Higher Specialty Curricula 2022

(pending GMC approval and subject to change)

CCT Specialty Curricula 

Child and Adolescent Psychiatry (2022)

Child and Adolescent Psychiatrists assess and treat children and young people presenting with a wide range of mental health and developmental disorders. A Child and Adolescent Psychiatrist recognises the different clinical presentations across the age-span and developmental stages, from infancy to the onset of adulthood, and work with parents/carers for the child as appropriate.1 They work across age-related transitions, or service transitions with other psychiatric specialties when appropriate, and work within the systems and networks related to the child, which will include general practice and paediatric services. The Child and Adolescent Psychiatrist has the specialist knowledge to recognise the developmental changes in children and young people’s competency and capacity to make decisions about their treatment. 

It is clear that the need for child and adolescent psychiatrists across the psychiatric specialties is growing throughout the UK.2,3,4 The NHS Digital Survey (2018) showed that 1 in 8 children had a mental disorder; an increase from 1 in 10 in 2000.5 It is highlighted that 50% of all lifetime cases of mental disorder have origins in childhood or adolescence, by the age of 14.

The survey highlights an overall increase in the prevalence of emotional and behavioural disorders,7 emphasising a high rate of self-harm in teenage girls (1 in 4 of 17-19 year old females are reported to self-harm7). An increased rate of suicide has also been stated.

Higher rates of mental health needs were similarly described in young people who were using social media regularly. In particular, there is growing evidence demonstrating the link between higher mental health needs and morbidity, with increasing amounts of ‘on screen’ time.

Speciality training in Child and Adolescent Psychiatry usually begins with recruitment to the training programme after successful completion of Core Psychiatry training and the RCPsych examinations (MRCPsych). It is recommended that Child and Adolescent Psychiatry training is undertaken over an indicative 36 months (Whole Time Equivalent) in order to achieve the required capabilities and gain the necessary experience for entry on to the specialist register. The purpose of this training curriculum is to enable the Consultant Child and Adolescent Psychiatrist to specialise in the assessment, diagnosis, treatment and management of mental health and developmental disorders in children and young people (0-18 years of age). This includes evidence-based person-centred holistic (which includes biological, psychological and social) interventions, as well as preventative strategies, in a wide range of clinical settings in Child and Adolescent mental health services.  

These include community child and adolescent mental health services (CAMHS), crisis and home treatment, inpatient and other Tier 4 CAMHS , as well as other settings such as acute and community paediatric settings, primary care and local authority services. 

The curriculum builds on the clinical capabilities attained in Core Psychiatry training such as advanced communication and interpersonal skills, examination skills, diagnosis and treatment, to a mastery level. It also involves the further development of capabilities such as leadership and management, teaching, research and quality improvement. 

This curriculum provides a framework for training. It enables the achievement of essential specialty-specific clinical and generic professional capabilities through development of the professional values, behaviours, knowledge and skills required in order to provide high-quality, evidence- based care for children and young people. 

Trainees will rotate through a variety of approved Child and Adolescent Psychiatry posts to ensure experience and competence in a variety of clinical settings. A Consultant Child and Adolescent Psychiatrist will be able to work with and manage mental health conditions for the whole range of children and young people with acute and long-term illnesses. The long-term conditions include neurodevelopmental disorders, such as intellectual disabilities, Autism Spectrum Disorders, ADHD, Tic disorders, and other neurodevelopmental conditions. They would also manage the complex co- morbidity between mental health disorders and neurodevelopmental conditions (e.g. a young person with ASD and an eating disorder/child with ADHD and depression/psychosis). A Consultant may work across settings such as community mental health teams, and in specialised settings, such as CAMHS eating disorder services, CAMHS specific crisis intervention and home treatment services, inpatient units and specialist services for children and young people ‘looked after’ (i.e. children and young people in the care of the local authority). 

This work is underpinned by an understanding of how developmental stages and age impact on clinical presentations. The Child and Adolescent Psychiatrist evaluates the interaction between the child/young person and their various contexts such as family, education and social care and uses this to inform the formulation and management plan. 

Further curricula are available for the following other established psychiatry specialties: 

 

  • General Adult Psychiatry 

  • Forensic Psychiatry 

  • Psychiatry of Intellectual Disability 

  • Medical Psychotherapy 

  • Old Age Psychiatry 

 

Child and Adolescent Psychiatry has limited interdependencies with other psychiatric specialities. During training in Child and Adolescent Psychiatry, a trainee develops the knowledge and skills needed to have overall responsibility for clinical care, team leadership, and understanding governance and supporting structures. 

The indicative 36 months (WTE) spent in training will provide appropriate development of transferable skills and experience (e.g., advanced leadership, emergency psychiatry and complex decision making) as well as specialised skills and experience in Child and Adolescent Psychiatry. The skills and knowledge trainees develop and demonstrate in their training have not changed in this new curriculum. 

Trainees may also undertake dual training with Intellectual (Learning) Disability, Forensic Psychiatry and Medical Psychotherapy, building upon skills from training in Child and Adolescent Psychiatry. These GMC approved dual-training programmes include shared capabilities and combinations of skills and experience for diverse service and population needs. Due to these shared capabilities, dual programmes can be undertaken in less than six years, which would the standard recommended training time for training separately in two psychiatric specialties. Typically, training in the above dual CCT programmes takes an indicative 5 years. 

The Child and Adolescent Psychiatry learning outcomes are mapped to the Generic Professional Capabilities Framework (GPCs) ensuring ease of transfer between medical specialties. Through attainment of the High Level Outcomes (HLOs), this curriculum will enable trainees to become Consultants who work in multidisciplinary and multi-agency teams, provide leadership in formulating person-centred systemic management plans and participate in research, teaching and training in a variety of clinical settings. 

This purpose statement has been endorsed by the GMC’s Curriculum Oversight Group and confirmed as meeting the needs of the health services of the countries of the UK. 

By the end of ST6 you will be able to:ThemesKey Capabilities
Demonstrate the professional values and behaviours required of a Consultant Psychiatrist with reference to Good Medical Practice, Core Values for Psychiatrists (CR204) and other relevant faculty guidance.  1.1 Professional Relationships

Work collaboratively with patients, families, carers of all ages and colleagues respecting their autonomy, diversity and valuing their contribution. 

Recognise, validate and actively address systemic and structural inequalities, intersectionality, and their impact on clinical outcomes for patients and their carers of all ages and on working relationships with colleagues. 

Consistently demonstrate person-centred holistic clinical approach to children and young people/patients aged 0-18 years and their families and carers, that is honest, empathic, compassionate, and respects their dignity while maintaining therapeutic optimism. 

Demonstrate flexibility, leadership, use of initiative, prioritisation, and adaptability, effectively managing your time and resources and using new technologies as appropriate. 

 1.2 Professional Standards

Understand the impact of workload, patient factors, and organisational dynamics on your own well-being and help trainees and other colleagues in doing so too. 

Use supervision and reflection effectively recognising your skills, limitations, and your duty of candour. 

Apply strategies to take care of your wellbeing, seeking timely support and guidance, including acknowledging if you have a protected characteristic which might impact on your training or if you are having difficulties adapting to working in the UK. 

Use the method of receiving, reflecting and responding as a clinical leader within the team and actively promote reflective practice as a means of understanding the emotional impact of the clinical work (including trauma, suicide and homicide) on an individual and systemic level. 

Consistently demonstrate a positive and conscientious approach to the completion of your work.  

Make clear, accurate and contemporaneous records. 

Promote CAP as a specialty, including acting as an advocate for patients aged 0-18, and parents, family members and carers of all ages. 

Work with colleagues in a way that demonstrates appropriate professional values and behaviours, in terms of supporting colleagues, respecting difference of opinion, and working as a collaborative member of a team. 

Work autonomously and provide clinical leadership to MDT colleagues within an appropriate supervision structure. 

Demonstrate an understanding of the principles of sustainability and how they underpin sustainable psychiatric practice. 

 

By the end of ST6 you will be able to:

Themes

Key Capabilities

Demonstrate advanced communication and interpersonal skills when engaging with patients, their families, carers of all ages, their wider community, colleagues and other professionals. 2.1 Communication

Consistently demonstrate high level skills (independent practice) in effective communication with children and young people across the age range 0-18, adopting developmentally appropriate techniques in assessment, communication and interaction. 

Consistently demonstrate effective communication approaches with patients and relevant others, including those with neurodevelopmental disorders making reasonable adjustments and adaptations where appropriate, including the use of new technologies. 

Consistently use active listening skills and empathic language which respects the individual, removes barriers and inequalities, ensures partnership and shared decision-making and is clear, concise, non-discriminatory and non-judgemental. 

Demonstrate an adaptable approach which considers communication, sensory and cognitive needs, as well as the ethnic, social, cultural, spiritual and religious context of a patient making reasonable adjustments where appropriate. 

Demonstrate skills in supporting those in whom English is not their first language, including the use of interpreters, and providing information in other languages. 

Collect, assimilate, formulate and share information effectively with others, systemically, in a timely manner. 

Produce specialist reports that are comprehensive, timely, accurate, appropriate to context, and within the limits of your expertise in CAP.  

Effectively ensure active participation and collaboration with patients, families, carers of all ages, and other relevant persons in a variety of clinical and non-clinical settings. 

Manage the impact of different communication styles on patients and relevant others adapting formats tools and technologies to need. 

 Understand the ways in which you, as well as patients and others communicate both verbally and non-verbally (CORE). 

Demonstrate advanced skills in the psychiatric assessment, formulation, diagnosis and person-centred holistic* management of an appropriate range of presentations in a variety of clinical and non-clinical settings within Child and Adolescent Psychiatry. 2.2 Clinical Skills

Demonstrate an appropriate understanding of a person-centred holistic approach to mental disorders, including a knowledge of developmental, genetic and epigenetic risks (including resilience and vulnerability factors) and neurobiological influences on mental disorder. 

Apply expert knowledge of the impact of human psychology, including the importance of early relationships, attachment styles, parenting, adverse childhood experiences and traumatic events on the clinical presentation of children and young people across the age range of 0-18 years. 

Apply expert knowledge of learning and behavioural stages of human development across the age range of 0-18 years, including knowledge of normative as well as variations in presentations, for example with neurodevelopmental conditions, and across cultures and apply this knowledge to daily clinical practice.  

Apply expert knowledge of the social determinants of health, and systemic factors including the “lived environment”; environmental factors, technologies and the impact these have on the aetiology and presentation of mental disorder across the 0-18 years age span. 

Receive a full psychiatric history from the patient and collateral history from a range of informants and perform a Mental State Examination (MSE) across the range of mental and neurodevelopmental as well as neuropsychiatric disorders in the 0-18 age group. 

 Assess patients from a range of different cultural, spiritual, and religious backgrounds, including asylum seekers and refugees, and demonstrate and understanding of how protected characteristics may impact on clinical presentation. 

Conduct a thorough physical examination and undertake and advise on relevant physical investigations. 

Assess the general health of your patients (including consideration of nutritional, metabolic, endocrine and reproductive factors and disorders and the physical and mental impact of substance use and addiction on clinical presentation), taking into account the impact of their physical health on their mental health needs and vice versa. 

Assess independently patients across the age range of 0-18 and establish management plans across a wide range of clinical settings (including Tier 4 services) and wide range of clinical situations (routine, urgent and emergency). 

Apply relevant classification systems to establish a psychiatric diagnosis and differential and use these in a developmentally and systemically informed manner when communicating with patients and others. 

Establish a formulation based on the clinical presentation using an appropriate framework and share with patients and others in a timely and appropriate manner. 

Construct a management plan to ensure continuity of care which manages the risk of self-harm, suicide, risks to others, as well as other risks, and lead on the formulation and review of a risk management plan in collaboration with the patient, parents, persons with parental responsibility, and other professionals involved in the network around the patient. 

Lead on managing the impact of unconscious processes through the provision of supervision and reflection, to ensure that the patient continues to receive safe and effective clinical care. 

Actively promote and help patients and their families/carers to develop self-management strategies and use help from experts by experience. 

Take into account the impact of other health issues (including feeding and nutrition, substance use, and development) in devising safe and effective medication treatment. 

Provide consultation to other professionals regarding the impact of psychotropic medication, psychological and psychotherapeutic interventions for patients in the 0-18 age group in a wide range of situations and settings, and regarding the interaction between physical health and mental health. 

Make independent assessment and seek appropriate consultation regarding other biological treatments for mental disorders.  

Undertake psychotherapeutic assessment and tratment in two evidenced-based psychological or psychotherapeutic modalities. 

Manage the impact of unconscious processes through the provision of supervision and reflection, to ensure that the patient continues to receive safe and effective clinical care. A good way to attain this is via regular attendance at a Balint group or case-based discussion group.

Assess the suitability of psychotherapeutic interventions and their effectiveness especially when used in conjunction with other treatment modalities such as psychopharmacology and other biological/physical treatments. 

Demonstrate an understanding of how physical treatments can be used for the treatment of mental disorders and apply this under supervision. 

Lead on the timely transition of care for patients to different services actively involving patients, based on their person-centred holistic needs and systemic factors and taking into account relevant transition protocols and guidelines. 

Apply advanced management skills within Child and Adolescent Psychiatry in situations of uncertainty, conflict and complexity across a wide range of clinical and non-clinical contexts. 2.3 Complexity & Uncertainty

Recognise and understand unconscious processes, including transference, countertransference, projection and splitting and the impact of these on yourself and others. 

Demonstrate proficiency in recognising and safely managing clinical uncertainty, ambiguity, and complexity in those with mental disorders across the range of clinical contexts. 

Work within the limits of your clinical capabilities, seeking timely support and consultation. 

Demonstrate an understanding of individual variation and the impact of social, cultural, spiritual and religious factors, including effects of deprivation, discrimination and racism. 

Observe, absorb, contain and reflect on complex clinical/non-clinical situations. 

Develop a balanced response as a part of helping other professionals in managing differences of opinion and professional disagreements in complex and uncertain situations. 

Ensure timely review of the formulation and management of the health and care needs of patients when the outcome is not as expected or hoped for. 

 

By the end of ST6 you will be able to:ThemesKey Capabilities
Apply advanced knowledge of relevant legislative frameworks across the UK to safeguard patients and safely manage risk within Child and Adolescent Psychiatry. 3.1 Knowledge of legal and organisational frameworks in your UK jurisdiction 

Apply knowledge of health and care systems, as well as national policies, priorities and national drivers linked with delivery of CAMHS. 

Balance the duty of care to the patient and the protection of others within the framework of human rights when considering the use of legal powers. 

Apply the current legislation governing the care and treatment of children and young people with mental disorders. 

Apply knowledge about the role of parents/ persons with parental responsibilities and the relevant medico-legal frameworks. 

Meet the requirements to apply for relevant statutory approval where appropriate. 

Work effectively within the structure and organisation of the NHS, and the wider health and social care landscape. 3.2 Working within NHS and organisational structures 

 

Provide consultation to others on the complex medico-legal frameworks in CAP and policy changes in the delivery of CAMHS. 

Provide clinical leadership and consultation regarding the complex context of the patient’s developing competence/ capacity as well as their confidentiality, in terms of seeking their consent, active participation and collaboration in decision making about treatments. 

 

By the end of ST6 you will be able to:ThemesKey Capabilities
Demonstrate leadership and advocacy in mental and physical health promotion and illness prevention for patients within Child and Adolescent Psychiatry and the wider community. 4.1 Health promotion and illness prevention in community settings 

Apply knowledge of social determinants of mental health (such as societal health inequalities, the social, economic, cultural, spiritual and religious factors and impact of technology) to promote good mental health. 

Identify and challenge stigma and other barriers to accessing child and adolescent mental health services. 

Collaboratively work with the wider community around health promotion and illness prevention with regards to children and young people addressing health inequalities and the social, cultural, spiritual and religious determinants of health. 

Demonstrate understanding of the national health priorities in your UK jurisdiction, including the rationale behind annual health checks and associated health plans. 

Understand the benefits as well as potential harms and risks inherent in health-care interventions and apply this understanding in working with children and young people. 

Apply understanding of the link between good emotional mental health and quality of life for children and young people. 

Advocate for early intervention to promote health. 

 

By the end of ST6 you will be able to:ThemesKey Capabilities
Demonstrate effective team working and leadership skills to work constructively and collaboratively within the complex health and social care systems that support people with mental disorder. 5.1 Teamworking

Use your understanding of how individual personal qualities, emotions and behaviours impact on teamworking and the quality of patient care. 

Understand team dynamics and use effective negotiation skills to resolve conflict and dysfunction. 

Model, educate and adapt the service, using conflict resolution skills within and between teams, co-producing improvements with patients and carers. 

 5.2 Leadership

Demonstrate an understanding of your own leadership skills and behaviours, the impact these have on others, reflect on and explain decisions in a transparent manner. 

Demonstrate the development and application of your own leadership skills in a variety of clinical and non-clinical settings. 

Demonstrate inclusive leadership style and awareness of the impact of hierarchy and power within relationships with patients and colleagues. 

Demonstrate an understanding of how your own leadership style and approach impact on others, adapting your approach to meet the needs of the team. 

Apply an understanding of approaches and techniques of leadership.   

Mentor and support colleagues to enhance their performance and support their development. 

Appraise the performance of colleagues and escalate concerns. 

Demonstrate leadership in the context of team and multiagency working. 

 

By the end of ST6 you will be able to:ThemesKey Capabilities

Identify, promote and lead activity to improve the safety and quality of patient care and clinical outcomes of a person with mental disorder. 

6.1 Patient safety 

Understand and apply the principles of clinical governance and the impact of ‘human factors’ and team dynamics to assure patient safety and quality of clinical care. 

Advocate for the inclusion of the ‘voice’ of patients and families/carers as an important part of assuring patient safety and quality of services.  

Raise and address issues of patient safety and quality of care in a timely manner. 

 

6.2 Quality improvement 

Understand the role of the voice of the child and young person (‘expert by experience’) in improving patient care. 

Use quality improvement methodologies to identify and implement improvements within your service.  

 

By the end of ST6 you will be able to:ThemesKey Capabilities

Lead on the provision of psychiatric assessment and treatment of those who are identified as being vulnerable within Child and Adolescent Psychiatry.

Demonstrate advocacy, leadership and collaborative working around vulnerability and safeguarding in patients, their families and their wider community.

7.1 Safeguarding

Apply knowledge of the developmental stages of children and young people, relevant legislative frameworks, and systemic sociocultural, spiritual and religious issues, to assess safeguarding needs of patients and others.

Raise safeguarding concerns in a timely manner, with the relevant professionals and agencies, and actively participate in safeguarding processes.

Advocate, educate, support, and supervise colleagues in the recognition of safeguarding concerns, and how to act in a timely manner within relevant local protocols.

By the end of ST6 you will be able to:ThemesKey Capabilities
Promote and lead on the provision of effective education and training in clinical, academic and relevant multi-disciplinary settings8.1 Education & Training 

Provide education and training to medical and multi-agency colleagues including effective planning, delivery techniques and the use of feedback. 

Understand your own training needs and pursue your own continuing professional development. 

Understand the principles of co-production and have the ability to collaborate with children and young people and families/ carers to deliver education and training. 

Demonstrate effective supervision and mentoring skills as essential aspects of education to promote safe and effective learning environments. 8.2 Supervision 

Demonstrate the professional qualities of an effective trainer, teaching and guiding individuals and groups, providing safe and effective clinical supervision in emergency and non-emergency situations or settings. 

Provide clinical supervision and mentoring including those in training and within the multi professional team. 

 

By the end of ST6 you will be able to:ThemesKey Capabilities
Apply an up-to-date advanced knowledge of research methodology, critical appraisal and best practice guidance to clinical practice, following ethical and good governance principles. 9.1 Undertaking research and critical appraisal 

Critically evaluate data, papers, reviews, and meta-analyses and implement findings in daily clinical practice. 

Translate research into local clinical practice and disseminate critical appraisal findings to wider communities. 

Apply knowledge of up-to-date appropriate statistical methods. 

Demonstrate proficiency in the use of objective evidence-based clinical assessment instruments. 

Work within ethical frameworks when carrying out or appraising research. 

Apply the principles of Research Study Protocols where available.  

Demonstrate practical contribution to an ethically approved research study. 

Undertake research or academic activity, including a literature review at a level suitable for publication in a peer reviewed journal. 

 

Forensic Psychiatry (2022)

The purpose of Forensic Psychiatry is the assessment, care and treatment of mentally disordered offenders and others requiring similar services. Risk assessment and management and the prevention of further victimisation are core elements of this. 

Forensic psychiatrists assess and treat patients with mental disorders who have shown a capacity to cause serious harm to other people, which is usually related to their mental disorder. They have often caused harm to themselves and, commonly, others have harmed them. The patients tend to suffer from multiple mental disorders, particularly including severe and enduring mental disorders, and substance use disorders. Treatment is aimed at managing mental disorders but also reducing risk to others and reducing offending behaviour. Patients usually have criminal convictions and enter forensic mental health services from prison. Forensic psychiatrists work most often in secure healthcare settings, but also in the community and in custodial environments, treating patients directly and advising other agencies, particularly criminal justice agencies and criminal courts. Issues of risk occur in all psychiatric specialties, so forensic psychiatrists also provide consultation and advice to their non- forensic psychiatric colleagues. 

The need for psychiatrists across the specialties is growing throughout the UK.1,2 Public Health England states that, in any given year, one in six adults experience at least one diagnosable mental health condition, and that mental health conditions are the second leading cause of morbidity in England.3 It is predicted that there will be 2 million more people with mental health conditions by 2030. 

In 1998 the reported prevalence of mental disorder among male prisoners was twenty times that in the general population, and the rate among female prisoners is even higher. 4 The prison population has risen steadily since the middle of the last century and is forecast to continue to rise over the coming years.5 The rates of psychiatric morbidity among offender populations in the community is also high6, which is reflected in the recent development of a range of clinical services aiming to meet the needs of community offender populations, including criminal justice liaison teams, services to support offenders with mental disorders in the community, and enhanced community forensic psychiatric services. 

The NHS Long Term Plan7 for England is focused on population health systems and forensic psychiatrists will be expected to participate not just in- patient assessment and management, but also in improving clinical outcomes, health promotion, collaborative or integrated care and providing person-centred care. The depth and mastery accessible within the forensic psychiatry training curriculum affords trainee doctors opportunities to achieve these capabilities. 

The Welsh Government’s ten-year strategy to improve mental health and well-beinghas identified a range of measures that are required to ensure equality of care for people within the criminal justice system. These include timely transfer from prison to secure hospitals; development of criminal justice liaison services; timely advice to courts; and multidisciplinary risk assessment and case management. It also advocates the redeployment of resources to develop local secure mental health services in order to reduce out of area placements. 

The Scottish Mental Health Strategy9 identifies a need to increase mental health staffing in prisons in order to improve the mental health of prisoners, including young offenders. It recognises the importance of continuity of care for prisoners’ mental health during the transition back to a community setting. 

In Northern Ireland, where there are higher levels of mental ill-health than any other region in the UK10, the need to develop improved care pathways encompassing secure mental health care and forensic mental health care in the community has been recognised.11 

These current developments in the delivery of mental health care are accompanied by a changing legislative environment: a new Mental Health Act in Northern Ireland is awaiting implementation; a major review of the Mental Health Act in England and Wales has recently been published12 and a review of the Mental Health Act in Scotland is underway. The broad capabilities included within the forensic psychiatry curriculum will enable forensic psychiatrists to adapt to changing healthcare environments in the future. 

Training in Forensic Psychiatry begins with recruitment to and completion of the Core Psychiatry training programme and achieving membership of the Royal College of Psychiatrists. Selection into a Forensic Psychiatry training post is through competitive interview and is an indicative three-year programme (Whole Time Equivalent) in order to achieve the required capabilities and gain the necessary experience. Successful completion of the programme leads to entry on to the specialist register. 

The purpose of this training curriculum is to enable the Consultant Forensic Psychiatrist to specialise in the assessment, diagnosis, treatment and management of mental disorders in adults, specifically those posing risks of violence or involved with the Criminal Justice System. This includes the delivery of evidence-based biological, psychological and social interventions in a wide range of secure and non-secure settings within mental health services. 

The programme builds on the clinical and professional capabilities attained in core psychiatry training, including assessment (including of risk), diagnosis and treatment as well as communication, leadership and management skills, teaching and research, service development and quality improvement. The forensic curriculum also includes capabilities relating to the use of security and relevant legislation to deliver safe and effective treatment, an understanding of the causes of offending behaviour, and the perspective of victims of crime. 

The curriculum provides a framework for training, which enables trainees to attain these essential specialty-specific and generic professional capabilities, through development of the professional values, behaviours, knowledge, and skills required in order to provide high-quality, evidence-based forensic mental health care. 

Trainees will be expected to rotate through a variety of approved training posts to gain experience and capabilities in a variety of clinical settings. Trainees will be expected to undertake acute, unscheduled work while working on-call.  This on-call work will include providing psychiatric support to forensic or non-forensic inpatient or community services, while under supervision of an on-call consultant psychiatrist.  A Consultant Forensic psychiatrist will be able to work with and manage mental health conditions for the whole range of forensic patients, including acute and long-term mental disorders, in health care or custodial settings of any security level or in the community. 

Further curricula are available for the following other established psychiatric specialties: 

 

  • Adult psychiatry 

  • Child and Adolescent psychiatry 

  • Psychiatry of Intellectual Disability 

  • Medical Psychotherapy 

  • Old Age psychiatry 

Forensic psychiatry has interdependencies with other specialties which are limited in number, but which are of significance. As a specialty within psychiatry, there are capabilities which are common to all psychiatric specialties. The recommended three years spent in specialty training will provide for the development of transferable skills and experience as well as specialised skills and experience in Forensic Psychiatry. During training in Forensic Psychiatry, a trainee will develop the knowledge and skills needed to have overall responsibility for patient care, lead a team, manage complexity, respond to psychiatric emergencies and manage the physical health needs of their patients. They will also be able to understand governance and overall structures and know how to use relevant legislation. The skills and knowledge that trainees develop and demonstrate in their training have not changed in the new curriculum. 

Trainees may undertake dual training with another psychiatric specialty, specifically general adult psychiatry, child and adolescent psychiatry or medical psychotherapy. These GMC approved dual-training programmes include shared capabilities and combinations of skills and experience for diverse service and population needs. Due to these shared capabilities, dual programmes can be undertaken in less than six years, which is the standard recommended training time for training in two psychiatric specialties. 

The Forensic Psychiatry learning outcomes are mapped to the Generic Professional Capabilities Framework (GPCs) so the commonalities with other psychiatric specialty curricula and those capabilities relevant to other medical specialties are clear. 

In particular, through attainment of the High Level Outcomes (HLOs), this curriculum will enable trainees to lead and work in multidisciplinary and multi-professional teams, provide leadership and participate in research, teaching and training in a variety of clinical settings. It provides opportunities to develop the expertise to work with patients and understand the need to signpost to other relevant specialties where appropriate. 

This purpose statement has been endorsed by the GMC’s Curriculum Oversight Group and confirmed as meeting the needs of the health services of the countries of the UK. 

By the end of ST6, you will be able to:ThemesKey Capabilities
Demonstrate the professional values and behaviours required of a Consultant Psychiatrist with reference to Good Medical Practice, Core Values for Psychiatrists (CR204) and other relevant faculty guidance.  1.1 Professional Relationship

Work collaboratively with patients, families and carers of all ages and colleagues while managing complex risk and victim dynamics. 

Recognise, validate and actively address systemic and structural inequalities, intersectionality, and their impact on clinical outcomes for patients and their carers of all ages and on working relationships with colleagues. 

Consistently demonstrate and promote in others a holistic approach to patient care that is empathic, compassionate and respectful, while remaining realistically optimistic, honest, mindful of human rights and maintaining boundaries. 

Demonstrate flexibility, leadership, use of initiative, prioritisation, and adaptability, effectively managing your time and resources and using new technologies as appropriate. 

Set and maintain proper professional boundaries with legal professionals, the justice system and other agencies. 

 1.2 Professional Standards

Understand the impact of workload, patient and organisational dynamics on your own and others’ well-being. 

Use reflective practice in supervision effectively yourself, and while promoting and facilitating it for all clinical staff. 

Develop strategies to take care of your wellbeing, seeking timely support and guidance, including acknowledging if you have a protected characteristic which might impact on your training or if you are having difficulties adapting to working in the UK. 

Use the method of receiving, reflecting and responding to understand and manage the emotional impact and public perception of the work on the individual and the team, and the importance of reflective practice in managing this. 

Consistently demonstrate a positive and conscientious approach to the completion of your work. 

Maintain the appropriate professional standards while working clinically, as a leader within healthcare organisations, with justice system partners, and in courts. 

Demonstrate an understanding of the principles of sustainability and how they underpin sustainable psychiatric practice. 

 

By the end of ST6, you will be able to:ThemesKey Capabilities
Demonstrate advanced communication and interpersonal skills when engaging with patients, their families, carers of all ages, their wider community, colleagues and other professionals. 2.1 Communication

Consistently demonstrate effective communication approaches with patients and relevant others, including those with neurodevelopmental disorders making reasonable adjustments and adaptations where appropriate, including the use of new technologies. 

Adapt your style while remaining authentic, to take account of individual communication sensory and cognitive needs, as well as the ethnic, social cultural, spiritual and religious context, and ensure consistently that communication has been effective. 

Demonstrate skills in supporting those in whom English is not their first language, including the use of interpreters, and providing information in other languages. 

Use active listening skills and empathic and respectful language in the context of your own self-awareness to manage conflict, expectations and emotions, while maintaining boundaries and consistency of care and ensuring partnership and shared decision making. 

Demonstrate a high level of clear and salient written and oral communication in clinical and medico-legal settings. 

Consistently demonstrate unambiguous and courteous communication with patients, their families, carers of all ages, colleagues and others, including in the justice system, recognising problematic communication and being able to mediate. 

Understand the ways in which you, patients and others communicate verbally and non-verbally, including communication between organisations or between organisations and individuals. 

Demonstrate advanced skills in the psychiatric assessment, formulation, diagnosis and person-centred holistic* management of an appropriate range of presentations in a variety of clinical and non-clinical settings within Forensic Psychiatry. 2.2 Clinical Skills

Consistently take a person-centred holistic approach to the clinical assessment and management of people with mental disorders who show risk of harm to self or others, whether in hospital, custodial or community settings. 

Demonstrate an appropriate understanding of learning and behavioural stages of human development through the lifespan including awareness of normative as well as variations in presentations, for example with neurodevelopmental conditions and across cultures.  

Understand the ways in which mental disorders or symptoms of mental disorder may be associated with risk or problematic behaviours. 

Demonstrate an understanding of the importance of relational security in providing safe and effective treatment, and its relationship to physical and procedural security. 

Understand the relationships between addiction or problematic substance use, mental disorders, and offending. 

Demonstrate a detailed knowledge of the assessment of risk of harm to others in the context of mental disorder. 

Understand the role of different levels of physical and procedural security in providing safe and effective treatment for mental disorder and apply this knowledge to optimise the care of your patients. 

Understand developmental pathways to criminal behaviour and to mental disorders, including risk factors, protective factors and the importance of adverse childhood events. 

Apply criminological theories to your clinical practice. 

Undertake comprehensive assessments of adults who show risk of harm to self or others and may have a mental disorder, in a range of settings, including secure and non-secure inpatient services, custodial settings and in the community. 

Undertake comprehensive assessments of patients presenting with mental disorder or problematic trait. 

Assess patients from a range of different cultural, spiritual, and religious backgrounds, including asylum seekers and refugees, and demonstrate an understanding of how protected characteristics may impact on clinical presentation. 

Assess and manage the general physical health of your patients, taking into consideration of nutritional, metabolic, endocrine and reproductive factors and disorders, and the physical and mental impact of substance use and addiction and restricted freedom on clinical presentation. 

Use a detailed knowledge of psychopathology and the classification of mental disorders to make a differential diagnosis of mental disorders. 

Assimilate and synthesise person-centred holistic information into a coherent and structured case formulation. 

Use formulation to devise a safe, effective, collaborative and co-productive management plan to ensure continuity of care in the immediate, short and longer term. 

Use restrictive practices appropriately when they are necessary to provide safe and effective treatment for your patients. 

Recognise and work with unconscious dynamics between yourself, your patients and other professionals. 

Develop, and lead the delivery of, a comprehensive treatment plan which includes person-centre holistic interventions delivered by a multidisciplinary team, through the acute, rehabilitation and maintenance phases of recovery from mental disorder. 

Develop, and lead the delivery of, a comprehensive risk management plan, which encompasses health professionals and non-health agencies appropriately. 

Safely prescribe medication and other physical treatments for mental disorder, reviewing and adjusting according to response, in line with the best applicable evidence base. 

Develop and lead the delivery of a comprehensive treatment plan which includes evidence-based psychological therapies for mental disorder and for problematic substance use. 

Lead a clinical multi-disciplinary team in assessing and managing patients who have been charged with serious violent offences from arrest by the police through to final disposal by the court. 

Lead a clinical multi-disciplinary team in managing restricted patients from final disposal by the court towards conditional discharge. 

Practice psychiatry in a prison, taking into account the nature of the prison environment, adapting skills accordingly, and recognising what can and can’t be achieved. 

Apply advanced management skills within Forensic Psychiatry in situations of uncertainty, conflict and complexity across a wide range of clinical and non-clinical contexts. 2.3 Complexity and Uncertainty

Demonstrate an understanding of unconscious processes, including transference, countertransference, projection and splitting and the impact of these on yourself and others. 

Recognise and acknowledge uncertainty, conflicting information and complex co-morbidities and work with others to develop safe management plans to reduce the risk of harm. 

Demonstrate an understanding of individual variation and the impact of social, cultural spiritual and religious factors, including effects of deprivation, discrimination and racism. 

Apply knowledge of ethical theory consistently in clinical practice. 

Manage the complexities of diversity in restrictive settings and forensic psychiatric practice.  

Work effectively across custodial, inpatient and community settings and the justice system, understanding the impact of setting on the presentation and treatment of patients, and managing the interfaces. 

Address complex clinical or non-clinical situations so as to provide a balanced response and contain the anxieties of others. 

 

By the end of ST6, you will be able to:ThemesKey Capabilities
Apply advanced knowledge of relevant legislative frameworks across the UK to safeguard patients and safely manage risk within Forensic Psychiatry. 3.1 Knowledge of legal and organisational frameworks in your UK jurisdiction 

Demonstrate a general knowledge of relevant criminal law, and a comprehensive knowledge of those aspects relevant to mental disorder as applied in your UK jurisdiction. 

Demonstrate advanced knowledge of how clinical services and individual patient care pathways are organised and funded across the healthcare sector. 

Apply, current legislation, case law and procedural rules in your UK jurisdiction governing the care and treatment of people with mental disorders. 

Apply the standards and requirements governing the provision of evidence in medico-legal settings as applied in your UK jurisdiction. 

Apply clinical descriptions to specific legal definitions and tests. 

Recognise the potential for misuse of clinical concepts in a legal context, particularly including the use of classification systems of mental disorder and the communication of risk. 

Meet the requirements to apply for relevant statutory approval where appropriate. 

Work effectively within the structure and organisation of the NHS, and the wider health and social care landscape. 3.2 Working within NHS and organisational structures 

Demonstrate an advanced knowledge of the structure of the prison estate, other custodial environments, and the wider criminal justice system.  

Demonstrate an advanced awareness of the impact of political and social factors on patient care. 

 

By the end of ST6, you will be able to:ThemesKey Capabilities
Demonstrate leadership and advocacy in mental and physical health promotion and illness prevention for patients within Forensic Psychiatry and the wider community. 4.1 Health promotion and illness prevention in community settings 

Apply advanced understanding of the range of factors that contribute towards the development of, and protect against, offending behaviours and mental disorders, including understanding the role of trauma, in clinical practice. 

Identify and challenge stigma and discrimination against people with mental disorders and offending. 

Understand the impact of secure care and non-health custodial settings on health promotion and illness prevention. 

Act as a leader, advocate and educator for health and non-health professionals in promotion and illness prevention. 

 

By the end of ST6, you will be able to: ThemesKey Capabilities
Demonstrate effective team working and leadership skills to work constructively and collaboratively within the complex health and social care systems that support people with mental disorder. 5.1 Teamworking

Apply an advanced understanding of how teams develop and work effectively, including the role of the forensic psychiatrist in the team, while recognising divergent views and resolving conflict. 

Motivate patients and the team to follow treatment plans and maintain realistic therapeutic optimism.  

Work with team feedback to recognise excellence and promote improvement. 

 5.2 Leadership

Provide effective leadership when working with a multidisciplinary clinical team, valuing the leadership of others in the team according to the task in hand. 

Lead, support and supervise others in research and service development  

Demonstrate inclusive leadership style and awareness of the impact of hierarchy and power within relationships with patients and colleagues. 

Provide clinical supervision and mentor colleagues. 

Provide effective clinical leadership and represent a therapeutic perspective when working in prisons and with other non-healthcare agencies.  

Support colleagues, patients, and others following traumatic incidents. 

 

By the end of ST6, you will be able to:ThemesKey Capabilities
Identify, promote and lead activity to improve the safety and quality of patient care and clinical outcomes of a person with mental disorder. 6.1 Patient Safety

Lead effective clinical governance within a clinical team and within the wider service. 

Promote a therapeutic and open culture in secure environments for the benefit and safety of patients and staff. 

Apply the principles of investigating adverse clinical events.  

 6.2 Quality ImprovementUse accepted quality improvement methodologies to identify and implement improvements within your service, including supervising others, and involving patients and other stakeholders. 

 

By the end of ST6, you will be able to:ThemesKey Capabilities

Lead on the provision of psychiatric assessment and treatment of those who are identified as being vulnerable within Forensic Psychiatry. 


Demonstrate advocacy, leadership and collaborative working around vulnerability and safeguarding in patients, their families and their wider community. 

7.1 Safeguarding

Demonstrate specialist knowledge and understanding of factors that may lead to increased vulnerability to harm from others in healthcare, custodial and community settings. 

Work within legislative frameworks and local processes to anticipate and report safeguarding concerns, providing leadership when necessary. 

Demonstrate an advanced understanding of the impact of victimisation and trauma in vulnerable groups. 

Work with others to proactively protect vulnerable people from harm. 

 

By the end of ST6, you will be able to:ThemesKey Capabilities
Promote and lead on the provision of effective education and training in clinical, academic and relevant multi-disciplinary settings. 8.1 Education and Training

Plan, organise and deliver educational and training activities using a range of learning methods for medical, other healthcare or justice system colleagues, or for patients and carers. 

Consistently and proactively work to maintain an effective learning environment in the workplace. 

Demonstrate effective supervision and mentoring skills as essential aspects of education to promote safe and effective learning environments. 8.2 SupervisionProvide safe clinical supervision and developmental feedback to medical and non-medical colleagues. 

 

By the end of St6, you will be able to: ThemesKey Capabilities
Apply an up-to-date advanced knowledge of research methodology, critical appraisal and best practice guidance to clinical practice, following ethical and good governance principles. 9.1 Undertaking research and critical appraisal

Critically evaluate data, papers, reviews, and meta-analyses and implement findings in daily clinical practice. 

Translate research into local clinical practice and disseminate critical appraisal findings to wider communities. 

Apply knowledge of up to date appropriate statistical methods. 

Demonstrate proficiency in the use of objective evidence-based clinical assessment instruments. 

Work within ethical frameworks when carrying out or appraising research. 

Apply the principles of Research Study Protocols where available.  

Demonstrate practical contribution to an ethically approved research study. 

 

  1. Community Mental Health Survey 2018.  NHS Patient Survey Programme statistical release, Care Quality Commission, 2018 

  1. Mental Health Strategy 2017-2027. Scottish Government, 2017 

  1. Making Life Better. Northern Ireland Assembly, 2017 

  1. Evaluation of the 2009-2011 Bamford Action Plan. Dept. of Health, Social Services and Public Safety, 2012 

General (Adult) Psychiatry (2022)


Adult Psychiatrists assess and treat adult patients presenting with a wide range of mental disorders, including psychotic, non-psychotic and organic brain illnesses. They work across age-related transitions or service transitions with other psychiatric specialties when appropriate.  

It is clear that the need for psychiatrists across the specialties is growing throughout the UK.1/2/3 Public Health England states that, in any given year, one in six adults experience at least one diagnosable mental health condition, and that mental health conditions are the second leading cause of morbidity in England.4  

The Welsh Government’s ten-year strategy to improve mental health and well-being5 has identified a range of areas that require attention. This includes providing better perinatal mental health care; ensuring each health board has crisis services available seven days a week; the establishment of effective mental health psychiatric liaison capacity for district general hospitals; and addressing mental health/substance misuse needs of frequent attenders of emergency departments.  

The Scottish Mental Health Strategy6 has identified the need to shift the balance of care towards mental health. 

Northern Ireland has higher levels of mental ill heath than any other region in the UK7 and it has been identified that building up the range of specialist mental health services is required to meet need.8  

The NHS Long term plan9 is focused on population health systems and Adult Psychiatrists will be expected to participate not just in patient assessment and management but also in improving clinical outcomes, health promotion, collaborative or integrated care and providing person-centered care. The depth and mastery accessible within the Adult Psychiatry training curriculum affords trainee doctors opportunities to achieve these capabilities.  

Training in Adult Psychiatry begins with recruitment to the training programme, after successful completion of Core Psychiatry Training and the RCPsych examinations. It is recommended that Adult Psychiatry training is undertaken over 36 months (Whole Time Equivalent) in order to achieve the required capabilities and gain the necessary experience. Successful completion of the programme leads to entry on to the specialist register. 

The purpose of this training curriculum is to enable the Consultant Adult Psychiatrist to specialise in the assessment, diagnosis, treatment, management and prevention of mental disorders in adults. This includes evidence-based psychological, biological and social interventions in a wide range of clinical settings in adult mental health services including inpatient, community, crisis and home treatment. 

It builds on the clinical capabilities attained in Core Psychiatry training such as advanced communication and interpersonal skills, examination skills, diagnosis and treatment to a mastery level.  It also involves the further development of capabilities such as leadership and management, teaching, teamwork, research and quality improvement.  

This curriculum provides a framework for training. It enables the achievement of essential specialty-specific clinical and generic professional capabilities through development of the professional values, behaviours, knowledge and skills required in order to provide high-quality, evidence-based patient care for the adult population. 

Trainees will be expected to rotate through a variety of approved Adult Psychiatry posts to gain experience and capabilities in a variety of clinical settings. A Consultant Adult Psychiatrist will be able to work with and manage mental health conditions for the whole range of adult patients including acute and long-term illnesses, in settings such as inpatients or community mental health teams, and will be able to work in more specialised settings.10 

They would also be able to support the physical health of adults with mental health issues, through health promotion and management of physical health co-morbidities. 

Further curricula are available for the following other established psychiatry specialties: 

  • Child & Adolescent Psychiatry 

  • Forensic Psychiatry 

  • Learning (Intellectual) Disability Psychiatry 

  • Medical Psychotherapy 

  • Old Age Psychiatry 

Adult Psychiatry has limited interdependencies with other specialties. During training in Adult Psychiatry, a trainee develops the knowledge and skills required to have primary clinical responsibility, lead a team, understand governance and supporting structures. 

The recommended three years spent in training will provide appropriate development of transferable skills and experience (e.g., advanced communication, leadership, emergency psychiatry and complex decision making) as well as specialised skills and experience in Adult Psychiatry. 

The skills and knowledge trainees develop and demonstrate in their training have not changed in this new curriculum. Trainees will therefore continue to have the opportunity to undertake sub-specialty training in Rehabilitation, Addiction or Liaison Psychiatry, where patient demand and service need is high,11/12/13 as part of their Adult Psychiatry training programme. 

RCPsych is committed to working with the four countries to strengthen the systems in place to ensure local workforce needs can influence the allocations of areas of special interest. 

Trainees may also undertake dual training with another psychiatric specialty building upon skills from training in Adult Psychiatry.14 The GMC-approved dual training programmes include shared capabilities and combinations of skills and experience for diverse service and population needs. Due to these shared capabilities, dual programmes can be undertaken in less than six years, the standard recommended training time for training in two psychiatric specialties. 

There are numerous shared competencies that a trainee can continue to achieve whilst transferring from other higher speciality training programmes within Psychiatry and these have been mapped. They include most of the high level outcomes inclusive of professional values and behaviours; professional skills including clinical and communication skills and professional knowledge such as legislative powers and safeguarding. Leadership and team working are transferrable, so also education and training capabilities. All trainees will use similar safeguarding knowledge and skills, work on quality improvement and patient safety as priority. Research skills are also readily shared between higher specialties.  

The Adult Psychiatry learning outcomes are mapped to the Generic Professional Capabilities Framework (GPCs) ensuring ease of transfer between medical specialties. Through attainment of the High-level Learning Outcomes (HLOs), this curriculum will enable trainees to lead and work in multidisciplinary and multi-professional teams; provide leadership and participate in research, teaching and training in a variety of clinical settings. It will also enable trainees to gain experience in formulating person-centred holistic systemic management plans. 

It provides opportunities to develop expertise to work with adult patients and understand the need to signpost to other relevant specialties where appropriate. 

Sub-specialty training covers aspects of the Adult curriculum (e.g. leadership, multidisciplinary working, developing expertise in holistic patient care using psycho-bio-social care and working with wider communities and carers) within a subspecialty context. 

This purpose statement has been endorsed by the GMC’s Curriculum Oversight Group and confirmed as meeting the needs of the health services of the countries of the UK. 

By the end of ST6 you will be able to:ThemesKey Capabilities
Demonstrate the professional values and behaviours required of a Consultant Psychiatrist with reference to Good Medical Practice, Core Values for Psychiatrists (CR204) and other relevant faculty guidance.  

1.1 Professional Relationships

Work collaboratively with patients, families, carers of all ages and colleagues respecting their autonomy, diversity and valuing their contribution. 

Recognise, validate and actively address systemic and structural inequalities, intersectionality, and their impact on clinical outcomes for patients and their carers of all ages and on working relationships with colleagues. 

Consistently demonstrate a holistic and person-centred clinical approach to adult patients that is honest, empathic, compassionate, and respects their dignity while maintaining therapeutic optimism and boundaries. 

Demonstrate flexibility, leadership, use of initiative, prioritisation, and adaptability, effectively managing your time and resources and using new technologies as appropriate.  

 1.2 Professional Standards

Understand the impact of workload, patient and organisational dynamics on your own well-being. 

Use supervision and reflection effectively recognising your skills, limitations and your duty of candour. 

Apply strategies to take care of your wellbeing, seeking timely support and guidance, including acknowledging if you have a protected characteristic which might impact on your training or if you are having difficulties adapting to working in the UK. 

Use the method of receiving, reflecting and responding to understand and manage the emotional impact of work on yourself, the individual and the team, including the impact of suicide and homicide. 

Consistently demonstrate a positive and conscientious approach to the completion of your work. 

Make clear, accurate and contemporaneous records. 

Promote the specialism of adult mental health including acting as an advocate for your patients and their carers. 

Maintain the appropriate professional standards while working clinically, as a leader within healthcare organisations. 

Demonstrate an understanding of the principles of sustainability and how they underpin sustainable psychiatric practice. 

 

By the end of ST6 you will be able to:

Themes

Key Capabilities

Demonstrate advanced communication and interpersonal skills when engaging with patients, their families, carers of all ages, their wider community, colleagues and other professionals. 2.1 Communication

Demonstrate advanced interpersonal communication skills in order to appropriately diagnose, formulate and deliver a treatment plan. 

Consistently demonstrate effective communication approaches with patients and relevant others, including those with neurodevelopmental disorders making reasonable adjustments and adaptations where appropriate, including the use of new technologies. 

Use active listening skills and empathic and respectful language in the context of your own self-awareness to manage conflict, expectations and emotions, while maintaining boundaries and consistency of care and ensuring partnership and shared decision making. 

Appropriately and concisely summarise your key findings and communicate these to others. 

Recognise the limitations of assessment where language or cultural influences impact on communication and demonstrate skills in supporting those in whom English is not their first language, including the use of interpreters, providing information in other languages. 

Synthesise complex information and communicate this succinctly and coherently in your written and verbal communications. 

Produce reports that are comprehensive, timely, accurate, appropriate and within limits of expertise. 

Demonstrate proficiency in communicating potentially distressing diagnostic and prognostic information associated with severe and debilitating Mental Disorders with patients, carers and clinicians; develop therapeutic optimism and hope. 

Demonstrate advanced skills in the psychiatric assessment, formulation, diagnosis and person-centred holistic* management of an appropriate range of presentations in a variety of clinical and non-clinical settings within General Adult Psychiatry. 2.2 Clinical Skills

Demonstrate an advanced level of person-centred holistic understanding and approach to mental disorders their presentation and treatment, including taking into consideration gene-environmental interaction, developmental, neuro-developmental, trauma and biological influences. 

Apply an advanced level of knowledge of human psychology, including the importance of early relationships, attachment styles, parenting and becoming a parent, the impact of adverse childhood experiences, traumatic events, and protective factors and their impact on mental disorders in adulthood. 

Demonstrate an in-depth understanding of social determinants of health including the lived environment, deprivation and disadvantage and the impact these have on the aetiology and presentation of mental disorder in adults. 

Apply advanced knowledge of the pharmacodynamics, pharmacokinetics, efficacy, tolerability, interactions, and short and long-term side effects, of all relevant psychotropic medications as appropriate when initiating, reviewing changing or discontinuing regimes. 

Demonstrate proficiency in receiving a full psychiatric history and performing a Mental State Examination (MSE) for patients presenting from the whole spectrum of mental and neurodevelopmental disorders in adults; in routine, urgent and emergency situations and in various different settings (community, inpatient and acute hospitals). 

Assess patients from a range of different cultural, spiritual, and religious backgrounds, including asylum seekers and refugees, and demonstrate an understanding of how protected characteristics may impact on clinical presentation. 

Demonstrate an appropriate understanding of learning and behavioural stages of human development through the lifespan including awareness of normative as well as variations in presentations, for example with neurodevelopmental conditions and across cultures.  

Conduct relevant physical examinations, investigations and follow them up appropriately including further referrals e.g., to specialist teams where necessary. 

Diagnose physical health issues, taking into account nutritional, metabolic, endocrine and reproductive factors and substance use and addiction, considering their impact on mental health. 

Demonstrate proficiency in assessing, formulating, and managing the risk to a patient’s health, safety and the safety of others in a wide range of psychiatric disorders and in various settings. 

Use a detailed knowledge of psychopathology and recognised, relevant classification systems to make a differential diagnosis. 

Demonstrate proficiency in formulating the information that underpins the presentation of the patient using a systemic approach. 

Demonstrate proficiency in devising safe, effective, collaborative systemic treatment and management plans, depending upon the differential diagnoses, comorbidities, reproductive status, clinical situation and risks in an emergency, as well as in the short, medium and long term. 

Apply contemporary knowledge and principles of psychological therapies where appropriate and recommend psychotherapeutic/psychological treatment. 

Demonstrate proficiency in the prescribing and administering physical treatments in Psychiatry, utilising relevant guidelines. 

Demonstrate proficiency in working across interfaces, between psychiatric specialties, other medical and non-medical specialties and services, demonstrating appropriate liaison and collaboration to manage risks. 

Demonstrate proficiency in developing professional therapeutic alliances with patients to enhance treatment compliance and engagement. 

Safely prescribe evidence-based treatment considering recognised guidelines and standards for adult psychiatric illnesses and involving the patient in the decision making.  

Apply advanced management skills within General Adult Psychiatry in situations of uncertainty, conflict and complexity across a wide range of clinical and non-clinical contexts. 2.3 Complexity and Uncertainty

Demonstrate proficiency in recognising and managing clinical uncertainty, ambiguity and divergent views, complex co-morbidities in those with mental disorders. 

Demonstrate proficiency in managing unconscious dynamics including Transference/Countertransference effectively. 

Move beyond single condition guidelines and protocols, where clinically appropriate, in complex situations, for example those of multimorbidity and polypharmacy, while maintaining the patient's trust. 

Work within the limits of your own clinical capabilities and seek timely support where necessary. 

Demonstrate an understanding of individual variation and the impact of social, cultural, religious and spiritual factors, including effects of deprivation, discrimination and racism. 

Consciously vary from established care pathways where clinically indicated and justify these decisions as needed.  

 

By the end of ST6 you will be able to:ThemesKey Capabilities
Apply advanced knowledge of relevant legislative frameworks across the UK to safeguard patients and safely manage risk within General Adult Psychiatry. 3.1 Knowledge of legal and organisational frameworks in your UK jurisdiction 

Demonstrate proficiency in the application of current legislation in your UK jurisdiction governing the care and treatment of people with mental disorder, including the use of emergency powers and compulsory treatment aspects. 

 

Balance the duty of care to the patient and the protection of others with the restriction of human rights when considering the use of legal power. 

 

Meet the requirements to apply for relevant statutory approval where appropriate.  

Work effectively within the structure and organisation of the NHS, and the wider health and social care landscape. 3.2 Working within NHS and organisational structures Contribute to the development of National Health and Care Services.  

 

By the end of ST6 you will be able to:ThemesKey Capabilities
Demonstrate leadership and advocacy in mental and physical health promotion and illness prevention for patients within General Adult Psychiatry and the wider community. 4.1 Health promotion and illness prevention in community settings 

Apply an understanding of the factors contributing to health inequalities, and the social, cultural, spiritual and religious determinants of adult mental health.  

Promote mental well-being and prevention of Mental Disorders within the context of societal change and social technology, identifying and challenging stigma and discrimination against people with mental disorders. 

Demonstrate an understanding of the effect of public health measures relating to mental and physical health.  

Demonstrate proficiency in working collaboratively across agencies to promote mental well-being and quality of life, including in unforeseen circumstances. 

Ensure that appropriate physical health treatments, including optimal nutrition, lifestyle interventions and social prescribing are appropriately used for improving the outcome of treatment of mental disorders.

Participate in the design and delivery of services, taking into account local and national health promotion and illness prevention strategies.  

 

By the end of ST6 you will be able to:ThemesKey Capabilities
Demonstrate effective team working and leadership skills to work constructively and collaboratively within the complex health and social care systems that support people with mental disorder. 5.1 Teamworking

Use your understanding of how individual personal qualities, emotions and behaviours impact on teamworking and the quality of patient care. 

Demonstrate a working knowledge of the roles and responsibilities of, and the interface between multidisciplinary team members, including peer support and peer working.  

Understand team dynamics and use effective negotiation skills to resolve conflict and dysfunction. 

Model, educate and adapt the service, using conflict resolution skills within and between teams, co-producing improvements with patients and carers. 

Actively participate and contribute to the success of a team by working collaboratively with colleagues from diverse backgrounds and experiences and promoting inclusivity. 

Demonstrate proficiency in working with unconscious dynamics between yourself, your patients and other professionals, and be able to manage these within a team. 

 5.2 Leadership

Recognise and appraise the leadership skills of others in various contexts.  

Demonstrate the development and application of your own leadership skills in a variety of clinical and non-clinical settings. 

Demonstrate inclusive leadership style and awareness of the impact of hierarchy and power within relationships with patients and colleagues. 

Demonstrate an understanding of how your own leadership style and approach impact on others, adapting your approach to meet the needs of the team. 

Lead, take charge, and offer opinions and direction. 

Support colleagues to enhance their performance and facilitate their development.  

Competently manage and lead a team/service, providing consultation and specialist advice to team members and other agencies.  

 

By the end of ST6 you will be able to:ThemesKey Capabilities
Identify, promote and lead activity to improve the safety and quality of patient care and clinical outcomes of a person with mental disorder. 6.1 Patient Safety

Understand and apply the principles and systems of clinical governance that assure, promote, and improve safety and quality of patient care. 

Participate in activities that promote reflection and learning from critical incidents. 

 6.2 Quality Improvement

Apply an understanding of the impact of quality improvement activities in improving patient outcomes and system performance.  

Lead on quality improvement activities relevant to your clinical practice, including supervising others. 

Disseminate findings from quality improvement activities, implement and manage relevant change. 

By the end of ST6 you will be able to:ThemesKey Capabilities

Lead on the provision of psychiatric assessment and treatment of those who are identified as being vulnerable within General Adult Psychiatry. 

Demonstrate advocacy, leadership and collaborative working around vulnerability and safeguarding in patients, their families and their wider community. 

7.1 Safeguarding

Apply knowledge of individual and systemic factors contributing to vulnerabilities and safeguarding concerns in people of all ages. 

Work within legislative frameworks and local processes to raise and report safeguarding concerns in a timely manner and contribute to safeguarding processes. 

Demonstrate understanding of the impact of victimisation/exploitation and trauma in vulnerable groups. 

 

By the end of ST6 you will be able to:ThemesKey Capabilities
Promote and lead on the provision of effective education and training in clinical, academic and relevant multi-disciplinary settings. 8.1 Education and Training

Apply understanding of the principles and methods of learning, education, teaching, training and feedback in a variety of clinical and non-clinical settings. 

Identify your own training needs and pursue your own continuing professional development.  

Demonstrate effective supervision and mentoring skills as essential aspects of education to promote safe and effective learning environments. 8.2 Supervision

Demonstrate the professional qualities of an effective trainer, teaching and guiding individuals and groups, providing safe and effective clinical supervision in emergency and non-emergency situations or settings. 

Actively participate in clinical, psychiatric and educational supervision, demonstrating as appropriate effective skills, creating safe and effective learning environments. 

Use supervision and reflection effectively recognising your skills, limitations and your duty of candour. 

Work with increasing autonomy within a framework of supervision. 

 

By the end of ST6 you will be able to:ThemesKey Capabilities
Apply an up-to-date advanced knowledge of research methodology, critical appraisal and best practice guidance to clinical practice, following ethical and good governance principles. 9.1 Undertaking research and critical appraisal

Critically evaluate data, papers, reviews, and meta-analyses and implement findings in daily clinical practice. 

Translate research into local clinical practice and disseminate critical appraisal findings to wider communities. 

Apply knowledge of up to date appropriate statistical methods. 

Demonstrate proficiency in the use of objective evidence-based clinical assessment instruments. 

Work within ethical frameworks when carrying out or appraising research. 

Apply the principles of Research Study Protocols where available.  

Demonstrate practical contribution to an ethically approved research study.

 

  1. ”There are predicted to be two million more people with mental health conditions by 2030.” Facing the Facts, Shaping the Future – a draft healthy and care workforce strategy for England to 2027, Public Health England, 2017. 

  2. Old Problems, New Solutions: Improving acute psychiatric care for Adults in England, The Commission to review the provision of acute inpatient psychiatric care for adults, 2016. 

  3. The State of Care in Mental Health Services 2014 to 2017, Care Quality Commission, 2017 

  4. Community Mental Health Survey 2018  NHS Patient Survey Programme statistical release, Care Quality Commission, 2018. (P6) 

  5. Together for Mental Health, Welsh Government, 2012 

  6. Mental Health Strategy 2017-2027, Scottish Government, 2017 

  7. Making Life Better, Northern Ireland Assembly, 2014 

  8. Evaluation of the 2009-2011 Bamford Action Plan, Dept. of Health , Social Services and Public Safety, 2012 

  9. The NHS Long Term Plan, NHS, 2019 

  10. Specialised settings: Eating disorders, Early intervention teams, Assertive outreach teams, Perinatal, Neuro, Access team 

  11. “Comprehensive liaison mental health services are currently available in only one in six (16 per cent) of England’s 179 acute hospitals.” The Five Year Forward View for Mental Health, NHS England, 2016 (p30) 

  12. “Around 20% of people receiving care from early intervention services have longer term and complex needs that will require input from rehabilitation services.”  Guidance for Commissioners of rehabilitation services for people with complex mental health needs Joint Commissioning Panel for Mental Health, 2016  (p6) 

  13. Alcohol and Drugs Prevention, Treatment and Recovery: Why Invest. Public Health England, 2018 

  14. Training for Two CCTs in Psychiatry, Royal College of Psychiatrists, 2018 

Medical Psychotherapy (2022)

Specialists in Medical Psychotherapy are experts in integrating psychiatric, medical and psychological understanding of patients presenting to mental health services.1  

Medical Psychotherapy is deeply committed to a person-centred holistic (which includes biological, psychological, and social) approach to psychiatry and it provides expertise in the psychological and developmental aspects of mental illness/disorder. The majority of mental disorders presenting in adults are associated with adverse childhood experiences and a developmental holistic approach forms the bedrock of psychotherapeutically informed psychiatry.2/3/4 

Medical Psychotherapists take a lead on the provision of comprehensive evidence-based psychotherapeutic interventions to those with complex and severe mental disorder and emotional distress, including personality disorder,5 complex trauma and psychosomatic disorders. This need has been identified in NHS Long term plan6 and psychotherapeutic interventions have shown to be effective in the treatment of mental disorders.

Psychotherapeutic medicine and psychotherapeutic psychiatry are central to person-centred compassionate good medical practice.Specialists in Medical Psychotherapy are essential for the leadership, practice, development, and delivery of psychotherapeutic psychiatry through a range of clinical and training activities. These include playing a key role in the training of all psychiatrists through the provision of supervision, psychotherapy cases, and reflective practice, and in leading in these aspects of training as psychotherapy tutors.  

In addition, they play a key role within the wider organisation in developing reflective practice, contributing to complex case discussions, providing supervision to colleagues and advising on service changes that impact on training and clinical care. In these ways, medical psychotherapists apply psychotherapeutic expertise in psychiatric practice.9 They are trained in the leadership of multi-disciplinary psychotherapeutic teams working across a range of settings; managing and understanding complexity and risk; promoting a culture of enquiry and facilitating enabling environments for patients and staff.10 

Exposure and engagement to psychotherapeutic practice and training within psychiatry fosters recruitment to psychiatry,11 mitigates burn out, facilitates retention and supports the aims of ‘Stepping forward to 2020/21: The mental health workforce plan for England’.12/13 

The Welsh Government’s ten-year strategy to improve mental health and well-being has identified a range of areas that require attention.14 This includes providing better perinatal mental health care and addressing the mental health needs of frequent attenders of emergency departments.15 The strategy emphasises the importance of widening access to medical psychological therapies that tailor care to the individual.16 

The Scottish Mental Health Strategy has identified the need to shift the balance of care towards mental health.17  The Scottish Mental Health Strategy 2017-2027 has an aim of achieving parity of esteem between mental and physical health. There is a particular focus on the prevention of mental illness and early intervention, improving access to treatment and improving the physical wellbeing of people with mental disorders. The Scottish Government plans to invest in the transformation of Primary and Urgent Care as well as in further development of Child and Adolescent Mental Health Services.  

The Scottish Mental Health Strategy emphasises the importance of understanding and addressing Adverse Childhood Experiences as an integral aspect of early intervention and prevention of mental illness. Commissioned by the Scottish Government, NHS Education for Scotland has developed the National Trauma Skills and Knowledge Framework as well as the national training plan for practitioners. 

Northern Ireland has higher levels of mental ill-health than any other region in the UK.18 It has been identified that specialist services that address the underlying causes of mental disorders are required to meet need and holistic psychological medical assessment is crucial to proactively respond to mental health population trends.19/20 

Exposure to medical psychotherapy starts at the outset of core training in order to ensure all trainees develop their skills a psychologically informed psychiatrists. Higher training in Medical Psychotherapy begins with recruitment to specialist Medical Psychotherapy training, after successful completion of Core Psychiatry Training and the RCPsych examinations. Successful completion of the programme leads to a CCT in Medical Psychotherapy with entry on the specialist medical register. 

Medical Psychotherapy specialty training can be a single CCT training that is recommended to take place over 36 months (Whole Time Equivalent) in order to achieve the required capabilities and gain the necessary experience. This can also be undertaken as a dual training alongside specialty training in General Adult Psychiatry, Forensic Psychiatry, and Child and Adolescent Psychiatry. Dual training is recommended to take place over 60 months, with a recommended 36 months equivalent time spent training and working in Medical Psychotherapy. 

The purpose of Medical Psychotherapy curriculum is to provide training in a range of psychotherapeutic treatments applicable to different mental disorders. The objective of this training is to enable those working towards a CCT in Medical Psychotherapy to gain expertise to mastery level in one evidence-based treatment modality of psychotherapy, and additional capabilities in at least two further psychotherapeutic modalities to ensure that they have the skills to meet the needs of a diverse patient population. 

The CCT holder will have the skills to draw on a wide range of psychotherapeutic frameworks including psychodynamic, cognitive, behavioural, and systemic alongside their psychiatry training. 

The training equips the CCT holder to specialise in the development, delivery and leadership of services focusing on assessment, diagnosis, treatment, management and prevention of mental disorders in adults, bringing together psychotherapeutic, psychological, social and biological perspectives. 

The curriculum enables the Medical Psychotherapy consultant to lead on psychotherapeutic education and training for psychiatrists, allowing them to take up the GMC designated role of psychotherapy tutor. 

The training allows the CCT holder to gain expertise to mastery level in reflective practice, supervision and education skills, being a resource for the rest of the medical workforce and other members of the multidisciplinary team to enhance and continue the development of psychotherapeutic skills within their psychiatric practice. The Medical Psychotherapy CCT holder can also lead on multidisciplinary team working, through their integration of psychotherapeutic, psychiatric and medical perspectives in the understanding of individuals, groups and organisations recognising how working with complex clinical presentations may create strain within teams.  

The training builds on psychotherapy and psychiatry training in the core curriculum, including the development of advanced communication and interpersonal skills, examination skills, diagnosis and treatment to a mastery level. It also involves the further development of capabilities in leadership and management, research and quality improvement. 

This curriculum provides a framework for this training enabling the achievement of essential Medical Psychotherapy specific clinical and generic professional capabilities through development of the professional values, behaviours, knowledge and skills required in order to provide high-quality, evidence-based care for a diverse patient population. 

A consultant Medical Psychotherapist will be able to work with and treat mental disorders for the whole range of patients including acute and long-term disorders, in settings such as psychological therapy services, specialist units such as personality disorder services, psychiatric inpatient units, physical health settings and community and primary care mental health teams. 

Further curricula are available for the following other established psychiatry specialties: 

  • Child & Adolescent Psychiatry 

  • Forensic Psychiatry 

  • Intellectual (Learning) Disability Psychiatry 

  • General Adult Psychiatry 

  • Old Age Psychiatry 

Medical Psychotherapy has limited interdependencies with the training with other specialties. During training in Medical Psychotherapy, a trainee develops the knowledge and skills needed to have overall clinical responsibility, lead a team, understand governance, and health care structures. 

The recommended three years spent in training will provide appropriate development of transferable skills and experience (e.g. advanced leadership, emergency psychiatry, reflective practice and complex decision making) as well as specialised skills and experience in Medical Psychotherapy. 

The skills and knowledge trainees develop and demonstrate in their training have not changed in this new curriculum. 

The Medical Psychotherapy learning outcomes are mapped to the Generic Professional Capabilities Framework (GPCs) ensuring ease of transfer between medical specialties. Through attainment of the High-Level Learning Outcomes (HLOs), this curriculum will enable trainees to lead and work in multidisciplinary and multi-professional teams; provide leadership and participate in research, teaching and training in a variety of clinical settings. It will also enable trainees to gain experience in formulating person-centred holistic care and treatment. 

It provides opportunities to develop expertise to work with a wide range of patients and understand the need to signpost to other relevant specialties where appropriate. 

This purpose statement has been endorsed by the GMC’s Curriculum Oversight Group and confirmed as meeting the needs of the health services of the countries of the UK. 

By the end of St6, you will be able to:ThemesKey Capabilities
Demonstrate the professional values and behaviours required of a Consultant Psychiatrist with reference to Good Medical Practice, Core Values for Psychiatrists (CR204) and other relevant faculty guidance.  1.1 Professional Relationships

Work collaboratively with patients, families, carers of all ages, and colleagues respecting their autonomy, diversity and valuing their contribution. 

Recognise, validate and actively address systemic and structural inequalities, intersectionality, and their impact on clinical outcomes for patients and their carers of all ages and on working relationships with colleagues. 

Consistently demonstrate a holistic and person-centred clinical approach to patients that is honest, empathic, and respects their dignity while maintaining a hopeful, realistic, helpful and compassionate approach, which maintains appropriate boundaries. 

Demonstrate a working knowledge of the specific ethical and legal principles which apply particularly to psychotherapeutic relationships. 

Appreciate and take into account different sensitivities of patients to a range of information held about them, and how they are recorded and shared, particularly in relation to psychological material. 

Apply an understanding of the role of the consultant psychiatrist in medical psychotherapy in the context of the multidisciplinary team and in multiagency working.  

Demonstrate when working with others, the ability to be flexible, lead, use initiative, be able to prioritise, and be adaptable, taking time to think and reflect in complex situations and tolerate uncertainty, including using new technologies as appropriate. 

 1.2 Professional Standards

Understand the impact of workload, patient and organisational dynamics and projective processes on your own well-being. 

Apply strategies to take care of your wellbeing, seeking timely support and guidance, including your own personal psychotherapy, acknowledging if you have a protected characteristic which might impact on your training or if you are having difficulties adapting to working in the UK. 

Use the method of receiving, reflecting and responding to understand the emotional impact of work on the individual and team, including the impact of suicide, trauma and homicide. 

Make clear, accurate and contemporaneous records, producing reports in a timely, accurate and appropriate way, within the limits of your expertise. 

Demonstrate continued personal, professional and psychological development through participation in appropriate personal psychotherapy. 

Consistently demonstrate a positive and conscientious approach to completion of your work. 

Adapt to patient needs and requirements, ensuring confidentiality and balancing this against risk and sharing of information. 

Maintain professional standards, and support colleagues and wider teams to maintain their standards, promoting structures to understand underlying dynamics and their impact. 

Demonstrate an understanding of the principles of sustainability and how they underpin sustainable psychiatric practice. 

 

By the end of ST6, you will be able to:ThemesKey Capabilities
Demonstrate advanced communication and interpersonal skills when engaging with patients, their families, carers of all ages, their wider community, colleagues and other professionals. 2.1 Communication

Demonstrate highly developed listening skills with attention to the meaning of verbal, non-verbal and bodily aspects of communication, including understanding how unconscious processes affect communication, especially projective processes (e.g., splitting). 

Demonstrate timely, effective and sensitive communication and liaison with colleagues including other members of the multidisciplinary team, the patient’s GP, and other primary/secondary/tertiary and third sector colleagues, acting as a consultant to wider teams where appropriate. 

Synthesise complex information, including outcome of assessment, treatment and management plans, and communicate it in a timely and effective tailoring language to convey complex psychological understanding with colleagues, patients, families and carers of all ages. 

Consistently demonstrate effective communication approaches with patients and relevant others, including those with neurodevelopmental disorders making reasonable adjustments and adaptations where appropriate, including the use of new technologies. 

Use communication to ensure shared, informed decision making with patients, taking into consideration their ideas, values, concerns and expectations. 

Recognise the limitations of assessment where language or cultural influences impact on communication and demonstrate skills in supporting those in whom English is not their first language, including the use of interpreters, providing information in other languages. 

Adapt your communication style and approach, taking into consideration communication and sensory needs, making reasonable adjustments when required. 

Establish authentic therapeutic relationships with patients while maintaining professional boundaries and consistency of care, to facilitate communication and help patients feel understood. 

Explain the outcome of assessment, treatment and management to patients, and their families, carers of all ages as well as relevant others.  

Demonstrate timely, effective communication and liaison with colleagues including other members of the multidisciplinary team, the patient’s GP, and other primary/secondary/tertiary and third sector colleagues, acting as an external consultant to staff teams where appropriate. 

Demonstrate advanced skills in the psychiatric assessment, formulation, diagnosis and person-centred holistic* management of an appropriate range of presentations in a variety of clinical and non-clinical settings within Medical Psychotherapy. 2.2 Clinical Skills

Demonstrate advanced knowledge of the theoretical underpinnings of the major psychotherapeutic treatment modalities and the psychological understanding of mental disorder and the development of the mind.  

Demonstrate an advanced understanding of mental disorders and how cognitive-behavioural, psychodynamic, systemic and other psychotherapeutic approaches may be applied in clinical practice across the full range of these disorders.  

Demonstrate an appropriate understanding of learning and behavioural stages of human development through the lifespan including awareness of normative as well as variations in presentations, for example with neurodevelopmental conditions and across cultures.  

Demonstrate an advanced understanding of the psychological effects of acute and chronic physical illness on emotional life and interpersonal relationships.  

Demonstrate a specialist understanding of the relative contributions of the factors below in formulation and differential diagnosis:   

  • emotional, cognitive, and behavioural developmental processes and transitions across the lifespan  

  • the integration of biological vulnerability with attachment relationships, adverse childhood experiences, the impact of loss, and trauma,  

  • understand developmental pathways of personality disorder  

Demonstrate advanced knowledge of the theory, technique and application of a recognised major modality (cognitive behavioural, psychodynamic, systemic) of psychotherapy, and capability in the theory and technique of two additional major modalities of psychotherapy. 

Demonstrate advanced psychotherapeutic skills across a broad range of clinical conditions, within a range of clinical settings.   

Establish a comprehensive psychotherapeutic assessment, taking into account the biological, social, cultural and spiritual factors of the patient, clarifying key issues, treatment needs, referrals to other services and assessment of patients presenting with personality disorder or problematic personality traits. 

Promote psychological and psychotherapeutic understanding of mental disorder; complex psychiatric presentations; and factors that predispose to and maintain psychiatric breakdown including the impact upon staff, towards improving case formulation and patient care.  

Assess the general health of patients, taking into account the impact of their physical health on their mental health needs and vice versa. This assessment should include consideration of nutritional, metabolic, endocrine and reproductive factors and disorders, and the physical and mental impact of substance use and addiction on clinical presentation.  

Assess patients from a range of different cultural, spiritual, and religious backgrounds and demonstrate and understanding of how those with protected characteristics, including asylum seekers and refugees, may impact on clinical presentation. 

Elicit information required for each component of a psychiatric history and psychological formulation and be able to gather this information, identifying and seeking to understand the underlying psychopathology.  

Assess and evaluate the impact of a patient’s current social situation, motivation and readiness to receive treatment and psychological defences, balancing the benefits and potential harms of psychological treatments and factors affecting the appropriate choice of psychotherapy, making use of available resources. 

Offer psychiatric and psychotherapeutic expertise to other practitioners, in order to enhance the clinical understanding, management of complex presentations, under the care of a range of health and social care teams. 

Establish a person-centred holistic formulation which is well-evidenced, coherent and person-centred, and use this as the basis for appropriate recommendation for treatment in each of the major psychotherapeutic modalities or other appropriate interventions.  

Conduct a range of individual, group and family therapies using standard accepted models.  

Lead the triage and discussion of referrals for psychotherapeutic and psychological treatments, taking into account the clinical complexity and the organisational context in which you are working.  

Use formulation to devise a safe, effective, collaborative and co-productive management plan to ensure continuity of care in the immediate, short and longer term.  

Lead on the delivery of a comprehensive psychological treatment plan including evidence-based psychological therapies for personality disorder.  

Demonstrate an understanding of how physical treatments can be used for the treatment of mental disorders and apply this under supervision. 

Apply advanced management skills within Medical Psychotherapy in situations of uncertainty, conflict and complexity across a wide range of clinical and non-clinical contexts. 2.3 Complexity and Uncertainty

Demonstrate an understanding of unconscious processes, including transference, countertransference, projection and splitting and the impact of these on yourself and others. 

Demonstrate advanced psychotherapeutic assessment and treatment skills when working with complex and multiple comorbid presentations. 

Effectively use advanced communication, including use of technology, where appropriate and necessary, taking into account limitations, complexities and demands of this on psychotherapeutic practice and complex dynamics, including establishing and maintaining appropriate boundaries, managing challenges. 

Provide psychotherapeutic understanding, strategies and support for the impact of suicide and anxiety about risk, the impact of this on teams, and all those around the patient, and how it affects clinical management. 

Demonstrate expertise in understanding the underlying factors in crisis presentations, taking into account the patient’s developmental history and individual vulnerabilities, to formulate urgent care plans. 

Assess, liaise and provide psychotherapeutic advice on the clinical management of patients with mental disorders, including personality disorder, in high risk situations. 

Provide a psychotherapeutic perspective on risk. encompassing unconscious projective processes and splitting, using specialist psychotherapeutic knowledge and skills to inform assessment of risk. 

Apply an understanding of organisational dynamics to enhance the capacity of the organisation to contain anxiety and manage risk and clinical complexity. 

Assess suitability of, and where appropriate provide, psychotherapeutic intervention in the aftermath of an emergency. 

Identify psychopathology in all clinical situations, including those that are urgent and/or complex.  

Work systemically with complex relationships and family dynamics which impact on mental health. 

 

By the end of ST6, you will be able to:ThemesKey Capabilities
Apply advanced knowledge of relevant legislative frameworks across the UK to safeguard patients and safely manage risk within Medical Psychotherapy. 3.1 Knowledge of legal and organisational frameworks in your UK jurisdiction. 

Demonstrate advanced awareness of specialist aspects of the law applied to psychotherapy and legal and ethical limits to confidentiality, including the situations, principles and frameworks for disclosure of confidential information.  

Apply national and local guidance and developments in relation to the provision of psychological therapy services.   

Balance the duty of care to the patient and the protection of others taking into consideration human rights legislation, the patients’ self-empowerment, and potential impact on patients’ commitment to therapeutic relationships when considering the use of legal powers.   

Apply knowledge of how healthcare governance and policy influences patient care, research and educational activities at a local, regional and national level.    

Demonstrate an advanced understanding of the impact of political and social factors on patient care, organisational dynamics and anxiety.    

Apply the legal and ethical requirements and duties in providing psychotherapy and in relation to psychotherapeutic relationships.  

Use the relevant mental health legislation, including the use of emergency powers and compulsory treatment where appropriate.    

Develop and adopt clinical guidelines and integrated care pathways.    

Assess patients for the purposes of preparing and delivering medico-legal reports.   

Meet the requirements to apply for relevant statutory approval where appropriate. 

Work effectively within the structure and organisation of the NHS, and the wider health and social care landscape. 3.2 Working within NHS and organisational structures 

Apply an advanced understanding of the structures of NHS and social care services, including psychological therapy services and regulatory authorities, and demonstrate ability to work within their requirements, including understanding how services are funded and organised, organisational policy, dynamics and practice across the healthcare sector. 

Apply an advanced understanding of organisational policy, dynamics and practice at a national and local level in the wider health and social care system.  

Demonstrate an advanced understanding of the requirements of outside agencies for reports that are timely, accurate and appropriate. 

 

By the end of ST6, you will be able to:ThemesKey Capabilities
Demonstrate leadership and advocacy in mental and physical health promotion and illness prevention for patients within Medical Psychotherapy and the wider community. 4.1 Health promotion and illness prevention in community settings 

Promote a psychological understanding of well-being, and how this can contribute to the prevention of Mental Disorders, including an understanding of the interrelationship between the body and mind. 

Engage with your wider community around health promotion and illness prevention, addressing health inequalities, and the social, cultural, spiritual and religious determinants of health. 

Lead, advocate and educate health and non-health professionals in health promotion and illness prevention.  

 

By the end of ST6, you will be able to:ThemesKey Capabilities
Demonstrate effective team working and leadership skills to work constructively and collaboratively within the complex health and social care systems that support people with mental disorder. 5.1 Teamworking

Demonstrate an advanced understanding of group and interpersonal dynamics, including individual personal qualities and emotions, and use these to formulate unconscious, conscious and systemic contributors to interactions within and between teams.  

Demonstrate how skills have been gained through training in organisational and interpersonal dynamics, as well as through your own therapy.  

Apply an advanced working knowledge of the roles and responsibilities of, and the interface between, multidisciplinary team members.  

Demonstrate open mindedness and encourage dialogue, recognising the importance of different/divergent perspectives and utilise team feedback.  

 5.2 Leadership

Recognise and appraise the leadership skills of others in various contexts.  

Demonstrate the development and application of your own leadership skills in a variety of clinical and non-clinical settings. 

Demonstrate inclusive leadership style and awareness of the impact of hierarchy and power within relationships with patients and colleagues.  

Demonstrate an understanding of how your own leadership style and approach impact on others, adapting your approach to meet the needs of the team.  

Lead, take charge, and offer opinions and direction.  

Support colleagues to enhance their performance and support their development.   

Provide clinical supervision to colleagues at all times.  

Competently manage and lead a team/service, providing consultation and specialist advice to team members and other agencies.  

Critically appraise the performance of colleagues and to escalate concerns where appropriate.  

 

By the end of ST6, you will be able to:ThemesKey Capabilities
Identify, promote and lead activity to improve the safety and quality of patient care and clinical outcomes of a person with mental disorder. 6.1 Patient Safety

Demonstrate a comprehensive psychotherapeutic understanding and perspective on risk.    

Demonstrate an advanced knowledge of methods to obtain feedback from patients, the public, staff and other interested groups.    

Undertake reviews of a critical incident with sensitivity to the needs and standpoints of all participants.   

Apply the principles of empathic understanding and a psychologically minded approach to risk assessment and management.  

 6.2 Quality Improvement

Apply an understanding of the impact of quality improvement activities in improving patient outcomes and system performance.  

Lead on quality improvement activities relevant to your clinical practice, including supervising others.  

Disseminate findings from quality improvement activities, implement and manage relevant change. 

 

By the end of ST6, you will be able to:ThemesKey Capabilities
Promote and lead on the provision of effective education and training in clinical, academic and relevant multi-disciplinary settings. 7.1 Safeguarding

Understand the principles of lifelong learning, undertaking opportunities for continuing professional development as a doctor, psychiatrist and psychotherapist.  

Apply understanding of the principles and methods of learning, education, teaching, training and feedback in a variety of clinical and non-clinical settings, adapting as appropriate to the target audience in a timely and constructive manner.  

Adapt teaching or training to the needs of particular learners e.g., medical students, colleagues from other professions and specialties, including primary care.   

Lead in developing training activities that promote the specialty of medical psychotherapy and its contribution to psychiatry.  

 

By the end of ST6, you will be able to:ThemesKey Capabilities
Promote and lead on the provision of effective education and training in clinical, academic and relevant multi-disciplinary settings. 8.1 Education and Training

Understand the principles of lifelong learning, undertaking opportunities for continuing professional development as a doctor, psychiatrist and psychotherapist.  

Apply understanding of the principles and methods of learning, education, teaching, training and feedback in a variety of clinical and non-clinical settings, adapting as appropriate to the target audience in a timely and constructive manner.  

Adapt teaching or training to the needs of particular learners e.g., medical students, colleagues from other professions and specialties, including primary care.   

Lead in developing training activities that promote the specialty of medical psychotherapy and its contribution to psychiatry.  

Demonstrate effective supervision and mentoring skills as essential aspects of education to promote safe and effective learning environments. 8.2 Supervision

Actively take part in clinical, psychiatric and educational supervision; demonstrate effective supervision and mentoring skills and promote safe and effective learning environments.   

Demonstrate experience and expertise in providing clinical supervision in psychotherapy.   

Provide safe and effective clinical supervision in emergency and non-emergency situations and settings.  

Demonstrate the professional qualities of an effective trainer; be able to teach and guide individuals and groups.   

Use supervision and reflection effectively, developing therapeutic and reflective skills and technique within a modality, recognising your limitations.  

Conduct appraisal effectively and at the appropriate time.  

 

By the end of ST6, you will be able to:ThemesKey Capabilities
Apply an up-to-date advanced knowledge of research methodology, critical appraisal and best practice guidance to clinical practice, following ethical and good governance principles. 9.1 Undertaking research and critical appraisal

Critically evaluate data, papers, reviews, and meta-analyses and implement findings in daily clinical practice.  

Translate research into local clinical practice and disseminate critical appraisal findings to wider communities.  

Apply knowledge of up to date appropriate statistical methods.  

Demonstrate proficiency in the use of objective evidence-based clinical assessment instruments.  

Work within ethical frameworks when carrying out or appraising research.  

Apply the principles of Research Study Protocols where available.   

Demonstrate practical contribution to an ethically approved research study where relevant research support is available. 

 

  1.  The Role of the Consultant Psychiatrist in Psychotherapy, RCPsych, CR139, 2006
  2. The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. The Lancet Public Health, 2017
  3. Adverse childhood experiences and mental health in young adults: a longitudinal survey BMC Public Health, 2007
  4. Childhood Determinants of Adult Psychiatric Disorder Tom fryers, Traolach Brugha, 2013
  5. Learning from the Cradle to the Grave: the psychotherapeutic development of doctors from beginning to end of a career in medicine and psychiatry RCPsych
  6. The Five Year Forward View, NHS, 2016
  7. Psychotherapy for mental illness in Europe Eva Woelbert, JRC Science and Policy Reports, 2015
  8. The Place of Psychotherapy in Contemporary Psychiatry Saman Tavakoli, 2014
  9. The Place of Psychotherapy in Contemporary Psychiatry Saman Tavakoli, 2014
  10. The Role of the Consultant Psychiatrist in Psychotherapy, RCPsych, CR139, 2006
  11. Quality assurance report for medical psychotherapy, GMC, 2012
  12. Stepping forward to 2020/21: The mental health workforce plan for England NHS, 2017
  13. The State of Medical Education and Practice In the UK GMC, 2018
  14. Together for Mental Health, Welsh Government, 2012
  15. Together for Mental Health, Welsh Government, 2012
  16. Together for Mental Health, Welsh Government, 2012 p.9
  17. Mental Health Strategy 2017-2027, Scottish Government, 2017
  18. Making Life Better, Northern Ireland Assembly, 2014
  19. Service Framework for Mental Health and Wellbeing 2018-2021 Department of Health, 2018
  20. Evaluation of the 2009-2011 Bamford Action Plan, Dept. of Health , Social Services and Public Safety, 2012

Old Age Psychiatry (2022)

Old Age Psychiatrists assess and treat older adult patients and those with needs relating to the ageing process, who present with a wide range of mental disorders including psychotic, non-psychotic, and organic brain illnesses such as dementia. They combine expert knowledge of mental and physical health care needs to provide person-centred care for patients. 

It is clear that the need for psychiatrists across the specialties is growing throughout the UK.1,2,3 Public Health England states that, in any given year, one in six adults experience at least one diagnosable mental health condition, and that mental health conditions are the second leading cause of morbidity in England.4 Dementia is the leading cause of death in England and Wales.

The Welsh Government’s ten-year strategy to improve mental health and well-being has identified a range of areas across all ages that require attention.5 This includes Wales being a ‘Dementia Friendly Nation’ specifically with the goal of improving the quality of life and care for people with or at risk of dementia and their caregivers.6  

The Scottish Mental Health Strategy has identified the need to shift the balance of care towards mental health.7 Currently, there are 90,000 people living in Scotland with dementia. By 2020 it is estimated that there will be around 20,000 new cases diagnosed each year. We know that more people are developing dementia much later in their lives than previously assumed. This demands that our services are responsive to the range of challenges that people and their families face. 

While dementia prevalence in Scotland and elsewhere in the world has stabilised, it is recognised that more people are developing dementia even later in life than previously estimated, and are living, often with other significant and life-limiting chronic conditions, for shorter periods of time.8 This means we should continue to embrace the process of redesign and transformation of services. More care should be delivered in our communities, but we must also ensure that palliative and end-of-life care services for people with dementia are flexible and responsive to individual need.  Old Age Psychiatrists and the services they work in have a long tradition of working within multidisciplinary settings in the community.   

Northern Ireland has higher levels of mental ill-health than any other region in the UK and it has been identified that building up the range of specialist mental health services is required to meet need.9,10 

The NHS Long Term Plan is focused on population health systems,11 and Old Age Psychiatrists can expect to participate not just inpatient assessment and management but also in improving clinical outcomes, health promotion, collaborative or integrated care and providing person-centred care. The Old Age Psychiatry training curriculum equips trainee doctors with the expertise to achieve these outcomes and provide high-quality effective care for the older adult population. 

Training in Old Age Psychiatry begins after successful recruitment to the specialist training programme. This occurs after completion of Core Psychiatry Training (CT1-CT3) and passing the RCPsych membership examination (MRCPsych). 

In order to achieve the required capabilities and necessary experience to gain a CCT in Old Age Psychiatry, it is recommended that training is undertaken over a recommended 36 months (Whole Time Equivalent). Trainees will be expected to rotate through a variety of approved Old Age Psychiatry posts to ensure experience and capability in a variety of clinical settings. Successful completion of the programme leads to eligibility for entry on the specialist register. 

The purpose of this curriculum is to develop Consultants who specialise in the assessment, diagnosis, treatment, management and prevention of mental disorders in: 

  • People of any age with primary dementia.  

  • People with mental disorder and physical illness or frailty that contributes to, or complicates, the management of their mental disorder. This may include people under 65 years of age.  

  • People with psychological or social difficulties related to the ageing process, or end-of-life issues, or who feel their needs may be best met by a service for older people. This would normally include people over 70 years of age, such as in-patient, community, hospital liaison, crisis and home treatment, and memory assessment and treatment services. 

This includes evidence-based psychological, biomedical, and social interventions in a wide range of clinical settings in Old Age Mental Health Services.12  

It builds on the clinical capabilities achieved through Core Psychiatry training, such as advanced communication and interpersonal skills, examination skills, diagnosis and treatment to consultant level. It also involves the high-level development of capabilities such as team working, leadership and management, teaching, research and quality improvement.  

This curriculum equips consultants in Old Age Psychiatry with the ability to provide high-quality, evidence-based patient care for older adults, and support for their carers and families.  

A Consultant Old Age Psychiatrist will be able to work with and manage organic and functional mental health conditions, within a holistic framework that includes attention to physical health and frailty. They will be able to manage acute and long-term mental disorder, in community, care homes and inpatient settings. They will be able to work in more specialised settings, such as Liaison Psychiatry.  

During training in Old Age Psychiatry, a trainee develops the knowledge and skills needed to have overall responsibility, lead a team, understand governance and overall structures within older adult mental health services. The principal interdependencies are with other medical specialties e.g., general practice, geriatric medicine and neurology and with non-medical healthcare specialties, in particular, mental health nursing and psychology. Old age psychiatry equips specialists with the ability to manage complex psychiatric cases that require in-depth multidisciplinary input that would be outside the scope of general practitioners. Similarly, the focus on mental health, community input and psychosocial factors sets the specialty apart from the more traditional medical specialities of geriatrics and neurology. Mental health nursing and psychology share many of the capabilities of old age psychiatry, but with far less emphasis on advanced leadership, and the assessment and management of both risk and medical illness.  

The recommended three years spent in training will provide appropriate development of transferable skills and experience (e.g., advanced leadership, emergency psychiatry and complex decision making) as well as specialised skills and experience in Old Age Psychiatry.  

The skills and knowledge trainees develop and demonstrate in their training have not changed in this new curriculum. Trainees will, therefore, continue to have the opportunity to undertake training in Liaison Psychiatry, where patient demand and service need is high as part of their Old Age Psychiatry training programme.13 

Trainees may also undertake dual training with Adult Psychiatry building upon skills from training in Old Age Psychiatry.14 The GMC approved dual training programmes include shared capabilities and combinations of skills and experience for diverse service and population needs. Due to these shared capabilities, dual Old Age/Adult Psychiatry training can be undertaken in less than six years, the standard recommended training time for training in two psychiatric specialties (for Old Age Psychiatry and General Adult Psychiatry, the recommended training time is an indicative 4 years). 

The Old Age Psychiatry learning outcomes are mapped to the Generic Professional Capabilities Framework (GPCs) ensuring ease of transfer between medical specialties. 

The High Level Outcomes (HLOs) within this curriculum will facilitate the development of transferable knowledge and skills in leadership, research, education, health promotion, patient safety and quality improvement.  

In addition to advanced skills in the psychiatric assessment of older people, trainees in Old Age Psychiatry will be able to deliver holistic care across care settings including in psychiatric hospitals, general hospitals, residential and nursing homes and private residences. Additionally, trainees will acquire the flexibility required to be able to work within and lead multidisciplinary teams including within community and in-patient environments. These skills, alongside the ability to manage complexity, conflict and uncertainty and knowledge of ageing, frailty and safeguarding procedures are transferable to other disciplines and related specialties. As trainees progress through the training programme, the level of performance and transferability to other disciplines will increase. 

Sub-specialty training (endorsements) will encompass aspects of the Old Age Psychiatry curriculum, for example, leadership, multidisciplinary working and the acquisition of expertise in holistic patient care using psychological, bio-medical and social interventions.  

This purpose statement has been endorsed by the GMC’s Curriculum Oversight Group and confirmed as meeting the needs of the health services of the countries of the UK

By the end of ST6 you will be able to:ThemesKey Capabilities
Demonstrate the professional values and behaviours required of a Consultant Psychiatrist with reference to Good Medical Practice,  Core Values for Psychiatrists (CR204) and other relevant faculty guidance.  1.1 Professional Relationships

Work collaboratively with patients, families, carers of all ages and colleagues respecting their autonomy, diversity, dignity, and valuing their contribution.  

Recognise, validate and actively address systemic and structural inequalities, intersectionality, and their impact on clinical outcomes for patients and their carers of all ages and on working relationships with colleagues.   

Consistently demonstrate a holistic and person-centred clinical approach to older adults that is honest, empathic, compassionate, and respects their dignity while maintaining therapeutic optimism, remaining realistically optimistic, honest and maintaining boundaries.  

Recognise the importance of liaising with colleagues from other psychiatric specialties where appropriate to provide advice and support on the management of care of older adults with mental disorders in these specialties.  

Demonstrate flexibility, leadership, use of initiative, prioritisation, and adaptability, effectively managing your time and resources and using new technologies as appropriate. 

 1.2 Professional Standards

Understand the impact of workload, patient, team, and organisational dynamics on your own well-being, taking into account available resources.  

Use supervision and reflection effectively, recognising your skills, limitations and your duty of candour.  

Apply strategies to take care of your wellbeing, seeking timely support and guidance.  

Use the method of receiving, reflecting and responding towards understanding the emotional impact of the work you do, on the individual and team, including the impact of self-neglect, vulnerability, availability of resources, suicide, and homicide.  

Consistently demonstrate a positive and conscientious approach to the completion of your work.  

Make clear, accurate and contemporaneous records.  

Promote and protect the specialism of Old Age Psychiatry including acting as an advocate for your patients and their carers.  

Demonstrate an understanding of the principles of sustainability and how they underpin sustainable psychiatric practice. 

 

By the end of ST6, you will be able to:ThemesKey Capabilities
Demonstrate advanced communication and interpersonal skills when engaging with patients, their families, carers of all ages, their wider community, colleagues and other professionals. 2.1 Communication

Consistently demonstrate advanced communication skills when undertaking complex clinical discussions with your patients and with others in relation to their care.  

Consistently demonstrate effective communication approaches with patients and relevant others, including those with neurodevelopmental disorders making reasonable adjustments and adaptations where appropriate, including the use of new technologies. 

Demonstrate proficiency in explaining the outcome of assessment and management to patients, families, carers of all ages, and relevant others. 

Demonstrate skills in supporting those in whom English is not their first language, including the use of interpreters, and providing information in other languages.  

Synthesise complex information and communicate this succinctly and coherently in your written and verbal communication.  

Build and sustain therapeutic relationships with older adult patients, relatives and carers. Be sure to recognise and manage the complexity and conflict that may arise in the course of these relationships.  

Demonstrate flexibility in your communication style with older adults taking into account difference and diversity and how these impact on the therapeutic interaction.  

Demonstrate an inclusive approach which considers all aspects of communication, language, sensory and cognitive needs, as well as the ethnic, social, cultural, spiritual and religious context of older adult patients.  

Demonstrate and promote shared decision making with older adult patients, taking into consideration their ideas, values, concerns and expectations. 

Demonstrate advanced skills in the psychiatric assessment, formulation, diagnosis and person-centred holistic* management of an appropriate range of presentations in a variety of clinical and non-clinical settings within Old Age Psychiatry. 2.2 Clinical Skills

Demonstrate an advanced understanding of functional mental disorders and how these present differently in older adults, delirium, cognitive impairment and dementias and other organic health disorders, substance use disorders and the interplay between physical health disorders and mental health. 

Apply an advanced level of knowledge of psychology, including the importance of early relationships, attachment styles, parenting, the impact of adverse life experiences, traumatic events, and protective factors and their impact on functional and organic disorders in older people. 

Understand the importance of, and consistently demonstrate, the ability to receive a collateral history from the relevant people involved in the care of your patients 

Demonstrate proficiency in the specialist risk assessment and management of older adults.   

Demonstrate advanced skills in assessing and managing the issues of self-neglect, vulnerability, physical health co-morbidities, frailty, self-harm and abuse. 

Confduct person-centred holistic assessments of older people including history, mental state, and relevant psychopathology, that includes psychological, social, cultural, spiritual and religious aspects of ageing, activities of daily living, physical health, medication, frailty and falls, and death and dying. 

Demonstrate an appropriate understanding of learning and behavioural stages of human development through the lifespan including awareness of normative as well as variations in presentations, for example with neurodevelopmental conditions and across cultures.  

Synthesize all information available, including collateral information to construct a formulation relevant to older people and share your formulation with patients and others in a timely and appropriate manner. 

Demonstrate advanced knowledge in assessing capacity in older patients with complex needs. 

Assess the general health of your patients, taking into account the impact of their physical health on their mental health needs and vice versa. This assessment should include consideration of nutritional, metabolic, endocrine, and reproductive factors and disorders, and the physical and mental impact of substance use and addiction on clinical presentation. 

Conduct relevant physical examinations of your patients and interpret findings, referring on appropriately to other clinicians. 

Assess how relationships, systems and dynamics within the older patient’s life impact on their wellbeing and work with them and others to manage these. 

Conduct and interpret detailed cognitive assessments, including the use of relevant, standardised, neuropsychological tools.   

Use international classification systems to establish diagnoses and co-morbidities in older adult patients. 

Assess patients from a range of different cultural, spiritual, and religious backgrounds, including asylum seekers and refugees, and demonstrate and understanding of how protected characteristics may impact on clinical presentation. 

Appropriately interpret the findings of relevant biological, psychological, and social investigations and assessments for both functional and organic mental disorders in older people and refer to others as appropriate.   

Use early diagnosis in general, and post diagnostic support in older people with mental disorders to help prevent vulnerability and safeguarding concerns in older people with mental disorders. 

Construct a safe, effective, collaborative and co-productive management plan based on the individual views, needs, and wishes of the patient, and review the effectiveness of these interventions in a timely manner to ensure continuity of care in the immediate, short and longer term. 

Manage patient care in emergency, urgent and routine situations. 

Work across a variety of settings including the community, other residential settings, care homes and in-patient services. 

Use formulation to devise a safe, effective, collaborative and co-productive management plan to ensure continuity of care in the immediate, short and longer term. 

Demonstrate an understanding of how physical treatments can be used for the treatment of mental disorders and apply this under supervision. 

Apply an understanding of psychological and psychotherapeutic interventions in order to assess the suitability of, and refer, older adult patients and their carers for these treatments.

Be able to apply principles of functional and behavioural assessment in patients with dementia presenting with behavioural and psychological symptoms and use these assessments in the development of appropriate management plans.

Demonstrate advanced skills in the safe prescribing and management of medications in older people. 

Apply advanced management skills within Old Age Psychiatry in situations of uncertainty, conflict and complexity across a wide range of clinical and non-clinical contexts. 2.3 Complexity and Uncertainty

Demonstrate proficiency in managing unconscious processes, including transference, countertransference, projecting and splitting, and know how to manage these effectively and safely to help with ongoing management. 

Demonstrate an understanding of individual variation and the impact of social, cultural, spiritual and religious factors, including effects of deprivation, discrimination and racism. 

Elicit salient information from the psychiatric history and mental state examination in situations of urgency and complexity and prioritise management as appropriate.  

Devise care plans in urgent situations where information may be incomplete or unavailable. 

Consciously vary from established care pathways where clinically indicated and justify these decisions as needed. 

Recognise why, when and how to access timely support and consultation as part of your professional practice when uncertain/stuck. 

Maintain good professional attitudes and behaviour when responding to difficult situations involving ambiguity and uncertainty. 

Manage unconscious dynamics between yourself, patients, and other professionals.  

Provide support, advice and consultation to trainees and other professionals to work in complex situations. 

 

By the end of ST6, you will be able to: ThemesKey Capabilities

Apply advanced knowledge of relevant legislative frameworks across the UK to safeguard patients and safely manage risk within Old Age Psychiatry. 

3.1 Knowledge of legal and organisational frameworks in your UK jurisdiction 

Apply the current legislation governing the care and treatment of older people with mental disorder; both as inpatients and in the community, including the use of emergency powers and compulsory treatment. 

Balance the duty of care to the older adult patient and the protection of others, taking into consideration human rights legislation. 

Demonstrate and develop advanced knowledge and application of legal and safeguarding frameworks appropriate for managing older patients who lack capacity to make decisions about their care or treatment.  

Demonstrate an understanding of relevant legislation as applicable to the patient’s families and carers of all ages.   

Apply the principles of least restrictive practice when considering the application of legal powers across different settings.  

Meet the requirements to apply for relevant statutory approval where appropriate.  

Prepare and deliver relevant legal reports. 

Work effectively within the structure and organisation of the NHS, and the wider health and social care landscape. 3.2 Working within NHS and organisational structures 

Demonstrate knowledge of and contribute to the structure and function of national health and social care services and regulatory authorities, particularly as it applies to the care of older adults.  

Demonstrate proficiency in inter-agency working. 

 

By the end of ST6, you will be able to:Themes Key Capabilities
Demonstrate leadership and advocacy in mental and physical health promotion and illness prevention for patients within Old Age Psychiatry and the wider community. 4.1 Health promotion and illness prevention in community settings 

Apply an understanding of the factors (including physical economic and cultural factors) that contribute to health inequalities, and the social, cultural, spiritual and religious determinants of health as relevant to older adults. 

Apply, where appropriate, the basic principles of global health including governance, health systems and global health risks, and use these in your practice.  

Apply the principles of patient self-management, self-care and “expert by experience” in your practice.  

Identify and challenge stigma and discrimination that are associated with both ageing and mental disorder in older adults in both clinical and community settings.  

Lead, advocate and educate health and non-health professionals in health promotion and illness prevention for older adults.  

Promote physical health, mental health and wellbeing in older adult patients, and the wider community.  

 

By the end of ST6, you will be able to:ThemesKey Capabilities
Demonstrate effective team working and leadership skills to work constructively and collaboratively within the complex health and social care systems that support people with mental disorder. 5.1 Teamworking

Recognise the strengths, weaknesses and skill levels within a team and work with these to provide containment and support to the team and to colleagues when needed contributing to service development. 

Understand the role of the Consultant Psychiatrist for older adults in identifying and managing conflict and dysfunction that can arise in teams and use effective negotiation skills to manage these. 

Encourage contribution from individual team members in order to develop their practice whilst also taking into account their particular skills and build confidence. 

Support colleagues to develop their practice.  

 5.2 Leadership

Understand the leadership role of a consultant psychiatrist in relation to the team and wider systems in managing and adapting to difficult clinical and nonclinical situations as they arise and delegate when required.  

Manage the prioritisation and assessment of referrals and allocate according to need and expertise within the team.  

Actively seek out opportunities to gain feedback about your practice and adapt and develop in response to this feedback as appropriate.  

Demonstrate inclusive leadership style and awareness of the impact of hierarchy and power within relationships with patients and colleagues. 

 

By the end of ST6, you will be able to:ThemesKey Capabilities
Identify, promote and lead activity to improve the safety and quality of patient care and clinical outcomes of a person with mental disorder. 6.1 Patient Safety

Demonstrate proficiency in reflective practice when involved in adverse incidents, learning and adapting as appropriate.  

Apply the principles of clinical governance, human factors and team dynamics to assess and improve patient safety for older adults.   

Respond in a timely and effective way to address concerns relating to the safety of older adult patients. 

 6.2 Quality Improvement

Use accepted quality improvement methodologies to identify and implement improvements within older adult services and supervise others in this regard as appropriate.  

Consistently apply the principles of service improvement and high-quality care. 

 

By the end of ST6, you will be able to:ThemesKey Capabilities

Lead on the provision of psychiatric assessment and treatment of those who are identified as being vulnerable within Old Age Psychiatry. 

Demonstrate advocacy, leadership and collaborative working around vulnerability and safeguarding in patients, their families and their wider community. 

7.1 Safeguarding

Demonstrate specialist knowledge and the ability to manage the individual and systemic factors contributing to the vulnerabilities and safeguarding concerns in older adults with mental disorders.  

Demonstrate clinical expertise in recognising all forms of abuse in older adults, families and carers of all ages, and the wider community.  

Apply your understanding of how physical health comorbidity contributes to the vulnerabilities and safeguarding concerns in older people with mental disorders.  

Recognise physical, emotional and economic pressures on patients, their families and carers of all ages which contribute to the vulnerabilities and safeguarding concerns in older adults with mental disorders.  

Apply legislative frameworks where safeguarding concerns are identified and contribute to interagency assessments and risk management and protection plans.  

Demonstrate a detailed working knowledge of safeguarding frameworks for older adults within which identified risks can be managed.  

 

By the end of ST6, you will be able to:ThemesKey Capabilities
Promote and lead on the provision of effective education and training in clinical, academic and relevant multi-disciplinary settings. 8.1 Education and Training

Teach effectively on clinical and non-clinical topics using a variety of teaching methods.  

Provide supportive, effective, honest and constructive feedback to colleagues.  

Effectively complete appropriate workplace-based assessment tools for other medical colleagues. 

Demonstrate effective supervision and mentoring skills as essential aspects of education to promote safe and effective learning environments. 8.2 Supervision

Demonstrate a knowledge of the principles of, and differences between clinical, psychiatric and educational supervision.  

Demonstrate provision of safe and effective clinical supervision to others in emergency and non-emergency situations involving older adults. 

 

By the end of ST6, you will be able to:ThemesKey Capabilities
Apply an up-to-date advanced knowledge of research methodology, critical appraisal and best practice guidance to clinical practice, following ethical and good governance principles. 9.1 Undertaking research and critical appraisal

Critically evaluate data, papers, reviews, and meta-analyses and implement findings in daily clinical practice.  

Translate research into local clinical practice and disseminate critical appraisal findings to wider communities.  

Apply knowledge of up to date appropriate statistical methods.  

Demonstrate proficiency in the use of objective evidence-based clinical assessment instruments.  

Work within ethical frameworks when carrying out or appraising research.  

Apply the principles of Research Study Protocols where available.   

Demonstrate practical contribution to an ethically approved research study. 

 

Psychiatry of Learning (Intellectual) Disability (2022)

Intellectual Disability (previously ‘learning disability’) is defined as: ‘A condition of arrested or incomplete development of the mind, which is especially characterised by impairment of skills manifested during the developmental period, skills which contribute to the overall level of intelligence, i.e. cognitive, language, motor, and social abilities’.  

The diagnosis requires: 

  • IQ of below 70. 

  • Deficits in one or more areas of adaptive functioning, for example, communication, social participation, independent living. 

  • Onset during the developmental period (up to age 18). 

Psychiatrists working with people with Intellectual Disabilities assess and treat people with an Intellectual Disability who present with a wide range of psychiatric disorders and associated behavioural challenges. They also assess and manage Autism, ADHD and other neurodevelopmental conditions as well as epilepsy1 in this patient group.  

The need for psychiatrists across the specialties is growing throughout the UK2,3,4. People with Intellectual Disabilities have higher rates of mental illness than the general population. The prevalence of clinically diagnosed mental ill-health in adults with Intellectual Disabilities has been found to be around 40%5; across the Intellectual Disability population, there is an association between severe to profound Intellectual Disability and mental ill-health6. Psychiatrists work with people with Intellectual Disabilities across service transitions with other psychiatric specialties across the UK. They work with other teams, within the health service (e.g., specialist Autism teams), external agencies (e.g., social care and education) and the independent and third sectors, to provide systemic, holistic person-centred care. Intellectual Disability Psychiatrists work in a range of clinical settings in the community and inpatient services. They work with children, adults and offenders with Intellectual Disabilities. 

NHS England has stated in the NHS Long Term Plan that it is important for people with Intellectual Disabilities to access mainstream services with support from specialist services where necessary, but equally that many people with Intellectual Disabilities need to access specialist services to optimise their mental health7. The 2016 NICE guidance on mental health problems in people with Intellectual Disabilities8 highlights the key role of specialists with expertise in treating mental health problems in this population.  

The Welsh Government’s ‘Together for Mental Health’ 10-year strategy published in 2012 highlights the need for primary mental health services to be skilled and supported by Learning Disability Specialist Teams9

The 2018 ‘Improving Lives’ Programme for people with Intellectual Disabilities includes the recommendation that people with complex needs have timely and easy access to specialist Intellectual Disability services through maintaining multidisciplinary teams, and developing appropriate care services, including mental health and out of hours access10.  

The Scottish Mental Health Strategy11 has identified the need to shift the balance of care towards mental health. Following on from this, the Scottish Government has included people with Intellectual Disabilities in the new Mental Health Quality Indicators, so that people’s experiences can be improved12

Northern Ireland has higher levels of mental ill health than any other region in the UK13. An independent review of Mental Health and Intellectual Disability service provision identified that building up the range of specialist mental health services is required to meet that need14.  

Training in Psychiatry of Intellectual Disability begins with recruitment to the training programme, after successful completion of Core Psychiatric Training and the MRCPsych examinations.  

It is recommended that training in Psychiatry of Intellectual Disability is undertaken over a recommended 36 months whole time equivalent (WTE) in order to achieve the required capabilities and gain the necessary experience to practice as a Consultant Psychiatrist in Intellectual Disability. Successful completion of the training programme leads to entry on to the Specialist Register. 

The Psychiatry of Intellectual Disability curriculum builds on the clinical capabilities attained in Core Psychiatric training such as advanced communication and interpersonal skills, examination skills, formulation, diagnosis and treatment to a mastery level. The particular focus at higher level is on adapting these skills to meet the needs of people with Intellectual Disabilities. It also involves the further development of capabilities such as leadership and management, teaching, research and quality improvement.  

By the end of ST6 trainees in Psychiatry of Intellectual Disability will have developed the necessary capabilities to gain a CCT in this specialty registerable with the GMC, and will be ready to practice as a Consultant Psychiatrist in Learning (Intellectual) Disability.  

These capabilities include specialist skills in the assessment, formulation, diagnosis and management of mental disorders, behavioural challenges, neurodevelopmental disorders and epilepsy in people with Intellectual Disabilities. 

Trainees will have developed high level communication skills and specialist clinical expertise in the complex presentation of mental disorders in this population and be able to manage both simple and complex presentations at all levels of intellectual and communicative functioning. 

They will also develop specialist capabilities in the delivery of psychological, pharmacological, and social interventions modified to meet the unique needs of people with Intellectual Disabilities.  

Training will be delivered in multidisciplinary teams in community, inpatient and settings across both health and social care services. 

Trainees will have particular expertise in applying legal frameworks surrounding capacity/incapacity and mental disorder and be fully versed in the management of risk in patients with Intellectual Disabilities.  

They will practice systemic, holistic care for people throughout the patient journey, taking into account the psychological, biomedical and social context for each individual and be active advocates for their patients within the wider health and social care system.  

People with Intellectual Disabilities experience the same range of mental disorders as the wider population, albeit with a more varied presentation dependant on developmental level, cognitive profile and nature of any communication impairment. Higher level trainees will, therefore, gain experience of assessing and managing the full range of mental illnesses as seen by other psychiatric specialties, allowing for flexibility and transferability of skills. 

Psychiatry of Intellectual Disability has limited interdependencies with other specialties. The following are a list of medical specialists that a CCT hold in Psychiatry of Intellectual Disability will work with as part of the regular service delivery: 

  • Child and Adolescent Psychiatry  

  • General Adult Psychiatry  

  • Forensic Psychiatry  

  • Old Age Psychiatry  

  • Liaison Psychiatry  

  • General Practitioners 

  • Secondary Care Specialists including Medicine and Surgery specialists, in particular we work closely with Neurology, Cardiology, Genetics and Sleep specialists.  

  • Paediatrics 

Wider professionals include: 

  • Health professionals in the ID Multidisciplinary Team including Learning Disability nurses, speech and language therapists, Occupational therapists, Psychologists and psychotherapists, Physiotherapists. 

  • ID Crisis / Intensive Support Teams 

  • Neurodevelopmental teams e.g., Autism support teams. 

  • Primary care/secondary care ID liaison nurses 

  • Dental services including specialist dentists 

  • Dietitians 

  • Pharmacists 

  • Social workers. 

  • Education 

  • Police/probation/CJS 

  • Advocates / IMCAs 

  • Third sector 

  • Support providers 

  • Private sector providers 

  • Health and Social Care Commissioners 

  • Healthcare regulators e.g., CQC 

The recommended three years spent in training will provide appropriate development of transferable skills and experience (e.g., advanced leadership, emergency psychiatry and complex decision making) as well as specialised skills and experience in Psychiatry of Intellectual Disability. Trainees will also have transferrable skills and expertise in the diagnosis and management of neurodevelopmental disorders, including Autism and ADHD, which they can apply within the wider psychiatric population. 

Trainees may also undertake dual training with Child and Adolescent Psychiatry15 building upon skills from training in Psychiatry of Intellectual Disability. The GMC approved dual-training programmes include shared capabilities and combinations of skills and experience for diverse service and population needs.  

Due to these shared capabilities, dual training programmes can be undertaken in less than six years, the standard recommended training time for training in two psychiatric specialties. 

The learning outcomes in the Psychiatry of Intellectual Disability curriculum are mapped to the Generic Professional Capabilities (GPC) Framework, ensuring ease of transfer between medical specialties.  

Through attainment of the High-Level Learning Outcomes (HLOs), this curriculum will enable trainees to lead and work in multidisciplinary and multi-professional teams, provide leadership and participate in research, teaching and training across a variety of clinical settings. It will also enable trainees to gain experience in formulating person-centred, systemic, holistic management plans for people with Intellectual Disabilities and their care and support networks. 

This purpose statement has been endorsed by the GMC’s Curriculum Oversight Group and confirmed as meeting the needs of the health services of the countries of the UK. 

By the end of ST6, you will be able to:ThemesKey Capabilities
Demonstrate the professional values and behaviours required of a Consultant Psychiatrist with reference to Good Medical Practice,  Core Values for Psychiatrists (CR204) and other relevant faculty guidance.  1.1 Professional Relationships

Work collaboratively and effectively with patients with an intellectual disability, their families, their carers of all ages, and colleagues, while managing complex risk and system dynamics.  

Recognise, validate and actively address systemic and structural inequalities, intersectionality, and their impact on clinical outcomes for patients and their carers of all ages, and on working relationships with colleagues.  

Consistently demonstrate, and promote in others, a person-centred holistic approach to patients with an intellectual disability, their families and their carers of all ages that is empathic, compassionate and respects their dignity, whilst remaining realistically optimistic and honest.  

Demonstrate flexibility, leadership, use of initiative, prioritisation, and adaptability, effectively managing your time and resources and using new technologies as appropriate.  

Understand the fundamental role of multidisciplinary team working in intellectual disability practice and the role of the psychiatrist within this.    

Apply an understanding of how culture and community influence patients with intellectual disability and their families, affecting their interaction with services.   

Set and maintain professional boundaries with stakeholders, for example adult services, commissioners, support providers, legal professionals, the police and primary and secondary care.   

Advocate for your patients with intellectual disability; where necessary do so separately to the needs and wishes of other systems, for example families and carers, primary and secondary care and social care. 

 1.2 Professional Standards

Understand the impact of workload, patient, team and organisational dynamics on your own well-being.  

Use supervision and reflection effectively, recognising your skills, limitations and your duty of candour.   

Apply strategies to take care of your wellbeing, seeking timely support and guidance, including acknowledging if you have a protected characteristic which might impact on your training, or if you are having difficulties adapting to working in the UK, and support trainees and other colleagues to do so too.   

Actively use and promote reflective practice in your team to address the emotional impact of work on yourself, the individual and the team.   

Consistently demonstrate a positive and conscientious approach to the completion of your work.  

Make clear, accurate and contemporaneous records.  

Promote psychiatry of intellectual disability as a specialty, including acting as an advocate for patients, families and carers.   

Maintain appropriate professional standards whilst working clinically, as a leader within a healthcare organisation and with other stakeholders.  

Maintain appropriate confidentiality in intellectual disability practice and advise other professionals within and outside the health and social care setting.    

Identify and challenge stigma and discrimination against people with intellectual disability.  

Promote the resources available within the specialist team to the wide health and social care system, in order to enable optimal physical health of patients.   

Take responsibility for raising and addressing issues of patient safety and quality of care in a timely manner.   

Maintain appropriate professional attitudes and behaviour when managing situations of ambiguity and uncertainty.  

Demonstrate an understanding of the principles of sustainability and how they underpin sustainable psychiatric practice. 

 

By the end of ST6, you will be able to:ThemesKey Capabilities
Demonstrate advanced communication and interpersonal skills when engaging with patients, their families, carers of all ages, their wider community, colleagues and other professionals. 2.1 Communication

Demonstrate an understanding of your own style of verbal and nonverbal communication and the impact of this on professional relationships.  

Consistently communicate effectively with patients across the spectrum of cognitive ability, including those with neurodevelopmental disorders and relevant others, utilising a range of methods and adapting your style of communication to the patient's needs, making reasonable adjustments as appropriate.  

Demonstrate skills in supporting those for whom English is not their first language, including the use of interpreters, and providing information in other languages.  

Develop and maintain therapeutic relationships with your patients with intellectual disability, their families and their carers of all ages.  

Communicate effectively with colleagues in the multidisciplinary team and promote interagency working through effective liaison with external organisations.  

Analyse complex information and express your professional opinion coherently through both written and verbal communication.  

Produce written reports within the limits of your expertise, which are coherent, comprehensive, timely, accurate, relevant, and as appropriate taking into account legal principles and requirements.  

Effectively explain to patients with intellectual disability, their families and their carers of all ages, the outcome of the assessment and the recommended care plan, considering their ideas, concerns and expectations.  

Demonstrate advanced skills in the psychiatric assessment, formulation, diagnosis and person-centred holistic* management of an appropriate range of presentations in a variety of clinical and non-clinical settings within Psychiatry of Learning (Intellectual) Disability. 2.2 Clinical Skills

Demonstrate a person-centred holistic approach to the assessment and treatment of mental disorders in patients with intellectual disability considering relevant social, cultural, spiritual and religious factors.  

Demonstrate a working knowledge of the genetic causes of intellectual disability and the associated behavioural phenotypes.  

Understand the principles of life span issues that affect people with intellectual disability and their families, and how these influence the management of transitions.   

Demonstrate an appropriate understanding of learning and behavioural stages of human development through the lifespan including awareness of normative as well as variations in presentations, for example with neurodevelopmental conditions and across cultures.  

Demonstrate proficiency in the assessment of capacity to consent to care and treatment in patients with intellectual disability.  

Demonstrate an understanding of the social determinants of health, including economic deprivation, inadequate nutrition, educational and environmental factors and the impact of these on the aetiology and presentation of mental disorders in patients with intellectual disability.  

Apply advanced knowledge of the pharmacodynamics, pharmacokinetics, efficacy, tolerability, interactions and adverse effects of psychotropic medication in patients with intellectual disability as appropriate when initiating, reviewing, changing or discontinuing regimes. 

Demonstrate proficiency in obtaining a detailed psychiatric history and performing a mental state examination in patients with intellectual disability in both routine and urgent settings.  

Assess patients from a range of different cultural, spiritual, and religious backgrounds, including asylum seekers and refugees, and demonstrate an understanding of how protected characteristics may impact on clinical presentation.  

Conduct a thorough physical examination, request relevant investigations and make referrals to other specialists where appropriate.  

Assess the general health of your patients, taking into account the impact of their physical health on their mental health needs and vice versa. This assessment should include consideration of nutritional, metabolic, endocrine and reproductive factors and disorders, and the physical and mental impact of substance use and addiction on clinical presentation.  

Demonstrate proficiency in the assessment and diagnosis of mental and neurodevelopmental disorders in patients with intellectual disability across the spectrum of cognitive ability using classification systems as appropriate.  

Demonstrate proficiency in the assessment of risk in people with intellectual disability leading to a formulation and risk management plan.  

Demonstrate proficiency in the construction of a comprehensive clinical formulation relevant to patients with intellectual disability and use this to devise a safe, effective and evidence-based management plan.  

Demonstrate proficiency in use of formulation to support the understanding of challenging behaviour in patients with intellectual disability, including the link between communication and behaviour.    

Demonstrate an understanding of the utility and limitations of clinical rating scales and psychometric testing for people with intellectual disability.  

Demonstrate skills in the assessment and management of acute mental health crises in patients with intellectual disability.  

Demonstrate specialist skills in the assessment and management of cognitive impairment in older patients with intellectual disability.  

Demonstrate an understanding of the assessment and treatment of epilepsy in patients with intellectual disability.  

Demonstrate advanced knowledge of psychological and psychotherapeutic treatments in the management of mental and behaviour disorders in adults with intellectual disability.  

Understand the range of community and inpatient treatment options for mental and behaviour disorders in patients with intellectual disability.  

Work effectively across professional interfaces by collaborating and liaising with other medical and psychiatric specialities to support provision of holistic care and treatment for your patients with intellectual disability.  

Demonstrate proficiency in prescribing safely and effectively for patients with intellectual disability in routine and urgent settings, considering the research evidence base, prescribing guidelines, individual patient factors and the views of patients and their support networks.  

Demonstrate an understanding of how physical treatments can be used for the treatment of mental disorders and apply this under supervision.  

Work with others using a person-centred holistic approach to safely manage behavioural challenges and to support behavioural and environmental change.   

Evaluate the outcome of interventions and treatments in patients with intellectual disability.  

Work across a variety of service settings including care homes, supported living placements, day services, educational facilities and hospitals.  

Apply advanced management skills within Psychiatry of Learning (Intellectual) Disability in situations of uncertainty, conflict and complexity across a wide range of clinical and non-clinical contexts. 2.3 Complexity and Uncertainty

Demonstrate an understanding of unconscious processes including transference, countertransference, projection and the experience of splitting, and the impact of these on professional relationships.   

Demonstrate proficiency in recognising and managing clinical uncertainty, ambiguity, divergent views and complex co-morbidities and associated risks relating to those with intellectual disability.  

Consciously vary from established care pathways where clinically indicated and justify these decisions as needed. 

Understand and work within the limits of your clinical capabilities, seeking timely support and consultation when needed.  

Demonstrate an understanding of individual variation and the impact of social, cultural, spiritual and religious factors, including effects of deprivation, discrimination and racism.  

Work with others to promote therapeutic optimism and hope in the management and care of patients with intellectual disability.   

Manage divergent views about patient care leading to appropriate clinical interventions. 

 

 By the end of ST6 you will be able to:ThemesKey Capabilities
Apply advanced knowledge of relevant legislative frameworks across the UK to safeguard patients and safely manage risk within Psychiatry of Learning (Intellectual) Disability. 3.1 Knowledge of legal and organisational frameworks in your UK jurisdiction 

Apply the current legislation governing the care and treatment of people with intellectual disability and mental disorders in a variety of settings, including the use of emergency powers and compulsory treatment.  

Apply the principles of least restrictive practice and human rights, when considering the application of legal powers across different settings.  

Demonstrate an understanding of complex ethical issues relevant to the care of people with intellectual disability.  

Give testimony at appropriately convened settings to review the legal status of a patient.  

Meet the requirements to apply for relevant statutory approval where appropriate. 

Work effectively within the structure and organisation of the NHS, and the wider health and social care landscape. 3.2 Working within NHS and organisational structures Demonstrate understanding of the national health priorities for people with intellectual disability in your UK jurisdiction, including the rationale behind annual health checks and associated health plans. 

 

By the end of ST6 you will be able to:ThemesKey Capabilities
Demonstrate leadership and advocacy in mental and physical health promotion and illness prevention for patients within Psychiatry of Learning (Intellectual) Disability and the wider community. 4.1 Health promotion and illness prevention in community settings 

Apply an understanding of the range of health inequalities faced by people with intellectual disability and the multiple factors that contribute to premature mortality.  

Demonstrate an understanding of public health as it applies to people with intellectual disability, including mortality and morbidity data and how this relates to health disparity.   

Work with primary care, secondary care and statutory services as required to support your patients with intellectual disability in having their health needs met.  

Promote a healthy lifestyle in patients with intellectual disability and an understanding of the interrelationship between the body and the mind including the management of sleep, mental and physical disorders.  

Develop an understanding of the local data and how this compares with regional/national data. 

Demonstrate knowledge of the screening required in your patients with a genetic cause of their intellectual disability with appropriate onward referral/advice.  

Demonstrate an understanding of the physical health conditions associated with the most significant causes of morbidity and mortality in people with intellectual disability and engage with the local mortality review process for people with intellectual disability.  

Demonstrate advanced understanding of the concept of diagnostic overshadowing and how this affects people with intellectual disability and the care they receive, including challenging when this occurs in both primary and secondary care.  

Demonstrate advocacy for your patients and support other health professionals to make reasonable adjustments. 

 

By the end of ST6 you will be able to:ThemesKey Capabilities
Demonstrate effective team working and leadership skills to work constructively and collaboratively within the complex health and social care systems that support people with mental disorder. 5.1 Teamworking

Recognise the strengths and weaknesses within a team and demonstrate how to work with these, using emotional intelligence and maintaining an awareness of one’s own cognitive biases.  

Work in collaboration with patients with intellectual disability, their families and carers of all ages, and the multi-disciplinary team.  

Appraise, question and challenge the performance of other team members when standards appear to be compromised, and escalate concerns appropriately. 

 5.2 Leadership

Understand the importance of leadership and the role of a consultant psychiatrist in intellectual disability, in the context of team and multiagency working.  

Develop and apply your own advanced leadership skills in a variety of clinical and non-clinical settings.  

Demonstrate inclusive leadership style and awareness of the impact of hierarchy and power within relationships with patients and colleagues.  

Demonstrate an understanding of how your own advanced leadership skills and behaviours impact on others and adapt your approach where appropriate to meet the needs of the team.  

Lead, support and supervise others in both clinical and non-clinical settings.  

Understand the principles of mentoring and its role in career development and apply this knowledge in your practice.  

Demonstrate an understanding of the principles underpinning the management and delivery of services for people with intellectual disability.  

Manage and lead on improving and adapting the service in which you work, including managing referrals and delegating work appropriately. 

 

By the end of ST6 you will be able to:ThemesKey Capabilities
Identify, promote and lead activity to improve the safety and quality of patient care and clinical outcomes of a person with mental disorder. 6.1 Patient Safety

Understand and apply the principles of clinical governance, taking into account the impact of human factors and team dynamics, to assure patient safety and quality of clinical care.  

Apply understanding of the serious incident review process taking appropriate action where required.  

Demonstrate knowledge of risk management issues for services for people with intellectual disability, including risks to patients, families, carers of all ages, staff and members of the public.  

Understand the role of environmental risk assessment in intellectual disability settings and apply the principles of this to the settings in which you work.  

Demonstrate knowledge of the relevant policies and procedures for patient safety in your organisation and how to escalate concerns if these arise. 

 6.2 Quality Improvement

Demonstrate knowledge of a range of quality improvement methodologies for developing creative solutions to improve services and apply this knowledge through participation and leadership of activity in your service.   

Demonstrate knowledge of mechanisms for obtaining feedback from patients, the public, staff and other interested groups, and utilise the feedback obtained to implement/manage change.  

Understand the role of the ‘expert by experience’ in improving patient care and support patients with intellectual disability and their families and carers of all ages to undertake this role.   

Demonstrate a clear understanding of local complaints procedures and participate in handling complaints made about services.  

Participate in and lead on clinical governance activities, risk management and audit in order to improve the quality of the service.    

Apply audit principles, relevant clinical guidelines and integrated care pathways to your own work and team practice. 

 

By the end of ST6 you will be able to:ThemesKey Capabilities

Lead on the provision of psychiatric assessment and treatment of those who are identified as being vulnerable within Psychiatry of Learning (Intellectual) Disability. 

 

Demonstrate advocacy, leadership and collaborative working around vulnerability and safeguarding in patients, their families and their wider community. 

7.1 Safeguarding

Recognise any health concerns, emotional and economic pressures impacting on carers of all ages, which contribute to vulnerability and safeguarding concerns in your patients with intellectual disability.   

Work within legislative frameworks and local processes to anticipate and report safeguarding concerns, providing leadership when necessary.  

Understand the role and responsibilities of psychiatric services in safeguarding people with intellectual disability and their support networks.  

Demonstrate an understanding around the use of safe, approved restrictive interventions in psychiatric services and the guidance surrounding this and work with others to minimise the use of these in clinical practice.  

Recognise signs of abuse and trauma in people with intellectual disability, their families, carers of all ages and the wider community.  

Demonstrate applied knowledge of risk management, including risks to patients with intellectual disability, carers of all ages, staff and members of the public.  

Assess risk, capacity to consent and the need for detention in complex cases with intellectual disability. 

Demonstrate an understanding of the issues around confidentiality in intellectual disability practice.  

Include the views and voice of the person with intellectual disability when working within safeguarding processes, mindful of capacity. 

 

By the end of ST6 you will be able to:ThemesKey Capabilities
Promote and lead on the provision of effective education and training in clinical, academic and relevant multi-disciplinary settings. 8.1 Education and Training

Provide education and training to medical, multi-disciplinary and multi-agency colleagues including effective planning, delivery techniques and feedback using technology as appropriate.  

Demonstrate knowledge of the process of continuing professional development and its role in maintaining practice and supporting revalidation.   

Apply the principles of co-production in teaching and training with people with intellectual disability and their families/carers. 

Demonstrate effective supervision and mentoring skills as essential aspects of education to promote safe and effective learning environments. 8.2 Supervision

Apply knowledge of the principles of clinical and psychiatric supervision, providing safe and effective clinical supervision in both emergency and non-emergency situations, in a timely manner.   

Actively participate in clinical, psychiatric and educational supervision. 

 

By the end of ST6 you will be able to:ThemesKey Capabilities
Apply an up-to-date advanced knowledge of research methodology, critical appraisal and best practice guidance to clinical practice, following ethical and good governance principles. 9.1 Undertaking research and critical appraisal

Critically evaluate data, papers, reviews, and meta-analyses and implement findings in daily clinical practice.  

Translate research into local clinical practice and disseminate critical appraisal findings to wider communities.  

Apply knowledge of up to date appropriate statistical methods.  

Demonstrate proficiency in the use of objective evidence-based clinical assessment instruments.  

Work within ethical frameworks when carrying out or appraising research.  

Apply the principles of Research Study Protocols where available.   

Demonstrate practical contribution to an ethically approved research study where relevant research support is available. 

 

Sub-Specialty/Endorsement Curricula 

Addictions Psychiatry (2022)

Addiction Psychiatrists provide assessment and treatment for patients of all ages with severe and enduring medical and psychiatric co-morbidities arising from or complicated by, the use of substances such as alcohol, nicotine and other drugs.1,2,3,4,5,6 They also assess and treat people with gambling addiction and other addictive behaviours. Addiction Psychiatrists have significant expertise, being the most highly trained professionals in the addictions field.  They apply their medical training and knowledge to the field by providing evidence-based quality treatment to patients in an efficient and cost-effective way, developing treatment guidelines and delivering training. In addition, they play an important role in raising awareness and providing treatment interventions to prevent harm to children including treatment during pregnancy; they work in collaboration with other specialities and disciplines to understand the needs of families and carers.10,11 They have an understanding of the aetiology of addictions, especially childhood trauma and an ability to work and lead in a non-hierarchical way which includes advocacy for their patients. 

The Dame Carol Black report12 (February 2020) highlights that illicit drug use is now big business; drug related deaths have reached an all-time high and are closely associated with poverty and deprivation and more than a third of people in prison are there due to causes related to drug use. Patients are now presenting with increasing levels of co-morbidity and complex needs.  Key points highlighted from the report include: 

  • Funding reductions exacerbating gaps in treatment provision 

  • Treatment commissioning outside of the NHS raises concerns for quality management 

  • Competition with funding has meant that a small number of third sector providers have dominated the market 

  • The number of training places for addiction psychiatrists has plummeted, raising general concerns around current training opportunities. 

 

Training in Addiction Psychiatry is essential to provide expert advice to other doctors and clinicians, and non-medical prescribers on assessment (including risk), diagnosis, complex prescribing and recovery care planning, as well as liaison with other statutory and non-statutory services.13 The provision of effective specialist addiction treatment and advice contributes to cost savings, including the contribution to local needs assessment, commissioning and service development, research and audit.14,15,16  

It is clear that the need for psychiatrists across the specialties is growing throughout the UK.17,18,19   

The UK Drug strategy reported that up to 70% of people in community addiction treatment also experience mental disorder.20,21 People with cooccurring substance use disorders (SUD) and mental health conditions are too often unable to access the care they need. People with co-occurring mental health conditions are at higher risk of dying by suicide. Between 2004 and 2014 one third (33%) of patients in mental health treatment who died by suicide had a history of SUD, but only 7% were in contact with addiction treatment services.22 The strategy committed to working with Health Education England and other stakeholders - in line with the Five Year Forward View for Mental Health recommendation – and aims to support the development of an appropriately trained and competent workforce to meet the needs of people with co-occurring substance use and mental health conditions.  

The Global Burden of Disease (GBD) study ranks alcohol and drug use in the top five contributors to causes of premature deaths in England.23 The NHS Long term plan makes a firm commitment to strengthen work on disease prevention and health inequalities by prioritising the development of alcohol care teams within acute hospitals, aiming to prevent 50,000 admissions over five years.24   

The NHS Long term plan is focused on population health systems and Addiction Psychiatrists will be expected to participate not just in patient assessment and management, but also in improving clinical outcomes,25 health promotion, collaborative or integrated care and providing person-centered treatment. The Centre for Mental Health highlights that only 17 of 55 English mental health trusts have specialist addiction services,26 the Five Year Forward view for Mental Health details up to a £30 million future investment for outcome-based interventions for patients with alcohol or other substance use disorders.27    

The Welsh Government’s ten-year strategy to improve mental health and wellbeing has identified a lack of inpatient and specific services for the treatment of addictions. 28 In conjunction with this, the strategy outlines the challenge to address the rise of frequent attenders to emergency departments with mental health needs combined with SUD as adequate services and continuity of care are simply not available.29,30   

In 2018, Scotland had the highest number of drug related deaths in the EU with a rise of 27% on the previous year and the highest since records began.31  

The Scottish Mental Health Strategy has identified the need to shift the balance of care towards mental health and has determined specific actions that are required to improve care in Addictions Psychiatry to meet soaring population trends:32   

  1. Test and learn from better assessment and referral arrangements in a range of settings for dual diagnosis for people with SUD and mental health diagnosis.  

  1. Offer opportunities to pilot improved arrangements for dual diagnosis for people with SUD and mental health diagnosis.  

  1. Support efforts through a refreshed Justice Strategy to help improve mental health outcomes for those in the justice system.   

 Ensure unscheduled care takes full account of the needs of people with mental health problems and addresses the longer waits experienced by them. 

Scotland’s strategy “Rights, Respect and Recovery” aims to improve health by preventing and reducing alcohol and drug use, harm and related deaths and details an eight-point plan for Treatment and Recovery through the improvement of access to effective services, quality treatment and recovery-orientated support.33  

Northern Ireland has higher levels of mental ill heath than any other region in the UK and it has been identified that building up the range of specialist mental health services is required to meet the need.34,35 The Health and Social Care Board has emphasised the monumental financial burden and indescribable social impact addictions can have on individuals, families and communities in Northern Ireland.36 A review of the health care available stated “Not to act on these facts will condemn the population and the system to failure.”37 The ‘You in Mind’ Mental Health Care Pathway that subsequently developed pledges to provide future addiction services to meet the overwhelming need.38  

It is recommended that Addiction Psychiatry training is undertaken over 12 months (Whole Time Equivalent) in order to achieve the required capabilities and gain the necessary experience. Successful completion of the programme leads to entry on to the specialist register with an endorsement (currently termed ‘Substance Misuse Psychiatry’, but with a request that this is renamed ‘Addiction Psychiatry’).   

The purpose of this training curriculum is to enable the consultant Addiction Psychiatrist to develop the necessary skills to assess, diagnose and treat the full range of addictive behaviours, recognise and manage the impact of addiction on mental disorder, develop specialist prescribing skills and gain experience of multiagency working in a variety of complex environments.  This includes evidence-based psychological, biomedical and social interventions in a wide range of clinical settings including criminal justice and acute hospitals.  

This curriculum provides a framework for training. It enables the achievement of essential sub-specialty-specific clinical and generic professional capabilities through development of the professional values, behaviours, knowledge and skills required in order to provide high quality, evidence-based care for those of all ages with addictions, including substance use disorders and behavioural addictions (e.g., gambling).  

Treatment for addiction is delivered in a variety of clinical and non-clinical settings and in conjunction with a range of statutory and non-statutory services including safeguarding, criminal justice and social care. Trainees would be expected to gain experience in these different settings and understand the roles of other stakeholders. A consultant psychiatrist with an endorsement in Addictions will be able to co-ordinate the management and treatment of patients with chronic enduring and acute complex mental and physical health co-morbidities.  

Subspecialty training in Addiction Psychiatry is integrally linked to training in Adult Psychiatry. The three years spent in Adult and Addiction Psychiatry will provide appropriate development of transferable skills and experience (e.g. advanced leadership, emergency psychiatry and complex decision making), as well as specialised skills and experience in Adult and Addictions Psychiatry.  

Further curricula are available for the following established psychiatry specialties:  

  • Child & Adolescent Psychiatry  

  • Forensic Psychiatry  

  • Intellectual (Learning) Disability Psychiatry  

  • Medical Psychotherapy  

  • Old Age Psychiatry  

During training in Addiction Psychiatry, a trainee develops further knowledge and skills to manage complex cases of addiction with comorbid mental and physical health problems. Collaborative working with other physical health specialties such as hepatology, maternity services and gastroenterology develops the trainees understanding of the common comorbid physical health problems seen in the addicted population allowing early detection and signposting for appropriate treatment.  

Training in Addiction Psychiatry provides the Addiction Psychiatrist with the skills to manage complex addiction within all general adult settings where prevalence is high and the need to reduce morbidity and mortality in this group is a recognised challenge.  

The Addiction Psychiatry learning outcomes are mapped to the Generic Professional Capabilities Framework (GPCs) ensuring ease of transfer between medical specialties. Through the attainment of the High-level Learning Outcomes (HLOs), this curriculum will enable trainees to lead and work in multidisciplinary and multi-professional teams, provide leadership and participate in research, teaching and training in a variety of clinical and non-clinical settings. It will also enable trainees to gain experience in formulating person-centred holistic systemic management plans for patients with addictions and additional complex needs.  

Trainees will be provided with the opportunities to develop the expertise to work with people with Addictions and understand the need to signpost to other relevant specialties where appropriate.   

This purpose statement has been endorsed by the GMC’s Curriculum Oversight Group and confirmed as meeting the needs of the health services of the countries of the UK. 

By the end of ST6, you will be able to:ThemesKey Capabilities
Demonstrate the professional values and behaviours required of a Consultant Psychiatrist with reference to Good Medical Practice, Core Values for Psychiatrists (CR204) and other relevant faculty guidance.  1.1 Professional Relationships

Work collaboratively with patients, families, carers of all ages and colleagues respecting their autonomy and valuing their contribution. 

Recognise, validate and actively address systemic and structural inequalities, intersectionality, and their impact on clinical outcomes for patients and their carers of all ages and on working relationships with colleagues. 

Consistently demonstrate a holistic and person-centred clinical approach to adult patients that is honest, empathic, compassionate, and respects their dignity while maintaining therapeutic optimism and boundaries. 

Demonstrate when working with others, the ability to be flexible, lead, use initiative, be able to prioritise, and be adaptable, effectively managing your time and resources, and using new technologies as appropriate.

 1.2 Professional Standards

Demonstrate understanding of the role of personal and professional boundaries in the management of patients with substance use disorder (SUD) and Non-drug Addiction (NDA). 

Demonstrate an understanding of the need for equality and diversity in addiction treatment. 

Act appropriately on any concerns about own or colleagues SUD or NDA. 

Maintain appropriate professional standards whilst working clinically across organisations 

Demonstrate an understanding of the principles of sustainability and how they underpin sustainable psychiatric practice. 

 

By the end of ST6, you will be able to: ThemesKey Capabilities
Demonstrate advanced communication and interpersonal skills when engaging with patients, their families, carers of all ages, their wider community, colleagues and other professionals. 2.1 Communication

Demonstrate the ability to communicate and advocate the current best practice around SUD and NDA evidence to professionals, patients, families and carers of all ages in appropriate formats. 

Consistently demonstrate effective communication approaches with patients and relevant others, including those with neurodevelopmental disorders making reasonable adjustments and adaptations where appropriate, including the use of new technologies. 

Establish and maintain working and supportive relationships whilst understanding the needs of patients, families and carers of all ages. 

Demonstrate skills in supporting those in challenging situations including when English is not their first language, involving the use of interpreters, and providing information in other languages.  

Demonstrate an understanding the principles of involving families, carers of all ages and social networks in the management of SUD and NDA.   

Effectively advocate on behalf of patients with SUD or NDA and their carers in respect of public awareness and stigma.  

Conduct motivational interviewing. 

Effectively communicate across a range of professional bodies and organisations, policy, public awareness, and civil society. 

Demonstrate advanced skills in the psychiatric assessment, formulation, diagnosis and person-centred holistic* management of an appropriate range of presentations in a variety of clinical and non-clinical settings within Addiction Psychiatry. 2.2 Clinical Skills

Assess the impact of SUD and NDA across a variety of clinical populations over the life span, as well as in a wide range of settings.  

Demonstrate an appropriate understanding of learning and behavioural stages of human development through the lifespan including awareness of normative as well as variations in presentations, for example with neurodevelopmental conditions and across cultures. 

Undertake a comprehensive risk assessment, putting in place an appropriate management plan. 

Demonstrate an understanding of the principles of harm minimisation and apply these in practice. 

Demonstrate an understanding of the principles and availability of mutual aid and peer support for addiction. 

Assess patients from a range of different cultural, spiritual, and religious backgrounds, including asylum seekers and refugees, and demonstrate and understanding of how protected characteristics may impact on clinical presentation. 

Use formulation to devise a safe, effective, collaborative and co-productive management plan to ensure continuity of care in the immediate, short and longer term. 

Demonstrate an understanding of the principles of group therapies for addiction. 

Demonstrate an understanding of Addiction Psychiatry in inpatient settings, and treatments provided. 

Demonstrate in-depth knowledge of person-centred holistic management of mental disorder and co-occurring SUD and NDA. 

Demonstrate in-depth knowledge of integrated person-centred holistic management of alcohol, illicit and prescribed substances and NDAs. 

Demonstrate proficiency in acute medical management of in-patients with addiction. 

Demonstrate knowledge and practical application of evidence-based behavioural change techniques. 

Initiate and maintain a comprehensive care plan, potentially involving a broad range of agencies. 

Manage intoxication in emergency settings. 

Demonstrate proficiency in the use of relevant screening tools and rating scales and their relevance to diagnosis and management in patients with SUD and NDA. 

Apply advanced management skills within Addiction Psychiatry in situations of uncertainty, conflict and complexity across a wide range of clinical and non-clinical contexts. 2.3 Complexity and Uncertainty

Demonstrate an understanding of unconscious processes, including transference, countertransference, projection and splitting and the impact of these on yourself and others. 

Demonstrate proficiency in the management and highly specialised treatment of patients with complex psychiatric, medical and social comorbidities. 

Demonstrate an understanding of the place of highly specialised treatments for complex patients.  

Demonstrate knowledge of the systemic complications of substance use, NDAs and relevant treatments. 

Demonstrate an understanding of individual variation and the impact of social, cultural, spiritual, and religious factors, including effects of deprivation, discrimination and racism. 

Undertake appropriate risk assessments in patients who present with SUD and NDA. 

 

By the end of ST6, you will be able to:ThemesKey Capabilities
Apply advanced knowledge of relevant legislative frameworks across the UK to safeguard patients and safely manage risk within Addiction Psychiatry. 3.1 Knowledge of legal and organisational frameworks in your UK jurisdiction 

Demonstrate an understanding of the application of appropriate legislation in the management of patients with SUD and NDA. 

Demonstrate a working knowledge of the legislation around driving with respect to both drug and alcohol use. 

Meet the requirements to apply for relevant statutory approval where appropriate. 

Work effectively within the structure and organisation of the NHS, and the wider health and social care landscape. 3.2 Working within NHS and organisational structures 

Demonstrate a working knowledge of the structure of national health, local authority and third sector services in the management of patients through your interaction with them. 

Demonstrate a working knowledge of the relationships between relevant regulatory bodies including the criminal justice system in service provision for patients with SUD and NDA. 

Demonstrate an understanding of the differences in governance frameworks across organisations. 

Understand the relationship between SUD, NDA and mental health and social factors in service design. 

 

By the end of ST6, you will be able to:ThemesKey Capabilities
Demonstrate leadership and advocacy in mental and physical health promotion and illness prevention for patients within Addiction Psychiatry and the wider community. 4.1 Health promotion and illness prevention in community settings 

Engage with patients with addiction, their families, and carers of all ages and the wider community around health promotion and illness prevention.  

Encourage and empower patients in the management of their condition. 

Apply your understanding of the factors affecting health inequalities and social, cultural, spiritual and religious determinants of mental and physical health to improve your patient’s health. 

Undertake opportunistic brief interventions. 

Identify and challenge stigma and discrimination against people with addictions both amongst professionals and with the public.  

Demonstrate an understanding of, and implement, principles of harm minimisation and other public health measures. 

 

By the end of ST6, you will be able to:ThemesKey Capabilities
Demonstrate effective team working and leadership skills to work constructively and collaboratively within the complex health and social care systems that support people with mental disorder. 5.1 Teamworking

Demonstrate the ability to work across a full range of service providers for people with addiction and understand their role within local and national treatment systems. 

Demonstrate the ability to work closely with colleagues in the Multi-Disciplinary Team (MDT) and external statutory/non-statutory agencies. 

Review and supervise the implementation of care plans with colleagues in the MDT. 

 5.2 Leadership

Demonstrate appropriate assumption, sharing and delegation of responsibility in patients’ best interests. 

Demonstrate the ability to recognise and appraise the clinical and leadership skills of others in a range of contexts.  

Develop supervision and mentorship skills to enhance the management of patients with SUD and NDA.  

Demonstrate inclusive leadership style and awareness of the impact of hierarchy and power within relationships with patients and colleagues. 

Recognise the impact of leadership across systems and manage partnerships. 

 

By the end of ST6, you will be able to:ThemesKey Capabilities
Identify, promote and lead activity to improve the safety and quality of patient care and clinical outcomes of a person with mental disorder. 6.1 Patient Safety

Engage with the systems of clinical governance that assure safety and quality of care for patients with SUD and NDA. 

Promote the effective implementation of national clinical guidelines for patients with SUD and NDA.  

 6.2 Quality Improvement

Demonstrate the importance of quality improvement to enhance patient safety and outcomes of patient care as applied to people with SUD and NDA. 

Undertake quality improvement activities relevant to your clinical practice. 

Actively participate in service development work. 

Demonstrate an awareness of national statistics to inform service development and practice as applied to populations with SUD and NDA. 

 

By the end of ST6, you will be able to:ThemesKey Capabilities

Lead on the provision of psychiatric assessment and treatment of those who are identified as being vulnerable within Addiction Psychiatry. 

Demonstrate advocacy, leadership and collaborative working around vulnerability and safeguarding in patients, their families and their wider community. 

7.1 Safeguarding

Demonstrate specialist knowledge of the individual and systemic factors contributing to the vulnerabilities and safeguarding concerns in people of all ages, their families, and carers of all ages with SUD and NDA.   

Work within legislative frameworks and local process to raise and report safeguarding concerns in a timely manner and contribute to safeguarding processes. 

 

By the end of ST6, you will be able to:ThemesKey Capabilities
Promote and lead on the provision of effective education and training in clinical, academic and relevant multi-disciplinary settings. 8.1 Education and TrainingPromote and lead on the provision of effective education and training in Addiction Psychiatry across a wide range of settings.  
Demonstrate effective supervision and mentoring skills as essential aspects of education to promote safe and effective learning environments. 8.2 Supervision

Demonstrate the professional qualities of an effective trainer, teaching and guiding individuals and groups, providing safe and effective clinical supervision in emergency and non-emergency situations or settings.  

Actively participate in clinical, psychiatric and educational supervision, demonstrating as appropriate effective skills, creating safe and effective learning environments.  

 

By the end of ST6, you will be able to:ThemesKey Capabilities
Apply an up-to-date advanced knowledge of research methodology, critical appraisal and best practice guidance to clinical practice, following ethical and good governance principles. 9.1 Undertaking research and critical appraisal

Describe a range of appropriate research methods for the investigation of SUD and NDA.  

Understand the specific research ethics relating to people with SUD and NDA.  

Demonstrate an awareness of substance use and NDA trends. 

Demonstrate the ability to critically appraise research of the evidence base in addiction psychiatry and apply it to your clinical practice.

 

  1. Independent report: Review of Drugs. Dame Carol Black (2020) 

  1. Delivering quality care for drug and alcohol users: the roles and competencies of doctors. Royal College of Psychiatrists and Royal College of General Practitioners CR173, 2012.  

  1. ”There are predicted to be two million more people with mental health conditions by 2030.” Facing the Facts,  

  1. Old Problems, New Solutions: Improving acute psychiatric care for Adults in England. The Commission to review the provision of acute inpatient psychiatric care for adults, 2016.  

  1. 2017 Drug Strategy. UK Government, 2017 p33  

  1. Comorbidity of substance misuse and mental illness in community mental health and substance misuse services. The British Journal of Psychiatry Sep 2003, 183 (4) 304-313. Weaver et al 2003  

  1. Together for Mental Health. Welsh Government, 2012 (p43)  

  1. Together for Mental Health. Welsh Government, 2012  

  1. “Scotland has highest drug death rate in EU” https://www.bbc.co.uk/news/uk-scotland-48938509 BBC News, Accessed August 2019  

  1. Mental Health Strategy 2017-2027. Scottish Government, 2017  

Liaison Psychiatry (2022)

Liaison Psychiatry is the sub-speciality of psychiatry concerned with clinical practice, teaching and research in medical settings; the liaison referred to is therefore between psychiatry and other clinical disciplines.1 Specialists in Liaison Psychiatry assess, manage and treat people with co-morbid physical and mental health problems across the age range. They have expertise in the relationship between physical illness, psychological distress and social adversities.  

Liaison Psychiatry services have been rapidly expanding across the country following an economic evaluation demonstrating the cost effectiveness of mental health care in physical health settings. Evidence shows a list of benefits including reduction in psychological distress, improved service user experience, improved dementia care, decreased length of stay and enhanced knowledge and skill of general hospital clinicians.2,3 Liaison Psychiatry services can improve the care of patients with medically unexplained symptoms and long term physical conditions in both acute hospital and primary care settings.4,5 

The NHS Five Year Forward View plan for England is on track to implement the ambition of providing all acute hospitals with age appropriate mental health liaison teams, of which at least 50% will meet the ‘Core 24’ service standard as a minimum.6 The NHS Long Term Plan for England has pledged to maintain this commitment that all general hospitals will have mental health liaison services, with 70% of these hospitals meeting the ‘core 24’ standard for adults and older adults by 2023/24. 

The Welsh Government’s ten-year strategy to improve mental health and well-being has determined a range of areas that require attention.8 This includes providing better perinatal mental health care; ensuring each health board has crisis services available seven days a week; the establishment of effective mental health psychiatric liaison capacity for district general hospitals; and addressing mental health/substance misuse needs of frequent attenders of emergency departments.  

The Scottish Mental Health Strategy has identified the need to shift the balance of care towards mental health.9 The Strategy highlights the crucial need to fund Liaison services and work in partnership with the NHS to increase the provision of specialist Liaison Psychiatry services available for acute patients.  

Northern Ireland has higher levels of mental ill health than any other region in the UK.10 It has been emphasised that building up the range of specialist mental health services is required to meet need;11 policy details that a focus on the interface between mental and physical health is required to see drastic improvement in treatment and the economic effectiveness of acute hospital care.  

Given the status of Liaison Psychiatry across the United Kingdom, there is hence a clear need to train more consultant psychiatrists with specialist knowledge and skills in Liaison Psychiatry to meet patient and service need.12 

An endorsement in Liaison Psychiatry will be awarded alongside successful completion of a CCT in either General Adult Psychiatry or Old Age Psychiatry. This can include dual training programmes with either General Adult or Old Age components. It is recommended that the training is undertaken over 12 months (Whole Time Equivalent), in order to achieve the required capabilities and gain the necessary experience.  

The purpose of this training curriculum is to enable the Consultant Liaison Psychiatrist to specialise in the assessment, diagnosis, treatment, management and prevention of mental disorders in adults/older adults in non-psychiatric environments. This includes evidence-based psychological, biomedical and social interventions in a wide range of physical health care settings.  

The curriculum builds on the clinical capabilities attained in Core and Higher Psychiatry training such as advanced communication and interpersonal skills, examination skills, diagnosis and treatment to a mastery level.  It also involves the further development of capabilities such as leadership and management, teaching, research and quality improvement. This curriculum provides a framework for training and enables the achievement of essential sub-specialty-specific clinical and generic professional capabilities.  

This is acquired through the development of the professional values, behaviours, knowledge and skills to provide high-quality, evidence-based patient care in physical health care settings. 

Trainees will be expected to work in an approved Liaison Psychiatry post to ensure experience and capabilities in a variety of physical health care clinical settings such as the acute hospital, primary care and specialist medical and surgical inpatient and outpatient environments. A Consultant Liaison Psychiatrist will be able to work with the whole range of acute and long-term mental health conditions for the whole range of adult/older adult patients in these settings.  

Further curricula are available for the following other established psychiatry specialties: 

  • Child & Adolescent Psychiatry 

  • Forensic Psychiatry 

  • Intellectual (Learning) Disability Psychiatry 

  • Medical Psychotherapy 

  • Old Age Psychiatry 

The Liaison Psychiatry Curriculum has widespread interdependencies which include the General Adult and Old Age Psychiatry curricula and builds on the capabilities outlined in Core Psychiatry. During training in Liaison Psychiatry, a trainee develops the knowledge and skills needed to have overall responsibility, lead a team, understand governance and overall structures. In addition to this, a trainee learns how to use the knowledge and capabilities gained through previous training to function within physical health settings, such as a general hospital, taking into account the complexities of the system and the needs of their staff. An in-depth understanding of the physical health care environment is essential for safe delivery of care. Due to this unique position, experience in service development and an understanding of the working of the wider health economy is an important aspect of training.  

The training will provide appropriate development of transferable skills and experience (e.g. advanced leadership, emergency psychiatry and complex decision making), as well as specialised skills and experience in Liaison Psychiatry, such as assessment and management of medically unexplained symptoms and mental health problems in patients with long term conditions. 

The Liaison Psychiatry learning outcomes are mapped to the Generic Professional Capabilities Framework (GPCs) ensuring ease of transfer between medical specialties. Through the attainment of the High-Level Learning Outcomes (HLOs), this curriculum enables trainees to lead and work in multidisciplinary and multi-professional teams, provide leadership, and participate in research, teaching and training at the interface of physical and mental health. It will also enable trainees gain experience in formulating integrated psychological, bio-medical and social, person-centred management plans for a range of mental health presentations within physical health care settings.  

This purpose statement has been endorsed by the GMC’s Curriculum Oversight Group and confirmed as meeting the needs of the health services of the countries of the UK. 

By the end of ST6, you will be able to: ThemesKey Capabilities
Demonstrate the professional values and behaviours required of a Consultant Psychiatrist with reference to Good Medical Practice, Core Values for Psychiatrists (CR204) and other relevant faculty guidance.  1.1 Professional Relationships

Work collaboratively with patients, families, carers of all ages and colleagues respecting their autonomy, diversity and valuing their contribution.  

Recognise, validate and actively address systemic and structural inequalities, intersectionality, and their impact on clinical outcomes for patients and their carers of all ages and on working relationships with colleagues. 

Consistently demonstrate a holistic and person-centred clinical approach to adult patients that is honest, empathic, compassionate, and respects their dignity while maintaining therapeutic optimism and boundaries. 

Demonstrate flexibility, leadership, use of initiative, prioritisation, and adaptability, effectively managing your time and resources and using new technologies as appropriate. 

 1.2 Professional Standards

Understand the impact of workload, patient and organisational dynamics on your own well-being. 

Use supervision and reflection effectively recognising your skills, limitations and your duty of candour. 

Apply strategies to take care of your wellbeing, seeking timely support and guidance, including acknowledging if you have a protected characteristic which might impact on your training, or if you are having difficulties adapting to working in the UK. 

Use the method of receiving, reflecting and responding to understand the emotional impact of work on the individual and team, including the impact of suicide, trauma, and homicide. 

Consistently demonstrate a positive and conscientious approach to the completion of your work. 

Make clear, accurate and contemporaneous records. 

Promote the specialism of Liaison Psychiatry, including acting as an advocate for your patients and their carers. 

Maintain the appropriate professional standards while working clinically, as a leader within healthcare organisations. 

Work with increasing autonomy within a framework of supervision. 

Act as an ambassador to promote mental health in physical health care settings including acting as an advocate for your patients and their carers.  

Develop safe, confidential settings as a secure base for clinical work in physical healthcare settings.  

Demonstrate an understanding of the principles of sustainability and how they underpin sustainable psychiatric practice. 

 

By the end of ST6, you will be able to: ThemesKey Capabilities
Demonstrate advanced communication and interpersonal skills when engaging with patients, their families, carers of all ages, their wider community, colleagues and other professionals. 2.1 Communication

Demonstrate advanced communication and interpersonal skills when engaging with patients in physical healthcare settings, their families, carers of all ages and healthcare professionals.   

Consistently demonstrate effective communication approaches with patients and relevant others, including those with neurodevelopmental disorders making reasonable adjustments and adaptations where appropriate, including the use of new technologies. 

Reflect your understanding of how patient values and perspectives may differ in a physical health setting and the influence this may have on engagement, assessment, treatment and management, ensuring a shared approach.  

Appropriately explain a range of psychological therapies to patients, families, carers of all ages, and other professionals and organise subsequent management appropriately. 

Communicate complex person-centred holistic concepts in communication with others.  

Demonstrate skills in supporting those in whom English is not their first language, including the use of interpreters, and providing information in other languages.  

Communicate risk assessments effectively and succinctly to other healthcare professionals.   

Reflect on the different communication needs of patients, families, carers of all ages, primary and secondary care professionals, mental health teams and social services, and tailor your communication accordingly.  

Demonstrate proficiency in communicating potentially distressing diagnostic and prognostic information associated with the overlap with physical and mental health, with patients, families, carers of all ages, and clinicians.  

Demonstrate advanced skills in the psychiatric assessment, formulation, diagnosis and person-centred holistic* management of an appropriate range of presentations in a variety of clinical and non-clinical settings within Liaison Psychiatry. 2.2 Clinical Skills

Demonstrate an appropriate understanding of learning and behavioural stages of human development through the lifespan including awareness of normative as well as variations in presentations, for example with neurodevelopmental conditions and across cultures.  

Demonstrate proficiency in the use of relevant questionnaires and screening tools in the liaison psychiatry setting and their limitations.  

Demonstrate advanced skills in person-centred holistic assessment, investigation, formulation and diagnosis of mental disorders in physical health care settings.  

Demonstrate detailed knowledge of epidemiology and common presentations of psychiatric and psychological problems in physical health care settings.  

Identify and diagnose mental disorders in physical healthcare settings.  

Use physical healthcare records to develop a systematic chronology of a patient’s history to aid assessment.   

Perform a detailed assessment of cognitive function taking in to account the limitations of the setting and physical health of the patient.  

Assess patients on busy wards and in the emergency department (ED) respecting patient dignity and confidentiality.   

Demonstrate a flexible approach in assessment, taking into account the patient’s current physical health status.  

Conduct relevant physical examinations, investigations and follow them up appropriately including further referrals e.g., to specialist teams where necessary. 

Assess the general health of your patients, taking into account the impact of their physical health on their mental health needs and vice versa, correctly interpreting the results. This assessment should include consideration of nutritional, metabolic, endocrine and reproductive factors and disorders, and the physical and mental impact of substance use and addiction on clinical presentation.  

Assess patients from a range of different cultural, spiritual, and religious backgrounds, including asylum seekers and refugees, and demonstrate and understanding of how protected characteristics may impact on clinical presentation. 

Integrate information from multiple sources to develop a formulation.   

Be familiar with and adept with terminology used in physical healthcare settings.   

Use a detailed knowledge of contemporary classification systems to understand presentations in physical healthcare settings, including functional symptoms and long-term physical health conditions.  

Liaise and discuss additional investigations with colleagues in the multi-professional team in order to utilise investigations appropriately.  

Carry out a comprehensive assessment of risk including self-harm, suicide; violence; exploitation; neglect; environmental risk; unintentional physical harm, elder abuse.   

Demonstrate knowledge of evidence-based psychological treatments and use these skills in the assessment and management of patients in a liaison psychiatry setting.   

Apply contemporary knowledge and principles of psychological therapies where appropriate and recommending psychotherapeutic /psychological treatment, using an appropriate psychotherapy modality, drawn from the liaison psychiatry setting.

Demonstrate up to date knowledge of the risk and benefits of psychotropic medication and safely prescribe it in patients with physical health challenges.   

Work collaboratively to develop and deliver integrated person-centred holistic management plans (inclusive of risk) for patients with functional symptoms and long-term physical conditions with the individual and their healthcare team, sustaining a therapeutic relationship over a period of time to enable its implementation.   

Understand the changes related to ageing, or of a compromised brain and body, and adapt treatment strategies accordingly.   

Arrange appropriate follow up when required to provide continuity of care.  

Manage psychiatric emergencies in the physical health care setting including emergency use of medication, rapid tranquilisation, use of restraint and post event management aspects.   

Demonstrate an understanding of how physical treatments can be used for the treatment of mental disorders and apply this under supervision. 

Manage at least one supervised psychotherapy case, using an appropriate psychotherapy modality, drawn from the liaison psychiatry setting.  

Demonstrate proficiency in initiating, changing, discontinuing psychotropic medication, including advising colleagues who don’t have a mental health care background, and be aware of limitations and interactions.   

Work across interfaces, between psychiatric, and other medical and non-medical specialties and services, demonstrating appropriate liaison and collaboration.   

Offer psychiatric expertise and guidance to other practitioners (e.g., through consultation or clinical supervision) to provide alternative perspectives for understanding and treatment.   

Demonstrate involvement and contribution to multi-professional management of patients’ needs and risks.  

Apply advanced management skills within Liaison Psychiatry in situations of uncertainty, conflict and complexity across a wide range of clinical and non-clinical contexts. 2.3 Complexity and Uncertainty

Demonstrate an understanding of unconscious processes, including transference, countertransference, projection and splitting and the impact of these on yourself and others. 

Identify, understand, and negotiate complexity and uncertainty in a wide range of clinical and non-clinical contexts.   

Demonstrate proficiency in managing conflict involving patients, professionals, teams and systems, and utilise psychotherapeutic skills in assisting staff groups in other disciplines to manage complex situations.   

Recognise and manage clinical uncertainty, ambiguity, complex co-morbidities of mental and physical illness, including risks associated with various presentations.   

Deviate from care pathways/guidelines when clinically indicated.   

Understand the limits of your clinical capabilities, seeking timely support and consultation when appropriate.   

Manage divergent views about patient care or intervention and deliver appropriate interventions.   

Prioritise information in situations of urgency and demonstrate expertise in applying the principles of crisis intervention in emergency situations. Be able to make urgent care plans and maintain professionalism.   

Observe, absorb, contain and reflect on complex clinical/non-clinical situations in liaison psychiatry, develop a balanced response, and support colleagues to do likewise.   

Review treatment and management plans of patients when the outcome is not as expected or hoped for.  

 

By the end of ST6, you will be able to: ThemesKey Capabilities
Apply advanced knowledge of relevant legislative frameworks across the UK to safeguard patients and safely manage risk within Liaison Psychiatry. 3.1 Knowledge of legal and organisational frameworks in your UK jurisdiction 

Demonstrate understanding of and apply the current legislation governing the care and treatment of people with mental disorder in physical healthcare settings, including emergency powers and compulsory treatment.  

Balance the duty of care to the patient and the protection of others with the restriction of human rights when considering the use of legal powers.  

Demonstrate advanced practical knowledge and application of the relevant mental capacity legislation, in physical healthcare settings.  

Demonstrate understanding of the current national standards, policies and guidelines in relation to the mental health and social care needs of patients in physical health care settings.  

Understand models of consultation within liaison psychiatry and emergency working sufficiently to explain and negotiate with physical and mental health care colleagues and managers.  

Meet the requirements to apply for relevant statutory approval where appropriate. 

Work effectively within the structure and organisation of the NHS, and the wider health and social care landscape. 3.2 Working within NHS and organisational structures 

Demonstrate working knowledge of local health and social care services through your interactions with them.  

Demonstrate awareness and understanding of clinical governance structures in physical health care settings.  

Awareness of interfaces between Liaison Psychiatry and other psychiatric specialties, other branches of medicine and other service providers, including social services.  

 

By the end of ST6, you will be able to:ThemesKey Capabilities
Demonstrate leadership and advocacy in mental and physical health promotion and illness prevention for patients within Liaison Psychiatry and the wider community. 4.1 Health promotion and illness prevention in community settings 

Apply an understanding of the factors contributing to health inequalities, and the social, cultural, religious and spiritual determinants of adult mental health.  

Promote mental well-being and prevention of Mental Disorders within the context of societal change and social technology, identifying and challenging stigma and discrimination against people with mental disorders. 

Demonstrate understanding of public health issues related to mental and physical health; work collaboratively with colleagues within physical health disciplines, and other agencies to promote mental well-being and quality of life.  

Demonstrate proficiency in working collaboratively across agencies to promote mental well-being and quality of life, including in unforeseen circumstances. 

Ensure that appropriate physical health treatments, including optimal nutrition, lifestyle interventions and social prescribing are appropriately used for improving the outcome of treatment of mental disorders. 

Participate in the design and delivery of services, working with patients, families and carers of all ages and the wider community, taking into account local and national health promotion and illness prevention strategies. 

 

By the end of ST6, you will be able to:ThemesKey Capabilities
Demonstrate effective team working and leadership skills to work constructively and collaboratively within the complex health and social care systems that support people with mental disorder. 5.1 Teamworking

Use your understanding of how individual personal qualities, emotions and behaviours impact on teamworking and the quality of patient care. 

Demonstrate a working knowledge of the roles and responsibilities of, and the interface between multidisciplinary team members, including peer support and peer working.  

Understand team dynamics and use effective negotiation skills to resolve conflict and dysfunction. 

Recognise and manage unconscious dynamics between yourself, your patients, the liaison team, and other healthcare teams.   

Model, educate and adapt the service, using conflict resolution skills within and between teams, co-producing improvements with patients and carers. 

Actively participate and contribute to the success of a team by working collaboratively with colleagues from diverse backgrounds and experiences and promoting inclusivity. 

Demonstrate proficiency in the use of negotiating skills with medical and surgical colleagues and managers in physical healthcare settings.   

 5.2 Leadership

Recognise and appraise the leadership skills of others in various contexts.  

Demonstrate the development and application of your own leadership skills in a variety of clinical and non-clinical settings. 

Demonstrate inclusive leadership style and awareness of the impact of hierarchy and power within relationships with patients and colleagues. 

Demonstrate an understanding of how your own leadership style and approach impact on others, adapting your approach to meet the needs of the team. 

Lead, take charge, and offer opinions and direction. 

Support colleagues to enhance their performance and support their development.  

Provide clinical supervision to colleagues at all times. 

Competently manage and lead a team/service, providing consultation and specialist advice to team members and other agencies, including medical and surgical colleagues, and managers in physical healthcare settings. 

 

By the end of ST6, you will be able to:ThemesKey Capabilities
Identify, promote and lead activity to improve the safety and quality of patient care and clinical outcomes of a person with mental disorder. 6.1 Patient Safety

Understand and apply the principles and systems of clinical governance that assure, promote, and improve safety and quality of patient care. 

Participate in activities that promote reflection and learning from critical incidents. 

 6.2 Quality Improvement

Apply an understanding of the impact of quality improvement activities in improving patient outcomes and system performance.  

Lead on quality improvement activities relevant to your clinical practice, including supervising others. 

Disseminate findings from quality improvement activities, implement and manage relevant change. 

 

By the end of ST6, you will be able to:ThemesKey Capabilities

Lead on the provision of psychiatric assessment and treatment of those who are identified as being vulnerable within Liaison Psychiatry. 

 

Demonstrate advocacy, leadership and collaborative working around vulnerability and safeguarding in patients, their families and their wider community. 

7.1 Safeguarding

Apply knowledge of individual and systemic factors contributing to vulnerabilities and safeguarding concerns in people of all ages. 

Work within legislative frameworks and local processes to raise and report safeguarding concerns in a timely manner and contribute to safeguarding processes. 

Demonstrate understanding of the impact of victimisation/exploitation and trauma in vulnerable groups. 

Understand how physical health comorbidity contributes to the vulnerabilities and safeguarding concerns in people with mental disorders.  

Demonstrate advocacy, leadership and collaborative working around vulnerability and use of safeguarding procedures in patients in physical health care settings.  

Advise others on the use of mental health and capacity legislation in people in physical health care settings.  

 

By the end of ST6, you will be able to:ThemesKey Capabilities
Promote and lead on the provision of effective education and training in clinical, academic and relevant multi-disciplinary settings. 8.1 Education and Training

Apply understanding of the principles and methods of learning, education, teaching, training and feedback in a variety of clinical and non-clinical settings. 

Identify your own training needs and pursue your own continuing professional development. 

Adapt teaching and training to the needs of particular learners in physical healthcare settings. 

Demonstrate effective supervision and mentoring skills as essential aspects of education to promote safe and effective learning environments. 8.2 Supervision

Demonstrate the professional qualities of an effective trainer, teaching and guiding individuals and groups, providing safe and effective clinical supervision in emergency and non-emergency situations or settings. 

Actively participate in clinical, psychiatric and educational supervision, demonstrating as appropriate effective skills, creating safe and effective learning environments. 

 

By the end of ST6, you will be able to:ThemesKey Capabilities
Apply an up-to-date advanced knowledge of research methodology, critical appraisal and best practice guidance to clinical practice, following ethical and good governance principles. 9.1 Undertaking research and critical appraisal

Critically evaluate data, papers, reviews, and meta-analyses and implement findings in daily clinical practice. 

Translate research into local clinical practice and disseminate critical appraisal findings to wider communities. 

Apply knowledge of up to date appropriate statistical methods. 

Demonstrate proficiency in the use of objective evidence-based clinical assessment instruments. 

Work within ethical frameworks when carrying out or appraising research. 

Apply the principles of Research Study Protocols where available.  

Demonstrate practical contribution to an ethically approved research study where relevant research support is available. 

 

  1. Commissioning Guidance for Rehabilitation NHS, 2016
  2. Guidance for commissioners of rehabilitation services for people with complex mental health needs. JCP-MH. 2016 p.3
  3. “People with severe and enduring mental illness die on average 10 years earlier than the general population. Women with a schizoaffective disorder can die as much as 17.5 years earlier.”
  4. Together for Mental Health. Welsh Government, 2012
  5. The Lancet Psychiatry Commission; a blueprint for protecting physical health in people with mental illness. The Lancet, 2019
  6. Clinical outcomes and costs for people with complex psychosis; a naturalistic prospective cohort study of mental health rehabilitation service users in England. Killaspy et al, BMC Psych 2016, 16:95
  7. Predictors of move-on from mental health supported accommodation in England; a national cohort study. British Journal of Psychiatry, 2019
  8. A Guide to good practice in the use of out-of-area placements. RCPsych, FR/RS/06, 2012
  9. The NHS Long Term Plan, NHS, 2019
  10. https://gettingitrightfirsttime.co.uk/medical-specialties/mental-health/ Accessed August 2019
  11. Interim NHS People Plan, NHS, 2019
  12. Together for Mental Health, Welsh Government, 2012 p23
  13. Mental Health Strategy 2017-2027, Scottish Government, 2017, p29
  14. Making Life Better, Northern Ireland Assembly, 2014
  15. Mental Health in Northern Ireland: an urgent situation The Lancet Psychiatry, 2018
  16. Evaluation of the 2009-2011 Bamford Action Plan, Dept. of Health , Social Services and Public Safety, 2012
  17. Service Framework for Mental Health and Wellbeing 2018-2021, Department of Health NI, 2018
  18. The NHS Long Term Plan, NHS, 2019 p14
  19. NICE Guideline 181: Rehabilitation for adults with complex psychosis and related severe mental health conditions.
  20. Service Quality and Clinical Outcomes: an Example from Mental Health Rehabilitation Services in England. Killaspy et al, British Journal of Psychiatry, 2013
  21. National Institute for Clinical Excellence (NICE) Guidance, August 2020
  22. CQC Report – Mental Health Rehabilitation Services, NHS (2018)

Rehabilitation Psychiatry (2022)

Rehabilitation Psychiatry specialises in assessment and treatment of people with particularly long term and complex mental health problems who require specialist input to optimize their recovery with integrated psychological, biomedical and social care.1 Around 20% of people diagnosed with severe mental illness will require mental health rehabilitation. The majority have a primary diagnosis of psychosis with functional impairments that lead to longer term high support needs.2,3 

The complex problems these patients experience lead to functional impairment which affects activities of daily living as well as social, interpersonal and occupational functioning. These problems include treatment-resistant symptoms, co-occurring mental health comorbidity that can include substance misuse and co-occurring physical health conditions.4  Specialist rehabilitative care improves the outcome for this group of patients with highly complex and long-term needs.5,6    

It is clear that the need for rehabilitative care is growing across the UK despite the disinvestment in services. There is increasing use of ‘out of area treatments’ for this group which are associated with poorer outcomes including longer lengths of stay and social exclusion.7 This has been acknowledged in the NHS Long Term Plan. 8 NHS England has implemented a national programme to enhance the provision of local rehabilitation services.9 The new specialist programmes indicate the need for better services and an adequate and appropriately skilled workforce.10   

The Welsh Government’s ten-year strategy to improve mental health and well-being has identified a range of areas that require attention. The Welsh Government is focusing on the needs of people with complex and enduring mental disorder.11   

The Scottish Mental Health Strategy has identified the need to shift the balance of care towards mental health. The strategy details the need to address the dramatic decrease in life expectancy of those with severe and enduring mental illnesses. Scotland aims to develop holistic services that address the effect long term mental health conditions have on functional decline to encourage recovery.12    

Northern Ireland has higher levels of mental disorders than any other region in the UK13 with psychiatric morbidity 25% higher than England.14 Specialist mental health services to address enduring and severe mental health conditions are only available in Belfast City14. It has been identified that building up the range of specialist services is required to meet need.15,16    

The NHS Long Term Plan stresses that building up rehabilitation support alongside core services is vital to support those with long term mental health conditions.17 In addition, the first NICE guideline on mental health rehabilitation was published in August 2020 and specifically recommends that ‘All local mental healthcare systems should include a defined rehabilitation pathway as part of their comprehensive service’. The guideline recommends that this should include inpatient rehabilitation services (high-dependency rehabilitation units and/or community rehabilitation units) and a community mental health rehabilitation team to care co-ordinate people living in mental health supported accommodation (residential care, supported housing and floating outreach).18 

There is significant and accumulating evidence that provision of psychiatric rehabilitation is cost-effective for complex long-term mental illness. Around two-thirds of people supported by rehabilitation services progress to successful community living within 18 months of admission to an NHS inpatient rehabilitation unit, and two-thirds sustain this over five years without requiring further hospital admissions, and around 10% achieving independent living within this period. People receiving support from rehabilitation services are eight times more likely to achieve/sustain community living, compared to those supported by generic community mental health services.2 Without specialist rehabilitation, people with severe and complex mental health problems are at very high risk of self-neglect, exploitation from others and long term institutionalisation.19

The evidence has been collated in the recently published National Institute for Clinical Excellence (NICE) Guidance published in Aug 2020.20    

The purpose of this training curriculum is to enable the Consultant Rehabilitation Psychiatrist to specialise in the assessment, diagnosis and effective management of people with complex mental health problems in order to ensure they receive appropriate treatment and are able to achieve and sustain a successful and rewarding life in the community.   

The capabilities in this curriculum include longitudinal, in-depth person-centred assessment, formulation and treatment planning using evidence-based psychological, biomedical and social interventions. Specialist and targeted interventions include those to improve engagement, improve skills in activities of daily living and relapse prevention. Skills to manage transitions of patients from inpatient settings to supported accommodation and independent community living are specifically relevant. Specific training in Rehabilitation Psychiatry offers skills in working with complexity to ensure incremental gains and therapeutic change when working with patients with enduring complex needs and complex co-morbidity.  

The Rehabilitation Psychiatry Endorsement Curriculum ensures that trainee doctors have appropriate and sufficient opportunities to achieve these capabilities.  

After successful completion of Core Psychiatry Training and MRCPsych examinations, trainees are recruited into the Adult Psychiatry training programme to gain necessary experience and capabilities.  Specific training in Rehabilitation Psychiatry focuses on working with patients with enduring complex needs and multi-morbidity. It is recommended that this training period is for 12 months (Whole Time Equivalent) of the 36 months (Whole Time Equivalent) in order to achieve the required capabilities and adequate experience to lead to an endorsement on to the specialist register.  

This curriculum provides a detailed framework for training. It enables the achievement of essential rehabilitation and recovery specific clinical and professional capabilities. This will be through demonstrating professional values, attitudes, behaviours, knowledge and skills required in order to provide high-quality, evidence-based patient care for adults with complex enduring mental disorder.  

Trainees will gain experience and competence in inpatient and community-based rehabilitation services, thereby ensuring the trainee gains appropriate knowledge and skills relevant to both these essential components of the rehabilitation pathway. A Consultant Rehabilitation Psychiatrist will be confident to work with and manage complex mental disorders for a diverse range of patients with long-term mental disorders. This includes multiple co-morbidities such as addictions, physical health conditions, neuro-developmental disorders and other mental disorders.  

These capabilities should be acquired across both inpatient and community rehabilitation settings. Inpatient rehabilitation, community rehabilitation, supported accommodation, secure care settings such as low secure rehabilitation amongst others offer such opportunities, under specialist supervision.  

Further curricula are available for the following other established psychiatry specialties:  

  • Child & Adolescent Psychiatry  

  • Forensic Psychiatry  

  • Intellectual (Learning) Disability Psychiatry  

  • Medical Psychotherapy  

  • Old Age Psychiatry  

Training in Rehabilitation Psychiatry offers specialist enhancement of skills and knowledge that are acquired in General Adult Psychiatry training. The trainee develops the capabilities needed to treat patients with longer term complex disorders, lead effective multidisciplinary teams and understand governance and commissioning structures.    

The recommended indicative one year spent in training will provide appropriate development of transferable skills and experience in Rehabilitation Psychiatry.    

The Rehabilitation Psychiatry learning outcomes are mapped to the Generic Professional Capabilities Framework (GPCs) ensuring ease of transfer between medical specialties. Through attainment of the High-Level Learning Outcomes (HLOs), this curriculum will guide trainees to lead and work in multidisciplinary and multi-professional teams, provide leadership, and participate in research, teaching and training in a variety of clinical settings. It will also enable trainees gain experience in formulating integrated psychological, bio-medical and social, person-centred management plans for a range of mental health presentations within diverse health care settings. It provides opportunities to develop the expertise to work with patients and their social networks and understand the need to work collaboratively with a range of allied agencies and services as needed.   

Rehabilitation sub-specialty training includes all aspects of the adult curriculum while supporting the development of specialist skills and expertise in managing complex disorders and the clinical leadership and multidisciplinary working needed to achieve this. This utilises an integration of psychological, biomedical and social approaches to increase clinical effectiveness in the delivery of evidence-based treatments to improve outcomes for people and their families.   

The curriculum builds on the clinical capabilities attained in Core Psychiatry and Adult Psychiatry training such as advanced communication and interpersonal skills, diagnosis, managing complex treatment regimens to treat mental and physical co-morbidities and relapse prevention work to provide better outcomes for patients, which are above and beyond what general psychiatric training offers. There are opportunities for further development of capabilities such as leadership and management, teaching, research and quality improvement that are specific to services for people with complex needs.   

Rehabilitation Psychiatry patients are a distinct group of patients who, although low in numbers, consume a high proportion of available resource within the healthcare system when their specialist care needs are not met. These are patients for whom standard mental health services have not proved effective. Thus, in the absence of Rehabilitation Psychiatrists, these patients would not get effective treatment for their mental health conditions and would end up longer term in secure units, other inpatient settings, or prison settings.  

This work is predominantly undertaken within the National Health Service, although in recent years, rehabilitation services have also developed in the independent sector.21    

Mental health rehabilitation services provide a whole system approach to support people’s recovery, working closely with other parts of the health and social care system; for example, providing specialist clinical input to people living in supported accommodation services run by the voluntary sector, liaising with primary care and secondary services for their physical health care, and in-reaching to people placed in inpatient rehabilitation and forensic services in the independent sector, in order to facilitate their access to local rehabilitation services at the earliest opportunity.   

Doctors with a Rehabilitation Psychiatry sub-specialty recognition are instrumental in developing services that allow patients to return from placements in the Independent Health Sector which have a proven higher overall cost.21 These services also often act as the final step in the pathway that allows Mentally Disordered Offenders to receive rehabilitation to return to community settings, thus forming an integral part of the Forensic Pathway. The Rehabilitation Psychiatry curriculum has some key interdependencies with Intellectual Disability, Forensic psychiatry, Addiction psychiatry, Old Age psychiatry and other disciplines across secondary and primary care interfaces, which reflects the longer term and complex clinical needs of these patient populations.   

This purpose statement has been endorsed by the GMC’s Curriculum Oversight Group and confirmed as meeting the needs of the health services of the countries of the UK. 

By the end of ST6, you will be able to:ThemesKey Capabilities
Demonstrate the professional values and behaviours required of a Consultant Psychiatrist with reference to Good Medical Practice, Core Values for Psychiatrists (CR204) and other relevant faculty guidance.  1.1 Professional Relationships

Work collaboratively with patients, families, carers of all ages, colleagues within and external to the service/trust, respecting their autonomy, diversity, and valuing their contribution.   

Recognise, validate and actively address systemic and structural inequalities, intersectionality, and their impact on clinical outcomes for patients and their carers of all ages and on working relationships with colleagues.  

Consistently demonstrate a person-centred holistic strengths-based clinical approach to adult patients with long-term complex mental health conditions, that is honest, empathic, compassionate, and respects their dignity and autonomy while maintaining therapeutic optimism.   

Demonstrate the ability, when working with others to be flexible, lead, use initiative, be able to prioritise, and be adaptable, effectively managing your time and resources, including effective use of new technologies where appropriate. 

 1.2 Professional Standards

Recognise and develop strategies (seeking guidance when necessary) to respond to the impact of workload, patient and organisational dynamics on your own well-being.  

Use supervision and reflection effectively, recognising your skills, limitations and your duty of candour.  

Use the method of receiving, reflecting and responding to understand the emotional impact of the work on the individual and team, including the impact of natural deaths, suicide and homicide, in the context of longstanding therapeutic relationships with patients and families.  

Consistently demonstrate a positive and conscientious approach to the completion of your work.  

Make clear, accurate and contemporaneous records.  

Maintain the appropriate professional standards while working clinically as a leader within healthcare organisations. This includes relevant CPD and personal development plans with the aim of improving patient care.  

Work with increasing autonomy within a framework of supervision.  

Promote the specialism of Rehabilitation Psychiatry, including acting as an advocate for your patients, their families and carers of all ages.  

Demonstrate an understanding of individual variation and the impact of social, cultural, spiritual and religious factors, including effects of deprivation, discrimination and racism.  

Demonstrate an understanding of the principles of sustainability and how they underpin sustainable psychiatric practice. 

 

By the end of ST6, you will be able to: ThemesKey Capabilities
Demonstrate advanced communication and interpersonal skills when engaging with patients, their families, carers of all ages, their wider community, colleagues and other professionals. 2.1 Communication

Consistently demonstrate effective communication skills with all patients, families, carers of all ages, colleagues and all other agencies.  

Consistently demonstrate effective communication approaches with patients and relevant others, including those with neurodevelopmental disorders making reasonable adjustments and adaptations where appropriate, including the use of new technologies.  

Communicate effectively in person, using technology or via third parties.  

Adapt communication formats to the needs of all patients, families, carers including those with frailty, sensory problems and cognitive needs.  

Demonstrate skills in supporting those in whom English is not their first language including the use of interpreters and providing information in other languages.  

Use and apply advanced communication skills in managing de-escalation in challenging settings.    

Adapt communication in dealing proactively with those who are likely to present with anger, frustration and violence.   

Use communication skills to build and sustain effective therapeutic relationships on a long-term basis in community and inpatient settings.   

Demonstrate strengths-based approaches to clinical engagement and incorporate patient narratives into clinical care and treatment planning.  

Effectively communicate clinical information including ‘bad news’ to patients and be able to listen to concerns and respond.  

Write clinical notes that can summarise complex clinical patient presentations to formulate the evidence into appropriate treatment plans.  

Prepare informed and succinct reports and present evidence at Mental Health Act hearings in a focused and expert, evidence-informed manner, presenting facts and opinions separately.  

Write detailed and focussed new referral assessment reports to communicate to referring agencies. 

Demonstrate advanced skills in the psychiatric assessment, formulation, diagnosis and person-centred holistic* management of an appropriate range of presentations in a variety of clinical and non-clinical settings within Rehabilitation Psychiatry. 2.2 Clinical Skills

Demonstrate an appropriate understanding of learning and behavioural stages of human development through the lifespan including awareness of normative as well as variations in presentations, for example with neurodevelopmental conditions and across cultures.   

Assess the general health of your patients, taking into account the impact of their physical health on their mental health needs and vice versa. This assessment should include consideration of nutritional, metabolic, endocrine and reproductive factors and disorders, and the physical and mental impact of substance use and addiction on clinical presentation.  

Perform detailed mental state examinations that can separate the presence of different groups of symptoms.  

Chart the timelines of symptom progression to enable more accurate clinical diagnosis. 

Assess patients from a range of different cultural, spiritual, and religious backgrounds, including asylum seekers and refugees, and demonstrate an understanding of how protected characteristics may impact on clinical presentation.  

Screen for organic disorders and request appropriate laboratory investigations to assist with this e.g., CT/MRI and EEG as indicated.  

Integrate the use of structured clinical assessment tools in clinical practice, for the evaluation of nature and severity of psychosis, level of disability, indices of social function and quality of life, and to monitor change with treatment and to use validated outcome measures. 

Effectively obtain information to formulate detailed clinical assessments including person-centred holistic factors, leading to a diagnostic formulation for patients presenting with complex needs, and severe and enduring Mental Disorders/disorder.   

Effectively follow a multi-disciplinary approach in the assessment and management of people with both short term and long term Mental Disorders, taking into consideration a corroborative history as well as factors relating to ethnicity, race, gender and other relevant protected characteristics to arrive at a personalised understanding of clinical problems and how protected characteristics may impact on clinical presentation and on patient preferences.  

Apply appropriate clinical criteria to diagnosing, investigating and managing treatment resistant psychosis before initiating Clozapine or alternative medication.   

Apply knowledge of policy and protocols when using high dose antipsychotic medication to ensure patient safety.   

Develop effective personalised, multi-faceted treatment plans that take into account primary conditions, clinical comorbidity, social needs and disability.  

Use formulation to devise a safe, effective, collaborative and co-productive management plan to ensure continuity of care in the immediate, short and longer term.  

Adopt an evidence-based approach to treatment planning incorporating person-centred holistic interventions to deliver safe, effective, collaborative and co productive management plans ensuring continuity of care.  

Demonstrate knowledge and skills to treat comorbidity including depression, insomnia, anxiety, OCD, ASD, addiction, eating disorders, and other conditions that co-exist in people with long term severe and enduring Mental Disorders.  

Utilise non-pharmacological (social, occupational therapy and psychological) interventions as appropriate in those with severe and enduring Mental Disorders.   

Assess the medication burden and undertake safe de-prescribing of non-essential medications, through active discussions with patients, their families and carers of all ages.   

Optimise medication, balancing the benefits and risks depending upon the stage of the illness.   

Recommend the appropriate level of support for those with SMI in the community to ensure risk is managed appropriately.  

Demonstrate an understanding of how physical treatments can be used for the treatment of mental disorders and apply this under supervision. 

Apply advanced management skills within Rehabilitation Psychiatry in situations of uncertainty, conflict and complexity across a wide range of clinical and non-clinical contexts. 2.3 Complexity and Uncertainty

Demonstrate an understanding of unconscious processes, including transference, countertransference, projection and splitting and the impact of these on yourself and others.  

Manage the interpersonal dynamics between yourself, your patients and others to undertake an effective formulation.  

Demonstrate a pragmatic and flexible approach to your clinical practice to support the patient with SMI to achieve their goals and maintain therapeutic optimism.   

Assess risks taking into account the contributory factors (e.g., addiction, mental disorder, lifestyle variables and lack of social support) that increase risk and vulnerability.  

Assess and evaluate iatrogenic and environmental factors that leading to increased risk.  

Demonstrate knowledge of factors that can lead to injustice and invalidation during an episode of care ensuring you listen to and value subjective experience and personal narratives.  

Demonstrate an enhanced understanding of the dynamics of clinical encounters, where there are challenges to achieving therapeutic engagement. These will include both patient and clinician factors and arrive at a shared understanding of the management.  

Demonstrate safe and autonomous practice incorporating multi-disciplinary views and seeking support and supervision from senior colleagues as appropriate.  

Recognise, acknowledge and manage uncertainty, clinical complexity and conflicting information, navigating and developing creative and appropriate management plans to progress clinical situations that are at an impasse/stuck. 

 

By the end of ST6, you will be able to:ThemesKey Capabilities
Apply advanced knowledge of relevant legislative frameworks across the UK to safeguard patients and safely manage risk within Rehabilitation Psychiatry. 3.1 Knowledge of legal and organisational frameworks in your UK jurisdiction 

Apply national mental health legislation and relevant case law in the care and treatment of patients and management of risk, in rehabilitation settings. 

Apply local and national health and social care policies, guidelines and legal frameworks in relation to the overall care needs of patients in rehabilitation settings.  

Apply an understanding of equality, disability, human rights and other relevant civil law to support patients to retain dignity, combat discrimination, and access justice and fair treatment in society.  

Apply an understanding of aspects of criminal and mental health legislation, and the procedural frameworks of the Criminal Justice System as relevant to patients in rehabilitation psychiatry settings.  

Demonstrate knowledge of legislation and principles of care under the least restrictive principles and enabling autonomy and choice.   

Apply the specific legislative frameworks governing care, treatment, and restriction of liberty where patients receive care in community mental health settings.  

Meet the requirements to apply for relevant statutory approval where appropriate. 

Work effectively within the structure and organisation of the NHS, and the wider health and social care landscape. 3.2 Working within NHS and organisational structures 

Work at a system level to ensure the best provision and outcomes for the rehabilitation population with complex needs.  

Demonstrate knowledge of how rehabilitation services and individual patient care pathways are organised and funded across the health and social care sectors.  

Use relevant data across the health and social care system collaboratively to develop and run services optimally with continuous improvement.  

Support patients at interfaces between mental health rehabilitation, the Criminal Justice System and forensic mental health services, with regard to systemic inequalities and biases that patients may encounter. 

 

By the end of ST6, you will be able to:ThemesKey Capabilities
Demonstrate leadership and advocacy in mental and physical health promotion and illness prevention for patients within Rehabilitation Psychiatry and the wider community. 4.1 Health promotion and illness prevention in community settings 

Advocate for, and ensure access to, all relevant services for our patients and carers.  

Apply an in-depth knowledge of the person-centred holistic model of psychiatry to inform and advise on the development of public mental health strategies for those with SMI.   

Advocate for patients suffering from the effects of discrimination and social isolation using resources to promote inclusion.   

Lead and advocate for individuals with severe and complex co-morbidities to achieve optimal physical and mental health.   

Ensure patients are linked into appropriate national screening and prevention programmes, including reasonable adjustments to prevent discrimination and exclusion.  

Deliver appropriate, targeted and audience-specific education on Mental Disorders to relevant stakeholders.  

Screen for common complications and physical health comorbidities arising alongside the prescription of psychotropic medications, e.g., diabetes, hyperlipidaemia and obesity.  

Promote a healthy lifestyle and encourage the self-management of both mental and physical health problems by working collaboratively with patients to create wellness recovery action plans.  

 

By the end of ST6, you will be able to:ThemesKey Capabilities
Demonstrate effective team working and leadership skills to work constructively and collaboratively within the complex health and social care systems that support people with mental disorder. 5.1 Teamworking

Demonstrate effective leadership, team working and negotiation skills to work constructively and collaboratively within the complex health, housing and social care systems and with other stakeholders including families and carers, criminal justice, commissioning bodies and non-statutory organisations.  

Liaise with both primary and secondary care colleagues, following shared care systems and protocols to ensure equal access and parity of esteem to optimise physical health and reduce mortality in those with SMI.  

Understand the evidence base around building and running good teams, and the inherent risks of poor teamworking, including negative impact on quality of care and patient safety, as well as increased staff turnover, sickness and burnout.  

Work with staff and carers to address challenging behaviour in a manner that is sensitive to the individual and sustains the therapeutic relationship.  

Understand the importance of optimising one’s own self-care and wellbeing and supporting that of the wider staff team. 

 5.2 Leadership

Recognise the impact of leadership across systems and in managing partnerships, including optimizing one’s own impact and influence for the benefits of patients, carers, staff and the whole system.  

Know how to maintain a strategic focus on and influence the provision of, work opportunities, leisure, social and educational services for patients with severe Mental Disorders.  

Use negotiation and management skills to promote and develop rehabilitation services and care settings for patients with severe and enduring Mental Disorders and to develop strategies to promote rehabilitation services.  

Promote enthusiasm for, and satisfaction with, work with long-term and enduring conditions, amongst trainees and other staff.  

Promote a social psychiatry/recovery culture amongst staff of services delivering rehabilitation.  

Sensitively develop understanding of staff in partner services/agencies, such as residential and community support staff, of concepts and culture of recovery, social inclusion and social psychiatry, both in the immediate clinical situation and through teaching programmes.  

Demonstrate inclusive leadership style and awareness of the impact of hierarchy and power within relationships with patients and colleagues.  

Demonstrate knowledge and ability to collect and analyse service, organisational, and system level data, and implement necessary changes to ones services.  

Manage conflict within a team to provide a balanced professional response ensuring you are able to contain the anxiety of others.  

 

By the end of ST6, you will be able to: ThemesKey Capabilities
Identify, promote and lead activity to improve the safety and quality of patient care and clinical outcomes of a person with mental disorder. 6.1 Patient Safety

Apply the principles of clinical governance, team dynamics and human factors to manage and improve patient safety and care.  

Recognise and respond to patient safety and critical incidents.   

Respond to complaints in a timely and appropriate manner.   

Engage with patients and carers in responding to safety concerns.  

Demonstrate proficiency in reflective practice when involved in adverse incidents, learning and adapting as appropriate. 

 6.2 Quality Improvement

Adopt models and principles of continuous quality improvement in rehabilitation services.    

Acquire skills to design a QI project, with identified change ideas. To be able to design and deliver a plan-do-study-act model for an identified area for improvement. Show ability to engage a wide group of patients, carers and all stakeholder professionals in the project.   

Demonstrate ability to collect data in real time as relevant to the project, present the data and to show where change needs to happen in subsequent cycles of PDSA.   

Ability to present the findings and to disseminate and embed learning at team level and to present the findings and methodology to other services to scale up the project.   

Demonstrate skills to design and collect routine patient outcomes using validated measures.   

Show ability to use routinely collected feedback measures from patients and carers, as well as other agencies to evaluate and improve services.   

Understand the importance of obtaining feedback from patients, families and other services. Learn about the processes in place used to obtain feedback.   

Demonstrate awareness of locally, regionally and nationally collected rehabilitation data and how they are utilised to improve or commission rehabilitation services. 

 

By the end of ST6, you will be able to: ThemesKey Capabilities

Lead on the provision of psychiatric assessment and treatment of those who are identified as being vulnerable within Rehabilitation Psychiatry. 

 

Demonstrate advocacy, leadership and collaborative working around vulnerability and safeguarding in patients, their families and their wider community. 

7.1 Safeguarding

Demonstrate knowledge of the individual and systemic factors contributing to vulnerability and safeguarding concerns in mental health rehabilitation settings.  

Recognise that patients with complex mental health conditions may have experienced trauma, abuse and victimisation, and continue to be at increased risk of victimisation and exploitation by others.  

Assess capacity in those with long-term complex mental health conditions, in particular regarding making decisions about placement/community support packages and making decisions about physical healthcare and undergoing interventions and treatment.  

Apply safeguarding guidelines when appropriate.  

Understand and work within legislative and local frameworks to anticipate and report safeguarding concerns, providing leadership and demonstrating cross-agency working.  

Understand that people with complex mental health needs face disadvantages in access to both criminal and civil justice; collaborate with relevant agencies to ensure patients receive appropriate advocacy and support.  

Demonstrate advocacy, leadership and collaborative working around vulnerability and in safeguarding procedures, for patients with severe and complex mental disorders and with their families and carers.  

Understand that people with complex mental health conditions are at increased risk of self-neglect and social isolation and demonstrate leadership regarding interventions to address this. 

 

By the end of ST6, you will be able to:ThemesKey Capabilities
Promote and lead on the provision of effective education and training in clinical, academic and relevant multi-disciplinary settings. 8.1 Education and Training

With respect to all education and training, ensure that factors such as complexity of needs, the longer length of time required for recovery and number of services involved in a patient’s care, are considered and training is tailored accordingly.  

Promote enthusiasm for and satisfaction with work with long term and enduring condition, amongst trainees and other staff.  

Promote a social psychiatry/recovery culture amongst staff of services delivering rehabilitation.  

Sensitively develop the understanding of staff in partner services/agencies, such as residential and community support staff, of concepts and culture of recovery, social inclusion and social psychiatry both in the immediate clinical situation and through teaching programmes.  

Promote and lead on the provision of effective psychiatric education and training in clinical, academic and relevant multi-disciplinary settings in collaboration with patients and their wider community.   

Use feedback effectively and adopt lifelong learning. 

Demonstrate effective supervision and mentoring skills as essential aspects of education to promote safe and effective learning environments. 8.2 Supervision

Supervise, mentor and coach colleagues to enhance their performance and development.  

Demonstrate effective supervision and mentoring skills to promote safe and effective learning environments. 

 

By the end of ST6, you will be able to:ThemesKey Capabilities
Apply an up-to-date advanced knowledge of research methodology, critical appraisal and best practice guidance to clinical practice, following ethical and good governance principles. 9.1 Undertaking research and critical appraisal

Critically evaluate data, papers, reviews, and meta-analyses and implement findings in daily clinical practice.  

Translate research into local clinical practice and disseminate critical appraisal findings to wider communities.  

Apply knowledge of up to date appropriate statistical methods where appropriate research support is available. 

Demonstrate proficiency in the use of objective evidence-based clinical assessment instruments.  

Work within ethical frameworks when carrying out or appraising research.  

Apply the principles of Research Study Protocols where available.   

Demonstrate practical contribution to an ethically approved research study.  

Demonstrate an understanding of the findings from classic studies that have informed the development and practice of mental health rehabilitation. 

 

  1. Together for Mental Health, Welsh Government, 2012 p23 

  1. Mental Health Strategy 2017-2027, Scottish Government, 2017, p29 

  1. Making Life Better, Northern Ireland Assembly, 2014