Billy Boland, Consultant Psychiatrist; Deputy Medical Director, Hertfordshire Partnership University NHS, Foundation Trust; Vice Chair (elected), Faculty of General Adult Psychiatry, Royal College of Psychiatrists

Why holistic care is vital - an insider's view of psychiatry

There are many wonderful things about being a psychiatrist. As a medical student and junior doctor, I realised it was the career for me early on. Having not been aware that psychiatry was a medical specialty even when I started out, I was captivated by how the psychiatrists that I met were trying to help the whole person. Yes there were medical treatments, but there were psychological approaches too. And social. I’d never met a social worker before my medical school placement in psychiatry and wasn’t sure what they did. But then, there they were in the ward round, taking part, and challenging the consultant on whether they fully understood the patient.

Had they properly thought about the home circumstances? What about their relationship with work? Were financial problems part of the reason they were here?

Connecting the parts

It was fascinating to me. As I sat there and took it all in, the penny began to drop. A lot of medical school had been about breaking down people in to parts. Quite literally. In my anatomy class we would study a leg, or a hand even. I vividly remember one afternoon focusing entirely on a shoulder blade. Whilst I could see that that segmenting things to understand them and learn was necessary, I was frustrated that it left me feeling not fully getting to grips with what was going on. How did this condition affect this person? What was the impact on them and their family? What was important to them to help them move forward?

During my ward round, this was all brought together in front of my eyes.. What I had thought a doctor was, was now materialising. The conversations I was now witnessing were about the person in the round, and understanding them. I was hooked.

It also made sense to me that life stressors have an impact on health. I had of course learnt about the deleterious effects of things like smoking and alcohol. But financial problems? Nope. It didn’t come up.

The impact of financial difficulty

You don’t have to think too hard to realise why financial problems might be important. Making decisions around money can be stressful, and the burden of debt on an individual’s mental health is all too easily imagined. Asking questions about personal finance is so important to understanding predisposing, precipitating or perpetuating factors for mental health problems (what we psychiatrists call the ‘Three Ps’). If debt is there looming in the background, aggravating, picking away at your peace of mind, the pressure on one’s mental health can be real.

One of the frustrations of course is that having identified that debt is an issue, we clinicians can have limited impact in how we help address that. Helping people access debt and money advice can be key. We are very privileged in my area to have close working links with our money advice unit in the county council (see the Money and Mental Health Policy Institute’s publication Whose Job is it Anyway?), but this is not the case everywhere. Good practice needs to evolve and spread.

What’s out there to help?

The Royal College of Psychiatrists has an information leaflet about debt and mental health that is worth reading. Raising awareness about the relationship between the two is important to aid understanding. It can also be the first step in helping people address these distressing challenges.