Psychiatry’s role in the prevention of post-intensive care mental health impairment: stakeholder survey

Abstract

Background Many critical illness survivors experience new or worsening mental health impairments. Psychiatry consultation services can provide a critical role in identifying, addressing, and preventing mental health challenges during and after admission to the acute medical care setting. However, psychiatry involvement in the ICU setting is lower than in other hospital settings and the conventional process in many hospitals requires other care providers to request consultation by psychiatry. Despite these differences, no studies have sought ICU provider perspectives on psychiatry consultation’s current and desired role. We aimed to obtain stakeholder feedback on psychiatry’s current and desired roles in the ICU, and potential benefits and drawbacks of increasing psychiatry’s presence. Methods A web-based survey obtained perspectives from 373 critical care physicians and advance practice providers, bedside nurses, physical and occupational therapists, pharmacists, and consultation-liaison psychiatry physicians and advance practice providers at a tertiary care center using multiple choice and open-ended questions. Descriptive information and content analysis of qualitative data provided information on stakeholder perspectives. Results Psychiatry’s primary current role was seen as assistance with management of mental health issues (38%) and suicide risk assessments (23%). 46% wished for psychiatry’s increased involvement in the ICU. Perceived benefits of increased psychiatry presence in the ICU included early psychological support in parallel with medical care, identification of psychiatric factors impacting treatment, and facilitation of family understanding of the patient’s mental state/delirium. An additional perceived benefit included reduction in provider burnout through processing difficult situations and decreasing family psychological distress. However, one concern included potential conflict among providers regarding treatment. Conclusions Those who work closely with the critically ill patients think that increased psychological support in the ICU would be beneficial. By contrast, psychiatry’s current involvement is seen to be limited, perhaps driven by varying perceptions of what psychiatry’s role is or should be.

Telepsychiatry readiness assessment at the Department of Psychiatry, Dr. Soeharto Heerdjan Hospital, Indonesia

“…“The psychiatrists continue to rely on telehealth for treating psychiatric and substance use disorders, and the regulatory changes made at the beginning of the Public Health Emergency to increase access to these services continue to be essential for doctors and patients alike”(American Psychiatric Association, 2021). Telehealth or telepsychiatry can improve access to healthcare, increase delivery options and improve patient outcomes (Bieber et al, 2022; MHCC, 2020; Torales et al, 2022). Patients and providers are generally satisfied with telepsychiatry services.…”

From the Intensive Care Unit to Recovery: Managing Post-intensive Care Syndrome in Critically Ill Patients

“…Furthermore, the insufficient participation of psychiatry in the ICU underscores the necessity for enhanced psychological assistance. Nevertheless, differing interpretations of psychiatry's function and possible disagreements among healthcare professionals continue to impede a cooperative approach [ 61 ]. In order to effectively treat the physical, cognitive, and psychological concerns of individuals with PICS, it is crucial to have proactive interdisciplinary collaboration.…”

Sepsis-Associated Delirium: A Narrative Review

“…Previous studies reported a relationship between delirium and physical impairment [ 56 ]. On the other hand, mental disorders, such as anxiety, depression, and post-traumatic stress disorder, were not associated with delirium [ 57 ]; however, psychiatric consultation services are offered to ICU patients with the aim of attenuating the mental component of PICS through the management of delirium [ 58 ]. Delirium may be regarded as an important factor affecting the outcome of PICS centered on cognitive dysfunction and may be controlled with appropriate assessments and management.…”