mental Health Survey, 2016, estimated that over 85% of people with
common mental disorders such as depression or anxiety disorder and 73.6% of people
with severe mental disorders such as psychosis or bipolar disorder do not receive any
mental healthcare and treatment.
 Prevalence of mental illness ranges from 41.3% to 46.5%
 10% of Indian population affected with the depression, anxiety disorder and
substance abuse
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7.  India records the highest rate of suicide in the world, with victims ranging from
15 -44 years, as per the WHO.
 According to the NCRB (2015), a student commits suicide every hour in India.
 India spends less than 1% of its total health budget on mental health
 Mental illness accounts for One fourth of the primary care setting in India
 80% of the population with diagnosed mental illness are not on treatment
despite the presence of symptom for more than one year
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9. SCOPE OF LIAISON PSYCHIATRY NURSE
PRACTISIONER
 The scope of liaison psychiatric nurse
ranges from inpatient unit, outpatient unit,
in terms of hospital settings. Whereas,
irrespective of anyone including the
patient and the care givers with the
mental health needs /problems.
 it has a wide scope of practice from
hospital to hospice in our community.
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10. Conti….
 Primary care
 Emergency department psychiatric care
 Worksite based programs
 Home psychiatric care
 Virtual mental heath care
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11. Primary care settings- Behavioral
counseling in primary care
 ASSESS –Behavioral health risk
 ADVISE-clear, personalized behavioral change advise
 AGREE-on collaborative treatment goals
 ASSIST-in change
 ARRANGE-follow up contacts
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12. Styles of liaison psychiatry
 Consultation style
 Liaison Style
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13. Consultation Liaison Model
 Based on focus of Consultation:
 Patient oriented approach
 Crisis oriented approach
 Consultee oriented approach
 Situation oriented approach
 Expanded psychiatric consultation model
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14. Cont..
 Depending on the function :
 Traditional consultation model
 Liaison model
 Bridge model
 Hybrid model
 Autonomous psychiatric model
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15. Cont..
 Depending on the focus of work
 Critical care model
 Biological model
 Milieu model
 Integral model
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16. Areas to be vigilant for liaison
psychiatric care
The focus of specific need are listed below:
 Patient with medical conditions those results in psychiatric or behavioral symptoms such
as delirium.
 Individuals who have self –harmed and are being seen in the emergency department.
 Patient with mental illness got admitted for medical illness.
 Patient with medically unexplained physical symptoms, where there is no organic causes
of illness
 Patient experiencing distress out of their medical illness
 Medical /surgical Patients having psychiatric symptoms , e.g. suicidal ideation,
hallucination, delusion, etc 02/24/19

17. VULNERABLE POPULATION IN THE
COMMUNITY
 HOMELESS PEOPLE
 RURAL PEOPLE
 INCARCERATED PEOPLE
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18. ROLES OF LIAISON NURSE:
 They provide psychiatric Assessment and a treatment to those patients
who may experience distressed in hospital and provides a valuable
interface between the mental and physical health.
 Assess the patient level of risk to self and others to make the hospital
environment secured for everyone. For example, suicidal prevention in the
hospital, structuring the environment for client safety and prevention of
accidents when the client is delirious.
 They can suggest the patient’s mental capacity to make important
decisions either related to treatment or life style modification and
adaptation based on the growth and development needs of the
individual
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19.  Identify the triggers to symptoms and behaviors which are the basis of
physical illness, for example gastritis and arthritis aggravates with life
stressors.
 They can assist with the consultant for making the diagnosis of the patient
and care, because nurses are predominantly with the patient and will
have more inputs, related to the client psychosocial environment of the
client.
 They can formulate the nursing care based on the needs and problems of
the patient in the general health setting e.g., Antenatal counseling,
management of adolescent crisis, problem solving and decision making.
 Provide guidance and counseling services for both promotive and
curative mental health services availability, referral and follow up.
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20.  Provide cognitive behavioral therapy as part of the Liaison team, in
identifying the vulnerable populations at risk for violence and abuse. And in
times advocating them for obtaining legal protection. Especially Domestic
violence, geriatric abuse and negligence, child abuse etc.
 Take part in updating the trends in mental health nursing and incorporating
in the day to day practice.
 Undergoing continuing nursing education on caring the mental health
needs of the patient at the general health setting.
 Incorporating the evidence based practice in to research and training as a
advanced practice nurse.
 It is essential to keep up the privileged communication and confidentiality
of the patient information until or unless it is essential for the protection of
the patient.
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21. CHALLENGES TO LIAISON NURSING
PRACTICE
There are various challenges to realize the Liaison nursing practice like
 Shortage of nursing manpower and training in mental health at general
health setting.
 Lack of policy guidelines for autonomy in nursing practice.
 Lack of team work and mutual respect to the other health care members
 Poor working and service conditions of nurses without any clear cut job
description.
 There is no nursing practice act in India to legally protect the nurses and
the ensure the boundary of practice
 Individualized Lack of will from the practicing nurses.
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22. CHALLENGES TO OVERCOME:
The following are the major problems of health services:
 1. Neglect of Rural Population:
 2. Emphasis on Culture Method:
 3. Inadequate Outlay for Health:
 4. Social Inequality:
 5. Shortage of Medical Personnel:
 6. Medical Research:
 7. Expensive Health Service:
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23. RESEARCH ABSTRACTS….
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Indian journal of psychiatry,2010 S.p parkar and N.S.sawanth Liaison in
Psychiatry refers to the branch of Psychiatry involving assessment and treatment in
the general hospital of referred patients, like in the casualty, or patients of
deliberate self farm. The Indian scene also reveals major reference from medicine,
surgery, surgical super specialty and orthopedics with psychiatric disorders like
anxiety, depression and / or organic brain syndromes seen in about 40 to 50 % of
the medical or surgical patients. Though the Indian published data is limited, most
tertiary hospitals in India carry out liaison work with various departments like
Neurology, Organ transplant, Intensive Care Units and Cosmetic Surgery, so as to
give comprehensive health services to patients. Liaison in Psychiatry has thus
brought the emphasis on the teaching of psycho-social aspects of medicine and
also increased research possibilities.

24. CONCLUSION:
 The liaison psychiatric nursing services “liases” with many other services like
social services, community services.
 Most of the chronic medical diseases are predisposed by stress and its
impact on the alteration in the psychosocial homeostasis of an individual.
 When nurses are going to pay attention to the mental health care needs,
in general health setting ,probably it is the holistic nursing, a mere dream
for every common man.
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