Psychiatry

If you are asked to think about a psychiatrist, you might conjure an image of a bespectacled individual, warm-mannered, smartly dressed, sitting neatly in an armchair opposite a couch for you to lie on. Your conception of psychiatry itself may be that you sit or recline next to your therapist and talk about your feelings and deep, difficult memories. If you think of this, what you may be recalling is the image of the psychoanalyst. In fact, psychoanalysis is quite different from psychiatry, which the NHS defines simply as ‘a medical field concerned with the diagnosis, treatment and prevention of mental health conditions.’ Psychiatry is, therefore, a much broader field – and often less intimidating – than we may first realise. It can be used in the management of a range of mental health conditions and concerns, including substance and behavioural addiction.

What is psychiatry?

Broadly put, psychiatry refers to the treatment of mental health conditions. There are many different types of psychiatry, including:

• Addiction psychiatry
• Child and adolescent psychiatry
• Forensic psychiatry
• General psychiatry
• Liaison psychiatry
• Medical psychiatry
• Old age psychiatry
• Psychiatry of intellectual disability

The Royal College of Psychiatrists explains that psychiatrists are individuals who ‘draw on […] medical, scientific and interpersonal skills to work with people of all ages and from all walks of life.’ Above all, the aim of psychiatric intervention is to ‘change lives.’

What is psychiatry used for?

Mental health conditions that may be managed by a psychiatrist include:

• Anxiety disorders
• Depression
• Bipolar disorder
• Post-traumatic stress disorder (PTSD)
• Obsessive-compulsive disorder (OCD)
• Schizophrenia
• Schizoaffective disorder
• Psychosis
• Personality disorders
• Eating disorders
• Sleep disorders
• Neurodevelopmental disorders

Psychiatrists are likely to be involved when there are instances of:

• Long-term intense distress
• A safety risk
• A need for medication to be monitored
• A complex mental health condition

Access to psychiatrists

Psychiatry can be offered through the NHS or private providers. However, there are requirements for a psychiatrist to be recognised through the Royal College of Psychiatrists, including a medical degree, an additional two years of training and three years of training in psychiatry specifically. This means that in order to become a chartered psychiatrist you first need to become a qualified medical doctor. If you are seeking a psychiatrist privately, it is important to check if they are a chartered professional with the RC Psych.

In England, there is currently only one working consultant psychiatrist for every 12,567 people in England. This suggests that there is a large unmet treatment need for individuals dealing with mental health conditions.

What does psychiatry look like?

Beginning contact with a psychiatrist can be overwhelming. However for the most part, sessions with a psychiatrist will take a similar structure. This will start with an initial appointment. During this appointment, you may be asked to discuss:

• What difficulties you are currently dealing with
• About your current life situation
• About your current thought patterns, feelings and behaviours
• If you are currently at risk
• If you are currently using any medication for your mental health

This initial assessment can sometimes incorporate additional professionals, such as social workers or a primary care clinician.

You may sometimes be required to have a physical examination. These often take the form of checking weight, heart rate and blood pressure if appropriate and relevant. These are typically conducted to monitor your physical health in response to medications you may be using.

After this appointment, you are likely to begin sessions with your psychiatrist for a period of time. It is quite common for individuals to also access a different form of support (such as counselling or psychotherapy) while seeing a psychiatrist.

Addiction psychiatry

An addiction psychiatrist will have initially trained in the same manner as any other psychiatrist. However, they may have specialised by training in addiction contexts for longer before beginning practice. An addiction psychiatrist is primarily ‘concerned with the assessment and treatment of people with complex medical and social needs arising out of addictions of addictive behaviour.’ Addiction psychiatrists are experts in the physical and psychological effects of dependency and behavioural addiction. This means that they will have a strong working knowledge of:

• The mechanisms of specific substances
• Withdrawal symptoms associated with specific substances
• The way substances affect our brain
• The role of neurotransmitters in behavioural addictions
• Detox protocols
• The physiological effects of addiction
• The psychological causes of addiction
• Social and economic concerns related to addiction
• Relapse prevention
• Medically assisted treatments
• Appropriate therapies
• Self-help techniques

Your psychiatrist is often the first contact in order to manage risk and medication. As trained doctors, they are able to establish any threats to your wellbeing and health and can make appropriate decisions about your treatment when and where needed.

Addiction treatment: The role of psychiatry

The phrase ‘addiction treatment’ typically suggests a rehab centre – perhaps a detox process. We might not initially include psychiatry in this image of what addiction treatment looks like. However, psychiatry can be just as lucrative a support option as other methods available in rehab. Psychiatry is associated with the following positive outcomes:

• The maintenance and monitoring of physical health
• The provision of a diagnosis
• Improved quality of life
• Better self-awareness
• Confidence in dealing with difficult thoughts
• Identifying specific issues
• Providing space and practice to speak

A lot of the time, we can find it difficult to talk about our thoughts and feelings. This can especially be the case in the context of addiction, where a lot of individuals struggling may worry about being judged. A psychiatrist is a neutral agent who is able to priority your wellbeing and safety. By practising being honest, open and receptive with a psychiatrist, you can begin your journey to recovery by building skills and insight you can carry forward for the rest of your life.

Addiction treatment: The role of psychiatric medication

A psychiatrist, as a medical doctor, has the ability to prescribe you medications when and where they are needed. This means that medically assisted treatments are relatively common during psychiatric support. There are many types of psychiatric medication. If, when and what you are prescribed will depend on your situation and current concerns. Types of psychiatric medications commonly prescribed include:

• Antidepressants
• Antipsychotics
• Mood stabilisers
• Sleeping medication and tranquillisers

Antidepressants are typically used in the treatment of mood disorders (such as depression). But they are sometimes helpful in managing other distressing symptoms, such as intense anxiety or if you are dealing with an eating disorder.

Antipsychotics primarily help individuals to manage symptoms of mania, and psychosis that can be a result of a range of different conditions.

Mood stabilisers are used for people with a diagnosis of conditions such as bipolar disorder or schizoaffective disorder. They can be helpful for managing mania and mood swings.

Sleeping medications are typically prescribed if you have chronic issues with sleep hygiene. They are sometimes offered to individuals struggling with treatment resistant anxiety.

It is thought that around half of individuals dealing with addiction have a dual diagnosis. This means that engaging with psychiatry can allow you to tackle both concerns at the same time in order to enhance your quality of life and provide the best chance at symptom management in a healthy, safe way.