Organization of Services

In the United Kingdom, wide variability exists in the organization of pediatric psychosomatic medicine services (termed consultation-liaison services in the United Kingdom), with no standard or agreed-upon format. The professions involved include child psychiatry, clinical psychology, nursing, social work, and child psychotherapy. In London, 92% of consultation-liaison services have a child psychiatrist, 46% a clinical psychologist, and 31% either a nurse or a child psychotherapist. Consultation-liaison services are located primarily in the major NHS hospitals or university medical centers.

In general, the provision of child and adolescent mental health care is multidisciplinary, and inpatient consultation-liaison services are supported by approximately 20 hours/week of nursing time and 15-20 hours/week of clinical psychology and child psychiatry. The larger services located in London teaching hospitals may have an additional 10 hours/ week of time from a child psychotherapist. All major hospitals have funding for 24-hour emergency room care, but the comprehensiveness of the child and adolescent mental health care varies widely. Some subspecialty units, such as pediatric oncology or rheumatology, may have a dedicated mental health professional, usually a clinical psychologist, although funding for such arrangements is inconsistent and variable. A multidisciplinary approach is the recommended service model.

Most pediatric patients who require inpatient care are hospitalized in a general or specialty pedi-atric unit under the care of a pediatrician, or with joint care also provided by child and adolescent mental health services. Patients with diagnoses of conversion disorder or severe chronic fatigue syndrome may also be hospitalized in adolescent psychiatry units. Some centers have developed adolescent medical wards, which have proven very helpful for adolescents with complex combined medical and psychiatric needs. One academic unit, directed by Professor Elena Garralda at Imperial College, London, has a particular interest in psychosomatic medicine.

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