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

The on-call experience

Being on-call for a medical specialty and providing round the clock care is a unique and challenging experience. As a trainee, it is probably the arena where most professional development occurs, often out of necessity. In psychiatry you work independently from the very beginning of training and you gradually learn how to contain your own anxiety, when to seek support and how and when to take decisions for which you are clinically responsible.


A wide variety of psychiatric referrals are made, many originating from the emergency department. As a psychiatrist, you can feel like a guest and the welcome can be variable. However, you are an ambassador for mental health services by default and, by demonstrating a professional attitude and showing a willingness to discuss clinical matters with referring staff, there is a chance to address the underlying stigma still associated with psychiatry (and those people who self harm in particular).


Prolonged exposure confers a sense of what is understandable behaviour in response to life situations, and what is less so. More than any other specialty, you look down the telescope of life and, if you do enough assessments, you will access all layers of British society and realise that good mental health is important to us all. In return for the privilege of exploring the intimate details of peoples’ lives, you will field diverse and challenging questions from patients and their families alike. In the absence of a textbook to refer to, you need to develop an ability to think on your feet. As well as being asked directly what is wrong with them and the world at large, you may be asked to intervene personally in peoples’ lives, be issued ultimatums about being admitted into hospital and be invited to ease an individual’s responsibility for their actions. Many such questions do not have a straightforward answer and, if this sounds daunting, it is worth remembering that we tend to underestimate the simple act of listening.


Being on-call in psychiatry is a rich experience. Mental distress and disorder can be seen to have their roots in peoples’ real and imperfect lives and you are reminded that we are complex, social animals. As Engleby surmised when considering his own mental health problems, “my own diagnosis of the problem is simple. It’s that I share 50% of my genome with a banana and 98% with a chimpanzee. Bananas don’t do psychological consistency, and the tiny part of us that’s different - the special homosapiens bit - is faulty. Sorry about that” (Faulks, 2008).


Dr David Brunskill

Specialty Registrar in forensic psychiatry


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