Andrew Blewett Psychiatrist

Psychiatry is the medical specialty dealing with the diagnosis, treatment and care of disorders of the mind, usually termed mental illness. Mental illness can manifest abnormally distressing and enduring experiences touching behaviour, aspects of neurological function, mood, thinking, reasoning, perception, memory, intellect and personality including a range of acquired or innate psycho-behavioural trait disorders. As mental ill-health is commonly linked to physical disease and illness, good psychiatric care often involves complex interactions requiring skills in general medical assessment and care. In recent decades the bio-psychosocial model has provided a useful framework both for assessment and a context to diagnosis, treatment and care interventions.

While patients may present urgent problems requiring immediate help to address pressing and sometimes life-threatening situations, the reality of mental health problems requiring specialist psychiatric help for many people is one of longer term recurrent or persistent difficulties. Although many mental health conditions are to a large extent "self-limiting" and treatment will alleviate acute psychological distress, usually very successfully, mental health care in common with general health care is concerned with a range of conditions associated with long term disability. Such treatment and care involves maximising quality of life not least through working collaboratively with people using conventional medical understanding and approaches combined with psychological and social interventions to help recover autonomy and the possibility of a lifestyle experienced positively and fruitfully. Crucially and of immense importance in psychiatry, a key part of all mental health professional's work involves the recognition, understanding and alleviation of the effects of stigmatisation, isolation, exclusion and prejudice.

Much psychiatric work including specialist assessment, advice and treatment with medications and psychological help takes place in a variety of community settings including clinics, GP surgeries, places where people receive informal or formal social support and sometimes and where appropriate in people's homes. People may be seen individually, with partners, family members, friends or carers depending on their need and preferences. Choice of setting will be determined by the circumstances of the presentation, the concerns, dignity and safety of the patient and the practical demands of treatment provision. The strong association with physical ill-health means that general hospitals are the focus of increasingly organised and  more readily available specialist help, in Emergency Departments as well as in-patient wards and outpatient clinics. Most psychiatrists will periodically or for some regularly see and advise on treatment for people subject to the criminal justice system.  The role of specialist psychiatric hospitalisation itself has changed dramatically in character over recent decades as most of the old psychiatric hospitals in the UK had closed or substantially reduced in size by the end of the twentieth century.

The realities of severe and lasting mental ill-health, the high risk of long term suffering, the experience of trauma, continuing problems with stigma and the risk of despair and harmful behaviour all mean that the role of psychiatrists in common with other mental health professionals work with people at their most vulnerable. There is much scope for misunderstanding and misinformation, perhaps now gradually becoming less acute as mental illness has to some extent "emerged from the shadows". This gradual, uneven process of reform, increasing openness and social maturity owes much to those who have been willing to share their experiences publicly using supportive media or entirely through their own efforts, helping others recognise and gain the confidence to address their difficulties. It has also been assisted by the long slow process of de-institutionalising psychiatry, not least in moving away from the old hospital system. Meanwhile the task of public education, helping society to develop and sustain the resources to support and protect its more vulnerable citizens and indeed for learning from patients and oneself is never-ending.

The views expressed above are those of Dr Andrew Blewett, Consultant Psychiatrist. They do not specifically refer to any particular patient or psychiatric establishment.