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

General adult psychiatry

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 hospital admission.

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.

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Personal perspective

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 expressed views.

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 lives.

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.

Deenesh Khoosal

Consultant psychiatrist, Leicester

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