萝莉视频

In the fifth and final of our series of podcasts exploring ways in which we can help members to thrive in psychiatry, we speak to three psychiatrists about their career – what have been their career highlights, what barriers have they faced, and what more are they looking to achieve?

Our Presidential lead for Retention and Wellbeing, Dr Ananta Dave, interviews former RCPsych President Professor Dinesh Bhugra, Chair of RCPsych in Northern Ireland Dr Julie Anderson and Dr Gwen Adshead, Consultant Forensic Psychiatrist, Psychotherapist and Author.

Transcript

Ananta:

Hello everyone, and welcome to another edition of the podcast series for the campaign Thrive in Psychiatry, which is being run by the 萝莉视频 this year to focus on retention of psychiatrists.

And we've covered various topics in the podcast series so far. And in this one we have an excellent lineup of inspiring psychiatrists whom I'm going to be talking to in a minute to hear about their journey and their career in psychiatry, and what it is that we can take away and be inspired by.

So I'm going to introduce the three psychiatrists in turn, and I'll be asking them a few questions, and I'm looking forward to hearing from them about what it's been like and their journey through psychiatry.

So if I start with Gwen Adshead. So Gwen, I'm going to ask you just to give a brief snapshot of your career, once I’ve finished introducing the three of you.

So just to let you know, Gwen Adshead is one of our panellists and guests on the podcast today. And then we have, Dinesh Bhugra. Professor Dinesh Bhugra, Professor Gwen Adshead, and Dinesh, I think I can see you on the screen, so once again, once I've finished introducing Julie as well, I'll come to you to just ask you, to give, to give us a very brief snapshot of your career, to introduce yourself briefly.

And then lastly, we come to Doctor Julie Anderson, and Julie, similarly, if you could just tell us a bit about yourself and a brief glimpse into your journey in psychiatry.

Now all three of you have had long, illustrious careers still continuing, so it's quite a sort of feat to try and compress everything into a very short introduction. But if you could do that before we go on to the rest of the questions.

So the whole aim of this is to let people get a glimpse into what it is that you have been able to do and how you have been able to have this long, illustrious career, and how it is that we can be inspired, especially the coming generation of psychiatrists, who are about to embark on their career in psychiatry and what it is we can learn.

And I'm really delighted that the three of you have been able to join us today.

And even before we start, I just want to thank you all for your time in coming for this podcast.

So, Gwen, if I could begin with you, please, if you could introduce yourself fully

and just tell us a bit about your career.

Gwen:

Thank you, Ananta and thank you for inviting me

to be part of this podcast. So I'm Gwen Adshead, I'm a forensic psychiatrist and a psychotherapist. I trained first as a forensic psychiatrist at Saint George's Hospital, and then I was a lecturer at the Institute of Psychiatry, focusing on trauma and trauma psychiatry. And that experience made me think that I wanted to train as a therapist.

So I trained as a psychotherapist. And from, the mid 90s, I worked as a consultant psychotherapist at Broadmoor Hospital working with perpetrators of violence.

And that's really what I've done for most of my career. I stepped away for a little bit, when I retired, but then I came back, and since I've come back to work, I'm still seeing patients. I'm still doing supervision. I'm still writing. I'm still teaching, things that I really, things that I really enjoy.

Ananta:

Excellent. And that is a super short summary of what you've been doing over the years, Gwen. So, thank you. And I'll come back to you to talk in greater detail about your work.

And Dinesh, if you could tell us a bit about you, I think people know you, but just to give a very brief snapshot of your career.

Dinesh:

Thanks very much. Thank you for inviting me. I'm delighted to be here. And, I trained, did my basic medical training in India and then moved to the UK to do psychiatry in 1979.

I did my basic training in Leicester and then higher training, in the Maudsley, where I worked with Julian Leff to do my PhD in social and cultural psychiatry, but also at the same time I did, Master's in Social Anthropology and a Masters in Sociology before doing that. So, I’m Professor Emeritus of Mental Health and Cultural Diversity at the Institute of Psychiatry and King's College London, and also past President of the 萝莉视频, past President of the World Psychiatric Association, past President of Mental Health Foundation, and also past President of British Medical Association.

Since then, in every job, I have been interested in looking at the impact of culture on people's mental health and, how people from different cultures backgrounds present, with psychiatric disorders, how they seek help, how they respond. Since my retirement, I have been working, on burnout in medical students and doctors, did a series of surveys through the BMA initially and then independently and, initially in 12 countries and then in 25 countries looking at, the rates and responses. And in the last three years, I've become much more interested in geopolitical factors, on mental health, looking at the political, geographical and commercial determinants and how they impact upon social determinants.

And currently, I have an international institute of geo Psychiatry based in Switzerland.

Ananta:  

Dinesh, that's an incredible amount that you've packed in. And again, would be lovely to hear more about it as we go on. Thank you for that.

And Julie, please tell us a bit about your work so far in psychiatry and welcome from Northern Ireland.

Julie:

Thank you.

I feel it's a little bit unfair asking me to introduce myself after your last two speakers, but here we are. I am a slightly earlier point in my career. I feel I need to say, at this point, but yeah, thanks again for having me on.

And yeah, so I am currently a perinatal psychiatrist in Northern Ireland, and have been for the last few years and worked in a community mental health team as a consultant for nearly a decade before that. And I suppose I have had, what I mostly probably talk about for the time we have, as I suppose, just the enjoyment in psychiatry through all the different roles that I've had, sort of clinical roles and, training and education and various other roles.

So, at the minute, I also have, as I've mentioned, sort of undergraduate and postgraduate roles. So, I look after the mental health module and other sort of aspects within the university at Queen's here in Belfast, and also have a postgraduate role in the deanery. I was previously in the school of psychiatry in TPD, and, for various slightly painful reasons, ended up moving to the profession support team instead.

And so that's been lovely, because you get to see resident doctors and trainees across all specialties, and not just psychiatry.

And I suppose the other sort of main sort of thing that I'm quite involved in, which is I'm assuming why I'm here today actually, is as the chair of the College in Northern Ireland.

So I've really got a lot more involved in the college over the last 18 months of being Chair.

But for quite a wee while before that, more within the sort of perinatal role in Northern Ireland and the perinatal faculty in the college.

So, yeah, that's kind of the current main things I'm up to right now.

Ananta:

Excellent. And what a breadth we've heard just from that, a very quick summary of your careers.

Now it's fair to say that, you know, the three of you embody thriving in psychiatry.

You've had, very fulfilling, illustrious careers, not only as psychiatrists, but in various other roles that you've held, you know, each of you in, in whether it's in the education domain, in leadership, you know, in professional organisations.

So, it's been quite a span of work. So if I could just start with you, Dinesh, what is it that you feel has helped you, enjoy psychiatry, have this, you know, long, illustrious career in psychiatry and continuing, what is it about psychiatry, about the profession?

And what is it generally about the things that you've done that have helped you enjoy your career?

Dinesh:

There are sort of several things. I mean, for me personally, psychiatry is the best medical specialty, bar none, for the simple reason that this is the only specialty which brings together, biology, social factors, psychology, spirituality, culture, all together to make sense of the person who's sitting in front of us.

And that makes it, much more interesting, because you're looking at different aspects. You're just not focusing just on symptoms, you're focusing on the person, and you're focusing on, what they expect from you and be just finishing a piece of work, looking at patient expectations of psychiatrists.

And it's very clear that out of the, small sample that we've interviewed there is a significant interest in people that they can live with their symptoms as long as they have a job, they've got a roof over their head, they've got some money in their pocket, they've got relationships and friendships. So that's what makes psychiatry really interesting and exciting, because it's, you're looking at the whole person rather than, a set of symptoms.

I mean, I did look at other possibilities. I mean, I was interested in psychiatry from very early on in medical school, and, I had a very clear moment when I decided why I wanted to do psychiatry, and that was because physiologically, anatomically, we are all very similar.

But the way we see the world, the way we function is very, very different. And that's what makes psychiatry so interesting, that even if you see two patients with so-called diagnosis of schizophrenia, their experiences are going to be very, very different.

Their outlook is going to be very different, their worldview is going to be very different. They're going to be responding very, very differently. So that's what to my mind, makes psychiatry so exciting. And one of the messages that I would give your listener is that in order to thrive, every 5 to 7 years, change something in your portfolio, whether you get involved in college politics, whether you get involved in education, teaching, research, change, clinical bits.

So over my career, I've worked in a community mental health team. I did community rehab, I did intensive care, I did psychosexual check. Every few years I was changing something, and that's absolutely critical that if you want to have a thriving career.

Ananta:

So beautifully put it, Dinesh, I couldn't agree with you more about psychiatry being that specialty, which really brings everything together and allows you to see the whole person and what you've described, I mean, you just you, you know, earlier you were talking about doing research in burnout, and what you have described is actually one of the antidotes to burnout as well, isn’t it? Changing, you know, finding a new focus and trying out new things.

So I'm sure great sage advice for those who are listening.

Thank you. And Julie, what would you say? I mean, what is it about psychiatry and what has helped you enjoy your career so far?

Julie:  

I'm smiling, because I suppose it's the same broad couple of things that Dinesh has just said, so I'm in good company. So, I'm, I'm pleased about that for myself, but I suppose for me, life is all about connections and connection, other humans and getting to know them.

And I also made variety personally. So I suppose over the last two plus decades, I suppose I just feel like I've managed to connect with so many different people and so many different roles that I have done, and that's what absolutely brings me joy, keeps things fresh sometimes. Also makes me quite stressed when you're trying to balance them.

But that's definitely what I have loved and has always kept my interest. I suppose in a, in a similar way, the the first thing that Dinesh has just said, I suppose at a core of what we do as psychiatrist is patients and people and, and I have to say, my clinical job, particularly in perinatal, but I absolutely love it, and I, it just brings me joy.

I suppose just the opportunity to sort of sit with somebody, really explore their, their own personal story, how they've got to that point in their life with the particular difficulties that are going on, and then trying to unpick that a little bit and put some sort of plan together around them. It's just, I guess, a privilege and a bit of a twee sort of way, but it really is.

And, and most other people don't get to do so. I really love that. And I suppose alongside that, I just, I love the, the different professionals and the different clinical teams that I worked in that I've got to know.

And some of them sort of remain good friends and hopefully will stay that way, throughout life going forward, I suppose.

Just on the theme of variety as well, I've sort of mentioned, as others have, about the kind of roles in education and training.

And again, I love the opportunity of all the different things that I've got to do, just the people that I've got to meet. I suppose I really enjoy teaching, but I do enjoy a little bit more, when you kind of have the opportunity to have those 1-to-1 connections and schools, particularly, within the professional support team in the deanery here in Northern Ireland, you really get to do that.

You get to, again, just understand a little bit more about that person, what's going on for them, what are the challenges, and try and get things signposted and and pointed in the right direction so that things improve a little bit.

I do have to mention the College, this is a college podcast isn’t it? But for me, at the College, sort of involvement that I have got to have in the last number of years has been another thing that's just really made me enjoy my work overall, and my career.

So initially was more than sort of perinatal and the perinatal faculty in the college.

And then more recently as, as chair in Northern Ireland. I've got to, I suppose, again, it's repeating myself, but it's true. It's connections. So, the different people that I've got to meet here in Northern Ireland, getting to know the members better, getting to know some of the politicians, a little bit with the lobbying that we do, getting some media connections, all of those different things are just interesting. And I really enjoy it.

And then centrally within the College, just to even get to know some of the College staff. Rachel on reception at the college is one of my favourite people. She's great.

And just getting to know some of the College Officers, the other members, again, I personally just enjoy that as well. It is helping me sort of, sort of bring more and new ideas to kind of the things that we are trying to do locally.

So I suppose that is the main thing I would say, I suppose kind of like for me life is all about sort of connections and variety. And I guess I have found myself today included, but very often in kind of unexpected spaces that have just been really, enjoyable.

And that, as I say, keeps the kind of energy levels going when things are also busy and heavy and difficult at times, it kind of keeps that balance.

So, I suppose, yeah, that sort of my advice is very similar.

Again, I'll come back to Dinesh’s, to others maybe listening. You do have to find variety

and I think you have to find things that you just find interesting and spark a little bit of joy

and then push those doors and see, see what happens. Sometimes they work out, sometimes they don't. But, that's certainly what I have done that has not been planned, It’s been a little bit more chaotic. But yeah. Thank you.

Ananta:

Thank you so much, Julie.

And I think, again, you know, just listening to you, I can see that enduring fascination and that curiosity not to renew clinical field, but also, you know, that you share interactions with so many different kinds of people, you know, both within the clinical setting and outside.

So again, I think, you know, nuggets of wisdom for those who are listening and those who are hoping to have a long career in psychiatry and thriving while having that career.

Thank you. So, Gwen.

Gwen:

Well, I'm not sure I have much to add to the beautiful summary, summaries, from Dinesh and Julie, but I and I guess I would start with where they started, which is the humanities aspect of medicine.

For me, psychiatry is very much, a medical practice. I think our medical identity is absolutely crucial to being a good psychiatrist.

Because when we train in medicine, we train kind of in the round, we train to think about different systems that may be going wrong for somebody. So, for example, if somebody falls to the floor, a trained doctor is going to think of about 6 or 7 things that might cause a person to fall to the floor,

And there'll be a whole range of things, so you have to be able to think in a number of different dimensions as a doctor. And that seems to me, is one of the things that we bring, to psychiatry is being able to think in numbers of different dimensions simultaneously. And I really enjoy that, and I find that very stimulating.

And it also kind of reminds me that, that I'm not my perspective is not the only one that matters. Other people's perspective is also important.

And, I trained as a group analyst. So, I practice mainly as a group therapist, not only, but mainly and so a bit like Julie, the connectedness, the working in teams, working with other people has been an incredibly important part of how I've, grown and learned from other people, all the people who trained me, but also learning from the patients

that I've worked with. I think particularly now, I've done a lot of work in services for people living with personality disorders.

And the experts, by experience, who've had, I have learned so much from about what it's like to live with a disorder that can be very stigmatizing, and very painful and difficult to live with.

And obviously in my day job, I work with people who are stigmatized in different ways. And so I've had an opportunity to learn about the law. I've had done a lot of work in philosophy. In fact, I was a founder member of the 萝莉视频’ Philosophy Special Interest Group and, and just taking the taking the time and making connections with other people gave me the courage to go and get involved in things.

Just picking up on Julie's point, you know, I, I haven't planned anything, in my working career. I've just followed things that were of real interest to me and the wonderful thing about psychiatry is that it offers lots of different things to be interested in and offers lots of wonderful colleagues, to be to, to cooperate and generate with.

So I guess that's kind of, you know, when I think about psychiatry, I think that I wanted to be a doctor from a very young age. And then when I was training at medical school, I had a, I had a brief, affair with orthopaedics, which is kind of yin to psychiatry’s Yang, you know, where there's a lot of fixing of people's problems and not much discussion about what's going on.

But then, personally, but I went away from that, and I know I made the right decision. I've had I've really enjoyed my career to date, because it's just the most interesting job you can have.

Ananta:

Yeah. Thank you.

Well, with due apologies to orthopedics colleagues, I think their loss is our gain. When that you chose psychiatry. But thank you.

I mean, again, I've heard, as you said, about the importance of connections and the curiosity and trying out different things. But also, I think what I've heard from you

and Julie as well is that, you know, you don't have to have a very clear plan always mapped out as to what it is you're going to do in your career and how you're going to proceed.

But something about following a deep passion or something that calls to you, and what I've heard from all of you, is your deep interest in making a difference to people, whether it's patients, whether it’s colleagues, professionals, or indeed, you know, the wider community, that interest in making a difference to people and seeing that people in there, those people in the round rather than as a collection of symptoms.

And again, I think, you know, things for people to take away as they consider a career in psychiatry and longevity in psychiatry, so that they can continue doing what they're doing.

Now, I before we go on to the next part of the podcast, just to remind people that the Thrive in Psychiatry campaign runs from the 28th of October to the 9th of December, so it's a six week campaign. And as part of that, we have a dedicated website and link on the 萝莉视频 website, where you can find links to the other podcasts, but also resources, you know, blogs, articles, surveys and some other information around retention in psychiatry. There's also the retention charter, which I have developed as the presidential lead for retention and wellbeing, and which takes us through some of the themes that we have discussed here as to what are the factors in an organisation that affect retention in a positive way, and what is it that we can do.

And one of the things that struck me about what you said when you touched upon it is about the importance of the medical identity, the fact that this is a medical discipline, and such an important message to not only keep in mind and own, but also make it very clear and articulate it regularly to everyone around us to, you know, make sure that we are, really realizing it and owning it as a medical specialty and developing our medical identity and showing that medical leadership. So, thank you for those insights.

Now, maybe staying with you, Gwen, I want to ask you, what do you think has been your greatest achievement in your career so far? And conversely, what is maybe the biggest challenge you faced and how you overcame it?

Gwen:

Well, in terms of the greatest achievement, I don't know if I've done it yet. I kind of hope the achievements are still in the offing. But obviously it was an extraordinary honour to be asked to give the Reith Lectures in 2024 on the theme of violence.

And, and can I just say that, that, was a pretty big challenge, too, because I was asked in the May to complete four lectures by October. So that's not an awful lot of time to write, good quality lectures. So that was, that was quite a challenge. But most of all, it was an extraordinary, extraordinary, and completely unlooked for absolutely unlooked for invitation. I never thought that anything like that would ever happen to me.

And, and I felt very privileged to, to be the first mental health professional to give the Reith Lectures, which is an extraordinary thing, really, if we think about the history of psychiatry and psychology. It really is. It raises very interesting questions, I think, about stigma around mental about mental illness, about the mind in general, and kind of slightly English wariness, I think, about mind and mentality and mental-isation and all those kind of things.

So I was it was a tremendous, it was tremendous opportunity, which I, which was very hard work, but, very, very special. But I guess the other challenge really,

that was that it became very clear to me, as I was when I was I finished my higher training as a forensic psychiatrist, and I was doing this academic post,

and it was clear to me that I was probably not going to be a career academic.

Certainly not the way academics were set up then. Now I think I might be more suitable,

but not then. So, but I one of the reasons that I wasn't suitable was I really wanted to train as a psychotherapist. And that was quite a challenge, because then as now, there's only few places and places to train as a medical psychotherapist.

And I think we need a thousand more. I think we need a workforce, we need a psychiatric workforce that at least a third of us are trained to deliver some kind of psychological therapy, doesn't have to be Psychonamic? psychotherapy, doesn't, could be in the range of therapies. But I think we need to go back to an idea that a psychiatrists can also deliver psychotherapies.

So I was, so I had a bit of a challenge, to train as a psychotherapist. And I've come out of my training and I took a locum job, because that gave me the opportunity

to train as a therapist, and I should always be grateful to the medical director who gave me that job. And people said to me, why are you doing a locum post? That's not that's not good for your career. You, you should be getting a consultant post.

And I said, no, I don't, I want, I want to do what I want to do, I want to do the thing that enables me to do what I want to do. And of course, it turned out to be it was the best decision ever. Because the consult the locum post gave me a way of learning how to be a consultant, which was great. And I was in this hospital here at Broadmoor, and I had lots of colleagues to support me, but I also was enabled to do the training as a group analyst, which has been a really important part of my career, for me.

So and as a therapist, really important and actually really important to understanding, NHS organisational dynamics.

Ananta:

Yes, I can imagine. Thank you for that, Gwen. I mean, you've showed I suppose you know, how important it is to persevere when you feel strongly about something and when you want to do it. You can find creative ways around it. And I just have to say the Reith Lectures, you know, a must listen if, people, if they've not heard it, I would thoroughly recommend. So, thank you for doing that. I mean, you wouldn't guess that it was done in that extraordinarily short time frame, those four lectures. Thank you. It was a real treasure.

Thank you, Gwen. And Dinesh, what would you classify as your greatest achievement? And, what would you say was one of your biggest challenges?

Dinesh:

I agree with, Gwen, that, is for other people to decide what my achievement or legacy is, was. But I suppose being a migrant and making it to the pinnacle of the College, and that to being elected unopposed was a big, big surprise and achievement, because I kept thinking that, nobody's standing against me. Does that mean that they know something that I don't know? And they’re setting me up to fail?

And at the same time, I think one of the, for the first few months of in that role, I did have an imposter syndrome. You feel that, you know, I haven't, you know, again, what's going on here? I haven't earned it. Maybe. And what that, means.

But it's also, you know, I think there was that. Then at the same time, there were sort of academic pressures and, you know, kind of, you know, in academia in the UK, certainly at the moment it is that not only do you have to bring in millions of pounds in grants, but you also have to provide teaching and you have to provide clinical services.

So basically you're doing three people's job. So that was a big, challenge in the kind of professional way. But there were also issues related to race and racism. There were two things that kind of strike me.

I mean, one was, that a very eminent fellow of the college, came to me and sort of, you know, said to me, what do we have to do to get you to speak proper English? And I was kind of taken aback. And then you think, yes, I know English is my third language, and occasionally I do miss definite and indefinite articles in my, you know, I can write much better than I can speak. And but what was, you know, so I shrug my shoulders and said, fine, that's their problem, not mine. And I'll just carry on. But then they went to the head of the department in the college and said, what do we have to do to get him to? And that was hurtful because, you know, people I'll be working with on, on a daily basis,you're   them something.

And in some ways it's kind of that brought home the other-ism that no matter what you do, you're still not one of us. And combined with that, roughly about the same period, maybe a bit earlier, I was bumped off a multi-million pound grant with the explanation that, oh we will not have any Asian patients in the study, so we don't need you - as if I was only good enough for Asian patients and not, you know, so at some point you just have to kind of take it on the chin and okay, you know, I haven't done too badly in spite of all that.

And you learn to, you can do it in two ways. I mean, either you come out fighting and you say, well, okay, this is what I'm going to be doing.

I'm not going to put up with this, or you just sort of say it's their mindset, it's their stupidity. I'm just going to get on and, you know, do what needs to be done.

So part of the challenge for thriving is you need to get away from those kind of incidents, which could become major. And the fact that I'm talking about it here means that I can remember the time and giving it up, but at the same time, you have to kind of put them to one side and get on with whatever else is happening. And you kind of build on your strengths and deal with your weaknesses. And one of the key lessons through all this was that there are things that I cannot change, no matter how hard I try.

So the point is that you really need to identify things you can't change. No point trying to fight them. Things that you can change. If you don't change them, that's a problem.

So it's how you incorporate all that and it's also, I mean, you know, as Gwen was saying that there are different things. And one of the big lessons, lessons for me, when I was training in Leicester, we had, every trainee had to undergo psychotherapy. So people from Leicester, went to Derby, people from Derby went to Nottingham, people from Nottingham came to Leicester. So, all of us did at least 18 months of personal psychotherapy and which was incredibly helpful in understanding the dynamics not only with patients, but also with the organisation and committees and, you know, so on and so forth.

So, I would sort of urge that if people get a chance, go through that experience to understand what it feels like and how you deal with those kind of emotions which are generated in personal interactions.

Ananta:

Thank you, Dinesh.

I mean, firstly, I mean, your achievement of, you know, your, becoming the president of the 萝莉视频 cannot be, you know, underestimated what it would have taken for you to get there. And also the sobering stories that you shared about how even at that level, you suffered racism.

And it's thanks to, I think, the work of people like you that we are now able to hopefully call it out a bit more, say it for what it is, say that it is unacceptable and the college hopefully has become a more inclusive place, accepting of diversity and appreciating contributions.

We, we still have a way to go, but I think the narrative is a bit different also.

Dinesh:

I think one of the interesting things was that when I started in the institute in the Maudsley, there was only one female consultant.

Ananta:

Right.

Dinesh:

And that's changed completely. So yes, change is inevitable. It's just a question of how we deal with that. And change is always an opportunity.

Ananta:

Yes, absolutely. And both of you, Gwen and you, sorry, have touched upon the psychotherapy training which has been invaluable. And I can attest to that, because as a child and adolescent psychiatrist, I underwent one year of psychodynamic psychotherapy as part of my training, you know, understanding infant maternal interactions and personal therapy as part of that. And it's invaluable. And there is something about, you know, realising, what is it, the specific skills that psychiatrists have, you know, it's a medical specialty with a very unique ability to understand the inner workings of people's minds. And, you know, how they behave, and that therapeutic grounding, I think, very important for professionals as well.

Thank you, Dinesh, for sharing that.

So, I think I wanted to, this is the last series of questions I'm going to be asking you all.

And I, you know, both of you, Gwen and Dinesh, you have alluded to the fact that maybe your biggest achievement is yet to come or others will decide. So, it's really good to see there is a passion still that zest to continue working, you know, in this field.

So, Gwen, if I start with you, what do you think you still want to achieve? Or do you know when you think about, you know, the coming years, what is it that you would still like to do or what or that you would like to achieve in the field?

Gwen:

Well, it it's, it's a it's such an interesting question. And, I suppose one of the things that I've been thinking about, the again, one of the many, nice things about psychiatry, I think, is that one's always learning. So, I've felt that I've learned an enormous amount in the last ten years, but I learned an enormous amount in the previous ten years, and I kind of feel like I'm just getting good at this now. So. so this is absolutely not the time for me to stop, because I think that I have learning and experience that, is really helpful, that can be really helpful and not just to patients, but also to trainees, both the core trainees and higher trainees. And I really enjoy that. Really, really enjoyed training and teaching. So, I'm kind of hoping that I can do, more of that.

And I'm also looking forward to what else I'm going to learn as a psychiatrist going forward. Again, there are some kinds of medicine where you probably can't keep going, into your seventh decade. But psychiatry is one where you can, I think, and there's a kind of experience that I feel that I've accumulated, and I hope to continue to keep learning, so that I can give more.

And, I just this is making me think of, one of George Vaillant’s studies, about how do we grow old successfully. And one of the ways that we do that is by giving to the next generation, that generativity about handing over what we've learned. And so that is what I'm kind of working on now. And I've also been working on books for a general population, about the experience of mental distress and psychological therapy. So, I'm going to carry on with that a bit, too.

Ananta:

Lovely to hear that. I love the fact that you have these ideas and, you know, lovely to see you going strong and may continue for long Gwen. And Dinesh?

Dinesh:

You know, sexual dysfunction and things like that. And then, but, you know, moving to burnout in medical students, looking at geo psychiatry, too, have got, you know, a major textbook on men's mental health coming out next year. We've got, a small book on mental health for nations, which is what each nation's mental health policy should have. That should be coming out in early next year.

We set up a new journal, called Geo Psychiatry, which, looks at those, you know, political, commercial and geographical determinants of mental health and, focusing on impact of, conflict, wars, natural disasters, climate change on people's mental health.

And again, I mean, I think with these things, as Glenn quite rightly pointing out, sometimes these opportunities emerge and you have to kind of look at them, you can't sort of sit down and, you know, write on the back of an envelope and say, in five years’ time, I will be doing this, And when the whole sort of, you know, Michael Marmot social determinants things came, and it has taken 50 years since Douglas Black's report on social determinants, and suddenly it's become very fashionable.

We talk about it, but social determinants are not bounded by national boundaries. They are impacted upon climate change, wars, conflicts, political determinants, political ideology of politicians. So, I've kind of moved in that direction and taking a much bigger overview, but also linking within the basic training of an individual and what our identities are and how we see ourselves and how we see others seeing us, and how we see that in the context of mental illness.

So it's how you kind of use those milestones, in a way. And you know what I tell the trainees and medical students is the most important thing in being, a successful, thriving psychiatrist is whatever you do, have fun. If you're not having fun, you're missing something. And that is absolutely crucial that we can have fun in different ways from different sources. So, it's how do we utilize those opportunities and methods to achieve the best potential? And as Gwen said, quite rightly, pass it on to the younger generation.

What are the lessons? And, you know, part of me is quite grumpy. I'm a grumpy old man, because, you know, you can see the bigger picture and sometimes people don't want to listen to you. So how do you deal with that? And that's also a strategy that you need to learn to sort of say, well, okay, I've had my time in the sun, which is one of the reasons why I walked away from the College, I walked away from BMA, I walked away from WPA. You know, I had my time. It's now the younger generation’s opportunity and they can do whatever they wish with it. If they want my advice, I'm there. If they don't, fine.

I can get on and do other things. And one of the big advantages at this point is I can say no to things. Previously I could not, but what I miss most is seeing patients, because they are the sane ones, and sometimes the system is insane.

Ananta:

It's so fascinating and such a vast array of interests you have, Dinesh, and I think, you know, the geo psychiatry you're talking about, you know, the social, commercial, determinants, climate. This is so topical. And, you know, we are seeing increasingly and rightly so, we are seeing psychiatry and mental health as a public health discipline, you know, which is impacted upon by so many factors. So, you know, what you're doing I think is such a need, so needed for what's to come in the future.

Dinesh:

I am quite proud of the fact that I was the first one to appoint, public mental health lead in the College.

Ananta:

Excellent.

Dinesh:

All those years ago.

Ananta:

Excellent. I mean, yes, absolutely. I mean, I can see that vision. I mean, both of you and all of you.

In fact, have spoken about there not being it's not a scripted plan that you have. It sort of emerged and evolved organically.

But still the vision was there about doing something, you know, different, which might take a few years to actually achieve, but you’ve sown the seeds of it. So, really fascinating.

And Julie, I hope you're back and you can hear us and see us. Oh yeah. Great.

Julie:

I can.

Ananta:

We are going to, so, we come to you towards the end and you've got the question in three parts.

What do you think is your biggest achievement, maybe the biggest challenge you have faced and what are your plans for the future?

Julie:

Oh, certainly.

So, the, the challenges, and the, the achievements definitely go hand in hand so I can answer them together. And I suppose all of that, as anybody who knows me, well, I'm going to talk about perinatal briefly with the Northern Ireland.

I suppose I've had an interest in perinatal for really from the start of my career, from sort of some small aspects of personal sort of experiences, family experiences. And then again, as we've talked about this whole time, patients that I have seen right from the start of my career, and that just kind of sparked that interest.

And I suppose I could see, you know, that point in life when there's most risk in some ways, but also the most opportunity to kind of do things well. And if we can get things right at that time, the kind of real positive outcomes there can be for that individual mum and baby both now.

But also much further down the line for them and their lives. And so I suppose I kind of if you cut me down in the middle, you would find perinatal in the core.

I think, of me. So, in Northern Ireland, we didn't have any specialist perinatal services at all until 2022. So, they are brand new, I know. So, they are literally brand new.And I suppose I was involved quite a lot during my training and as a, a psychiatrist in community mental health team, I was, I was involved with loads of other people, other professionals, mums, community, voluntary sector, to be really pushing and championing for perinatal services. It was a slog, emotionally, time wise, everything it actually really was. But I suppose we talked about when you know, there's something that does spark joy, spark interest. You know what's really important? I think it's really important. You have to keep finding the energy to push for it. When you know what's something that is important to push for. Occasionally maybe do have to let things go.

But when you know what's something important, you kind of have to keep going. So, that was, it was, it was really frustrating and, challenging and interesting, all at once.

And I suppose from an overcoming point of view, I suppose, one thing that I'm pretty proud of, and it was with many other people, of which I was a small cog in the wheel, is that in 2020, when other things were starting to go on in the world, if people can remember that lovely time, we actually managed to get, confirmation that we were getting funding in Northern Ireland for community perinatal teams and then actually got funding in 2021.

And the teams are now up and running in the five, five trusts in Northern Ireland since 2022. So, that was amazing.

The type of person that I am, I sometimes forget that, and I am constantly frustrated that the teams are not quite where they should be. They're not seeing all the mums I would like them to see. We still have no mother and baby unit, which is diabolical and is really awful.

Whenever you're making decisions about does a mum need to be admitted or not? And personally, to be honest, I do have a real worry that at times. We manage mums at home at a higher level of risk than what we should, because we know here in Northern Ireland, if the decision is made to admit somebody, it’s separating from their baby at that point to general ward. So, I think all of that answers a, is a mixture of, yeah, achievements and barriers and frustrations.

But I suppose, it’s repeating what we've said, I think, well, me as an individual, I'm pretty stubborn, very stubborn. But I do think that's a good thing most of the time. But a lot of that journey in perinatal in Northern Ireland has been absolutely coming back to what I said right at the start. It's been about connections with other people. So, it's been finding other people who've been like minded.

So that's across maternity, mental health services and the college, mums who have experienced things, reaching out to media connections, reaching out politicians and gradually, somehow I'm not quite sure how, I, but all those bits sort of came together to actually get our perinatal teams, in the community.

And I suppose that push is continuing very, very hard around a mother and baby unit. So, I guess, sort of looking ahead, is kind of what I want to achieve. I hope I have quite a few years left in me. Sometimes I do feel quite tired and I think I'm not sure. But anyway, definitely that sort of piece around actually getting a mother and baby unit, I think is something that we'll have to make sure happens before I collapse.

And I suppose the other more broad thing, that I've more seen from my College work, I guess also has been around, I suppose, just the shape of the psychiatry workforce in Northern Ireland right now, broadly is not good. It's, it's much worse than what it was sort of ten years ago when it really is in crisis, when they might have gaps that we have and consultant posts.

So, I suppose that's my other main focus right now. I, kind of, looking ahead in the next few years of just what we can do as a college, with other people to really try and, lobby and push even harder than what is happening now, but do it in a positive way and not in a complaining or negative way. To try and kind of improve things across the workforce, because that's how we get things improve for patients, I guess.

So, yeah, they're probably my two big things.

Ananta:

Excellent. I mean, Julie, I think you've, you know, been very modest. You've impacted psychiatric services in Northern Ireland in so many ways. I mean, you're leading the College division. You've, you know, you're doing a lot of work around medical education, the psychiatric support, support service, but also the perinatal services.

And I have no doubt, I mean, you mentioned that there's an ambition going forward, but I have no doubt you will actually lead the work on getting a mother and baby unit in Northern Ireland. So, we'll watch the space.

But thank you.

I just love to see, you know, it's lovely to see the enthusiasm, the passion still coursing strong and what I've heard from the three of you as well is there have been times when things have felt a bit, you know, difficult, challenging. Dinesh, you've said. you've felt grumpy, you know; Julie, you've talked of being tired; Gwen, perhaps, you know, when you felt that it was a bit difficult. But you've all we all go through these undulations. I suppose, you know, what I learned from all of you, and you emerge stronger sometimes.

And it's okay to feel like that for a while, because we can't be at that high rate of level of energy and enthusiasm all the time. I suppose it waxes and wanes, but you will emerge stronger. There are so many takeaways from the things that you've all said, and I think for psychiatrists at every stage of their career, in fact, those who are thinking of entering psychiatry as well, there's a lot to learn and think about, ponder and reflect and take away. I have learned a lot from listening to all of you.

So, I just want to say a huge thank you once again for sharing your insights and your thoughts so generously, openly, and, truly inspiring and, giving a lot of pointers to people who want to thrive in psychiatry.

I think it's a fitting way to end the podcast and once again, reminding people of the website that the 萝莉视频 web page, where you can also, leave feedback and your thoughts and suggestions for what we can cover in the future around thriving in psychiatry and retention in psychiatry. So please do have a look.

And thanks all once again.