Consultation–liaison psychiatry

Background

Mental disorders account for a small but significant proportion of emergency department presentations (around 3–5% in Australia), while psychiatric comorbidity affects a substantial proportion of hospital inpatients (often cited at around 25–30%), contributing to complexity of care and poorer outcomes.[1, 2] For more than 50 years, consultation–liaison psychiatry (CLP) services in this region have been developing somewhat idiosyncratically, driven often by local interest, opportunity, and perceived need, resulting in inconsistent service models and delivery.[3] Over the same period, CLP as a subspecialty has evolved, becoming a mandatory 6-month rotation for psychiatric trainees in 1978, progressing from interest group to full faculty from 1992 to 2016. CLP acquired an advanced training certificate in 2003 and the Faculty has hosted biennial conferences since 2019.

Recent major service model and workforce surveys in both Australia and New Zealand [4, 5] showed that CLP services were heterogeneous with highly variable service models and significant resourcing challenges. Neither country has a national policy framework for CLP and there is little consensus on service models, priorities, standards, outcome measurements, and pathways for further development. This means that responding to rising rates of self-harm, the increasing hospital prevalence of delirium and dementia, and escalating bed-blocks to discharge is especially challenging. The “Service Model for Consultation–Liaison Psychiatry in Victoria, July 2016”[6] and “Consultation–Liaison Psychiatry in Aotearoa New Zealand – past, present and a blueprint for the future, February 2022”[7] were significant milestones in the local evolution of CLP, but a binational position statement is now required to support the further service and policy development of this subspecialty in our region. 

Purpose 

This Position Statement defines CLP in the Australasian context and outlines its role, value, challenges and priorities for further development.

Definition of consultation-liaison psychiatry

Consultation–liaison psychiatry is the term generally used in Australasia, but terms used in other jurisdictions for the same subspecialty include liaison psychiatry, psychosomatic medicine, and general hospital psychiatry. The consensus definition of CLP adopted by the RANZCP FCLP is that:

Consultation–liaison psychiatry (CLP) is the psychiatric subspecialty that operates in the interface between physical and mental health, focuses on the care of people presenting with both mental and physical health symptoms regardless of presumed cause, and strives to ensure they receive comprehensive, holistic care that addresses both sets of needs. CLP employs the bio-psychosocial model and operates mainly in the wards of general hospitals and to varying degrees in emergency departments and medical and surgical outpatient clinics. CLP services generally have a degree of multidisciplinary staffing, and provide a mix of consultation, liaison, specialised psychological interventions, teaching and research, though individual services vary widely depending on local needs and circumstances.

Patient groups

Consultation–liaison psychiatrists see patients in a wide range of medical or surgical settings with a very wide range of psychiatric presentations including those with high prevalence disorders that are rarely seen in acute mental health units or public outpatient clinics, and those without psychiatric illness whose responses are best seen as understandable reactions to life stressors and should be differentiated from pathological states. CLP spans the entire lifespan with sub-specialty coverage and service models that meet the age-specific needs of perinatal, paediatric, adolescent, adult and older adult patient groups.

Comorbid mental health/physical health presentations

• Patients whose mental health disorders (e.g. depression, anxiety, bipolar disorder, schizophrenia, OCD) complicate the treatment of their medical or surgical conditions. 
• Patients with behaviours of concern within the general hospital environment, including self-harm, suicidality, aggression, treatment refusal, and resistiveness to care.
• Patients with organic psychiatric disorders (e.g. autoimmune encephalopathy, thyroid disorders, hepatic encephalopathy) or medication-related psychiatric effects (e.g. steroid-induced psychosis, psychiatric side effects of chemotherapy).
• Patients with substance use disorders in medical and surgical settings, including intoxication, withdrawal, substance-induced mental disorders, and associated physical complications.
• Patients with significant neurodevelopmental or mental health disorders (e.g. intellectual disability, autism spectrum disorder, anorexia nervosa) admitted with medical or surgical conditions.
• Patients with medical complications of psychotropic medications (e.g. QTc prolongation, seizures, hyponatraemia, myocarditis, pseudo-obstruction).

Psychological issues / health management

• Patients of physical health services where adjustment or psychological issues significantly impact their access to healthcare (e.g. withdrawal, denial, anxiety, depression, rage).
• Patients with psychosomatic disorders (e.g. chronic pain, functional neurological symptoms, medically unexplained symptoms).
• Patients of specialist physical health services where health management/behavioural issues impact their health outcomes (e.g. diabetes, smoking, addictions etc.).

Cognitively impaired patients

• Inpatients with suspected or significant cognitive impairment (e.g. delirium and dementia; Wernicke-Korsakoff syndrome, acquired brain injury; intellectual disability).
• Inpatients with capacity and decision-making issues (e.g. informed consent for treatment, guardianship assessments).

Core roles of consultation–liaison psychiatrists

Consultations for patients with comorbid physical and mental health needs

Consultation in CL involves providing specialist assessment and pragmatic management advice for patients with complex comorbid physical and mental health needs, including diagnostic uncertainty, neuropsychiatric presentations, psychopharmacology in medically unwell patients, functional disorders, substance use, cognitive impairment and behavioural disturbance.

Liaison and integration with medical teams

The liaison aspect of CL focuses on building relationships and working within and alongside multidisciplinary hospital teams (including physicians, nurses, and allied health staff) to improve mental health knowledge, skills, and attitudes; support colleagues managing complex cases; and model patient-centred integrated healthcare. CL psychiatrists may also be involved in specific integrated care pathways (e.g. assessment for transplant or bariatric surgery, cancer, burns, spinal injury, trauma etc.).

Psychosocial support, rehabilitation and advocacy

CL psychiatrists address the psychological impact of medical conditions, including adjustment disorders and trauma reactions; assist patients in coping with chronic illness, disability, and end-of-life issues (e.g. palliative care, oncology support); and support rehabilitation programs for patients recovering from serious illnesses or injuries (e.g. post-stroke depression). CL psychiatrists work to reduce the stigma experienced by people with mental health problems, support the psychological aspects of holistic care, and support the wellbeing of general hospital staff.

Education, training and research

Education, training and research are major roles for CL psychiatrists.

CL psychiatrists:

• provide an immersive experience for medical, nursing, allied health and paramedic students, to gain a foundation in psychiatry, multimorbidity, and working across complex health systems
• ensure psychiatric trainees have an immersive experience in CLP in order to develop core generalist psychiatry competencies and specialist CL skills for managing comorbidity and operating across complex health systems
• ensure advanced trainees in CLP acquire the knowledge, skills, and attitudes to enable them to become competent CL Psychiatrists who can respond to the current and future challenges for this subspecialty
• enhance the mental health capacity of the general hospital workforce by providing junior and senior doctors, nurses, and allied health staff with teaching/supervision to extend their mental health knowledge, skills, and attitudes, enhance their recognition and basic management of common mental health problems in medical settings, and feel more confident in doing so
• conduct research in psychosomatic medicine, integrated care models, and psychiatric aspects of medical disorders
• develop hospital policies and guidelines on managing psychiatric comorbidities in general hospital settings.

Behaviours of concern in the hospital environment

CL Psychiatrists assess and manage psychiatric emergencies in medical and surgical wards, such as suicidal behaviour, acute agitation, or withdrawal syndromes; provide assessments for self-harm or harm to others; and support medical teams with de-escalation strategies and behavioural management plans.

Decision-making capacity assessments and medico-legal consultations

CL psychiatrists contribute specialist expertise to complex medico-legal issues within general hospitals, including capacity and consent, guardianship, advance care planning, treatment refusal, mental health legislation, restrictive practices and ethical decision-making. 

CLP management options include assessment only, short-term treatment during a medical/surgical admission, ongoing specialist care (inpatient or outpatient), and referral to another mental health provider. Related subspecialties, such as health psychology, neuropsychology, neuropsychiatry, pain services, psychosomatic medicine, and perinatal mental health, may be part of, or work alongside, CLP services. While CL psychiatrists may contribute to integrated care models in primary care settings, CLP is distinct from primary care liaison models, in which psychiatrists provide general consultations and advice to primary care practitioners.

The importance of consultation-liaison psychiatry

CL psychiatrists provide specialist expertise to medical, surgical and allied health teams caring for people with complex physical, psychological, cognitive and behavioural needs. Their work includes managing diagnostic uncertainty, neuropsychiatric presentations, psychopharmacology in medically unwell patients, capacity and consent issues, and complex ethical or medico-legal matters. By working across medical and mental health systems, CLP supports more integrated, person-centred care for patients, hospital teams and the broader health system.

Benefits for patients 

CL psychiatrists improve patient outcomes and enhance quality of life through early detection and management of mental disorders (e.g. depression, anxiety, delirium),[1] reducing treatment noncompliance through psychoeducation and motivational support,[8] treating psychosomatic conditions (e.g. functional neurological disorders, chronic pain), and supporting adjustment to and coping with serious illness/disability (e.g. cancer, heart disease, stroke, amputation, organ failure).[9] 

Benefits for hospital teams

CL psychiatrists help medical teams manage complex psychiatric and behavioural issues by ensuring mental and physical health needs are addressed together, reduce the disruptions to care associated with undetected mental, substance and behavioural disorders, train and support hospital staff to become more confident managing common mental health presentations, teach de-escalation and behavioural management strategies for challenging patient behaviours, and improve decision-making in medically complex cases such as capacity assessments and withdrawal management.[10, 11]

CL psychiatrists also support hospital teams following adverse events and challenging clinical encounters, facilitate communication between treating teams, patients and families, assist teams to understand behavioural and relational complexities that may affect care, and support maintenance of compassionate, patient-centred care in difficult clinical circumstances.

Benefits for the system

CLP can support safer, more coordinated care by identifying mental health needs early, preventing patient deterioration and complications, reducing unnecessary over-investigations and avoiding iatrogenic harm, [1, 12] supporting discharge planning and improving collaboration between hospital and community services. The impact of CLP on system outcomes varies by service model, resourcing and local context. CLP contributes to improved patient outcomes, health provider support and can produce significant cost savings for the healthcare system.[13, 14] While there is no one-size-fits-all CL service, proactive investment and development of CL services, to fit local needs, will contribute to improving long-term health outcomes for consumers. 

Key challenges

Fragmented health, mental health and disability systems

While co- and multi- morbidity are the rule and not the exception, divisions within the hospital system (medicine, surgery, women and children, older people’s health and mental health) and funding and delivery siloes outside of it (health, mental health, disability, personal injury) produce structural and functional obstacles in the way of meeting the full set of patients’ needs in an equitable manner. Furthermore, management of mental disorders within the general hospital setting is often inhibited by outdated divisions between mental and physical health and a lack of understanding of the complexity and role of CLP services.

Inadequate service capacity and funding models that are unfit for purpose

Demand for CLP services exceeds current capacity. Funding models often do not reflect the complexity, scope or whole-of-hospital value of CLP activity, limiting service growth despite increasing demand.

Marked heterogeneity and lack of standardisation across services

The heterogeneity that exists amongst services within and across states in Australia and districts/regions in Aotearoa New Zealand in terms of service, funding and governance models makes benchmarking and policy development difficult, and many services are unable to provide the full continuum of consultation, liaison, outpatient care, education, research and service development. CLP service provision is often inconsistent across different age groups. In many hospitals, psychiatric input is provided by external mental health teams rather than dedicated hospital-based CLP services, resulting in fragmented care, reduced continuity, and variability in service quality

Workforce and training pipeline vulnerabilities

An effective and sustainable training pipeline ensuring adequate numbers of future CLP psychiatrists requires sufficient students training and qualifying in medicine, sufficient psychiatric trainees being exposed to a core experience in CLP, and sufficient advanced trainees completing the subspecialty certificate, with all three phases being coordinated and sustainable.

Insufficient outpatient and integrated ambulatory CLP services

Insufficient CLP outpatient clinics and resources means that many patients in the community with complex and chronic conditions (e.g. mental disorder associated with inflammatory bowel disease, epilepsy, diabetes, chronic pain, oncology, palliative care) have unmet needs.

Opportunities for consultation

Positioning CLP as a core component of modern hospital redesign

It is essential for CLP to become embedded in hospital-system redesign to improve flow, safety, and outcomes. As hospitals increasingly manage patients with intertwined physical, psychological, cognitive, behavioural, and social complexity, CLP represents a critical interface specialty rather than an adjunct service.

Advancing integrated, holistic, person-centred specialist health care

CLP operationalises contemporary biopsychosocial models of care by integrating psychiatric expertise directly within medical and surgical settings.[14] This aligns with Australian and New Zealand healthcare priorities emphasising: person-centred care, mental health parity, integrated chronic disease management, trauma-informed practice, culturally safe and equitable healthcare, and reduction of fragmentation between services.

Addressing unmet psychiatric morbidity and health inequities

Hospital inpatients have substantially higher rates of psychiatric illness than the general population, much of which remains unidentified or undertreated.[15] Vulnerable populations such as Aboriginal and Torres Strait Islander peoples, Māori, confused frail elderly, and those with severe and persistent mental illness, social disadvantage, trauma histories, substance use disorders, and medically complex frequent presenters are over-represented in general hospital presentations. Expansion of CLP services therefore represents a significant opportunity to address inequity within acute healthcare systems.

Expanding the multidisciplinary workforce and models of care

Effective CLP models increasingly rely on embedded multidisciplinary teams capable of delivering proactive, preventative, and integrated models of care across inpatient and outpatient settings. These include CL Psychiatrists that work in medical teams and screen admissions rather than waiting for referrals,[11] enhanced specialist CLP teams across the lifespan (i.e. PCLP teams for children and young people, and OACLP teams for older people) integrated within a full CLP framework[16-19], and mechanisms for coordinating mental health service activity within the general hospital. Hospital based services and CLP ‘one-stop shops’ are preferred over inreach services and multiple unrelated services.

Reforming funding models toward value-based and functional outcomes

There is a significant opportunity to promote the awareness of the solid evidence base that CLP produces significant cost efficiencies and improves patient outcomes, and advocate for funding reform. Recognising that CLP reduces length of stay, readmission rates, behavioural incidents, and the costs involved with intensive supervision, prevents low-value care, and improves functional and psychosocial outcomes, discharge coordination, and community engagement, future funding models should better reflect whole-of-hospital value rather than narrow activity-based metrics alone.

Developing national benchmarking, data capability, and outcome measurement.

The development of a standardised dataset across Australia and New Zealand would enable benchmarking of activity and outcomes, workforce planning, health economic evaluation, quality improvement, service comparison, research collaboration, and stronger advocacy for investment. Key metrics could include referral volumes and timeliness, delirium rates, behavioural emergencies, length of stay impact, readmission rates, restrictive intervention use, patient-reported outcomes, staff wellbeing and occupational violence indicators.

Recommendations

• The investment in adequately staffed multidisciplinary CLP teams to deliver timely, proactive, and integrated care across inpatient and outpatient settings and across the lifespan.
• The realignment of CL funding models with whole-of-hospital value, including reduced length of stay, readmissions, behavioural incidents, and low-value care.
• The recognition that CLP is a core hospital service that bridges mental and physical healthcare, with scope for expanded ambulatory and chronic disease interfaces.
• The development of Australasian CL benchmarks for staffing, scope, and outcomes to support consistency, evaluation, and advocacy.
• Ensure training opportunities to support the development of broad and specialist psychiatric skills, including, where appropriate, CL competencies.
• The sustained investment in multidisciplinary CL workforce growth and retention.

References

1. Wood R, Wand AP. The effectiveness of consultation-liaison psychiatry in the general hospital setting: a systematic review. J Psychosom Res. 2014;76(3):175–92.
2. Australian Institute of H, Welfare. Emergency departments: Australian Institute of Health and Welfare; 2025 [updated 2025/05/20. https://www.aihw.gov.au/mental-health/topic-areas/emergency-departments.
3. Gribble R. Australia: Consultation-Liaison Psychiatry not Psychosomatic Medicine. Chapter 26, Pages 559 – 596 in Global Psychosomatic Medicine and Consultation-Liaison Psychiatry Theory, Research, Education, and Practice. Edited by Hoyle Leigh. Springer Nature Switzerland AG 2019.
4. Hopkins J, Skudder E, Vroegop P, Sundram F. Broadening the state of play – the second national survey of Consultation-Liaison Psychiatry services in New Zealand, 2021. Australasian Psychiatry 2023; 31(5): 635–645. DOI: 10.1177/10398562231191689
5. Flavel M-J, Holmes A, Ellen S, Khanna R. Evaluation of consultation liaison psychiatry in Australian public hospitals (AU-CLS-1). Australasian Psychiatry 2023, Vol. 31(1) 95–98. DOI: 10.1177/10398562221143930

6. Victorian Branch of the RANZCP. Service Model for Consultation-Liaison Psychiatry in Victoria. July 2016.
7. Hopkins J, Sundram F, de Beer W. Consultation-Liaison Psychiatry in Aotearoa New Zealand - past, present and a blueprint for the future. Occasional Paper, Royal Australian and New Zealand College of Psychiatrists, March 2022.
8. Rahmani F, Ebrahimi H, Ranjbar F, Razavi SS, Asghari E. The Effect of Group Psychoeducation Program on Medication Adherence in Patients with Bipolar Mood Disorders: a Randomized Controlled Trial. J Caring Sci. 2016;5(4):287–97.
9. Nguyen AD, Medrano O, Syed S. A Call for Integrated Psychiatry-Psychology Collaboration on Consult-Liaison Services: Experiences of a Psychology Extern and Recommendations for Collaborative Care. Cureus. 2023;15(8):e43874.
10. Royal College of Psychiatrists. Liaison psychiatry for every acute hospital: Integrated mental and physical healthcare. Royal College of Psychiatrists; 2013. (College Report No.: CR183).
11. Sharpe M, Toynbee M, Walker J, Consultation THSPI. Proactive Integrated Consultation-Liaison Psychiatry: A new service model for the psychiatric care of general hospital inpatients. General Hospital Psychiatry. 2020; 66: 9–15.
12. Vulser H, Vinant V, Lanvin V, Chatellier G, Limosin F, Lemogne C. Association between the timing of consultation-liaison psychiatry interventions and the length of stay in general hospital. The British Journal of Psychiatry. 2021; 218(4): 204–9.
13. Quinlivan L, Westhead J, Graney J, Su F, Steeg S, Nielsen E, et al. Psychosocial interventions for self-harm and suicide prevention in liaison psychiatry: an overview of systematic reviews. BMC psychiatry. 2025;25(1):1127.
14. Royal College of Psychiatrists (December 2019) Position statement: The role of liaison psychiatry in integrated physical and mental healthcare. PS07/19.
15. Hoffmann JA, Krass P, Rodean J, Bardach NS, Cafferty R, Coker TR, et al. Follow-up After Pediatric Mental Health Emergency Visits. Pediatrics. 2023;151(3):e2022057383.
16. Royal College of Psychiatrists (May 2019) Position statement on the provision of liaison psychiatry services across the lifespan. PS02/19.
17. Davies, V. No wrong door: addressing injustices and achieving better mental healthcare provision for under-18s in acute physical healthcare settings. BJPsych Bulletin (2022) 46, 20–26, doi:10.1192/bjb.2021.
18. Kraemer S. Liaison and co-operation between paediatrics and mental health. Paediatrics and child health. 2010; 20(8): 382 – 7.
19. Hopkins J, Sundram F, Cullum S, and Cheung G. Towards integrated Consultation-Liaison Psychiatry for older adults in New Zealand. Australian & New Zealand Journal of Psychiatry. 2023; 57(5): 625–628. DOI: 10.1177/00048674231168069

Disclaimer

This information is intended to provide general guidance to practitioners, and should not be relied on as a substitute for proper assessment with respect to the merits of each case and the needs of the patient. The RANZCP endeavours to ensure that information is accurate and current at the time of preparation, but takes no responsibility for matters arising from changed circumstances, information or material that may have become subsequently available.