The Role Of A Psychiatrist
A psychiatrists job is to diagnose and treat mental health conditions in persons of all ages. Psychiatry is a branch of medicine that comprises six specialties – child and adolescent psychiatry, forensic psychiatry, general adult psychiatry, medical psychotherapy, old age psychiatry and psychiatry of learning disability. Psychiatry is the fifth largest medical specialty in the UK.1
It combines scientific knowledge, medical expertise and personal skills, for example, communication, problem-solving and situational awareness, to establish therapeutic partnerships that facilitate psychiatric care using pharmacological, psychological and social interventions. It is possible to unite a career with other interests including medicolegal work, teaching and research.2
Much is still unknown about the brain and, consequently, this is a rapidly developing field with significant potential to conduct innovative research and develop novel treatments. In 2017, 51% of psychiatrists were women.1
Child and adolescent psychiatrists engage in the management of mental health disorders in people up to 18 years of age. They operate in conjunction with multidisciplinary and multiagency teams comprising, for example, mental health nurses, educational psychologists and teachers. Primarily, care is delivered in outpatient clinics and the community by use of psychotherapeutic and pharmacological modalities. Examples of daily activities are running cognitive behavioural therapy, meeting school staff about children in difficulty and conducting medication reviews. They manage between four and ten cases each day.3
Forensic psychiatrists work with individuals regarding whom there is a concern of violent behaviour, for example prisoners or people who have committed crimes because of mental illness. The aim is to minimise risk of harm to patients and the public and is achieved in conjunction with multidisciplinary teams that include mental health nurses, psychologists and lawyers.
The work is conducted in prisons, secure hospitals and the community. Forensic psychiatrists advise colleagues on the care of patients that pose a risk of violent behaviours, including about risk management, modes of pharmacological and psychological treatment and psychotherapeutic strategy.
Additionally, they provide expert witness to courts, for example, assessing defendants’ fitness to stand trial and capacity to form intent and advising on relevant psychiatric defences.4
General adult psychiatrists diagnose and treat mental health conditions in adults. The specialty benefits from extended appointment lengths. General adult psychiatrists devise and implement management strategies which make use of pharmacological and psychological treatments. Additionally, they make interventions which consider individuals in social contexts.1
Typically, care is delivered in the community alongside a team that includes general practitioners, psychologists and mental health nurses.
Medical psychotherapists treat patients of all ages using psychotherapies, for example, psychoanalytical psychotherapy, cognitive behavioural therapy and trauma focused therapy. They assess complex cases and devise treatment plans.
Longer appointment lengths and extended treatment durations allow medical psychotherapists to have prolonged involvement in patient care. They work in multidisciplinary teams in outpatient clinics or the community. Examples of activities performed in a typical week include providing individual and group psychotherapies, giving consultations to colleagues and teaching.5
Old age psychiatrists traditionally cared for persons above 65 years of age. Increasingly, the specialty is redefined to include individuals with cognitive disorders who have physical and mental comorbidities. Old age psychiatry is a growing specialty in accordance with increasing life expectancy. Dementia constitutes a significant number of cases but is balanced in equal proportions with other mental illnesses, for example, schizophrenia and personality disorders.6
Old age psychiatrists employ a holistic and socially contextualised approach to promote independence in the elderly. Generally, they operate in multidisciplinary teams in the community and patients’ residences.
Psychiatry of learning disability is engaged in the treatment of mental health conditions in people with intellectual disabilities. A holistic and multidisciplinary approach is applied using pharmacological, psychological, social and educational interventions. Typically, care is delivered in the community.2
A Typical Week
On average, psychiatrists work eight hours per day and no more than 48 hours per week, according to ‘Working Time Regulations 1998’. In a standard week, around ten hours are devoted to non-clinical activities, for example, clinical governance, teaching and training.
Typically, psychiatry offers regular and flexible working hours with significantly reduced frequency of on-call work relative to other medical specialties. For example, an on-call rota of 1 in 10 may be followed and on-call work is often conducted remotely. Many psychiatrists work part-time.
The Route To Psychiatry
The route to psychiatry commences with successful completion of a medical degree (MBChB) and two years of foundation training which typically comprises six rotations across diverse specialties and healthcare settings. Subsequently, Core Psychiatry Training is attained.2 This is a three-year programme.
Application to this is through a form examining entry requirements, for example, core competence, clinical reference, and details of achievement in various areas – and an interview. In 2016, the competition ratio for Core Psychiatry Training was 1.50.1 During Core Psychiatry Training, trainees work in various specialties within psychiatry. Prior to progression to advanced training, the Membership of the Royal College of Psychiatrists (MRCPsych) examination is undertaken which comprises two MCQ papers and a Clinical Assessment of Skills and Competencies.
Advanced training in one of the six psychiatric specialties is typically completed in three years. In 2019, the competition ratios were 0.96, 1.13, 0.99, 2.67, 1.09 and 0.45 for child and adolescent psychiatry, forensic psychiatry, general psychiatry, medical psychotherapy, old age psychiatry and psychiatry of learning disability respectively.7 For child and adolescent psychiatry, it is possible to apply for run through training which commences immediately after foundation training.2 The competition ratio for this was 8.57 in 2019.7 Dual training in specific combinations of the psychiatric specialties may be completed. This is achieved in four or five years.
Finally, trainees are awarded a certificate of completion of training (CCT) by the General Medical Council and can apply for consultant posts. Dual training results in the attainment of two CCTs.
The South London and Maudsley NHS Foundation Trust is a notable institution in psychiatric care and research, providing the broadest array of mental health services in the UK.
Medical students interested to pursue a career in psychiatry can join the Royal College of Psychiatrists (RCPsych) as Student Associates. Associates benefit from invitations to events for medical students, discounted tickets for the college’s annual international conference and access to online learning and journal subscriptions. RCPsych also offers an array of awards, prizes and bursaries with similar benefits.
Additionally, careful observation and enquiries on clinical placements, attendance at conferences and selection of relevant topics for student selected components is favourable.
Foundation trainees should attempt to secure full placements in psychiatry. RCPsych, in conjunction with the UK Foundation Programme Office, appoints Psychiatry Foundation Fellowships (PFF) that function concomitantly with foundation training to enhance exposure to psychiatry. Fellows are provided regular access to psychiatric supervision and Balint groups. Additionally, the RCPsych facilitates educational opportunities, for example, attendance at the college’s annual international congress and access to online learning and journal subscriptions.8
These opportunities can also be availed by joining the college as Foundation Doctor Associates. It is useful to obtain research and management experiences.
Research and management experiences are also advised for core and specialty trainees. Core and specialty trainees can join the RCPsych as Pre-Membership Psychiatry Trainees.
There are three established subspecialties of general psychiatry. These are liaison psychiatry, addictions psychiatry and rehabilitation psychiatry. Liaison psychiatrists form the interface between physical and psychological health and care for medical patients with psychiatric disorders who have presented to general hospitals. They work in emergency departments, hospital wards and outpatient clinics.
Addictions psychiatrists treat persons with substance misuse disorders using physical and psychological interventions.
Lastly, rehabilitation psychiatry addresses quality of life improvement and social integration of people with prolonged and complex mental illnesses.2
Other emerging subspecialties include eating disorders psychiatry and perinatal psychiatry. Additionally, psychiatrists from all specialties have the option to enter academic psychiatry and assume increased teaching and research roles. Research can be conducted on biological, social or psychological disciplines relevant to psychiatry, in accordance with personal interests.
NHS consultant salaries are the same for all specialties but vary between Scotland (highest), England, Northern Ireland, and Wales (lowest) and increase with service (up to 19 years). In 2020 the salary bands range from £77,779 to £109,849.9 Salaries can be further enhanced with NHS excellence awards.
Many psychiatrists conduct private work alongside NHS jobs. There is major earnings potential in private practice; earnings may match or exceed the NHS salary.
The recommended starting salary of accredited consultants in the British Army is similar to that in the NHS. In 2017, this was £80,527.9
For more information on salaries within the NHS, please feel free to review The Complete Guide to NHS Pay.
The primary body operating to support psychiatrists in the UK is the RCPsych. It comprises faculties corresponding to each of the psychiatric specialties and subspecialties. Annual conferences are organised by each of the faculties in addition to the RCPsych’s international congress.
Globally, the World Psychiatric Association (WPA) is an alliance of psychiatric societies from 120 countries that promotes shared working through numerous scientific sections, education programmes, publications and events. The WPA also hosts the World Congress of Psychiatry.
The RCPsych publishes the British Journal of Psychiatry – an international peer-reviewed journal. Other notable journals in the field are World Psychiatry, Lancet Psychiatry and JAMA Psychiatry.
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3. Child and adolescent psychiatry [Internet]. Health Careers. [cited 12 May 2020].
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2020 [cited 12 May 2020]. Available from: https://www.rcpsych.ac.uk/become- a-psychiatrist/med-students/awards-prizes-and-bursaries/foundation- fellowships
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