Psychiatric liaison with a primary care clinic--14 years' experience

An analysis is presented of the experience of a psychiatric liaison team that visited one primary care community health center on a monthly basis for 14 years. The content of the liaison changed character over time, starting as a teaching relationship and developing successively into case discussions, tripartite consultations with joint interviews, a satellite psychiatric clinic, a Balint group, observation of routine general practice consultations and, finally joint assessments of video-tapes of routine consultations. The primary care team of nurses and doctors developed insight into the complexities of their relationships with each other and with their patients. The psychiatric team developed a more holistic view of psychological distress in the community and of the therapeutic potential of routine primary care. The patient population benefited from the improved accessibility of psychiatric care and from the increased psychological sensitivity of their doctors and nurses.