Mohammed T. Abou-Saleh

TRAINING FOR OLD AGE PSYCHIATRISTS, UK 79313. Royal College of Psychiatrists. Policy for the Continuing ProfessionalDevelopment of Psychiatrists. Council Report CR58. London: RoyalCollege of Psychiatrists, 1997: 32.14. Benbow SM, Jolley DJ. Psychiatrists under stress. Psychiat Bull, 1998;22: 1–2.15. Department of Health. Reform of the Mental Health Act 1983.Proposals for Consultation. London: The Stationery Office, 1999: 93.16. Lord Chancellor’s Department. Making Decisions. The Government’sProposals for Making Decisions on Behalf of Mentally IncapacitatedAdults. London: HMSO, 1999.Old Age Psychiatrists and StressSusan M. BenbowWolverhampton Health Care NHS Trust, Wolverhampton, UKStress, and its effect on the workforce, is a matter of increasingconcern in the Health Service. Stress levels in health professionalsgenerally are high 1 . Doctors as a group have increased rates ofcirrhosis, road traffic accidents and suicide, compared with thegeneral population 2 . They are prone to symptoms of anxiety anddepression, and are more likely to misuse alcohol or othersubstances 3 .WHY WORRY ABOUT SERVICES FOR OLDERPEOPLE?Working with older people, especially those with mental healthproblems, might be particularly stressful, for various reasons. Thisclient group is more likely to exhibit challenging behaviours. Theyare subject to the increasing disadvantages, disabilities andprogressive loss of independence associated with increasing age,and are approaching death. Consultants (and other staff) ingeriatric medicine and geriatric psychiatry are working in socalled‘‘Cinderella specialties’’, which struggle to compete forresources with the more ‘‘sexy’’ acute specialties. The stigma ofbeing old, mentally ill and cognitively impaired is contagious andaffects attitudes towards the staff who work in these specialties 4 .In addition, staff will have to confront their own beliefs and fearsabout ageing, dementia and death for themselves and members oftheir own families 5 .It is not surprising, in this context, that psychiatrists are retiringearlier 6 and recruitment to the specialty is inadequate to maintainconsultant numbers 7 . Stress is an important issue for theworkforce.WHAT DO WE KNOW?Studies of the work patterns of old age psychiatrists have foundthat they have long working days with little opportunity forrecreation, family life, personal study and research 8,9 . More than40% of old age psychiatrists do extra work at home on every dayof the working week except Friday, and more than 30% do so onSaturdays and Sundays 9 . Most of the stresses identified by old agepsychiatrists relate to work overload or organizational structureand climate 10 . Many of these factors are equally applicable to staffworking in geriatric medicine.WHAT CAN BE DONE?Appointment as a consultant brings long working hours and anumber of different, often conflicting, roles (including responsibleclinician, manager, budget holder, counsellor, researcher, teacher,team member, perhaps team leader) in various settings (wards,day hospitals, community and others). The result is roleambiguity, conflict and overload. Doctors could be better trainedfor the demands of consultanthood. The means by whichconsultants are supported, supervised and valued could beradically revised 11 . Individuals need to be able to change anddevelop their interests and work patterns over time, in order toallow re-energization. Time allocated to clinical work, teaching,research, family and other interests will vary at different stages ofa person’s working life. Organizations need to accept and supportthe evolving careers of their staff members.REFERENCES1. Caplan RP. Stress, anxiety and depression in hospital consultants,general practitioners and senior health service managers. Br Med J1994; 309: 1261–3.2. Margison FR. Stress in psychiatrists. In Payne R, Firth-Cozens J, eds,Stress in Health Professionals. Chichester: Wiley, 1987: 107–24.3. Holmes J. Mental health of doctors. Adv Psychiat Treatm 1997; 3:251–3.4. Benbow SM, Reynolds D. Challenging the stigma of Alzheimer’sdisease. Hosp Med 2000; 61: 174–7.5. Turner SJ, Benbow SM. Dementia, stigma and the generalpractitioner. Update (in press).6. Kendell RE, Pearce A. Consultant psychiatrists who retiredprematurely in 1995 and 1996. Psychiat Bull 1997; 21: 741–5.7. Storer D. Prematurely retiring consultant psychiatrists. Psychiat Bull1997; 21: 737–8.8. Benbow SM, Jolley DJ, Leonard IJ. All work? A day in the life ofgeriatric psychiatrists. Int J Geriat Psychiat 1993; 8: 1019–22.9. Jolley DJ, Benbow SM. The everyday work of geriatric psychiatrists.Int J Geriat Psychiat 1997; 12: 109–13.10. Benbow SM, Jolley DJ. Old age psychiatrists: what do they findstressful? Int J Geriat Psychiat 1997; 12: 879–82.11. Benbow SM, Jolley DJ. Psychiatrists under stress. Psychiat Bull 1998;22: 1–2.