Contemporary issues in liaison psychiatry and growing older adult population in India: experiences from UK initiatives

Background: Most tertiary hospitals in India carry out liaison work with various departments like neurology, organ transplant, intensive care units and cosmetic surgery. Mental disorders affecting older people admitted to general hospitals is poorly detected and managed in many general hospitals in India and elsewhere. Aim: To evaluate the service of an old age psychiatric liaison team working in a general hospital and reviewing the parallels which could be drawn with respect to Indian perspective. Method: The study model is based on the cross sectional assessment and service evaluation of a psychiatric liaison team (PLT) for older adults working in conjunction with general hospital. Parallels are drawn to compare and contrast the liaison service model in India and the United Kingdom (UK). Results: A total of 143 patients out of 174 were screened by the PLT; 29.3% were males and 70.6% were females and just more than 60% were above the age of 80 years. Around 32.2% of patients were between the age group of 66-80 years. Most referrals (71.3%) to the PLT were from nursing staff of general hospital belonging to varying seniority. Around 30.8% of the patients referred to PLT have a previous diagnosis of psychiatric illness. Diagnosis of dementia was the commonest (17.4%), followed by depression which was 4.2%, Mild Cognitive Impairment (MCI) was present in 2.8% of patients, 2% have diagnosis of vascular dementia. A survey of non-psychiatry clinicians showed a substantial proportion of doctors underestimate the psychiatric morbidity especially about unexplained physical symptoms and specific depressive symptoms. Conclusion: Psychiatry as a specialty has been neglected at all levels in India and service development has been scanty. The inception of the concept of liaison psychiatry in India has been almost an ancient one but it has not raised the standards of care to any significant level.