What to expect of your psychiatrist in the
UK?
What is a psychiatrist?
A psychiatrist is a medically-qualified practitioner who will
have spent 5-6 years training as a doctor. He or she will then have
worked as a doctor in general medicine and surgery for at least a
year. He or she will then have had at least 6 years of further
training in helping people with psychological problems.
What are a psychiatrist’s special skills?
All psychiatrists will learn how to:
- assess a person's state of mind
- use the “biopsychosocial” model of understanding. This
emphasises the importance of a person's past experiences, family,
culture, surroundings and work as well as any medical
features.
- diagnose a mental illness
- use a range of psychological treatments
- use a range of medications
- help a person recover
As well as these 'core' skills, a psychiatrist will specialise
and develop skills in working with the particular problems that
affect different groups of people.
For example:
- a general adult psychiatrist needs to develop skills in talking
with people who have disordered thinking and hallucinations.
- a child psychiatrist will usually develop skills in
working with families and with the special needs of children.
Where do psychiatrists work?
These days, NHS psychiatrists work across a whole range of
places – from the street (literally) to specialist hospital units.
However, most work in community mental health teams, out-patient
departments and hospital wards. Some do sessions in general
practices.
How do they work?
Psychiatrists sometimes see patients on their own in an
out-patient clinic. More often, they work as part of a team with
colleagues from other professions such as nursing, social work,
psychology and occupational therapy.
The team will ask the psychiatrist to see patients, either on
their own or with another member of the team present. The
psychiatrist will also work as a consultant to the team, discussing
people's individual mental health needs and working out how to best
manage them.
The psychiatrist will also review patients with other team
members in their regular team review meetings.
How would I get to see a psychiatrist?
Usually your GP will need to refer you. Quite often, the first
person you will see is a nurse, a social worker or an occupational
therapist from the community mental health team. They will usually
decide with you whether you need to see the psychiatrist. Some
specialist teams accept referrals directly from families, social
workers or voluntary groups.
What might a psychiatrist ask me about?
A psychiatrist will ask you about the problem that has brought
you to see them. They may also ask about anything that has happened
in your life, your thoughts and feelings and your physical health.
This is so that he or she can get a thorough understanding of your
situation.
What might a psychiatrist recommend?
- Psychological treatments
- Medications
- Practical ways of dealing with an illness
- Practical ways to stay well
- Ways to get active, see other people and get back to things
you like doing.
What can I ask the psychiatrist about?
You might want to ask about:
- Your diagnosis (if any)
- How your psychiatrist has made sense of your situation
- How best to sort out your problems
- Your care plan
- What to do in an emergency, or even just if your situation
changes
- Information about your diagnosis, treatment or recovery. This
might include websites, books or leaflets
- Local self-help groups
You should be able to get some of this information from other
members of the mental health team.
Can a psychiatrist make me go into hospital, even if I don't
want to?
A psychiatrist is always involved in the decision to admit
someone to hospital against their will, but cannot do it on his/her
own. An approved social worker always has to agree that this needs
to be done and, in nearly all cases, another independent doctor
also need to agree that this needs to be done.
You may want to make an advance directive to say what you would
like to happen in the future, should you become unwell.
What not to expect from your psychiatrist
A psychiatrist may need to feel
your pulse at your wrist, take your blood pressure or look into
your eyes with an opthalmoscope. He or she will not usually need to
do a physical examination for which your clothes need to be
removed. Any physical problems that need this should normally be
dealt with by your GP. The only exception to this would be if you
were admitted to hospital for a mental health problem. In this
case, the admitting doctor, usually a junior doctor, should do a
complete physical examination.
- A “special
“relationship
- A psychiatrist should
not be asking to see you outside normal clinic hours or when there
are no other staff around.
- As with all other
doctors, sexual relationships between a psychiatrist and a patient
are completely forbidden.
Produced by the RCPsych Public Education Editorial Board.
Editor: Dr Philip Timms.
© August 2008 Royal College of Psychiatrists.
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