General psychiatry: cuckoo

Sir: The articles from Colgan (Psychiatric Bulletin, January 2002, 26, 3-4) and Tyrer (Psychiatric Bulletin, January 2002, 26, 5) on the state of general psychiatry make sad reading. They look at the speciality from within and do not enjoy what they find. Everywhere else looks better: cardiothoracic surgeons luxuriate in a waiting-list and child and adolescent psychiatry in a well-stocked library; and general practice is vibrant with control of budgets. Perhaps someone should tell them that child and adolescent psychiatry has a massive recruitment problem and general practice cannot fill its empty training posts or its career posts. It is a tough old world out there for all of us — even old age psychiatry in its ‘quiet and homely sitting room’.

Where have they been? Old age psychiatry lives in the car and other people's sitting rooms — and that is why it is alive and still expanding. It's approach has not been to exclude people but to say progressively ‘yes’ as workforce and resources have begun to flow to allow this: thus most people with early onset dementia will find a welcome in an old age service. Increasingly, older people with chronic psychosis travel the same route and we are learning all the time.

There are all sorts of difficulties for general psychiatry but the discipline has a great deal to offer. That is why the customers keep on coming — services must remodel to the needs of these people rather than wish they would behave in a way that suits the established system. Perhaps the greatest difficulty is posed by the establishment itself, which confirms status on a subset of the speciality within the confines of the Institute of Psychiatry and the bigger university departments. They are massively overstaffed when compared with anywhere else in the country and their senior staff are heavily protected from the real world of Colgan. Yet it is they who have the accolades (count the A and A+ awards) and they who have the ear of the Government. Contrast this with the old age psychiatry of the 1970s and 1980s, when young psychiatrists were encouraged to join pioneers working in unfashionable places with the heart-sink condition of dementia and the stigma of senility.

Perhaps if the cuckoo could be persuaded to leave, the true birds of the nest could grow strong and fly.