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Psychiatry – recruitment crisis or opportunity for change?

  • Helen Henfrey (a1)

Summary

Psychiatry is suffering an enduring crisis in recruitment. In this editorial I discuss the reasons for this that are most pertinent to recruitment from foundation training and also review the Royal College of Psychiatrists' current 5-year plan for recruitment and what else could be done.

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References

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1 Mukherjee, K, Maier, M, Wessely, S. UK crisis in recruitment into psychiatric training. Psychiatrist 2013; 37: 210–4.
2 Brown, T. Recruitment Strategy 2011-2016. Royal College Psychiatrists, 2012 (http://www.rcpsych.ac.uk/pdf/Recruitment%20Strategy%20-%2010092013.pdf).
3 Nasrallah, H. The antipsychiatry movement: who and why. Curr Psychiatry 2011; 10: December (http://www.currentpsychiatry.com/index.php?id=22661&tx_ttnews[tt_news]=176468).
4 Royal College Psychiatrists. Misconceptions about Psychiatrists ‘Common’ among Public and Medical Students. Royal College Psychiatrists, 2013 (http://www.rcpsych.ac.uk/mediacentre/pressreleases2013/psychiatristsrole.aspx).
5 Wiesenfeld, L, Abbey, S, Takahashi, SG, Abrahams, C. Choosing psychiatry as a career: motivators and deterrents at a critical decision-making juncture. Can J Psychiatry 2014; 59: 450–4.
6 Bassiri, M, Lyons, Z, Hood, S. Stigmatisation of psychiatrists: experiences of psychiatrists and psychiatric registrars in Western Australia. Educ Res Perspect 2011; 38: 3544.
7 Malhi, GS, Coulston, CM, Parker, GB, Cashman, E, Walter, G, Lampe, LA, et al. Who picks psychiatry? Perceptions, preferences and personality of medical students. Aust N Z J Psychiatry 2011; 45: 861–70.
8 Volpe, T, Boydell, KM, Pignatiello, A. Choosing child and adolescent psychiatry: factors influencing medical students. J Can Acad Child Adolesc Psychiatry 2013; 22: 260–7.
9 Lyons, Z. Attitudes of medical students toward psychiatry and psychiatry as a career: a systematic review. Acad Psychiatry 2013; 37: 150–7.
11 The UK Foundation Programme Office. Foundation Programme Annual Report 2012. UK Foundation Programme Office, 2013 (http://www.foundationprogramme.nhs.uk/pages/home/keydocs).
12 Time to Change. About. Time to Change, no date (http://www.time-to-change.org.uk/about).
13 Vaughan, G, Hansen, C. ‘Like Minds, Like Mine’: a New Zealand project to counter the stigma and discrimination associated with mental illness. Australas Psychiatry 2004; 12: 113–7.

Psychiatry – recruitment crisis or opportunity for change?

  • Helen Henfrey (a1)

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Psychiatry – recruitment crisis or opportunity for change?

  • Helen Henfrey (a1)
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eLetters

Looking inwards to make a difference

Nadim Almoshmosh, Consultant Psychiatrist, Priory Group
18 August 2015

Dr Henfrey’s editorial is timely and rightly focuses on some important factors affecting recruitment into psychiatry. Despite the College various efforts so far we still talk about “recruitment, not a selecting specialty”. Besides the community and professional stigma as barriers to recruitment there is in, my view, another important factor to be taken into account, that is from within.

Psychiatry as a specialty continues to be less well defined than other medical specialties, understandably, as psychiatry deals with the person as a whole, body and mind. This comes with some complexities particularly when there is little in terms of tests to confirm diagnoses. Therefore the clinical opinion of the treating psychiatrist often is the main drive when it comes to making a diagnosis and devising the medical management of mental disorders. Here psychiatrists can vary widely on their views on these two important areas for doctors, diagnosis and treatment. I was a College Tutor and an Educational Supervisor for Foundation Years trainees for a number of years and I listened to their feedback. For the observing new comers or potential recruits these conflicting views expressed on often the same conditions do not go down well in terms of attraction to the specialty. It can give the impression that psychiatrists do not seem to agree on diagnosing or managing common conditions. For the indecisive candidate this is not very encouraging sign.

For me, psychiatrists should do more to help define our specialty to show what we good at and why no one else can do it better than us. The psychiatrist, over time and not to undermine the value of team work, is looked at as a team member only with a role that is sometimes difficult to distinguish from other MDT members. This can be seen as we are slowly allowing ourselves to be less distinguished even in within our own teams. Therefore new doctors and potential recruits who are influenced by the “prestige” of the medical profession will I guess be less interested in the specialty.

Psychiatry is an art that should involve clear communication and we hear this all the time but unfortunately it does not always feature in our practice. Amid all these complexities of our specialty, psychiatrists should always document and state clear reasons on why we do things the way they do them. For example, a psychiatrist’s impression, should state the diagnosis is made because of the following psychopathology/symptoms and signs and that is based on a particular disorder classification. This clarity and reasoning can make a difference in helping trainees and other professionals understand the rational and the process followed for decisions we make. Naming things in a simple way can go a long way to make others understand what we say and do.

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Re. Psychiatry- recruitment crisis or opportunity for change?

Sophie Behrman, ST5 General/Older Adult Psychiatry, Oxford Health NHS Foundation Trust
09 August 2015

I read Dr Henfrey’s editorial (1) with great interest. I am pleased that the 5 year recruitment plan is receiving due recognition towards the end of its existence. However, I would argue that 5 years is not long enough to reap the benefits of the recruitment drive. The recruitment plan is three pronged: addressing school students, medical students and foundation doctors. I would argue that the most powerful impact can be had on the former, and that any changes here will take at least 9 years to come into effect (by the time the students have achieved A-levels, attended medical school, completed foundation jobs and applied for core training).

I have been running a work experience programme for 17+yr olds applying to medical school (www.psychedupformedicalschool.org) and have been amazed by how one week’s experience can change their attitude towards psychiatry, mental health and their career plans (2). As part of the project I have become interested in what the cohort see as priorities for their career. Data I have collected suggest that brain-science and research, opportunities for flexibility within a career and teamwork tend to be high on their agendas. The students tend to be surprised that these features are all common to psychiatry, having a very Freudian view of what a psychiatrist does. Psychiatry, is therefore in an excellent state to “sell” itself to students at this early stage. The specialism will remain on their radar through medical school and the early years of their careers. A further benefit of starting young is that the students may progress to address stigma, first amongst peers in school (a key target group from the Changing Minds strategy (3)), and then from the “bottom up” in medical school, when, as they have had tangible experience of psychiatry before their peers they may be in a good position to address misunderstandings and negative attitudes.

There are shortages of work experience placements for students applying to medical school, particularly in psychiatry (4). It would seem that would-be psychiatrists tend to have considered the career before medical school (5), therefore recruitment strategies aimed at medical students and foundation doctors may be less influential. I would urge other psychiatrists to set up work experience schemes locally and am very happy to support other projects- please get in touch (sophie.behrman@doctors.org.uk).

(1) Henfrey, H. Psychiatry- recruitment crisis or opportunity for change? British Journal of Psychiatry 2015; 207: 1-2

(2) www.psychedupformedicalschool.org

(3) Crisp A, Gelder M, Goddard E, Meltzer H. Stigmatization of people with mental illnesses: a follow up study with the Changing Minds campaign of the Royal College of Psychiatrists. World Psychiatry 2005. 4 (2) 106-113

(4) Albert A M, Raoof A. Availability of work experience placements in psychiatry: the real picture. Psychiatric Bulletin 2014; 38(6): 306

(5) Goldacre MJ, Fazel S, Smith F, Lambert T. Choice and rejection of psychiatry as a career: surveys of UK medical graduates from 1974 to 2009. BJPsych 2013 202:228-234

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Global Relevance of Recruitment Crisis in Psychiatry

K.A.L.A. Kuruppuarachchi, Senior Professor of Psychiatry, Faculty of Medicine, University of Kelaniya, Sri Lanka
Chirantha S. Kuruppuarachchi, Medical Student, South Asian Institute of Technology and Medicine, Malabe, Sri Lanka
31 July 2015

The editorial on Psychiatry – recruitment crisis or opportunity for change? ( Henfrey 2015) has been read with interest.

Even though the author has focused mainly on the current situation in the U.K. , we believe that it has a global relevance.

Obviously stigma towards psychiatry and psychiatrists has been existing for centuries. This area has been addressed /discussed extensively all over the world. Discrimination of psychiatrists and the field within the profession as well as amongst the other colleagues has been a universal phenomenon and a major issue. Challenges to the field including decrease confidence about the knowledge , shortage of a proper theoretical basis and external challenges such as competition from other professions , patients dissatisfaction and negative image have been pointed out(Katschnig 2010). Also psychiatrists seem to have an identity crisis. Obviously similar factors could negatively affect the undergraduates as well.

It is interesting to note that the article tries to highlight the feelings/views about psychiatrists by the public and also the hostile socio-cultural factors which can adversely influence the recruitment potential.

Even in countries like Sri Lanka the importance of improving undergraduate psychiatric education has been emphasized ( Kuruppuarachchi & De Silva 2014). The factors influencing the recruitment potential and carrier choice seem to be essentially similar to the west.

As mentioned in the article it is necessary to integrate psychiatry into the other disciplines. We need to concentrate on ways of improving liaison work too. If we are able to improve the knowledge of psychiatry amongst the undergraduates , then they can act as messengers to reduce the stigma towards psychiatry( whichever the discipline selected) as poor knowledge could exacerbate stigma and fear. This endeavor will also help to attract the good quality graduates to the field who are respected by the rest of the non psychiatric colleagues which will further help to improve the outlook of psychiatry.

The Royal Colleges, Psychiatric societies and Colleges and Psychiatric departments in medical schools globally have a crucial role to play with regard to this important area.

We also believe that the time has come to focus more on the positive aspect of psychiatry and to do more research work on the positive outcomes/aspect to improve the image of psychiatry.

References;

Henfrey H. Psychiatry – recruitment crisis or opportunity for change? British Journal of Psychiatry 2015; 207: 1-2.

Katschnig H. Are psychiatrists an endangered species? Observations on internal and external challenges to the profession. World Psychiatry 2010; 9(1) : 21-28.

Kuruppuarachchi KALA , de Silva NR. Burden of mental illness and the need for better undergraduate education in psychiatry. Ceylon Medical Journal 2014; 59(2): 35-38.

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Might more than 'rebranding' be required?

Jonny Martell, CT1 psychiatry trainee, Chase Farm Hospital
20 July 2015

Henfrey’s editorial offers a cogent review of the profession’s enduring recruitment crisis. However, her depiction of community and professional stigma is puzzling and complacent.

To portray the profession’s nemesis as the antipsychiatry movement, misleadingly portrayed as arguments ‘based on now-outdated ideas such as lobectemies and excessive use of electoconvulsive therapy,’ ignores more contemporaneous and pressing ‘critical arguments.’ The last Maudsley debate, published in the BMJ(1), found in favour of the motion that psychiatry is failing in that most basic ethical duty- primum non nocere. The heated exposure of conflicts of interest on both sides of the panel led to a less than favourable comparison of our academics’ corner-fighting antics to that of our political class in the national press the following morning(2).

‘The many advances in treatment,’ which might muffle the profession’s vocal critics are well qualified in a New York Times editorial last week by Weill Cornell Psychiatry Professor Richard Freeman(3). He writes, ‘with few exceptions, every major class of current psychotropic drugs.. basically targets the same receptors and neurotransmitters in the brain as did their precursors, which were developed in the 1950s and 1960s.’

How much ‘reality of evidence-based psychiatric practice’ should we offer ‘in tackling discrimination within the medical community’? Perhaps not the 2006 study that reviewed every trial of psychiatric drugs in four academic journals over a ten year period (n=542) (4). Favorable outcomes were significantly more common in studies sponsored by the drug manufacturer (78%) than in studies without industry sponsorship (48%) or sponsored by a competitor (28%). Indeed, as the authors conclude, ‘further research is needed to elucidate the mechanisms underlying this relationship.’

A more humble appraisal of the product’s difficulties would be bitter medicine but perhaps better than a punchy marketing strategy. Might more than ‘rebranding’ be required to tackle psychiatry’s long-standing recruitment woes?

References:

(1) BMJ; 2015;350:h2435

(2) http://www.theguardian.com/commentisfree/2015/may/14/psychiatrists-argue-taking-antidepressants

(3) http://www.nytimes.com/2015/07/19/opinion/psychiatrys-identity-crisis.html?rref=collection%2Fcolumn%2Frichard-a-friedman&action=click&contentCollection=opinion®ion=stream&module=stream_unit&contentPlacement=1&pgtype=collection

(4)Psychol Med. 2006 Nov;36(11):1647-56. Epub 2006 Aug 8.

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The Psychiatry Early Experience Programme: an innovative teaching strategy to aid recruitment?

Clare Holt, CT1 Psychiatrist, South London and the Maudsley Core Training Programme
Ross Mirvis, CT1 Psychiatrist, South London and the Maudsley Core Training Programme
Helen Hutchings, CT2 Psychiatrist, South London and the Maudsley Core Training Programme
18 July 2015

Dear Editor:

As core trainees in psychiatry Helen Henfrey’s editorial provided a welcome source of debate [1]. For us psychiatry was a positive choice, not a back-up plan. However, we are well aware of the challenges to recruitment in psychiatry [2]. Most of us can identify on a personal level with the issues raised in the editorial about the negative attitudes towards psychiatry from other doctors – sentiments such as “why would you do that” or “what a waste, you are such a good doctor”.

Dr. Henfrey identifies the undergraduate period as a crucial time when enthusiasm for psychiatry may wane. While clinical attachments may improve attitudes towards psychiatry, this effect is often transient [3]. Also, during clinical placements face-to-face contact with psychiatrists can be variable as is students’ exposure to the sub-specialties. The editorial emphasises in particular the need for “innovative teaching strategies” and also the importance of greater integration of psychiatry into the curriculum. With these factors in mind we would like to present our own initiative – the Psychiatry Early Experience Programme (PEEP), which we believe meets both these aims.

PEEP was first introduced at King’s College London in 2013. The premise is that 1st year undergraduate medical students are paired with volunteer psychiatry trainees and shadow them at work, including when on-call. The recommendation is that students spend two days with their paired trainee every six months. Students are encouraged to remain in PEEP throughout medical school, providing regular exposure to psychiatry and a broad experience of its sub-specialties. It is hoped that PEEP will help to maintain more consistently positive attitudes towards psychiatry and also enable students to see first-hand the “high levels of satisfaction” psychiatrists have with their work that is cited in the editorial.

In September 2015 PEEP will enroll its third cohort of undergraduate medical students and there are also plans to extend the scheme to Sheffield University. PEEP is therefore aimed at British graduates and, as highlighted by Dr. Henfrey, it is this group that is a particular target in terms of increasing recruitment into psychiatry. In order to more objectively assess the effect of PEEP we are measuring students’ attitudes towards psychiatry on an annual basis using the validated 30-point attitudes towards psychiatry questionnaire (ATP-30) [4]. This is clearly an on-going project, but initial data are promising.

Finally, we want to make clear that PEEP is not only about recruitment and does not aim to convert all participants into psychiatrists. We hope that students enrolled in PEEP will develop both a more well-rounded and sensitive view towards psychiatry patients and a better understanding of the work done by psychiatrists. Thus we propose that initiatives like PEEP have a role to play in reducing the stigma faced not only by psychiatrists, but also more importantly by our patients. We welcome further correspondence from those interested in the scheme.

studentpeep@hotmail.co.uk

References:

1. Henfrey, H. 2015. Psychiatry – recruitment crisis or opportunity for change?. Br J Psychiatry 207:1-2

2. Brockington IF, Mumford DB. 2002. Recruitment into psychiatry. Br J Psychiatry, 180(4):307-12

3. Qureshi H, Carney S, Iversen A. 2013. Narrative review of the impact of clinical attachments on attitudes to psychiatry. The Psychiatrist Online, 37:104-110

4. Burra P et al. 1982. The ATP-30 – a scale for measuring medical students’ attitudes to psychiatry. Medical Education, 16(1):31-38

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Rebranding is not enough

Jennifer L Burgess, Final Year Medical Student, St George's, University of London
10 July 2015

The Royal College strategy seems entirely focused on ‘rebranding’. If psychiatry could only change its image, then people would be interested. But Goldacre et al (2013) found that 71% of doctors who considered psychiatry but rejected it in favour of another speciality gave ‘job content’ as the primary reason. What is it about psychiatry that is so off-putting? The article gave some verbatim examples: ‘negative experience as medical student,’ ‘…pace too slow’, ‘…numerous bad placements…’, ‘too slow moving’. It seems that ordinary psychiatrists are hampering the College’s best efforts.

One area I believe psychiatrists differ from other specialties is in their attitude towards research. I hear at recruitment events that psychiatry is as evidence-based as everybody else and that they want to encourage academic activity, but last month’s Royal College online poll (results published in the July 2015 eNewsletter) found that 69% disagreed with the statement “All psychiatrists should be actively involved in research”. Can you imagine this result coming from the Royal College of Surgeons? All the aspiring surgeons I know are working on a paper. They won’t get their training post without one, and the imperative to publish reinforces the image of surgery as a forward-thinking and innovative area.



Instead of moaning that recruitment is low because other people are being mean, perhaps the Royal College should be ensuring that current psychiatrists are living up to the image they would like to project.

References:

1) Goldacre, M.J., Fazel, S., Smith, F., & Lambert, T. (2013). Choice and rejection of psychiatry as a career: surveys of UK medical graduates from 1974 to 2009. The British Journal of Psychiatry, 202(3), 228-234; DOI: 10.1192/bjp.bp.112.111153

2) Royal College of Psychiatrists, eNewsletter July 2015. http://www.rcpsych.ac.uk/usefulresources/rcpsychenewsletters/enewsletters2015/july2015.aspx
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Re: Psychiatry – recruitment crisis or opportunity for change?

Kelvin Leung, FY2, South Tees Hospitals NHS Foundation Trust
09 July 2015

Dear Editor,

Stigmatisation toward mental illness has been a long established problem amongst the general public – throughout history, across cultures and even before modern diagnostic categories were constituted(1). The general public has, largely if not completely, been influenced by how psychiatric illnesses and treatments are portrayed in popular culture. Certain stereotypes circulate based on what people have seen and discussed in films. For instance, violence seems to be a recurrent representation of psychosis perpetuated by filmmakers(2). However, this situation has placed psychiatry as a profession at stake. Remember the cannibalistic psychiatrist Dr Hannibal Lector in The Silence of Lamb(3)? I have to admit that I was very drawn into his manipulative and twisted dialogues. With the success of a couple of Academy Award-winning films portraying a perceived phoney side of psychiatrists, I can imagine how difficult it would be to rectify the public image on this matter.

Stigma among patients themselves is not to be overlooked. Patients have increasingly been discontented and been criticising different aspects of the psychiatric service. From “clients” and even “consumer” to, in recent years, “user” or “service user”, the evolution of how patients are called within the mental health sector reveals the movement away from a paternalistic model(4). With the current advances in social media and technology, it’s much easier for people to share their experiences of mental health services with the world. This enhances the development of some notorious high profile cases, ingraining the stigma attached to mental health problems.

Having a poor public image as mentioned, psychiatry does not seem to be respected within the medical profession as a whole either(4). Psychiatry becomes a field where overlap with other professions, such as neurology, general practice, psychotherapy and clinical sociology, contributes to loss of credibility and competence on its own. Speaking from personal experience – I got the “Is that what you really want?” a lot when I told my colleagues that I am going into psychiatry training soon. They would look at me in disbelief as if I am some sort of alien creatures who just made the most extraordinary decision in his life. Sadly, some doctors would think psychiatry as a “last resort” or “backup” to their career option(4). You would be surprised to learn that the perception of psychiatry being “not real medicine” exists among doctors of other disciplines.

In response to the named article I have shared my views on stigmatisation on both community and professional levels as laid out by the author. I recently performed a systematic review with colleagues on qualitative studies addressing recruitment(5). We identified factors contributing to the current recruitment crisis in psychiatry. Apart from stigma attached, other factors include senior psychiatrists as role models, quality of mentorship and training, work-life balance, job satisfaction, interpersonal interactions and academic opportunities(5). Some solutions tackling these identified factors were also suggested in the paper.

Recruitment into psychiatry is a complex process. It involves a heavy cultural influence by the public and the profession(1). In my opinion, open and non-judgemental professional conversations should be commenced between students or pre-specialist doctors and psychiatry tutors as early as possible. This could be carried out in the form of tutoring sessions. Psychiatry tutors and teachers could also discuss doubts, issues and concerns surrounding psychiatry with them(5). It is also worthwhile to expand such discussion to the wider public. With the implementation of Royal College of Psychiatrists’ 5-year recruitment policy underway, I am hopeful that there is indeed an opportunity for change. However, I agree that more still has to be done, due to the fact that stigmatisation in psychiatry is immensely instilled into people’s lives, hindering the recruitment of high-quality applicants.

References:

1. ALARCÓN RD. Culture, cultural factors and psychiatric diagnosis: review and projections. World Psychiatry. 2009;8(3):131–9.

2. Rueve ME, Welton RS. Violence and Mental Illness. Psychiatry Edgmont. 2008;5(5):34–48.

3. Leistedt SJ, Linkowski P. Psychopathy and the Cinema: Fact or Fiction? J Forensic Sci. 2014;59(1):167–74.

4. Katschnig H. Are psychiatrists an endangered species? Observations on internal and external challenges to the profession. World Psychiatry. 2010;9:21–8.

5. Leung K, Awani T, Chima C, Udo I. What Can Qualitative Studies Reveal About Recruitment Into Psychiatry? Acad Psychiatry. 2015;39(3):286–92.

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We Need More Friends in Psychiatry

Itoro Udo, Consultant Psychiatrist (Locum), Broadoak Unit, Liverpool
09 July 2015

The editorial by H. Henfrey [1] has generated interesting conversations this week. She has presented a well thought out review of the problem of recruitment into psychiatry, identifying barriers to improving recruitment among junior colleagues. I write to discuss a few thoughts.

She has stated how often our adversaries maybe within the profession itself. [1] Her thoughts echo the thoughts expressed by our former college president, Professor Dinesh Bhugra on the need for psychiatrists to unite to strength the profession and hence improve recruitment. [2] I often think that psychiatry also needs more friends in the society, especially in high places. As Henfrey has pointed out, advocacy by persons of influence may have a positive effect on stigma. I noticed that David Aaronovitch’s attendance of our International Congress last week was captured in social media. Former minister, Norman Lamb’s advocacy for mental health has also been recognisable in British public service. [3] These sorts of associations, where active and resolute, could improve the public perception of psychiatry.

It is important to recognise that stigma is not a static concept. There seems to be a general sense of nihilism that often accompanies discussions about stigma towards, within and without psychiatry. The Time for Change campaign has now been associated with an improvement in public perception of mental illness. [4] We must recall that history has shown how public opinion has come to shift with regards to issues like the suffrage movement, slavery and slave trade, civil rights movement and more recently same sex marriage and the American confederacy flag. So it is not an unsurmountable task to attempt to improve public perception of mental illness.

The late psychiatrist, Dr. Simon Sinclair, in his medical anthropological analysis of medical training, observed that compared to other medical specialties, psychiatry scores low in status (including economic), high in undesired responsibility and low in (scientific) knowledge. [5, 6] This observation may be viewed as still valid today. Each of these domains may be tackled but system wide and college level changes would be needed. The implementation of New Ways of Working may have contributed to or maintained this low status. [7-10]

The challenge of recruitment into psychiatry is an international one [11] but there may be more UK specific deterrents. In a qualitative study among foundation trainees, in the UK, trainees expressed concerns about the quality of jobs, induction processes, the responsibilities under the Mental Health Act, professional isolation and separation from acute hospital services. [12] Mentoring and positive role models in Psychiatry would be of help. [11]

I often think that the recruitment drive needs to tap into the potential resource of college trainees. Well supported, contented trainees are potentially the best advocates for the college to those we are aiming to recruit. Friends and trainees are within proximal spheres of influence of those we are hoping to attract. Just as they now use electronic review pages to determine whether to buy a product or service, they would access the experiences of trainees known to them or whom they have met on placements to determine whether to put in that vital application. I was recruited by my close friend and I have in turn recruited 5 other friends. When trainees were over burdened with 4 professional exams to be taken within 3 years of basic specialist training, with its then persistently low pass rates; this was a gross disservice by the college towards itself. I am happy that good sense has now got hold. [13] I also note that foundation year 2 doctors may now be admitted to Part A of our college exams, [14] bringing us, finally, in line with other medical colleges such as that of the physicians. Until the recent past, a potential recruit, would have had to sit with their enthusiasm while they act on their other interests by studying for, attending courses and taking other specialty examinations, in order to improve their placement chances.

Finally, a good portion of Foundation year jobs needs to be in liaison psychiatry (adult, old age or paediatric aspects). This could enable potential recruits to observe how psychiatry integrates and overlaps with, supports, enhances and indeed challenges the rest of medicine, enabling them to value its contributions to the modern National Health Service. We cannot be trying to separate the head again from the rest of the body.

References:

1.Henfrey H. Psychiatry- Recruitment Crisis or Opportunity for Change? British Journal of Psychiatry 2015;207(1): 1-2.

2.Bhugra D. Alienated Alienists: A New Hope? Lancet Psychiatry 2014;1(4): 257-259.

3.British Broadcasting Cooperation. Norman Lamb Talks about Son's Mental Health Struggles. http://www.bbc.co.uk/news/uk-politics-31895972 (accessed 09 July 2015).

4.Corker E, Hamilton S, Henderson C, Weeks C, Pinfold V, Rose D, et al. Experiences of discrimination among people using mental health services in England 2008–2011. British Journal of Psychiatry 2013; 202 (suppl 55): s58–63.

5.Sinclair S. Making Doctors: An Institutional Apprenticeship. Oxford: Berg Publishers; 1997.

6.Bland J. Profile: Dr Simon Sinclair. Psychiatric Bulletin 2014;38(6): 303-305. doi: 10.1192/pb.bp.114.049809

7.Vize C, Humphries S, Brandling J, Mistral W. New Ways of Working: time to get off the fence. The Psychiatrist 2008;32(2): 44-45. doi: 10.1192/pb.bp.107.016279.

8.Lelliott P. Time for honest debate and critical friends. Commentary on... New Ways of Working. The Psychiatrist 2008;32(2): 47-48. doi: 10.1192/pb.bp.107.018176 .

9.Kennedy P. We need to monitor implementation. Commentary on... New Ways of Working. The Psychiatrist Jan 2008, 32 (2) 46; DOI: 10.1192/pb.bp.107.018184.

10.Anderson D. New Ways of Working. The Psychiatrist 2008;32(5): 195. doi: 10.1192/pb.32.5.195.

11.Cheug K, Awani T, Chima C, Udo I. What Can Qualitative Studies Reveal About Recruitment Into Psychiatry? Academic Psychiatry 2015; 39(3): 286-292.

12.Welch J, Bridge C, Forest A. Improving Psychiatry Training in the Foundation Programme. The Psychiatrist 2011;35: 389–93.

13.Royal College of Psychiatrists. Changes to the MRCPsych Written Papers and Transitional Arrangements. http://www.rcpsych.ac.uk/traininpsychiatry/examinations/resourcestab/changestowrittenpapers.aspx (accessed 09 July 2015).

14.Royal College of Psychiatrists. Eligibility Criteria and Regulations for MRCPsych Written Papers and Clinical Assessment of Skills and Competencies (CASC). http://www.rcpsych.ac.uk/pdf/MRCPsych%20Exams%20Eligibility%20Criteria%20and%20Regulations%20effective%2014%20January%202015.pdf (accessed 10 July 2015).

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Psychiatry in the Foundation programme: opportunities and challenges

Gopinath Ranjith, Consultant Liaison Psychiatrist, South London and Maudsley NHS Foundation Trust
08 July 2015

The editorial by Helen Henfrey1 discusses the Foundation programme as one of the key points of intervention in efforts to enhance recruitment into psychiatry. She is right to point out that historically the number of Foundation posts in psychiatry has been very low. Fortunately this is changing, the main driver for the change being the report ‘Broadening the Foundation Programme’ (2014)2. By an explicit focus on long term conditions and mental health problems and setting of targets for community-based and psychiatry posts it has had a dramatic effect on re-distribution of jobs within the two year Foundation programme. Foundation programmes have had to significantly increase the number of Foundation posts in psychiatry so that 45% of Foundation trainees will have a psychiatry job during their training. In the mental health Trust where the author leads on Foundation training this has meant an increase in the number of Foundation posts from 6 to 26 between August 2013 and August 2015.

This increase is a great opportunity for psychiatry. While it remains to be seen if it has a direct effect on enhancing recruitment into psychiatry it will certainly help in an indirect way by ‘mainstreaming’ psychiatry posts, enhancing doctors’ psychiatric and non-technical skills, and countering negative perceptions about the profession and patients with mental illness.

But with the opportunity come challenges. Psychiatry programmes will need to carefully identify posts that provide the right balance of educational and clinical experience. The urge to use this unexpected gift to plug gaps in services or rotas must be resisted. Good induction, effective supervision, educational programmes exclusively for Foundation trainees, mentoring schemes and availability of taster experiences are some of the ingredients suggested by local and national guidelines to improve the quality of placements in psychiatry.3,4 It is also essential that there is an identified lead for Foundation training within the postgraduate medical education departments of mental health Trusts to monitor the quality of these placements, offer pastoral support and promote faculty development.



References

1.Henfrey H (2015) Psychiatry- recruitment crisis or opportunity for change? British Journal of Psychiatry, 207: 1-2.

2.Health Education England (2014) Broadening the Foundation Programme. http://hee.nhs.uk/wp-content/uploads/sites/321/2014/02/Broadening_the_Foundation_V15-Final.pdf (accessed 08/06/2015)

3.South Thames Foundation School (2014) Foundation posts in psychiatry: Roles, responsibilities, clinical supervision and training. http://www.stfs.org.uk/sites/stfs/files/Foundation%20Posts%20in%20Psychiatry%20-%20standards%202014%20(Mar%2014)_1.pdf (accessed 04/06/2015)

4.Royal College of Psychiatrists (2015) A guide to psychiatry in the Foundation programme for supervisors. https://www.rcpsych.ac.uk/pdf/A%20Guide%20to%20Psychiatry%20in%20the%20Foundation%20Programme.pdf (accessed 04/06/2015)

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