My mum, the liaison psychiatrist

Akshita Brahma is one of millions of students whose exams were upheaved by the COVID-19 outbreak. Forced to adapt to this new and stressful reality, she turns to her mum, liaison psychiatrist Dr Sanjukta Das, to find out how the pandemic has also posed major challenges for mental health professionals – and how they’re overcoming them.

Sanjukta and her daughter Akshita

Convoluted examination processes are simply one element of the calamity that COVID-19 has brought upon the nation. From a student’s perspective, it’s been sheer pandemonium: our exams, parties and social calendars have been completely uprooted. Although this lifestyle is slowly becoming our new normal –and for the sake of my own and other’s health, I have learned to embrace it – I thrive on interaction, and I found the change somewhat difficult at first.

Of course, there are very few people that haven’t been affected by the pandemic, and many whose existing mental health problems have been made worse. Both my parents are medical consultants supporting society’s most vulnerable, who – in front of my eyes – were transformed into frontline COVID warriors. My mum, who works as a liaison psychiatrist, has faced many new challenges due to COVID-19, from coordinating crisis responses online, to trying to connect with patients whilst wearing PPE.

As someone who is passionate about mental health – especially now, given my own experiences – I was keen to find out how she is coping, how her work has changed, and how the workforce has been forced to handle this disruption.

So, Mama, can you tell me what a liaison psychiatrist is? And what one does?

Liaison psychiatry is about providing mental healthcare in physical healthcare settings, like hospitals and primary care facilities. It is about treating the mind and the body together. This is key to ensure that patients can access the right care, in the right place, at the right time.

We have expertise in the assessment and treatment of mental illness when the patient is also being treated for physical illness. This combination often presents the most complex of cases for us to solve – for example, you might find us treating patients with medically unexplained symptoms, or those whose mental ill health is preventing their physical recovery.

Liaison psychiatry services are also sometimes known as ‘psychological medicine services’. They are made up of multidisciplinary teams including liaison psychiatrists, liaison psychiatry nursing staff, clinical and health psychologists, healthcare support workers, occupational therapists, social workers and pharmacists.

When you go to work, what does a typical day look like for you?

One of my favourite aspects of being a liaison psychiatrist is that each day I wake up not quite knowing what sort of cases I will face. Each day is a mystery!

The day begins with a handover of what happened overnight, and a briefing on any ongoing cases. During my working hours, the day develops into a plethora of different, challenging situations in the hospital – with psychiatric referrals, often urgent, from A&E, inpatient wards and the outpatients’ clinic. My entire day is spent assessing, formulating and planning a route of action for the referred cases, frequently within tight time-frames.

In order to do this successfully, we have to be like detectives almost, digging up background and collateral information and sifting through the elaborate history of the service user. It is crucial to manage the crisis that caused the admittance of the patient in the acute hospital.

The hardest part of my role is diagnosing overlapping illnesses from a complex presentation of symptoms – and then knowing what to treat first. Putting a feasible plan of action in place is demanding, but plenty rewarding.

If needs be, we also establish a follow-up plan after the service user is due to leave the hospital, which involves engaging the appropriate service, and creating a suitable management plan for the physical, psychological and social aspects of the service user’s conditions. Some days it is possible to be overwhelmed by referrals – in the same way that other days can be quieter.

As much as this is a very immersive and high intensity job, I feel privileged to be able to provide a specialised service with my team. It is an honour to be able to make a difference, listening to people’s stories and creating a positive impact, especially in a time of crisis.

… And then you come home and make us dinner?! Woah. What exactly happens when someone comes to you in an emergency? What sort of support do they need?

When a service user arrives in an emergency, they are quite often a risk to themselves or others. This is the bitter truth of many crises – it keeps us on our toes and means that we have to de-escalate the situation as quickly and effectively as we can.

This requires the most efficient team coordination within the healthcare systems. These emergencies call for the utmost support of a series of professionals – right from the moment they step into the hospital, where they might come into contact with a triage nurse or foundation doctor, to when they rejoin the community, for instance, and someone like me is putting the appropriate management plan into place.

You do this everyday? If it was so fast-paced before, how has the pandemic changed this?

Due to the nature of COVID-19, government guidelines encouraged people to remain safe at home, unless a life-threatening emergency was to arise. In this branch of psychiatry, the majority of the emergencies we face have the potential to be fatal. But still, appointments, meetings, and genuine human connection is crucial to our role in the hospital and in people’s lives, and to have COVID-19 snatch these things from us was fairly detrimental to our work.

Nonetheless, our service introduced a 24/7 helpline for patients, that they could access in times of crisis. The First Response team – made up of clinicians – could provide immediate support to patients, and refer them to our team for further assessment. The helpline has been a success: it’s enabled psychiatrists and clinicians to continue their journeys with service users to recovery, and support them in a time where it is predicted that there will be a surge in mental health decline.

It is imperative that everyone takes care of their mental wellbeing at all times regardless of whether or not they need extra guidance on how to do so. But when a pandemic calls for societal restrictions away from family and friends – on top of a socioeconomic crisis – those who are already predisposed to mental illness, or have circumstances that have caused an unhealthy mind, really benefit from support from a psychiatric service. Taking this service away was very tough on those who rely on it, and so the new measures to help bring it back were incredibly important to establish as early as possible.

Another aspect that changed is that a lot of my meetings – for instance, the daily morning meetings and briefings that help keep the healthcare workers safe – are done online now. This in turn means that we are still being as productive as we can, whilst juggling face-to-face time and online time!

You mentioned how important genuine human connection is to your work. What is it like wearing PPE, and how do service users react when they see you wearing it?

Wearing masks and such continually was a new experience and – despite its benefits – it presented new challenges for us.

To begin with, we weren’t able to see all our patients in person in the first place. For those that we could, mask-wearing made introducing and familiarising ourselves with service users more difficult, even though we were able to overcome this in part by using our identification badges. This new way of building a rapport and a relationship is time-consuming, and it infringes on our ability to gauge symptoms – but we must protect each other from this virus. Consequently, service users faced adversity when attempting to express themselves, which called for ample reassurance and care.

Elsewhere, video consultation is very helpful in allowing us to contact those who are shielding, for instance, or for whom it isn’t a necessity to come in. As you can imagine, introducing an unfamiliar medium of pursuing the service user’s healing was a task in itself. Keeping all those using the system up to date with technology updates, following the ever-changing government guidelines and, most importantly, curating the perfect answers and solutions when our entire examination and assessment format had been altered was… challenging!

Each case and each day brings about more clarity on how our service is accommodating these changes, and as we fight COVID-19, we will strive to take on the mental health epidemic with just as much urgency.

This is really important work you do Mama… but it sounds seriously demanding. How do you switch off after a tough day? More importantly, how do you prevent a burnout?

Finding that work-life balance is essential, especially in a field such as my own. I have a rather busy non-medical schedule, keeping busy with activities that rejuvenate me such as being a mother and enjoying all the other relations and roles I have, taking quality time with my family and friends etc.

Personally, cooking is a form of therapy for me. There is just something about homemade food, and being able to feed my family, that is incredibly satisfying. Keeping connected to my friends and family assures that I have a low-pressure environment to relax in, and it brings me joy to fulfil the other roles in my life aside from the one of Dr Das.

Maintaining my bond with my ethnic background is another factor that allows me to switch off. I contribute regularly to various events and gatherings, organised to celebrate the heritage and diversity of the East of India, which is where I grew up. I love being involved in such a multitude of things, and that sustains me.

Being a liaison psychiatrist is only part of who I am, and in order to execute my job to the best of my capabilities, I need to look after myself first. Often, my biggest stress-busters are both my kids and my husband! I prevent burnout through taking time out and reconnecting with things I enjoy on a daily basis, and by finding gratification in the smallest of things. I spend plenty of time driving, therefore, plenty of time listening to the radio, laughing and singing along, or sometimes listening to podcasts about spirituality or other positive and lighthearted themes.

Surrounding psychiatrists inspire me everyday – especially the many empowered women and psychiatrists from minority backgrounds who contribute so heavily to the wider society, whom I have had the pleasure of encountering in my time. They help keep me motivated and focused on my professional and personal goals as a doctor and a homemaker, which make me strong and will always need nurturing. Networking in this way is a lifeline, and is such a beautiful and collective way to bring vitality to numerous individuals at once.

Your passion astounds me! I’m eager to know why you chose liaison psychiatry in the first place...

In short, because of its complexity. The cohesive nature of working with many specialities and interacting with different forms of the health service intrigues me.

I have always felt that working with other specialty doctors opens a door where we can explore one another’s area of expertise in ways that otherwise we may have been unable to. Working as a liaison psychiatrist gives me the scope to see psychiatry through a different lens, from the bigger picture point of view rather than a cocooned glimpse of such a broad faculty.

I was first introduced to the subject at postgraduate level in India, which instigated my curiosity, cultivated by a year of research. Once the opportunity arose, I was determined to chase this passion, and the rest is history!

Speaking of history, to conclude I must ask... if you could change the service in some way, what would you do?

I think I’d want to find more innovative ways to manage crises. There is always room for improvement. Using technology is important – focussing on psycho-education for the general public, through the use of social media and the unlimited power that we hold at our fingertips!

I’d want to find new ways of using technology to craft meaningful structures of support and education that are widely and easily available, and hold the dexterity to create a more sustainable community. I believe this would lead to taking pressure off the healthcare system, and would equip all members of society to help themselves and make better choices overall. That is the dream after all, isn’t it?