Psychiatrists
Diagnose, assess, treat and prevent mental, emotional and behavioural conditions.
A clinic day in community mental health
You are a psychiatrist in a community mental health clinic, seeing people for assessments and reviews, and working with a team of nurses and case managers. It is 9am. You have eight appointments booked, two with people you have not met before, and a registrar who will sit in on some of them. The day will test how you listen.
Choose what you would do. Then see what happens. There are often good reasons for each choice.
I've been feeling much better, so I've decided to stop the treatment. I think I'm cured. I don't want to be one of those people who is on tablets for life. I just wanted to tell you.
Ask what feeling better means to her and how she'd like to plan a change
She explains she wants to feel in control of her life. You talk through a gradual plan with a safety net, and she agrees to regular check-ins. She leaves feeling heard.
Tell her it's a bad idea to stop and that she should continue as prescribed for now
Your concern is well founded, but she hears an order. She stops anyway and doesn't tell you, and the plan you made is lost.
Accept her decision and wish her the best, as she's an adult
She does have the right to choose, but you have missed the chance to plan safely. A few weeks later she is unwell and unsure whether to come back.
I'm his mother and I need to know what he's told you. He's an adult but he lives with me, and I'm the one who sees him struggling. Please, just give me an update. I'm at my wit's end.
Give her a brief summary of how he is going, since she lives with him and is clearly very worried about him
Your patient finds out and feels betrayed. He stops attending, and his mother, who wanted to help, now has less information than before.
Listen to her worries without sharing details, explain why and ask him about a joint chat
She is frustrated but feels heard, and you pass her concerns on. Your patient agrees to a joint meeting, which helps the family talk to each other.
Tell her you can't speak to her at all, since he is an adult with his own rights, and then end the call
You protect your patient's privacy but leave a worried mother with nowhere to go. She feels shut out, and her worry gets heavier.
I'm not sure about my assessment of the next patient. I think I might be missing something. He's quite guarded and I don't want to push him. Could you come in with me for part of it?
Tell him you trust his judgement and that he should go ahead on his own
He feels some pressure and finishes the assessment, missing a key detail that you would have asked about. The patient has to return another day.
Take over the assessment and have him watch
You gather the information, but the patient's guardedness grows with an extra person in the room. Dr Tan learns nothing about how to build trust.
Join for the second half, let him lead, and talk it through afterwards
He leads, you step in once with a gentle question, and the patient opens up. Afterwards you both reflect on what worked, and Dr Tan's confidence grows.
How it went
The last patient leaves, your notes are done, and you still have messages to answer. Psychiatry is about careful listening, medical knowledge and respect for people's choices, even when you are worried. Do you think you would be able to hold both care and respect at the same time?
This is a simplified, fictional situation to help you explore. It is not professional instruction or a test of your ability.
Case study: The tablets that were left in the cupboard
A fictional case set in a public community mental health clinic, with sessions in a hospital liaison service.
The situation
Dr Imani Okoye, a psychiatrist, met Callum, twenty-six, at a community clinic. He had been doing well for months on a medication that helped him, but at his review he told her he'd stopped taking it two weeks earlier. He was embarrassed, and said he didn't want to talk about why. His mother, who had come with him, was visibly angry. Dr Okoye had a long list of patients and she could have simply told him to start again. But she suspected the reason he had stopped mattered more than the fact that he had.
What they did
Dr Okoye asked Callum's mother to wait outside for a few minutes, and she spoke with him alone. She told him she wasn't angry, and asked what had made him stop. After a while he said a side effect was making him feel flat in front of his friends, and that he'd been scared to admit it. She thanked him for telling her. She explained that there were other options, and together they made a plan to try a change, with a check-in after two weeks. She then invited his mother back and, with Callum's permission, shared what they'd decided.
How it turned out
Callum started the new plan and felt more like himself within a few weeks. His mother later told Dr Okoye that she'd learned to ask questions before being angry. Dr Okoye said the real work of the appointment was to make it safe for him to tell her.
What would you do?
- Why did Dr Okoye speak with Callum on his own?
- How might a person feel if they believe they will be judged for stopping treatment?
- What could families do to help someone feel safe talking about their health?