"Liaison services for older adults": Author’s reply

Résumé

Reply by the current authors to the comments made by Elizabeta B. Mukaetova-Ladinska & Ann Scully, Matthew Rowett & Itoro Udo, and Mukesh Kripalani on the original article. Rowett & Udo doubt whether psychiatry is up to the 'sheer scale of the task' in helping other areas of medicine to address the 'compassion vacuum' highlighted by the Francis Inquiry. They conclude that medicine should put its own house in order by re-engaging with its patients and carers rather than seek solutions from another specialty. They are clearly correct in noting that the task is great and that the change required cannot be delivered by psychiatry alone. But the editor thinks they are too pessimistic, both about the appetite for change within medicine and about how much can be achieved by psychological medicine; it cannot transform medicine on its own, but it can be an important facilitator of change. Mukaetova-Ladinska & Scully emphasize the importance of old age psychiatry in light of the rising age of general medical patients. They argue for the specific development of liaison psychiatry of old age. Although fully agreeing with them that expertise in the psychiatry of old age is an essential ingredient of a modern psychological medicine service, the editor was less convinced of the merit of subspecialized services. Integration with medical services requires that we map onto the way in which they are provided and the very demographic trend they have highlighted is breaking down the division between adult medicine and geriatrics. Finally, Kripalani makes the important point that we need to consider the role of psychiatry in ensuring patient safety. The point is made that services which concentrate on 'severe mental illness' may miss the risk of suicide posed by the individual suffering from stress and adjustment disorders. The editor is sure that most practitioners working in psychological medicine services would endorse this point. Psychological medicine can play an important role in helping medical services to reduce risk, as well as in improving patient outcomes and experience and making medical care more efficient. (PsycINFO Database Record (c) 2014 APA, all rights reserved) AÎNÉ SANTÉ-MENTALE QUALITÉ-SOIN ARGUMENT