The role of the consultant psychiatrist in adult
mental health services
The consultant
psychiatrist in adult mental health services is a registered medical
practitioner who has been admitted onto the UK specialist register by virtue of
having undergone approved training, passed essential professional examinations
and acquired extensive experience in the diagnosis and treatment of mental
disorders in adults. This training now
encompasses five years as a medical undergraduate student, two years as a
foundation doctor in an acute hospital and six years as a specialty registrar
in psychiatry (3 years in core training and 3 years in higher specialist
training in adult psychiatry). This
gives the consultant an unrivalled depth and breadth of experience both in and
outside of the mental health field.
Consultants have
a thorough training in evidence-based medicine and critical appraisal of the research
literature and many will be active in medical research. They may also have additional qualifications in
disciplines such as medical genetics, anthropology, ethics and philosophy: all
disciplines that apply a critical and reflexive lens in which to improve the
quality of adult mental health care and practice.
Consultant
psychiatrists work in very diverse settings in adult mental health services in
the UK,
including inpatient, crisis and community care.
However they invariably work with and within a team of other mental
healthcare professionals. The key skills
and attributes of consultant psychiatrists have been described elsewhere1. This document seeks to define the unique role
of the consultant adult psychiatrist in the team.
The consensus
statement on the Role of the Doctor2
published in 2008 has stated that
“Doctors alone amongst healthcare
professionals must be capable of regularly taking ultimate responsibility for
difficult decisions in situations of clinical complexity and uncertainty,
drawing on their scientific knowledge and well developed clinical judgement.”
Benefit of the consultant psychiatrist to the mental
health team.
Until
recently, adult mental health teams in the UK have usually, but not
invariably, had a consultant psychiatrist working as a fully integrated member
of the team, as recommended by the Department of Health Policy Implementation
Guides3,4. However, recent
service developments have seen increasing diversity with some teams lacking
direct psychiatric input. Direct
evidence to demonstrate the key role of the psychiatrist is lacking, but there
is emerging evidence from studies into crisis intervention and home treatment
that teams are more effective when psychiatrists are fully integrated members
of the team5,6. Consequently,
we recommend that all adult mental health teams include a psychiatrist as a
full member of the team.
The unique role
of a consultant psychiatrist can be described under the CanMEDS role framework7
as follows:
Medical
Expert
·
understands the scientific basis of psychiatry and has
a detailed knowledge of the diagnosis and treatment of mental disorders.
·
prescribes treatment where the evidence base is
limited or lacking and intervenes when a care plan is not working.
·
has expertise in therapeutic conversations, supportive
work, and some will be expert in specialist psychological treatments.
·
supports, recommends and in some cases manages the
delivery of social interventions, closely streamlined with psychological and
pharmacological treatment.
·
manages, as a responsible clinician, patients detained
under the Mental Health Act using experience gained from an early stage of training.
·
tackles medico-legal and ethical dilemmas while
adhering to legal safeguards.
Communicator
·
uses skills in clinical interviewing
to establish a diagnosis and a therapeutic relationship.
·
can describe medical concepts in
terms understandable for a lay audience (for patients and carers, for the
courts, for the media).
·
understands the complexity of mental
health service provision which enables effective working at the interface
between their own team and other mental health teams.
·
understands the wider healthcare
system which enables effective working with doctors and healthcare
professionals from other specialties, particularly primary care.
Manager
·
provides clinical leadership of
mental health teams in terms of setting out the vision and direction of the
service and clarifying the boundaries.
·
understands the wider NHS policy
context, and pressures of modernisation and budget management, whilst meeting
the requirements of commissioners
Health advocate
·
advocates for individual patients and
their carers within their service.
·
advocates for adult mental health
within the medical profession and in the planning of services.
·
champions patient issues, addresses
inequalities and injustice in health care delivery, and provides patient
centred and recovery orientated care, irrespective of the policy, modernisation
and financial context of the day
Scholar
·
has a fundamental role in the
education of medical students and doctors in training, whether or not they are
planning a career in psychiatry as well as making a contribution to the
training of other mental health professionals.
·
has undergone extensive training in
audit and research and uses this in critically appraising the literature and in
an evidence-based approach to treatment.
Professional
·
accepts accountability for patients
referred to their service.
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