Chapter 17 - Social Aspects of Consultation-Liaison Psychiatry

Summary

Taking a history is an essential part of patient care for all clinicians but there can be a tendency for the social history to be brief, formulaic or even absent. The possible reasons for this and how liaison psychiatry might respond, given that history-taking skills are highly developed in the specialty, are described. The individual in the wider multidisciplinary team who is best placed to take a social history from a patient is considered, reviewing the attitudes of both doctors and nurses alongside evidence from studies where frameworks have been established to take the social history from all patients. The sources of information other than the patient that might be considered are described. Several key aspects of the social history are explored in detail – debt, employment, housing and social isolation. The evidence of impact on physical health and mental health is detailed for each, together with a summary of the evidence of benefit for interventions. Finally, the issue of how the information obtained should be shared and with whom and what can be done to improve patient outcomes is discussed.