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The spirituality of the psychiatrist is important because of the way that it may impact the well-being of the psychiatrist, clinical practice and the understanding of psychiatry more widely. In some cases, it may influence a psychiatrist’s sense of vocation to be a psychiatrist. The case study in this chapter draws on the author’s own experience of the ways in which spirituality and formation as a psychiatrist were entangled during training. Three historical examples are offered of different ways in which religion and psychiatry might be entangled in the life, work and thought of psychiatrists: a pragmatic atheism (Maudsley), religion understood as pathology (Freud) and religion as beneficial to mental flourishing (Jung). Three more recent examples are then considered, one of a Christian attempt to integrate theology and psychiatry (Frank Lake), one of reflections on how Buddhism influences practice as a psychiatrist (Mark Epstein) and one of a personal encounter of a psychiatrist with shamanism (Olga Kharitidi).
Psychiatrists have responded nationally and internationally to the growing scientific evidence on spirituality and psychiatry and to concerns about bad professional practice, by developing good practice guidelines/policies and by way of continuing professional development initiatives (special interest groups, conferences, etc.). Professional boundaries have historically been understood as keeping psychiatry, as a secular concern, separate from patients’ spiritual and religious concerns. However, as earlier chapters demonstrated, this is unrealistic in light of the entanglements of spirituality and psychiatry, and unlikely to be helpful for many patients. It does not address the importance of religion to patients worldwide or the transition in Western countries from a secular to a post-secular age. The Jungian concept of temenos is taken up as a way of understanding boundaries as protecting safe therapeutic spaces for psychological and spiritual transformation. Boundaries in clinical practice are thus created not to keep the psychological and spiritual domains separate but to protect a safe psychological and spiritual space within which positive therapeutic change may occur.
Causality extends across many areas of psychiatry, from the purely conceptual and philosophical to the interpretation of genetic, epidemiological, and neurobiological work. This book offers new, interdisciplinary perspectives on causation in psychopathology, exploring it in relation to the latest scientific and philosophical advances, as well as through psychiatric research and practice. It features contributions from many internationally known psychologists, clinical researchers, and philosophers of science actively studying the phenomenology of mental illness. The chapters are organized into four sections: The Causes Themselves; Causes, Genes, and Neuroscience; Causality and Nosology; and Causality and Phenomenology. Each main chapter is preceded by a brief introduction written by the editors and a commentary by another author in this volume. By taking a multidisciplinary approach spanning psychiatry, philosophy, and psychology, the book is written to be accessible for members of all three disciplines.
Chapter 8 provides a description of the process of putting together an effective Periodic Review Board (PRB) presentation for Fawzi Al Odah. Fayiz Al Kandari elected to stay with his confrontational lawyer, who attacked both the US and Kuwait and argued about human rights violations. Fawzi Al Odah adopted the strategy of the author to present Fawzi as having matured and ready to return and live a peaceful life with his family. It describes visits with the client to make him mentally ready for what might happen at the hearing and to convince him to put away his legitimate grievances and convince the decision-makers that he should not be a forever prisoner, dealing with difficult facts but focusing on the family and Kuwaiti government infrastructure that would support him. In addition, Fawzi had built trust with the military representatives who were part of the PRB team, and they supported his release. Fawzi knocked the presentation out of the park, and it was clear that the Board trusted him and the process. A month after the hearing, we were notified of a positive decision, although bureaucratic hitches resulted in an additional three months before he could go home.
Written referrals and follow-up correspondence between referring general practitioners (GPs) and psychiatrists is a medico-legal responsibility and integral part of caring for patients with mental illness. Objective: To describe expectations and practices that GPs and psychiatrists have when exchanging correspondence concerning patients with mental health problems.
Methods:
In this observational, declarative, and cross-sectional study, two surveys were used to evaluate the expectations, frequency, and content of correspondence exchanged between GPs and psychiatrists. The questionnaire was based on the National College for the Quality of Psychiatric Care 2010 recommendations. Conducted in a regional setting in France between 2014 and 2016, the study involved 2754 GPs and 575 psychiatrists.
Results:
Overall, we achieved a positive response rate of 33% (189/575) of psychiatrists and 23% (628/2754) of GPs, which was similar in each local region. Regarding the correspondence from GPs to psychiatrists, 478 (75%) GPs declared having written a referral for an initial consultation and 84 (44%) psychiatrists declared having received a referral. Regarding the correspondence from psychiatrists to GPs, 144 (76%) psychiatrists declared having written at least one letter after the initial consultation or during follow-up and 160 (25%) GPs declared having received return correspondence. The GPs would like to be better informed about psychotherapeutic or long-term management, leave of absence from work, surveillance measures, prognosis, and division of specialist roles. The psychiatrists would like to receive more information about previous medication trialed, the level of willingness the patient has to consult a psychiatrist and any allergies or intolerances to medication.
Conclusion:
This study highlights the need to improve the disparity between expected and received correspondence from GPs and psychiatrists concerning patients with mental health problems.
Through examining three areas of focus within public mental health; prevention, healthy environments and reducing inequalities, we consider how interventions in these domains also have the potential to create a more sustainable healthcare system.
Results
We show how psychiatrists and mental health professionals alongside the wider health and social care system can be involved in advocating for this change.
Clinical implications
We aim to empower individuals working within mental health to advocate for change and consider how public mental health approaches can be integrated into their practice to improve outcomes.
Patient death by suicide is a distressing occupational event associated with far-reaching impacts on professional practice and wellbeing. Psychiatrists are commonly tasked with suicide risk assessment and management and ultimately experience greater incidences of patient suicide in comparison with other medical specialists. Therefore, it is important to understand psychiatrists’ experiences of patient suicide and the required supports in an Irish context. This study investigated how patient suicide affects the personal and professional lives of consultant and non-consultant psychiatrists, and what resources/systems psychiatrists find helpful in mitigating the impact of a patient suicide.
Methods:
Survey data collected from 232 consultants and non-consultant clinicians was analysed using frequency analyses and Independent Samples t-tests,. Most participants were female (61.6%) and the largest age group represented was 50–59 years (28.4% of the sample).
Results:
Key personal and professional impacts in the aftermath of a patient’s suicide include pre-occupation with suicide, decreased self-confidence, sadness, burnout, desire for career change/break and fear of negative events following the suicide. A significant difference was observed across gender with respect to sense of responsibility (F = 3.69, dfs = 2,200, p = .026) with females displaying more feelings of responsibility (M = 3.9, SD = 3.1) than males (M = 2.8, SD = 2.7). Support from colleagues and line managers was largely identified as helpful in the aftermath of patient death by suicide.
Conclusions:
Ultimately, there is a need for greater access to guidelines/policy and occupational support for psychiatrists to assist their responses. This study provides much-needed insight into the landscape of experiences and needs of psychiatrists in Ireland who experienced a patient death by suicide.
Negative perceptions of mental health professionals can deter individuals from seeking mental healthcare. Given the high burden of mental health globally, it is essential to understand attitudes towards mental health professionals. Social media platforms like Twitter/X provide valuable insights into the views of the general population.
Aims
This study aimed to use social media to investigate the (a) public perceptions (positive or negative) of mental health professionals, (b) changes in these perceptions over time and (c) engagement levels with tweets about mental health professionals over time.
Method
We collected all tweets posted in English between 2007 and 2023, containing key terms such as ‘mental health’, ‘psychology’, ‘psychologist’, ‘psychiatry’, ‘psychiatrist’, ‘neurology’ and ‘neurologist’. A total of 1500 tweets were manually classified into categories, which were used in conjunction with semi-supervised machine learning to categorise a large data-set.
Results
For most key terms, there was a higher frequency of positive perceptions compared with negative, with this trend improving over time. However, tweets containing ‘psychiatrist’ exhibited a higher proportion of negative perceptions (n = 4872, 39.52% negative v. n = 1972, 15.99% positive before 2020). After 2020, the gap narrowed, yet negative perceptions continued to dominate (n = 5505, 36.10% negative v. n = 3472, 22.77% positive).
Conclusions
Overall, positive perceptions of mental health and mental health professionals increased over time. However, ‘psychiatrist’ had a consistently higher proportion of negative perceptions. This study underscores the need to improve public perception of psychiatrists, and demonstrates the potential of using Twitter/X to better understand public attitudes and reduce stigma associated with accessing mental health services.
Returned to Edinburgh five months pregnant, admitted immediately to local psychiatric hospital with psychotic depression. Treated with medication (antidepressants and antipsychotics) and ECT for the first. Poor with medication and relapse.
Poor memory for this time due to repeated admissions, ill-health, and ECT. I was acutely aware and frightened of detention under the Mental Health Act, and of compulsory treatment. Susceptibility to mental illness in families, and how friends and families attempted to explain things. Discussion of my feelings about my psychiatrists and hope that they could help me – also that it was difficult for them as they had never known me well.
Understanding variations in knowledge and attitudes of psychiatrists to psilocybin therapy is important for the collective discourse about the potential impact on clinical practice and public health in Ireland.
Methods:
A 28-item questionnaire was designed based on previous studies and distributed to psychiatrists in Ireland via online mailing lists and at in-person academic events.
Results:
151 psychiatrists completed the questionnaire (73.3% were under 40 years of age, 76.0% were trainees, and 49.0% were female). In the total sample, 81.5% agreed that psilocybin therapy shows promise in the treatment of psychiatric disorders and 86.8% supported funding research, 86.8% would be willing to refer a patient if it was licensed and indicated, and 78.1% would consider the treatment for themselves, if indicated. Conversely, 6.6% agreed that psilocybin therapy was unsafe even under medical supervision, and 21.9% thought it was potentially addictive. 15.9% of the total sample reported at least one concern including, lack of robust evidence, long-term effectiveness, superiority to current interventions, potential harmful effects, cost and accessibility, and impartiality. Less than half of respondents felt knowledgeable (40.0%) and 9.9% felt adequately prepared to participate in psilocybin therapy. Consultant psychiatrists trended towards less optimism for a potential role in bipolar depression and emotionally unstable personality disorder compared to trainee psychiatrists.
Conclusion:
Overall psychiatrists in Ireland held positive attitudes towards psilocybin therapy. However, there was a lack of knowledge evident. Addressing the knowledge gap and aligning with the best available evidence will be key if psychedelic therapy is to prevail in a clinical setting.
Diagnosis of autism falls under the remit of psychiatry. Recognition that psychiatrists could be autistic is recent. Psychiatrists are the second largest specialty group in Autistic Doctors International, a peer support group for autistic doctors.
Aims
To explore the experiences of autistic psychiatrists in relation to recognising themselves and others as autistic.
Method
This was a qualitative study using loosely structured interviews and an interpretive phenomenological analysis.
Results
Eight autistic senior psychiatrists based in the UK participated. One had a childhood diagnosis, two had been diagnosed in adulthood and the remainder self-identified as autistic as adults. Recognition of autism followed diagnosis of their children or encounters with autistic patients. Barriers to self-recognition included lack of autism training, the deficit-based diagnostic criteria and stereotypical views of autism. Recognising that they were autistic led to the realisation that many colleagues were also likely to be autistic, particularly in neurodevelopmental psychiatry. All participants reported the ability to quickly recognise autistic patients and to develop a good rapport easily, once they were aware of their own autistic identity. Difficulties recognising patients as autistic occurred before self-recognition when they shared autistic characteristics and experiences. ‘If we don't recognise ourselves as autistic how on earth can we diagnose patients accurately?’
Conclusions
Autistic psychiatrists face multiple barriers to recognising that they are autistic. Lack of self-recognition may impede diagnostic accuracy with autistic patients. Self-recognition and disclosure by autistic psychiatrists may be facilitated by reframing the traditional deficit-based view of autism towards a neurodiversity-affirmative approach, with consequent benefits for autistic patients.
This study aimed to explore the experiences and support requirements of psychiatrists undergoing investigations within their mental health organisation. An anonymous online survey was distributed to all non-training psychiatrists registered as members of the Royal College of Psychiatrists.
Results
Of the 815 psychiatrists who responded to the survey, 287 (35%) had been investigated. The majority (76%) were unaware of the concerns before being notified, 36% lacked understanding and 62% experienced timeline deviations. Furthermore, 34% had concerns over conflicts of interest, with 52% perceiving the investigation as unfair, 62% were not informed of their rights. Many respondents reported feeling isolated and lacking support and experienced significant psychological distress, such as symptoms of post-traumatic stress disorder. Suggestions for improvement included better communication, transparency, impartiality, adherence to timelines, proactive support and oversight, and opportunities for learning and reparation post-investigation.
Clinical implications
Mental health service providers should recognise the multifaceted nature of complaints and provide comprehensive support and guidance to psychiatrists undergoing investigations.
It is widely acknowledged that personal therapy positively contributes to the continued personal well-being and ongoing professional development of mental health professionals, including psychiatrists. As a result, most training bodies continue to recommend personal therapy to their trainees. Given its reported value and benefits, one might hypothesize that a high proportion of psychiatrists avail of personal therapy. This systematic review seeks to investigate whether this is the case.
Aim:
To identify and evaluate the findings derived from all available survey-based studies reporting quantitative data regarding psychiatrists’ and psychiatry trainees’ engagement in personal therapy.
Method:
A systematic search for survey-based studies about the use of personal therapy by psychiatric practitioners was conducted in four databases and platforms (PubMed, Scopus, Embase and EbscoHost) from inception to May 2022 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were assessed for quality using the quality assessment checklist for survey studies in psychology (Q-SSP) and findings summarized using narrative synthesis.
Results:
The proportion of trainees who engaged in personal therapy ranged from a low of 13.4% in a recent UK based study to a high of 65.3% among Israeli residents. The proportion of fully qualified psychiatrists who engaged in personal therapy varied from 32.1% in South Korea to 89% in New Zealand.
Conclusion:
This review represents the first known attempt to collect and synthesize data aimed at providing insights into the past and current trends in psychiatrists’ use of personal therapy across different geographic regions and career stages.
Informed by the UN Convention on the Rights of Persons with Disabilities, the Indian government replaced the 1987 Mental Health Act with the transformative “Indian Mental Healthcare Act, 2017” (IMHCA 2017), which gained presidential approval on April 7, 2017. While the new act aligns with CRPD guidelines, emphasizing the promotion, protection and realization of complete and equitable human rights, legal capacity, equality and dignity for persons with mental illness, it has faced diverse criticism from various stakeholders, particularly psychiatrists. This study systematically explores the critiques and apprehensions expressed by psychiatrists regarding the IMHCA 2017 using available published resources and assesses these criticisms within the context of CRPD guidelines.
Methodology
We conducted a scoping review of the literature, using two search engines like PubMed and Scopus. The review covered academic publications, reports and documents from both national and international sources, authored by psychiatrists and psychiatric organizations, related to the IMHCA 2017. The primary search term “IMHCA 2017” was used without temporal restrictions. Publications authored by mental health professionals from India and around the world were included in the final analysis. Through qualitative analysis, key themes reflecting psychiatrists’ viewpoints were identified. These themes, marked by substantial criticism, were then assessed in accordance with the guiding principles of the CRPD, including its optional protocol and general comments.
Results
The study analyzed 33 manuscripts discussing criticisms and concerns about IMHCA 2017. Manuscript types included opinion papers (60.6%), original research articles (21.21%), review articles (9.09%), editorials (6.06%) and comments (3.03%). All but one article were authored by psychiatrists, with five by non-Indian authors and the rest by Indian psychiatrists. Most articles were published in the Indian Journal of Psychiatry (75.76%), with some in other journals. About 54.55% critically scrutinized act provisions, while 45.45% highlighted positive aspects. The analysis identified seven prominent criticism themes: clinical apprehensions, lack of clarity and comprehensiveness, feasibility challenges, neglect of caregivers, mistrust toward psychiatrists, crises in general hospital psychiatry units and ideological reservations.
Conclusions
Each theme was critically assessed in the context of CRPD guidelines, and corresponding recommendations were formulated.
The bidirectional relationship between poverty and poor physical and mental health is well-known. All physicians should have sufficient knowledge on poverty as a social determinant and its impact on (mental) health. The knowledge of poverty in physicians is seldom investigated. An online and paper survey was circulated in March/April 2022 in Belgium, to assess physician’s opinions about and attitudes toward patients in poverty. Not only was interest in the subject rather low, but there were also substantial contradictions in the responses. The lack of knowledge about poverty among physicians leads to reduced quality of medical care for this target group. This is an individual medical–ethical and societal problem. We suggest 10 point-action plan for policymakers, educational institutions, and physicians.
This brief commentary reflects on navigating two dangers of historical research into psychiatry: hagiographic representations of psychiatrists; and accusations of their self-interest and oppression of vulnerable people.
Chapter 28 explains how specialist child and adolescent mental health services work in the UK. We explain the roles of different professionals in children’s and young people’s mental health teams and describe the most common types of specialist children’s and young people’s mental health teams.