Proactive Consultation-Liaison Psychiatry: American Psychiatric Association Resource Document

Abstract 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.