I have been enjoying my psychiatric observational placement and have had a rich environment in which to observe an NHS mental health care setting. I have been shadowing the consultant psychiatrist in outpatient clinics and in (locked) ward rounds as well as attending team meetings of a community mental health team (CMHT). I have also attended a Mental Health Act Tribunal meeting as an observer and that was an added bonus to my training. The whole experience has given me great insight into the care plans of patients suffering with various mental illnesses as well as to the current legislative and legal environment surrounding hospital care.
It was baffling at times when I started as all I was hearing was abbreviated terms that I did not understand. For instance, terms such as CPA (Care Programme Approach), CTO (Community Treatment Order), IAPT (the Improving Access to Psychological Therapies), DNA (did not attend), AMHP (Approved Mental Health Professional) were banded around at will and often I felt like asking people to slow down. However, finding out how the NHS practices work has been an interesting learning curve as well as understanding the role of patient care co-ordinators.
.As I said in a previous post the 1-1 session between psychiatrist and patient is essentially a business like arrangement where discussion centres on how to agree a treatment plan.
Spotting the symptoms of these illnesses will be a critical part of the placement for me and will be an on-going process. I am also intrigued about the formulation of care treatment plans. In depressed patients medication is prescribed but often with CBT sessions. With “paranoid schizophrenia” CBT sessions can be a part of treatment but there is more evident symptoms of psychosis. It seems that the more patients understand about their condition the more they will realise and appreciate the need to take long term medication. Consultant psychiatrists describe their illness as not being that dissimilar in some ways to high blood pressure or diabetes in that it needs regular and long term medication to remain healthy and help keep the symptoms away. The care plan will outline the relapse symptoms so that the wider healthcare team can be enpowered to spot signs of relapse.
I have wondered what it would have been like for people suffering from mental illness in times past when anti psychosis medicine was not around and when there was a very different societal attitude to mental illness. Some hospitals indeed would have had up to 4 times the number of in patients as recently as 50 years ago. My own intrigue about nature vs. nurture and the cause of mental illness diagnosis – whether it is due to genetic issues, personality disorder or psychosis – will continue.
The 1-1 session between patient and psychiatrist