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Aim To study the profile of psychiatric disorders in medical-surgical inpatients so that subpopulations with particular mental health care needs could be identified. Findings: a retrospective analysis of 1245 referrals seen over seven years showed that psychiatric profiles in referrals from different sub-populations divided according to age, gender, source of referral and medical-surgical diagnosis, were quite dissimilar. It was felt that non-recognition of specific needs of these client groups had led to low referral rates (0.65%), and to referral practices wherein the needs of the consultee (referral for disturbed behaviour) and the consultant (management by pharmacologic agents) and certain social biases (low referrals for suicide attempts) had taken precedence over the requirements of optimal management of the cases. Implications : Financial and manpower constraints limit the advocacy for a superspecialist orientation, as a policy in India. It is recommended that while continuing with the provision of general consultation services, psychiatrists should acquire expertise in areas of C-L work, which fit in with their area of interest in general psychiatry.