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Working as a Psychiatrist within the NHS

  • January 13, 2021

This Blog briefly explores Psychiatry within the NHS, outlining the different specializations and their accompanying responsibilities, alongside the associated higher training specialty interests.

As an international recruitment agency, BDI Resourcing recommend that any Psychiatrist wanting to work within the UK and practice within the NHS, takes the MRCPsych examination suite.
 

Can I specialise?

During Core Training within the UK, a Doctor will complete placements in a number of sub-specialties including at least 12 months in General Adult, before going on two train in one or two of the below specialties.

Child and Adolescent

Child and adolescent psychiatrists work with children and young people who have mental health problems.

Doctors working in Child and Adolescent Psychiatry within the NHS deal with a wide range of mental health problems, including emotional and psychiatric problems. Much of the work is to identify the problem for the young people and advise on what may help.

When working within this specialism your work may be carried out with other professionals or carers of young people, rather than directly with the young person themselves.  For example, child and adolescent psychiatrists within the NHS may work with teachers, foster carers, paediatricians, siblings or others involved with a young person in difficulty.

The majority of your work will take place in local community settings, such as clinics, schools and people’s homes.  Other settings include inpatient units, with specialist community teams or within acute hospitals.
 

General Adult

General adult psychiatrists normally treat people who are “working age”, with a wide range of disorders, including manifestations of “organic” brain disorders, psychoses, depressive illness and personality disorders. They work closely with other agencies within mental health. The psychiatrist works as an integral part of the team.

Work in general adult psychiatry allows you to maintain a varied practice, but there are also many opportunities to subspecialise. As such, you could work in a variety of settings and with a huge range of colleagues.

Knowledge of psychiatric disorders is developing, as are treatments. General Psychiatry is, therefore, a rapidly changing area of psychiatry and one that will allow significant personal development for those within it. The working hours in general psychiatry often follow a regular Monday-Friday daytime pattern. On call work, especially at associate specialist or consultant level is generally less onerous than other medical and surgical specialties.

There are three recognised sub specialties within general adult psychiatry:
1) liaison psychiatry
2) rehabilitation psychiatry
3) substance misuse psychiatry
 

Old Age

Mental illness in older people is increasingly recognised as a major public health issue. Increased life expectancy within the UK has resulted in a growing demand for dedicated old age psychiatry services within the NHS. Dementia care and memory problems are a significant aspect of the work. Depression and other mental health problems common across the spectrum of psychiatric illness including delirium, schizophrenia and personality disorder are also treated. About 50% of the work is non-dementia.

The complexity of interaction between physical, psychiatric and social problems experienced in old age requires close collaboration with a broad range of professionals. There is certainly no typical working day in old age psychiatry.  The work also varies nationally according to the local NHS trust service model.

Old age psychiatrists working in a community mental health team often visit patients either in their own homes or residential nursing homes. They may also undertake outpatients’ clinics. Consultants based in hospitals will attend regular ward rounds and may also have outpatient clinics.
 

Psychotherapy

Medical psychotherapy involves sitting in a room with a person or people in mental pain and psychological confusion, conflict and distress and trying to make sense of what is going on.

Medical Psychotherapy is unique among the specialties in psychiatry in the sense that it’s not about the type of patient or their particular condition. Within the NHS, medical psychotherapists contribute a psychological and relationship-oriented understanding to other aspects of psychiatric practice, such as the impact of mental illness on patients’ lives and the role of carers and relatives in promoting health and compliance with medication.
 

Forensic

Forensic psychiatrists within the UK work at the interface between the law and psychiatry, managing patients with mental disorders who have been or have the potential to be, violent.

Forensic psychiatry is a fascinating and diverse career. You will mainly be treating offenders who have committed crimes when mentally ill or who become unwell in prison. You could also sub-specialise in areas such as forensic learning disability and forensic psychotherapy. With this in mind, you will be expected to work in a range of settings such as high, medium and low secure hospital services, in prisons and community settings. Most forensic mental health services operate from well-equipped, purpose-built modern facilities, but work often involves travelling considerable distances for prison assessments.
 

Intellectual Disability

Also known as learning disability psychiatry, the psychiatry of intellectual disabilities within the NHS involves working with people with learning disabilities, who are much more likely than the general population to experience mental health conditions.

Psychiatrists within the NHS will treat severe mental illness as well as a range of other mental health conditions such as autistic spectrum disorders and anxiety disorders. The clinical work is often made more complex and interesting by associated physical problems such as epilepsy and cerebral palsy, along with sensory and communication problems and challenges in accessing services.

In this field, you are very likely to be working in a community setting such as a clinic or even someone’s home. The number of patients seen per day can vary according to the post. NHS appointments will be longer than those in mainstream psychiatry, to allow sufficient time to communicate effectively with the patients and their carers.
 

Specialty Interests

In higher training within the NHS, you’ll have the opportunity to develop a special interest, or even an endorsement, in other specialty areas. Such Interests include, but are not limited to, the following.

Academic Psychiatry

Academic psychiatrists can be from any of the above psychiatric specialties and they split their time between clinical work, research and teaching. The content and split of jobs vary depending on your location and speciality. You might be teaching undergraduates or post-graduates and, as with all roles in Psychiatry, there will be opportunities to take on additional roles. There are many very areas you could research within Psychiatry and your research can reflect your own interests.

Eating Disorders

Eating disorders psychiatrists need to safely assess and manage medical risk and so need skills in physical medicine as well as an ability to work with different psychological models and therapies (individual and family). It’s a hugely varied and impactful career. You’ll work with acute medical & psychiatric emergencies but also with people with long-term impairments and disabilities to keep them safe, prevent decline and support their quality of life.

Neuropsychiatry

Neuropsychiatrists work with patients with mental disorders which in most cases originate from a brain malfunction. More than most other types of psychiatry, you’ll spend a lot of time looking at images of the brain and interpreting effects of conditions and treatments. As a Neuropsychiatrist, you are likely to work in a multi-disciplinary setting alongside other Neuroscience clinicians, for example in a general hospital.

Rehabilitation and Social Psychiatry

Rehabilitation psychiatry focuses on the needs of people with longer term and complex mental health problems. This field involves work with people’s families and social circles to promote integration or reintegration into the local community. Individuals’ values and beliefs must be respected and integrated into treatment plans.

Addictions

As an addictions psychiatrist, you need a good knowledge of physical health issues along with both psychological and physical treatment approaches. You’re also likely to work with courts, probation services and social and children’s services. The patient may also have a range of physical illnesses caused by their addictions. In short: addiction psychiatry includes a bit of general medicine, quite a bit of general psychiatry, and a lot of psychology.

Liaison Psychiatry

Liaison psychiatrists work at the interface between physical and psychological health. Providing specialist mental health assessment and treatment for patients attending general hospitals, Liaison Psychiatrists deal with a range of problems including self-harm, adjustment to illness and physical and psychological co-morbidities. Liaison Psychiatrists educate general hospital colleagues to improve their knowledge, skills and confidence in the basics of management of common mental health problems that they encounter in their practice.

Perinatal Psychiatry

Perinatal psychiatrists treat people at an extremely sensitive period in their lives, around pregnancy and after childbirth. Perinatal services vary across the country but tend to comprise both Mother and Baby Units and specialist community mental health team. Perinatal psychiatrists work in a multidisciplinary team and also closely with health visitors, midwives, general practitioners and obstetricians.

References:

RC PSYCH ROYAL COLLEGE OF PSYCHIATRISTS. 2021. Intellectual Disability. [online] Available at: [Accessed 11 January 2021].

Health Careers. 2021. Child And Adolescent Psychiatry. [online] Available at: [Accessed 11 January 2021].

 
 

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