Mental Health

Dr Andrew K Black

Consultant Psychiatrist

MENtal Health

What does a psychiatrist actually do?

Good question! There must be as many answers as there are encounters between Psychiatrists and their patients. In an attempt to simplify things a little, I would venture to assert that, in general terms, there are four basic qualities that are desirable, perhaps even necessary, in a Doctor who wishes to practise Psychiatry.

Clinical Assessment

Although it may be unfashionable in some quarters to regard mental health problems as a form of illness, few would argue with the notion that a Psychiatrist needs to have a good idea of the body of knowledge relating to Medicine, and in particular to Psychiatry. He or she needs to have knowledge of general Medicine, since many medical illnesses can present with predominantly psychiatric symptoms and signs. An understanding of specific psychiatric disorders, (and the clinical management of these conditions), is important, for reasons that should be fairly obvious.

A further important requirement is for the Psychiatrist to possess the skills necessary to elicit specific information from the patient, by a combination of asking appropriate questions and observing and listening to the patient and others involved in his or her care. Usually this will enable the Psychiatrist to make a diagnosis, although sometimes further investigations will be necessary.

The third prerequisite involves the attitude of the Psychiatrist to his or her professional work. Ideally some combination of interest and motivation are needed to work in what can be a demanding, but often very rewarding field.

The last requirement focuses on the attitude of the Psychiatrist towards the patient. Qualities such as empathy and the capacity to understand the patient are very important. In my experience, patients tend to be very perceptive when it comes to assessing the attitude of the Psychiatrist! Apart from helping the patient directly, by fostering an atmosphere of mutual confidence, the Psychiatrist is helped enormously in his or her task of eliciting the information necessary to make a diagnosis, if the patient feels reassured by the manner in which the assessment is conducted.

Psychiatrists are not born with the first two qualities, but Education and Training can help to provide the necessary knowledge and skills. A period of apprenticeship and supervision can help the trainee Psychiatrist to develop the personal qualities necessary to complement the more scientific aspects of his or her learning.

Clinical Management

If clinical assessment can sometimes be a lengthy and problematic process, clinical management is often fraught with difficulties.

It is not my intention to deal with individual mental illnesses here, though information is readily available on the Internet about specific conditions: - please see my Psychiatry Links page for more information.

Again, at the risk of oversimplification, there are four factors that are likely to influence whether a management plan will be successful for a given individual.

It is clear that the Psychiatrist and/or members of the clinical team need to be aware of the possible range of treatments or care plans that may be available.

Secondly, it is necessary to decide on a treatment plan that takes into account the individual circumstances of the patient, (for example some treatments may have helped in the past, while others may not have done so).

It must also be within the Psychiatrist's power to provide any necessary treatment or to arrange for the provision of such a treatment plan. This may have resource implications.

Finally it must be possible to "sell" the treatment plan, not necessarily only to the patient, but often to a whole army of other interested parties. This is an important aspect of clinical management which, in my experience, has often been overlooked.

Regular reviews are necessary, and if progress in treatment is not as expected, it may be helpful to examine each of the four requirements in turn to discover where things are going wrong.

Last Updated August 30th 1998