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Bridging the Gap: How India's Mental Healthcare Referral Patterns Compare Globally

Elliot Brynn in Health & Wellness December 2025 • 4 min read.

"A deep dive into the consultation liaison psychiatry services in India and their alignment with international standards, offering insights for patients and healthcare professionals."

Consultation liaison (CL) psychiatry, which focuses on the interface between physical and mental health, is still developing in India. While general hospital psychiatric units (GHPUs) provide mental health services, including CL psychiatry, these often operate on a consultation basis with limited integration.

A recent study compared referral patterns at a CL psychiatry service in a tertiary care general hospital in North India with similar services worldwide. This comparison aims to highlight similarities and differences in how mental healthcare is approached across different countries, ultimately improving patient care.

The study was conducted at a GHPU in North India with a capacity of 2439 beds, serving a large population of outpatients and inpatients annually. The hospital follows a consultation model where the psychiatry department receives referrals from various disciplines within the hospital. A retrospective chart review of CL psychiatry referrals was conducted over two years, utilizing the ICD-10 diagnostic system.

Key Findings: Understanding Referral Trends and Diagnoses

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Over two years, the service received 2355 referrals, averaging 4.4 referrals per day. Most patients were male (60%), with 97.2% being adults and 19.2% over 60 years old. Referrals primarily came from medicine and allied disciplines (over 40%), followed by surgical disciplines (about 20%). Neurosciences and trauma services each contributed approximately 10% of referrals.

The most common diagnoses were delirium, depression, and anxiety disorders. However, a significant portion (32%) did not receive a specific psychiatric diagnosis. The mean age for patients with delirium was 50.57 years. A smaller percentage (3.2%) were referred for deliberate self-harm (DSH), with a majority being male.

Delirium, depression, and anxiety disorders were the most prevalent diagnoses among those referred.
A substantial portion of referrals did not result in a specific psychiatric diagnosis, highlighting potential areas for improved assessment or alternative explanations for symptoms.
Self-harm attempts, though less frequent, underscore the importance of addressing suicide risk within the consultation liaison setting.

The study found that about one-fifth of patients were prospective donors sent for psychiatric clearance from organ transplantation services. Of these, only a small number received a psychiatric diagnosis. Patients with delirium were older, while those with DSH were younger than the average sample. The prevalence of DSH being more common in males contrasted with typical reports in females.

Implications and Future Directions: Improving Mental Healthcare Integration

The study highlights both similarities and differences in referral patterns compared to Western countries. While the sample size was large, the mean age of subjects was lower than in Western studies, potentially due to demographic differences.

The study underscores the need for continued efforts to integrate mental health services within general hospitals in India. By understanding referral patterns and diagnostic trends, healthcare providers can better address the mental health needs of patients in various medical settings.

Further research is needed to explore the reasons behind the high percentage of referrals without a specific psychiatric diagnosis. This could involve improving assessment tools, enhancing collaboration between medical and psychiatric professionals, and addressing potential cultural factors influencing mental health presentation.

About this Article -

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This article is based on research published under:

DOI-LINK: 10.1016/j.genhosppsych.2018.10.011, Alternate LINK

Title: Referral Patterns In A Consultation Liaison Psychiatry Service In India: A Comparison With The Western World

Subject: Psychiatry and Mental health

Journal: General Hospital Psychiatry

Publisher: Elsevier BV

Authors: Rakesh Kumar Chadda, Koushik Sinha Deb, Ananya Mahapatra, Rishi Gupta

Published: 2019-07-01

Everything You Need To Know

What is consultation liaison (CL) psychiatry and why is it significant?

Consultation liaison (CL) psychiatry focuses on the intersection of physical and mental health within a hospital setting. In this context, it involves psychiatrists consulting with other medical teams about patients who have both physical and mental health concerns. This is important because it ensures that mental health needs are addressed in patients admitted for other medical conditions, improving overall patient care. The study shows how CL psychiatry operates in a specific tertiary care general hospital in North India, revealing referral patterns, diagnoses, and implications for better integrating mental healthcare.

Where did most of the referrals to the CL psychiatry service come from?

The primary referral sources within the hospital were medicine and allied disciplines, followed by surgical disciplines. Neurosciences and trauma services also contributed to the referrals. This pattern highlights the importance of recognizing mental health issues in patients with medical or surgical conditions. It indicates that CL psychiatry services are essential for addressing the mental health needs of patients across various medical specialties, leading to improved diagnosis and treatment of psychiatric disorders.

What were the most common diagnoses, and what do they indicate?

The most common diagnoses were delirium, depression, and anxiety disorders. A significant portion of patients did not receive a specific psychiatric diagnosis. Delirium, often associated with older age, underscores the vulnerability of hospitalized patients to cognitive and psychiatric symptoms. Self-harm attempts, though less frequent, indicate the need for addressing suicide risk in the CL setting. These diagnoses highlight the complex interplay between physical and mental health and the critical role of CL psychiatry in providing appropriate care.

How do referral patterns compare to those in Western countries?

The study compared the referral patterns with those observed in Western countries. While there were similarities, such as the types of referrals and common diagnoses, differences emerged, including the mean age of patients. The variations reflect demographic and healthcare system differences. Understanding these differences helps in tailoring mental healthcare services to the specific needs of the patient population, thus improving the quality of care, and identifying areas where services can be enhanced.

Where was the study conducted and what methodology was used?

The study was conducted in a general hospital psychiatric unit (GHPU) with a large number of beds, serving many outpatients and inpatients. The GHPU followed a consultation model, with the psychiatry department receiving referrals from various disciplines within the hospital. The use of the ICD-10 diagnostic system was crucial for standardizing and analyzing the diagnoses. The study reveals the importance of the GHPU model in providing mental health services and the need for continued development and integration of CL psychiatry to improve the treatment of patients in India.