Old age psychiatry
Old age psychiatrists (OAP) are doctors who provide specialised and holistic assessment, treatment and continuing care for older adults (or those with similar needs) who suffer from a range of mental health problems including dementia and other disorders including depression and schizophrenia.
This page provides useful information on the nature of the work, the common procedures/interventions, sub-specialties and other roles that may interest you.
In this video Dr Alex Bailey, Consultant old age psychiatrist, gives an insight into his working life and also the nature of the demands and rewards that come from working in the community with elderly people and the type of person that it would suit as a career.
You can also watch a video of Sarah, a trainee in old age psychiatry, talking about her experiences.
Nature of the work
Mental health problems in older people are increasingly being recognised as a major health issue. Increased life expectancy has resulted in a growing demand for dedicated old age psychiatry services. Dementia care and memory problems are a significant aspect of the work. Depression and other mental health problems common across the spectrum of psychiatric illness including delirium, schizophrenia and personality disorder are also treated. About 50% of the work is non-dementia. There are significant differences in mental health problems in older adults compared to the younger population, meaning there is a great need for specialised skills to manage these problems effectively.
In the past old age psychiatrists worked with people over the age of 65. However, most old age psychiatry services now work in a ‘needs-led’ way rather than strictly on age. Generally speaking, old age psychiatrists work with people with cognitive problems, plus those with mental health and significant physical health co-morbidities or ‘frailty’. They will also work with people who have psychological problems as a result of the ageing process. Working with patients’ families and carers is an important and interesting aspect of the work. Person-centred, individualised care, promoting independence and prioritising choice are at the very heart of old age psychiatry.
Mental health and social problems in old age are closely related. Old age psychiatrists collaborate closely with many different agencies including GPs, social services, occupational therapy and voluntary agencies. Nowadays, there is a strong emphasis on community care and delivering interventions and care packages that enable older people to stay in their own homes. Other priorities include developing memory services and improving acute in-patient services.
Physical problems also affect mental health and in this respect a holistic, integrated approach is important. Old age psychiatrists therefore need good working knowledge of general medicine and it is therefore amongst the most ‘medical’ of all the psychiatric specialties.
An understanding of the legal and philosophical issues regarding protection of individuals’ human rights, end of life decisions, capacity, informed consent and mental health legislation is essential in providing safe, holistic care of a high quality. Clinical decisions are always balanced with ethics.
Old age psychiatry services may be provided in acute general hospitals (as a liaison service given the recognition of the high prevalence of mental health problems suffered by patients in these hospitals) as well as in community settings including residential and nursing facilities or in mental health in-patient units for those requiring a hospital admission.
Assessing patients is an essential of the work. There's a growing demand for cognitive assessments for patients with cognitive impairment. Both assessments and follow-up may be carried out in the patient’s home or in designated memory clinics.
Patients may present with organic disorders (such as memory loss) as well as functional disorders (such as depression or psychosis). They may also suffer from multiple complex physical and social issues.
Treatment can involve medication, talking therapy or a combination of the two. Prescribing and monitoring appropriate medication is an important part of the role. Old age psychiatrists need a detailed knowledge of the way in which older people metabolise medication, since this can change as part of the aging process. The interaction of physical health medications, as well as the high rate of polypharmacy in this population, means that old age psychiatrists need a high level of pharmacological expertise.
Talking therapies such as cognitive behaviour therapy may be provided by the old age psychiatrists themselves, or they may refer patients to a therapist or clinical psychologist who specialises in this treatment.
Old age psychiatrists may also be required to treat patients who are subject to the legal framework provided by the Mental Health and the Mental Capacity Acts. They may be detained against their will under a “section” or may not be able to make some or all of their own decisions.
Want to learn more?
Find out more about:
- the working life of someone in old age 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), specialty doctors, consultants and general practitioners.
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 old age 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 HEE local office/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 HEE local office/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 old age psychiatry pathway or are interested in research there are opportunities in academic medicine. However, opportunities within psychiatry are fairly limited. Academic psychiatrists make up 7.6% of the total medical academic workforce. There has been a 33% decrease in the number of academic psychiatrists between 2000 and 2013. 11% of the total medical workforce are academics, meaning that psychiatry is under-represented. (CfWI 2014).
For those with a particular interest in research, you may wish to consider an academic career in old age 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
Further information can be found on their website: National Institute for Health Research.
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 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). Most areas of psychiatry have seen considerable growth in the consultant workforce in the last ten years, and old age psychiatry is no exception. Old age psychiatry has shown the largest growth of all the psychiatry specialties. CfWI analysis based on HSCIC, 2014).
In 2019, the competition ratio for core psychiatry training (CT1),was 1.72, and it was 1.09 for ST4 old age psychiatry training (NHS Health Education England, Specialty recruitment ratios 2019).
For information regarding Scotland, Wales and Northern Ireland please click on the links below.
Where to look for vacancies
Specialist old age 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 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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