What to expect of your psychiatrist in the UK

A psychiatrist is a medically-qualified practitioner who will have spent 5-6 years training to be a doctor. They will then have worked as a doctor in general medicine and surgery for at least a year. They will then have had at least 6 years of further training in helping people with psychological problems.

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.

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.

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.

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.

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 they can get a thorough understanding of your situation.

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.

A psychiatrist is always involved in the decision to admit someone to hospital against their will, but cannot do it on their 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. Your psychiatrist, GP or community nurse should be able to advise you on this if you are interested in setting one up.

Physical examination

A psychiatrist may need to feel your pulse at your wrist, take your blood pressure or look into your eyes with an opthalmoscope. They 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.

Some people believe psychiatrists are immediately 'psychoanalysing' them whenever they meet. This can make people feel under pressure when they meet a psychiatrist. Psychiatrists do not analyse people in this way. Psychoanalysis is only done by specially trained psychotherapists in proper therapeutic setting which a patient has agreed to.