Acute assessments in psychiatry

As a core trainee in psychiatry, I feel the issue of trainees working out of hours is vitally important.

With changes to rotas as described by Conn & Husain, ¹ trainees find themselves not having to do acute crisis assessments and instead, nurse-led assessments are becoming more common. These factors have a huge impact on psychiatry as a specialty. Junior doctors on certain rotas are not involved in the decision-making process for admission and are simply used as clerking machines responsible for completing paperwork and a physical examination once the patient is admitted. No other specialty works in this way; all acute non-psychiatric referrals are seen by doctors and a full assessment is carried out, including discussion with senior medical personnel, before the management plan is finalised.

I feel that patients needing acute psychiatric assessments usually present with multiple problems and comorbidities which require the doctor’s input to ensure a holistic approach and that organic factors are taken into account. During my first core training year, the experience I got with acute assessments helped considerably to develop my skills in assessing and managing risk and dealing with acute presentations.

The image of psychiatry among numerous medical students whom I have been involved in teaching, and that revealed in recent surveys, is that ‘psychiatry is an easy option’. ² I feel it is time that psychiatry stands up and shows what it has to offer. This needs trainees to get involved in assessments and take responsibility to ensure that psychiatry has a future.