Psychiatry, a field of medicine both challenging and rewarding, offers a plethora of specialist paths for the newly qualified specialist and junior doctor embarking upon specialist training. In this article we shed light on the various, and growing, branches of this discipline guiding both candidates and clients through the intricate landscape of this vital medical field.

Psychiatry, long regarded as a marginal specialism by the medical profession, has emerged as one of its largest and increasingly diverse, requiring an unique range of skills and expertise which distinguish it from other medical fields. Increasing demand for psychiatric services in many countries (particularly developed countries) has contributed to the shortage of psychiatrists experienced by many healthcare systems and created career opportunities for international medical graduates to work as specialist psychiatrists and enter training programs as resident medical officers.

Before commending a job search, it is wise to review the development of psychiatry, once a unified speciality, into a diverse range of specialist areas practising in different settings with different demographics and objectives.

General Adult Psychiatry

This is the cornerstone of psychiatry and the largest discipline, dealing with the diagnosis, treatment, and prevention of mental disorders in adults. From anxiety to schizophrenia, general adult psychiatrists provide a beacon of hope to those navigating mental health challenges.

General adult psychiatrists manage patients aged 18 to 65, although there is variation between countries on the precise boundaries between adulthood and adolescence and old age. They treat patients in the community, in out patient clinics or offices and where necessary, as hospital in patients. At times they may need to use legal procedures to forcibly admit patients to hospital for treatment. Using drugs, psychological therapies and sometimes electroconvulsive therapy (ECT), they aim to return patients to home and health.

Within the speciality, various subspecialist fields have emerged focused upon developing expertise in the management of the acutely psychotic or disturbed patient in psychiatric intensive care units (psychiatric intensive care), the management of patients with mild mental illness or in remission from severe mental illness in the community (community psychiatry or out patient psychiatry) and the care of acutely ill patients on hospital wards (in patient psychiatry).

Child and Adolescent Psychiatry

As the name implies, this speciality focuses on the assessment, diagnosis and treatment of mental illness in minors, generally under the age of 18. It adopts a holistic approach involving all family members to identify and treat a wide range of mental health issues including autistic spectrum disorder, depression, eating disorders, emotional problems, developmental and behavioural problems.

Child and adolescent psychiatrists work with children across their developmental stages, from infancy to the onset of adulthood and collaborate with other psychiatric specialties in addition to general practitioners and paediatricians.  Historically this speciality developed in response to the establishment of juvenile courts, with the first organised child psychiatry service opening in Chicago in 1909.

Old Age Psychiatry

With the grace that accompanies aging comes a range of mental health considerations. Old age psychiatry, also known as geriatric psychiatry, focuses on the assessment, diagnosis and treatment of  mental health disorders in older adults, including dementia, cognitive impairment, mood disorders, anxiety disorders and personality disorders.

Old age psychiatrists work in the community to promote independence and choice and collaborate with GPs, occupational therapists, and other professionals to provide personal care at home where possible. Serious mental disorders require hospital admission and most general hospitals have beds dedicated to psychogeriatric patients. 

Liaison Psychiatry

Liaison psychiatry, also known as consultative psychiatry or consultation-liaison psychiatry, is a recognised subspecialty of general adult and old age psychiatry which focuses on the relationship between physical and psychological health. Liaison psychiatrists provide mental health care to hospital patients who are being treated for physical illnesses

Liaison psychiatrists treat patients with a range of mental health problems, including anxiety, depression, eating disorders, and self-harm. They also work with patients who have multiple chronic health conditions in a variety of hospital settings, including out-patient clinics, accident and emergency departments, and in-patient wards. They assess and treat patients, educate general hospital colleagues, and work with medical and surgical colleagues. 

Some examples of problems that may be referred to liaison psychiatry include:

• Psychological reactions to physical illness
• Deliberate self-harm
• Medically unexplained symptoms
• Organic mental disorders
• Alcohol and substance misuse
• Mental illness related to childbirth

Addiction Psychiatry

Addiction psychiatry is a medical subspecialty within psychiatry which focuses on the evaluation, diagnosis, and treatment of people who have one or more disorders related to addiction. This may include disorders involving legal and illegal drugs, gambling, sex, food, and other impulse control disorders. Addiction psychiatrists are substance use disorder experts.

Growing amounts of scientific knowledge, such as the health effects and treatments for substance use disorders, have led to advancements in the field of addiction psychiatry. These advancements in understanding the neurobiology of rewarding behavior, along with research funding, has allowed for ample opportunity for research in the discipline of addiction psychiatry. Addiction psychiatry is an expanding field, and currently there is a high demand for substance use disorder experts in both the private and public sector.

One of the newest specialities, addiction psychiatry was first recognised in 1993 by the American Board of Psychiatry and Neurology and the American Board of Medical Specialties and was later accepted in other countries including the UK, Canada, Australia and New Zealand.



Forensic Psychiatry

Forensic psychiatry combines psychiatry with law to treat people with mental disorders who may be violent or pose a risk to the public. Forensic psychiatrists must have a detailed knowledge of criminal and civil justice systems, and mental health systems.

Forensic psychiatrists work in a variety of settings, including prisons, secure hospitals, and the community to treat people with mental disorders who have committed crimes, or who become unwell in prison. They work with the police, probation, courts, Crown Prosecution Service, and prisons. 

Their responsibilities include the assessment of the risk of harm to others and the patient, formulation of treatment plans, and provision of advice to the courts, probation service, and prison service. Some forensic psychiatrists specialize in areas such as forensic learning disability or forensic psychotherapy. 

Intellectual Disability Psychiatry

Psychiatrists working in the field of intellectual disability assess and treat adults with intellectual or learning disabilities which includes the assessment and management of neurodevelopmental disorders such as attention deficit hyperactivity, autism spectrum disorder and epilepsy. The patient demographic has a higher prevalence of mental illness with poorly differentiated presentations, creating diagnostic challenges. Patient management is holistic, involves family members and support staff and is often conducted in the community.



Medical Psychotherapy

Medical psychotherapy is a speciality which combines psychiatry and psychotherapy to assess, diagnose and treat patients with mental disorder.  It involves sitting in a room with a person or people in mental pain, psychological confusion, conflict and distress and trying to make sense of what is going on before offering a range of psychological treatments. Psychotherapists develop expertise in how experiences such as trauma, loss and attachment patterns are central to shaping personality, and vulnerability to psychiatric breakdown and are able to offer an advanced level of clinical understanding across psychiatry.

Neuropsychiatry

Neuropsychiatry combines psychiatry and neurology to understand how the brain and social psychology interact to cause behaviour. Neuropsychiatrists assess and treat patients with mental disorders which may be caused by brain malfunctions. They work in a variety of settings, including general hospitals and multidisciplinary teams and use a variety of methods to evaluate disorders, including neurological investigations, psychometric studies, brain images, and the interpretation of the effects of treatments and conditions

Neuropsychiatrists treat a range of conditions, including epilepsy, multiple sclerosis, Parkinson's disease, Huntington's disease, dementia, schizophrenia, Alzheimer's, and cerebral palsy.  

Rehabilitation and Social Psychiatry

Rehabilitation and social psychiatry focuses on managing patients with complex and long-term mental health issues to enable them develop the skills they need to live, learn, and work in the community with minimal professional support. It involves working with families and social circles, respecting the individual's values and beliefs, and taking a broad view of their wellbeing in order to maximise quality of life and social inclusion, and promote independence and autonomy. Rehabilitation psychiatry is an important part of the Forensic Pathway, as it allows mentally disordered offenders to receive rehabilitation and return to community settings. 

Perinatal Psychiatry

Perinatal psychiatry is concerned with the assessment, diagnosis, and treatment of mental health disorders during pregnancy and after giving birth. Perinatal mental health issues can affect up to 27% of new and expectant mothers and if left untreated, can have long-lasting effects on the mother, child, and family.

Perinatal psychiatry is considered a relatively new specialty, but mental health problems after childbirth have been recognized for a long time. The first written account of postnatal mental illness was published in 1858 by French psychiatrist Louis Victor Marcé. 

Positioning Yourself in the Psychiatry Landscape

Specialising in one of the above disciplines allows you to refine your expertise, contribute to the field through dedicated practice and research, and provide exceptional care tailored to specific populations or disorders. However, choosing your specialisation is akin to selecting the right instrument for a piece of music; it must resonate with your skills, interests, and abilities.

We are here to help you harmonise those factors with the right organisational opportunities, ensuring your career sings the right notes of success and satisfaction. As we navigate the currents of medical recruitment together, remember that we are committed to illuminating your path, offering insights that pierce the shrouds of uncertainty, and introducing you to opportunities that align with your specialty and aspirations.

If you are seeking to connect with organisations in need of your psychiatric expertise, or if you represent a healthcare organisation looking to enrich your team with dedicated professionals, together, we shall weave a narrative of success, building bridges between talent and opportunity in the realm of psychiatry.

Let us start a dialogue about how we can steer your career in psychiatry to its next horizon or how we can solidify the backbone of your psychiatric department with stellar talent. Get in touch, and make meaningful and impactful connections that resonate with your goals.

Useful Resources

While you continue your job search, Odyssey Recruitment provides useful resources to keep your career moving in the right direction. Begin the application process now, and then learn more about how we can help you.

• Medical Job Search Tips: Use the content here to learn everything you need to know about optimal searches for medical jobs in different geographical locations and the physician recruitment processes.
• Medical Jobs by Specialty: Explore medical jobs around the world and learn about the various options and remuneration packages
• 7 Essential Tips for Drafting a Compelling CV for Psychiatrist Jobs
• The Top 10 Skills Every Psychiatrist Needs For Career Success
• Navigating the Complexities of Psychiatry Recruitment
  
• The 4 Stages of Medical Education in Australia and New Zealand
• New Zealand | Residency, Visas and Citizenship for Doctors and Dentists
• New Zealand | Understanding Medical and Dental Employment Contracts
• Practise Medicine and Dentistry in New Zealand - A Guide to the Healthcare System