Objective: The aim of this study was to examine the provision of psychiatric care to inpatients in two Irish general hospitals without psychiatric units and to comment on (a) how this service model compares with previous Irish studies, (b) whether it meets the goals of liaison psychiatry, and (c) the implications for future service planning. Method: Demographic and clinical details relating to all the psychiatric consultations to inpatients (i.e. there was no emergency service to the casualty department) in two general hospitals were collected over a six month period. Results: Although the service was provided on a nonemergency basis the referral rate [1.6% of total admissions], patient characteristics, reasons for referral, diagnoses, and suggested management strategies were very similar to previous Irish studies. Assessment of deliberate self-harm cases was the most common reason for referral [37.9% of 145 referrals]. Notably, there was a high level of diagnostic accuracy from non-psychiatric colleagues in this liaison model. Conclusions: This study, of a service model characterised by an emphasis on liaison, points to efforts on the part of the psychiatrist to improve communication with medical and surgical colleagues as being of primary importance in the development of general hospital psychiatry services.

Objectives: To ascertain the frequency and nature of emergencies referred to psychiatrists at the A & E Department of an urban teaching general hospital. Deliberate self-harm and other forms of violence were to be special foci of the study, as was substance abuse, particularly alcohol abuse. Clinical management strategies used by psychiatric emergency staff were also to be assessed. Method: A retrospective audit was made of all of the reports of emergencies written by psychiatric trainees (who were first on call to the A & E) during a six-month period (January-June, 1991). The reports were analysed according to demographic characteristics, main clinical problem, presence or absence of each special focus problem, and also clinical management strategies. Main outcome measures were recorded as percentages of relevant groupings. Mean and median ages were reported as indicated. Results: The 550 emergency psychiatric reports represented 2.2% of A & E attendances. Fifty-two percent were male and 70% were between 15 and 44 years of age. Forty-eight percent resided outside the psychiatric catchment area of St. James's Hospital. Forty-six percent of all psychiatric emergencies required careful assessment of suicidal potential; twenty percent were admitted to inpatient care, 53% were referred to out-patient or day-patient care, 7% to their general practitioner and just 3% to social services. Conclusions: 1. Emergency assessment at the A & E provides a considerable workload for the psychiatric service of an urban general hospital. 2. Careful assessment of suicidal potential still represents an important part of this emergency work. 3. Only 1 in 5 patients were referred on to in-patient care. Undue pressure should not be placed on psychiatric trainees to manage potentially suicidal patients outside hospital. 4. Few referrals were made by psychiatric trainees to general practitioners or to the social services, suggesting that more formal consultant supervision of trainees in this emergency work is warranted.

Objective: Psychiatric units in general hospitals are becoming a key feature of Irish psychiatric practice. This is in accordance with national policy as laid down in “Planning for the Future” in 1984. To date these units have not been the subject of much research. This paper presents baseline data, gives some clinical impressions of how these units are operating, and discusses the implications of these findings. Method: Questionnaires were sent to the medical directors of all 12 psychiatric units in general hospitals in Ireland. In addition, statistical data was collected from the Health Research Board and from the Mental Health Services Section of the Department of Health. Results: All the questionnaires were returned and the results showed that these units were operating in a largely self sufficient way with little usage of local psychiatric hospitals. Outside Dublin 35% of all Health Board admissions are now going to such units, a figure comparable to England and Wales. There was little evidence of patient selectivity as units seemed to be treating the full range of psychiatric disorders. Conclusion: The picture given of general hospital units in Ireland is, in the main, very encouraging. The main problems encountered were the management of disturbed patients and the heavy demands of liaison psychiatry and these two areas would need to be further researched.