th
4 YEAR
PSYCHIATRY
ATTACHMENT
Wythenshawe Hospital
CONTENTS
CONTENTS .................................................................................................................. 2
General Information ..................................................................................................... 3
Welcome ............................................................................................................................... 3
Skills acquisition .................................................................................................................. 3
Skills validation.................................................................................................................... 3
Patient contact ..................................................................................................................... 3
Clerking validation .............................................................................................................. 4
Knowledge ............................................................................................................................ 4
Attendance ........................................................................................................................... 4
Undergraduate textbooks ................................................................................................... 4
Safety .................................................................................................................................... 4
Clinical teaching .................................................................................................................. 5
CLINICAL PSYCHIATRY – RECORD OF PATIENTS CLERKED .......................... 6
RECORD OF SKILLS ACQUISITION ........................................................................... 7
Local Information ......................................................................................................... 8
Details of Attachment .......................................................................................................... 8
Postgraduate Centre............................................................................................................ 8
Sign Up Sessions .................................................................................................................. 8
Tutorials ............................................................................................................................... 9
SERVICE OVERVIEW .............................................................................................. 10
Wythenshawe catchment area:- ....................................................................................... 10
Department of Psychiatry ................................................................................................. 10
SAFIRE .............................................................................................................................. 11
In-Patient Beds ........................................................................................................... 12
Psychotherapy Services ............................................................................................. 14
ADDITIONAL TEACHING ....................................................................................... 16
‘Sign Up Sessions’ .............................................................................................................. 16
APPENDIX ................................................................................................................. 17
.................................................................................................................................................
2
UNIVERSITY DEPARTMENT OF PSYCHIATRY
4TH YEAR PSYCHIATRY ATTACHMENT
General Information
This handbook is intended to orientate students during their fourth year
psychiatry attachment.
Welcome
Welcome to the psychiatric module of the Mind and Movement semester.
You will be attached to us for four weeks, in addition to receiving a series of
clinical skills lectures during the first week of the semester.
Overall, we aim to teach you the acquisition of clinical skills relevant to
psychiatry as well as helping you learn about major psychiatric disorders. As
psychiatry is multi-professional and multi-dimensional, we encourage you to
think socially, psychologically and biologically about the problems you are
going to learn about. Your attachment in psychiatry will offer you the
opportunity of working with non-medical team members and to understand
how a multidisciplinary team works. You should make every effort to
participate in this.
Skills acquisition
You need to ensure that you acquire the necessary clinical skills during your
attachment. These are:




Principles and components of history taking and mental state
examination.
Examination of cognitive function, examination of psychotic
phenomena.
Examination of mood and assessment of suicide risk.
Ability to take a history of alcohol and substance abuse.
Skills validation
There is a self-assessment schedule (attached). In addition, your clinical
teachers will review your skills acquisition with you.
Patient contact
You are expected to clerk two patients per week and over the four weeks to
see one or two patients from the following diagnostic categories:
Two people with schizophrenia (preferably one acute, one rehabilitation).
Two people with depressive disorder.
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One person with bipolar disorder.
One person with dysthymia, anxiety disorder or other neurosis.
One person with dementia.
One person with alcohol or substance abuse.
Clerking validation
There is an attached form for the record of patients clerked. This form will be
collected at the end of your attachment and forward to the Undergraduate
Dean.
Knowledge
Overall, the content of your new knowledge should be focused around the
PBL cases. These are of dementia, affective disorder (including deliberate
self-harm), schizophrenia (including other psychoses) and alcohol/substance
misuse or aggression.
Attendance
One of your learning objectives for this attachment is to develop professional
responsibility. Your teachers have gone to considerable trouble in organising
your attachments. Thus attendance at all clinical sessions is compulsory and
you are expected to attend all teaching sessions arranged for you. Failure to
attend is both bad manners and poor professional conduct. As the Dean has
asked to be informed of poor professional behaviour, attendance registers will
be kept. If you cannot attend a session, you should inform the consultant or
senior doctor running the session.
Undergraduate textbooks
You are required to read background material. The PBL book has a
recommended reading list and your clinical teachers will be able to give you
additional advice.
Safety
It is important that you are aware of various aspects related to your own
safety. Most patients with psychiatric problems are not violent or dangerous.
However, a small number of patients who are acutely psychologically
disturbed may be violent or aggressive. If you are seeing a patient on any of
the inpatient wards, before you see the patient please check with a member
of staff that the patient is safe to be interviewed alone. You should not see
any patient by yourself whom the ward staff are concerned may be potentially
violent.
You may see that patient in the company of other health
professionals if this can be arranged.
When you interview a patient, always place yourself between the patient and
the door of the interview room. If at any point you feel uneasy or alarmed
during the interview, end the interview immediately and leave. Most
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potentially violent situations can be defused. If the patient becomes angry, do
not contradict the patient or try to argue with him or her. Try to make
understanding statements, and if these do not work then suggest that the
interview should be stopped.
You must not visit a patient in his or her home in the
community unless a member of staff accompanies you.
You may visit patients at day centers or residential units.
Clinical teaching
The consultants to whom you are attached will arrange teaching for you.
Broadly speaking, this will consist of teaching on ward rounds, new patient
clinics, follow-up clinics, multidisciplinary team meetings and home visits.
In addition, most consultants will arrange at least one tutorial a week with one
of their team members.
There is one theatre-based event per week (list attached) which will form the
theoretical basis for your PBL case. You only need to attend these lectures
whilst you are doing your psychiatry attachment.
You are also strongly encouraged to spend some time with members of the
multidisciplinary team (for example, community nurses or occupational
therapists).
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CLINICAL PSYCHIATRY – RECORD OF PATIENTS CLERKED
Student name:
Firm:
Patient initial
Date seen
Diagnosis
Signature of clinical lead
1.
2.
3.
4.
5.
6.
7.
8.
2 people with schizophrenia (1 acute, 1 rehab)
2 people with depression
1 person with bipolar disorder
1 person with dementia
1 person with dysthymia, anxiety disorder or other neurosis or adjustment disorder
1 person with alcohol or substance misuse disorder
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UNIVERSITY DEPARTMENT OF PSYCHIATRY
4TH YEAR PSYCHIATRY ATTACHMENT
RECORD OF SKILLS ACQUISITION
Student name:
Firm:
SKILL
SIGNATURE OF
CLINICAL LEAD
DATE
Principles and components of history taking and mental state examination
Examination of cognitive function, examination of psychotic phenomena
Examination of mood and assessment of suicide risk
Ability to take a history of alcohol and substance abuse
TO BE SIGNED AND DATED BY THE CLINICAL LEAD WHEN THE STUDENT HAS ACQUIRED EACH SKILL
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University Department of Psychiatry
Wythenshawe Hospital Attachment (4th Year)
Local Information
Welcome to the psychiatry part of the Mind and Movement Module. During your
attachment in psychiatry, you will be attached to small individual teams so that
that you will receive personalised teaching and clinical experiences, which match
your curriculum requirements.
Details of Attachment
You will be attached to one of the following Consultants:
Dr
Dr
Dr
Dr
Dr
Tel:
Tel:
Tel:
Tel:
Tel:
Appendix A at the back of this handout identifies the Consultant you will be
attached to and also the individual with whom you should contact on your first
day in psychiatry.
Postgraduate Centre
There is a library in the postgraduate centre, which has access to most common
journals. There is also a large collection of books.
Internet and email facilities are also available in the postgraduate department.
Sign Up Sessions
You need to observe at least one session of ECT during your attachment. ECT
occurs in the ECT Suite in Park House on Tuesdays and Fridays. There is a sign
up sheet in the ECT Department and there is one slot available for students on
each ECT day.
Attendance with the Manchester Drug Service is via appointment, please contact
Phil Doherty on 273 4040.
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In addition, please make every effort to access the sign up sessions at the MRI
which include the affective disorders and psychosexual clinics.
Tutorials
In addition to the teaching with your firms, you will receive a tutorial from one of
the specialist registrars.
Please feel free to use all the learning opportunities offered to you in this
department. Staff will usually be eager to help, but you need to ask! If you
encounter any difficulties, or if there is something you wish to discuss,
please do not hesitate to approach either the Consultant on your team, Sam
Abbott, Medical Education Manager, or Dr. Damien Longson, Director for
Medical Education both on 720 2905.
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SERVICE OVERVIEW
Wythenshawe catchment area:

Whilst these localities are our natural catchment area it is always reasonable to
check with the bed Managers and consultant on call whether a patient comes
under our services.
Department of Psychiatry
The Department of Psychiatry in Wythenshawe Hospital is part of the Manchester
Mental Health & Social Care Trust. It is based at Laureate House, a purpose
built in patient unit with outpatient facilities
General Adult psychiatry patients are admitted to the three acute admission
wards, Bronte Ward ( ), Blake Ward ( ) Oxford Ward ( ) and the Mother &
Baby Unit. In total, there are forty seven acute admission beds and ten mother
and baby beds on Anderson Ward. These wards accept admission for patients
between the age of 16 years and 65 years though occasionally older patients will
be cared for temporarily before transfer to elderly services.
The Old Age psychiatry service for patients who are older than 65 years there is
a purpose built unit with 26 beds.
The General Adult Community Service is provided by the three Community
Mental Health Teams, Team 1 and Team 2 based at Chorlton House and Team 3
based at Kingslea House. The Community Mental Health Team provides a 24hr,
7 days a week service.
Each Community Mental Health Team works with a defined group of GP’s for
whom they provide all the liaison/assessment and treatment services. Each
Community Mental Health Team provides two elements of service, Acute Home
treatment and support for patients with enduring mental health problems. The
purpose of the acute home treatment is to prevent hospital admissions and
facilitate earlier discharge.
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The Community Mental Health Teams have access to a multi-disciplinary input,
including psychology, occupational therapy, Art Therapy and Psychotherapy.
Each Community Mental Health Team has a lead consultant and one clinical coordinator who is the senior nurse and has a responsibility for day to day
management of the team.
SAFIRE
SAFIRE is a unique service for the intensive resolution of psychiatric
emergencies. SAFIRE offers patients who present in North, Central or South
Manchester up to 48 hours of intensive multidisciplinary assessment, during
which time staff aim to identify suitable alternatives to in-patient care. About half
the patients are discharged from SAFIRE back to community services.
SAFIRE offers assessments to patients with a wide range of diagnoses, ranging
from severe psychosis, to adjustment reactions, moderate depression, substance
misuse and personality difficulties. Many of the patients have not had previous
contact with psychiatric services.
You are strongly encouraged to see patients on SAFIRE. There are new patients
everyday, and many will not have seen junior doctors before. SAFIRE is open
Saturday 0700 to Thursday 1700 every week.
This is an opportunity for you to see first hand a unique and award-winning
service. There are no equivalents anywhere else in the UK. Apart from giving you
the opportunity of seeing up to 15 new patients per week, SAFIRE will also show
you the benefits of multidisciplinary team-work.
Students are welcomed on SAFIRE, although there are times when it may not be
appropriate for students to be present. Remember that every patient there
presented as an emergency just a few hours previously. You MUST ask for
permission from the Shift-leader before seeing patients on SAFIRE, and on some
occasions the staff may invite you to participate on one of their assessments
rather than seeing the patient on your own.
Old Age Psychiatry Service
The Old Age Psychiatry service provides a service for all new referrals from GPs
and other hospital consultants for patients over the age of 65 and, after
discussion, for adults of any age who are developing dementia. We tend to offer
a somewhat more inclusive service than in General Adult Psychiatry, accepting
referrals of patients for example who have alcohol problems and also those with
learning difficulties, developing dementia etc. Patients are not routinely
transferred to the service when they reach their 65th birthday but their care is
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continued on the basis of the patients need with transfers agreed between the
consultants in General Adult Psychiatry and Old Age Psychiatry.
The service is organised into two sectors - north and south. At present there are
no community teams which accept referrals as found in General Adult Psychiatry
although this development is promised for the future. We provide a service for
Manchester residents and the allocation of patients across the sectors depends
on the patient’s GP. A list of South PCT GPs and the relevant consultants is
enclosed. In general, patients living south of the River Mersey are cared for by
Dr Lennon and those north of the River Mersey are under the care of Dr Russell.
The two consultants retain responsibility for their patients whether they are in the
community, in-patients on Cavendish Ward or in one of the two day hospitals Hall Lane Day Hospital for the south sector and Phoenix Assessment Unit at the
Minehead Centre for the north sector.
In addition to the sector service provided by the two NHS consultants there is a
Memory Clinic under the leadership of Professor Burns and Dr Byrne which
accepts patients of any age who are thought to be developing dementia. There
is no geographical limit to referrals but patients need to be able to come up to
Wythenshawe Hospital for appointments. Patients under the care of the Memory
Clinic are dealt with separately and if they are resident in South Manchester
when the diagnostic process is complete, they may then be referred over to the
care of either Dr Russell or Dr Lennon.
Professor Burns and Dr Jane Byrne take responsibility for a consultation service
for patients referred from consultants in the general hospital. The SpRs also see
patients in the General Hospital on an alternate referral system which is
organised by Dr Jane Byrne’s secretary.
In-Patient Beds
Cavendish Ward is a 26-bedded acute assessment unit. Junior doctor cover is
provided by the two SHOs working with Dr Lennon and
Dr Russell. The Duty Psychiatrist may be asked to attend to a patient out-ofhours or exceptionally if both SHOs are absent during working hours.
The Bruntwood Wing is managed as part of Cavendish Ward and currently
provides continuing care for 3 patients under the supervision Dr of Jane Byrne.
No patients will in the future be admitted to the Bruntwood Wing.
THE STABLES AND THE ROUNDHOUSE
These two facilities are based on the Withington Hospital site and focus on
patients with long-term and complex mental problems, including patients with
personality disorders, and can provide an alternative to inpatient admission. The
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team in the Stables is led by Irene Stivaros and consists of nurses and support
workers.
The Roundhouse offers a varied program of activities to patients from the Stables
and patients with rehabilitation needs in the community. For details of this
program please contact the staff.
KINGSLEA HOUSE
Kingslea House is the community base for the CMHT 3 but also has three 24hour crisis or respite beds. There is only one staff member in residence overnight
and patients accepted must not be at risk of self-harm or harm to others.
ASSERTIVE OUTREACH TEAM – N’GAGE
The Assertive Outreach Team is based in Central Manchester but provides a
citywide service. Dr Tim Garvey is the consultant for this service and is based in
the Rawnsley Building at the MRI. Non-medical staff includes Nurses, Social
Workers and Housing and Benefits Workers.
The service focuses on patients with severe and enduring mental health
problems who have a history of poor engagement with mental health services
and frequent inpatient admissions. Patients mostly suffer from schizophrenia and
often have a substance misuse problem. The team can be contacted on 831 –
9792. It operates form 9am – 5pm 7 days a week.
MANCHESTER ALCOHOL SERVICE
The Manchester Alcohol Service covers the whole of North, Central and South
Manchester. There are four agencies within the Service:Community Alcohol Team:
This team offers input at the Primary Care level to all GPs throughout
Manchester. Its primary aim is early intervention. The Community Alcohol
Team also carry a small caseload of more complex clients with alcohol
problems and additional mental health issues who require longer-term followup. The Community Alcohol Team offers GP clinics, home detoxification,
individual advice and information.
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The Alcohol Care Management Team:
This is staffed by Social Workers involved in the assessment and care
planning of more complex cases, including Community Care assessments
and assessments for rehabilitation. They also carry a small caseload of more
complex clients, including those with dual diagnosis needs.
Turning Point – Smithfield Project:
This provides a residential detoxification for the City of Manchester. It is run
by Turning Point, with support from GPs, and provides the majority of
inpatient detoxification in the Manchester area. It also provides a day centre,
short-term accommodation in dry house facilities at a different site and a 24hour help line for individuals with alcohol problems.
The Brian Hore Unit:
This is a day hospital facility open seven days a week, providing a variety of
support groups for individuals aiming for abstinence, 1-1 sessions with
mental health workers, specialist mental health support in terms of Consultant
led outpatient services and day detoxification and review of specialist
prescribing. The medical staff consists of the Consultant Dr. Chris Daly, an
SHO and an SpR.
CLINICAL PSYCHOLOGY SERVICES
Clinicians work across Community Mental Health Teams, Primary Care Mental
Health Teams and General Medicine offering cognitive behavioural treatments for
complex adjustment disorders and psychoses. The department also offers
supervision and consultancy for psychosocial interventions for families and
carers of people suffering from schizophrenia. Special interests of various
clinicians include Obsessive Compulsive Disorders, Depression, Bi-polar illness,
Schizophrenia, Post Traumatic Stress Disorder, Behavioural medicine, Eating
Disorder and Personality Disorder.
PSYCHOTHERAPY SERVICES
The psychotherapy service at Gaskell House provides a clinical service to
Central Manchester and accepts a small number of referrals from the North West
Region. Referrals are currently accepted from GP’s and other doctors, although
there are plans to work more closely with CMHTs. Short and long term
dynamically based and behavioural treatment, marital and family therapy and
group therapy are offered at Gaskell House. Further information about the
service can be obtained at http://www.geocities.com/~nwidp/ by clicking on the
‘Gaskell House’ link.
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SERVICE FOR PEOPLE WITH LEARNING DISABILITY
Non-medical services for this patient group are delivered by a separate
organisation, the Manchester Learning Disability Partnership. Staff are organised
into three local Community Learning Disability Teams (North, Central and South).
Medical staff are provided by the MMHSC Trust.
SERVICE FOR PATIENTS UNDER 16 YEARS OF AGE
This service is now provided by the Child and Adolescent Mental Health Services
(CAMHS). The service for South Manchester is located at the Carol Kendrick Unit
at the Duchess of York Hospital on the Withington Hospital site. The team
consists of a consultant psychiatrist, CPNs, psychologists and play therapists. If
an inpatient admission is required in most cases the children will be admitted to
the Duchess of York. Occasionally, if an admission of an adolescent under the
age of 16 to a children’s ward is not appropriate an admission to the local general
acute ward is requested. Such cases need to be discussed with the duty
consultant.
SERVICE FOR PATIENTS WITH PSYCHOSEXUAL DISORDERS
Dr. Lynn Webster, Consultant in Psychosexual Medicine, and a multidisciplinary
team of therapists trained in psychosexual counselling provide short-term,
cognitive and behavioural treatments. The service is based at Manchester Royal
Infirmary.
Referrals: Patients should only be referred to the clinic after discussion with the
consultant. Referrals can be made directly to Dr Lynn Webster. Patients are
routinely sent a questionnaire with their initial appointment requesting
background information and details of symptoms.
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ADDITIONAL TEACHING
‘Sign Up Sessions’
We have arranged for you to attend the following sessions – you must
make every effort to attend at least 1 session in each of the services.
Psychosexual Clinic
Please add your name by the appropriate date to the ‘sign up’ sheet.
For further information contact 276 5354
Stimulant Service contact 819 2020
Affective Disorders
Please add your name by the appropriate date to the ‘sign up’ sheet.
For further information contact 276 5396
ECT
Please add your name by the appropriate date to the ‘sign up’ sheet.
For further information contact 276 5421 (MRI) 720 2009 (NMGH).
Should you experience any difficulties in attending these sessions
please contact Samantha on 720 2905
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APPENDIX
Sign Up Sessions
Allocations
On – Call Information
PBL Groups
PBL Lectures
17