Psychiatry Student Placements in NHS Lothian 

Welcome to your undergraduate psychiatry placement. This builds on your experience last year. We hope you have a great time on placement and enjoy the variety there is on offer! 

Teaching 

Most of your teaching during your placement you will get on the wards and in clinics, from the consultants you sit in with on clinics and ward rounds, the resident doctors on the wards or seeing patients yourselves. 

You will be told at the start of your placement where you will be each day and week – most placements have a week or two in a variety of sub-specialties as well as some out-of-hours exposure. Scroll down for an overview of each sub-specialty. 

In addition to this however, there are a number of further learning opportunities for you during your placement. 

All Students 

Simulation Sessions 

You will be invited to a simulation session on one of the Wednesdays during your placement. This happens in the Royal Edinburgh Hospital (REH) and will last from 09.30 to about 12.30. We cover three common scenarios in psychiatry in a fun, interactive and information dense format. It is a long session, so bring water and snacks! 

Formative OSCE 

In the penultimate Friday of each rotation, you will be invited to a formative psychiatry OSCE. This will involve 5 psychiatry stations and help you practise your exam skills without the full pressure of the exam. Always well received, there will be a mix of stations for you to try your hand at with real OSCE timing. Feedback will be given at the end of each station to help with your growth and hopefully to help you feel less nervous for the real thing! Invitations will be sent out at the very latest the week before the event telling you when your formative OSCE is. Please turn up on time as the afternoon runs like clockwork and you don’t want to be left behind! 

Edinburgh Students 

Clinical Skills Sessions 

An optional tutorial that runs on the first two Fridays of the rotation. Two difficult patient interactions will be examined with a simulated patient in a lively learning experience that allows you test out your communication skills, history taking abilities and mental state examinations. Invitations will be sent out in your first week of placement and it is first come first served. 

SimConverse 

We appreciate that practising clinical skills and seeing complex patients can be difficult. To help with this you will be invited to trial your clinical skills with a number of AI scenarios that we have made ourselves. These can be more complex patients that you can practice clinical skills on safely and at home. There are also opportunities to practise other clinical skills like handing over to nurses or referring to a registrar from other specialities allowing you to hone the skills that you will be tested on and will rely on in your day-to-day life as a doctor. 

Choose Your Own Adventures 

We have created three scenarios for you to work through during your time with in psychiatry. Harking back to the days of choose your own adventure flipbooks, these clinical scenarios will help you learn common psychiatric situations in and out of the psychiatric ward (some of which you will see daily as an F1). These fun and short scenarios are perfect for quieter moments, like when you are waiting for a resident doctor to return or for a clinic to start. In addition, we will be running two tutorials with these resources as the basis; troubleshooting any questions, queries or difficulties that might come up! You will receive invitations to these in the first week of your placement and it is first come first served. 

West Lothian Students 

Reflective Practice Group 

Students in West Lothian will be invited to a weekly reflective practice group where they can bring and discuss patients that have stuck with them. This is based on Balint principles and is a great way to learn about your own thoughts and feelings when seeing patients. 

East Lothian Students 

Weekly Tutorial 

Students placed in East Lothian will be invited to a weekly tutorial on their topic of interest. This will take place at the East Lothian Community Hospital (ELCH) or online if you are not able to attend in person. The provides flexible and bespoke teaching based on the students’ chosen topics. 

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Specialties in NHS Lothian Psychiatry 

General Adult Psychiatry 

Edinburgh 

Dealing with all patients aged 18-65, General Adult Psychiatry (GAP) in Edinburgh is split between inpatient ward in the Royal Edinburgh Hospital (REH) in Morningside and four community mental health teams (CMHTs) spread around the cities. 

Edinburgh also has an intensive psychiatric care unit (IPCU) for psychiatric patients who require more intensive management; an intensive home treatment team (IHTT), which acts like a ‘hospital at home’ for patients requiring daily psychiatric support but can be managed in the community; and the mental health assessment service (MHAS) who deal with referrals for urgent psychiatric review from GPs, the police and A&E. These are all also based at the REH. 

The CMHTs are similar to outpatient departments you will be familiar with, however they function more using a multidisciplinary approach and include a variety of team members to help the patients. All CMHTs will have psychiatrists who will do outpatient appointments in clinic and sometimes home visits as well. In addition, community psychiatric nurses and social workers support patient need while in the community. You may also meet other members of the CMHT team, such as psychologists and occupational therapists, who provide specialist therapeutic care to patients. 

West Lothian (St John’s Hospital) 

The general adult psychiatry services covers people across west Lothian with mental illness aged 18-65. There are community mental health teams with outpatient clinics are held at OPD5 and at many of the primary care centres throughout West Lothian. The west CMHT is located in Bathgate House, Bathgate, and the east CMHT is in Strathbrock,Livingston.  There is also the neurodevelopmental disorders service seeing patients in the community with various NDD presentations as well as new referrals .   

There is also one general adult ward at SJH, ward 17 which is a 23 bed mixed gender ward for people requiring hospitalisation for psychiatric problems. In addition there is an IPCU (intensive psychiatric care unit) at SJH for psychiatric patients who need more intensive psychiatric nursing support.   

The Acute Care and Support Team (ACAST) takes urgent crisis referrals for psychiatric assessment from the general community as well as provides home treatment or hospital at home style care for people with acute mental illness in West Lothian.  

Midlothian 

Midlothian GAP services are situated in the Joint Mental Health Team (JMHT) building in St Andrew’s Square in Dalkeith. This is one building with multiple services, including the Midlothian CMHT, the Midlothian IHTT and MHARS (Mental Health and Resilience Service). The IHTT and MHARS works 7-days a week 8am to midnight, and provides intensive care in the community, as well as reviews of acutely unwell patients who are referred from GPs and the police. Inpatient GAP care occurs in the REH for Midlothian patients. 

East Lothian 

In East Lothian, inpatients are seen in Hermitage Ward in the REH, but community patients are seen in clinics either in the ELCH or in the Esk Centre in Musselburgh. East Lothian also has an IHTT services which also sees urgent psychiatric reviews from GPs, the police and A&E, much like MHAS in Edinburgh. 

Old Age Psychiatry 

Edinburgh 

Old Age Psychiatry (OAP) deals with psychiatric patients over the age of 65. This is often split between patients with mental health disorders in common with GAP patients, such as psychosis or mania (often called ‘functional patients’); and those who have behavioural and psychiatry symptoms of dementia (BPSD). 

Much like GAP, OAP in Edinburgh has inpatient wards in the REH and CMHTs within the city. OAP also has its own versions of IHTT and MHAS called the rapid response team (RRT). 

In OAP, you will see a greater use of cognitive screenings and functional assessments being carried out. Physical health issues can be more prevalent in this population and OAP teams often liaise with geriatricians, neurologists and supported accommodations throughout the city to provide the best care for their patients. 

West Lothian (St John’s Hospital) 

There is an older adult psychiatric ward at SJH (Ward 3) which takes patients 65+ with mental health problems in older life including degenerative disorders such as dementia, and general psychiatric illness.   

There are also older adult community mental health services serving the older adult population of West Lothian. There is an older adult liaison team which takes urgent referrals for patients over 65 with mental health problems as well as reviews patients on the general medical wards.  

Midlothian 

Outpatient OAP services have two separate Community Psychiatric Nurse (CPN) teams for: The Dementia Midlothian Team and The Community Mental Health Team for the Elderly (who sees patients’ where their main psychiatric problems are not dementia related). However, from a medical point of view, all OAP patients are seen together in a clinic in the Outpatient Clinic Rooms within the Midlothian Community Hospital. 

Also within the Midlothian Community Hospital, is the Rossbank Centre – the inpatient OAP service. This is split between two ‘lanes’ (wards). Penny Lane accommodates patients with BPSD and Rose Lane which accommodates all OAP patients. 

East Lothian 

East Lothian boasts its own OAP service (Psychiatry of Older Adults: POA) housed in the ELCH, with an inpatient ward and outpatient services. There is also a memory clinic for the diagnosis and management of memory impairment and dementias in the community, which also runs weekly from the ELCH. 

Child and Adolescent Mental Health 

Edinburgh 

For patients under the age of 18, there is child and adolescent mental health services (CAMHS). 

CAMHS, like GAP and OAP, has inpatient facilities in the Royal Hospital for Sick Children (RHSC) and outpatient CMHTs throughout the city. There is also an CAMHS crisis team for more intensive at home management and emergency outpatient assessments. 

CAMHS covers a similar range of conditions to GAP, but you are likely to see more diagnosis and management of neurodevelopmental disorders such as autism and ADHD, as well as eating disorders such as anorexia and bulimia. Psychological therapies are often first line management in CAMHS and you may see therapies that are rarer in GAP, such as family therapy. The CAMHS team also works closely with paediatricians and safeguarding services due to the nature of their work. 

West Lothian (St John’s Hospital) 

There is a large multidisciplinary team based at SJH seeing CAMHS patients from across West Lothian. This is entirely community based at SJH as well as at the Day Unit at Willowgrove House, Livingston West Lothian, which provides intensive assessment for children and young people with mental health difficulties. Inpatient cover is based at the Royal Infirmary (Melville Unit). There is a CAMHS Unscheduled care service which reviews children and young people presenting out of hours with mental health problems , in concert with the SJH duty psychiatrist. 

Midlothian 

CAMHS services in Midlothian are comprised of a CMHT located in Eastfield Medical Practice in Penicuik, boasting a wide range of professionals from psychiatrists to CPNs and a variety of psychologists in different disciplines. Inpatient care for Midlothian CAMHS patients can be found at the RIE. 

East Lothian 

East Lothian CAMHS inpatients also go to the RHSC, from outpatient perspective they are seen in the Musselburgh Primary Care Centre. 

Psychiatry of Intellectual Disability 

Psychiatry of Intellectual Disability (ID) covers patients who have an IQ less than 70 and have mental health problems. A low IQ itself does not require specialist management, and many people with ID live healthy and happy lives without ever being seen by the IQ services. 

Edinburgh 

The ID wards are situated in the REH and much like the other services there are CMHTs throughout the city. ID also has its own service that assesses crisis referrals from GPs. 

Unique features of ID psychiatry include the different presentation of common mental health illnesses, an understanding of genetic and congenital conditions, management of epilepsy in patients with ID and functional testing and support in the community. 

East Lothian 

East Lothian ID inpatients also go to the REH, but they have their access to more local outpatient services from the ELCH. East Lothian also has the East Lothian Neurodevelopmental Services which is an outpatient service for adults with and without ID who have Attention Deficit Hyperactivity Disorder (ADHD). 

Forensic Psychiatry 

For those who have committed serious crimes and are psychiatrically unwell, forensic psychiatry has a wide range of support available. 

Forensics in Edinburgh and the Lothians operates out of the REH, and Edinburgh has its own medium secure unit with male and female wards. There is also a forensic CMHT for forensics patients who are out in the community. 

Forensics exists within complex legal frameworks that makes it a unique specialty to experience. The service offers a range of therapies from pharmacological to psychological and occupational. The forensic approach to risk management is also interesting to see. 

Addiction Psychiatry 

Addiction psychiatry covers patients who have substance addictions and would like help with those addictions.  

Access to addiction psychiatry is almost entirely voluntary, by the nature of the service and therapies. Thus, the mental health act is rarely used. Patients self-refer or self-present to services to begin their journeys.  

Outpatient addictions tends to focus on opiate and alcohol addictions, but addictions to other substances can be managed through therapy. Outpatient services can facilitate detoxifications, medications (such as methadone, or ‘antabuse’), social support and psychological support. Most patients will have a caseworker who will help them through their journeys. 

Trickier detoxifications are done in the inpatient units. As examples, these could be alcohol detoxes or conversion from methadone to buprenorphine. 

Many patients find coming off substances to be life-altering and it can be quite gratifying to see their recovery. 

Edinburgh 

Addictions psychiatry in Edinburgh has both inpatient and outpatient services available. Outpatient care occurs in addictions clinics throughout the city, whereas inpatient care can be found in the REH. 

West Lothian (St John’s Hospital) 

The addictions team base is in the Civic Centre in Livingston with lots of outreach community clinics as well as other clinics which also take place at SJH. There is an addictions liaison nurse who additionally provides cover for all the wards at SJH and takes referrals for inpatients with addictions issues. 

Midlothian 

There is also an addictions outpatient service in Midlothian, offering a wide variety of support including nursing support, psychiatric and psychological support and occupational therapy. They work closely with general psychiatry, social work, transition-to-work services and the criminal justice service (supporting patients coming out of prison) as with a local voluntary organisation: MELD (Mid and East Lothian Drugs). 

East Lothian 

East Lothian uses the REH for inpatient care but has its own addictions outpatient services in the Esk Centre in Musselburgh.  

Liaison Psychiatry 

Edinburgh 

Based at the main medical hospitals (Royal Infirmary of Edinburgh (RIE) and Western General Hospital (WGH)), liaison psychiatry bridges the gap between physical and psychiatric medicine.  

Liaison psychiatrists receive referrals from other specialities who are struggling with psychiatric symptoms from physical health issues or medications, physically unwell patients with concomitant psychiatric issues, or patients who are now physically well but still struggling with psychiatric issues. The team is composed of psychiatrists, trainees and nurses and cover all the wards in the RIE and WGH, as well as A&E Monday to Friday 9-5. 

You will often see interesting presentations that you would not see in a psychiatric ward in liaison and see common issues faced on medical wards (such as delirium), gaining an understanding on how to manage these as they arise. 

West Lothian (St John’s Hospital) 

There is liaison psychiatry cover for the general medical and surgical wards at SJH providing cover for patients 18-65, Monday – Friday 9-5. The service will see all patients who are treated following any form of self-harm and general hospital patients who appear to have mental health difficulties. At weekends and public holidays, liaison psychiatry cover is provided by the duty psychiatrist. 

Rehabilitation Psychiatry 

For patients with treatment-resistant and enduring mental illness, long admissions and residual symptoms can make returning to the community difficult. Rehabilitation psychiatry (rehab) aims to help patients achieve their maximum potential and return to the community with the best possible prospects they can. 

Edinburgh 

In Edinburgh, the rehab wards are located in the REH. There are also outpatient teams to help patients once they are back in the community to adjust more smoothly. 

West Lothian (St John’s Hospital) 

Pentland Court is situated in the residence area next to SJH. It is a residential mental health rehabilitation unit for patients with severe and enduring mental health difficulties. There is an MDT including a consultant psychiatrist and specialist nursing staff. 

The rehab teams work in a very multidisciplinary way, looking at the patient holistically. Psychiatrists work on medications, which can be complex. Nurses and OTs help with retraining the patient to live as independently as they can and to fulfil their own goals. Psychologists help with psychological hurdles that have arisen throughout each patient’s journey. Each patient can be complex and it is interesting to see the unique approach the teams take to each patient. 

Eating Disorders 

Psychiatry of eating disorders covers all psychiatric conditions where disordered eating causes psychological and physical harm. More common in the CAMHS population, eating disorders can often be life-threatening and require intensive medical and paediatric support. Care for patients with eating disorders is therefor by necessity multidisciplinary, with psychiatrists, paediatricians, physicians, dieticians, psychologists and nurses working together to support these complex patients. 

The Regional Eating Disorders Service is based in SJH. This is the regional unit for South East Scotland. This is a 12 bed inpatient unit for people with eating disorders requiring inpatient admission. There is also a Lothian Eating Disorder Service which covers referrals for eating disorders for adults 18 and above across Lothian, which is based at the Cullen Centre at the Royal Edinburgh Hospital. 

Perinatal Services 

Perinatal services help patients with mental health issues who are pregnant and up to a year post pregnancy. This may be a patient with longstanding mental health disorders who become pregnant, or disorders you only see post-partum, such as post-natal depression and psychosis. Medication plays a big part treating these patients, and so a good understanding of obstetric physiology as well as what drugs are safe in pregnancy and during breast feeding is key.  The perinatal services therefore need to work closely with obstetrics services, midwives and social services (as home dynamics may be complex). 

The community perinatal services see people with mental disorders in pregnancy and the postpartum period. There are perinatal community mental health teams based at SJH and the royal infirmary, and the team covers referrals across Edinburgh and the Lothians.  

The mother and baby unit (MBU) located at SJH takes admissions for mothers and their infants in the perinatal period. The MBU is a 6-bedded unit (maximum capacity 6 mothers and 6 babies). It is a regional centre for South East Scotland for admission of women in pregnancy and the postpartum for psychiatric conditions requiring inpatient care. 

Neuropsychiatry 

Split between the REH and Astley Ainslie Hospital (AAH), with some clinics in the WGH and RIE, Neuropsychiatry works at the interface between neurology and psychiatry.  

In neuropsychiatry you will see management of psychiatric symptoms from head injuries, functional disorders such as functional weakness or blindness, or psychiatric complications of neurological disorders such as young onset Parkinsons. 

With both inpatient and outpatient services, this is a very specialised field. 

Psychological Therapies 

Spread throughout the city in different services, as well as having its own base in the REH, there are a range of psychological therapies that can be accessed in Edinburgh. 

The East Lothian service is based in the ELCH and works closely with the East Lothian CMHT. 

Whether this is Cognitive Behavioural Therapy, Interpersonal Therapy, Cognitive Analytical Therapy or psychodynamic psychotherapy there will be opportunities to talk to psychologists, psychiatric nurses and psychiatrists about what therapies they provide, how they work and their views on them.