Background to general adult psychiatry
As those who work in this field are
becoming more “specialist” and less “generalist” so the name seems
to change. Most commonly, general adult psychiatry is now
referred to as “working age psychiatry” as it covers people between
the ages of 17 (or sometimes 18) and 65 years. This remains
confusing though as other specialties also treat people of working
age depending on the problems they present with. However, within
general psychiatry a wide range of disorders are treated. These
include manifestations of “organic” brain disorders such as
Huntington’s Disease, psychoses such as schizophrenia, severe or
difficult to treat depressive illness, and personality disorders.
The wide range of disorders and problems encountered necessitates
close working with other agencies such as social services and the
police and clear effective team working within the mental health
field. More so than ever, the psychiatrist works as an integral
part of the team.
Within general adult psychiatry
specialisation is developing. Assertive outreach teams work with
people who, usually having a psychotic illness, find it difficult
to engage with standard services and would, without persistent
effort from professionals, require frequent admission to hospital.
In many areas of the country, psychiatrists are specialising into
different areas. Some work solely with inpatients and others solely
in the community – the challenges are often different and require
different skills in different measures. Crisis resolution teams are
now widespread. They assess the needs of people with acute mental
health problems and provide an alternative treatment plan to
In addition to specialising as a
result of how or where we deliver services, there are other areas
of subspecialisation. These include rehabilitation (or recovery)
psychiatry, liaison psychiatry, addictions, eating disorders and
perinatal psychiatry. All require a subtly different mix of skills
and knowledge base.
Our understanding of the disorders
we treat is developing as are the treatments themselves. We are
also understanding better how to deliver those treatments
effectively to those who need them. This is therefore a rapidly
changing area of psychiatry and one that will allow significant
personal development for those within it.
I made up my mind at an early age
that I wanted to be a psychiatrist. As soon as I qualified as
a doctor, I began my postgraduate training. I have been a
psychiatrist at a time of tremendous change. When I started my
career, old-style Victorian institutions were still commonplace.
They have been closed and replaced by modern residential
services. The big change has been in the development of
community-based services, where we aim to see patients in, or as
close to, their own homes as possible. Some of the changes
have been made possible by the advances in our knowledge. For
example, when I started, only a few drugs were available. Now, they
are much better and have fewer side-effects.
My work benefits from the
involvement of the multidisciplinary team with which I
work. The team consists of psychiatrists, community
psychiatric nurses, occupational therapists, social workers,
pharmacists and so on. This is a positive step, as no single person
can hope to meet all the needs of patients.
It can be a challenging job, for
example when I have to detain a patient against their
will. Training and experience gives you the confidence to
weigh up what is in the patient’s best interests despite their
My job is helped by having good
listening skills and empathy as I work with patients with a wide
range of problems. One of the other things I like in
psychiatry is that diagnosis is based on talking with people –
skills and knowledge count because you can't call for a blood test
to help you!
The most satisfying part of my job
is to see patients improving. It is so rewarding to see this happen
and to know that you have been able to make a difference to their
After all this time, I have never
had a single day's regret about my career choice. I highly
recommend choosing psychiatry as a career.
Consultant psychiatrist, Leicester
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