Psychiatry - Adult mental health F1
Where is it?
Adult mental health is based at The Orchards AMH Inpatient Unit, Saint James’ Hospital. The Unit
consists of 2 wards - Maples & Hawthorns. Maples is a Psychiatric Intensive care unit with 10 beds
and Hawthorns is an acute ward with 20 beds. There is also a 136 suite on site which is used by the
police to detain individuals until they have had a mental health assessment. It is part of Solent NHS
Trust.
The Orchards Unit is part of Saint James’
hospital which is located in Southsea,
Portsmouth. The unit isn’t located on the
main hospital site but just adjacent to it
(see map). Probably the easiest way to
get there is by car via eatern road.
Parking is free and onsite. There is a bus
stop outside.
Contact details for the unit:
The Orchards, Locksway Road,
Portsmouth, Hampshire, PO4 8FE
Telephone: 02392 682520
Typical Day
A typical working day starts at 9am and finishes at 5pm.
9am-9.30am – Arrive at the unit, collect personal alarm, review bloods and prepare for MDT
9.30am -11:00am – MDT. Each patient is discussed in MDT and a plan for them going forward is
made. MDT is attended by doctors, ward nurses, Social services and Community mental health team.
11:00am – 5pm complete jobs on the ward. This includes seeing patients for physical health reasons,
taking bloods, performing ECGs, writing TTOs and discharge summaries and sitting in ward rounds at
the consultant requests.
Common Jobs on the Ward
Any new patient that comes in during working hours needs a full Psychiatric clerking. This includes
history of presenting complaint, past psychiatric history, past medical history, medication history,
allergies, personal history, social history, substance history, forensic history, pre morbid personality,
MSE and physical health check. This can take over an hour and a half easily, especially in complex
cases. If a new patient comes in after 4pm it is entirely reasonable to defer this onto the duty doctor,
but it goes down a lot better if you notify them about it!
Each new patient requires bloods and ECG soon after their admission. The bloods are to check 2
things: Make sure there are no organic causes for the mental health symptoms and to check the
physical health markers such as cholesterol and HBA1c. ECGs are taken to check QTC (which can be
lengthened by antipsychotics). Bloods are picked from the unit at 1pm.
Patients on lithium and/or clozapine need there bloods taken routinely as well. Lithium levels need
to be taken 12-14 hours post dose (dose is given at 22:30). Just one gold top is required and always
make sure that U&Es are checked every time and that TFTS have been checked. Lithium bloods need
to be checked 5 days after a dose has changed. Patients on clozapine need to have a FBC once a
week when they first start to look out for agranulocytosis.
TTOs are written for patients when they are going on both overnight leave and when they are being
discharged. If TTOs are required for the same day, they need to have been faxed to pharmacy by
1pm.
Physical health checks can range from a multitude of things, which may or may not be psych related.
Be prepared to see some serious pathology that you need to dial 999 for. In my time on the unit I
have seen asthma attacks, renal stones, overdoses, swallowing of razor blades, seizures, and much
more. Some conditions can be managed on the ward with guidance from the doctors either in ED or
at ambulatory clinic in QAH. Other times patients have to be transferred immediately by ambulance
to ED. It can be frustrating that conditions you feel comfortable managing in QAH cannot manged in
orchards because of lack of equipment, monitoring or medications. For instance, there are no
cannulas on the unit! Also, be prepared to be asked by psychiatrists for you opinion about medical
conditions!
Working Week
Working week is 9am – 5pm, Monday to Friday.
On Tuesdays there is teaching at St Mary’s hospital, Portsmouth. Teaching starts between 9- 11am
and lasts until roughly 2pm. You are not expected to go to be on the unit before teaching! (But are
expected back afterwards). Teaching consists of a mix of journal club, GP core training, case
conference meetings, drug rep meetings and balint group. Also, don’t forget F1 teaching on
Thursdays at QAH.
Staying Safe on Ward
Your safety is top priority while on the ward. On the wards there are often patients who very unwell
and potentially violent. They may have previous history of assaulting staff or being arrested for
violent crimes. It is NOT uncommon for members of staff (including Doctors) to be assaulted by
patients, sometimes seriously. Here are some tips to staying safe on the ward.
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Always carry an alarm on your person. Make sure it’s easily accessible at all times (people
tend to either clip onto their belts or Lanyards). If you need assistance push the button on
the alarm and people will come. If you need help immediately yank the alarm downwards
and the pin will come out which will trigger an alarm. People will come running to help you.
If in doubt PULL THE ALARM!
Don’t turn back on patient until you are a safe distance apart
Don’t become sandwiched between 2 patients
Always position yourself between the door and the patient
Don’t leave doors to the office, treatment room or onto the ward open
Always look through the window before entering the ward
Check with nursing staff how the patient is that day
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If you feel you need a chaperone – Get One!
And probably most importantly – if you feel unsafe leave the area immediately. It is not
worth staying and it is not your job to get hit.
Useful tips/tricks/intricacies of the ward
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Know how to do ECG as you will end up doing one on pretty much every new patient.
Drugs will seem foreign at first but eventually you will get used to them. Don’t be afraid to
ask for clarification when asked to prescribe.
Make friends with nursing staff – they are very helpful, useful as chaperones and will also
invite you out on their socials if your friendly enough!
Don’t be afraid to say hello to the patients
Know what’s happening on the ward and roughly what medication the patients are on
(useful for MDT)
Understand about the different sections of the mental health act
Annoyingly both bloods and TTOs need to be ready to go by 1pm which mean prioritising
can be difficult. However, although they won’t readily admit this some members of nursing
staff can do bloods and ECGS.
Nursing obs are different in mental health. They do not mean physical health observations.
They mean that the patient has been checked on to make sure they are safe on the ward
You may get asked to see patients for physical health problems they have had for a while, if
it is not urgent and the patient is either informal or likely to be discharged soon, it is entirely
reasonable to send them to see their GP!
Get access to computer programs early eg APEX, ICE, PACS, Oceano, Hampshire health
records. It saves a lot of time ringing different labs/GPs/secretaries looking for information.
Useful links
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How to record an ECG - http://geekymedics.com/record-ecg/
Mental health sections -https://www.rethink.org/living-with-mental-illness/mental-healthlaws/mental-health-act-1983/sections-2-3-4-5
Psychiatric clerking -http://www.askdoctorclarke.com/content/c447.pdf
Overall, Enjoy it. Psychiatry is not like any other speciality and it can be very interesting. It’s possible
to make a big difference to the patients’ lives and help people when they are most vulnerable. And
you definitely get 1 or 2 funny stories from it!
Harry Pollard F1