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Job planning in rehabilitation psychiatry
Learn about the structure and activities specific to rehabilitation psychiatry and read guidance regarding what would constitute an acceptable job plan.
Rehabilitation psychiatrists work with people with long-term and complex mental health problems, the majority of whom have a diagnosis of schizophrenia or other types of psychosis.
People who require mental health rehabilitation are those whose problems are of such complexity or severity that they are unable to be discharged home following an acute admission or whose needs cannot be met by general adult services in the community.
These difficulties include treatment resistance (non-response to first-line medications), cognitive impairment (most commonly affecting executive function and verbal memory), pervasive negative symptoms (e.g. apathy, a motivation, blunted affect), and/or co-existing problems (e.g. substance misuse, pre-morbid intellectual disability, developmental disorders such as those on the autism spectrum).
These complex problems contribute to major impairments in social and everyday functioning and may lead to challenging behaviours that impede recovery and increase the risk of adverse outcomes. Significant long term physical health problems are also commonly present.
Consultants in rehabilitation psychiatry have expertise in the assessment and long-term treatment and management of this complex patient group. They adopt a biopsychosocial approach that embraces recovery-oriented practice. They work within multidisciplinary teams in a variety of settings, such as:
- inpatient rehabilitation wards (including: high-dependency rehabilitation units; community rehabilitation units; longer term high dependency rehabilitation units; highly specialist rehabilitation units)
- community mental health rehabilitation teams.
In addition to the general roles of the consultant, the consultant in rehabilitation psychiatry has the following specific expertise:
Detailed assessment and management of patients with complex psychosis. This includes:
- expertise in medication management for treatment-resistant conditions
- physical health screening and medical liaison with colleagues in primary and secondary care
- appropriate use of mental health and mental capacity legislation, safeguarding processes, and the Court of Protection
- detailed knowledge of local mental health supported accommodation provision
- expertise in managing patients’ transitions between different settings.
- providing second opinions and advice to colleagues on the diagnosis and management of patients with complex mental health needs.
- support and advice to services that provide supported accommodation and complex community care packages for people with complex mental health needs.
- The consultant in rehabilitation psychiatry uses their leadership skills alongside their experience in conflict resolution and good communication in everyday clinical practice to manage the challenges of working with other agencies and services when dealing with patients with complex needs.
- Rehabilitation psychiatrists use their clinical leadership skills to facilitate successful partnership working with voluntary sector agencies that facilitate social inclusion, including those that provide supported accommodation, education, vocational training and employment.
- Rehabilitation psychiatrists should be part of local funding processes to ensure the appropriate placement of patients in facilities that are tailored to their needs, that opportunities for local treatment and support have been fully explored prior to a placement being made out of area, and that there is ongoing review of an individual’s suitability for local repatriation at the earliest opportunity (if they are sent away).
SAS psychiatrist job plans should follow the same principle as above. The College supports 8 DCC; 2 SPA for both speciality and specialist psychiatrists. The model job plan for SAS psychiatrists should reflect the 0.5 SPA difference, which should be added to patient facing DCC.
If the SAS doctor does not have formal or informal educational responsibilities in relation to resident doctors, medical students and other health professionals, the specific time allocated for this in the consultant model job plan should be added to DCC activities for either patient reviews or for liaison with families/carers/other professionals in relation to patient care as appropriate to the service and their role in the team.
Factors that should be taken into consideration in a job description include the following:
Workload expectations will vary according to the degree of complexity of patients in the particular service, the proportion of patients subject to compulsory treatment, ,and the staffing of the rest of the team, including the amount of CT1–3, ST4–6 and S time. The geographical spread of services also needs to be considered given the importance of having both community and rehabilitation consultant provision in all catchment areas.
Bearing these issues in mind, we suggest the following summary guide to the direct patient contact time required for a consultant in rehabilitation psychiatry.
| Description | Professional activities |
|---|---|
| High-dependency inpatient rehabilitation unit (average 14 beds, most patients on compulsory treatment, average length of stay 12 months): direct patient care, referral assessment and meeting, in-reach to acute wards, MDT meeting, care review meetings, family interventions, mental health legislation work, clinical administration: | 7.5 |
| Long-term high-dependency rehabilitation unit (average 14 beds, most patients on compulsory treatment, average length of stay >2 years): direct patient care, assessment of referrals, care review meetings, family interventions, mental health legislation work, clinical administration | 6 |
| Community rehabilitation unit (average 14 beds, may have patients on compulsory treatment, average length of stay 18 months): direct patient care, care review meetings, assessment of referrals, family interventions, mental health legislation work, clinical administration | 4 |
| Community rehabilitation team (average case-load 80, some patients under CTO): direct patient care, home visits, care review meetings, weekly MDT meeting, family interventions, mental health legislation work, clinical administration | 7.5 |
| Other specialist tasks: assessment of patients placed out of area and attendance at their care review meetings, membership of placement funding panel (usually monthly), assessment and advice to colleagues regarding patients with complex needs, assistance to supported housing providers. | 1 |