“I’ve got my life back … thanks.”
Through the clinic window, autumn’s blaze of colour is muted with drizzle and dark skies, but inside I am cast in light. I am privy to a private miracle. A corrosive mental illness that was throttling a life is no longer wreaking havoc. Hope, agency and opportunity has emerged. Career and relationships are reinvigorated and joy has been restored. The grace with which I am shown gratitude moves me profoundly and I reconnect with my sense of mission and purpose as a psychiatrist. Not a bad way to start a Monday.
These moments happen for me time and again. How’s that for job satisfaction? Given the ample rewards and ability to make a real difference, you would think doctors would be falling over themselves to train in psychiatry. But tragically, that’s just not how it is.
We are struggling to recruit doctors into the profession. There is now a national recruitment programme in line with other medical specialties, and we know more than we did about our ability to attract and appoint doctors to training posts – but the most recent round of appointments in August this year left 18% of core training posts in psychiatry unfilled. The problem is not new. Since 2010, between 8.7% and 35% of such posts have been left vacant through the national recruitment programme.
So what’s going on? Probably a number of factors. Changes in immigration laws mean fewer overseas doctors are able to secure posts, while the numbers of psychiatrists required in the UK grows in response to increasing demand and population size. Recruitment is left lagging behind the growing problem.
More sinister reasons may lie in the stigma that continues to haunt mental illness and those associated with it. This can affect doctors as much as anyone else. Medical students and graduates interested in a career in psychiatry could be swayed by the negative attitudes of colleagues, friends and others. Once aversive opinion gets under the skin, it can be difficult to eradicate.
I remember being warned off entering the specialty as a medical student – I was told that if I changed my mind, there would be no way back into “proper” medicine. Such was the perceived aversive effect of having a psychiatry job on my CV. Subsequently, as a young trainee I saw negative attitudes to people with mental health problems. I lost count of the times I was bleeped to “sort out” somebody with apparent psychiatric symptoms on a general hospital ward, only to discover that an untreated physical illness had been overlooked or ignored and was causing the problem. Sometimes I got a thank you for my diagnosis, sometimes there was a blank stare. Why health professionals wouldn’t rule out physical illness as a cause was beyond me then, but I now see it was another form of discrimination. At the time, I was happy to do the “proper” medicine for them and challenge their assumptions.
We need to get our house in order. Not just in psychiatry itself, but among the medical profession and indeed the healthcare community as a whole. If one in four of us will develop a mental health problem at some point in our life, that means vast swathes of colleagues in psychiatry and other specialties will be personally affected. Our own attitudes need to change if we are to change the attitudes of potential trainees.
Furthermore, we need to do more to extoll the positives of becoming a psychiatrist. The work is fascinating, challenging and stimulating. The work-life balance is enviable. You can choose to help anyone from the very young to the very old, you can specialise or work as a generalist. We do “proper” medicine all the time, yet also study psychology and the mysteries of the mind. We save lives. Not in the drama of the operating theatre, but quietly through preventing suicide and supporting relief from mental illness.
We need to tell people we work miracles.
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