Mental illness and public health: exploring the role of general hospital physicians at a teaching hospital in Jamaica.

OBJECTIVES Against the public health implications of untreated mental illness among general hospital inpatients, this study aimed firstly to examine hospital physicians' level of referral to a psychiatric service, and secondly, to explore the extent of these doctors' knowledge of psychiatric issues by comparing their reasons for referring patients with patients' final psychiatric diagnoses. METHODS Over a one-year period, data were collected on all patients referred to a consultation liaison psychiatric service at a multi-disciplinary teaching hospital. Reasons for referral and final psychiatric diagnosis were recorded. Official hospital census data were also used in the calculation of referral rates. Chi-square or Fisher's Exact tests were used as appropriate to explore potential associations between reasons for referral and psychiatric diagnosis. Statistical significance was taken at the 0.05 level. RESULTS The referral rate was 1.5%. Strange and disruptive behaviour as reasons for referral were strongly associated with the presence of underlying medical conditions as the cause of mental disturbance. Anxiety and psychotic symptoms as reasons for referral were associated with anxiety and psychotic disorders respectively. Depression was often given as a reason for referral when clinical depression was absent, but adjustment issues were prominent. CONCLUSIONS The psychiatric service was underutilized. Generally, the psychiatric knowledge of physicians was fair However, closer attention to underlying medical conditions as a potential cause for psychiatric, disturbance, as well as to the difference between maladjustment and depression, seems warranted. It is possible that clinicians were less able to detect mild to moderate cases of psychiatric illness.