General psychiatrists are medically qualified doctors who contribute to the management and treatment of adults with mental health problems.
This page provides useful information on the nature of the work, the common procedures/interventions, sub-specialties and other roles that may interest you.
Nature of the work
The work is based around developing a therapeutic alliance with the patient and often involves co-operating as part of a team with other professional disciplines.
Specific interventions include medication and psychological interventions including cognitive behaviour therapy and other talking therapies, as well as interventions that take into account the social factors that might be contributing to the clinical picture.
Watch a video of Arthita Das talking about general psychiatry:
Note: this video is part of a longer film that can be watched from the psychiatry introductory page.
General psychiatry is underpinned by a detailed knowledge of anatomy, physiology, psychology and pharmacology as well as a good understanding of the social factors that contribute to mental wellbeing and mental ill health.
Mental illness is more common than we might think – in any one year about 25% of the population suffer with a mental health problem.
Mental health disorders include:
- mood disorders such as depression and bipolar disorder
- psychoses including schizophrenia, schizoaffective disorder and bipolar disorder with psychotic symptoms
- eating disorders
- anxiety disorders and phobias
- obsessive compulsive disorder
- drug and alcohol abuse, including psychosis in association with substance use
- post-traumatic stress disorder (PTSD)
- organic disorders such as dementia
- personality disorders
Psychiatrists emphasise the importance of developing a good collaborative therapeutic alliance with their patients and their patients’ families. They work as part of multi-disciplinary teams in which they have a key leadership role.
Psychiatrists, with their deep and broad training, often take a lead role in establishing the strategic management plan for an individual patient, utilising their therapeutic skills to involve the patient and develop a constructive pathway to recovery.
In straightforward cases they may work individually with patients. Most psychiatric care is delivered in community settings and patients live in their own homes. A range of different community based services are available, including Early Intervention in Psychosis teams, Crisis and Home Treatment Teams and Access and Recovery Teams. Other specialist teams include Eating Disorders and Perinatal services.
In-patient care remains available and is an important part of the care pathway for some patients.
The work is varied and fascinating. General adult psychiatrists usually work with patients of working age from 18 years and may work in specialised teams or in more generic teams dealing with a range of different diagnoses.
“I run outpatients clinics most days of the week, and see patients with substance misuse problems”. Grace Ofori-Attah, Higher specialty trainee,Camden Specialist Drug Service.
Psychiatrists are trained in, and able to use both pharmacological and non-pharmacological approaches and to develop therapeutic alliances in situations which may appear initially unpromising.
They are trained to understand the social contexts within which their patients lead their lives with an explicit aim of working to instil a sense of hope and optimism.
They have an understanding of different psychological and social approaches and are supported by social work and psychology colleagues. Psychiatrists will also work closely with specialist pharmacists in their trusts (in England only) who can assist with more unusual drug treatments.
When someone is referred to a psychiatrist, an initial assessment is carried out, sometimes alongside another member of the multi-disciplinary team.
Most patients receive their interventions in the community. Treatment will often include a combination of medication and psychological and social interventions. The talking therapy may be provided by the psychiatrist themselves or by another professional such as a therapist or psychologist.
When admission to an in-patient unit is required, most patients are admitted on a voluntary or informal basis. However, a proportion of psychiatric patients are admitted under sections of the Mental Health Act 1983 (England and Wales only). This legislation allows in certain circumstances for patients to be admitted to hospital against their wishes and the legal ‘sections’ in which the law is set out lead to the colloquial term ‘being sectioned’.
Some psychiatrists choose to develop a particular interest for instance in the drug or alcohol fields or eating disorders and go onto receive additional training and develop particular expertise in these areas.
There are three recognised sub specialties within general adult psychiatry:
- liaison psychiatry
- rehabilitation psychiatry
- substance misuse psychiatry
Want to learn more?
Find out more about:
- the working life of a doctor in general psychiatry
- the entry requirements and training and development
Pay and conditions
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This section provides useful information about the pay for junior doctors (doctors in training), SAS doctors (specialty doctors and associate specialists) and consultants.
NHS employers provides useful advice and guidance on all NHS pay, contracts terms and conditions.
Medical staff working in private sector hospitals, the armed services or abroad will be paid on different scales.
Where the role can lead
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Read about consultant and non-consultant roles in general psychiatry, flexible working and about wider opportunities.
Managerial opportunities for consultants include:
- clinical lead - lead NHS consultant for the team
- clinical director - lead NHS consultant for the department
- medical director - lead NHS consultant for the Trust
Most NHS consultants will be involved with clinical and educational supervision of junior doctors.
Here are some examples of education and training opportunities:
- director of medical education - the NHS consultant appointed to the hospital board who is responsible for the postgraduate medical training in a hospital. They work with the postgraduate dean to make sure training meets GMC standards.
- training programme director - the NHS consultant overseeing the education of the local cohort of trainee doctors eg foundation training programme director. This role will be working within the LETB/deanery
- associate dean - the NHS consultant responsible for management of the entirety of a training programme. This role will be also be working within the LETB/deanery
SAS doctor roles
SAS doctors (Staff, Associate Specialists and Specialty Doctors) work as career grade specialty doctors who are not in training or in consultant posts. You will need at least four postgraduate years training (two of those being in a relevant specialty) before you can apply for SAS roles.
Further information on the SAS doctor role is on this site.
Other non-training grade roles
These roles include:
- trust grade
- clinical fellows
If you have trained on an academic psychiatry pathway or are interested in research there are opportunities in academic medicine.
For those with a particular interest in research, you may wish to consider an academic career in psychiatry. Whilst not essential, some doctors start their career with an Academic Foundation post. Entry is highly competitive. This enables them to develop skills in research and teaching alongside the basic competences in the foundation curriculum.
Entry into an academic career would usually start with an Academic Clinical Fellowship (ACF) at ST1-2 and may progress to a Clinical Lectureship (CL) at ST3 and beyond. Alternatively some trainees that begin with an ACF post then continue as an ST trainee on the clinical programme post-ST4.
After completion of the academic foundation trainees can then apply for academic core training posts (instead of normal core training). A PhD is often taken, either during core or specialty training.
Applications for entry into Academic Clinical Fellow posts are coordinated by the National Institute for Health Research Trainees Coordinating Centre (NIHRTCC).
There are also numerous opportunities for trainees to undertake research outside of the ACF/CL route, as part of planned time out of their training programme. Find out more about academic medicine.
The Clinical Research Network (CRN) actively encourages all doctors to take part in clinical research.
Psychiatrists often undertake research, which includes collaborating with colleagues in the UK and overseas, writing papers and presenting work at conferences. Research within this specialty, as is often the case, is subject to financial constraints. There is not always sufficient money to carry out all the necessary work.
There is a wide scope for psychiatrists to become involved in teaching at both medical undergraduate and post-graduate level and in contributing to the training of other disciplines and the organisation and management of training within the structures of Health Education England.
Psychiatrists are encouraged to become involved in management within their Trusts (England only), contributing to the further development and delivery of services. They may also become involved in work through the Royal College of Psychiatrists and through regulatory bodies.
There may also be opportunities to work in the private sector and overseas.
Job market and vacancies
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This section provides useful information about the availability of jobs, how to find vacancies and sources of further information.
Job market information
Psychiatry is the fifth largest medical specialty in the UK. Consultant psychiatrists comprise 4.5% of the mental health workforce and 10.5% of the total NHS consultant workforce (Health and Social Care Information Centre, HSCIC 2014).
54% of consultant psychiatrists specialise in adult psychiatry (CfWI 2014).
In 2016, the competition ratio CT1/ST1 for core psychiatry training was 1.50, and for ST4 general psychiatry was 1.30 (NHS specialty training 2016).
On this section we have information for England only. For information regarding Scotland, Wales and Northern Ireland please click on the links below.
Where to look for vacancies
Specialist general psychiatry training is open to those who may want to train flexibly on a less than full-time basis (LTFT). You can request and apply for this after you have been offered the job. Restrictions apply.
Recruitment into specialist psychiatry training (excluding Northern Ireland) is coordinated by the North Western Deanery, Health Education North West.
Registration and applications for psychiatry core and higher specialist training is online via Oriel.
Northern Ireland has its own recruitment process for psychiatry. For further details please visit the Northern Ireland Medical and Dental Training Agency website.
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