What drives trainee psychiatrist Dr Mary-Ellen Lynall is “seeing people get better who have been in a very dark place”. Mental health problems such as depression affect one in four adults and their only hope may be a talking therapy or a prescription for antidepressants. In future, says Lynall, a simple blood test could lead to an entirely different course of treatment.
“Research shows that brain inflammation may be a cause of depression and in five or 10 years we could have a blood test to detect whether that inflammation is present,” she says. “Talking therapies are always going to be a mainstay because they’ve been shown to work incredibly well, but neuroscience research will mean that we have more tools in our box as psychiatrists.”
Lynall, who has a neuroscience background and combines psychiatry with research at Cambridge University, argues that understanding the physical basis of psychiatric disorders could be the key to better mental health. She is a prime example of the new wave of young doctors that the Royal College of Psychiatrists (RCPsych) hopes to draw into the profession, partly to make up for historic shortages but also to meet the government’s £1bn pledge to transform mental health services and treat an extra 1 million patients by 2020/21.
The college is running a Choose Psychiatry recruitment drive for psychiatric training – 20% of places are unfilled every year – and one aim is to dispel myths about the profession, for example, that patients never recover or that it is unscientific. RCPsych dean Dr Kate Lovett says the beauty of psychiatry is that cutting-edge neuroscience is interwoven with a psychosocial approach to patients.
“When we did focus groups with newly qualified doctors, some of them told us they didn’t think psychiatry was very scientific, but there’s a huge amount of science involved,” Lovett says. “There were real positives for attendees around the fact that psychiatry takes a holistic approach to people’s situations and difficulties – biological, psychological and social. You can’t do cognitive behavioural therapy (CBT) if you’re hungry or homeless and you can’t recover from depression if there are things going on in your life that stand in the way. You have to see people in the round.”
Choose Psychiatry, boosted by funding from Health Education England, relies on a series of professionally produced videos and the power of social media to raise the visibility of the psychiatry brand among newly qualified doctors who are deciding which specialty to pursue. Half of junior doctors drop out after foundation training, some never to return, so the hope is that many can be lured back.
“Historically, we’ve struggled to recruit and train enough doctors to meet demand in psychiatry and we’ve been about 100 trainees short each year,” Lovett explains. “But the campaign has significantly exceeded our targets and we’ve had the highest number of applicants we’ve ever had in a single year.”
Budding psychiatrists do three years of core training, then specialise in one of six areas: old age, forensic, learning disability, psychotherapy, general adult, or child and adolescent mental health services (CAMHS).
A new “CAMHS run-through” programme allows trainees to complete all their training in a single region, which Lovett says has generated a “huge response”, to the extent that more posts have been created for it.
While science is a strong pull factor for some doctors, the arts are the main attraction for others. Dr Saffron Homayoun is in the last year of her child and adolescent psychiatry training and runs psychART, a project part-funded by the College, which celebrates creativity in medicine and targets like-minded medical students and newly qualified doctors. It encourages them to show their artistic side and use books and films to deepen their understanding of psychiatry.
Artistic expression provides an insight into patients’ psychic worlds, Homayoun says, opening up vistas that would otherwise be closed. She recalls a musician, who also has a diagnosis of bipolar affective disorder, who performed at a psychART conference, playing his guitar to show how being manic and then depressed felt to him.
“For me as a psychiatrist, this was really so powerful because we can see an extra facet of the mind through music and the arts,” she says. “One way to examine someone’s mental state is to ask a standardised list of questions, but an alternative could be to ask: ‘Could you play on your guitar how you feel at the moment?’ Taking someone’s blood pressure or using a stethoscope when examining someone’s mental state aren’t options for us, so we need this extra modality in psychiatry.”
Homayoun has travelled the world, doing research and learning languages, and loves the fact that life experience is highly prized in her chosen profession. Breadth of experience unlocks empathy with patients, disclosing new avenues into their minds, thoughts and feelings.
It is a profession that welcomes the “emotionally mature”, as Lovett calls them, and career changers like the astrophysicists, journalists and teachers whom she says have taken up psychiatry.
Homayoun describes psychiatry as medicine for those who are curious about life and culture. Psychiatrists, unlike doctors in other specialties, also have the luxury of time, she says.
“When I was in an A&E foundation training post, before choosing to specialise in psychiatry, I was always told I was spending too much time with patients,” she adds. “We’re very fortunate in that we’re able to spend a long time getting to the heart of people’s distress.”
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