Assement Of The Utilization Of Consultation Liaison Psychiatry Services At The Kenyatta National Hospital

Abstract

Despite mental illnesses contributing significantly to the global burden of disease, they are poorly understood by non-mental health care providers, leading to a huge treatment gap of up to 75% as reported by the World Health Organization. Consultation Liaison Psychiatry (CLP) focuses on inter-disciplinary cooperation between psychiatrists and other practitioners in hospital settings aimed at reducing mortality and morbidity, cost of care and length of hospital stay. This study aimed to document the utilization patterns and efficiency of CLP at Kenyatta National Hospital (KNH), and was a cross-sectional study of patients referred to the liaison clinic at KNH and postgraduate students at the University of Nairobi’s (UoN) College of Health Sciences. Data was collected by a researcher developed socio-demographic questionnaire, Mini International Neuropsychiatric Interview, version 6 (MINI 6.0) and the Mental Illness: Clinician’s Attitude Scale, version 4 (MICA 4) and was analyzed using the Statistical Package for Social Sciences then presented in tables and figures. This study found poor utilization of CLP services, with a referral rate of 0.42% and 0.2% in 2016 and 2017 respectively. The department of internal medicine had the most referrals (33.96%), with the commonest reason for referral being low mood (14.5%). The commonest primary condition was trauma (19%) and a diagnosis of depression was made in 24.5% of the patients. Overall, the resident doctors had a stigmatizing attitude, with a mean MICA score of 52.05. Having internship rotations in psychiatry was found to be significant (p<0.005) in ameliorating this attitude. Recommendations to adopt a more efficient (Computerized) system and a concise standardized diagnostic tool by the CLP department were made. Regular mental health trainings for residents by the department of psychiatry should be done. Psychiatry should be incorporated into internship training by the Ministry of Health. Further research into stigma against mental illness among healthcare workers was recommended.