Authors' reply

It is encouraging that the ideas expressed in my editorial on psychological medicine have stimulated such interest and associated correspondence. The three letters published above support the thrust of the editorial that a re-engagement of psychiatry with other areas of medicine in the form of psychological medicine services (also called liaison psychiatry) would benefit both medicine and psychiatry. Each letter also raises specific additional points.

Rowett & Udo doubt whether psychiatry is up to the ‘sheer scale of the task’ in helping other areas of medicine to address the ‘compassion vacuum’ highlighted by the Francis Inquiry. They conclude that medicine should put its own house in order by re-engaging with its patients and carers rather than seek solutions from another specialty. They are clearly correct in noting that the task is great and that the change required cannot be delivered by psychiatry alone. But I think they are too pessimistic, both about the appetite for change within medicine and about how much can be achieved by psychological medicine; it cannot transform medicine on its own, but it can be an important facilitator of change.

Mukaetova-Ladinska & Scully emphasise the importance of old age psychiatry in light of the rising age of general medical patients. They argue for the specific development of liaison psychiatry of old age. Although fully agreeing with them that expertise in the psychiatry of old age is an essential ingredient of a modern psychological medicine service, I am less convinced of the merit of subspecialised services. Integration with medical services requires that we map onto the way in which they are provided and the very demographic trend they have highlighted is breaking down the division between adult medicine and geriatrics. Hence although the skills of old age psychiatry are increasingly important for psychological medicine services, setting up service barriers defined by age is unlikely to achieve effective integration with medicine.

Finally, Kripalani makes the important point that we need to consider the role of psychiatry in ensuring patient safety. The point is made that services which concentrate on ‘severe mental illness’ may miss the risk of suicide posed by the individual suffering from stress and adjustment disorders. I am sure that most practitioners working in psychological medicine services would endorse this point. Psychological medicine can play an important role in helping medical services to reduce risk, as well as in improving patient outcomes and experience and making medical care more efficient.

I wish to thank these correspondents, and others who have emailed me personally, for their interest in the points raised in the editorial. The opportunities for psychiatry to re-engage with clinical medicine are enormous. I would strongly urge all those with an interest in developing integrated patient-centred psychological medicine services to help psychiatry to rise to this challenge. Our patients and our specialty need us to succeed.