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 ReachOut.com 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).

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?

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.

Bursary opportunities

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.

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

The 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.

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

Weekend events

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; 21^st 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.

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.

References

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 1^st 2012)

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

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

Social networking

I 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.

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.

Potential

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.

References

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

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

Unique aspect

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

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.

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.

Philip Rankin is a medical student at the University of Birmingham

Mix of students

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.  

Verdict

So 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 psychsoc@hotmail.com if you wish be informed of upcoming events such as this.

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

Poverty

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.

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.

References:

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).

Dr Emma Brandish is a foundation year two doctor 

Single best decision

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.

Award

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

Post 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.

Dr Alan Spratt is a foundation year two doctor 

Four months

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

However, 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. 

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

Larger than life

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.

Inspired

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.