The Medical Psychiatry SIG consists of members of the Academy of Consultation-Liaison Psychiatry who have either completed combined training (internal medicine/psychiatry, family medicine/psychiatry, neurology/psychiatry, pediatric/psychiatry/child psychiatry) or are practicing in the field of integrated medical and psychiatric care. This SIG aims to bring professionals practicing at the interface of medicine and psychiatry together to discuss topics relevant to building practices, clinical services, and careers that integrate medicine and psychiatry. We also discuss interesting clinical cases, potential research initiatives, and training issues. At the ACLP’s Annual Meeting, the Med-Psych SIG has also presented numerous workshops as well as Updates in Internal Medicine for the CL Psychiatrist Preconference Course.
Members of the Medical Psychiatry SIG have always been interested in new and innovative ways to improve the care of patients experiencing medical and psychiatric comorbidity or co-occurring disease states. Towards that end, we welcomed members of the Med-Psych Unit Consortium to the ACLP and the ACLP’s Med-Psych SIG. This multidisciplinary association of providers and healthcare institutions is invested in implementing and studying acute care inpatient medical and psychiatry units, also called Complexity Intervention Units.
The Medical Psychiatry SIG also has the support of the Association of Medicine and Psychiatry, an organization with a shared interest in working together to promote high-quality patient care for those with concurrent physical and psychiatric difficulties. The Med-Psych SIG will also gather annually at the Association of Medicine and Psychiatry’s Annual Meeting.
Medicine and Psychiatry SIG
Thomas Heinrich, MD, FACLP
Professor of Psychiatry and Behavioral Medicine
Professor of Family and Community Medicine
Medical College of Wisconsin
Marsha Wittink, MD, MBE
Departments of Psychiatry and Family Medicine
University of Rochester School of Medicine
Susan Padrino, MD
Departments of Psychiatry and Internal Medicine
Case Western Reserve University
Aubrey Chan, MD, PhD
Departments of Psychiatry and Internal Medicine
University of Iowa
What is a medical-psychiatry unit?
MPUs, also known as Complexity Intervention Units (CIUs), were created to deliver optimum acute hospital care to patients with concomitant medical and psychiatric needs. Due to their trans-disciplinary nature, MPUs are also ideal for engaging patients in the services they may struggle to navigate in a fragmented healthcare system.
MPU Consortium Goals
The primary mission of the MPU Interest Group is to bring together clinicians, educators, and scholars working in Medical Psychiatry Units to exchange experiences and collaborate on new initiatives to improve outcomes for patients with complex needs.
History of the MPU Consortium
Clinicians working at the intersection of medicine and psychiatry, including Dr. Roger Kathol, the pre-eminent scholar of MPUs, have been strong proponents of the value of MPUs. Yet, despite evolving evidence of the benefits of MPUs, most MPUs developed in isolation from one another with little concerted effort to organize data or outcomes across institutions. The MPU Interest Group aims to change this.
MPU Consensus Project
What are the essential qualities of an MPU? What features are must-haves, and what things are optional and customizable? The MPU consortium is currently recruiting experts from diverse disciplines and experiences to produce a formal consensus document of what makes an MPU.
MPU Operating Characteristics
A significant hurdle for those interested in founding an MPU is administrative buy-in and ensuring financial viability and sustainability. Therefore, the MPU consortium is collaborating on a project describing several independently-established MPUs. This project will describe patient populations served by these MPUs, common diagnoses, and performance metrics like length-of-stay, discharge disposition, and readmission rates.
The MPU consortium already has several future projects planned, such as measuring quality, safety, and performance metrics on MPUs compared to conventional inpatient units at the same institutions, measuring the prevalence of patients well-suited to MPUs and demand for MPU beds, and future interventional studies to determine how MPUs can contribute to improving longitudinal care for people with severe mental illnesses.
MPU Guidebook (Work in progress)
How to Join
If you are interested in more information about the MPU Consortium portion of ACLP Medicine and Psychiatry SIG or to be added to the email listserve, please send an email to: MedPsychUnit@URMC.Rochester.edu
Organization and Outcomes of Integrated Inpatient Medical and Psychiatric Care Units: A Systematic Review. M.A. van Schijndel, J.D.H. van Wijngaarden, J.J. van de Klundert. Psychiatric Services. Jan 2022. https://doi.org/10.1176/appi.ps.202000416
Medical Psychiatry Units: Improving their organization, focus, and value. M.A. van Schijndel PhD dissertation, Sept 2020. https://repub.eur.nl/pub/131221/MvS-proefschrift-binnenwerk-zh2.pdf
Taking the Long View in an Inpatient Medical Unit: A Person-Centered, Integrated Team Approach for Patients With Severe Mental Illnesses. M.N. Wittink, W.Cross, et al. Psychiatric Services. Sept 2020. https://doi.org/10.1176/appi.ps.201900385
Factors influencing the admission decision for Medical Psychiatry Units: A concept mapping approach. P.J. Caarls, M.A. van Schijndel, et al. PLoS One. Sept 2019. https://doi.org/10.1371/journal.pone.0221807
Towards integrated medical and mental healthcare in the inpatient setting: what is the role of psychology? L.R. Pudalov, M.T. Swogger, M. Wittink. International Review of Psychiatry. Dec 2018. https://doi.org/10.1080/09540261.2018.1552125
Integrated Inpatient Medical and Psychiatric Care: Experiences of 5 Institutions. A.C. Chan, C.A. Burke, et al. Annals of Internal Medicine. June 2018. https://doi:10.7326/M17-3186
Closing the Mortality Gap — Mental Illness and Medical Care. L. Rosenbaum. New England Journal of Medicine. Oct 2016. 375;16:1585. https://www.nejm.org/doi/10.1056/NEJMms1610125
Co-managed Care for Medical Inpatients, C-L vs C/L Psychiatry. P.R. Muskin, A. Skomorowsky, R.N. Shah. Psychosomatics. May-June 2016. https://doi.org/10.1016/j.psym.2016.02.001
Integrated Models of Care for Medical Inpatients with Psychiatric Disorders: A Systematic Review. M. Hussain, D. Seitz. Psychosomatics. July-Aug 2014. https://doi.org/10.1016/j.psym.2013.08.003
The Hennepin County Medical Center Program in Medical Psychiatry: Addressing the Shortened Lifespan of Patients with Mental Illness. M. Linzer, M.K. Popkin, E. Coffey. Journal of General Internal Medicine. March 2013. https://doi.org/10.1007/s11606-012-2325-9
The rewards and challenges of treating psychiatric patients. B. Darves. Today’s Hospitalist. June 2012. https://www.todayshospitalist.com/the-rewards-and-challenges-of-treating-psychiatric-patients/
Barriers to Physical and Mental Condition Integrated Service Delivery. R.G. Kathol, M. Butler, et al. Psychosomatic Medicine. July 2010. https://journals.lww.com/psychosomaticmedicine/Fulltext/2010/07000/Barriers_to_Physical_and_Mental_Condition.1.aspx
Cost outcomes on a medical psychiatry unit. R.G. Kathol. Journal of Psychosomatic Research. Mar 2010. https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S0022399909002657
Managing complex patients on a medical psychiatric unit: An observational study of university hospital costs associated with medical service use, length of stay, and psychiatric intervention. C. Leue, G. Driessen, et al. Journal of Psychosomatic Research. Mar 2010. https://doi.org/10.1016/j.jpsychores.2009.04.010
Integrating Medical and Psychiatric Treatment in an Inpatient Medical Setting. A. Stoudemire. Psychosomatics. July-Aug 2000. https://doi.org/10.1176/appi.psy.41.4.366
To join this, or any SIG, please see the How to Join a SIG webpage.