The role of the psychiatrist in Australia and New Zealand

Summary

Psychiatrists play key roles in mental health care in Australia and New Zealand. Working in private, public or academic practice they see patients in hospitals, their private rooms, clinics and other community settings. They play pivotal roles in the teaching, research and administration of mental health care as well as advocating for and leading improvements in service provision. Psychiatrists treat all types of mental illness, emotional disturbance and abnormal behaviour from mild or episodic conditions to those that are severe, persistent and life threatening. They work with people of all ages and from all ethnicities and backgrounds.

A psychiatrist is a specialist medical doctor who assesses and treats patients with mental health problems. He or she is skilled in undertaking a comprehensive psychiatric assessment to arrive at an accurate diagnosis and formulation that considers the interaction between physical and mental illness and the unique needs and attributes of the individual patient. On this foundation a psychiatrist develops a comprehensive treatment plan and provides shorter or long term care depending on the needs of the patient. Longer term care may include psychotherapy. Psychiatrists often work in collaboration with general practitioners and other health professionals to best meet the mental health and emotional needs of patients. Psychiatrists work in partnership with patients and their families and carers and are attuned to the array of social and cultural factors that impact on the individual patient.

At its core, psychiatry involves listening carefully and sensitively to people’s most personal thoughts and feelings, understanding their mental state, and working with them to identify and implement appropriate treatments including psychotherapy, psychotropic medication, social strategies and other interventions.

Background

In recent decades there has been enormous change in psychiatric practice and the provision of mental health care more broadly. Psychiatry has increasingly taken a person-centred approach with a focus on assisting patients to achieve recovery from mental illness. Psychiatrists collaborate with general practitioners and other health practitioners such as psychologists, occupational therapists, social workers and psychiatric nurses to achieve the best care for patients. Early intervention for mental illness together with improvements in treatment such as new medications and other therapies have led to better mental health outcomes.

Psychiatry practice on a day-to-day basis involves a combination of:

• listening to and talking with patients, their families and others
• providing specialist care for patients admitted to hospital for treatment or recovery
• undertaking and coordinating specialist mental health treatment
• conducting research and teaching
• advocating for individual patients as well as improved mental health services more broadly
• providing expert opinion to the community on a range of mental health issues
• leading mental health services.

Psychiatry training

A psychiatrist is a qualified medical doctor who has obtained additional qualifications to practise in the specialty of psychiatry, and is registered by the Medical Board of Australia or the Medical Council of New Zealand.

In order to become a psychiatrist in Australia or New Zealand, an individual must first complete a basic medical qualification to enable registration with AHPRA or MCNZ, and then undertake specialist psychiatry training with the Royal Australian and New Zealand College of Psychiatrists (RANZCP). It takes a minimum of five years in addition to the time taken in basic medical education to complete this training. Psychiatrists may also choose to complete further training in a range of subspecialties including: psychotherapy, forensic psychiatry, child and adolescent psychiatry, the psychiatry of old age, consultation-liaison psychiatry, addiction psychiatry, neuropsychiatry, peri-natal and infant psychiatry, the psychiatry of intellectual and developmental disability and general adult psychiatry. After qualifying as a Fellow of the RANZCP, psychiatrists are required to undertake continuous professional development to maintain and update their skills.

Psychiatrists are privileged to lead the treatment of patients who suffer from mental illness. Often patients see psychiatrists during very challenging and difficult periods in their lives when they may be at their most vulnerable. In order for psychiatrists to provide care at the highest possible standards they need to possess a number of key attributes and skills:

• Medical expertise: Psychiatrists apply their medical knowledge, specialist clinical skills and acumen in the provision of person-centred care. They understand the impact of ‘biological’, ‘psychological’ and ‘social’ factors on mental health and the causation of mental illness. This ‘bio-psycho-social’ model is a holistic approach that recognises the impact of social adversity and physical health on mental well-being.
• Communication skills: Excellent communication skills underpin positive interactions with patients, families, carers and other health professionals.
• Ability to collaborate: Psychiatrists work in partnership with others who are involved in the care of individual patients or groups of patients to provide optimal care, education and scholarship.
• Proficiency in health care management: Psychiatrists are regularly called upon to make decisions about the allocation of resources and to provide input to the ongoing improvement of systems of health care.
• Dedication to ongoing scholarship: Psychiatrists engage in lifelong development of their expertise through constant learning, scholarly dissemination and teaching.
• Commitment to the highest ethical standards: Psychiatrists maintain high ethical and professional standards. In Australia and New Zealand psychiatrists are bound by the RANZCP’s Code of Ethics and other professional regulations.

Responsibilities of a psychiatrist

All psychiatrists should first be good doctors. The Australian Medical Council and The Medical Council of New Zealand have defined what it means to be a good doctor:

‘Patients need good doctors. Good doctors make the care of their patients their first concern: they are competent, keep their knowledge and skills up to date, establish and maintain good relationships with patients and colleagues, are honest and trustworthy, and act with integrity’. Medical Council of New Zealand, Good Medical Practice 2008

‘Doctors have a duty to make the care of patients their first concern and to practise medicine safely and effectively. Doctors have a responsibility to protect and promote the health of individuals and the community’. Australian Medical Council, Good Medical Practice 2010

The responsibilities of a psychiatrist are wide reaching, but the care of patients and their families is paramount. Every psychiatrist, whether they work in public or private practice, will manage the following important tasks in their work:

1. Caring for patients: Patients allow psychiatrists access to information that is often very private. In order to provide psychiatric assessment and treatment psychiatrists need to know about very personal aspects of patients' lives, including their feelings, thoughts and behaviours. Psychiatrists are responsible for assessing the risk of self-harm and suicide as well as the risk of harm to others. In specific legally sanctioned circumstances, generally when patients are at imminent risk of serious harm and refuse treatment, psychiatrists treat patients against their will. Psychiatrists have legislated and ethical responsibility for ensuring that the rights of involuntary patients are protected at all times.
2. Managing complex and severe psychiatric conditions: A psychiatrist’s expertise in the complex interaction between physical and mental illness is crucial to the successful treatment of patients whose illnesses have both physical and psychological symptoms. Psychiatrists have a detailed understanding of the potential physical side effects of psychotropic medications and the potential psychological side effects of treatments for physical illness.
3. Providing clinical leadership: By virtue of having both medical and psychiatric training, psychiatrists have the unique abilities to prioritise clinical needs and make complex clinical decisions. Hence they are best placed to lead multidisciplinary teams that are able to achieve the best possible outcomes for patients and the ongoing improvement of service provision.
4. Teaching and training: Psychiatrists educate patients, carers and the broader community while also learning from them. They also teach medical students, general practitioners, trainee psychiatrists and other health professionals.
5. Researching mental illness: Developing a better understanding of illness and pursuing more effective treatments is an intrinsic part of the role of a psychiatrist.
6. Advocating for health by challenging stigma and discrimination: Stigma and discrimination can be enormous issues for those who use mental health services. As health advocates psychiatrists partner with patients, their carers and others to bring about improvements in the design and provision of services. Psychiatrists have a responsibility to promote the health of individual patients as well as the broader community, and ensure that mental health care is delivered in ways that avoid stigma and discrimination.

Conclusion

Psychiatrists play a crucial role in the provision of health care for the community. Like other doctors, they often work with people at times of great need and vulnerability. They provide clinically effective, safe and person-centred assessment and treatment utilising a range of therapies including medication, psychotherapy and other treatments.

Psychiatrists are the leading experts in the mental illness sphere in Australia and New Zealand. Through the RANZCP they receive rigorous training, which enables them to provide optimal patient care, work collaboratively in the interests of patients with other health professionals, act with the highest professional and ethical standards, undertake research to improve mental health care and lead mental health services.

In Australia and New Zealand most psychiatrists are members of the Royal Australian and New Zealand College of Psychiatrists. 

Responsible committee: Practice and Partnerships Committee 

Disclaimer: This information is intended to provide general guidance to practitioners, and should not be relied on as a substitute for proper assessment with respect to the merits of each case and the needs of the patient. The RANZCP endeavours to ensure that information is accurate and current at the time of preparation, but takes no responsibility for matters arising from changed circumstances, information or material that may have become subsequently available.