Bhakti Visani, a GP ST1 trainee talks about her psychiatric placement in a mother and baby unit.
During my F2 year I undertook a 4 month psychiatry placement, based in a mother and baby unit. Before starting, psychiatry was definitely not in my top 5 list of coveted jobs. I initially saw it as just having to ‘get through’ the 4 months. Little did I know that this specialised cocktail of psychiatry, obstetrics and paediatrics would afford me the opportunity to learn about topics that will be invaluable to me as a GP. To me, the most important of these were risk assessment in both inpatient and outpatient settings, and being aware of which services to call upon in different scenarios.
The ward itself was very homely, accommodating up to 7 mothers with their babies at a time. It was different to my previous experience of a general psychiatry ward, as it fostered a calm and nurturing environment for the service users. The nature of these womens’ illnesses inevitably made them vulnerable, and put them at higher risk of domestic abuse. Adult and child safeguarding was always a hot topic, but staff were experienced and vigilant, providing support at such a pivotal time in a family’s life. Partners and families could not stay on the ward, but visiting hours were very flexible.
When a new patient was admitted to the ward, I would carry out a full psychiatric assessment of mother, and physical examination of both mother and baby. I was the only junior ward doctor, therefore all medical questions and concerns were also directed to me; ranging from post-natal contraception to baby rashes, and referring to secondary medical services as appropriate. This felt like a lot of responsibility at first, but it was a fantastic learning opportunity, and I was always able to access senior support when needed.
In addition to the ward, I would help with an outpatient clinic once a week, seeing women who were currently pregnant and either had existing mental health issues or had signs of or risk factors for new onset mental illness. These patients were safe in the community, and I would formulate a management plan together with the consultant and patient. The job also involved general psychiatry on call shifts which meant I wasn’t missing out on experiencing acute mental health issues in other population groups.
Providing time and support to partners and family members was also a significant part of the job. Fathers who were separated from their partners and babies at what was supposed to be one of the happiest times of their lives often had anxieties about if their partner would ever get better, when they could come back home and whether this could happen again in future pregnancies. For me, this was one of the most emotionally challenging aspects of the job.
Having a baby is expected to be one of the most exciting and joyful times in a woman’s life, however peri-and post-natal mental health is under-acknowledged and seldom discussed. Coming from a cultural background in which psychiatric issues and mental health diagnoses are not openly discussed or sometimes not believed in, this placement gave me the opportunity and confidence to challenge and discuss this often taboo topic with others, as well as the practical knowledge to deal with similar presentations and concerns in the future.
As a GP trainee, I think this has been an unrivalled experience, as it boosts awareness of this important topic amongst community physicians, as well as allowing exposure to community obstetrics, gynaecology and paediatrics under the same roof.