2) Some wards, especially forensic or intensive care psych wards won't let you work in them if you have mobility problems. There are two main reasons for this - not being able to make a quick enough getaway if somethings kicks off, and the potential for a stick or crutches to be used as a weapon.
Noone mentioned this to me before my placement, but I suppose the people to talk to would be whoever decides which student goes to which ward (to ask them to avoid placing you on secure wards), occie health for the hospital, or your supervisor for the placement to ask if they do any work on a secure ward, and what the local policy is on this.
3) It is worth spending some time with CPNs, to get an idea of how community psychiatric services are organised. House visits may not be possible, depending on issues of accessibility, but CPNs will often run clinics at the CMHT base. If nothing else, ask a CPN to describe their job, and ask a few patients what their experiences are with CPNs.
4) This isn't actually psych-specific, but this is just where it came up for me. My partner would have been placed with one of the doctors who I saw when I was under the CMHT if she hadn't happened to be on holiday. It hadn't occured to me before that I could end up placed with one of my doctors. There is not really any facility to deal with this at my med school, because allocation of supervisors is handled at the hospitals rather than centrally.
If you do end up in that situation, I suppose there are two options : either get in touch with the med school / teaching administrators and ask to be transferred to somewhere else, or sit down with the doctor in quesion and talk about any issues that might come up. It might even be helpful for your consultant to see exactly how you're managing on placement.
5) During my A and E placement, I found it really difficult how certain doctors talked about / to patients who had self-harmed or overdosed. I reported one particular incident to a consultant because it was so inappropriate. I understand the frustration that doctors feel when they feel like they're getting taken away from people who didn't "choose" to be there, but this frustration should not be taken out on patients.
People will not think of the possibility that you, or members of your close family/friends may have been affected by similar issues. There is an 'us' and 'them' mentality, which feels very awkward as someone who is both.
6) If you are likely to be at all triggered by anything that comes up during placement, make sure your 'support network' - partner, friends, family, minister, disability advisor, CPN etc - know that you are starting the placement, and that it may be difficult for you. Make suggestions about how they can best help and care for you, if you know.
7) I have done two psych placements now, and both times I have told my supervisor that "I have a history of mental health problems" so that they knew in case I was struggling. If this feels too personal, or for whatever reason, you could say that a close family member / friend has mental health problems instead. This will hopefully stop them saying stupid things in front of you, will give you a chance to raise any suggestions e.g. "can you give me a brief run down of each patient before they come in so I don't get surprised by anything difficult?",
8) I don't normally journal regularly, but I wrote in a journal every day during my two psych blocks, so I could explore anything that had triggered me, and any emotions that the placement had brought up. Having said that, neither I nor any of my friends with MH problems have found the psych block particularly bad. I still think it's a good idea to prepare for the worst, just in case. Have a think about what you can do to cope if you have a tough time of it.
9) Prioritise your own health. Don't put yourself in any situations that you know are bound to cause problems, such as patients with a similar condition or history to you, or those who are aggressive and intimidating. Focussing on some of the theory (side effects of psych meds seem to make for popular exam questions) can help to take out some of the 'sting' of it
10) That being said, you will have to face some psychiatry in both final exams, and as a junior doctor (and, obviously, you will always find patients with mental health problems popping up in other specialities), so you need to find a way to, for example, assess a suicidal patient, and do it well and thoroughly, without damaging your own health. There are no easy answers to this, but I suspect that, as with many things, the key may lie in practice.
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