I am an NHS Psychiatrist AMA

[ipredictariot5]

There has been so much in the news this week about the mental healthcare of the man who killed the three people in Nottingham. If anyone wants to
ask any questions about this or psychiatry in general fire away

Thank you very much @ipredictariot5 I appreciate your answer.

It's a very raw and sore issue for me as a family member, who lost someone very dear recently as a result of decisions they were deemed to have capacity for, yet obvious to me they were not in their right mind. It's been a torturous journey that has left me scarred with ptsd, after years of stepping in where services have seemingly been unable to act. It's been like watching a car crash unfold, gagged with my hands tied behind my back.

I agree locking someone up in hospital when they only have fluctuating capacity isn't the best solution. I think we fall very short on providing adequate solutions for those who are "in between". I personally think it's an area that needs a complete overhaul and there should be more powers to step in, and a different type of safe house offered (rather than a hospital) where there is a clear history of risk and fluctuating capacity - is that something that's felt within the profession do you think? Will things ever change? Cheeky second question, sorry.

I wish … in the old NHS we used to have crisis houses and beds and properly resourced teams and support workers and we would have been able to step in more
The impact of the political choices of austerity just gets worse and worse each year. We do our best but as an example a I detained spent nearly a week in an A and E as there was no bed anywhere in the country. Our Trust spends millions a year on out of area beds and can’t resource its own teams. The system is entirely broken and I can only hope a new government will at least care enough to change direction
sorry to be so negative

That is the sort of thing CBT would help with. Guilt Shame and Anger are emotions that therapy exposes and gives tools to deal with

Thank you and I completely appreciate your honesty. It's a desperately sad situation for some of our most vulnerable and very short-sighted that we don't step-up and deliver what is needed. The knock on effects on patients and their families can literally last a lifetime, and the costs in emergency welfare checks and hospitalisations must surely be significantly higher. Support workers are so under-valued.

Do you think psychiatrists should have their own (mandated) therapy as part of their training ? It is a requirement on many counselling courses.

If you are training as a medical psychotherapist it is mandatory. If not it isn’t. But you have psychotherapy training and are taught about how you need to understand your own emotions and experience should not come into the therapeutic space and to recognise if it does
I have accessed CBT as a patient but wouldn’t see any benefit to having it or any other modality unless I was actually unwell.
I am not sure what it would achieve ( for
me ) - if I was looking after diabetic patients it wouldn’t be mandatory
for me to take insulin - are you thinking it would make us better psychiatrists?

One of the most illuminating threads that I have ever read on MN.

Thank you, OP.

Do you see alot of mental health issues caused by cannabis use? I think it's very worrying how many younger people are using it.

My question was from genuine curiosity around the training, rather from a "should" perspective. There was a case in the press a few years ago which ended in a psychiatrist being struck off and testimony given that indeed their past emotional history had negatively influenced their work, and they admitted that. A different generation, maybe. It was quite a sad story.

I guess the reason we might expect someone working in this area to need therapy themselves is because they are listening to people talking about their trauma. Surely listening to this all day everyday it would be hard not to let it affect you? I’ve had treatment for depression at the priory and I remember one group session being moved as that day was the monthly staff recharge day. They dedicated a whole day to therapy for the staff.

Yes, it's interesting that it's necessary for therapists, but not psychiatrists or nurses. As we're moving towards more trauma focussed treatment, I wonder if it will become more necessary.

Yes it is a real problem especially in young men where it can definitely drive if not cause psychosis

We should all have some sort of psychological supervision where we can take cases we are struggling with. As well as reflective practice in a peer group and line management support

See my answer re the support we have ( as well as psychological support via occupational health and mental health services if needed)
psychology is a different profession to nurses and doctors and although trained in psychotherapy we do not deliver it to patients generally. We would need additional psychological training at act as therapists

I would like to know why is it a safeguarding concern if an individual does not admit to / disclose MH issues / conditions? Surely it’s a matter of individual privacy but I’ve now seen multiple times how disguised MH issues are seen as a safeguarding issue (threads on MN and one case in RL)

Surely some people just want to keep things private or in the past - why is that not ok ?

What do you think about new research showing ECT as being most effective in treatment resistant schizophrenia if clozapine/ olanzapine doesn't work?

@ipredictariot5 read 'when the body says no' and 'the body keeps the score'

Do you feel under pressure to diagnose something as being within the individual when it's clearly lots of societal and life experience favors that are making them
Stressed and behaving like that

CAMHS were the psychologists he saw

I can’t comment on this without specifics -safeguarding is a tricky area

Try not to - there’s often a lot of debate as to what is an adjustment reaction ( normal reaction to circumstances ) compared to anxiety/ depression etc

Don’t know much about it - I don’t prescribe ECT in my role but generically anything that reduces the use of drugs with high side effect burdens is worth consideration

Just googled looks interesting. Thanks

Hello @ipredictariot5. This is a great thread, thank you.

My question is, why are so many struggling teens getting emerging personality disorders diagnosis when 1. their brains and personalities are still developing and 2. they're displaying symptoms of trauma which are often due to undiagnosed/unidentified neurodiversity?

Is this for political/financial reasons?

Oh I have another question if I may @ipredictariot5.

I am over simplifying this, but without assessment/diagnosis, what would be a way for a lay person to have a strong idea of whether an ADHD as opposed to ASC assessment is necessary? I am aware of the overlap between both, but what behaviors/symptoms/traits are the main differentiators?

Thank you!