Psychosis is commonly defined as a series of mental health conditions which cause people to perceive or interpret things differently from those around them. This might involve hallucinations or delusions as well as a host of other ‘manifests’. The most common psychotic illnesses are schizophrenia and some forms of bipolar disorder.
The word schizophrenia certainly is still misinterpreted in many settings, including in the popular press. Schizophrenia does not mean that you have a split mind or a split personality. It definitely does not mean that you are necessarily violent.
Schizophrenia is how we describe a particular collection of symptoms and observations when they come together. We don't have a blood test or a brain imaging scan that will tell us whether somebody has schizophrenia or not, so it's a very clinical diagnosis.
As with many physical health conditions, it is possible to have more than one problem at the same time. About 40 per cent of people with schizophrenia can also have depression and about 25 per cent have various different forms of anxiety disorders.
My role is to help to treat people with psychosis who have not got better through the usual treatment routes. It’s varied, as I don’t have a solely clinical role – I’m also involved in service development, in particular in planning physical health strategies for all patients with psychosis attached to South London and Maudlsey NHS Foundation Trust (SLaM).
The week starts with clinic day. As a national level service, we see people from all over the country, offering second opinions for NHS colleagues based outside of London. People are referred to us when they haven't responded as hoped to conventional treatments for their psychosis. The expert team meets at lunchtime to discuss the patients that we have seen over the last week, to develop alternative avenues of treatment and care that we can explore.
The next day, we’re off to the Bethlem for the main ward round. We meet patients and sometimes their families to see how things have gone over the last week. We are working with people for the best outcomes, fine-tuning their care to find a management plan that they going to be happy to stick with over time.
Wednesday is primarily a research day. My own research focuses on improving physical health in people with psychosis. When somebody gets a diagnosis of psychosis, it doesn't just affect their mental health. Some of this is because people make unhealthy lifestyle choices - people are more likely to smoke even before their diagnosis with psychosis and then even more so when the illness persists. The medication used to treat psychosis can cause people to eat more and put on weight so very commonly we find that our patients are overweight and haven't made the lifestyle choices needed to get their weight down. There are ways of helping people manage weight loss so it’s really important to work with people on this – otherwise sometimes patients can think that the answer is to stop medications – but that leads to problems with both mental health and physical health.
On Thursday, I am back on the ward again. We have a management round, following up on decisions and scheduled appointments. Not everybody we work with will agree with the medical perspective on their mental health. Often people believe that they do not have any mental health problems and then it becomes really important to reach a consensus, with the shared goal being making things easier in life. The ideal goal is always is to hand back control to the person themselves, because otherwise, in the long term, it is much more challenging.
On a Friday, we return to research and physical health service development once more, as well as linking with the Department of Health funded Collaborative Leadership for Applied Health Research Programme. This complements my work linking with Colleagues across King's Health Partners (KHP) to find ways to better manage the physical health of our patients. KHP have made better physical health for people with mental health problems one of their top priorities so the staff there are really motivated to think of new creative approaches to joint working.
When I first qualified (many years ago) there seemed to almost be a stigma associated with psychiatry as a choice of speciality, as if you had chosen not to be a “real doctor”. Now with increasing recognition that mental health involves the whole person, psychiatry as a profession is experiencing renewed parity of esteem. I consider my job a privilege. I have the chance to help people be as healthy as they can be, even when the challenges are multi-level and complex. Each person I see has their own unique story and our job is to apply the available knowledge in the context of that individual for the best outcome. Psychiatry is increasingly seen as a profession for the best and brightest of graduates, those with flexible and enquiring minds – I predict that the biggest breakthroughs in medicine in the 21st century will be in mental health – come and help make it happen!