DRAFT
The Role of the Psychiatrist in health services
Professor Dinesh Bhugra
February 2009
1
Introduction
Psychiatry is the branch of medicine that deals with the medical treatment of
mental illness, emotional disturbance and abnormal behaviour. The term
‘psychiatry’ was first coined about 200 years ago, replacing the now archaic term
‘alienism’.
A psychiatrist is a medically-qualified doctor who deals with mental illness, as well
as the interaction between physical and mental illness. It is well established that a
significant proportion of physically ill patients will also suffer from mental illness. An
equally large number of patients with mental illness will have physical problems,
either contributing to their illness or as a sequel of their mental illness. A major
advantage of psychiatry training is learning about psychological and social causation
in addition to medical knowledge in aetiology and the management of mental
illness. Psychiatrists are thus best placed to use integrated bio-psychosocial models
in understanding the aetiology of mental illness and managing mental illness,
emotional disturbance and abnormal behaviour. This is what makes us different
from other disciplines.
Following the MMC and MTAS fiascos in 2007, Professor Sir John Tooke in his
admirable report, Aspiring to Excellence, suggested that doctors need to redefine
their role. Independent of this suggestion, the Royal College of Psychiatrists had
already embarked on looking at issues related to professionalism and the role of the
psychiatrist in the 21st century.
His paper sets out a proposed road map for the role of the psychiatrist, and the
competencies and skills required to deliver services. Other documents on
professionalism in psychiatry and psychiatry’s contract with society will follow later
in 2009.
Background
Psychiatry, like other branches of medicine, is a patient focused speciality.
Patient-centred Psychiatry depends upon delivering care which is patient focused.
Patient-centred care is defined as “(Care) which explores the Patients’ reasons for
their visit, their concerns and need for information, seeks an integrated
understanding of the patient’s world i.e. their whole person, emotional needs and
life issues and finds common ground on what the problem is and mutually agrees
on management, enhances prevention and health promotion and enhances the
continuing relationship between the patient and the doctor” (Stewart 2001:445).
The core of the therapeutic intervention is doctor-patient interaction which has six
components as illustrated in Table 1.
Table 1. Six interactive components of the patient-centred process.
(After Brown et al 2003)
1. Exploring both the disease and the illness process

History, physical examination, investigations.

Dimensions of illness [explanatory models, feelings, ideas, effects on
function and expectations]
2
2.
3.
4.
5.
6.
Understanding the whole person

The person (life history, development and personal issues)

The proximal context (family, employment, social support)

The distal context (culture, community, society)
Finding common ground

Problems and priorities

Goals of treatment and management

Roles of patient and doctor
Incorporating health promotion and prevention

Health advancement

Avoiding and reducing risk

Early identification

Reducing complications
Enhancing doctor-patient relationship

Compassion

Power

Healing

Self Awareness

Transference and counter transference
Being realistic

Time and timing

Team building and teamwork

Managing resources
The CanMEDS 2005 physician competency framework (Frank 2005) sets the scene
for the training of physicians, competence of physicians, and quality care. It
provides a competency-based framework for educators and resources for
Continuing Professional Development (CPD), as well as information for other
stakeholders. These competencies can be equally valid for psychiatry. They can also
be common to other disciplines dealing with mental ill health and related
complications. However, as in Psychiatry, the medical expert lies at the core of the
CanMEDS construct (see figure 1).
3
Figure 1.
There are seven components within this framework and these will be discussed
below. However, each competency in the CanMEDS framework is made up of
elements of their own and can further be broken down into smaller components for
teaching, training and, learning. The seven competencies of the psychiatrist will
define the professional, although each role will vary in different individuals
according to their individual interests and responsibility. For example, those who
are heavily involved in teaching, whether it is undergraduate or postgraduate, may
have developed their role as a communicator or scholar better than their role as a
manager or an advocate. However, this is not to say that most individuals cannot
attain or follow these roles.
From a UK perspective, Good Psychiatric Practice, published by the Royal College of
Psychiatrists (2009 edition in press), highlights the key characteristics expected of a
good psychiatrist.
Good Psychiatric Practice lists attributes of a good psychiatrist in following
areas:

Trusting Relationship

Good Clinical Care

Consent to treatment

Note keeping and inter-agency/inter-professional communication

Confidentiality

Availability and emergency care

Working as a member of the team

Referring patients

Clinical governance

Teaching and training
4

Researcher

Being good employee and employer
The core attributes listed in Good Psychiatric Practice (p5) are:

Clinical competence

Being a good communicator and listener

Being sensitive to gender, ethnicity and culture

Commitment to equality and working with diversity

Having a basic understanding of group dynamics

Being able to facilitate a positive atmosphere within a team

Ability to be decisive

Ability to appraise staff

Basic understanding of operational management

Understanding and acknowledging the role and status of vulnerable
patients

Bringing empathy, encouragement and hope to patients and carers

Critical self awareness of emotional responses to clinical situations

Being aware of potentially destructive influence in power relationship

Acknowledging situations where there is potential for bullying
A comparison between Table 1 and the attributes of a good psychiatrist as laid
down in Good Psychiatric Practice indicates a tremendous area of overlap in the
qualities of an individual as well as the characteristics of a service that will be
acceptable to patients and their carers.
The CanMEDS Components
Medical Expert: Whatever the sub-speciality within psychiatry, the role of the
psychiatrist as a medical expert and a healer is at the core of it. This role
distinguishes psychiatrists, especially in the treatment of mental illness, more than
anything else. Whether one or all components of bio-psychosocial model are
considered or employed in identifying causation and planning management of
mental illness, the psychiatrist is primarily a medical expert and a healer.
Psychiatrists possess a defined body of knowledge and clinical skills (including
diagnostic, investigatory and management skills) which focus on patient centred
care. The psychiatrist as a medical expert, is trained and able to collect, explore and
synthesise information on the patient’s illness from history taking, direct
observation and investigations through third party information and physical or
laboratory investigations, which contribute to accurate diagnosis. The medical
expert then uses evidence to plan and carry out treatment within the boundaries of
their discipline and with clear responsibilities discussed and allocated within the
team. The care is characterised by healing and using up to date, ethical, resourceefficient treatments through communications with key stakeholders.
The core of the doctor–patient interaction lies in the patient centred processes. In
order to be a medical expert, the psychiatrist needs to be able to integrate different
models of aetiology and management embedded in medical knowledge, which will
lead to appropriate diagnostic reasoning and clinical judgement associated with
clinical decision making. These will lead to identification of appropriate therapies
and human care within the prevalent ethical framework. The expert must remain up
to date in both skills and knowledge and be aware of one’s limits of competence.
5
This awareness will contribute to appropriate help seeking and suitable referral
whenever indicated.
Six enabling competencies highlighted in CanMEDS framework are illustrated in
Table 2
1.
Functions effectively as a consultant; integrating roles provide optimal,
ethical and patient centred care
2.
Establish and maintain clinical knowledge, skills and attitudes appropriate
to their practice
3.
Perform a complete and appropriate assessment of the patient
4.
Use preventative and therapeutic interventions effectively
5.
Demonstrate proficient and appropriate use of procedural skills; both
diagnostic and therapeutic skills
6.
Seek appropriate consultations from other health professionals –
recognising the limits of their expertise
Table 2: Enabling competencies for the medical expert (CanMEDS Framework).
Communicator: As a communicator, the psychiatrist facilitates the doctor–patient
relationship. Communications with the patient, their carers and community and
society at large, are a significant part of the role of a psychiatrist. Essential
components of this role are establishing rapport and trust, formulating and
explaining diagnosis, sharing information and facilitating a mutually agreed and
shared plan of management. There may be disagreements or acknowledged
differences in understanding of aetiological factors within the team and these need
to be taken on board.
The psychiatrist, as a communicator, must demonstrate empathy, compassion,
trustworthiness and integrity with respect for diversity of opinion and cultural
values, with clear attention to psychosocial aspects of illness. Keeping clear,
appropriate and accurate notes and maintaining confidentiality are part of this role.
Conveying appropriate information to patients, their carers and community and
society at large in an easily understood manner at the right level are important. It
can be argued that the role of psychiatrist as a communicator is at a different level
when compared with other professionals in the team. This role is communicating a
treatment and information strategy that informs patients, carers and society at
large.
Collaborator: As collaborator, the psychiatrist works effectively within a team to
deliver acceptable and appropriate optimal patient care. Working within a team is at
the heart of modern health care delivery. Shared decision making, conflict
resolution, awareness of team dynamics, negotiation, and awareness of each team
member’s roles and responsibilities are some of the components of the role. Other
components include working with community agencies, such as voluntary
organisations and primary care, and working across religious, cultural, sexual
orientation, age, or gender divides.
6
Manager: Health care resources are finite whereas the demand is ever increasing.
The psychiatrist has to manage resources, time and teams. As managers,
psychiatrists are essential in organising sustainable clinical practice, making
decisions about allocating resources, and contributing to a resource-efficient and
effective health care system. The role of the clinician as a clinical leader is
important in identifying needs in allocated finite resources where demands continue
to rise. The functional split of teams requires an open discussion regarding validity
and resources required for such a development. Psychiatrists therefore need to
negotiate with society as to what is required in the delivery of mental health care
and discuss prioritisation of resources. They need to be aware of resources and
allocation, and look at the effectiveness and efficiency of services being provided.
They should be aware of research base and evidence and employ this information
appropriately As mangers they should be able to manage their careers effectively,
and have the skills to work and develop as managers and administrators.
Advocate: As health advocates, psychiatrists should be able to advocate for their
patients and carers, and work with them and their organisations to advocate jointly
for resources for patients. They should also advocate for health promotion and
prevention of disease as well as for their own role in society. They should be able to
advise on mental health care policy and patient safety. As part of public mental
health process, they ought to identify determinants of health for the populations
that they serve. They have a responsibility to promote the health of individual
patients, communities and populations.
Scholar: As a scholar, the psychiatrist has a life long commitment to reflective
learning, along with development of medical knowledge.
Dissemination and
application of new knowledge are important components. Elements included in this
role are life-long professional development and learning with reflective practice,
critical appraisal of evidence, using a variety of learning methods, mentoring, role
modelling and research ethics and research questions along with facilitating learning
by patients, their carers, psychiatric trainees and other disciplines.
Professional: As professionals, psychiatrists are committed to the mental well
being of their patients and treating mental illness using ethical practice, following
professional standards, high personal standards and setting high standards with
self-regulation. Elements of professionalism will be expanded in a later document
but include among others: altruism; integrity and honesty; compassion and caring;
morality and codes of ethics; responsibility to self, profession and society;
commitment to excellence; accountability and self-awareness. A good psychiatrist
will be able to demonstrate commitment to their patients, profession and society
through ethical practice, self-regulation and sustainable practice.
A psychiatrist is a clinician – dealing with mental illness in all its variations – who
delivers expert clinical care for mentally ill individuals, usually within a team. They
are able to diagnose and manage the complex end of the illness spectrum
(diagnosing and managing complicated and complex cases and working with the
society and communities they serve to prioritise cases and function effectively
within available resources). They are also experts in managing simple cases which
may become complex in the hands of inexperienced clinicians. They also have a role
in running services, managing resources, teaching, training, researching,
developing and delivering acceptable and accessible services with clear involvement
in leadership roles and abilities.
7
According to the BMA, the consultant (psychiatrist’s) role is to:




Demonstrate the competence and experience to cover complex cases
e.g. more than one condition (or simple conditions that may have
become complex as a result of handling by inexperienced clinicians)
Train, supervise (and mentor) trainees and junior doctors
Accept ultimate responsibility for the care of all patients referred to
their service (under their leadership even if treatment is being carried
out by others)
Provide definitive (clinical) opinion and treatment that cannot be
provided or managed in primary care
The central role of a consultant is as a medical expert to provide high quality
patient care. Delivery of care is interconnected with other roles such as ability to
communicate, manage, innovate, educate and train. The primary objective of a
psychiatrist is to use expert knowledge of psychiatry and personal skills to diagnose
and treat patients with mental illness, retaining ultimate clinical responsibility for
their care. An awareness of the evidence base or lack thereof and consequent
acknowledgement of this is crucial in functioning well in clinical settings. The spirit
of scientific enquiry is vital in clinical functioning. Healing may not be evidence
based, but treatment can be. Medical and psychiatric decision cannot be
automated. The patient must be viewed and treated in their world – with proximal
factors such as employment, family and distal factors such as community, society,
and cultures. Delivery of optimal health care which will be accepted by the patients
and their carers depends on accurate diagnosis, treatment plans and adequate
resources along with effective communication. Psychiatrists must be good role
models and try to inspire and motivate colleagues and team members.
Key skills:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
Specialist psychiatric assessment
Treatment planning
Managing complex cases
Risk assessment and managing risk
Developing and sustaining ethical practice
Pharmacological treatment
Psychotherapeutic treatments
Physical treatments
Social treatments
Physical medical skills
Team working
Appraisal and educational skills
Teaching skills
Critical appraisal skills
Audit and research skills
Collaborating with others
Being a resource for others
Clinical leadership, management and strategic planning
Advocacy
8
Appendix 1
Core Competencies

Demonstrate diagnostic and therapeutic skills to efficiently and ethically
manage a spectrum of patient care problems within the boundaries of the
specialty


Elicit a relevant concise and accurate history

Conduct an effective physical examination

Carry out relevant procedures to collect, analyse and interpret data.

Reach a diagnosis

Perform appropriate therapeutic procedures to help resolve the patient’s
problem
Access and apply relevant information and therapeutic options to clinical
practice


Pose an appropriate patient related question

Execute a systematic search for evidence

Critically evaluate medical literature and other evidence
Demonstrate medical expertise to situations other than indirect patient care.
This includes the ability to do the following:


Be an expert witness

Give presentations/public education
Recognise personal limits of expertise

Decide when and whom to refer to

Implement own professional development

Demonstrate effective consultation skills

Present well-documented patient assessments and recommendations in
both verbal and written forms
Essential Roles and Key Competencies
Medical Expert:

Demonstrate diagnostic and therapeutic skills for ethical and effective
patient care: precise clinical history, physical examination, investigation

Assess and apply relevant information and therapeutic options to clinical
practice

Demonstrate medical expertise in situations other than direct patient care
9

Recognise personal limits of experience

Demonstrate effective consultation skills with respect to patient care,
education and legal opinions: present well-documented patient
assessment
Communicator:

Establish therapeutic relationships with patients and their families:

Elicit and synthesise relevant information from patients, their families and
communities: beliefs, age, gender, culture

Listen effectively, foster understanding

Discuss appropriate information with patients, their families and
communities and other healthcare professionals
Team Player:

Consult and liaise with other health professionals

Recognise limits of personal competence

Contribute effectively to multidisciplinary team, activities (training etc)

Aware of roles and expertise of other disciplines

Integrate opinions of patients in decision-making
Manager:

Managing resources and time effectively to balance patient care, learning
needs, outside activities and personal life

Allocate finite healthcare and education resources effectively and work
efficiently

Utilise I.T. effectively for patient care, CPD
Health Advocate:

Help promote health and prevent disability

Identify social/cultural factors of health

Recognise and respond to settings related to advocacy: populations at
risk, policy awareness, development of policy
Scholar/Educator:

Personal CPD strategy and learning needs and methods
10

Be a critical appraiser of sources of medical information

Educator: help others to define learning needs and development, provide
feedback, adult learning
Professional:

Deliver highest quality care with integrity, honesty and compassion:
racial, cultural and societal issues

Appropriate personal and interpersonal behaviours: self-awareness

Ethically acceptable/responsible: local laws
Attributes:
Medical Knowledge

Up to date knowledge needed to evaluate and manage patients
Clinical Skills

Demonstrate proficiency in history taking

Effective physical examination

(Investigations: organise and evaluate)

Lead and manage diagnostic studies

Demonstrate practice skills

Show proficiency in technical skills
Clinical Judgement

Demonstrate clinical reasoning

Make sound diagnostic and therapeutic decisions

Understand the limits of knowledge

Incorporate cost awareness and risk benefit analysis
Interpersonal Skills

Communicate and work effectively with patients, families, other members
of the team and agencies
Professional Attitudes and Behaviour

Accountability
11

Accept responsibility

Maintain comprehensive, timely and legible medical records

Available for consultation

Seek improvement in quality of care provided

Facilitating learning of patients, communities, students and other
disciplines

Lifelong learning

Evaluate critically relevant new medical and scientific information relevant

Self-awareness

Humanistic qualities

Demonstrate integrity and honesty

Demonstrate compassion and empathy

Respect for privacy and dignity

Ethical
Managerial Skills

Effective and efficient working

Utilise IT
Health Advocacy

Health promotion and prevention

Advocate for patients (families and communities)
12
Patient Care Core Competencies
General
Psychiatry
1 History and examination
Complaint
History
PMH
Systematic review
FH/sociocultural history
Developmental history
1
Differential diagnosis/ evaluation plan
Treatment plan
2 Differential diagnosis
2
Assess and document psych. potential
Risk assessment
Involve treatment standards
Intervene effectively to minimise risk
Implement prevention methods
3 Evaluate assess and
recommend effective
management
3
To conduct therapeutic interviews
4
To conduct a range of individual, group and
family therapies
5
To recognise and treat psychiatric disorders
13
Medical Knowledge Core Competencies
General
Psychiatry
1 Epidemiology, aetiology,
phenomenology,
diagnostic criteria,
effective treatment
strategies, course and
prognosis
1
Knowledge of human growth and development
included. Behaviour, cognitions, psychosexual
including culture
2 Differential diagnosis
healthcare delivery
systems and family work
2
Behavioural sciences - learning theory, formal
family organisations, family dynamics and
communication, group dynamics, anthropology,
sociology and theology, cultural psychiatry,
community mental health, epidemiology, research
methods, psychodynamic theory
3 Ethics
3
Patient evaluation and treatment selection include
psychological testing, lab tests, MSE, diagnostic
interview, treatment comparison, psychosocial.
Therapies
 All forms of psychotherapy
 Brief therapy
 CBT
 Psychodynamic psychotherapy
 All delivery systems of Psychotherapy
 Individual/Family
Treatment of psychosexual dysfunction
Doctor-patient relationship
 Biometric treatments
Pharmacotherapy
Pharmacological actions
Clinical indications
Side-effects
Drug interactions
Toxicities
Appropriate prescribing
Cost effectiveness
Ethnopsychopharmacology
Li
ECT,
Light
14
Medical Knowledge Core Competencies Cont.
General
Psychiatry







Emergency psychiatry
Suicide
Crisis intervention
Home treatment
Differential diagnoses in emergency
PICU
Homicide, rape and violent behaviour
Early onset management
Substance abuse
Pharmaceutical actions of substance abuse
Signs/symptoms and onset of
toxicity/withdrawal
Epidemiology
CAP
Assessment and training
Disorders in infancy
Learning Disability
Psychiatry of old age
Forensic
Liaison
 Specific syndromes
 Psychological and neurological aspects of
physical illness
 Psychological and neurological complications
of physical illness
 Psychosomatic/Somatopsychic
 Coping strategies
 Ethical issues
15
1.



Interpersonal and Communication Skills Competencies
Level 1

Listen to and understand patient’s verbal and non-verbal communication

Communicate effectively with patients verbal, non-verbal and written.

Develop and maintain therapeutic alliance through trust, empathy,
honesty, openness and comfort.
Level 2

Partnerships with patients and carers.

Transmit information clearly and meaningfully.

Understand ‘counter transference’.
Level 3

Communicate
members.
collaboratively
and

Educate patients, carers, community
work
with
multidisciplinary
team
2.
To elicit important diagnostic data affecting treatment from individuals from
different ethnic, racial, gender and educational backgrounds -including
assessing and managing highly charged affect in patients.
3.
Ability to know when to seek consultation, how to discuss it with patients and
families and evaluating the consultation.
4.
Offer consultancy to other disciplines and communities, thus communicating
effectively, clearly and meaningfully, and respect the knowledge and expertise
of the requesting professional.
Communication with patients and their families at appropriate educational
level, cultural sensitivity, explanatory models, preventative strategies,
developing rapport.
5.
Maintaining medical records and prescriptions in a legible and clearly
understandable format with confidentiality, privacy and dignity.
6.
Listen effectively to members of the team, elicit needed information, integrate
information, manage conflict and communicate treatment plan.
7.
Communicate effectively the results of the assessment, use of informed
consent, genetic counseling, risk/benefit of treatment, alternative plans, and
appropriate education.
Practice Based Learning
1.
Recognise and accept limitations in their own knowledge base and clinical
skills.
2.
Appropriate skills for obtaining training and evaluating up to date information
using IT, participation in educational activities.
16
3.
Appropriate education of caseload, supervision, consultation, case based
learning, practice guidelines, reviewed patient records, examining errors in
practice, patient education.
4.
Critical evaluation of relevant medical literature.
5.
Effective remediation if required.
Professionalism Core Competencies

Demonstrate responsibility in communicating to and from patients, families
and other health professionals.

Responsibility to be demonstrated by adequate record keeping, coordinating
care, providing cover appropriately, providing continuing care.

Demonstrate
ethical
behaviour,
integrity,
honesty,
compassion
and
confidentiality, informed consent, professional conduct and conflict of interest.

Respect for patients and their families irrespective of gender, sexual
orientation, religious or political beliefs.

Review conduct and re-medicate, review other’s conduct if required and
acknowledge and mediate the medical errors.
Systems Based Practice

Be aware of and follow protocols and guidelines

Lead and delegate authority

Accurate medical data etc.

Limitation of health care resources.

Awareness of available resources.

Awareness of legal aspects.
17
Role
Learning
“Bedside” Teaching
Structured Teaching
Workshops
Apprenticeship Model
Medical Expert
Self Directed
Individual Mentoring
Problem based learning
Clinical reasoning
Effective Consultation
Presentation Skills
E.B. Medicine
I.T.
Bioethics
Empathy
Respect
Individual and group
Reflection of experiences
Role models in effective
communication
Conceptual frame skills
in communication
Racial/Cultural
Role playing
Video +
Interdisciplinary
organisation
Seamless healthcare
delivery
Role modelling
Governance structures
Teambuilding
Managing time, teams
and structures
Leadership skills
Role modelling
Shadowing
Allocation of resources
Practice Management
Individual patient and
patient population issues
Modelling
Multidisciplinary teaching
Effective intervention and
assistance
Self directed learning
Evidence base
Lifelong learning
Practice reflection
Modelling
Clinical standard setting
Quality assurance
Quality management
Health economics
Critical appraising
Direct observation
feedback
Modelling
Case based discussion
Medicolegal W.R.
Medical ethics W.R.
Awareness of
professional
responsibilities
Communicator
Collaborator
Manager
Health
Advocate
Scholar
Professional
18
Appendix 3
MANAGEMENT AND LEADERSHIP TRAINING
1.
2.
3.
4.
5.
6.
7.
8.
9.
Self-awareness and self-management
Managing teams
Managing conflict
Supervision, feedback and appraisal
Time management and priority setting
Problem solving
Strategy and vision
Chairing meetings
Working with other groups and agencies
Appendix 4
From UEMS document: Profile of a Psychiatrist
The core function of a psychiatrist is to integrate biological,
psychotherapeutic and social factors in aetiology and intervention,
Biological treatment
Definition
To apply biological methods in the treatment of persons with mental
disorders. Biological understanding of mental disorders is essential for
assessment and treatment of patients with mental disorders. Biological
treatment is based on a systematic theory and on good clinical practice. It is
evidence based on specific methods comprising a theory of mental and
behavioural health and pathology.
Biological treatment competencies
The psychiatrist is able to…
1. Establish and maintain the treatment alliance
2. Establish a diagnosis of the mental disorder based on assessment
3. Assess which biological method is most appropriate
4. Apply and/or refer to specific biological interventions whenever
appropriate
5. Evaluate outcome of biological treatment
Psychotherapy
Definition
To apply psychotherapeutic methods in the treatment of persons with mental
disorders. Psychotherapeutic understanding of mental disorders is essential
for assessment and treatment of patients with mental disorders.
Psychotherapy is based on a systematic theory and on good clinical practice.
19
It is evidence based on specific methods comprising a theory of mental and
behavioural health and pathology.
Psychotherapy competencies
The psychiatrist is able to…
1. Establish and maintain the therapeutic alliance
2. Establish a diagnosis of the mental disorder and of personality based on
psychotherapeutic assessment
3. Assess which psychotherapeutic method is most appropriate
4. Apply and/ or refer to specific psychotherapeutic interventions whenever
appropriate
5. Evaluate outcome of psychotherapy
Social psychiatric intervention
Definition
To apply social interventions in the treatment of persons with mental
disorders. Understanding of mental disorders in their social context is
essential for assessment and treatment of patients with mental disorders.
Social psychiatric interventions are based on a systematic theory, and on
good clinical practice. It is evidence based on specific methods comprising a
theory of mental and behavioural health and pathology.
Social psychiatric intervention competencies
The psychiatrist is able to…
1. Establish and maintain the therapeutic alliance
2. Establish a diagnosis of the social dysfunction based on assessment
3. Assess which social psychiatric intervention method is most appropriate
4. Apply and/ or refer to specific social psychiatric intervention whenever
appropriate
5. Evaluate outcome of social psychiatric interventions
Integrated treatment
The psychiatrist is able to…
Plan and apply treatment, integrating assessment and knowledge of
biological, psychotherapeutic and social psychiatric areas in such a way that
it is experienced by the patient as coherent.
References and selected further reading:Academy of Medical Royal Colleges (2004) Implementing the European
Working Time Directive: Guidance from the Academy of Medical Royal
Colleges.
20
Bhugra, D. Bell S, Burns, A (eds) (2008). Management Training for
Psychiatrists
London:. Royal College of Psychiatrists Press.
Crawford M (2001) Involving users in the development of psychiatric
services – no longer an option. Psychiatric Bulletin; 25, pp114-116.
Donaldson L (2004) Towards excellence in assessment in medicine: a
commitment to a set of guiding principles. Department of Health.
Elwyn, G., Greenhalgh, T. and MacFarlane, F (2001). Groups: a Guide to
Small Group Work in Healthcare, Management, Education and Research.
Radcliffe Medical Press Ltd., Oxford.
General Medical Council (1993) Tomorrow’s Doctors: recommendations on
undergraduate medical education.
Ikkos G (2003) Engaging patients as teachers of clinical interview skills.
Psychiatric Bulletin; 26, pp53-55.
Piachaud J (2002) Teaching learning disability to undergraduate medical
students. Advances in Psychiatric Treatment; 11, pp334-341.
Reynolds, A. and Thornicroft, G. (1999). Managing Mental Health
Services, Open University Press, Buckingham.
Royal College of Psychiatrists (2004) Being seen and heard. A training
package.
Southgate L and Grant J (2003) Principles and standards for an
assessment system for postgraduate medical training. PMETB subgroup on
assessment.
van der Vleuten C; Newble D; Case S; Holsgrove G; McRae C;
McCann B; and Saunders N (1994) Methods of Assessment in Certification:
in Newble D; Jolly B; and Wakeford R. (Eds.). The Certification and
Recertification of Doctors: Issues in the Assessment of Clinical Competence;
105-125; Cambridge University Press.
Young, A. (1999). The Medical Manager. BMJ Books, London
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