The multi-disciplinary arena of psychosomatic medicine – Time for a transitional network approach

Background and objectives: Diverse disciplines, ranging from medical psychology to general hospital psychiatry and somatic specialties, are involved in efforts to understand psychosomatic conditions and to advocate multi-disciplinary management. Depending on the kind of problem, its acuity, severity and complexity, patients present at different settings. We aim to give examples of existing integrated care approaches at diverse health care settings and to depict obstacles to and benefits of that care. Furthermore, perspectives to overcome shortcomings concerning the organization of integrated care are outlined. Method: Narrative review. Results: This review describes obstacles to integrated psychosomatic care and delineates integrated medical and behavioural health services, ranging from the inpatient medical hospital setting to primary care. Benefits, shortcomings and aspirations of integrated care are drawn, suggesting that a transitional network approach might bridge the gap between medical disciplines and settings, within the medical hospital and back to primary care. Conclusions: Various medical and behavioural health service models deliver integrated care. Research mainly focused on collaborative care in primary care. There are uncertainties about the effectiveness of primary care-based interventions targeting somatic complexity and severity in multi-conditional patients. Uncertainties remain, for instance, in cancer or cardiovascular disease with comorbid psychiatric disorders. Furthermore, current evidence does not support the use of primary caregivers in cases of functional somatic symptoms. Given that care transition is a vulnerable moment in health care, a transitional network approach using staff-guided case managers could bridge the gap between medical hospital disciplines and primary care, possibly having impact of societal relevance.

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