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The Royal College of Psychiatrists Improving the lives of people with mental illness

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28/02/2014 15:14:10

Fantastic first year


Opened my eyes

Liana Romaniuk: Pathfinder Fellowships

The first year of the Pathfinder Fellowship has been fantastic: I’ve had many opportunities to increase my exposure to psychiatry and neuroscience, and pursue my own interests to greater depths.

The opening symposium of the Anne Rowling Regenerative Neurology Clinic opened my eyes to new ways of understanding and treating brain disorders.

The College’s own International Congress gave me a solid appreciation for psychiatry’s inspirational quality. While good progress is being made, there’s still so much more to be done, clinically and academically.


Superb elective

The fellowship also made it possible for me to go on a superb elective.

Here the stories people tell are startling; a window into the lives of others that were completely removed from my own experience.

I spent the first four weeks at Scotland’s maximum security psychiatric facility, The State Hospital, Carstairs. Here the stories people tell are startling; a window into the lives of others that were completely removed from my own experience. 

There was a strong sense of partnership between the medical and psychological approaches: one addressing the neurobiological basis of the illness through tailored medication, the other taking this improved neural foundation and building better awareness and coping strategies. Equally, social work tried to make sure the patient has a chance to put things into practice by securing a decent environment with some hope.

The second four weeks were spend conducting research at the Translational Neuromodeling Unit in Zürich, which was a wonderful experience, taught me a great deal, and will hopefully lead to a publication.

Finally, I attended the Oxford Psychiatry Autumn School, which gave me a chance to explore a deanery I’d be interested in applying to for my foundation training.


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16/01/2014 14:54:21

Applying for a Pathfinders Fellowship with a research project


Sleeping on the job

Alex Berry on applying for Pathfinders fellowships

I’m currently a final year student at Brighton and Sussex Medical School (BSMS), and have been interested in psychiatry since my second year of medical school. I have been involved with the medical student psychiatry society at BSMS, undertaken an intercalated BSc in neuroscience, and I spent my elective attached to psychiatry and neurology teams in India.


I’m interested in biological psychiatry and sleep medicine, and am currently trying to explore these areas further.


Don’t be afraid to admit possible shortcomings in your project design.

When I applied for the Pathfinder Fellowship, part of my application involved including a proposal for a research project I was hoping to undertake, which looked at poor sleep as a predictor for depressive disorder in patients receiving interferon-α-based treatment for chronic hepatitis C infection.


I used the funds from my Pathfinder Fellowship to present these results on a poster last summer.



Advice on applying

For anyone considering applying for a Pathfinder Fellowship with a research project, my advice would be:


  • Ensure you’re able to explain what you intend to do in your project clearly and concisely. I would recommend practising this, as whilst some concepts may be clear in your head, explaining them clearly to others is a skill.


  • Make sure that you have a clear idea about what it is you are investigating. This sounds obvious, but for some projects (particularly those involving lots of data) it can become confusing. If your project requires you to make a hypothesis about something, be clear on what your hypothesis is, and why you’ve decided on that particular hypothesis.


  • Be prepared to justify why you’ve decided to research the particular area that you’ve chosen.


  • Don’t be afraid to admit possible shortcomings in your project design.


  • Importantly, think about what you would use the Pathfinder funds for specifically.


  • Finally, remember that the Pathfinder Fellowship is meant to fund you, rather than just your project/elective, and try and enjoy the interview!   


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12/11/2013 10:59:19

So What Do You Want To Be?


Innocent question

So What Do You Want To Be?

‘So what kind of doctor do you want to be?’


It’s an innocent enough question and, after six years at medical school, one I have grown very familiar with. It can be applied to conversation with a medical student in any kind of social situation: friends and family over rarefied Christmas get-togethers; friends at university when the well of discussion pieces dries up; doctors of every speciality, peering at you with the ill-concealed desire that you want to follow their illustrious footsteps into their chosen speciality.


I have always disliked the inquiry because I have never had a good answer.


For the first five years or so, I would mumble that I didn’t really know, that I enjoyed every field of medicine I had tried so far, that I hadn’t had enough experience to make a decision yet.


But with the spectre of FPAS looming and the prospect of being a doctor becoming frighteningly real, this cop-out of an answer increasingly fails to impress. When I was younger, it showed openness and eagerness. Now it shows a lack of direction, and people follow my reply by listing the specialities, trying to find one that fits on the spot.


Thankfully, I was blessed with a very informative fifth year. Having had a series of attachments on a diverse range of specialities, for the first time, I can actually refine my tastes. I know that in specialities like obstetrics or orthopaedics, I would fit in as well as a mosquito at a malaria clinic. Conversely, I can see myself working in, and importantly, enjoying myself in other specialities.



Thought you wanted to be a real doctor

So now when I am asked what I want to be when I grow up, I can confidently claim that I like the cut of paediatrics’ jib. It appeals to the generalist in me and I enjoy working with children. When I explain this to people, they all nod and smile approvingly. Everybody likes a paediatrician. By whatever metric they use to judge me, taking care of sick children is a ‘good’ job. 


...every presentation of issues of mental health is as unique as the patients they affect. I like that...


However, I still dislike being asked the question because, even though my answer is honest, I feel like a fraud.


I do really like paediatrics but it comes second in my affection after psychiatry. While I find paediatrics interesting, I find psychiatry fascinating. Tenderness in the right iliac fossa can only prove novel so many times but every presentation of issues of mental health is as unique as the patients they affect. I like that, if I am able to help someone, my impact on them could be equivalent to treating meningitis. Psychiatry also offers a generalist approach in its holism.


But when I try and explain this to people, they nod curtly and the conversation wilts. Or they look at me askew and ask, ‘don’t you like medicine any more?’ or ‘I thought you wanted to be a real doctor?’


Trying to reach someone with suicidally deep depression or attempting to help a person with schizophrenia live a stable life is, to most people, a waste of my talents. Psychiatry is a bad job.



Myths and assumptions

Why is this speciality, under-appreciated and under-subscribed, so maligned? Is it because psychiatrists are considered by some to be agents of social control, policing the norms and enforcing rightspeak? Is it because they dole out powerful psychotropic medication (which is, at the same time, equally criticised, equally unjustly, as being no better than placebo) like candy for what is just a case of feeling a bit sad or a rowdy child with bad parenting?



We need to end the medical school cliché that psychiatry is a career for the crazy, eccentric and weird.


The Time to Change campaign aims to end the stigmatisation of issues of mental health, something I am so very keen on. Having witnessed the reality of mental health issues, both professionally and privately, the myths and assumptions I see stagger me. On the eve of my psychiatry attachment, my mum asked me if I was worried about catching schizophrenia from the patients. Yes, she thought it was contagious.


I think we need a parallel campaign to de-stigmatise psychiatry. We need to end the misinformation and hearsay that the likes of Giles Fraser and Ruby Wax replicate in the Guardian and on BBC Radio 4. We need to end the medical school cliché that psychiatry is a career for the crazy, eccentric and weird. We need to change things so that when asked what they want to do, a medical student can proudly reply, ‘Psychiatry.’


With the response, ‘Cool. Good for you.’



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14/10/2013 12:14:48

An elective in psychiatric research


Zurich study

An elective in psychiatric research

As I write, I’m just coming to the end of a seven-week elective spent in Zurich working with Professor Jules Angst. 


Professor Angst is an enormous figure in epidemiological and clinical psychiatry and has hundreds of prestigious publications, so it’s been very exciting to learn from him.


One particular contribution he has made to the field has been the celebrated Zurich Study. Whereas most prospective enquiries seem to last for about five years (or less) before funding dries up or people feel a point is proved and move onto something else, the Zurich Study has followed subjects up for three decades now – with fascinating results. 


When I came, I had the impression that the data collected were largely psychometric with a few demographic details, but in fact the scope is much larger than that, covering somatic symptoms, personality, family characteristics and coping resources, as well as diagnostic information. Numerous analyses have then arisen from these data, tackling questions as diverse as conversion from unipolar to bipolar depression and whether smoking is associated with mental illness.



Building a strong case

Most of the work I’ve been doing has focused on quality of life, an increasingly important metric in medical research. We were interested in how aspects of demographics, personality and somatic symptoms are associated quality of life. In particular, are the relationships any different in a group with high psychopathology compared to a more representative sample? 



The first lesson I’ve learnt from my stay here has been not to make your research or clinical interests too narrow, especially when you’re starting out...


I’ve also had the chance to get involved with some work on suicidality and learn a bit about postpartum psychiatric disorders, so it’s been quite varied.



Enjoy the process

The first lesson I’ve learnt from my stay here has been not to make your research or clinical interests too narrow, especially when you’re starting out: you don’t know how the scientific landscape is going to change, so don’t put all your eggs in one basket. 



Finally, it’s been really instructive to see someone who is still humble in accepting other people’s ideas, despite his own vast experience.


Also, when looking at research findings, don’t just focus narrowly on p-values: examine effect sizes and evaluate whether there is anything interesting happening. 


Finally, it’s been really instructive to see someone who is still humble in accepting other people’s ideas, despite his own vast experience.


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19/08/2013 11:19:15

Process of Applying


The application - drawing on experience

New online resource to help people return to work after mental illness

When I was emailed the advert about the Pathfinder Fellowship from our undergraduate psychiatry course administrator I decided to apply for it although I did not think I would stand a chance of getting it. 


The elective bursary was an attraction but I had already set plans I was excited about which were located in the UK and so money was not my biggest concern. I was more interested in the mentorship scheme on offer and that the fellowship sounded like it would be brilliant in helping me achieve my goal of specialising in psychiatry. 


Although I had only recently decided that psychiatry was the career for me, I felt I had some experience I could draw upon to put into my CV. I felt one of the biggest strengths I could offer was that I had taken a year out doing a BMedSci degree which I had chosen to do in the field of psychiatry, specifically looking at auditory hallucinations in the healthy population. From this I was also able to attend the international congress in Liverpool to present a poster on my study which had stimulated my interest in psychiatry further.



Good links with the psychiatry clinical lead

My advice when writing your CV for the application would be to just consider any experience you have had that has been related to psychiatry. Hopefully you would have done your psychiatry rotation by the time you apply so at the very least you have some experience to dwell upon there. 


I would also suggest that your elective plans should be psychiatry related, but then if you want to become a pathfinder I would expect that that is what you would choose to do anyway. If you have time it may be also worth contacting the psychiatry lead at your university and asking for any additional experience or if there is any research they are doing you could get involved in.  Even if these are for future plans by the time you apply, it will all look good and show your interest in psychiatry and your willingness to go above and beyond your colleagues; and will help your future career as well. To be honest, I would recommend anyone who is interested in psychiatry to get in touch and make good links with the psychiatry clinical lead at their university. I find psychiatrists are often very happy to hear from and help out any student interested in their specialty who is willing to get some further experience. 


In addition make sure to include on your CV any of your other achievements during medical school; academic and non-academic, for example, if you are in any societies showing leadership or teamwork etc as this all shows you are a well-rounded person which is essential to becoming a balanced doctor.



The interview - relax

When it comes to the interview just try and relax as much as possible. The interviewers are not there to scare or intimidate you but want to see what you are like and your motivation for psychiatry. 


For preparation my advice would be to have a think about answers to the obvious questions you may be asked, for example, what it is about psychiatry that interests you, why you’ve chosen to do what you have for your elective/research plans and what it was about your previous psychiatry experiences you enjoyed (and what you didn’t enjoy about them). They are also likely to be keen to hear about your views on what could be done to stimulate interest in psychiatry amongst medical students and why many students are put off going into the specialty, and also about how you think we could reduce the stigma of mental health illness amongst the general population. Apart from that maybe have a read of some current psychiatric research/issues you are particularly interested in. 



It is not often you have the chance to talk to fellow students who are as interested in psychiatry as you are...


On the day on the interview its worth getting there a bit before you are due to go in so you can relax after the stressful London commute and it is also nice to have the opportunity to speak to some of the other applicants waiting. It is not often you have the chance to talk to fellow students who are as interested in psychiatry as you are and it is good to hear about others’ experience and future plans.



Why it's worth applying?

If you are thinking psychiatry is the field for you then I would whole heartedly recommend applying to become a Pathfinder Fellow. I am loving it and already finding it very useful. 


As I said at the start, I applied thinking I did not stand a chance of getting it, but in medicine you have to go for what you want - you may surprise yourself. At the very least it is an opportunity to see the Royal College, meet some like-minded students and eminent psychiatrists, and practise being interviewed; and if you do get awarded one of the fellowships you will have a wealth of opportunities opened up to you. 


If you have any questions then please do not hesitate to get in touch with me. Good luck to you all!



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05/08/2013 14:56:11

Becoming a Pathfinder Fellow


Too good to refuse

RCPsych Informatics Committee: survey

I decided to apply for a Pathfinder Fellowship because I was interested in Psychiatry and liked what the opportunity offered:


  • elective funding,
  • free journals
  • the potential to meet like-minded people. 

I started thinking about my application about a month before the deadline, but ideally it’s probably best to give it some consideration as soon as possible, so you can try to get any additional experiences that might be helpful.



Building a strong case

Essentially, I was trying to prove two things: firstly, that I was interested in Psychiatry and, secondly, that I was a good medical student. When putting together your CV and cover letter, it’s worth brain-storming everything you’ve ever done that might be relevant – from school onwards. 



Look through your application again, because you’ll be asked about what you’ve written.

In terms of your academic profile, think of any special study modules or SSCs you may have done that are related to Neuroscience, Psychology or Psychiatry. Consider any areas of your course that have particularly interested you and ask why that was. If you’ve won any prizes or earned special recognition for some piece of work, it’s worth mentioning. 


Outside of your course, think about extra-curricular activities where you’ve displayed leadership, imagination or drive. If you’ve been to any conferences, consider how they have informed your thinking and your practice.  When you’re putting all of this together, try to form it into some coherent structure, grouping activities by category and showing that they have a particular purpose and importance.



Enjoy the process

If you’re offered an interview, enjoy it!  You’ll be talking with people who are just as interested in Psychiatry as you – they just know a bit more.’s worth brain-storming everything you’ve ever done that might be relevant – from school onwards.

Look through your application again, because you’ll be asked about what you’ve written. Make sure you can concisely explain any research or publications you’ve undertaken in an enthusiastic but coherent way.  It’s worth asking a supervisor or friend if they can do a practice run with you as well. 


It’s a good idea to keep up-to-date with any Psychiatry issues that may have arisen recently in the media and reading a few articles in good journals in the weeks before the interview is helpful.


If you have any questions, feel free to get in touch at Good luck!



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10/07/2013 16:15:50

5 Children, 2 Husbands, 2 Dogs & 1 Fantastic Job


Not following the traditional approach

5 Children, 2 Husbands, 2 Dogs & 1 Fantastic Job

So the title is somewhat misleading; sorry to disappoint but please read no further if you were hoping for an intriguing insight into the life of a polygamist!


We are in-fact, two higher trainees in Intellectual Disability Psychiatry and we have had the privilege of job-sharing for the past 5 years.


Fortunately there are lots of opportunities to work ‘differently’ within medicine these days. Be it working reduced sessions, slot-sharing, less than full-time supernumerary posts, availing of career breaks – there are options!


People have a variety of reasons for seeking a shift from traditional working patterns; including disability, ill-health, responsibility for caring for young children or responsibility for caring for ill/disabled partner, relative or other dependant. Other reasons can include, for example; those who have unique opportunities for personal/professional development (e.g. national/international sporting events), religious training commitments, or non-medical professional development such as management courses, law courses, fine arts courses etc. (NIMDTA, 2013).



Why do we do it?

For us it was a personal choice because of decisions we have made mainly around childcare options, which were necessary because of needs specific to each of our families.  


We are highly motivated trainees, passionate about our specialty and focussed on our career aspirations. We are also busy mums to small children with significant childcare commitments.


However, we feel strongly that our greatest asset was actually the shared investment to make this arrangement work.

Like many in our situation we also hold the lofty leadership role of home-manager where we get to be our own boss in co-ordinating the posts of chief dog-walker, dinner-maker, homework facilitator, house-worker, laundry lady, school runner and bed-time officer. We should add that all of the afore-mentioned would also fall apart in the absence of two equally hard-working and perhaps exceptionally patient husbands.



How did we do it?

In the beginning all we had was an earnest desire to make a success of the chance to work as a slot-share. We had both previously had experience of working full-time and working less than full-time in full-time posts.


For us personally, neither had enabled us to give 100 % to both our occupational  & our family commitments. We wanted to strike a balance that would afford us the ability to be both the dedicated doctors we have worked so hard to become while also allowing us to fulfil to our satisfaction our very important functions within our family and home lives.



How did we start?

We knew each other before we commenced the job-share and we are in no doubt that this was a help.


However, we feel strongly that our greatest asset was actually the shared investment to make this arrangement work. It was fairly straightforward – we were being handed an opportunity. We could both get on board and commit to making it successful in every sphere of our working lives so that the arrangement would be sustainable and enable us the security of knowing that we could continue working less than full time for as long as was necessary……..or we could risk losing the opportunity of a long-term fantastic working schedule and therefore work-life balance.


What makes it work?

We figure that at this stage we are probably very alike in terms of our clinical practice and colleagues would support this. We suppose this is not surprising as we have come though much of our training at the same time, attended many of the same courses etc. 


Overall, in keeping with the social science literature, we imagine that we work well together more because of similarity than complementarity.  That said, over time we have learned each others’ fortes and this comes in useful in allocating tasks, particularly within our non-clinical workload.



How does it work practically?

For most of our higher training we have each worked 6 sessions (3 full days) per week amounting to 1.2 whole time equivalent. The 0.2 is funded by our local deanery. We understand that the slot-share option is much preferred by them as they can then fund a much higher number of trainees to work less than full time than, for example in supernumerary posts.


We typically overlap on one session per week (often when there are academic activities which we can both benefit from) and use this time to catch-up with each other on clinical work, hand-over anything that is necessary and keep on top of tasks for our special interest and research activities.


We sincerely hope that in the future we may have the option to apply for a substantive post in a job-share capacity

On commencing each new training post we have generally met with the supervising consultant in advance to talk through the weekly duties and timetable and then organised between ourselves how we think we could then divide the week. We would then seek agreement from the consultant.


In most cases it has been very straightforward. On a couple of occasions we have modified our timetables slightly a month or two in order to even up either our work-loads or our clinical experience.


We have been involved with public education through our local college division for a number of years and have worked with colleagues on a number of projects with school children that have expanded and been used to develop similar models in other parts of the UK. We are both co-ordinators of a psychiatry student selected component at our local medical school and we share a variety of other teaching roles with both undergraduate and post-graduate students.


We were delighted by the central college’s decision to appoint us as a job-share to the role of Student associate Editors.



What does the future hold?

We are currently acting-up in a consultant post, each covering 0.5 WTE. This has been a great opportunity to translate our experiences to date into the consultant role. We sincerely hope that in the future we may have the option to apply for a substantive post in a job-share capacity.


Our experience has ben incredibly positive. We feel that the job-share has enhanced our ability to thrive in our clinical training and enabled us to attain vastly more than we could have done individually in our special interest work.


If like us, you’re not a person that does things by halves – perhaps something less than a full job could be just what the doctor ordered!



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06/06/2013 12:31:20

What I Wish I’d Known As A Medical Student


Work it out

What I Wish I’d Known As A Medical Student

We are taught a whole system of treating patients: diagnosing, giving interventions such as medication, our assumptions of the primacy of our opinions and status in all situations. We aren’t taught critical thinking to properly evaluate the strengths and weakness of our ways of doing things.


Obviously our medical system is tremendously successful at helping people. However it does rest on certain assumptions that we are not trained to evaluate or recognise. This means we often react defensively when people challenge these assumptions. What we should be doing instead is to understand our system properly.



It gave me a much better understanding of how difficult it was for them to change their lifestyles to improve their health outcomes (as well as seeing someone’s Elvis tribute shed).

So how do we understand our system properly?  You can study others’ opinions but they often tend to be written by people who only understand a bit but convince themselves the bit they know explains the whole.


The best way is to read a bit of philosophy and then try and work it out yourself.



Degrees of separation

Another shortcoming is that we separate the illness from the person (for good reason I know) in order to better use our scientific medical knowledge. I remember seeing heart attack patients in their own homes as part of research I was doing. It gave me a much better understanding of how difficult it was for them to change their lifestyles to improve their health outcomes (as well as seeing someone’s Elvis tribute shed). was a fresh amazing thing to talk to patients and our lack of perfectly practised medical histories meant that we got more information and related better.

As our scientific medical abilities progress we seem to be losing touch with the powerful but static human healing qualities of medicine. “Der Arzt hilft” (the Doctor helps) said the poster of my German colleague.


Patients want us to help them and sometimes that involves being interested in them as a person and putting their goals first rather than abstract disease management. As medical students I think we had these qualities, it was a fresh amazing thing to talk to patients and our lack of perfectly practised medical histories meant that we got more information and related better.


I wish I’d known as a medical student that the “art of medicine” skills that I had were as good as they would get and that was what patient’s appreciated. The scientific knowledge could be acquired but the skills needed constant practise.



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06/06/2013 10:48:33

The Power of Emotional Intelligence


Wish list

The power of emotional intelligence

It was a strange experience being a medical student who already knew that psychiatry was the only career on my wish list. I was also lucky enough to have studied at a medical school where psychiatry was respected and which produced more than the typical 4% of students who went on to be part of this stimulating discipline. 


Having said that, there is much that I would like to have been told when I look back on the days where I was enthralled by the challenge of eliciting psychopathology, making a diagnosis and learning that there is much that can be done to improve mental health and reduce mental suffering.



Only 20%

Writing this after 15 years as a consultant, I honestly believe that only about 20% of the skills that are taught in medical school equipped me for the rigours of being a consultant psychiatrist.


During my first week, echoes of my first consultant during my training telling me, "things will be very different when the case notes have your name on the front", rang in my ears. My first reaction was ‘help!’ Like most jobs, a lot of what you learn will be on the job, but there are certain things that I wish that I had known at an earlier stage.



Mental stamina

Psychiatry is not just about ‘chatting to people’. It is both an art and a science and any budding psychiatrists out there need to know that it takes immense mental stamina to use your knowledge and to communicate this in a form that engages the patient, generates a therapeutic relationship and uses all your powers of deduction to make a diagnosis and plan treatment. 


I remember a consultant surgeon once telling me that managing situations effectively means having to deal with ambiguity and also knowing when not to say anything.

Just remember that it takes incredible resolve and resilience to have the energy and enthusiasm to carry out an assessment that may last over an hour after being woken up in the early hours of the morning, only to face a hostile patient who is restless, irritable, disinhibited or aggressive. You need tact, patience and the clinical encounter will demand your full concentration.


Probably the most important skill to have (which I really wish someone had told me about) is emotional intelligence. I remember a consultant surgeon once telling me that managing situations effectively means having to deal with ambiguity and also knowing when not to say anything. I have been a consultant for long enough now to know that a considerable proportion of being an effective psychiatrist is being to lead and manage your team. You will almost certainly find all the defence mechanisms that you learn about in medical school in full flow within teams in which you will work. It is up to you to have the knowledge, skills, attitudes and emotional intelligence to manage complex situations.



A voyage of discovery

Now to rewind the clock, back to my psychiatry firm. I would really like to have been told more:


  • about leadership and its different styles;
  • about how to deal with complex encounters involving  both patients and relatives;
  • about the importance of seeking support from peers and seniors (doctors are only human, no matter how we think that we can do it alone)
  • and learning from serious untoward incidents.


Above all, I wish I had known that it is alright to feel uncertain and apprehensive in the face of situations that are unpredictable, knowing also that you working in a world where there are few people who are going to pat you on the back or give you wine and chocolates for the time that you invest in carrying out your everyday work to a high standard.


...there are few people who are going to pat you on the back or give you wine and chocolates for the time that you invest in carrying out your everyday work to a high standard.

Psychiatry is still an expanding field where the world is your oyster. Never a minute has gone by when I have regretted it as a career choice. I just wish that I could have been better prepared for developing myself as ‘whole person’ before embarking on my chosen career path, in being able to think, reflect, learn and develop from clinical experience with both patients and colleagues.


It would have been even more fulfilling than it already has been and voyage of discovery rather than one of uncertainty.


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15/05/2013 11:44:34

Mental Health Services For Generation Y


Generation Y

Mental Health Services For Generation Y

Generation Y encompasses those who were born from the 1980s onwards. They are sometimes referred to as digital natives; perceived as being more familiar with digital technology, the internet is a natural space for them and has become an integral part of their lives.

There is a synergistic relationship between Generation Y and the internet, which is reflected in how social interactions have changed and evolved. This is especially relevant for the provision of mental health services in our ever advancing technological age, as current data from the Office of National Statistics show that 1 in 10 children or adolescents suffer from a mental health disorder.


Support, stigma and savvy online              

According to a YouthNet survey, 82% of young people will use the internet for health advice. As such, the internet is becoming an increasingly more robust forum to disclose and discuss mental health issues.

Online patients tend to be younger, more educated and are less likely to have ever attended psychiatric services. They generally use websites that are reputable and accurate. The internet provides disinhibition, giving young people the security of anonymity. This allows them to dissociate from their day to day identities, in turn allowing them to attain better insight into their own problems (Suler, 2004).

The sense of anonymity and inconspicuousness afforded by the internet is in many ways vital to Generation Y - due to the stigma still associated with mental health disorders. A study by Irish charity found that 61% of young people would use internet support during a tough time; whilst only 31% would talk to a health professional (Chambers and Murphy, 2011).


The sense of anonymity and inconspicuousness afforded by the internet is in many ways vital to Generation Y - due to the stigma still associated with mental health disorders.

Online resources, such as; the official RCPsych website, The Samaritans and YourMentalHealth aim to raise heightened awareness of mental health problems and serious issues such as self-harm and suicide. They strive to achieve a positive and resounding impact amongst Generation Y by reducing the apparent stigma surrounding mental health issues and encourage open discussion of these matters in a dynamic and overt medium.


Untangling the Web   

The advancement of technology has resulted in Generation Y now utilising the internet as a powerful instrument in the promotion of mental health awareness and advice. This has resulted in the emergence of a number of e-mental health web based interventions.

Countries such as Australia, Sweden and the Netherlands, have legitimised and highlighted the importance of Internet based mental health services by incorporating them into their respective national health systems. 

Australia continues to spear head this movement through the establishment of a web portal that offers a range of federally funded online interventions and connects its users to a range of web-based mental health services.

With regard to reducing adolescent anxiety disorders, one particular study found that online cognitive behavioural therapy is as effective and acceptable to young patients as clinic-based CBT (Spence et al, 2011). Parents of these patients however, preferred their child to receive CBT in a clinic based setting and this may indeed be representative of the discrepancies and disparities between Generation Y and X in terms of their attitudes to how the Internet is used in relation to dealing with health and wellbeing.

Another study, relating to adolescent depression, found internet CBT to be no more effective than the waiting list control group (Hoek et al 2012). A major benefit of online services is that they introduce a new level of flexibility; patients can tailor them to their own needs and lifestyles as opposed to the rigidity of attending regimented outpatient clinics in the community or hospital. It is also very appropriate for generation Y, as this era of app-loving young people are accustomed to instant information and have a low threshold for waiting times or being kept on hold for too long. By using online therapies, it enables mental health services to connect with these patients who may otherwise be lost to a system of waiting lists, delays or cancellations.

The internet can however be enigmatic in its promotion of mental health issues and the ways in which they are perceived by young and quite often vulnerable people. This is encapsulated by the prevalence of certain Internet sites which romanticise the concept of suicide thus increasing suicidal ideology amongst users, as well as the online pro-ana movement supporting and encouraging anorexia.

For those with a suicidal intent, the internet can be a potent and dangerous tool. Researching online methods or ways in which to end one’s life can unlock hundreds of un-monitored websites or forums which breed or evoke similar interest. They stand to have dangerous adverse effects on the mental health of users and show no regard for their safety or wellbeing. 

This emphasises the need to put restrictions in place, in terms of what is accessible online and how to ensure user safety. 

This is highlighted by the work of the search engine Google where user ideas of suicide and self harm are met with links to The Samaritans, which although was not the search result requested, may in fact, be exactly what is needed.



Scrolling down - What’s Next?

Mental Health Services For Generation Y

The therapeutic encounter forms a vital component of traditional Cognitive Based Therapy however could this be tailored to meet the needs of an increasingly internet savvy generation (Langhoff et al, 2008). According to an EU survey, the average young person now spends at least an hour online every day (O’Neill, Grehan and Ólafsson, 2011). As such this begets the question – is the most effective therapeutic encounter now found online for generation Y?

Google and the Samaritans collaboration to target suicidal individuals is an excellent example of how Mental Health Services are adapting to target generation Y and influence their perception of mental illnesses.


If these services are to keep up with and engage generation Y, they need to offer appropriate online services and therapies, but also need to infiltrate the sites and services used regularly by these young people. By doing this, the awareness of Mental Health can be raised and the stigma surrounding these conditions can be broken down for generation Y and those who follow.




Chambers, D. and Murphy, F. (2011) Learning to reach out: Young people, mental health literacy and the Internet, Dublin: Inspire Ireland Foundation.

Hoek W., Schuurmans J., Koot H.M., Cuijpers P. (2012) Effects of Internet-Based Guided Self-Help Problem-Solving Therapy for Adolescents with Depression and Anxiety: A Randomized Controlled Trial. PLoS ONE 7(8): e43485.

Langhoff, Christin; Baer, Thomas; Zubraegel, Doris; Linden, Michael (2008) 'Therapist-Patient Alliance, Patient-Therapist Alliance, Mutual Therapeutic Alliance, Therapist-Patient Concordance, and Outcome of CBT in GAD ', Journal of Cognitive Psychotherapy, 22(1), pp. 68-79.

O’Neill, B., Grehan, S., Ólafsson, K. (2011). Risks and safety for children on the internet: the Ireland report. LSE, London: EU Kids Online.

Spence SH, Donovan C.L., March S., Gamble A., Anderson R.E., Prosser S., Kenardy J. (2011) 'A randomized controlled trial of online versus clinic-based CBT for adolescent anxiety', Journal of Consulting and Clinical Psychology, 79(5), pp. 629-42.

Suler, J. (2004). CyberPsychology and Behavior, 7, 321-326

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07/02/2013 10:56:49

RCPsych Eating Disorders Section Annual Conference 2012


Bursary opportunities

Eating Disorders Section My experience with psychiatry as a specialty during medical school focussed mainly on general adult and inpatient psychiatry – eating disorders were simply not a huge focus on the curriculum. So when bursary opportunities became available for the Eating Disorders Section Annual Conference, I was lucky enough to be successful in my application to attend.



High profile speakers               

This year’s conference focussed on the medical manifestations and management of eating disorders, with several high profile speakers in attendance.

The first section discussed bone health in those with eating disorders. Dr Sanjeev Patel (Consultant rheumatologist at Epsom & St Helier’s NHST) ran through the pathophysiology of what to expect in women with eating disorders and covered medical interventions for the ensuing osteoarthritis and osteopenia as an adjunct to psychiatric interventions.


Dr Debra Katzman from the Hospital for Sick Children at the University of Toronto summised that transdermal oestrogens are more effective than the oral equivalent for bone health in those with eating disorders. Overall, the evidence base presented showed clear long-term health benefits through bone interventions in the eating disorder population.


The second section saw Professor Rona Moss-Morris from the Institute of Psychiatry, King’s College London map a CBT approach of irritable bowel syndrome onto the treatment of eating disorders, drawing several similarities between the cognitive processes in these two, seemingly different, patient populations.


Professor Helen Mason from St George’s, University of London presented her work on the use of pelvic ultrasound as a staging tool in the recovery from eating disorders in women. The results were very promising, correlating endometrial thickness with the stage of the disease.



Functional neurobiology of pleasure     

The delegates were treated to an inspiring talk from Professor Morten Kringelbach (University of Oxford and Aarhus, Denmark), where he presented his internationally renowned work on the functional neurobiology of pleasure. He suggested ways in which his work and methodologies could be used to understand the cognitive challenges that eating disorder sufferers must endure.


...this should not be seen as a quick fix in the way that lobotomies once were.

In an appropriate digression, Professor Kringelbach also explored the future of therapeutic deep brain stimulation in psychiatry, but also warned that this should not be seen as a quick fix in the way that lobotomies once were.



Into the unknown

Resources for eating disordersThe day concluded with presentations from large multi-centre treatment trials for anorexia nervosa. Interventions compared ‘best supportive treatment’ to experimental talking therapies and different types of family therapies.


The conference was well run and drew on some enthralling speakers. Debates that followed presentations were often lively and intellectually stimulating. The only negative would be that I am now even more confused about which higher speciality I want to pursue in the future!


This conference offered an opportunity to experience a sub-speciality of psychiatry that few get to see during their undergraduate training. I strongly recommend RCPsych Student Associates to pursue any bursaries on offer to attend events like these. They really are valuable and allow you to gain an insight into the relatively unknown parts of the speciality.



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30/11/2012 11:59:46

‘The final frontier’ – Scotland’s first ever Psychiatry Summer School, a review

Jenny Reid and Gordon McKinnon, 4th year medical students, Edinburgh University


Weekend events

‘The final frontier’ – Scotland’s first ever Psychiatry Summer School, a review

Psychiatry is a medical specialty like no other. Mental illnesses are diverse, and represent a major proportion of morbidity worldwide.  Although 1 in 7 medical students are reportedly interested in psychiatry as a future career option, negative attitudes from senior clinicians and a perception that treatment options are archaic and limited stop many from pursuing the specialty in their postgraduate training1


Stimulating medical students and maintaining interest in psychiatry throughout the undergraduate curriculum is therefore a major goal for both the Royal College of Psychiatrists and medical schools. Many specialties host weekend events to nurture interest, and this year saw the launch of the first psychiatry summer school in Scotland.



The place to be

The inaugural ‘Scottish Psychiatry Summer School’ was held in Edinburgh on the 31 August-1 September 2012. Chaired by Professor Lindsay Thomson and Dr Tom Brown, the summer school was attended by undergraduates from across Scotland, a school leaver and eminent speakers from a wide range of specialties. The message and enthusiasm were clear; 21st century psychiatry is exciting, diverse and the place to be in modern medicine.


In April 2012 the Lancet published a short article in its editorial detailing psychiatry’s international ‘identity crisis’2. Rather than a problem, the summer school presented the identity of psychiatry as one of the most exciting opportunities in medicine today. The vast range of talks highlighted the diversity of psychiatry, from medical, legal, psychosocial and philosophical domains to prospects in research, public health policy and leadership.



Complimentary glass of wine

The summer school sche dule was itself innovative. A ‘speed-dating’ session, with a complimentary glass of wine, was a novel way to meet professionals from many different subspecialties; from learning disability, forensics and old age psychiatry to psychotherapy, substance misuse, and academia, to name but a few.


Psychiatry has been criticised for lagging in the past, and there still exists a stigma and ignorance towards the profession. To the contrary, the lectures at the summer school were absolutely current; they reflected upon the way psychiatry must respond to social, environmental and economic circumstances, the ever-growing evidence base and the emerging understanding of biology and genetics. Dr Mandy Johnstone’s talk on modeling psychosis using stem cells showed how forward-thinking psychiatry can be and demonstrated how such spectacular developments could alter future diagnosis in psychiatry.



These talks illustrated the evolution of psychiatry, a specialty with groundbreaking research, pushing the boundaries on our understanding of the human mind/condition.


The summer school did not neglect psychiatry’s past. Pivotal figures like Leon Eisenberg, famous for attaching the social with molecular medicine in the diagnosis and treatment of autism, and Goffman’s essays3 on the social situation of patients were part of the narrative. However, the focus of the weekend was psychiatry today and the psychiatrists of the future.



Dish of the day

Of particular note during the lecture schedule was Dr James Currie’s captivating talk about current research in neuro-economics and decision making in schizophrenia, game theory and functional neuro-imaging. Professor David Owens also presented an inspiring talk on human minds. These talks illustrated the evolution of psychiatry, a specialty with groundbreaking research, pushing the boundaries on our understanding of the human mind/condition.


Above all, what made the summer school stand out from other conferences and summer schools, and what makes psychiatry stand out to us as a profession, was humanity. A meal on the first day allowed a dialogue between undergraduates, trainees and professors, all of whom were friendly, approachable and keen to share their experience.



First ever

The future of psychiatry is not only fascinating but it is also practically appealing; there is flexibility in the training, a great deal of personal support and there are a number of additional opportunities along the way. No other specialty is so fundamentally based upon the bio-psycho-social model that is humanity itself. Mental health affects all of us on a daily basis and a career in psychiatry offers life changing, stimulating and fulfilling work.


Psychiatry cannot be disregarded; it is clearly embedded within every area of medicine. For those skeptics that believe that psychiatry will be superseded in the future by neuro-psychiatry the summer school was a reminder of the diversity of modern psychiatry and its fundamental crux; human beings and all their idiosyncrasies.


To be a part of the first ever Psychiatry Summer School in Scotland was a privilege and the authors thoroughly recommend future Scottish Psychiatry Summer Schools. It opened up questions, was inspirational and presented opportunities and challenges in a specialty that in our opinion is mind-blowlingly exciting.


If psychiatry is the ‘final frontier’ of medicine then it requires bravery and innovation in its future approach. Humanity is dynamic, and so too must be psychiatry.




1. Budd S, Kelly R, Day R, Variend H & Dogra N. Student attitudes to psychiatry and their clinical placements.  Medical Teacher 2011; 33: 586-592.

2. Editorial published online. The Lancet 2012; 379: 9828:1274 (DOI:10.1016/S0140- 6736(12)60518-2. Accessed October 1st 2012)

3. Erving Goffman, Asylums, 1968, Penguin books.



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26/10/2012 11:43:14

Professional procrastination: using social media for recruitment to psychiatry

Samantha Batt-Rawden, Final Year Medical Student, University of Bristol

Social networking

Joining in the conversation - social media and mental health servicesI am staring at the essay before me. It doesn’t very much look like an essay. In fact, it’s just the title, but that in itself was an arduous 10 minutes of mental exertion and I decide I’ve earned the right to a well-deserved break.


And I’m back where I was 10 minutes ago; on Facebook.


I am just one of 901 million active users of Facebook1 and have recently been adding to the 200 million tweets that are posted on Twitter each day.2 Whilst the use of social media by students can only be described as prolific, medical professionals are not immune from these statistics. According to a recent survey, social networking sites have been adopted into the lives of 79.4% of doctors - well above the national average.3


Medicine 2.0

The rapid incorporation of internet tools for education, research and collaboration within the field of medicine has been dubbed Medicine 2.0, a nascent yet thriving machine within which social media is a just a small cog.4

Whilst many readers will be well acquainted with the personal benefits of social networking, the broader implications for healthcare may be less readily apparent - psychologists have been crafting virtual reality worlds for psychotherapy patients5 and social media has been successfully applied in cultivating empathy, humanism and professionalism in medical students.6.

Engagement with such tools may present a unique opportunity for recruitment. In these times, where psychiatry is looking for novel and innovative methods to recruit students, could social networking provide the answer? Recently, a small scale survey was carried out to investigate this possible strategy. media has been successfully applied in cultivating empathy, humanism and professionalism in medical students


What did we learn?

A total of 57 responses were received. All respondents used Facebook. 56% used Twitter, 18.2% used Google +, 13.6% used MySpace, Pinterest and Live Journal were both used by 6.8%, LinkedIn was used by 4.5%.

73% listened to podcasts, but of those only 16.2% listened on a regular basis (at least once weekly). Many reported difficulties in finding listenable, psychiatry-themed podcasts.


Respondents checked Facebook more than they checked their email, with most receiving ‘push’ updates in real-time via smartphone applications.


83% were members of their university psychiatry Facebook groups with 76.2% signed up to their mailing lists. Respondents felt that they were most likely to hear of psychiatry opportunites through Facebook and felt the current RCPsych groups weren’t relevant to students. An emerging theme during subsequent interviews was that students often missed College opportunities and external psychiatry events. This was attributed to the fact that university groups are often updated by a single committee member and that not all information is easily accessible and/or advertised to every university society.


And what of Twitter? Only 7.3% followed @RCPsych or @future_psych as many reported that tweets weren’t always directly relevant to students.


What did students want?

Respondents agreed that social media use in psychiatry made the specialty ‘technologically advanced’ (65%), ‘modern’ (82%), and ‘interested in students who are interested in them’ (88%). Furthermore, 41% endorsed that recruitment efforts of the College have made them more likely to consider psychiatry as a career.


Whilst 63% responded that current use of social media in psychiatry has made them feel more involved in the specialty as a student, many felt that there would be additional benefit from a national Facebook group (72%), student dedicated podcasts (66%) and an RCPsych Student Associate Twitter (25%). Figure 1 illustrates what students wanted from a psychiatry social media tool.



What did students want from a psychiatry social media tool



The RCPsych Student Associate Twitter is well established (@future_psych) and currently has 125 followers.


Although not officially affiliated with the College at this time, the National Student Psychiatry Network Facebook group has also been independently developed. With over 120 members, it is hoped that the group will continue to expand and become a national bulletin board for committee members from several university psychiatry societies to advertise their events and summer schools. It may also serve as a networking hub for students to connect with psychiatrists who are offering opportunites for SSCs, research, electives and mentorship.


Many studies have reported the tangible benefits of adoption of social media by students and doctors alike. Yet for many this is a cause for concern; much of this anxiety has centred on issues of confidentiality, professionalism, and doctor-patient boundaries. These are real, but manageable challenges and whilst the full potential of social media in healthcare has yet to be established, this article highlights its potential use for recruitment to psychiatry.


Please see the General Medical Council’s guidelines for medical students on social networking.





1.Facebook Newsroom Fact sheet. Accessed 14 May, 2012

2.Twittereng. 200 million tweets per day. Twitter Blog. Accessed 14 May, 2012

3.Bosslet G, et al. The patient-doctor relationship and online social networks: results of a national survey. J Gen Intern Med. 2011, 26(10):1168-1174

4.Eysenbach G. Medicine 2.0: social networking, collaboration, participation, apomediation, and openness. J Med Internet Res. 2008;10(3):22

5. Giuseppe R. Virtual reality and psychotherapy: a Review. Cyberpsychol Behav. 2005; 8(3): 220-230

6. Rosenthal S, et al. Humanism at heart: Preserving empathy in third-year medical students. Acad Med. 2001;86(3):350-358




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26/10/2012 11:39:38

Elective Psychiatry placement in Hamilton New Zealand, Hauora Waikato, April-May 2012

Maria Spears is a 4th year medical student at the University of Birmingham

Unique aspect

Hamilton base for Hauora Waikato

My elective is currently underway in the idyllic country of New Zealand. As someone who is interested in psychiatry as a career, I decided to plan a placement within a unique aspect of psychiatry. Luckily I found it at Hauora Waikato.

Steeped in Kaupapa Maori philosophy and teaching, this elective placement has exposed me to transcultural psychiatry involving the management, treatment and diagnosis of mental health conditions, within a cultural and spiritual framework.


The 3 'R's

Hauora Waikato is primarily a Maori, community-based, independently-funded mental health organisation, based in Hamilton city centre. It focuses on assessment, referral and treatment, allocating patients to appropriate services where their needs can be met. Hauora focuses on providing healthcare that specifically meets the cultural and spiritual needs of individuals. Patients do not have to be Maori to utilise the service; any patient can choose to commit to treatment with Hauora.

In terms of the Kaupapa Maori principles, at the most basic level it involves the 3 'R's:

  • Respect for others
  • Respect for yourself
  • Respect for the environment


Support network

Picture taken at Tamahere forensic hospital, at Maria Spears ‘powhiri’ (welcoming ceremony

Every morning at Hauora there is a ‘whakamoemeti’, which literally means thanksgiving. It involves singing of Maori hymns and prayers (‘karakia’) to start the day positively. Karakia are also used during consultations with patients if they request/accept it and in multidisciplinary meetings called ‘whiriwhiris’.

The importance of ‘whanau’ (family) is a key feature of the holistic approach at Hauora to helping patients with their difficulties. Hauora strives to develop a good support network for patients and has a variety of health professionals who interlink within the team. The concept of the healthcare team being like a family with elders who offer advice to other members, is a very traditional Maori principle. It certainly helps that everyone is in the same building and can communicate immediately.

I think this is one of the key factors which stands out for me - how there is a strong emphasis on the social and cultural aspects of the patient’s life and how everyone works as a collective for the patient. No decisions are made without consulting other members of the team first.

So far this elective has exposed me to a variety of subspecialties in psychiatric medicine: child and adolescent, early intervention, forensic, and maternal mental health. I've also managed to go out on home visits in the country, to a forensic rehabilitation hospital which focuses on Kaupapa Maori treatment, as well as clinics based at the town centre.


There is certainly a stronger emphasis on the patient’s cultural needs and background at Hauora

Although the underlying medical treatments for mental illness are very similar to UK practice, there is certainly a stronger emphasis on the patient’s cultural needs and background at Hauora. For example, I sat in on a nurse's assessment where a patient felt that she had been cursed with 'makutu' (evil spirits), which had been present during a 'tangi' (funeral).

For anyone thinking of organising a psychiatry elective, hoping to get more exposure and experience in sub-specialties with a cultural focus, it's worth considering a placement in New Zealand.

Many thanks to all at Hauora Waikato for giving permission to use these photographs.



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27/06/2012 15:21:20

Medical Student Career Evening at the Royal College of Psychiatrists

Philip Rankin is a medical student at the University of Birmingham

Mix of students

Medical Student Career Evening

Currently the Royal College of Psychiatrists is based in an old London mansion in Belgrave Square. The imposing, impressive building felt intimidating for a third year medical student.


Yet once inside, a warm welcome from the organisers put to rest any thoughts that I had come to this career evening too far ahead of my clinical years. In fact, sitting in the grand Council room, I met over 40 medical students, who were a mix of first years to final years and had come from all over the UK to gain insight of what a career in psychiatry might be like. It seems you do not have to wait to the year before FY1 job applications to start getting involved in medical careers events.


Inspiring talks

We were all welcomed to the College by Dr Tom Brown, the Associate Registrar for Recruitment and a Liaison Psychiatrist who gave an inspiring talk about his passion for psychiatry.


Next we heard two talks about psychiatry electives and international psychiatry – two topics which are often not mentioned. For example we listened to a current student’s first-hand account of her psychiatry elective in South Africa where she was able to visit community clinics in the Townships of Cape Town.


Furthermore Dr Peter Hughes, a Consultant who leads the Volunteer and International Psychiatry Special Interest Group gave out his contact details to all attendees and encouraged us to get in touch with him so the College could help us plan and fund electives which suit our needs. This invitation to access tailored support to plan an elective was a rare and extremely useful opportunity to help organise a high quality elective – an often quite daunting task.


This led into a discussion with Dr Alice Lomax, Chair of the Psychiatric Trainees’ Committee about core and higher training in psychiatry. Despite this topic seeming to be way into the future, it was surprisingly useful even at this early stage because as well as the career guideline (exams et al.) – we were given a glimpse of how psychiatry training may change in the next few years, what a typical trainees’ working day is like and crucially, advice on what students can start doing now to land the jobs they hope for in the future. This last point was developed through a talk by two medical students who highlighted how to go about organising a research project for yourself (a useful thing to know whatever specialty you end up in), upcoming student-friendly conferences and tips for bursary and prize applications.


The evening ended with a question and answer session and finally a drinks reception with various members of the College – not least the current President, Professor Sue Bailey – who even gave us a personal tour of the premises.  



The 2011 Institute of Psychiatry Summer SchoolSo what did I think about this overall? For a few hours of my time I had the privilege of learning more about a career in psychiatry than I would have at medical school, I made some great contacts who I can collaborate with and learn from in the future and that attending careers events even in the early years of medical school can lay the foundations for a good application and career in your chosen specialty.


I also left feeling that I would encourage students to attend these usually free and high-quality events as often as possible, as useful information which is applicable to all branches of medicine is often given out.


Someone once said to me that a good way to help you find the right medical specialty for you is to see how well you get on with doctors already in that specialty. A careers event such as this is a perfect opportunity to meet many high-profile, interesting clinicians who may serve as such inspirations.

  • The Royal College of Psychiatrists have an excellent website for interested medical students.
  • The medical student voice of the College can be followed on Twitter @future_psych.
  • Finally please get in touch with Birmingham PsychSoc on if you wish be informed of upcoming events such as this.


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13/06/2012 11:45:18

Youth Offending: A Symptom of a Greater Crime

Russell Gibson is a 4th year medical student at Cardiff University


Youth Offending: A Symptom of a Greater Crime by Russell Gibson

Empiricist philosophy was founded upon the belief that a child is born with a mind that is a tabula rasa – a ‘blank state’, with the child’s ensuing development entirely attributable to the environment to which they are exposed. Modern views incorporate the role of genetic inheritance, but it is hard to see how children can overcome maltreatment, neglect, inadequate parenting and poor schooling. These are risk factors for juvenile offending, factors that tend to coalesce around one single denominator: poverty.


Detention centres

Current findings suggest the higher rates of crime found among children of low socioeconomic status are mediated through the disparate effects of poverty on a child’s life course, be that adverse family, individual, school or peer factors (i).  


It must therefore be the utmost priority for youth detention centres to act as places of nurture and rehabilitation, rather than punishment. Stereos, Playstations and pool tables may seem to reward criminality, but lest we forget, these offenders are also children. Indeed, the greatest outrage is that life inside the detention centre is often preferable to that outside, not merely in material terms but also in basic parental input.


Youth Offending: A Symptom of a Greater Crime by Russell Gibson

Detention centre staff provide excellent support for these children, often becoming the parental figures otherwise lacking. However, they also report their input is ultimately limited, for when the child leaves, he or she re-enters the same environment that led to crime in the first place. Social workers can and do intervene, but removing children from their parents comes at a cost. And often, it comes too late.


So we blame the parents, as occurred following the UK riots in the summer of 2011. However, parents are often products of environments similar to those they now provide for their children. This is a self-sustaining cycle of crime, punishment and missed opportunity where the inadequate parenting received by one generation is passed on to the next.


Wider problem

Youth offending, therefore, will never be cured by detention centres, as it is merely a symptom of a much wider problem: social injustice.  It incorporates more than socio-economic disparity: inequality of opportunity, from finding a job to experiencing prejudice.  We expect poor children to act a certain way and we don’t give them the opportunity to act otherwise.


As future doctors, we cannot prescribe a cure for criminality, but being unable to treat does not mean we should not strive to understand the cause.  After all, we too are the product of environments into which we just happened to be born.




Percentage among sentenced young offenders by sex (ii)

  Male Female
Mental and emotional problems 14 22
Been admitted to mental health ward 4 9
Personality disorder 80 84
Hazardous drinking 70 51
Use of illicit drugs 96 84

Drug dependence (not alcohol)

57 56



i. Fergusson D, Swain-Campbell N, Horwood J (2004). How does childhood economic disadvantage lead to crime? Journal of Child Psychology & Psychiatry 45(5): 956-66.

ii. Lader D, Singleton N and Meltzer H (2000).


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15/05/2012 11:10:49

Undergraduate Fellowship in Psychiatry

Dr Emma Brandish is a foundation year two doctor 

Single best decision

Undergraduate Fellowship in Psychiatry

I entered medical school in 2006 as a graduate, having previously read International Business with French at Loughborough University. My first degree included an industrial placement year which I spent working in London at the head office of a high street fashion retailer. Working in fashion was exciting and I planned to return as a graduate, but I changed my mind during my final year and applied for medicine instead; this was the single best decision I have ever made.


As a second year medical student I became increasingly aware of the role of research in clinical practice. I knew absolutely nothing about research but wanted to learn more so I emailed my personal tutor for advice. He was a psychiatrist and he invited me to spend the summer vacation doing research with him. I successfully applied to the Wellcome Trust for a Vacation Scholarship which funded 8 weeks of basic research training and the opportunity to contribute to a number of different studies. During that summer I had my first taste of both clinical and academic psychiatry and I loved it. It was as if a light switched on - I knew what I wanted to do.



Further experience gained during my psychiatry clinical attachments increased its appeal. I enjoyed spending time with patients, talking to them, entering into their world and exploring. I became fascinated by the interaction between mental illness and the unique human experience of individual patients.


In 2010 I was awarded an Undergraduate Fellowship in Psychiatry. The Fellowship scheme is a Southampton initiative where clinical medical students with an expressed interest in psychiatry have the opportunity to compete for a monetary prize (to support educational development in psychiatry) and are assigned a psychiatrist mentor.  They are also encouraged to assume an active role in further development of the local student psychiatry society.


It was the combination of these academic and clinical experiences which prompted me to apply for an Academic Foundation Programme in Psychiatry to further explore my interest in the specialty.


Cement my career choice

Day hospitals for older people with mental illnessPost qualification I have frequently encountered significant psychopathology within the general hospital setting. I often considered how this contributes to the presentation of physical illness and it has served to remind me how important mental well-being is to overall health.  


Despite enjoying aspects of medical and surgical jobs I continue to be drawn to psychiatry and my four months as an academic FY2 in psychiatry has cemented my career choice. I have recently been appointed as an Academic Clinical Fellow in General Adult Psychiatry in the Wessex Deanery. I start in August 2012 and I am very much looking forward to the next stage of fmy psychiatric career.


I cannot deny that I have been lucky and mentorship has been a key factor in my progress to date. In particular, that of Professor David Baldwin and Dr Julia Sinclair who have supported me and guided me whilst introducing me to a world of clinical and academic possibilities. However, despite the convenience of having a receptive and supportive academic psychiatrist as a personal tutor I have met many psychiatrists who are extremely receptive to opportunistic emails from keen medical students and junior doctors looking for further clinical or academic experience. Therefore I would always encourage colleagues who express an interest in psychiatry to take that first step.


Psychiatry is still evolving, there is still so much to discover and learn, so much we don't understand and that is incredibly exciting. I want to be a part of its future. I shamelessly promote the virtues of psychiatry as a specialty wherever I go, both to medical students and to other doctors. I also encourage medical students and other junior doctors to consider academic medicine as I don't feel it is sufficiently well promoted to them yet it presents diverse, stimulating and exciting career opportunities.


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25/04/2012 14:40:43

The challenges of Old Age Psychiatry

Dr Alan Spratt is a foundation year two doctor 

Four months

Old Age Psychiatry Faculty

Old age Psychiatry is akin to an Addenbrooke’s cognitive assessment.

  1. The general populace of medics tend to avoid it (we’ll ignore the surgeons altogether).
  2. It seems it will take a while to get through it.
  3. Although it can seem simple to highlight a problem, the management and repercussions are far from simple.

Few FY2 rotations are available in psychiatry. Although I sought the rotation out, many do not. For a specialty that is essential in many other specialties including Emergency Medicine, GP and General Medicine, people do not have an opportunity at foundation level to experience it. 

Four months isn’t a long time unfortunately to fully submerse into a specialty or indeed a sub-specialty. 

Cross your path

Dr Alan SprattHowever, in a four month rotation I have seen the division of care between community and hospital and the importance of the community psychiatric team and the communication skills to keep it linked together (meeting upon meeting followed by phone calls and then referral letters). 

Caffeine-laced on call duties where no two referrals were ever the same provided exposure to acute admissions across all sub-specialties. These were by far the most challenging aspect of the rotation. In these situations although help was never far away, when you’re on your own the most prominent and lasting lessons are learnt. These situations are meant to be stressful in medicine, it just so happens in psychiatry you carry an alarm and the door opens both ways in the assessment room.


Now a humbling realisation is that care of the elderly was the highlight of the rotation. Organic illness will be an increasing problem in the future of the NHS. Regardless of what specialty people end up in, dementia and Alzheimer’s will cross your path and I guarantee you will have no idea how to manage it as successfully as is done in psychiatry. It will affect you, your patients or your family. 


It is therefore worth spending four months finding out about it and the challenges it brings. 


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21/12/2011 15:13:32

Mad Tales from Bollywood: Portrayal of Mental Illness in conventional Hindi Cinema

Josie Phizacklea is a 4th Year Medical Student at Cardiff University

Larger than life

Mad Tales from Bollywood: Portrayal of Mental Illness in conventional Hindi Cinema

For Cardiff University Psychiatry Society’s first event, Professor Dinesh Bhugra, President of the Royal College of Psychiatrists, spent an evening exploring the portrayal of mental illness in Bollywood through the decades. After enjoying a buffet of Indian food, 60 students and trainees settled down to enjoy a fascinating insight into another culture's perception of psychiatry.

Professor Bhugra began by emphasising the role cinema plays in the understanding of any culture, with social themes influencing film and film, in turn, influencing society’s thinking.

As the world’s largest producer of films, Bollywood is an important window to a global perspective of mental health and has a powerful role in shaping the views of a vast audience. Bollywood movies are unique in being very fantastical, colourful affairs, with larger than life sets and often unrealistic storylines. Ubiquitous across India, from small, shared TVs to glossy multiplexes, they are a huge part of the lives of ordinary Indians, often providing sanctuary from the trials and tribulations of everyday life in a developing country. Bollywood movies often do not reflect reality but are vital, instilling hope and giving something towards which to aspire.


Clichéd boxes

The Wellcome Trust has funded Professor Bhugra to study more than 50 films that include a protagonist with mental illness. This enabled him to examine the evolving attitudes towards psychiatric illness in Indian culture during periods of massive political, social and economic changes.

Professor Bhugra points out that the three main periods in Hindi cinema were each defined by turning points in the social norms. The films of the 1960s were influenced by the idealism of a newly independent republic, and reflected this confidence in a period of ‘Romanticism’, where a mood of optimism was coupled with a gentle representation of the mentally ill. 

Film clips illustrating this included Khamoshi (The Silence, 1969) which describes the story of a young nurse who migrates to the West and saves a psychiatric patient from misery by falling in love with him. Working alongside her was a caricature Freudian psychiatrist, sporting a fine beard, who ticked all the clichéd boxes you could hope for.

However, “growth of government corruption and an unstable political climate” during the 1980s led to a national feeling of discontent and spawned the period of ‘Villainy’ in the Hindi film industry, resulting in a plethora of ominous psychopaths appearing on Bollywood screens.

A ‘New Romanticism’ appeared with the economic liberalisation of the 1990s. Professor Bhugra described how, "women were seen as possessions in both society and the cinema, and the portrayals of stalking and morbid jealousy increased”. This point was illustrated by characters demonstrating signs of paranoia in clips of this era.



It was a privilege for the students and trainees who attended to be guided so thoughtfully through the captivating periods of India’s history in relation to mental health; we are enormously grateful to both Professor Bhugra and all those who organised the event.


It was fascinating to learn how the societal and political climate in India effected change in Bollywood Cinema and to consider how the portrayal of psychiatric patients reflects society’s treatment of the mentally ill at the time. An understanding of these cultural themes will help us to appreciate the perspective of patients we encounter as medical students and foundation trainees. Many of us left the event with a refreshed enthusiasm for pursuing our interest in the speciality.



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27/10/2011 10:16:55

Are psychiatrists subject to more violence than doctors in other specialities?

Sonia Sangha is a foundation year two doctor.

Risky business

Are psychiatrists subject to more violence than doctors in other specialities? by Sonia Sangha

I recently attended Psychiatry as a career: Everything you wanted to know but were afraid to ask at the Royal Society of Medicine.


Some of the lectures not only allayed concerns and myths about psychiatry, but challenged some of my own pre-conceived ideas. In particular, the section, Is psychiatry a risky profession? presented by Dr Mark Salter and Dr Victoria Cohen, was undeniably controversial, with 70% of the audience agreeing that it was. 


Two studies

Dr Salter compared two studies to debate the question he had set out for discussion.


The first (Wyatt and Watt) looked at 100 junior doctors working in Accident and Emergency departments in the U.K. The study found that 18% of doctors, not including duty on-call psychiatrists assessing patients in A&E,  had been assaulted by patients on a total of 23 occasions and that 32% had said that patients had tried to assault them. None of those assaulted received any counselling. Only 11% had received any training on how to manage aggressive patients, although 88% had believed that it would be useful.


The second study (S. Davies) set out to determine the annual rates of assaults and threats to psychiatrists. Over a year, 17% reported one or more assaults and 32% reported one or more threats (see table 1). In this case, 48% had attended a course on dealing with aggressive patients, which 87% had found useful.


Table 1. Frequency of assaults and threats reported by respondents (n=139)




Number of incidents Number of respondents (%)
Assaults 0 115 (83%)
  1 14 (10%)
  2 8 (6%)
  3 1 (%)
  4 1 (%)
Threat 0 94 (68%)
  1 26 (19%)
  2 14 (10%)
  3 3 (2%)
  4 2 (1%)


Davies S. (2001) Assaults and Threats on Psychiatrists. The Psychiatrist, 25, 89-91


Dr Salter concluded that the evidence from these studies illustrated that violence in the mental health population is no greater than that in the general population and the cause of it is likely to be related to the same factors in the two populations. Thus, psychiatry is no more ‘risky’ a profession than other specialities.

Further research presented, showed that substance misuse and psychopathy are often useful predictors of violence in the mentally ill. Often substance abuse and mental illness co-exist. These useful predictors, along with supervision, greater opportunity to attend appropriate courses and supportive colleagues, place psychiatrists in a ‘safer’ position.


Not deterred

Sonia Sangha is a foundation year two doctorIn conclusion, mental illness and violence are often considered intrinsically linked by doctors and lay people alike, often due to skewed media coverage. For example, the misunderstanding of schizophrenia as an illness, demonstrated in Alfred Hitchcock’s film Psycho and schizophrenic patients being portrayed as violent. 


This is being addressed currently by the campaign, Time to Change, after a YouGov poll of 2,010 people found that more than a third held the belief that all sufferers of schizophrenia are violent!


Overall, the meeting was a great success and it fulfilled my expectations. I left feeling that psychiatry is a speciality that has a great deal of uncertainty and complexity about it, but then that is what makes it unique and is the very reason why I am committed to pursuing psychiatry as a career.


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12/10/2011 12:51:49

Seclusion and Human Rights

Todd Kanzara is a fifth year medical student at Newcastle University.

Last resort

Seclusion and Human Rights by Todd Kanzara

Seclusion in psychiatry is controversial. Critics argue that it is draconian and infringes the patient’s human rights whilst supporters assert that it is a last resort measure used to manage the risk posed to others.


The detention and treatment of psychiatric patients in the UK is covered by the Mental Health Act 1983 as amended in 2008. One would assume that the MHA 1983 also covers the issue of seclusion; it doesn’t. Seclusion is only covered in the Mental Health Act Code of Practice 1983 which only provides guidance and as such is not a legally binding instrument. This issue has provoked considerable debate in the domestic courts.


Seclusion is defined as: “The supervised confinement of a patient in a room, which may be locked. Its sole aim is to contain severely disturbed behaviour which is likely to cause harm to others.”


It should not be used:


  • as a punishment or a threat,
  • as part of a treatment programme,
  • because of a shortage of staff,
  • where there is a risk of suicide or self-harm.


Potential for conflict

Todd Kanzara, fifth year medical student, Newcastle UniversityThe potential for conflict between seclusion and civil liberties is undeniable. However, the most pertinent issue is whether perceived infringements engage Articles 3 and 8 of the European Convention on Human Rights.


Article 3 provides that: “No one shall be subjected to torture or inhuman and degrading treatment or punishment.”


Article 3 robustly protects detained patients. It states that any interventions that cannot be justified under therapeutic necessity will breach the article. The patient must show that the interventions in question were not a therapeutic necessity. Therefore, in the absence of evidence that seclusion was unnecessary, it is presumed legal.


Seclusion potentially interferes with Article 8 (1) which provides that:“Everyone has the right to respect for his private and family life, his home and his correspondence.”


This is subject to derogation under specified conditions.


This being the case, it was established in the landmark decision in Munjazi that seclusion is justifiable if there was a threat to public safety, to prevent disorder or crime, to protect health and morals and to protect rights and freedom of others. Their Lordships stressed that used properly; seclusion is not a disproportionate measure because it matches the necessity that gives rise to its use.


The courts recognise the importance of seclusion in psychiatry. Along with this recognition comes a huge responsibility for psychiatric professionals to ensure its use is judicious.


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07/09/2011 10:48:58

The 2011 Institute of Psychiatry Summer School

Fiona Robertson is a medical student at the Unviversity of Dundee.

Getting to know you...

The 2011 Institute of Psychiatry Summer School

27 medical students, spanning from a variety of UK institutions, had the opportunity to converge in London for a week-long Summer School based at the Institute of Psychiatry, King’s College London.


The course kicked off with a warm welcome to the Institute followed by a ‘speed dating’ type session where we got the opportunity to briefly chat with psychiatrists from many sub-specialties, ranging from child and adolescent, psychotherapy, liaison and some of the emerging fields such as neuropsychiatry - a kind of overlap between neurology and psychiatry as it focuses on mental disorders pertaining to diseases of the nervous system (e.g. amnesia and dementia). This session gave us an insight into just how vast the field really is.


A day was spent at the Bethlem Royal Hospital where we learned about forensic psychiatry and also some fascinating history of psychiatry, touring the museum/gallery located there. In addition we met with forensic patients in one of the rehabilitation wards of River House, a medium secure psychiatric hospital. Here, we gained an insight about their experiences of living there; a truly memorable experience.


We were privileged to be lectured by some of today’s leading professionals of psychiatry, such as Professor Simon Wessely, who spoke about The Gulf War and its Aftermath, and Dr Avie Luthra a psychiatrist who devotes much of his time directing films such as Lucky, which was shortlisted for the Oscars. There truly were some very inspiring speakers, including a psychiatrist who revealed to us their own struggle in overcoming mental illness, showing that anyone, even us high-flying medics, are vulnerable to emotional instability.



As well as expanding our knowledge on psychiatry from an academic perspective, we also experienced the lifestyle of some psychiatrists outside their work and on a night out! We spent an evening in the pub with some psychiatric trainees and a brave few of us went out clubbing in London with them afterwards! Some of us non-Londoners were provided with accommodation at a psychiatrist’s own home (Scotland is rather far to commute to every day!), where we were lovingly catered for (I was lucky enough to be taken to the cinema by the family I stayed with to see the latest Harry Potter film!).


The 2011 Institute of Psychiatry Summer SchoolOur last evening was spent at the Royal College of Psychiatrists, where we were given a guided tour by the Dean of the College. That, along with some lovely food and wine, made for a very pleasant rounding off of a jam-packed week.


Overall, the summer school really opened my eyes to just how varied and fascinating life as a psychiatrist can be. It was a memorable week with many new friends from across the country made and amazing advice gained from some of the UK’s top psychiatrists.


I would certainly say that if you are contemplating a career in psychiatry and want to learn more; the Institute of Psychiatry Summer School provides you with a unique opportunity to experience a real insight into such a stimulating career. They certainly converted me!


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12/08/2011 10:45:53

Mental Health in Humanitarian Emergencies

Kaanthan Jawahar is a final year medical student at King's College London.

Medicine Overseas

Mental Health in Humanitarian EmergenciesA conference held in April at The Royal Society of Medicine, entitled ‘Medicine Overseas’, focussed on the global health challenges faced in post-conflict situations and humanitarian emergencies. Peter Medway, the director of the International Medical Corps (IMC), addressed the issues that surround mental health in such situations.


The IMC is one of the largest non-profit humanitarian aid organisations in the world and they focus their efforts on disaster relief health care, as well as training and development programmes. They currently operate in over 25 countries and look to integrate mental health into their community-based primary health care.


When considering a conflict or disaster zone, it is easy to see why mental health is an issue. Globally, mental illness is the most common non-communicable ‘disease’ and, when compounded with the stressors of disasters and conflicts, the baseline level of mental illness in the locality will rise and those with a pre-existing illness will be subjected to higher levels of stress. The IMC argue that too much emphasis has been placed on the more ‘fashionable’ mental disorders, such as post-traumatic stress disorder, as well as a largely Western focus when delivering treatment.


Kaanthan Jawahar is a final year medical student at King's College LondonThe IMC look to work with the local population to deduce what normality is and how best to return the situation to the normality of that area. By doing this, tribal leaders, local opinions and cultural practices are key in deploying effective mental health care. As such, Peter Medway argues that psychiatric health care must be location and context specific to achieve the best outcome.


He further argued that outcomes are better if psychosocial interventions are deployed in the first instance. He used the example of the IMC food distribution centres in Northern Uganda, where child health care was combined with the formation of mother-to-mother peer support groups. A pilot evaluation has shown this to improve maternal mood.


He also highlighted the lack of awareness of psychiatry in many of the countries in which the IMC operate; and that this is viewed as a developmental opportunity by the IMC. By integrating basic psychiatric care in their initial health care package, working with the few and often highly skilled psychiatrists in the area and training local health care workers, the IMC were able to expand mental health care in Haiti far beyond the initial solitary psychiatric hospital in the country. He also believes that by doing this, stigma surrounding mental health could be decreased and awareness raised in the long term.


Mental health seems to be a largely forgotten area in humanitarian aid missions. Where it is addressed, it typically follows other aid packages as they tend to be viewed as ‘more important’. The focus also seems to neglect local practices, customs and thus presentations of mental illness. This raises further questions about psychiatric diagnostic labels – can DSM-IV/ICD-10 criteria be effectively applied to extreme situations such as those experienced in conflict and disaster zones? In this respect, the way in which the IMC deploys mental health care is admirable. They look to treat symptoms using local knowledge and train the host country’s health care workers so that when the IMC leave the disaster zone, infrastructure remains for continuing care.


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09/05/2011 11:24:41

The Art of Psychiatry

Ashleigh Squire is studying Intercalated BA in Medical Humanities at the University of Bristol.

"Patients need to be heard"

London Psychiatry Trainee Conference A tube strike and a bomb scare hardly provided a promising start for a successful but despite various setbacks, the day was exciting, thought-provoking and fun.


The event was entitled “The Art of Psychiatry” and after an introduction by Dinesh Bhugra, conference speakers ranged from the artist Gemma Anderson and the writer Will Self, to Ruby Wax and Judith Owens who both performed their two-women stand-up/musical comedy show, Losing It. Losing It is Wax’s commentary on her own mental illness and how her desire to become famous was her ‘downfall’. She has controversially claimed that the desire to become famous is an illness in itself, and describes her own experience of this, whilst musing about our ambitious human nature and how we are always looking for something that we never quite find. This was interspersed with haunting yet humorous songs from Judith Owen. Both comical and moving, the performance was very entertaining – a perfect example of the different perspective the arts bring to psychiatry.


Portraits: Patients and Psychiatrists by artist Gemma Anderson Wellcome Trust Arts Award projectGemma Anderson’s artworks were beautifully intricate and delicate etchings of psychiatrists and patients from psychiatric hospitals in South London. The prints were not labelled, meaning that psychiatrists were indistinguishable from their patients, highlighting the universality of mental ill-health. She interviewed each person and the portraits incorporated representations of objects that carried meanings for the subject, together with medicinal herbs used in psychiatric medications. 


Another well-known and respected guest was writer Will Self, who began his career writing fiction and has recently published a ‘fictionalised memoir’. Self’s readings discussed his own experiences of mental illness and theories of psychiatry as social control, ideas shared by Michel Foucault and R.D Laing. The day was rounded off with a plenary chaired by Dr Tim McInerny, involving some of the day’s contributors, including the playwright, Nell Leyshon. Three members of Nell’s creative writing group for service users performed some of their own fantastic poetry, providing powerful and emotive accounts of anger, suicide and hope. A common theme resounded throughout: that patients need to be heard. The arts, be they poetry, film, graphic novels or music can aid both patients and doctors in addressing this need. They can help patients cope with their illness and help us as professionals to begin to understand their experiences.


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