Pediatric Consultation-Liaison Psychiatry Approach to Optimize Global Access to Child and Adolescent Mental Healthcare

  • Olurotimi Adejumo
  • Patricia Ibeziako
  • Myron Belfer


Children and adolescents in many parts of the world are unable to access much-needed mental health services for various reasons, including a general lack of trained personnel, unaffordability of services, a lack of awareness, and sometimes, stigma. Mental health problems in children are often first identified by non-mental health professionals who may be pediatricians, general practitioners, or primary care workers. Children receiving care in medical, surgical or emergency wards, or for chronic physical illnesses, often experience psychiatric symptoms. These facts reveal a potential role for psychiatric liaison services in the care of children with mental health needs where other health problems may have been the original focus of care.

Addressing such mental health needs is challenging. Pediatric psychosomatic or child psychiatric consultation-liaison practitioners work at the interface between primary and mental health, and may work collaboratively to address the child’s needs holistically. In more resource-constrained settings, effective interventions may involve the transfer of essential skills for mental health assessment and management to non-psychiatric personnel, or the development of partnerships between psychiatrists and paediatricians, general practitioners, and other health workers, such as in a collaborative care model. Amidst a variety of challenges to collaboration and effective task shifting, including differences in professional training and approach, communication barriers, funding challenges, and logistical difficulties, there is a need for creativity in working within the challenges of each setting to provide mental health care for children who require it, while addressing their other health problems.


Liaison psychiatry Collaborative care Task shifting Child psychiatric emergencies Pediatric psychosomatic Global mental health 


  1. Ali, S., Rosychuk, R. J., Dong, K. A., McGrath, P. J., & Newton, A. S. (2012). Temporal trends in pediatric mental health visits: Using longitudinal data to inform emergency department health care planning. Pediatric Emergency Care, 28, 620–625. Scholar
  2. Alvarez, O., Rodriguez-Cortes, H., Robinson, N., Lewis, N., Pow Sang, C. D., Lopez-Mitnik, G., et al. (2009). Adherence to deferasirox in children and adolescents with sickle cell disease during 1-year of therapy. Journal of Pediatric Hematology Oncology, 31, 739–744. Scholar
  3. Anders, T. F. (1977). Child psychiatry and pediatrics: The state of the relationship. Pediatrics, 60, 616–620.PubMedGoogle Scholar
  4. Aoki, T., Sato, T., & Hosaka, T. (2004). Role of consultation-liaison psychiatry toward shortening of length of stay for medically ill patients with depression. International Journal of Psychiatry in Clinical Practice, 8, 71–76. Scholar
  5. Bauer, A. M., Thielke, S. M., Katon, W., Unützer, J., & Areán, P. (2014). Aligning health information technologies with effective service delivery models to improve chronic disease care. Preventive Medicine, 66, 167–172. Scholar
  6. Belfer, M. L. (2008). Child and adolescent mental disorders: The magnitude of the problem across the globe. Journal of Child Psychology and Psychiatry, 49, 226–236. Scholar
  7. Bergman, A. S., & Fritz, G. K. (1981). Psychiatric and social work collaboration in pediatric chronic illness hospital. Social Work in Health Care, 7, 45–55.CrossRefGoogle Scholar
  8. Bernstein, C. M., Stockwell, M. S., Gallagher, M. P., Rosenthal, S. L., & Soren, K. (2013). Mental health issues in adolescents and young adults with type 1 diabetes: Prevalence and impact on glycemic control. Clinical Pediatrics (Philadelphia), 52, 10–15. Scholar
  9. Blancquaert, I. R., Zvagulis, I., Gray-Donald, K., & Pless, I. B. (1992). Referral patterns for children with chronic diseases. Pediatrics, 90, 71–74.PubMedGoogle Scholar
  10. Bujoreanu, S., White, M. T., Gerber, B., & Ibeziako, P. (2015). Effect of timing of psychiatry consultation on length of pediatric hospitalization and hospital charges. Hospital Pediatrics, 5, 269–275. Scholar
  11. Caradang, C., Gray, C., Marval-Ospino, H., & MacPhee, S. (2012). In J. M. Rey (Ed.), Child and adolescent psychiatric emergencies. Geneva: IACAPAP E-Textb. Child Adolesc. Ment. Health.Google Scholar
  12. Case, S. D., Case, B. G., Olfson, M., Linakis, J. G., & Laska, E. M. (2011). Length of stay of pediatric mental health emergency department visits in the United States. Journal of the American Academy of Child and Adolescent Psychiatry, 50, 1110–1119. Scholar
  13. Christodulu, K. V., Lichenstein, R., Weist, M. D., Shafer, M. E., & Simone, M. (2002). Psychiatric emergencies in children. Pediatric Emergency Care, 18, 268–270.CrossRefGoogle Scholar
  14. Cooper, J. L., & Masi, R. (2007). Child and youth emergency mental health care: A national problem. New York: Columbia University Academy Commons.Google Scholar
  15. DeMaso, D. R., Martini, D. R., & Cahen, L. A. (2009). Practice parameter for the psychiatric assessment and management of physically ill children and adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 48, 213–233. Scholar
  16. Divan, G., Hamdani, S. U., Vajartkar, V., Minhas, A., Taylor, C., Aldred, C., et al. (2015). Adapting an evidence-based intervention for autism spectrum disorder for scaling up in resource-constrained settings: The development of the PASS intervention in South Asia. Global Health Action, 8, 27278.CrossRefGoogle Scholar
  17. Eaton, J., McCay, L., Semrau, M., Chatterjee, S., Baingana, F., Araya, R., et al. (2011). Scale up of services for mental health in low-income and middle-income countries. Lancet London England, 378, 1592–1603. Scholar
  18. Erhart, M., Weimann, A., Bullinger, M., Schulte-Markwort, M., & Ravens-Sieberer, U. (2011). Psychological comorbidity in children and adolescents with chronic somatic diseases. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz, 54, 66–74. Scholar
  19. Foy, J. M., Kelleher, K. J., Laraque, D., & American Academy of Pediatrics Task Force on Mental Health. (2010). Enhancing pediatric mental health care: Strategies for preparing a primary care practice. Pediatrics, 125, S87–S108. Scholar
  20. Fulton, B. D., Scheffler, R. M., Sparkes, S. P., Auh, E. Y., Vujicic, M., & Soucat, A. (2011). Health workforce skill mix and task shifting in low income countries: A review of recent evidence. Human Resources for Health, 9(1).
  21. Garralda, M. E., & Bailey, D. (1989). Psychiatric disorders in general paediatric referrals. Archives of Disease in Childhood, 64, 1727–1733.CrossRefGoogle Scholar
  22. Gilbert, L. (2013). “Re-Engineering the Workforce to meet service needs”: Exploring “Task-Shifting” in South Africa in the Context of Hiv/Aids and antiretroviral therapy. South African Review of Sociology, 44, 54–75. Scholar
  23. Gillard, A., Witt, P. A., & Watts, C. E. (2011). Outcomes and processes at a camp for youth with HIV/AIDS. Qualitative Health Research, 21, 1508–1526. Scholar
  24. Glazebrook, C., Hollis, C., Heussler, H., Goodman, R., & Coates, L. (2003). Detecting emotional and behavioural problems in paediatric clinics. Child: Care, Health and Development, 29, 141–149.Google Scholar
  25. Gómez-Restrepo, C., Ramirez, S., Tamayo Martínez, N., Rodriguez, M. N., Rodríguez, A., & Rengifo, H. (2016). Probable mental health disorders prevalence in children with chronic conditions. Results from the national mental health survey of Colombia 2015. Revista Colombiana Psiquiatria, 45(Suppl 1), 135–140. Scholar
  26. Grupp-Phelan, J., Harman, J. S., & Kelleher, K. J. (2007). Trends in mental health and chronic condition visits by children presenting for care at U.S. emergency departments. Public Health Reports, 122, 55–61.CrossRefGoogle Scholar
  27. Haberer, J. E., Cook, A., Walker, A. S., Ngambi, M., Ferrier, A., Mulenga, V., et al. (2011). Excellent adherence to antiretrovirals in HIV+ Zambian children Is compromised by disrupted routine, HIV Nondisclosure, and Paradoxical income effects. PLoS ONE, 6. Scholar
  28. Harper, G. (2012). Child and adolescent mental health policy. In J. Rey (Ed.), IACAPAP E-textbook of child and adolescent mental health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions.Google Scholar
  29. Henderson, T. (2013). Pediatric consultation-liaison psychiatry: A description of the consultation-liaison service offered by a tertiary level children’s hospital in Cape Town, South Africa. Cape Town: University of Cape Town.Google Scholar
  30. Huijbregts, K. M. L., de Jong, F. J., van Marwijk, H. W. J., Beekman, A. T. F., Adèr, H. J., Hakkaart-van Roijen, L., et al. (2013). A target-driven collaborative care model for major depressive disorder is effective in primary care in the Netherlands. A randomized clinical trial from the depression initiative. The Journal of Affective Disorders, 146, 328–337. Scholar
  31. Hysing, M., Elgen, I., Gillberg, C., Lie, S. A., & Lundervold, A. J. (2007). Chronic physical illness and mental health in children. Results from a large-scale population study. Journal of Child Psychology and Psychiatry, 48, 785–792. Scholar
  32. Janse, A. J., Uiterwaal, C. S. P. M., Gemke, R. J. B. J., Kimpen, J. L. L., & Sinnema, G. (2005). A difference in perception of quality of life in chronically ill children was found between parents and pediatricians. Journal of Clinical Epidemiology, 58, 495–502. Scholar
  33. Kakuma, R., Minas, H., van Ginneken, N., Dal Poz, M. R., Desiraju, K., Morris, J. E., et al. (2011). Human resources for mental health care: Current situation and strategies for action. Lancet London England, 378, 1654–1663. Scholar
  34. Katon, W., Unützer, J., Wells, K., & Jones, L. (2010). Collaborative depression care: History, evolution and ways to enhance dissemination and sustainability. General Hospital Psychiatry, 32. Scholar
  35. Kieling, C., Baker-Henningham, H., Belfer, M., Conti, G., Ertem, I., Omigbodun, O., et al. (2011). Child and adolescent mental health worldwide: Evidence for action. The Lancet, 378, 1515–1525. Scholar
  36. Krauss, B., Letteney, S., de Baets, A., Murugi, J., Okero, F. A., & World Health Organization. (2011). Guideline on HIV disclosure counselling for children up to 12 years of age. Geneva: World Health Organization.Google Scholar
  37. Labhardt, N. D., Balo, J.-R., Ndam, M., Grimm, J.-J., & Manga, E. (2010). Task shifting to non-physician clinicians for integrated management of hypertension and diabetes in rural Cameroon: A programme assessment at two years. BMC Health Services Research, 10, 339. Scholar
  38. Lancet Global Mental Health Group, Chisholm, D., Flisher, A. J., Lund, C., Patel, V., Saxena, S., et al. (2007). Scale up services for mental disorders: A call for action. Lancet London England, 370, 1241–1252. Scholar
  39. Mapelli, E., Black, T., & Doan, Q. (2015). Trends in pediatric emergency department utilization for mental health-related visits. The Journal of Pediatrics, 167, 905–910. Scholar
  40. Martin, A., Volkmar, F. R., & Lewis, M. (2007). Lewis’s child and adolescent psychiatry: A comprehensive textbook. Philadelphia: Lippincott Williams & Wilkins.Google Scholar
  41. McCarthy, A. (2015). Summer camp for children and adolescents with chronic conditions. Pediatric Nursing, 41, 245–250.PubMedGoogle Scholar
  42. Moola, F. J., Faulkner, G. E. J., White, L., & Kirsh, J. A. (2014). The psychological and social impact of camp for children with chronic illnesses: A systematic review update. Child: Care, Health and Development, 40, 615–631.Google Scholar
  43. Munga, M. A., Kilima, S. P., Mutalemwa, P. P., Kisoka, W. J., & Malecela, M. N. (2012). Experiences, opportunities and challenges of implementing task shifting in underserved remote settings: the case of Kongwa district, central Tanzania. BMC International Health and Human Rights, 12, 27. Scholar
  44. Myrvik, M. P., Burks, L. M., Hoffman, R. G., Dasgupta, M., & Panepinto, J. A. (2013). Mental health disorders influence admission rates for pain in children with sickle cell disease. Pediatric Blood & Cancer, 60, 1211–1214. Scholar
  45. Nabukeera-Barungi, N., Elyanu, P., Asire, B., Katureebe, C., Lukabwe, I., Namusoke, E., et al. (2015). Adherence to antiretroviral therapy and retention in care for adolescents living with HIV from 10 districts in Uganda. BMC Infectious Diseases, 15.
  46. Naidu, S., Bolton, J., & Smith, J. (2015). London’s liaison psychiatry services: Survey of service provision. BJPsych Bulletin, 39, 65–69. Scholar
  47. National Department of Health South Africa. (2016). Disclosure guidelines for children and adolescents in the context of HIV, TB and non-communicable diseases. Republic of South Africa: National Department of Health South Africa.Google Scholar
  48. Neil-Urban, S., & Jones, J. B. (2002). Father-to-father support: Fathers of children with cancer share their experience. Journal of Pediatric Oncology Nursing, 19, 97–103. Scholar
  49. Newton, A. S., Ali, S., Johnson, D. W., Haines, C., Rosychuk, R. J., Keaschuk, R. A., et al. (2009). A 4-year review of pediatric mental health emergencies in Alberta. CJEM, 11, 447–454.CrossRefGoogle Scholar
  50. Newton, A. S., Ali, S., Hamm, M. P., Haines, C., Rosychuk, R. J., Warron, L., et al. (2011). Exploring differences in the clinical management of pediatric mental health in the emergency department. Pediatric Emergency Care, 27, 275–283. Scholar
  51. Pao, M., & Raza, H. (2006). Essential issues in pediatric psychosomatic medicine. Psychiatric Times. Accessed 25 Mar 2017.
  52. Patel, V., Kieling, C., Maulik, P. K., & Divan, G. (2013). Improving access to care for children with mental disorders. Medscape. Accessed December 20, 2015.
  53. Paula, C. S., Bordin, I. A. S., Mari, J. J., Velasque, L., Rohde, L. A., & Coutinho, E. S. F. (2014). The mental health care gap among children and adolescents: Data from an Epidemiological Survey from four Brazilian Regions. PLOS ONE, 9, e88241. Scholar
  54. Pinquart, M., & Shen, Y. (2011). Behavior problems in children and adolescents with chronic physical illness: A meta-analysis. Journal of Pediatric Psychology, 36, 1003–1016. Scholar
  55. Power, T. J., Blum, N. J., Guevara, J. P., Jones, H. A., & Leslie, L. K. (2013). Coordinating mental health care across primary care and schools: ADHD as a case example. Advances in School Mental Health Promotion, 6, 68–80. Scholar
  56. Remschmidt, H., & Belfer, M. (2005). Mental health care for children and adolescents worldwide: A review. World Psychiatry, 4, 147–153.PubMedPubMedCentralGoogle Scholar
  57. Saraceno, B., van Ommeren, M., Batniji, R., Cohen, A., Gureje, O., Mahoney, J., et al. (2007). Barriers to improvement of mental health services in low-income and middle-income countries. Lancet London England, 370, 1164–1174. Scholar
  58. Sayal, K. (2006). Annotation: Pathways to care for children with mental health problems. Journal of Child Psychology and Psychiatry, 47, 649–659. Scholar
  59. Sharma, A., Prematta, T., & Fausnight, T. (2012). A pediatric food allergy support group can improve parent and physician communication: Results of a parent survey. Journal of Allergy, 2012, 168053. Scholar
  60. Sharpe, M. (2014). Psychological medicine and the future of psychiatry. British Journal of Psychiatry, 204, 91–92. Scholar
  61. Shaw, R. J., Wamboldt, M., Bursch, B., & Stuber, M. (2006). Practice patterns in pediatric consultation–liaison psychiatry: A national survey. Psychosomatics, 47, 43–49. Scholar
  62. Shemesh, E., Annunziato, R. A., Arnon, R., Miloh, T., & Kerkar, N. (2010). Adherence to medical recommendations and transition to adult services in pediatric transplant recipients. Current Opinion in Organ Transplantation, 15, 288–292. Scholar
  63. Sills, M. R., & Bland, S. D. (2002). Summary statistics for pediatric psychiatric visits to US emergency departments, 1993–1999. Pediatrics, 110, e40–e40. Scholar
  64. Solberg, L. I., Crain, A. L., Maciosek, M. V., Unützer, J., Ohnsorg, K. A., Beck, A., et al. (2015). A stepped-wedge evaluation of an initiative to spread the collaborative care model for depression in primary care. Annals of Family Medicine, 13, 412–420. Scholar
  65. Spiegel, H. M. L. (2011). Nondisclosure of HIV status in adolescence. Adolescent Medicine: State of the Art Reviews, 22, 277–282. x.PubMedGoogle Scholar
  66. Stiller, C. (2002). Epidemiology of cancer in adolescents. Medical and Paediatric Oncology, 39, 149–155. Scholar
  67. Swartz, L., Kilian, S., Twesigye, J., Attah, D., & Chiliza, B. (2014). Language, culture, and task shifting – An emerging challenge for global mental health. Global Health Action, 7. Scholar
  68. Sztein, D. M., & Lane, W. G. (2016). Examination of the comorbidity of mental illness and somatic conditions in hospitalized children in the United States using the kids’ inpatient database, 2009. Hospital Pediatrics, 6, 126–134. Scholar
  69. Turkel, S., & Pao, M. (2007). Late consequences of pediatric chronic illness. Psychiatric Clinics of North America, 30, 819–835. Scholar
  70. Unützer, J., Katon, W., Callahan, C. M., Williams, J. W., Hunkeler, E., Harpole, L., et al. (2002). Collaborative care management of late-life depression in the primary care setting: A randomized controlled trial. JAMA, 288, 2836–2845.CrossRefGoogle Scholar
  71. Van Cleave, J., Gortmaker, S. L., & Perrin, J. M. (2010). Dynamics of obesity and chronic health conditions among children and youth. JAMA, 303, 623–630. Scholar
  72. van der Lee, J. H., Mokkink, L. B., Grootenhuis, M. A., Heymans, H. S., & Offringa, M. (2007). Definitions and measurement of chronic health conditions in childhood: A systematic review. JAMA, 297, 2741–2751. Scholar
  73. van der Veen, W. J. (2003). The small epidemiologic transition: Further decrease in infant mortality due to medical intervention during pregnancy and childbirth, yet no decrease in childhood disabilities. Nederlands Tijdschrift Voor Geneeskunde, 147, 378–381.PubMedGoogle Scholar
  74. Vandvik, I. H. (1994). Collaboration between child psychiatry and paediatrics: The state of the relationship in Norway. Acta paediatrica Oslo, Norway : 1992, 83, 884–887.CrossRefGoogle Scholar
  75. Vreeman, R. C., Wiehe, S. E., Pearce, E. C., & Nyandiko, W. M. (2008). A systematic review of pediatric adherence to antiretroviral therapy in low- and middle-income countries. The Pediatric Infectious Disease Journal, 27, 686–691. Scholar
  76. Vreeman, R. C., Gramelspacher, A. M., Gisore, P. O., Scanlon, M. L., & Nyandiko, W. M. (2013). Disclosure of HIV status to children in resource-limited settings: A systematic review. Journal of the International AIDS Society, 16, 18466.CrossRefGoogle Scholar
  77. Wissow, L. S., van Ginneken, N., Chandna, J., & Rahman, A. (2016). Integrating children’s mental health into primary care. Pediatric Clinics of North America, 63, 97–113. Scholar
  78. Woodgate, M., & Elena Garralda, M. (2006). Paediatric liaison work by child and adolescent mental health services. Child and Adolescent Mental Health, 11, 19–24. Scholar
  79. Woods-Jaeger, B. A., Kava, C. M., Akiba, C. F., Lucid, L., & Dorsey, S. (2017). The art and skill of delivering culturally responsive trauma-focused cognitive behavioral therapy in Tanzania and Kenya. Psychological Trauma: Theory, Research, Practice, and Policy, 9, 230–238. Scholar
  80. World Health Organisation. (2003). Adherence to long-term therapies - Evidence for action. Geneva: World Health Organisation.Google Scholar
  81. World Health Organization. (2005). Child & adolescent mental health policy and plans. Geneva: World Health Organisation.Google Scholar
  82. World Health Organization and World Organization of Family Doctors. (2008). Integrating mental health into primary health care a global perspective. Geneva: World Health Organization: Wonca.Google Scholar
  83. World Health Organization, World Psychiatric Association and International Association for Child and Adolescent Psychiatry and Allied Professions. (2005). Child and adolescent mental health resources: Global concerns – implications for the future. Geneva/Herndon: World Health Organization Stylus Pub., LLC [distributor].Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Olurotimi Adejumo
    • 1
  • Patricia Ibeziako
    • 2
  • Myron Belfer
    • 3
  1. 1.Hertfordshire Partnership University NHS Foundation TrustHertfordshireUK
  2. 2.Department of PsychiatryHarvard Medical SchoolBostonUSA
  3. 3.Department of PsychiatryBoston Children’s Hospital/Harvard Medical School, Boston Children’s HospitalBostonUSA

Personalised recommendations