With an increasing awareness of the importance of good mental health, let’s turn our attention to the work of psychiatrists. You might have seen them depicted in films and on TV talking to a patient on a couch, but what do psychiatrists really do?
Psychiatrists are doctors who diagnose, manage and treat patients with mental health disorders; they also have a role in preventing poor mental health.
In this article we address the key questions you should ask yourself if you are considering a career in psychiatry.
We’ll examine the specialties available, help you think about whether you’ve got what it takes, and look at how you train in psychiatry and where the career might lead.
What does psychiatry involve?
As psychiatrists are medically qualified (unlike psychologists and counsellors) they can treat patients with physical interventions and medication as well as ‘talking’ therapies.
The day-to-day work of a psychiatrist varies depending on their main psychiatry specialty (see below). All psychiatrists, however, undertake the following:
- Assess their patients to find out more about their past and current mental health
- Take into account their patients’ physical health, social circumstances and risk factors.
- Keep records, decide on treatments and monitor progress.
As a psychiatrist you may see patients all the way through their treatment plan.
General adult psychiatrists
Work with patients of ‘working age’. The mental health problems they treat are wide ranging and can include personality disorders, phobias, psychoses (e.g. schizophrenia), mood disorders, post-traumatic stress disorder, eating disorders, and issues caused by drug and alcohol dependency.
Child and adolescent psychiatrists
Treat children and young people up to the age of 18, and support their parents and carers. Patients may have, for example, autism, attachment disorder, attention deficit hyperactivity disorder (ADHD), anxiety or psychosis. Mental health problems in childhood can impact an individual’s development, but identifying disorders at an early stage can result in more successful treatment.
Forensic psychiatrists
Treat people with mental health problems within secure hospitals, prisons or in the community. They have to assess and manage risk and need a good understanding of the law. Forensic psychiatrists provide specialist advice to prison, probation and legal staff, and may be called as an expert witness in certain court cases.
Old age psychiatrists
Work with patients who have mental health problems, some of which, such as dementia, memory loss and cognitive impairment, can be as a result of the ageing process.
Mental health is often affected by physical conditions and medication is metabolised differently in older patients, so psychiatrists have to take such things into account when providing treatment.
Intellectual disability psychiatrists
Treat patients with learning disabilities who are often at greater risk of mental health issues such as anxiety, depression and obsessive compulsive disorder.
Patients may display a change in behaviour rather than presenting with a specific condition, so the psychiatrist has to establish the cause. A holistic approach has to be taken as patients may also have physical conditions, such as epilepsy.
Medical psychotherapists
Focus on the use of psychological or ‘talking’ therapies, such as cognitive behaviour therapy or trauma-focused therapy.
Where could I work as a psychiatrist?
There are opportunities within NHS mental health services, on psychiatric wards and in specialist psychiatric hospitals/secure units. Where possible, patients receive care in the community, sometimes in their own homes.
Some psychiatrists work in schools, prisons and residential homes. There are also positions in the private sector, with charities and in the Armed Forces. Some psychiatrists set themselves up in private practice.
Top Tip: To get an idea about the opportunities available in psychiatry, have a look at job vacancies on sites such as the Royal College of Psychiatrists Jobs Board or BMJ Careers.
Would I suit a career in psychiatry?
If you are thinking about training in psychiatry, you need a wide range of skills and aptitudes. In particular, you have to be good at listening, non-judgemental and perceptive to people’s reactions and emotions. You need patience, sensitivity and empathy, but it’s important to be resilient and not to become emotionally involved.
The work involves building trust and rapport with patients and their families or carers, and solving problems using a scientific approach. As you would normally work with a range of other health and social care professionals, you need to be comfortable working in a team.
Top Tip: Some of the patients you come across will be suffering a mental health crisis and occasionally display threatening behaviour. Think about how you would feel about this.
How do I get into a career in psychiatry?
It takes many years to qualify as a psychiatrist. The main steps are outlined very briefly below.
1. Medical school
You start by taking a degree in medicine approved by the General Medical Council (GMC). Undergraduate courses take at least five years. (If you already have a suitable degree, you may be able to take an accelerated, graduate-entry course.)
Medical school entry requirements vary, so check these carefully. You need high grades in your A levels/Highers; chemistry is normally required and usually biology. You also need supporting GCSEs/Nationals at good grades. Equivalent qualifications may be considered as part of your offer. If you don’t have the ‘right’ A levels/Highers, some medical schools offer six-year courses that include a preliminary or gateway year.
It is alos possible to qualify as a doctor in England via the new Medical Doctor Degree apprenticeship. The apprenticeship takes 5 years, and candidates will attend medical school, complete an accredited medical degree and meet the criteria as set by the General Medical Council, just as is required via the traditional university route. However, successful applicants won't have to pay university tuition fees.
Many medical schools ask you to take an entry test, such as the UCAT (University Clinical Aptitude Test) or BMAT (BioMedical Admissions Test). Interviews also form part of the selection process.
Gaining some relevant experience before applying for medical school is important to show your commitment to medicine and understanding about the work and its demands. You can find advice on the NHS Health Careers and Medical Schools Council websites.
Top Tip: Start organising work experience as soon as you can. You could interview or shadow a doctor, volunteer at a hospital, hospice or nursing home, or do some paid holiday or weekend work. If you’re already interested in psychiatry, perhaps you could volunteer with a charity for people with learning disabilities or in a mental health service. Just making cups of tea for patients will give you a feel of how things operate and a chance to talk to people about their roles.
The Medic Portal has useful information and advice on applying to medical school.
2. Foundation Programme
The next step is to undertake the two-year Foundation Programme. This involves a series of paid placements in different areas of medicine. If you’re thinking of specialising in psychiatry, it makes sense to aim for some relevant placements.
3. Specialty training in psychiatry
Core training, when you try out a range of psychiatry specialties in hospitals and in the community, takes three years. This is followed by another three years of higher training in one psychiatry specialty, although it is possible to do dual training (e.g. in adult and old age psychiatry) over a longer period of time.
During your specialty training you take a range of work-based assessments and have to pass Royal College of Psychiatrists exams in order to be awarded a Certificate of Completion of Training, join the GMC Specialist Register and apply for consultant posts.
Instead of becoming a consultant, if you successfully complete at least two years of specialty training, you can work as a specialty doctor.
Top Tip: Throughout your training, it’s important to keep up to date with developments within psychiatry. As well as reading around the subject, you could become a Student Associate member of the Royal College of Psychiatrists and take advantage of the networking and other development opportunities available. You could also join your medical school’s psychiatry society (PsychSoc).
What opportunities are there to progress in psychiatry?
You could develop a special interest and/or move into a team leadership or managerial role. Some psychiatrists go on to teach medical students, trainee doctors and other mental health staff. Others get involved in research; for academic research, you need to take a PhD.
Some psychiatrists run their own practices, often alongside working part time for the NHS or another employer.
How can I find out more about psychiatry?
The Royal College of Psychiatrists has lots of information and videos on how to become a psychiatrist. You can also find information through NHS Health Careers and view career profiles on sites such as Prospects, the National Careers Service and Careers Wales.
Questions around getting into psychiatry
It’s normal to have some worries or concerns about going into the role of a psychiatrist. Here’s a couple we see/hear frequently:
What if I don’t get into medical school?
You could take a degree in psychology accredited by The British Psychological Society with a view to training as a clinical psychologist and/or training in another psychological profession.
If you decide that you want to work in health, but not in mental health, there are many careers you could consider, from the allied health professions to healthcare science.
What if I’m not sure that psychiatry is right for me?
You may know before you start your medical training that you want to train in psychiatry, but don’t worry if you’re not sure as many doctors decide once they have more experience.
You can also purchase a Morrisby Pass to see how well your strengths and personality match with a psychiatry career.
Top Tip: Research the different medical specialties to be sure that psychiatry is right for you. Think about your personal interests, what might suit your circumstances, the number and type of opportunities available, and how you see your career progressing. The British Medical Association website has advice.
With more people seeking treatment for mental health conditions, career opportunities for psychiatrists are good. If you have what it takes to train as a doctor, and you’re interested in people and what makes them tick, psychiatry could offer you a varied, interesting and rewarding career.
Debbie Steel, February 2024
With a background working with apprentices and teaching in further education, Debbie was employed as an in-house careers author before establishing herself as a freelancer. As well as co-authoring numerous careers books, Debbie has produced resources and web content for a range of high-profile clients. She is an enthusiastic proponent of impartial and reliable careers information.
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