Consultation-Liaison and Emergency Psychiatry

Consultation-liaison (C-L) and emergency psychiatry are two aspects of public psychiatry that experienced considerable development during the last decade in France. Major disparities still persist as regards endowment in professional resources and organization of C-L activity from one general hospital to another. Several emergent practices are described that underlie the role attributed to the C-L psychiatrist or psychologist as an expert in some systematic screening or assessment requests, as well as address the issue of combining, for some clinical situations, psychiatric and medical consultations. Substantial efforts have also been made for implementing C-L psychiatry outside the general hospital wards, notably in prisons. Psychiatric emergencies are, henceforth, integrated within emergency facilities of general hospitals. Several sociological changes or health policy decisions in France, such as the deinstitutionalization movement of the mentally ill, led to an increased numbers of patients at psychiatric emergency departments. Progress in crisis management, as well as opening of crisis units outside the hospital wards and some experimental mobile emergency units to operate at patients' homes, limit the number of psychiatric hospitalizations, whether they are with or without patient's consent, which is following a visit to the emergency department of a general hospital. Management of suicide attempts and prevention of recurrences remain a priority goal of emergency psychiatry, as are a better exploration of mixed medical and psychiatric situations and the implementation of facilities specially devoted to child and adolescent emergencies.