American Psychiatric Association Resource Document
In 2019, the American Psychiatric Association Council on Consultation-Liaison Psychiatry convened a Work Group to develop a Resource Document on Proactive Consultation-Liaison Psychiatry. A draft of this document was reviewed by the Council in July 2020, and a revised version was approved by this Council in September 2020. The accepted version was subsequently reviewed by the APA Council on Healthcare Systems and Financing in November 2020. The final version was approved by the Joint Reference Committee on November 24, 2020 and received approval for publication by the Board of Trustees on December 12, 2020.
This Resource Document describes the historical context and modern trends that have given rise to the model of proactive C-L psychiatry. Styled as an inpatient corollary to outpatient collaborative care models, proactive C-L provides a framework of mental health care delivery in the general hospital designed to enhance mental health services to a broad range of patients. Its four elements include systematic screening for active mental health concerns, proactive interventions tailored to individual patients, team-based care delivery, and care integration with primary teams and services.
Studies have found that proactive C-L psychiatry is associated with reduced hospital length of stay, enhanced psychiatric service utilization, reduced time to psychiatric consultation, and improved provider and nurse satisfaction. These favorable results encourage further studies that replicate and build upon these findings. Additional outcomes such as patient experience, health outcomes, and readmission rates deserve investigation. Further studies are also needed to examine a broader array of team compositions and the potential value of proactive C-L psychiatry to different hospital settings such as community hospitals, surgery, and critical care.
Preconference Skills Course Resources
Deconstructing Proactive C-L (11/9/22)
Launching a Proactive C-L Psychiatry Service (11/13/19)
Executive summaries of several Proactive C-L Psychiatry services
CLP Advocacy Toolkit for Team-Based Proactive C-L Psychiatry
Service manuals and workbooks
Job/role descriptions of team members
Nursing and provider surveys
Electronic health record (EHR) materials
- University of Rochester screening note (Epic)
EHR optimization for efficient daily workflow (e.g., creating unit-specific consultation lists, dashboards, and new note types) and machine-learning approaches for early case identification do not lend themselves easily to documents. This topic continues to be explored and can be discussed further in the Listserv for those who are interested.
Incorporating trainees into a Proactive C-L Psychiatry service
Generic project charter template
Publications and articles
* Denotes primary data or systematic review of primary data.
News and reviews on Proactive C-L Psychiatry
- Desan P, Zimbrean P, Lee H, Sledge W: Proactive psychiatric consultation services for the general hospital of the future. in Integrated Care in Psychiatry: Redefining the Role of Mental Health Professionals in the Medical Setting. Edited by Summergrad P, Kathol R. New York, Springer; 2014.
- Sledge WH and Lee HB. Proactive Psychiatric Consultation For Hospitalized Patients, A Plan for the Future. Health Affairs. May 28, 2015.
- Lagnado L. Hospitals Test Putting Psychiatrists on Medical Wards. The Wall Street Journal. April 25, 2016.
- Desan PH, Lee HB, Zimbrean PC, Sledge WH. New Models of Psychiatric Consultation in the General Medical Hospital: Liaison Psychiatry Is Back. Psychiatr Ann. 2017;47:355-361.
- * Oldham MA, Chahal K, Lee HB. A systematic review of proactive psychiatric consultation on hospital length of stay. Gen Hosp Psychiatry. 2019;60:120-126.
- Oldham MA, Chahal K, Lee HB. Collaborative Care Meets Hospital Medicine. Psychiatric Times. Nov 14, 2019.
- Oldham MA and Lee HB. If Only We Could Have Avoided That Crisis. ACLP News. February 2020.
- Oldham MA, ‘Only Some Patients in Most Hospital Settings Who Would Likely Benefit from a Psychiatric Consultation Receive It’. ACLP News. January 2021.
- Bui, M, and Zamorano, N. Transforming the Landscape. ACLP News. February 2021. (version with references)
- Karol D and Triplett P. We Must Find Ways to Return to In-Person Evaluations Safely. ACLP News. March 2021. (version with references)
- Oldham MA and Lee HB. Proactive C-L Psychiatry: Re-envisioning Psychiatric Care in Medical Settings. Psychiatric News. 8 Feb 2021.
- Oldham MA. The Roles of Psychiatric Consultant and Liaison Realized Through Proactivity and Care Integration. Journal of the Academy of Consultation-Liaison Psychiatry (JACLP). 2021
- Asuquo SE, Goodman MB, Gaynes BN, Nakamura ZM. A proactive consultation-liaison psychiatry implementation framework for the management of medical and surgical inpatients with psychiatric comorbidities. Gen Hosp Psychiatry. 2022;74:149-151.
- APA Annual Meeting Highlights. Session presenters Matta S, Baik R, Sharpe M, Brendel R. Proactive C-L Psychiatry Addresses Social Factors Affecting Discharge, Outcomes for Hospitalized Patients With Comorbid Illness. Psychiatric News ALERT. May 21, 2022.
Team-based Proactive C-L Psychiatry
- * Sledge WH, Gueorguieva R, Desan P, Bozzo JE, Dorset J, Lee HB. Multidisciplinary Proactive Psychiatric Consultation Service: Impact on Length of Stay for Medical Inpatients. Psychother Psychosom. 2015;84:208-216.
- * Sledge WH, Bozzo JE, White-McCullum BA, Lee HB.The cost-benefit from the perspective of the hospital of a proactive psychiatric consultation service on inpatient general medicine services. Health Econ Outcome Res Open Access. 2016;2:1-5.
- * Triplett P, Carroll CP, Gerstenblith TA, Bienvenu OJ. An evaluation of proactive psychiatric consults on general medical units. Gen Hosp Psychiatry. 2019;60:57-64.
- * Walker J, Burke K, Toynbee M, van Niekerk M, Frost C, Magill N, Walker S, Sculpher M, White IR, Sharpe M. The HOME Study: study protocol for a randomised controlled trial comparing the addition of proactive psychological medicine to usual care, with usual care alone, on the time spent in hospital by older acute hospital inpatients. Trials. 2019.
- * Oldham MA, Walsh P, Maeng DD, Zagursky J, Stewart K, Hawkins SM, Lee, HB. Integration of a proactive, multidisciplinary mental health team on hospital medicine improves provider and nursing satisfaction. J Psychosomatic Res. 2020.
- Sharpe M, Toynbee M, Walker J, Proactive Integrated Consultation-Liaison Psychiatry: A new service model for the psychiatric care of general hospital inpatients. Gen Hosp Psychiatry. 2020.
- * Toynbee M, Walker J, Clay F, Hollands L, van Niekerk M, Harriss E, Sharpe M. The effectiveness of inpatient consultation-liaison psychiatry service models: A systematic review of randomized trials. Gen Hosp Psychiatry. 2021.
- * Oldham MA, Lang VJ, Hopkin JL, Maeng DD. Proactive Integration of Mental Health Care in Hospital Medicine: PRIME Medicine. Journal of the Academy of Consultation-Liaison Psychiatry (JACLP). 2021.
- * Khaustova OO, Markova MV, Driuchenko MO, Burdeinyi AO. Proactive psychological and psychiatric support of patients with chronic non-communicable diseases in a randomised trial: a Ukrainian experience. General Psychiatry 2022 ;35:e100881.
Embedded psychiatrist Proactive C-L Psychiatry
- * Desan PH, Zimbrean PC, Weinstein AJ, Bozzo JE, Sledge WH. Proactive psychiatric consultation services reduce length of stay for admissions to an inpatient medical team. Psychosomatics. 2011;52:513-520.
- * Muskin PR, Skomorowsky A, Shah RN. Co-managed Care for Medical Inpatients, C-L vs C/L Psychiatry. Psychosomatics. 2016. (note, this model differs from others presented here by employing co-management)
- * Bui M, Thom RP, Hurwitz S, Levy-Carrick NC, O’Reilly M, Wilensky D, Talmasov D, Blanchfield B, Vaidya V, Kakoza R, Klompas M, Stanley E, Gitlin D, Massaro A. Hospital Length of Stay With a Proactive Psychiatric Consultation Model in the Medical Intensive Care Unit: A Prospective Cohort Analysis. Psychosomatics. 2018.
- * Bronson BD, Alam A, Schwartz JE. The Impact of Integrated Psychiatric Care on Hospital Medicine Length of Stay: A Pre-Post Intervention Design With a Simultaneous Usual Care Comparison. Psychosomatics. 2019.
- * Kugler J, Key G, Oldham M. Proactive C-L psychiatry beyond academic hospital settings: A pilot study of effectiveness in a suburban community hospital. Psychosomatics. 2020.
- * Bronson BD, Alam A, Calabrese T, Knapp F, Schwartz JE. An Economic Evaluation of Proactive Consultation-Liaison Psychiatry Pilot as Compared to Usual Psychiatric Consultation on Demand for Hospital Medicine. Journal of the Academy of Consultation-Liaison Psychiatry (JACLP). 2022; in press.
Computer algorithms for screening
- Finn CT, Thakur D, Shea KM, Riblet NBV, Lee HB, Heng G, Scott R, Gardner TS, Randlett S, LaRock T, Siriwardana N, Green G, Torrey WC. Electronic Medical Record Reporting Enhances Proactive Psychiatric Consultation. Psychosomatics. 2018.
- Walker J and Sharpe M. The HOME Study. The Oxford Psychological Medicine Centre.
Previous ACLP presentations
Deconstructing Proactive C-L Psychiatry: Exploring the Elements of Change
Proactive C-L Psychiatry: Fostering a Culture of Mental Health Awareness
Updates in Proactive C-L Psychiatry (part of the Updates in C-L Psychiatry preconference course)
Proactive C-L Psychiatry: Implementation and Development
Unique Visions of Proactive Integrated Care in the General Hospital
Launching a Proactive Consultation–liaison Psychiatry Service: A How-to Skills Session for Participants. Oldham MA, Finn C, Triplett P, Anderson E, Kugler J, Bronson B, Livesey C, Horvath AJ, Lee HB.
Lipsitt Award Presentation. Current State and Future of Proactive C-L Model: How to Disseminate, Implement, and Expand Proactive C-L Services. Lee HB.
Innovative and Integrated Service Models for Hospitalized Patients with Medical and Psychiatric Co-morbidity: The Future of C-L Psychiatry? Triplett P, Olivares T, Walker J, Sharpe M, Lee HB.
Debate: Resolved: Proactive Psychiatric Consultation Should Be the Standard of Practice for Inpatient Psychiatric Consultation Services in General Hospitals. Lee HB, Heinrich T, Sharpe M, Caplan J, Wulsin L.
Proactive Consultation-Liaison Psychiatric Service – How to Propose, Start and Sustain the ‘Behavioral Intervention Team’ Model. Lee HB, IsHak WW, Triplett P, Finn C, Sledge WH.
Proactive Psychiatric Consultation in General Hospitals: Implementation and Expansion in Three Different Settings. Lee HB, Finn C, IsHak WW, Thakur D, Sledge WH.