Geriatric psychiatry subspecialization in Canada: past, present, and future.

Objective-Persons with severe mental illness have higher rates of chronic general medical illness compared with the general population.Similarly, compared with the general population, incarcerated persons have higher rates of chronic medical illness; however, there is little information about the synergy between severe mental illness and incarceration and the general medical problems of consumers.To address this gap in the literature this study addresses the following question: are consumers with a history of incarceration at greater risk of general medical problems compared with consumers without such a history?Methods-Administrative data were used to compare the medical problems of 3,690 persons with severe mental illness with a history of incarceration and 2,042 persons with severe mental illness with no such history.Results-Consumers with a history of incarceration were more likely than those with no such history to have infectious, blood, and skin diseases and a history of injury.Furthermore, when analyses controlled for gender, race, age, and substance use disorders, consumers with an incarceration history were 40% more likely to have any general medical problem and 30% more likely to have multiple medical problems.Conclusions-The findings presented here call for better communication among local public health and mental health providers and jails and better integration of primary care and behavioral health care among community mental health providers.Also, research on evidence-based interventions designed to divert persons with severe mental illness from the criminal justice system and facilitate community reentry for persons with severe mental illness who are released from jails and prisons should be accelerated.

AimsTo understand the challenges and barriers experienced by health-care professionals (HCPs) in providing acute cardiac care to patients with severe mental illness (SMI) (schizophrenia, bipolar disorder or severe depression) admitted to hospital following a myocardial infarction (MI).MethodsSemi-structured 1:1 videocall interviews with 12 HCPs in two central-Scotland Health Boards involved in delivering pre-/hospital acute care for a MI (paramedics, cardiology/A&E nurses, cardiology/A&E doctors). Interviewee recruitment was via clinical and research networks and newsletters e.g. the Scottish Ambulance Service, the Royal College of Nursing and Royal College of Physicians and through professional connections. Interviews were audio-recorded, transcribed verbatim and analysed thematically drawing on Braun & Clarke and using NVivo software.ResultsHCPs identified a number of challenges/barriers to providing optimal post-MI acute cardiac care to patients with a SMI across 3 key themes: patient-related; practitioner-related and system/environment-related. Core patient-related challenges/barriers included: diminished patient history capacities especially relating to chronology; the time-consuming nature of effective HCP-patient communication and engagement; medication and intervention concordance concerns and challenging patient behaviour including physical and verbal aggression or severe distress.Practitioner-related challenges/barriers were: fears of appropriately managing patient behaviour; stigma towards patients with a SMI (putatively arising from knowledge deficits or generational/age-related effects); staff burnout due to length of service and pressures from extreme workloads.Systemic issues included insufficient staffing precluding the additional time required for effective communication and the distressing nature of hospital environments for patients with a SMI. Side rooms were not routinely available even though these were identified as improving the environment for some patients. A core systemic finding, cited by all interviewees, was the lack of adequate training provision on caring for patients with a SMI. Additional system-level findings were degrees of challenges accessing input from the hospital psychiatric team especially outwith standard hours and problems obtaining rarer psychiatric medications potentially impacting patients’ mental health stability.Positive findings included that HCPs are generally enthusiastic about providing high quality care to this patient group and to seek help with this. Some HCPs indicated that caring for mentally stable patients with a SMI does not differ from the general population.ConclusionAlthough HCPs aspired to providing optimal acute cardiac care for this patient group, patient-level, professional and systemic barriers often make this challenging. A key area for improvement is enhancing staff training in caring for patients with SMI, ideally delivered in-person.

Back to table of contents Previous article Next article ProfessionalFull AccessResidents Interested in Public Sector Career Would Benefit From Geriatric TrainingHana Ali, M.D., Melanie Scharrer, M.D.Hana AliSearch for more papers by this author, M.D., Melanie ScharrerSearch for more papers by this author, M.D.Published Online:3 Mar 2021https://doi.org/10.1176/appi.pn.2021.2.31AbstractThe U.S. population is rapidly aging, and many have serious mental illness. Psychiatry residents should consider geriatric training to augment training in community psychiatry.“Do you like it?” Ms. M asked, fluffing her newly permed hair. It did seem unbelievable that several months ago, she had been referred for hospice care. At the time, the patient rarely spoke or ate during her frequent discharges and readmissions to the state geriatric psychiatric hospital and the university hospital nearby. Slowly, through collaboration among specialists from geriatric psychiatry, palliative care, and geriatric primary care, her multiple comorbid conditions were addressed, and her complex psychotropic medication regime was simplified. She experienced a remarkable recovery and was now ready to go on living.Community psychiatrists constantly use the skills acquired during a geriatric psychiatry fellowship, which can allow them to provide more comprehensive care for aging patients with serious mental illness (SMI), most of whom have multiple psychiatric and medical comorbidities.As the nation’s population ages, so too are individuals living with SMI. These individuals have unique needs that fall at the intersection of the subspecialties of public psychiatry and geriatric psychiatry. Today, many older patients with SMI receive care at public mental health clinics where they are cared for by community psychiatrists and in Assertive Community Treatment programs. However, the shortage of geriatric psychiatrists in this country is well known, and more public-sector psychiatrists with expertise in geriatric psychiatry are needed.In the last decade, fellowship programs in public and community psychiatry have gained popularity among psychiatry residents. A survey of psychiatry trainees found that most had a significant level of interest in public psychiatry. Since 2006 the number of public and community psychiatry fellowship programs in the United States has expanded from two to 21 programs, according to the American Association for Community Psychiatry. These programs equip trainees with skills needed to navigate increasingly complex public mental health infrastructures to provide care for individuals living with SMI. To provide more comprehensive and high-quality care for the rapidly aging population in the United States, trainees who intend to work in public mental health clinics will benefit from geriatric psychiatry training and should consider completing a postgraduate fellowship in geriatric psychiatry.Geriatric psychiatry and public psychiatry already overlap significantly. Geriatric psychiatrists care for patients with complex disease presentations that require collaboration with other medical specialists. They work on interdisciplinary teams to navigate complicated behavioral health and social service systems and are often at the forefront of developing innovative systems of care to meet the needs of our nation’s aging population. In many ways, geriatric training is a natural fit for residents interested in working in the public sector.The challenges that excite individuals interested in public and community psychiatry are the same challenges that exist in the field of geriatric psychiatry: working collaboratively with health care professionals in other disciplines; navigating complex health systems; effectively utilizing local, state, and federal resources; and developing other structural interventions to meet the mental health needs of underserved populations. The overlap is clear. Exposing trainees who have an interest in community and public psychiatry to experiences in geriatric mental health can help alleviate the geriatric workforce shortage and ultimately result in better treatment for our aging SMI population. ■To learn more about geriatric training and other opportunities in the field, please visit the American Association for Geriatric Psychiatry (AAGP) website here.Psychiatry residents and medical students are also encouraged to apply to the AAGP Scholars Program. Both authors are alumni of the AAGP Honors Scholars Program.Hana Ali, M.D., is a PGY-4 psychiatry resident at Yale University.Melanie Scharrer, M.D., is a community psychiatrist who recently completed her geriatric psychiatry fellowship training at the University of Wisconsin School of Medicine and Public Health. ISSUES NewArchived

Discussing the impact of air pollution on heart disease

"Chaplin, (T. H.) Arnold, (1864–18 Oct. 1944), Consulting Physician, London Chest Hospital; late Medical Inspector, P. & O., British India, and New Zealand Shipping Companies; Fitzpatrick Lecturer at the Royal College of Physicians on the History of Medicine, 1917 and 1918; Harveian Librarian since 1918, Royal College of Physicians, Harveian Orator Royal College of Physicians, London, 1922; President, Section for History of Medicine, Royal Society of Medicine, 1923–24; Chairman, Board of Trade Committee for the revision of the Scales of Drugs on board ship; President, Section History of Medicine, BMA Meeting at Oxford, 1936" published on by Oxford University Press.

Introduction: Transition to the medical registrar role often lacks sufficient support, particularly for non-training grade doctors such as speciality and specialist (SAS) and locally employed doctors (LEDs). In the UK, while simulation-based education is well-established in early postgraduate stages for trainees in medicine, opportunities at the registrar transition level are limited for these groups. At Medway NHS Foundation Trust, no ongoing simulation existed for registrars outside formal training, despite the Royal College of Physicians' recommendations advocating equitable educational access for SAS and international medical graduate (IMG) doctors. This study describes a local needs assessment identifying training gaps and evaluates a targeted simulation course designed for SAS medical registrars with non-UK primary medical qualifications.Methods: A three-step quality improvement (QI) approach was undertaken: (1) needs assessment via an anonymised online survey for SAS doctors, internal medicine training (IMT) stage 1 year 2 (IMT2) trainees, LEDs, and registrars, exploring demographics, clinical experience, self-perceived preparedness, and training gaps; (2) a bespoke one-day high-fidelity simulation course for six SAS medical registrars, targeting acute clinical scenarios and human factor skills, with live observation and facilitated debriefs focusing on clinical and non-technical competencies; (3) evaluation applying the Kirkpatrick model, including immediate post-course feedback assessing satisfaction and confidence change, and a one-month follow-up survey measuring behavioural changes, application of learning, and context barriers. Data were analysed quantitatively, and thematic analysis was applied to qualitative feedback.Results: Baseline survey results showed 70.6% (n = 13) of respondents felt unprepared for registrar duties despite most having 1-3 years’ experience in the role, highlighting a significant gap in confidence. All valued simulation training, mentorship, and shadowing, with some SAS/LEDs considering stepping down due to role challenges. Post-simulation, all participants rated scenarios as realistic and relevant, all (n = 6) reported increased confidence in managing acute medical emergencies, and 83.3% (n = 5) described improvements in leadership and communication skills. One participant’s performance concern was identified, prompting targeted support. At one-month follow-up, respondents reported practical application of skills such as leadership, on-call and improved communication, alongside increased reflective practice. Limited peer feedback constrained a comprehensive behavioural change assessment.Conclusions: This QI project demonstrates the feasibility of using high-fidelity simulation to support medical registrars, particularly non-training grade doctors, by enhancing perceived confidence and identifying learning needs. Given the small sample size and reliance on self-reported outcomes, findings should be interpreted as preliminary and reflective of perceived educational value rather than objective competence. Nevertheless, simulation may represent a feasible and locally scalable educational approach to support equitable professional development for SAS and LEDs in line with the Royal College of Physicians' recommendations.

CRITICAL APPRAISAL OF THE ROYAL COLLEGE OF PHYSICIANS' REPORT ON SMOKING AND HEALTH

Rationale, aims and objectives: The United Kingdom has an increasingly ageing population. With age, hearing declines and the risk of dementia rises. Sensory impairment such as hearing loss is strongly correlated with cognitive decline, mental illness and dementia. Hearing loss has a negative association with quality of life. Addressing hearing impairment, with early recognition and treatment, is a significant public health issue. The main aims of this study were to: (1) evaluate current practice in Old Age Psychiatry in addressing hearing impairment in older adults in contact with mental health services; (2) evaluate the accessibility of Audiology and/or Ear, Nose and Throat (ENT) services and (3) evaluate the level of awareness among clinicians routinely shared with patients and families or carers regarding relevant associations with hearing loss. Method: A national cross-sectional study of the Royal College of Psychiatrists Faculty of Old Age Psychiatry members in England was conducted over 8 weeks. Results: The majority of respondents routinely established a history of hearing impairment in their patients, as well as the possession and regular use of hearing aids. However, a significant proportion did not advise patients of potential links between hearing loss and cognitive impairment (26%) or mental illness (40%). Most respondents reported that their awareness of these links was primarily based on professional experience, rather than published evidence or clinical guidelines. Additionally, 20% reported the experience of referring patients to Audiology and ENT services, was ‘difficult’ or ‘very difficult’. Conclusions: There is a need for further research into hearing loss and its impact on mental health and cognitive impairment, as well as scope to improve dissemination of existing evidence. The identified difficulty in referring to Audiology and ENT should be explored and addressed. Clinicians in Old Age Psychiatry have an important role in identifying hearing impairment and promoting use of hearing aids as part of the person-centered healthcare of this vulnerable population.

The HiLo Trial: a Multicentre Randomised Trial of High- versus Low-dose Radioiodine, with or without Recombinant Human Thyroid Stimulating Hormone, for Remnant Ablation after Surgery for Differentiated Thyroid Cancer

EIGHT YEARS ago, as an outgrowth of his interest in psychosomatic medicine, one of the authors (E.D.W.) turned his scientific interest to the field of transcultural psychiatry. It was then that, jointly with Prof J. Fried of the Department of Sociology and Anthropology, he set up the Section of Transcultural Psychiatric Studies at the Department of Psychiatry of McGill University. This section was designed to serve three purposes: (1) as an information center, ie, to pool information gathered from many parts of the world concerning the relationship between culture and mental illness and to disseminate the information obtained to those interested in the field;^*(2) as a research center, ie, to enable psychiatrists as well as social scientists to carry out investigations in the fields of cultural psychiatry and transcultural psychiatry in Canada and in other countries; (3) as a teaching center, ie, to

IntroductionMedical ‘ward round’ (WR) is a complex clinical process and a key component of daily hospital activity. Despite this, there is a clear paucity of quality indicators and evidence base...

Clean air in the ‘big smoke’

New guidance on diagnosing and managing patients in the vegetative state were issued this week by the Royal College of Physicians, updating and clarifying guidelines issued in 1996 and correcting...

From the early 1870s, both leprosy treatment and scientific investigation of the disease did not remain entirely altruistic but were driven increasingly by political concerns. During the 1860s the investigation of leprosy was used by the Royal College of Physicians to bolster its emerging professional status. However, the testing of Beauperthuy’s cashew nut oil treatment in the early 1870s made clear the limits of the Royal College of Physicians’ authority. With the subsequent development of the gurjon oil treatment by Dougall in India, the Government of India and the sanitary department took the lead, displacing the British government and Royal College of Physicians as directors of leprosy investigation in India. The attention paid by both the British and Indian governments to each cure marked a considerable departure from the situation in the early nineteenth century when treatment initiatives such as Dalton’s came only to the attention of the presidency government. Beauperthuy and Dougall’s treatments, each of which was hoped to be a specific cure for leprosy, were trialled in the Madras presidency as part of a wider colonial program of treatment trials, indicating not only the degree of British and Indian government interest but also the extent to which intervention in and regulation of leprosy investigation had developed.

British Journal of Hospital MedicineVol. 78, No. 12 EditorialsDelivering the future hospitalR Mark TempleR Mark TempleSearch for more papers by this authorR Mark TemplePublished Online:14 Dec 2017https://doi.org/10.12968/hmed.2017.78.12.664AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Francis R (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry: executive summary. Stationery Office, London Google ScholarFuture Hospital Commission (2013) Future Hospital: caring for medical patients. A report from the Future Hospital Commission to the Royal College of Physicians. Royal College of Physicians, London Google ScholarHorton R (2013) Offline: clinical leadership improves health outcomes. Lancet 382(9896): 925. https://doi.org/https://doi.org/10.1016/S0140-6736(13)61866-8 Crossref, Google ScholarNHS England (2014) Five year forward view. NHS England, London Google ScholarRoyal College of Physicians (2013) Hospitals on the edge? The time for action. Royal College of Physicians, London Google ScholarRoyal College of Physicians (2017) Delivering the future hospital. Royal College of Physicians, London Google Scholar FiguresReferencesRelatedDetails 2 December 2017Volume 78Issue 12ISSN (print): 1750-8460ISSN (online): 1759-7390 Metrics History Published online 14 December 2017 Published in print 2 December 2017 Information© MA Healthcare LimitedPDF download