Consultation-liaison (C-L) psychiatry, also called psychosomatic medicine, is a branch of psychiatry that focuses on the interface between medicine and psychiatry. Dr. Melissa De Capua gave her testimony about her time as a C-L psychiatric nurse practitioner.
What is a C-L Psychiatric Nurse Practitioner?
C-L psychiatric nurse practitioners (NP) typically work at a general hospital and serve as expert psychiatric consultants. The types of patients they see vary but all relate to psychiatric conditions. Some patients have comorbid psychiatric and medical conditions, or a medical condition that causes a psychiatric condition. Sometimes patients have psychiatric conditions that present with physical symptoms.
What does a C-L Psychiatric Nurse Practitioner’s Day Look Like?
I worked on an innovative and collaborative team of C-L psychiatric providers including social workers, counselors, physician assistants, nurse practitioners, and physicians. Each day, 20 to 30 psychiatric liaison consults arrived and dispersed amongst the team. I arrived at 0730 hours, checked my email and awaited the buzzing of my pager, alerting me to my first psychiatric care consult.
As part of the liaison team, I traveled on foot across the hospital network and across medical specialties. I spent most of my time in the ER, burn unit, ICU/PICU/NICU/SICU, labor and delivery rooms, and the dialysis unit. In each of these areas I provided expert psychiatric consultation to the medical team and mental health services. Psychiatric consultation liaison nurses are always in demand.
The mental health conditions I dealt with varied. Some psychiatric disorders stemmed from substance abuse, bipolar disorder, or other underlying conditions. A day was not complete without a case of complex delirium, alcohol withdrawal, suicide attempt, and postpartum depression.
What Do C-L Psychiatric Nurse Practitioners Do?
I provided recommendations based off best practices, my specialized education, and collaborative discussions with the C-L team. I usually spent about an hour with each patient in their hospital room. I would conduct a psychiatric evaluation and brief psychotherapeutic interventions. Basically, I got really good at motivational interviewing.
After seeing the patient I reviewed the case with their nurse. After consultation, I created a 5-10 page report listing my recommendations for the medical team. Oftentimes I collaborated closely with the care team and reviewed the case via telephone with the lead medical provider.
As a C-L psychiatric nurse practitioner, I understood the complex relationship between physical and emotional well-being. I made tough decisions every day including suicide risk assessments and a patient’s capacity to make medical decisions. I had to ask myself difficult questions as a psychiatric liaison.
Should this person be committed to a psychiatric hospital against their will? Can this person function independently after discharge? Can this patient give informed consent? Will this patient decline medical treatment or leave against medical advice? Mental health disorders always kept me on my toes.
What are the Trials and Hardships for C-L Psychiatric Nurse Practitioners?
Without a doubt, I experienced some of the most emotionally exhausting and traumatic moments of my life with consultation. Every day I encountered either grieving, demoralized, or mentally ill patients across the lifespan. I offered all the biological, psychological, and social interventions that I could.
One of the hardest parts was the walk from one consult to the next. During that time I prepared for what was up ahead, and left behind what I had just seen. This is one of those medical specialties where you bear witness to the darkest moments in people’s lives. While medical school does prepare you, it’s still shocking to see it in-person.
Previously, I worked in a rural outpatient mental health clinic as well as an inpatient child psychiatric hospital. By far, C-L was the more thrilling and dynamic clinical position I ever held. I had the opportunity to manage conditions like conversion disorder, psychogenic amnesia, and factitious disorder! I interfaced with every type of healthcare provider across the continuum of care.
Why should I become a C-L Psychiatric Nurse Practitioner?
The career is extremely rewarding. I gained new knowledge every day. To me, this was the experience of a lifetime. One of my personal dreams is to develop a C-L fellowship or residency program for psychiatric NPs and aid C-L psychiatrists.
I want more of us to have the opportunity to learn from this invaluable experience. Patients should be able to address their mental health problems.
For those who are interested in learning more about C-L psychiatry, check out Amos & Robinson’s text, Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry. Aspiring NPs should also read Jacqueline Rhoads’ book, Clinical Consult to Psychiatric Mental Health Management for Nurse Practitioners.
Editor’s Note: This article was originally written by Dr. Melissa de Capua DNP PMHNP in June 2015. It was updated by Desirae Sin in May 2024 to reflect current information.
