Tips for Locuming in a New Specialty - CAMHS
Whether you chose to do an F3 Year for lifestyle reasons, to try out different specialties you didn’t get during your foundation rotations, or to gain more experience in a specialty you’re particularly interested in, you may at some point find yourself working in a specialty that you have no previous experience in. This can be a daunting prospect for doctors.
If you are going to be working in Child and Adolescent Mental Health (CAMHS) for the first time and are unsure about what you are expected to do, then this article is here to make life easier for you. We will explain what the job will be like, highlight the common clinical scenarios you’ll likely come across, and share some tips to help you prepare for starting the job!
📂 Where will I cover?
Most Trusts have a similar spread of clinical areas you may work in as a CAMHS SHO, but it’s worth finding out in advance – either from your locum agency or the hospital itself – which specific areas you’ll be covering, if you want to prepare ahead of time. These could include:
Inpatient - Where young people (typically aged 13-17, but occasionally younger) are treated as inpatients for various mental health concerns. In a non-specialist unit, you may expect to see patients with a variety of conditions including eating disorders, psychotic disorders, mood disorders, developmental disorders, complex trauma or PTSD, and/or personality difficulties. In a specialist unit, you may work with patients who are only being treated (or mainly being treated) for one of these conditions such as a severe eating disorder.
Liaison - Liaison Psychiatry is a hospital-based team tasked with seeing children and adolescents who present to hospital (usually as a result of their mental health difficulties i.e. after a suicide attempt or with self harm). Their role is to assess risk and capacity, and the need for further psychiatric treatment, and to consider whether a patient needs to be treated under a Section of the Mental Health Act (MHA).
Community - The community mental health team usually consists of an acute service (crisis service) and a routine outpatient service through which a patient is seen by their specialist team of psychiatrists and other mental health professionals. This is typically through clinic or home/site visits. While SHOs may be invited to attend clinic and home visits with a senior nurse or doctor, they generally will not be expected to do this alone as a locum SHO unless they have had substantial training or experience in this already.
Specialist units/teams - CAMHS consultants can specialise in a number of fields, including psychosis, learning difficulties, eating disorders, and complex childhood trauma to name a few. There may be specialist inpatient units or outpatient clinics that deal specifically with one group of disorders or conditions but this is normally staffed at a specialist trainee or consultant level.
For the purposes of this article, we will focus on work on a non-specialist inpatient unit.
🗓️ What’s the day-to-day like?
🩺 Daily Ward Job
Day shifts are typically 8 hours (9am-5pm) Monday to Friday and do not include bank holidays or weekends. Unlike medical wards, most psychiatric units have a weekly ward round, instead of a daily one. These are MDT ward rounds and may involve input from a variety of teams including medical, nursing, psychology, OT, education, pharmacy, and social services teams.
The rest of the working week is left to carry out the tasks of the ward round and for any other jobs that crop up. Typically this will involve clerking in new patients, taking collateral histories and developmental histories from parents and carers, doing mental state exams (MSEs), examining or treating any wounds or injuries sustained on the ward, prescribing and monitoring medications and their side effects, phlebotomy and interpreting bloods tests, performing and interpreting ECGs, and sometimes inserting NG tubes for feeding patients with severe anorexia nervosa (not all units do this). You may also be required to attend additional meetings to take notes, or contribute your medical opinion.
Sometimes patients become acutely unwell on the ward. This can be due to any regular medical issue that a child or teen can face (ie. constipation, GI or GU infections, ENT infection, dermatologial concerns, management of chronic diseases like diabetes or asthma, or questions/issues with contraception) or due to new psychiatric medications that they are taking (i.e. sedation, anitcholinergic symptoms, postural hypotension, extrapyrimidal side effects, restless legs, hypoerprolactinaemia, serotonin syndrome, and neuroleptic malignant syndrome). It may also include illness due to self-harm by cutting, ingesting toxic substances or foreign bodies, headbanging or ligaturing (tying items tightly around their neck to cut off their oxygen supply). It might also involve a patient acting violently towards another staff member or patient. This can result in a patient being taken to a ‘de-escalation space’ and may involve ‘rapid tranquilisation’ with oral or IM medications. Nursing and healthcare staff are highly trained in managing these emergencies and usually a brief medical assessment is required after such incidents to consider whether escalation is required. You may need to liaise with the local hospital to decide whether a patient needs out of hours monitoring, inpatient investigation, or emergency admission to A+E.
⏰ On call shifts
On-call shifts may be day (usually 9am-5pm on the weekend or a bank holiday), twilight (usually 5pm-8pm) or night (usually 8pm-8am) so that there is medical cover outside of the working hours of the normal day team.
Usually on-call shifts or out-of-hours work involves an SHO covering multiple psychiatric wards including low security and high security inpatient units. This often involves some travel between units if the are located far apart. The role of the on call SHO is to clerk in new patients and examine the patient fully (though usually this is left to the day team if the patient comes in very late at night and is asleep when the SHO goes to see them). They are expected to prescribe routine medications and any emergency medications that the patient needs and perform any routine initial investigations (bloods and an ECG) if the patient is awake (i.e. day time during the weekend or on bank holidays).
There is always a consultant on call with you, and though you may never physically cross paths out-of-hours you will usually be in contact with them by phone during your shift. Usually, the consultant will let you know when they have decided to admit someone out-of-hours and give you a bit of a handover as to what they are being admitted for. They will usually also give you a plan over the phone for how to manage the patient when they arrive to the ward, and any key details you need to hand over to the regular day team.
If you have any questions or concerns out of hours, you can always discuss with the on call consultant for advice. This is important to know if a patient who is not legally detained under a Section of the MHA decides they want to leave hospital. Your job in this case would be to speak to the patient and assess their capacity to remain in hospital and their risk should they decide to leave. You should communicate your findings and recommendations (i.e. allow the patient to leave with their family/carer or detain them under section 5(2) of the Mental Health Act) to the consultant on call before you allow any patient to leave the building as they may be highly vulnerable and at risk.
💡 Our top tips to get you started
✅ If you have never worked in psychiatry before, it is worth getting some taster experience before you start.
✅ Your Trust will have guidance for prescribing rapid tranquillisation for adults and for children. Be sure to follow your local policies and protocols.
✅ History taking and examining is psychiatry is different to medical histories and physical examinations. Be prepared to spend a long time taking psychiatric histories and developmental histories. You will also need to know how to perform a mental state examinations, a capacity assessment, and a risk assessment.
✅ When dealing with physical health emergencies that you are unfamiliar with or uncomfortable with (i.e. reduced GCS following headbanging or ligature, swallowing toxic liquids, sharp items, or magnets, or significant self harm injuries) it is best to discuss your concerns with the local emergency department and agree a management plan and escalation threshold out-of-hours. It is important to remember that a psychiatric hospital does not have the resources or staff of a physical health hospital and maintaining patient safety is a priority. Always ask for help if you need it!
✅ Working in CAMHS can be really fun. Unlike adult psychiatric services, CAMHS units are usually better funded and have more resources around. If you do spend time on a CAMHS unit you may find yourself making pottery, playing Mario Kart, and singing karaoke which can be great ways of getting to know your patients and taking mental state exams in a less formal environment.
📋 Specialty-specific guides
We've also written guides for each of the main specialties, giving you detailed advice on how to settle into those departments. These are especially useful if you haven’t rotated through that specialty in your Foundation Training rotations.
👉 Tips for Locuming in a New Specialty – Obstetrics and Gynaecology
👉 Tips for Locuming in a New Specialty – Paediatrics
👉 Tips for Locuming in a New Specialty – General Surgery
👉 Tips for Locuming in a New Specialty – Emergency Medicine
👉 Tips for Locuming in a New Specialty – Trauma & Orthopaedics
👉 Tips for Locuming in a New Specialty - General Medicine
This article is part of a wider series of resources and guides that are designed to support you as a locum doctor, covering areas such as getting your first job, managing your finances, understanding your rights, and many more. Visit our Locum Doctor Hub for everything you need to know about locuming today.
Additionally, if you're considering an F3 year, you might also find it useful to look through the selection of resources we've put together in our F3 Resource Hub.
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