Introduction to Psychiatric Training

The West Midlands Postgraduate School for Psychiatry offers trainees the full range of teaching, learning and experience, both clinical and non-clinical which would enable an individual to progress and develop from day one to the completion of training, the award of CCT and full preparation for specialist practice.

Psychiatry is a branch of medicine that specialises in the care and treatment of people suffering with mental health problems, including the most severe mental illnesses.  The primary purpose is the assessment and management, through treatment, of individual sufferers.  There is also a significant role in helping carers and families, as well as advice and support to communities at large. 

Mental health problems span the whole of society and represent some of the most common and disabling health problems confronting contemporary society.  Psychiatry provides a range of treatments, both biological and psychological, in order to treat and alleviate these problems. 

Psychiatrists themselves work with a range of other professions, including medical specialists, particularly in Primary Care, but also across the full range of secondary care specialties.  The work of psychiatrists is primarily as members, and sometimes as leaders, of multi-professional teams delivering services to defined patient populations.  These populations may be defined in terms of disorder, disability, and/or geography.  Teams include professions from a range of backgrounds, such as nursing, social work, psychology, occupational therapy, physiotherapy, and close working relationships exist with those in educational services, criminal justice services, and voluntary care agencies. 

Psychiatry itself includes a number of specialisms.  There are six major specialisms, each currently leading to a Certificate of Completed Training, these are general adult psychiatry, old age psychiatry, psychotherapy, the psychiatry of learning disability, child & adolescent psychiatry, and forensic psychiatry.  In addition, a number of further specialisms exist and are continuing to emerge as greater knowledge and therapeutic potentials appear.  These include neuropsychiatry, liaison psychiatry, psychiatry of addictions, the delivery of psychotherapy within specialised services such as forensic psychiatry settings, perinatal psychiatry, and the psychiatry of eating disorders, to name but a few. 

Psychiatry services are provided to defined catchment area populations (usually a number of GP practices, or a geographical area) or around specific conditions, settings or treatment modalities and are delivered through multidisciplinary teams with a strong emphasis on work in community settings (including patients’ homes). Community Mental Health Teams care for patients with a wide range of diagnosis, complexity and severity, Practice is evidence-based and within contemporary policy frameworks e.g. Care Programme Approach.

In general psychiatry and emerging in other branches such as old age and child and adolescent psychiatry new patterns of service are appearing including Crisis Resolution/Management, intensive Home Treatment, intensive management of First-Episode Psychotic illnesses (Early Intervention) and, Assertive Outreach/Community Treatment for severely-disabled and hard to engage patients,

The work of the specialist in psychiatry has been the subject of recent review by the Department of Health and the Royal College of Psychiatrists, and new policy and documentation has emerged, including the document “New Ways of Working for Consultants”.

The breadth and diversity of mental health problems, the range of clinical presentations, the emergence of new possibilities (through scientific investigation) for understanding the real nature of illnesses and disease processes with the consequent implications for new treatments mean that psychiatry presents an expanding and increasingly sophisticated area of clinical practice that will sustain interest and enjoyment throughout a doctor’s career.

Psychiatrists have the opportunity to utilise their basic medical knowledge and skills and augment these and gain other knowledge and skills, for example, in psychological therapies which they can put into operation, across a wide and changing spectrum of disorders, with opportunity to continuously develop further areas of expertise as true lifelong learners. The place of Psychiatry in the context of health and social care spans many professions, services and traditional boundaries. There is a huge opportunity to work and learn with an array of colleagues from a rich variety of backgrounds.

A career as a psychiatrist may develop in a number of directions. There are large numbers of research questions and programmes posed. Research is both quantitative and qualitative, spanning a range that includes molecular levels, through treatment trials and quality of life for patients and carers. Teaching has for many years been a well-developed role for psychiatrists facilitating learning for both undergraduates and postgraduates. There are development programmes specifically targeted at prospective teachers in psychiatry at a National level. Management and leadership are key roles for many psychiatrists and represent a potential career pathway for some. The attraction and challenge of drawing together services for individuals and populations is an attraction for many. Mental health services are a lead issue for society and the government and great attention has been and will continue to be paid to service design, delivery and assessment