Konsiliar- und Liaisonpsychiatrie in der Schweiz: aktueller Stand und Perspektiven

The present study has two goals: (1) to provide an up-to-date map of the psychiatric consultation and liaison services (C-L services) in Switzerland, and (2) to sketch the future perspectives and make suggestions for its enhancement which take into account the specifics of the Swiss situation, the international experience as well as current thinking on this matter. We analyse in the introduction the previous surveys of Swiss C-L psychiatry (1991, 1993 and 1996), and mention similar accounts from other European countries and the US. We further cite papers dealing with trends and perspectives of C-L psychiatry, which address issues such as its clinical function inside the somatic hospital, organisation, quality guidelines, training tasks and the emphasis of its research. We also present our position on our use of terms such as C-L psychiatry, C-L psychosomatic medicine and psycho-social medicine. Methodology: To collect the data we have developed a 24-items questionnaire covering various areas (among others C-L model, provided services, areas of responsibility, demand and utilisation of service, personnel and institutional characteristics, financing, use of diagnostic and documentation systems, teaching, research, cooperation and communication, development plans) of C-L activity. We contacted 88 services, institutions, hospitals or individuals that we came to know in the process of carrying out this study. 72 of these services (82%) delivered sufficient data to be included in our survey. The feedback we received provided us with data regarding the situation of the C-L services in all university hospitals (5), all big (7) and all medium (12) hospitals, and over 60% of the small hospitals (48). We have processed our data using descriptive-statistical methods. We present and comment the individual outcomes in the results section. They form the basis of the concluding remarks. These take into account the following aspects: - the political geography of Switzerland, with numerous, relatively small and community-based hospitals, - the peripheral position of psychiatry as a medical specialty, - a certain backwardness of Swiss C-L psychiatry on an international level. A detailed (self-)critical discussion of these three issues is provided, and, using the examples of C-L psychiatry in other European countries and the US, several proposals for improvement are put forward. Among the suggested measures to be adopted are: - the establishment of C-L services in all hospitals, from the small hospital level up; - for these we propose - using suggestions of other authors and bearing in mind the local specific conditions - a series of minimal requirements as a basis for a functioning C-L service; - clear contracts with the hospital administration, in particular regarding the financing aspect; - the development of C-L psychiatry in analogy to other subspecialties inside the specialty of psychiatry-psychotherapy, aimed at improving the training of C-L psychiatrists, the quality of their work, and the standing of the discipline; - the establishment of guidelines in this training which take into account the needs of somatic physicians; - as in other countries, the establishment of a Swiss Society for C-L Psychiatry inside the Swiss Society for Psychiatry as an important step for consolidating the discipline; - a more active participation of Swiss C-L psychiatry in international discussions on the state of the art and future perspectives.