First of all, the local coordinator Sebastiao Viola, helped me a lot to arrange my stay before I left France. He set up everything and introduced me to a great family which hosted me during my stay. The father is a psychiatrist and the mother is also a medical doctor as well as a medical anthropologist. It was a great opportunity to share and exchange views of both culture with them and their children.They were lovely and we had also a lot of fun together.
I spent about 10 days with older adult liaison team and some days with general adult liaison in the Bristol Royal Infirmary. It was very interesting for me to discover their way of working. I was supervised by a consultant psychiatrist with who I went to visit patients in different wards. I’ve learned a lot about specific diagnosis and how to use different rating scales (to evaluate suicidal risk and dementia for instance) which we don’t usualy use in France.
I also joined the nurse’s team and I was amazed how well trained and professional they are here. Some of them are able to prescribe medication for exemple, others can give CBT therapy; they usually write reports for every patients they see to the general practitioner and I felt that due to their high qualification, they have also more autonomy than in France where we don’t have specilized psychiatric nurses anymore.
The role of the psychiatrist is slightly different, he is more of a superviser and see mainly the most complicated patients, or when medication is involved. A system of filters enables consultants to focus on patients who have real psychiatric issues. This is not always the case in my country.
I had a really good time observing psychiatric consultation for non explained psychosomatic symptoms and some teaching given was given for the team on the role of EMDR in PTSD by a specialised nurse. Everybody was friendly and made me feel welcome.
I was very interested by England’s mental health management since most of it relies on community. There are very few psychiatric beds. This is indeed often very difficult to get a patient to hospital, and many consultants complain about that. However community work is very developped; for example Bristol have «crisis teams» which works 24 hours and can visit accute patients at home in emergency and follow them for few days to prevent them to go to hospital. This was very new for me.
On the second week I joined the Central Bristol Recovery and Crisis Team Service. I participated to consultation of complex cases and also visited patients at home.
I had the opportunity to participate in the Early Intervention in Psychosis team for some days. This team deals with patients from 16 to 35 years old who are at risk to develop a psychosis (first episod or early symptoms). Many social workers and nurses are involved to prevent and to treat patient as early as possible and to take care of them for a period of 3 years maximum. This is quite a novative structure wich cannot be found in France. During that time I also observed a trial since a patient appealed against his treatment and I also got to see two assesments to detain accute patients at risk.
Concerning Bristol. It is a great cosmopolite city, with a lot of little cafés, charity shops, nice restaurants. Alternatives cultures have a very strong influence (some places even have an alternative money called «Bristol Pound»!). You will be amazed by the street art, the magnificiant Cathedral and of course Bristol’s suspension Bridge.
I had an amazing time in Bristol from a personnal and prefessional point of view and I recommand all europeans trainees to take part to EFPT exchanges.
Thanks a lot for everything.
Douglas Liddell, France.