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Consultation-Liaison Psychiatry—from theory to clinical practice: an observational study in a general hospital

Giuseppina de giorgio.

Functional Homogeneous Area, Local Health Authority 3, Umbria, Italy

Roberto Quartesan

Section of Psychiatry, Clinical Psychology and Psychiatric Rehabilitation, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy

Tiziana Sciarma

Martina giulietti.

Department of Psychiatry, University of Modena and Reggio Emilia, Modena, Italy

Angela Piazzoli

Laura scarponi, silvia ferrari, laura ferranti, patrizia moretti, massimiliano piselli.

Psychiatry School, University of Perugia, Perugia, Italy

To investigate significant association between various clinical and extra-clinical factors brought out the activities of Consultation-Liaison Service.

Data from all psychiatric consultations for patients admitted to the Perugia General Hospital and carried out over a 1-year period (from July the 1st 2009 to June the 30th 2010) were collected by a structured clinical report including: socio-demographic features, features of referrals, features of back-referrals. T-test, Mann–Whitney U-test, χ 2 -test and Fischer’s were statistically used.

1098 consultations were performed. The consultations carried out the Emergency Unit were excluded from the study. The type and the reasons for the referrals were discussed such as the ICD-10 diagnosis and the liaison interventions too. Significant associations emerged between gender and: social status and occupation ( p  < 0.05 and p  < 0.01 respectively). Clinical sector related with reason for referral ( p  < 0.01), type of consultation ( p  < 0.01), liaison investigations ( p  < 0.01) and long-term treatment plan after hospital discharge ( p  < 0.01). The ICD-10 psychiatric diagnosis (Schizophrenia, Affective Syndrome and Neurotic-StressSomatoform Syndrome) was associated with social status ( p  < 0.01), social condition ( p  < 0.01), consultation type ( p  < 0.01), advice ( p  < 0.01) and reason for consultation ( p  < 0.01).

Conclusions

The need for better physical and psychological investigation is confirmed in order to promote not only disease remission but overall wellbeing.

Electronic supplementary material

The online version of this article (doi:10.1186/s13104-015-1375-6) contains supplementary material, which is available to authorized users.

Over the past two decades research in psychiatry has identified Consultation-Liaison Psychiatry (CLP) as “The guardian of holistic approach to the patient” [ 1 ], underlining its pre-eminent role in management of patients who are admitted to a general hospital. The CLP objectives and operating procedures have evolved in recent years from administration of psychiatric treatment [ 2 ] to integrating therapy [ 3 ] into the bio-psyo-social model along the lines of the recommendation from an editorial in the Lancet “No health without mental health” [ 4 ]. Hospital staff are confronted daily by physical/psychiatric multimorbidity [ 5 ] with its extensive costs of suffering for patient and consumption of medical and economic resources [ 3 ]. It is worth noting that psychiatric disorders, even when sub-clinical [ 6 ], worsen outcome, lengthen hospital stays and are associated with increased mortality and use of health service resources [ 7 , 8 ].

Although early detection and treatment of psychological distress and psychiatric disorders in comorbidity are known to reduce health care costs significantly [ 9 ], in Italy no shared systematic schema of CLP interventions has, as yet, been drawn up. Whereas CLP was token systematically, various limits appeared, underlying the need to apply new method both inside and outside of general hospital [ 10 , 11 ].

Moreover, awareness of how interdependent the psychological and physical features of disease are, appears to have widened the gap between research and clinical practice. The former measures outcome efficacy using parameters of little relevance to medicine overall [ 12 ], and the latter cannot intervene without taking into account social and health service organization and the network of family and social assistance that obtain [ 13 ].

All over the medicine understand that psycho-social features influence aetiopathogenesis and prognosis of many chronic disease such as ischemic heart disease, diabetes, cancer [ 14 ]. All over the medicine understand that psycho-social variables are crucial to management of the patient with multi-morbidity and “unexplained medical symptoms”, to the doctor–patient relationship, response to therapy, maintenance of illness behaviour and the onset of psychiatric complications in medical illness [ 15 ]. However this awareness has not yet brought significant change in research and particularly in clinical practice, with its two-pronged interventions directed towards patients (in consultation) and towards physicians and surgeons in other hospital units (in liasion). This raises the question of creating multi-disciplinary teams with the psychiatrist mediating CLP integration and system [ 16 ]. Furthermore, the unique features of CLP and the difficulties in implementing it are due to patients lacking both awareness of their own psychiatric disturbances and not personally requesting intervention [ 16 ].

Regarding research, few reports are available on long-term follow-ups and outcomes. Most studies are retrospective and descriptive [ 17 , 18 ], and often cannot be compared because of structural and methodological differences [ 17 ].

The success of CLP intervention depends on variables such as how the service is organised, the team experience and uniformity of intervention and ability to establish good lines of communication with specialists in internal medicine [ 19 ]. The consultant psychiatrist, when called upon to coordinate, inform and educate [ 16 ], needs standard procedures, guidelines and quality indicators [ 20 ]. This observational study describes CLP activity as conducted in Perugia General Hospital, Italy, with the aims of assessing

• which hospital unit most requested psychiatric consultation;
• what factors were most closely associated with the request (medical and psychiatric diagnosis, drug and psychological therapy) and
• the role bio-psycho-social variables played in determining the above factors.

CLP activity was performed by the Psychiatry, Clinical Psychology and Psychiatric Rehabilitation Unit, University of Perugia at Perugia General Hospital, Italy. The hospital has 740 beds for inpatients and Day Hospital/Surgery Services and treats about 43,500 patients per year.

The Psychiatry, Clinical Psychology and Psychiatric Rehabilitation Unit receives requests for urgent or planned consultations, via intranet, from all hospital units (in- and out-patients) and the Accident and Emergency Unit. Urgent requests are prioritized and all consultations are carried out within 24 h of request. Written comments and diagnosis according to Diagnostic and Statistical Manual of Mental Disorders-Text Revision (DSM-IV TR) [ 21 ] are provided. For present study purposes DSM-IV TR diagnoses were transformed into ICD-10 diagnoses. Upon patient discharge, the Psychiatry Unit contacts local health services, general practitioners (GPs) and, when required, organises patient transfer to other psychiatric institutes. All these activities are conducted in accordance with ECLW proposals for standardized data collection and training (1996), using a data collection form derived from the Patient Registration Form [ 22 ] and full-team participation in weekly supervision sessions [ 23 ].

In the present study consultations were carried out between 1st July 2009 and 30th June 2010, 6 days a week from 8.00 a.m. to 8.00 p.m. A pool of psychiatrists from Local Health Board No 2 in Umbria was on call for consultations at other times. All patients were over 18 years of age. To group data, Hospital Units requesting consultation were assigned to one of three sectors: medical, surgical or specialist 1 (Additional file 1 : Table S1).

The data were scheduled into:

• socio-demographic features;
• referrals features (urgency, referrals reason, referring ward, medical co-morbidity);
• referrals result (psychiatric history, psychiatric diagnosis, therapy, pharmacologic prescription).

Statistical analysis

Continuous variables were analysed by T-test and non-parametric variables by the Mann–Whitney U-Test. Categorical variables were analysed by the χ 2 -tests and Fischer’s exact test. Significance was set at p  < 0.05. The SPSS programme (version 12.0) was used for data analysis.

In the mentioned time 1098 psychiatric consultations were carried out (932 first examinations and 166 check-ups).

First examinations: 275/932 (29.5 %) were requested by the Accident and Emergency Unit (A&E) and the other 657 (70.5 %) from other Hospital Units. Excluding A&E requested from the present data analysis because the Unit did not have in-patients, a total of 811 patients were examined in psychiatric consultations. They constituted 1.8 % of the total number of in-patients. 657/811 patients (81 %) received only one examination and 154 (19 %) more than one. Additional file 1 : Table S1 reports the socio-demographic characteristics of patients who received psychiatric assessment through consultation.

Almost all the inpatients were from Europe, the mean age was 57.9 (SD ± 19.4); the female were 60.8 %; married people were 47.5 %; in most cases (39.5 %) the inpatients were pensioner.

Details of consultations: 24.7 % of requests were flagged as urgent and 84.6 % of patients had been informed of the request. Medical units provided 53.1 % of requests for psychiatric consultation, surgical units 8.8 % and specialist units 38.1 %. The most common reasons for requesting consultation were anxiety (18.9 %), symptoms of depression (18.2 %), confusion (13.4 %), unexplained somatic symptoms (11.2 %), suicide attempt/risk (11.2 %), psychomotor agitation (10.9 %) and history of psychiatric illness (14.4 %). Reasons from medical units focused on anxiety (22.3 %) and depression (16.9 %) (Additional file 1 : Table S2).

The main reasons for consultation from surgical units were suicide attempt/risk (31 %) and agitation (21.1 %) (Additional file 1 : Table S2). The specialist units motivated requests on the grounds of depression (21.7 %), unexplained somatic symptoms (17.8 %) and anxiety (159 %) (Additional file 1 : Table S2).

Referrals result: A history of psychiatric illness was present in 41.3 % of patients and 60.8 % used psychoactive drugs (usually benzodiazepine and/or antidepressant agents). Only 17.5 % of patients was being treated by the health service when hospitalised. The most common ICD-10 diagnoses (International Classification of Disease) were Somatic–Neurotic–Stress Syndrome (28.7 %) and Affective Syndromes (26.6 %).

The psychiatric consultation was the only diagnostic intervention in 83.3 % of cases. Liason interventions were mainly directed towards medical and nursing staff of the Unit requesting consultation (66.2 %). Therapeutic interventions included patient interviews (47.5 %) and prescription of psychoactive drugs (60.3 %). Benzodiazepine and antidepressant were the most prescribed drugs. However, use of BDZ as monotherapy was reduced from 14.5 % at admission to 8.1 % and monotherapy with neuroleptic agents was increased from 6.2 % at admission to 8.2 %. The discharge plan of care included referral to the CSM (24.8 %), to the Psychiatric Unit day service (20.1 %) or to the patient’s GP (17.1 %).

Associations between variables

Significant associations emerged between gender, the two options for marital status ( p  < 0.05), occupational status ( p  < 0.01) and information about the consultation ( p  < 0.05). Males were more frequently single and in work than females (Additional file 1 : Table S3).

Sources of requests for consultation correlated significantly reasons for requests ( p  < 0.01), the type of consultation ( p  < 0.01), interventions for diagnosis ( p  < 0.01), liason ( p  < 0.01) and discharge programme (<0.01).

Patients who had attempted or were at risk of suicide were more often admitted to surgical units which most frequently requested urgent consultations (Additional file 1 : Table S4).

The main ICD-10 psychiatric diagnoses (schizophrenia, affective or neurotic-stress-somatoform syndromes) were significantly associated with marital status ( p  < 0.01), socio-environmental status ( p  < 0.01), type of consultation ( p  < 0.01), patient information ( p  < 0.01) and reason for request ( p  < 0.01).

Post hoc analysis showed that patients with schizophrenia lived with their original families, were single, pensioners or invalids, assessed in urgent consultations, less informed than others and directed to the CSM when discharged, after having been put in contact with the CSM during the consultation (Additional file 1 : Table S5).

For patients with affective syndromes, suicide attempt or risk and depression were the reasons for requesting consultation. They were directed to their GP upon discharge from hospital (Additional file 1 : Table S5). Patients with neurotic-stress-somatoform syndromes had jobs and were assessed because of anxiety and unexplained medical symptoms. The main liason intervention was raising awareness among medical and nursing staff in the unit where they were being treated. Upon discharge they were directed to their GP or to the Psychiatry Unit Out-patient Service (Additional file 1 : Table S5).

The present study used a CLP service that was structured according to setting and codified assessment procedures [ 24 ]. As features satisfied some recommendations that have been reported in other papers the service may thus be considered valid for implementing compliance with CPL interventions and evaluating their effectiveness [ 19 ].

In particular referring to description of population and clinical variables the authors close:

• sending requests by intranet ensured the request is clearly stated, and facilitated identifying the most appropriate form of intervention and measurement tools [ 16 ];
• performing consultation within 24 h of request improved treatment compliance [ 19 ];
• adopting the “clinimetric” [ 25 ] rather than the “psychometric” approach led to detection of sub-clinical symptoms and of deficits in some functional areas that persisted after treatment [ 26 ];
• applying qualitative rather than quantitative parameters provided a more accurate definition of outcomes [ 27 ];
• writing down consultation findings encouraged communication within the multidisciplinary team [ 16 ];
• finally, as one feature of the CLP service was a link with the community health and social services, information could be provided about treatment plans after discharge from hospital [ 14 ].

Details of consultations: Consultations were requested for 1.8 % of all hospital admissions, which was in line with reports over the years of 1–2 % requests [ 28 ]. As observed elsewhere, most patients received only one consultation examination and required psychiatric treatment while in hospital [ 29 ].

Social backgrounds and demographic data from patients in the present study were also in line with other reports [ 30 ].

Adequate information was imparted to 80 % of patients during the consultation, which is a rise in the 66 % reported in an earlier Italian study by Gala [ 31 ]. The improvement may be due to World Health Organization (WHO) campaign which emphasizes that Mental Health is a crucial part of psycho-physical well-being [ 32 ]. The present study showed that schizophrenia was the only factor impacting upon lack of patient information, unlike a previous study of ours which had correlated male gender with poor patient information [ 33 ]. Provision of information to the patient with schizophrenia may be hampered not only by the patient’s psychopatology such as limited insight and sometimes bizarre behaviour studio [ 34 ], but also by the urgent status of consultation requests because of the patient’s agitation or distorted perception of, and contact with, reality [ 35 ]. The stigma arisen from referring area is to be confirmed.

The high prevalence of patients with affective and neurotic-stress somatoform syndromes in medical and specialist units focuses attention on physical/psychiatric multi-morbidity and the difficulties in medical and psychiatric managing patients with somatisation or with somatic expression of psychological pain [ 36 ]. In the surgical sector only about 20 % of requests were motivated by agitation due to physical distress [ 37 ], which illustrates the need for flexible, personalised interventions that not only satisfy the demands of patients and medical staff but which can also be adjusted to fit diverse clinical situations [ 38 ].

Findings in the present study show the usage rate of an in-depth diagnostic flow chart with psychometric and laboratory tests overlaps with Italian [ 31 ] and European [ 30 ] reports. Although more drugs were prescribed in interventions than is the trend in Europe, the drug prescription rate was still below what Gala reported in 1999. In any case drug treatment was the most common form of intervention [ 39 ], followed by staff support. In general, the most frequently prescribed drugs were anti-depressive agents and BDZ [ 31 ].

It is hard to compare the 38 % rate of expressive/supportive interventions which emerged in the present study with other reports because parameters vary greatly [ 40 ]. Even though reports demonstrate that in the hospital setting this form of intervention is more effective than interventions directed towards personal or family support or focal psycho- education or therapy, few data are available on the prevalence of expressive/supportive interventions probably because the use of such techniques in CLP has not been standardized. Hunter et al. [ 40 ] suggested developing a multi-focal setting to identify pre-morbidity and stressor factors that interfere with patient acceptance of illness and hospitalization and which are the focus of therapy.

Finally, a much lower rate of patient transfer to psychiatric units than reported elsewhere [ 41 ], and promotion of treatment plans after discharge from hospital provide evidence of the success the present approach, which aimed at reducing staff anxiety and promoting total care of the patient.

Hospitalization in itself is a stressful event which may disturb balance of mind in some cases and worsen the clinical condition of patients who are suffering from psychiatric co-morbities [ 42 ]. Without specialized training medical and nursing staff may not recognize psychological distress and consequently delay early intervention [ 43 ]. A CLP service is able to raise awareness among health service personnel and improve detection of psychological problems in patients, both of which have beneficial repercussions on the length of hospital stays and the well-being of patients. CLP, however, still needs to develop clinical and research standards that are in line with the trend towards Evidence Based Medicine. Innovative methodological tools are required to establish qualitative parameters [ 44 ].

A systemic schema of interventions will censure psychiatrists confront the full complexity of diagnosis and therapy, promote all round care of the individual patient and use liason interventions to foster multidisciplinary teamwork.

Authors’ contributions

DGG have made contribution to conception and design of the study, was involved in acquisition and interpretation of data, written the preliminary version of the manuscript and collaborate to the final draft. QR encouraged the study, provided to the supervision of the research group, revised the manuscript for intellectual content and gived the final approval to the version to be pubblished; ST: have made contribution to the conception and design of the study, and cooperated to write and to revise the manuscript; GM: have made contribution to acquisition the data; PA: have made contribution to acquisition the data; SL: have made contribution to conception and design, acquisition and interpretation of data; FS: have made contribution to conception and design; FL: have made contribution to acquisition the data; MP was involved to revised the manuscript. PM: have made contribution to conception and design, analyzed the data and cooperated to revised the manuscript. All authors read and approved the final manuscript.

Acknowledgements

We thank Geraldine Boyd who provided medical English translation on benhalf “Centro Linguistico d’ Ateneo”-University Language Center-Perugia University, funding by Division of Psyvhiatry-University of Perugia.

Compliance with ethical guidelines

Competing interests The authors declare that they have no competing interests.

Ethical approval This study was aproved from Comitato Etico Aziende Sanitarie dell’ Umbria–Umbria Health Service Ethic Committee with license number 2176/13.

Additional file

Additional file 1. Data analysis of clinical investigation. (246K, pdf)

1 MEDICAL SECTOR: internal medicine and endocrine science; occupational medicine; internal medicine, angiology and atherosclerosis; internal medicine and oncologic ward; internal and vascular medicine ward. SURGICAL SECTOR: intensive care; heart surgery; general surgery; thoracic surgery; vascular surgery; orthopedics; neurosurgery. SPECIALISTIC SECTOR: cardiology; dermatology; hematology; gastroenterology; geriatric ward; infectious medicine; nephrology; ophthalmology; oncologic ward; otorhinolaryngology; obstetrics and gynecology; neurology; lung ward; urology; spinal unit.

Contributor Information

Giuseppina De Giorgio, Email: [email protected] .

Roberto Quartesan, Email: [email protected] .

Tiziana Sciarma, Email: ti.gpinu@amraics .

Martina Giulietti, Email: [email protected] .

Angela Piazzoli, Email: ti.oohay@28ilozzaipalegna .

Laura Scarponi, Email: ti.uki@arual .

Silvia Ferrari, Email: [email protected] .

Laura Ferranti, Email: [email protected] .

Patrizia Moretti, Email: [email protected] .

Massimiliano Piselli, Email: ti.tenilacsit@mosip .

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The role of a psychiatric consultation liaison nurse in a general hospital: a case study approach

The Australian journal of advanced nursing: a quarterly publication of the Royal Australian Nursing Federation

Growing support for the role of the psychiatric consultation-liaison nurse in assisting general nurses in caring for patients experiencing mental health problems in the general hospital environment is evident from the relevant literature. However, there remains a paucity of research which examines the process of this nursing role or its impact on outcomes for nurses and patients. This paper seeks to contribute to the literature in articulating the role of the psychiatric consultation-liaison nurse using a case study approach to describe the role of the nurse in assessing the needs of, and, planning and providing care to two general hospital patients experiencing mental health problems, and the general nurses caring for them.

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This article reviews some of the recent data concerning Consultation-Liaison Psychiatry in a general hospital. As the organic medical conditions have a major impact on the one&#39;s quality of life and self-awareness as an ill-person, very often a psychiatric disorder appears as co-morbidity. It is the responsibility of the psychiatrist to recognize and to treat these psychiatric conditions, and also to develop good work-relationships with the patients and the clinical team.

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Background To describe the clinical activity patterns and nature of interventions of hospital-based liaison psychiatry services in England. Methods Multi-site, cross-sectional survey. 18 acute hospitals across England with a liaison psychiatry service. All liaison staff members, at each hospital site, recorded data on each patient they had face to face contact with, over a 7 day period. Data included location of referral, source of referral, main clinical problem, type of liaison intervention employed, staff professional group and grade, referral onto other services, and standard assessment measures. Results A total of 1475 face to face contacts from 18 hospitals were included in the analysis, of which approximately half were follow-up reviews. There was considerable variation across sites, related to the volume of Emergency Department (ED) attendances, number of hospital admissions, and work hours of the team but not to the size of the hospital (number of beds). The most common cli...

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BMC research notes

Massimiliano Piselli

To investigate significant association between various clinical and extra-clinical factors brought out the activities of Consultation-Liaison Service. Data from all psychiatric consultations for patients admitted to the Perugia General Hospital and carried out over a 1-year period (from July the 1st 2009 to June the 30th 2010) were collected by a structured clinical report including: socio-demographic features, features of referrals, features of back-referrals. T-test, Mann-Whitney U-test, χ(2)-test and Fischer&#39;s were statistically used. 1098 consultations were performed. The consultations carried out the Emergency Unit were excluded from the study. The type and the reasons for the referrals were discussed such as the ICD-10 diagnosis and the liaison interventions too. Significant associations emerged between gender and: social status and occupation (p &lt; 0.05 and p &lt; 0.01 respectively). Clinical sector related with reason for referral (p &lt; 0.01), type of consultation (p...

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Since 2002, all health establishments in South Africa including district hospitals are compelled by the Mental Health Care Act No. 17 of 2002 to admit acute psychiatric patients for 72 hours without consent for assessment and observation. The admission of psychiatric patients and those with medical conditions in the same units came with new challenges for the healthcare team. With the shortage of psychiatric trained nurses in most settings, non-psychiatric nurses are expected to work with psychiatric patients. The purpose of the study was to explore and describe the concerns of non-trained psychiatric nurses who work with acute psychiatric patients. Indepth interviews with 15 general nurses were carried out between January and March 2013 in a Government Hospital in South Africa. Data collection and analysis were carried out simultaneously and a modified Tesch method of data analysis was used. Two themes emerged from the analysis ( safety related concerns and psychiatric nursing rela...

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Hospitals and emergency departments (EDs) are caring for increasing numbers of patients who present with underlying mental health issues. Managing these patients can be challenging for clinical staff who often lack the specialist knowledge and skills required to provide appropriate care. This article, part two of two on the evaluation of a newly formed mental health liaison team (MHLT) working in a general hospital, focuses on the perceptions and experiences of the MHLT participants, and explores three sub-themes derived from the interview data. The article considers the effect of these themes on practice, and the relationship between MHLT members and staff in EDs and the wider hospital.

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The role of a psychiatric consultation liaison nurse in a general hospital: a case study approach

Affiliation.

• 1 The Centre for Psychiatric Nursing Research and Practice, The University of Melbourne, Australia.
• PMID: 12405282

Growing support for the role of the psychiatric consultation-liaison nurse in assisting general nurses in caring for patients experiencing mental health problems in the general hospital environment is evident from the relevant literature. However, there remains a paucity of research which examines the process of this nursing role or its impact on outcomes for nurses and patients. This paper seeks to contribute to the literature in articulating the role of the psychiatric consultation-liaison nurse using a case study approach to describe the role of the nurse in assessing the needs of, and, planning and providing care to two general hospital patients experiencing mental health problems, and the general nurses caring for them.

Publication types

• Case Reports
• Multicenter Study
• Consultants*
• Hospitals, General*
• Mental Disorders / nursing*
• Nurse's Role
• Psychiatric Nursing / organization & administration*

Pediatric Consultation-Liaison: Models and Roles in Pediatric Psychology

• First Online: 21 March 2020

Cite this chapter

• Bryan D. Carter 5 , 6 ,
• Kevin K. Tsang 7 ,
• Christine E. Brady 5 , 6 &
• Kristin A. Kullgren 8  

Part of the book series: Issues in Clinical Child Psychology ((ICCP))

1751 Accesses

4 Citations

Ever since the establishment of the subspecialty of pediatric psychology, psychologists have been called upon to provide consultation to their pediatrician colleagues in ever-expanding roles and in a variety of medical settings. In response, a number of models have been created to address how psychologists fit into the overall health-care system in order to address those psychosocial factors that can have a major impact on prevention/early intervention in pediatric illness and injury and overall adjustment and quality of life. This chapter addresses both theoretical and pragmatic issues in establishing and maintaining a viable consultation-liaison service while avoiding personal and professional burnout.

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Pediatric Consultation-Liaison Service, Norton Children’s Hospital, Louisville, KY, USA

Bryan D. Carter & Christine E. Brady

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Carter, B.D., Tsang, K.K., Brady, C.E., Kullgren, K.A. (2020). Pediatric Consultation-Liaison: Models and Roles in Pediatric Psychology. In: Carter, B.D., Kullgren, K.A. (eds) Clinical Handbook of Psychological Consultation in Pediatric Medical Settings. Issues in Clinical Child Psychology. Springer, Cham. https://doi.org/10.1007/978-3-030-35598-2_2

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ORIGINAL RESEARCH article

This article is part of the research topic.

Women in Urban Ecology 2022/2023

Urban trees as a lever for citizen engagement into public consultation processes: the case of Paris, France Provisionally Accepted

• 1 UMR5600 Environnement, Ville, Societe (EVS), France
• 2 UMR7178 Institut pluridisciplinaire Hubert Curien (IPHC), France

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In the present context of increasing human population demography, worldwide social crises and rapid ecological global change, large cities are facing major socio-environmental challenges. This convokes authorities to adapt their governance and urban planning for reconciliating urban development, ecological systems and city dwellers in the most sustainable way. To achieve such goals, local officials have to associate all local actors, including city-dwellers, to the decision-making process through participatory governance and/or participatory systems. Here we elaborated an original pilot project governance system for a "Participatory System Combining Town Planning and Science" (the 2PS-CiTy), as part of the revision of the Local Urban Plan (LUP) of Paris, France, into a Bioclimatic LUP held from 2020 to 2024. By implementing 2PS-CiTy, we aimed at answering "How to turn trees into a lever for inhabitants' engagement in urban consultation systems?". Trees were chosen because they are emblematic elements of nature with significant roles in ecosystemic services such as urban climate regulation. Parisians were invited to i) share in a first questionnaire some information on their knowledge about the LUP and their engagement in it, ii) identify urban trees they consider remarkable, iii) explain their choice in a second questionnaire, iv) contribute to the urban consultation as part of the LUP revision and finally v) give their feedback during a dedicated survey. Out of the 41 Parisians who took part to 2PS-City, 83% declared they were motivated to participate because they could contribute to tree census that in turns can constructively contribute to the Parisian LUP revision for the sake of bringing more nature and sustainability in town. This study demonstrates that trees can be used as a lever for inhabitants' engagement in urban consultation systems aiming at making cities more sustainable. Our survey also showed that the 2PS-CiTy governance system could be improved by 1) developing a participatory culture among decision-makers and 2) preventing nowadays silo governance for developing most promising public governance systems that involve the departments of green space, urban planning, and local democracy.

Keywords: Trees, Participatory democracy, governance, Ecological urbanism, Urban political ecology

Received: 28 Nov 2023; Accepted: 16 May 2024.

Copyright: © 2024 Dakouré and Georges. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Ms. Amélie Dakouré, UMR5600 Environnement, Ville, Societe (EVS), Lyon, France Dr. Jean-Yves Georges, UMR7178 Institut pluridisciplinaire Hubert Curien (IPHC), Strasbourg, 67037, Alsace, France

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