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Please see below the presentation slides for each session that took place on the day:
- Welcome/ introduction – Dr Helen Crimlisk
- Emotionally Unstable Personality Disorder - Dr Mike Crawford
- Perinatal Psychiatry -Dr Madeleine Bonney-Helliwell
- Mental Health Competence Framework for Physician Associates - Dr Pranav Mahajan & Ellie Wildbore
- Forensic Psychiatry - Dr Adrian James
- The Psychiatry OSCE station - Dr Declan Hyland
- Working within Psychiatric Specialties - Intellectual Disability (learning disability) - Liam Black
Please note these slides are the intellectual property of their named authors and are only intended to be view by those who attend the conference.
Please see below for all questions asked in the main conference in order of when they were discussed :
| Question | Answer |
| What is the best way of minimising subjectivity or confirmation bias (I.e. referral letters) and increasing objectivity for the diagnosis of personality disorders ? Other than the use of questionnaire scoring systems? | Live answered |
| Out of interest, what are the new term(s) for Borderline personality disorder (BPD) if any have as yet been established? | Live answered |
| Do you have any tips in managing attachment of BPD patients to clinicians; in primary care it can be difficult as not MDT approach | Live answered |
| What advice do you have for Physician Associates (PA) working closely with EUPD patients in maintaining their own mental health? | Live answered |
| Is the treatment for C-PTSD different to personality disorder? | Live answered |
| I’m a PA working in gastroenterology. There are a group of patients who present acutely to our team with poor control of Inflammatory bowel disease (IBD) and as a result have poor mental health. There's a common theme of having poor emotional coping techniques and many present to hospital after a suicidal attempt, and also present with a group of behaviours similar to someone with a personality disorder. Can damaging physical health illicit trauma enough to develop Personal Disorder (PD) in some patients? | Live answered |
| How can I differentiate between someone with BPD and bipolar, they share a lot of features. I am aware that wrong diagnosis is often made | Live answered |
| Do you know if community and hospital midwives out with mental health specialties have any fundamental training in mental health disorders as part of their midwifery degree? Or would they need to undertake extra training to specialise? | Live answered |
| Can you recommend any resources for learning more about Premenstrual dysphoric disorder (PMDD) ? Historically women suffering with this often have a long journey to get diagnosed and are often labelled with other diagnosis before PMDD is discovered | Thank you Kim, you are absolutely right - the key is in the history. It is really important to also ask women to keep a diary of their cycles but correlate with their mood. Women with PMDD will often report significant distress in the 10 days before their period - ovulation. This is where the diary comes in handy. NAPS – National Association for Premenstrual Syndromes | NAPS (pms.org.uk) Premenstrual Syndrome, Management (Green-top Guideline No. 48) These links above are really helpful |
| Hi, I wanted to ask if a mum has had increased stresses during pregnancy, what do you recommend parents to do to improve this? Thank you | Improving Access to Psychological Therapies (IAPT) referral may be helpful for women like this in developing some psychological strategies to manage stress/anxiety. But if this is specifically about pregnancy - such as birth, discussion with her Mid Wife (MV) might open up extra support for her. |
| I have had few requests of parents requesting starting antidepressants in a young child due to depression etc. I always refer these cases to children and adolescent mental health services (CAMHS). But aren't we sometimes medicalising some normal behavioural variants? In America children seems to be started on antidepressants as young as 7. | Whilst I'm not a CAMHS consultant, I would probably say that these sort of consultations can be tricky and can be difficult to manage. Mainly due to the expectations you many have to manage. The role of the school and concerns from them, along with health visitors would be really important here. It has been a difficult time for young people through the pandemic and some children may in fact be unwell. Your health visitor is priceless here, get them involved in giving you an opinion. |
| I work in a crisis team and often see perinatal patients who aren't known to services before, is there anything in particular we need to consider in risk assessments? | Risk to self is of course important, but it would be important to consider the risk to the unborn baby. This may not just be as a result of the direct effect of self harm or suicide end end baby's life, but also things like increase substance taking - which would put baby at increased risk. The risk of non-compliance of medication is important and disengagement from both obstetric and mental health services. Of course a referral to Social care may be required for some women for a more multi agency approach in understanding and managing these risks. |
| What is the general recovery timeframe for postpartum psychosis? | Great question, it is all about a timely response. There is no right answer and every presentation is different, but some women may begin to improve within a few days of antipsychotic treatment on a Mother and Baby Unit. Some women might have complex issues with their psychosis that might need longer. |
| Which Selective serotonin reuptake inhibitors (SSRIs) do you feel it is safer for pregnancy/ breastfeeding? Thank you | It's important to think about not just the safety but also the patient's wishes to breastfeed. The most commonly used SSRIs are generally Sertraline, Citalopram and Fluoxetine. Women can be prescribed in pregnancy. Worth considering the Relative Infant Dose (RID) in breastmilk as well. Fluoxetine, for example, has got a long half life and a very broad RID. Whilst it is not contraindicated in breastfeeding, the top limit of the RID is 14.6%. This is higher than what is generally considered safe. Some babies might be a little bit more jittery, difficult to settle and feed when exposed to high levels of antidepressant. But some babies do not have any such symptoms when exposed to Fluoxetine in utero or even have breastmilk with fluoxetine in it. The thing to remember is that every baby and women is different and it is important to think about risk. If a women is very well on fluoxetine and there is evidence that reducing or stopping this might cause a deterioration in her Mental Health (MH) - then perhaps remaining is needed |
| Women are more vulnerable to domestic abuse during pregnancy and postnatally; how much affect does this have on perinatal mental health and how can we be more aware of any potential safeguarding issues? | Important observation. You are right, Domestic Violence (DV) rate increases towards women during pregnancy and this can have an affect on her MH. She may present with disengagement to services/screening/scans - so reviewing women who do not attend scans is really important. My experience is that MWs do this very well. But DV can be difficult to see, and subtle interactions in appointments with partners is important to consider. As you mention, social care involvement would be very important especially as risks are high to the women and the unborn/baby. We work closely with our local DV refuge and will see women in secure and safe accommodations. |
| How does this framework differ to the PA competence framework produced by the Family Planning Association (FPA)? | Live answered |
| Are these competencies at the level of a graduate or post grad PA?. Is this meant to replace mental health knowledge part on the proposed General Medical Council (GMC) new curriculum. | Hi Lawrence. This is post graduation. (You have just 90 hrs of time in mental health in PA School). This is to guide your CPD working as a PA in MH but may also be useful for those not working specifically in MH but with a role which involves some MH work. It won't replace proposed new GMC curriculum, which is not likely to be this detailed but may inform it. |
| It's very helpful to have a framework of what we should aim to learn and know. It would be really helpful to have attached links and suggestions for how we get that training, and how to ask for that training in our work places. I know my work place are trying to figure out funding for me to have further training for example. | I think how this is achieved is likely to be different in different areas, we will try at RCPsych to continue to provide signposting to CPD and also deliver some of it, but there are likely to be many training courses and CPD which may address these learning needs. PA-MH may have access to Medical Education sessions, Regional PA Community of Practice sessions, bespoke PA-MH teaching (like this) and multidisciplinary Trust led development / training. You should use your appraisal to discuss your learning needs and discuss with your appraiser how best to access teaching / training. (I think you should have a study budget too although I don't think this is mandated by FPA) |
| How are you going to measure the effectiveness of this framework? How are you going to promote and create awareness of this framework across all mental health trusts? | Live answered |
| How can we ensure our generalist health knowledge stays up to date when working mental health, would there be opportunity to get exposure on a practical level in other healthcare settings? | Live answered |
| How will this ensure PAs don't become deskilled in other specialities working long-term in Mental Health? | Live answered |
| Does the framework include conditions that we need to know, the faculty of PA's is outdated or are you working closely with the GMC as they are updating the framework? | Live answered |
| I have found on placement many allied Health Care Professionals are confused about the role of a PA and scope of practice. I'm sometimes battling scepticism around the role. How are you supporting PAs with this? | Live answered |
| In my job, I’m feeling very unsupported and under utilised. I have asked numerous times for more experience in other areas and consultants have promised various things but never action these. I’m at a loss and not sure where else to go and was very much considering leaving the NHS. It’s the first and only job I have done as a PA. They’ve never had a PA before either. Any advice? | I'm so sorry to hear - what a shame - and you've asked some very relevant questions. I'd be happy to have a conversation to see if I can help you. Perhaps you could email me? helen.crimlisk@shsc.nhs.uk |
| Afternoon, thank you for the presentation. The trust I work for has been rated inadequate by the Care Quality Commission today. In my personal experience it has been a difficult year of employment since I have been in post. Does the college offer support for Physician Associates for impartial advice if they have concerns regarding supervision or how they are being utilised in role? | I'm sorry to hear this Alice, I heard the news today. It is obviously a worrying time for staff and patients. I am happy to have a conversation privately, please email me helen.crimlisk@shsc.nhs.uk. Also remember that this is also an opportunity to support the initiatives which will improve services in your Trust and that even Trusts rated "inadequate" have many committed clinicians working within them (spoken from personal experience too..) |
| Hello Adrian and thanks so much for the presentation. I worked in Forensic Psychiatry for seven years, but ultimately left to explore opportunities in clinical education within my Trust, ultimately due to a lack of progression and development. Is this something you have any ideas around, i.e. how the PA role in forensics could be moved forward with increasing experience? | Live answered |
| Having previously worked in nursing at one of the high-secure hospitals, there was a lack of awareness of the physician associate role. How can we as a profession and the college help to promote the PA role in this setting? | Live answered |
| Working in Forensic Psychiatry can be a high risk role and is one of the reasons, as a woman, I am weary about working in this specialty. With cases of sexually aggravated crimes on the rise, what measures are in place to protect staff from the potential risks? | Live answered |
| I ask this as I do feel that women are under-represented in this area of medicine. | live answered |
| Hi everyone, thank you for today. I am a PA working in GP and have noticed a significant increase in the amount of young people seeking help for their mental; including low mood, anxiety, erratic mood changes, behavioural challenges etc. It feels so restricted, and frustrating at times, about how little we can help them with the long children and adolescent mental health services (CAMHS) waiting list and restrictions in prescribing in <18. Any tips on how we can help these young people? | Live answered |
| Hi Dr Hyland, this is Mohammed. Nice to see you are still involved in promoting and supporting the PA profession. Just wondering if you are still trying to or have secured more PAs in Mersey Care? | Hi Mo, Great to hear from you. I am still begging for another PA. Hope you are enjoying your new role in Lancashire Care. |
| I work in forensic psychiatry on two male wards, one being medium secure long stay with many unwell patients on and I generally feel really safe, there are much more protective measures put in place than in general physical health hospitals so please don't let it stop you exploring forensics as an avenue | Live answered |
| How many CPD point does this study day carry? | Hi Lawrence, a full day conference is often up to 6 CPD points pending peer group approval. You will receive a certificate after the event. |
Links from Conference Chat:
Physician Associates | Royal College of Psychiatrists (rcpsych.ac.uk)
Physician Associate in Mental Health Recruitment film is below :
Radical Acceptance video is below:
Maternal Mental Health Alliance webpage: https://maternalmentalhealthalliance.org/about/perinatal-mental-health/
NICE: Guideline - Diabetes in pregnancy. Clinical Practice Guideline (2008) - CG63
Quality Network for Forensic Mental Health Services| Royal College of Psychiatrists (rcpsych.ac.uk)
Forensic psychiatry faculty | Royal College of Psychiatrists (rcpsych.ac.uk)
Meeting Recordings
Main Conference: 10.15am–3.20pm
Topic: Physician Associate in Mental Health Conference
Access Passcode: PAconference28/4
At 3.20pm we split into two separate sessions for the afternoon with Dr Hyland and Liam Black. Please see the links below for their sessions:
Topic: Physician Associates Conference - Liam Black - Working within Psychiatric Specialties - Intellectual Disability (learning disability)
Access passcode: PAconference28/4
Topic: Physician Associates Conference - Dr Declan Hyland on OSCE preparation for student
Access passcode: PAconference28/4
All links will be available for two months.
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