Psychiatrists for medically complex patients: bringing value at the physical health and mental health/substance-use disorder interface

Psychosomatics. 2009 Mar-Apr;50(2):93-107. doi: 10.1176/appi.psy.50.2.93.


Background: In their current configuration, traditional reactive consultation-liaison services see a small percentage of the general-hospital patients who could benefit from their care. These services are poorly reimbursed and bring limited value in terms of clinical improvement and reduction in health-service use.

Method: The authors examine models of cross-disciplinary, integrated health services that have been shown to promote health and lower cost in medically-complex patients, those with complicated admixtures of physical, mental, social, and health-system difficulties.

Conclusion: Psychiatrists who specialize in the treatment of medically-complex patients must now consider a transition from traditional consultation to proactive, value-added programs and bill for services from medical, rather than behavioral, insurance dollars, since the majority of health-enhancement and cost-savings from these programs occur in the medical sector. The authors provide the clinical and financial arguments for such program-creation and the steps that can be taken as psychiatrists for medically-complex patients move to the next generation of interdisciplinary service.

MeSH terms

  • Comorbidity
  • Cost-Benefit Analysis
  • Health Status
  • Humans
  • Mental Health Services / economics
  • Patient Care Team
  • Program Development
  • Psychiatry / economics
  • Psychiatry / methods*
  • Psychophysiologic Disorders / economics
  • Psychophysiologic Disorders / epidemiology*
  • Psychophysiologic Disorders / therapy*
  • Referral and Consultation* / economics
  • Substance-Related Disorders / economics
  • Substance-Related Disorders / epidemiology*
  • Substance-Related Disorders / therapy*