Clinical Review

ABC of mental health: Common mental health problems in hospital

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7095.1679 (Published 07 June 1997) Cite this as: BMJ 1997;314:1679
  1. Amanda Ramirez,
  2. Allan House

    Introduction

    The prevalence of mental health problems in patients attending acute general hospitals is high. The three main types of clinical problem are

    • Acute primary psychiatric disorder, including deliberate self harm and other psychiatric crises and emergencies

    • Psychiatric disorder in patients with physical illness

    • Psychologically based physical syndromes (somatisation).

    Prevalence of mental health problems in general hospitals

    • Hospital attendances for deliberate self harm average 150-200 per 100 000 population. A district general hospital with a population of 250 000 will have about 500 attendees a year. In central London 11% of acute adult medical admissions follow deliberate self harm

    • Up to 5% of patients attending accident and emergency departments have only psychiatric symptoms, 20-30% have important psychiatric symptoms coexisting with physical disorder

    • Patients with serious physical illness have at least twice the rate of psychiatric disorder found in the general population: 20-40% of all hospital outpatients and inpatients have an important psychiatric disorder

    • A quarter of new outpatients to a medical clinic have no important relevant physical disease: 9-12% of referrals of medical outpatients may involve somatisation

    All doctors have a role in addressing the mental health needs of their patients. However, the mental health problems of general hospital patients are closely tied to their physical illness, and specialist units (such as cancer, renal, pain, neurology, or AIDS services) may experience a high level of psychiatric disorder. Patients, and staff, benefit from specific psychiatric liaison support to facilitate integration of their psychological and physical care.

    Key features of a liaison psychiatry service

    • Fully integrated multidisciplinary team including liaison psychiatrists, clinical psychologists, psychiatric nurses, and social workers, with special skills in the use of psychological and social interventions

    • Based within the general hospital and easily accessible to all departments

    • Collaboration with other psychiatric services, social services, and non-statutory services to provide follow up for patients whose continuing needs for care are best met by community services

    • Provides …

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