Recruitment into psychiatry: an international challenge

The impact of COVID-19 on psychiatric and mental health services in Europe: suffering experienced by professionals

Background

The COVID-19 pandemic has not only impacted intensive care units, but all healthcare services generally. This PsyGipo2C project specifically investigates how psychiatry and mental health professionals have been affected by the reorganizations and constraints imposed, which have reshaped their often already difficult working conditions.

Methods

Our research combined quantitative and qualitative methods, surveying and interviewing health professionals of all occupations working in psychiatric and mental health services. A questionnaire was completed by 1241 professionals from 10 European countries, and 13 group interviews were conducted across 5 countries. In addition to this, 31 individual interviews were conducted in Belgium and France.

Results

Among the questionnaire respondents, 70.2% felt that their workload had increased, particularly due to their tasks being diversified and due to increased complexity in the provision of care. 48.9% felt that finding a work-life balance had become more difficult, and 59.5% felt their health had been affected by the crisis. The impact of the health crisis nevertheless varied across professions: our data provides insight into how the health measures have had a differential impact on professional tasks and roles across the various categories of occupations, obliging professionals to make various adaptations. The distress incurred has been linked not only to these new constraints in their work, but also to the combination of these with other pressures in their personal lives, which has consequently compromised their well-being and their ability to cope with multiple demands.

Discussion

The COVID-19 health crisis has had varying impacts depending on the profession and access to remote work, sometimes leading to conflicts within the teams. The suffering expressed by the professionals was tied to their values and patterns of investment in work. Our research also highlights how these professionals made little use of the psychological supports offered, probably due to a reluctance to acknowledge that their mental health was affected.

COVID-19 and Physical Distancing Measures: Experience of Psychiatric Professionals in Europe

A The COVID-19 pandemic has had a considerable impact on the organization of psychiatric care. The present study examines how care professionals experienced this period and faced these new constraints weighing on their professional practices. Based on a qualitative research methodology, 13 group interviews with healthcare professionals working in psychiatric wards were conducted in five countries in western Europe. To complement this, 31 individual interviews were carried out in Belgium and France. Public health measures hindered certain therapeutic activities, jeopardized communication, and obliged healthcare professionals to modify and adapt their practices. Confronted with a transformation of their usual roles, healthcare professionals feared a deterioration in the quality of care. Impossible to continue in-person care practices, they resorted to online videoconferencing which went against their idea of care in which the encounter holds an essential place. The lockdown contradicted efforts to co-build care pathways toward readaptation, social reintegration, and recovery, thus reviving the perception of psychiatric hospitalization based on isolation.

The Early Impacts of the COVID-19 Pandemic on Mental Health Facilities and Psychiatric Professionals

(1) Background: While in many countries, the psychiatric and mental health sectors had been in crisis for years, the onset of a novel coronavirus pandemic impacted their structures, organizations, and professionals worldwide. (2) Methods: To document the early impacts of the COVID-19 health crisis on psychiatry and mental health sectors, a systematic review of the international literature published in 2020 was conducted in PubMed (MEDLINE), Cairn.info, and SantéPsy (Ascodocpsy) databases. (3) Results: After applying inclusion and exclusion criteria, 72 articles from scientific journals were selected, including papers documenting the early impact of the COVID-19 pandemic on the organization of psychiatric care delivery, work processes in psychiatry and mental health units, and personal experiences of mental health professionals. This review identified the contributions aimed at preventing the onset of mental disorders in the early stages of the health crisis. It lists the organizational changes that have been implemented in the first place to ensure continuity of psychiatric care while reducing the risk of SARS-CoV-2 transmission. It questions the evolution of the rights and duties of mental health professionals in the first months of the pandemic. (4) Discussion and conclusions: Although this literature review exclusively documented the early impacts of the COVID-19 health crisis, it is of significant interest, as it pictures the unprecedent situation in which psychiatry and mental health care professionals found themselves in the first stages of the pandemic. This work is a preliminary step of a study to be conducted with mental health professionals on an international scale—the Psy-GIPO2C project—based on more than 15 group interviews, 30 individual interviews, and 2000 questionnaires. The final aim of this study is to formulate concrete recommendations for decision-makers to improve work in psychiatry and mental health.

Psychiatric education in Africa-Kenyan perspective

The existing huge global neuropsychiatry disease burden compared to the available meagre human resources underlines the need for alternative innovative approaches in psychiatry. The low middle income countries have very few psychiatry specialists who cannot meet the demand at current and even in the near future. In the Kenyan context, the prevalence of Common Mental Disorders is ∼10.8% in a country with less than 100 psychiatrists. This has a negative impact to the patients who suffer from mental disorders and also the caregivers. Undetected or undiagnosed mental disorders cause untold suffering including the socio-economic negative consequences. The lack of access to appropriate treatment is attributed to the depleted resources in terms of specialist manpower and low investment level in psychiatry infrastructure. This calls for committing substantial resources to boost mental health training and also boldly embrace alternative psychiatry remedies. Unfortunately, Psychiatry education is a discipline that has not been able to attract a significant share of medical health practitioners globally and the situation is not any different in Kenya. Therefore, the question of motivation level for students to pursue psychiatry is valid, and thinking through the strategies that can improve the intake of medical student at the post graduate psychiatry education is relevant. It is imperative to address the stigma heaped to the psychiatry discipline by other medical specialties and bring it to the limelight of medical practice. However, owing to the trend of very low psychiatrists who qualify and join the market annually, there is a need to explore alternative and innovative ways of addressing the mental health treatment gap. Involvement of primary healthcare workers and service integration should be explored as recommended by some researchers. In addition, Psychiatry should not be confined as a monopoly of western biomedical approach in an African context where traditional approaches are still in existence.

Burnout in consultants in child and adolescent mental health services (CAMHS) in Ireland: a cross-sectional study

Physician burnout has reached epidemic levels in many countries, contributing to adverse personal, patient and service outcomes. Adverse socioeconomic conditions, such as the economic downturn in the Ireland post 2008, contribute to a situation of increased demand but inadequate resources. Given a recent unprecedented increase in referrals to Irish child and adolescent mental health services (CAMHS), coupled with a fragmented and poorly resourced service, it is important to reflect on consultant child psychiatrists' well-being.

OBJECTIVES

To report on the level of burnout among consultants working in CAMHS in Ireland using a cross-sectional design.

SETTING

Community CAMHS in Ireland.

PARTICIPANTS

An online questionnaire was sent to all consultant child psychiatrists registered with the Irish Medical Council (n=112). Fifty-two consultants replied (46% response rate).

PRIMARY OUTCOME MEASURES

Questions assessed demographic and occupational details, career satisfaction and perceived management, government and public support. The Copenhagen Burnout Inventory measured personal, work and patient-related burnout.

RESULTS

The prevalence of moderate or higher levels of work-related and personal burnout was 75% and 72.3%, respectively. Fewer (n=14, 26.9%) experienced patient-related burnout. There was a strong correlation between work burnout and personal (r=0.851, n=52, p<0.001) and patient-related burnout (r=0.476, n=52, p<0.001). Lack of confidence in government commitment to investment in CAMHS (p<0.001) and perceived ineffective management by health authorities (p=0.002) were associated with higher burnout scores. Few consultants (n=11, 21%) felt valued in their job. The majority (n=36, 69%) had seriously considered changing jobs, and this was positively associated with higher burnout (p<0.001). Higher burnout scores were present in those (n=15, 28.8%) who would not retrain in child psychiatry (p=0.002).

CONCLUSION

The high level of burnout reported by respondents in this study, and ambivalence about child psychiatry as a career choice has huge professional and service implications. Urgent organisational intervention to support consultant psychiatrists' well-being is required.

Foundation trainees and changes in career intentions

OBJECTIVES

To understand whether foundation trainees change their career intentions during psychiatry placements and explore what factors influence such changes.

METHODS

Over a two-year period, foundation trainees completed questionnaires at the beginning, middle and end of their four-month placement. There were two questions, the first as to how likely they were to pursue a career in psychiatry and the second openly asked them to elaborate on their reasons.

RESULTS

Twenty-one out of 41 eligible trainees returned all three questionnaires. The number of trainees 'highly likely' to choose psychiatry increased over the four-month period, from 4.5% to 19%. The number of trainees 'highly unlikely' to choose psychiatry decreased, from 27.3% to 9.5%. An increasingly positive intention towards a psychiatry career appeared to relate to enjoyment of the placement and the quality of supervision. The most common reason for not choosing psychiatry was a pre-existing interest in another specialty.

CONCLUSIONS

Undertaking a psychiatry placement during the foundation programme continues to increase the likelihood of a positive attitude towards psychiatry as a career. The findings of our study suggest good practice in providing foundation placements in psychiatry includes identifying medical school experience, enjoyment, quality weekly supervision and mindful experiential design of placements.

Attitude of an Egyptian Sample of Medical Students Toward Psychiatry in Comparison to Previous Studies Using the Attitudes Towards Psychiatry (ATP-30) Questionnaire

OBJECTIVE

This study aims to determine the attitude of medical students toward psychiatry at the College of Medicine, Menoufia University, Egypt, and to compare it with previous similar studies in other countries.

METHODS

Four hundred medical students, randomly selected from four different years, completed the Attitudes Towards Psychiatry (ATP-30) in a cross-sectional study.

RESULTS

The mean ATP score was 99.31; 76.3% of the students had favorable attitudes toward psychiatry and 29.5% considered psychiatry as a potential career choice.

CONCLUSIONS

A generally positive attitude toward psychiatry was found among medical students in Menoufia University. Consistent with this positive attitude was the relatively high percentage of students who considered psychiatry as a potential career.

BASH: badmouthing, attitudes and stigmatisation in healthcare as experienced by medical students

Aims and method We used an online questionnaire to investigate medical students' perceptions of the apparent hierarchy between specialties, whether they have witnessed disparaging comments ('badmouthing' or 'bashing') against other specialists and whether this has had an effect on their career choice. Results In total, 960 students from 13 medical schools completed the questionnaire; they ranked medical specialties according to the level of badmouthing and answered questions on their experience of specialty bashing. Psychiatry and general practice attracted the greatest number of negative comments, which were made by academic staff, doctors and students. Twenty-seven per cent of students had changed their career choice as a direct result of bashing and a further 25.5% stated they were more likely to change their specialty choice. Although 80.5% of students condemned badmouthing as unprofessional, 71.5% believed that it is a routine part of practising medicine. Clinical implications Bashing of psychiatry represents another form of stigmatisation that needs to be challenged in medical schools. It not only has an impact on recruitment into the specialty, but also has the wider effect of stigmatising people with mental health disorders.

Social sustainability and mental health: a threat to evidence-based practice?

The availability and use of mental health treatments are influenced by many different factors. Prominent among these are scientific evidence, cost, ethics and politics. However, the social sustainability of treatments can also have a considerable influence on their use.

Future-proofing the psychiatry workforce in Australia: evaluation of an innovative enrichment programme for medical students

OBJECTIVE

The Claassen Institute of Psychiatry for Medical Students (the Institute) is an innovative enrichment programme aimed at attracting medical students to psychiatry. This paper reports on the effectiveness of the Institute as a strategy to increase interest in psychiatry as a career, and the career pathways of students who have attended since 2008.

METHOD

Students completed a baseline questionnaire on day 1 and the final day of the Institute. A follow-up survey was administered electronically to ex-Institute students to determine their career pathways and current level of interest in psychiatry.

RESULTS

Since 2008, 117 students have attended the Institute. There was a significant increase in those 'definitely' considering a career in psychiatry from 57% at baseline to 77% at the end of the week. Eighty-nine ex-Institute students were invited to participate in the follow-up survey, and of these 21% were currently psychiatry trainees.

CONCLUSION

The Institute has been successful in encouraging medical students to pursue a career in psychiatry. Enrichment programmes are emerging as an effective recruitment strategy and will assist in future-proofing the psychiatric workforce in decades to come.

Research into recruitment: critical gaps in the literature

The aim of this paper is to systematically review the literature available internationally on recruitment into psychiatry. A 5-stage search strategy was followed to identify all relevant studies published between 1999-2012. These were then critically appraised using a standardized tool, and the results summarized. A total of 128 studies were identified. Surveys were the most common design (40%), and 76% of studies used medical students as subjects; 36% of the studies were from the USA, followed by 25% from the UK. There were no studies found from South America. There is a need for more research into other potential applicant groups before medical school, and for research carried out in Africa, Asia and South America.

The future of psychiatry

OBJECTIVE

The objective of this paper is to forecast the future of psychiatry in the first world in the next 20 years.

CONCLUSIONS

There are no indications that psychiatry might significantly change in the near future. Yet two factors affecting today's psychiatry will most likely become more pronounced in years to come, first, the shrinking of psychiatrists' domain, and second, the declining interest in psychiatry among medical graduates.