During my F2 year I undertook a four 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 four months. Little did I know that this specialised combination 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 was risk assessment of inpatient and outpatient perinatal mental health patients, and being aware of which services to call upon in different scenarios.
The ward itself was very homely, accommodating up to seven 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 women’s 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, vigilant, and supportive without being intrusive, 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 well founded anxieties about whether 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 throughout the whole placement.
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.
Bhakti Visani, a GP ST1 trainee in London with an interest in medical education.
Competing interests: None declared.