Psychiatry is at Fulbourn Hospital (5-10 minute drive, 15-20 minute bike ride from Addenbrooke's). There is free car parking at Fulbourn Hospital with plenty of open car parks - you are allowed to park anywhere and do not require a permit. There are also bike racks. Although there is no canteen on site, the local Tesco's (with a Costa upstairs) is 2 minutes walk. There is a bus stop here with frequent buses from the city centre / Addenbrooke's. All of the wards have staff kitchens also. In 2017-2018 there were three FY1s at any one time working in psychiatry. There is usually one FY1 on Mulberry 1 (acute 3-day unit), one on Mulberry 2 (acute 3 week unit) and/or 3 (recovery 3 month unit) and one in Willow Ward (functional old age psychiatry). There are several other wards in Fulbourn and on the Ida Darwin Site, but FY1s do not tend to be placed there. There are two main sites: Fulbourn and Ida Darwin. Most things FY1s need to do are at Fulbourn (the main wards and Elizabeth House, which is the main administrative centre / reception desk). Ida Darwin is about 5 min drive/cycle/ 15 min walk from Fulbourn. The only thing of interest for most FY1s at Ida Darwin is Block 14, which has the teaching centre - that's where you get the induction and the library, well as as the weekly case conferences, attendance at which tends to be encouraged. This is also where you submit annual leave/study leave forms, as this is where medical staffing are based. Teaching is on Tuesdays and sometimes there are case conferences and other learning opportunities on Thursdays.

In 2017-2018, there were two Foundation Year 2 doctors working in liaison psychiatry based at Addenbrooke's Hospital. One works with the adult team and the other with old age. There is plenty of opportunity to see patients independently from the point of referral and think of an appropriate management plan, before discussing your findings with the respective teams. The autonomy integrated with the team-work attracts many doctors to liaison psychiatry. The general adult Liaison FY2 works at Fulbourn on Wednesdays in Mulberry 1 to admit the detox patienst who are later reviewed by the consultant in the afternoon. They also write up the discharge notifications and discharge summaries of the detox patients for the following Tuesday when the patients are discharged. Another F2 works at CAMEO, which is the local Early Intervention in Psychosis team (based at Union House). Another FY2 is also based at Union House who is rotating from Hinchingbrooke Hospital and is placed in the South Locality Team.

Try to find out from Nicholas Morgan (nicholas.morgan@cpft.nhs.uk) which ward and which consultant(s) you'll be working with. Failing this, medical staffing may know (medicalservices@cpft.nhs.uk, jan.hazell@cpft.nhs.uk, sandra.cooper@cpft.nhs.uk). Annual leave should be applied for 6 weeks in advance (though sometimes it can be more short-notice) and you need a consultant's signature so get that sorted near the beginning of your placement or even before it starts. The leave is not fixed, so you need to apply for it whenever you want and they normally give it to you without any fuss. However, you need to make sure that there is adequate cover on your ward, and in addition to the consultant's signature, you need the signature of those colleagues who will be on the ward when you're away. As the job is unbanded, you are guaranteed to get bank holidays off (great for those posted here over Christmas!). However, they are currently looking into including FY2s on the on-call rota. I don't know whether or when this will be implemented. FY1s are not included on the on-call rota. The job is supposed to be 9am-5pm Monday-Friday, but, as in any specialty, one will occasionally have to stay late. Currently there are shortages of staff (doctors) on the majority of wards so getting your leave planned in advance is advised.

There are also some CPFT elearning modules to complete in your first month. Some can be done in induction, the rest must be completed in your own time.

The first few days are filled with an induction to psychiatry where you will have lectures about specialist topics such as history taking in psychiatry, and various mental health conditions. After this you will start working on your home ward. There will also be training on the use of the emergency medical bags and what to do in emergencies, fires etc. There is very little equipment available in medical emergencies and therefore calling an ambulance is the first step if someone is acutely unwell.

Lots of little buildings spread out over a large area. Go to Block 14 in Ida Darwin when you first arrive (or wherever it tells you in your induction pack, or, if all else fails, to Elizabeth House).

The psychiatry services in Cambridge are in 3 main areas: Addenbrooke's, Ida Darwin and Fulbourn Hospital. There are also community services based in Union House.

Addenbrooke's consists of the liaison service (S2) and S3 (eating disorders ward). Fulbourn contains most of the adult and older people's wards. Ida Darwin has admin blocks and most of the child and adolescent services/wards.

Maps are provided at induction and it is relatively easy to find your way around as there are signposts throughout the site. Plenty of parking on site.

If you are the Liaison Psychiatry FY2, you will be based at Addenbrooke's Hospital every day except for Wednesdays, when your role will be in the Drug and Alcohol service on Mulberry 1, Fulbourn Hospital.

There is also a crisis resolution and home treatment team. This team (formed mainly of nurses and doctors, their consultant currently being Dr Monica Santos) is based in an office attached to Mulberry 1. They tend to have an FY2 attached to them.

Although you are unlikely to have to go there, it is useful to know about the existence of Union House which is where lots of outpatient psychiatric services are based and is located in the centre of Cambridge. THis is in the process of being transferred elsewhere.

Mulberry 1 Ward (3-day Assessment Ward): This is ward has 11 acute psychiatric beds and 3 detoxification beds. The team consists currently of: 1 Consultant (currently Dr Praseedom), 1 SpR (currently a staff grade working 5 days per week),2 CT1's (one only working 2 days a week) an FY1, psychiatric nurses and HCAs. . In addition to the ward staff, other support staff come and go (including OTs, a phlebotomist, a so-called homeless prevention officer, dietician, members of the crisis team, pharmacist, etc.). The three detox beds are for patients who are electively admitted for drug and alcohol detoxification. Patients are usually admitted every Wednesday morning for a 2-week admission (currently under consultant Dr Wood, who visits the ward on Wednesday afternoons (as well as at other times in case of any difficulty)). The psychiatry Liaison FY2 who attends the ward on Wednesdays, tends to clerk these patients in. For the rest of the week, one of the Mulberry 1 SHO's is responsible for these patients, and reports to Dr Wood by phone if there are any issues. You are also expected to complete the discharge summaries for the patients who have been discharged over the week when you arrive on Wednesday (FY2 doctor). The FY2 should also do a preliminary discharge notification for the week before, which can be amended by the Mulberry 1 FY1 / CT doctors.

Mulberry 2 (3-week unit) and 3 (3-month unit): those patients who need longer assessment and treatment than can be offered by Mulberry 1, tend to be admitted to these wards. This includes patients under section of the Mental Health Act (sometimes such patients are initially admitted to Mulberry 1 if there are no beds on Mulberry 2 or 3, but are transferred to Mulberry 2 or 3 once a bed becomes available.

Mulberry 2 and 3 therefore consists largely of patients with various forms of psychosis - schizophrenia, some mania, and very occasional depression or personality disorder. It is fast paced for a psychiatry ward (be sure to wear an alarm) but a fantastic experience, with a large amount of hard boiled psychiatry.

Willow Ward (functional old age psychiatry): 2 consultants (Dr Hatfield & Dr Rubinzstein), 1 SpR, 2 SHOs (psychiatry trainees and GP trainees), and plenty of MDT members (psychiatric nurses, physios, OTs and social workers and discharge planning people, plus input from crisis team). willow_ward_induction.docx

Denbigh ward is the old age dementia ward for patients whose condition cannot safely be managed at home or in a nursing home due to to their behaviour e.g physical/verbal/sexual aggression towards others.

CAMEO is based in Union House in Chesterton (north Cambridge). The team deals with first episode psychosis mainly in young people but now up to age 65. There are 3 consultants but usually only 1 on any given day. Sometimes, there is a part time specialist registrar, though this is variable. The rest of the team consists of different health care professionals- social workers, nurses, occupational therapists, support workers and peer support workers. The team have a case load of about 100 patients whom they see in the community. Patients are referred to this service by ARC, the wards, liaison psychiatry, the home treatment team, GPs, and college/school nurses. Patients can also directly self-refer. The patients are assessed by a doctor and another team member and then presented at the weekly team meeting on Tuesday to decide whether or not the case is taken on or the best service for them (e.g. GP, IAPT etc).

The Liaison Psychiatry team has the adult team which covers in patients 18 - 64 years old, the old age team which covers patients over 65 years and a substance misuse team which covers patients with alcohol and/or drug dependence. The adult team consists of 2 consultants, one registrar, one core trainee, specialist nurse and one FY2. The old age team consists of two consultants,specialist nurses, and one or more FY2s. There is also a psychology team including a specialist trauma service. The FY2 post provides an exceptional learning experience, as there is plenty of time and opportunity for teaching, which everyone is eager to do. In addition there is plenty of opportunity to have supervision when reviewing inpatients.

The crisis resolution and home treatment team (CRHTT) is a team of specialist nurses, occupational therapists, support workers and doctors (the consultant Dr Kar-Ray, 2 registrars and an FY2) who support patients during times of an acute deterioration in mental health. Patients can be referred by their GP through the “central hub”, by outpatient psychiatrists or at the point of discharge from Fulbourn inpatient services. The team provides a 24-hour service with a phone number that patients already under the CRHTT can call at any time. Generally patients are contacted once a day, either by telephone call or home visits, and they remain under the care of the CRHTT for between 1 and 2 weeks. Each patient is reviewed by a doctor once every 2-3 days or when another member of the team feels it is required. Unless it is unsafe to do so, it is generally better for patients to remain in their own home rather than being hospitalised; the CRHTT allows this to happen.

Other wards: George Mackenzie House (low-secure unit), Phoenix Centre (unit for young people with eating disorders), Darwin Centre (young people with mental illness).

Because psychiatry is 9-5 Monday to Friday with no weekends, late shifts or nights for FY1s, it is unbanded. It also means that it can be quite wearing working all the time, although at least the shifts are short and you often leave on time. You get 9 days annual leave but no zero days. You can take the annual leave whenever so long as you get a consultant signature and a signature of those colleagues who are going to cover for you, and apply for it in good time (see above). Due to rota shortages medical staffing are keen to incorporate F2s into the rota as locums, offering a 'shadowing' shift for you to get acquainted with what an SHO at Fulbourn does. This is quite a good opportunity for F2s to learn more from the job.

Willow Ward: This is an excellent placement – you will be supported at most time. You may find yourself on days (or weeks) when you are the only one on the ward, but should you need help you can call up duty doctor/consultants. Nursing staff are amazing and will help you – remember though they are not MEDICALLY trained and you will be dealing with all the medical worries.

Mulberry 1 Ward: This is appears to be the busiest of all the Fulbourn FY1 jobs. Due to the 3-day stay, there is a high turnover of patients. Usually, after 3 days, patients are either discharged home with follow-up in the community or transferred to Mulberry 2 or 3 for continued assessment/treatment. Sometimes, due to lack of beds on other wards, patients can stay longer than 3 days. Days are supposed to be 9am-5pm, but, as in all other rotations, one will need to stay longer at times.

The Liaison Psychiatry FY2 will attend a morning board round within the department each day (except for Wednesdays), where a brief discussion amongst the team members of each patient will take place. New referrals will then be allocated to each member. This will include the FY2, who will then have the opportunity to read the relevant case notes and discuss further with any of the consultants, before carrying out the initial assessment of the patient and creating a management plan in agreement with the consultant. There will also be remaining time during the day to review previous cases. The FY2 will have nine days of annual leave and the option of up to ten days of study leave. Dr Christmas, who will most likely be your supervisor, is extremely flexible with allocating this leave.

CRHTT - The normal working hours are from 9am-5pm. The team are often pretty flexible with leave and study days as there is almost always at least one SpR scheduled to work on weekdays. Will still require the consultant (Dr Kar-Ray) to review and agree to any leave requests.

Cameo is 9-5, 5-day weeks. You always leave on time. Leave is easy to organise. It does not have a great deal of variation in terms of day-to-day work, but if you're keen because the job is not highly pressured and at times the caseload is lighter, there is time for you to shadow or observe things, or go on visits more from an interest and learning perspective than anything else. Your are also responsible for running the Physical Health Clinic (which involves baseline assessments and antipsychotic monitoring) for all of the CAMEO patients.

Willow Ward Ward Rounds: Tuesday morning 9.15am – Dr Rubinsztein Wednesday afternoon 2.00pm – Dr Rubinsztein family meetings Thursday afternoon 2.00pm – Dr Hatfield

For this you will need to prepare the documents for each patient, usually the day before. This can be found in the ‘most important folder’ under MDT. Each consultant has a folder, then a year, month and finally dated. You have to create these as you go and it is self-explanatory once you find this. A template for the WR can be found on the first page of MDT for new patients. Usually you can copy them from the week before and adapt them.

You will also need to create a ‘REVIEW’ on RiO for each patient. This can be done by finding the patient you want to create a review for, find the section on the right had side saying ‘REVIEW’, CPA, Schedule Review (at the bottom), set the time and date it will happen (30mins long usually), tag the consultant only in the meeting, and then save without appointment at the bottom.

Copy and paste the word document into this appointment when it is done – click the green arrow on the appointment found in the ‘review section’ and copy it into the ‘Other’ box. Sadly you have to fill in the bottom parts (say retired, mainstream typically). The only important thing from this bottom area is ‘SOCIAL WORKER INVLOVED’ – for some of the section meetings (called 117 meeting) this is a legal requirement so if one is present please tick it off before ‘validating’. If you don’t validate the post, it will not come up on the

Apart from the infrequent ward rounds, Tuesday lunchtime psychiatry teaching (sometimes with lunch, sometimes not, at Ida Darwin), and Friday lunchtime teaching at Addenbrooke's, all the days are fairly similar.

Mulberry 1 Ward: MDT meeting/handover (doctors, nurses, crisis team, OTs) every day at 9:15am (before this, you will need to print the ward list, start any outstanding jobs from the previous day, etc.). Ward rounds are held every day and start after handover until lunch time, then resume at 2pm if necessary and go on until every patient has been seen. An FY1 or SHO sits in during the ward round (called ward review on Mulberry 1) and types what is discussed. After seeing patients with the Consultant and SpR, you are expected to carry out ward round jobs (some jobs are done by the nurses). For new admissions, you must ensure to clerk the patient in (including mental state examination and risk assessment), carry out a physical examination and an ECG, fill in a drug chart, VTE assessment and a medical alert card (to alert other members of the team of a patient's physical illnesses, and write up blood forms. Often, most of the clerking has already been done by the admitting team, but the FY1 or SHO usually still needs to conduct a mental state examination, and almost always the physical side of things. There is an agreed cut off at 4pm, whereby new admissions can be handed over to the twilight SHO on-call. For patients who are discharged, you need to write the discharge notification on the day of discharge so pharmacy can dispense the correct drugs, then you have 5 days to complete the GP discharge summary letter. Mary, the administrator is very good at keeping a list of outstanding discharge summaries, and you can ask her to keep you updated with this. There tends to be a case conference in Block 14 on the Ida Darwin site at lunchtime on Tuesdays, and talks at Addenbrooke's at lunchtime on Thursdays. Attendance is optional and depends on how busy you are, though some consultants encourage it.

CAMEO There are several meetings which take place regularly, and it is advisable to attend them: Tuesdays 9-11am: MDT meeting. New patients are presented by the member of the team who assessed them. The cases are discussed and then, if the patient accepted, a Care Co-ordinator is allocated. “Red”-unwell and high-risk patients are discussed and the management plan is established. Tuesday lunchtime - case presentations. Always interesting to attend. Be aware you will be expected to present one case during your rotation. Thursday mornings - case formulation. One of “difficult” patients is discussed in more detail. These sessions are usually led by Kate Treise, Clinical Psychologist.

The rest of the week can be spent going on visits with Care Co-ordinators. They are always happy to take you with them, however patients need to give their consent for you to be present during the visit. Both Consultants (Dr Murray and Dr Perez) are keen educators, and you are welcome to join the in clinics. You are also usually free to go to a Ground Round in Addenbrooke's on Wednesdays.

You will be in charge of Physical Health Clinic, which is run twice a week. You can choose a date and come up with a list of patients you need to see from an eExcel spreadsheet. The easiest way to do it is to email all Care Co-ordinators your tentative list in advance, so that you know who is unlikely to turn up or needs a lift. Attendance is very variable! Of 10 invites usually around 4 or 5 attend. More detailed information can be found in local induction pack, which you will get on your first day.

The typical psychiatry day tends to have a different structure than a day in medicine or surgery. Attend ward round if there is a ward round. Otherwise do jobs that have been generated by ward round, do TTOs (a much larger job than in other specialities - takes a long time), clerk in new patients once you feel confident, see patients on the ward.

Mulberry 1: Typical day has been explained above.

The Liaison Psychiatry FY2 will attend a morning board round within the department each day (except for Wednesdays), where a brief discussion amongst the team members of each patient will take place. New referrals will then be allocated to each member. This will include the FY2, who will then have the opportunity to read the relevant case notes and discuss further with any of the consultants, before carrying out the initial assessment of the patient and creating a management plan in agreement with the consultant. There will also be remaining time during the day to review previous cases. One day a week you will be the duty bleepholder, which means you will take incoming calls (seniors are always happy to help with calls requesting psychiatric advice), check for new referrals, triage and allocate to the appropriate team member.

If you are assigned to work with the CRHTT then the day begins at 9am with a handover meeting between the night team and the day team. The team goes through the list of patients under their care and staff decide who will go and see which patient. At 9:15 a member of the team (not usually a doctor but can be interesting to go along to see what happens) goes to Mulberry 1 to discuss any patients who are for discharge that day and may need CRHTT support. On Mondays there are 2 MDTs (one for the North team and one for the south team) which all the CRHTT doctors attend, along with the rest of the team and discuss how the patients are progressing. When a patient is first referred to the CRHTT they are assessed to see whether they are appropriate for home treatment or whether they need to be admitted as an inpatient. The CRHTT can also organise mental health act assessments for patients in the community. As the junior doctor working with the CRHTT you will be expected to go with members of the team on home visits. As visits are always done in pairs (for safety reasons), you will have lots of opportunities to complete mini-CEX’s / CBDs. When you get back to the office you document the review on RIO (Fulbourn’s computer system). You are also expected to write letters to the patient’s GP about their progress. Each patient has a drug card so you will have opportunities to develop your psychiatric drug prescribing. The workload can vary quite significantly, my advice would be to make the most of any quiet moments as the team are all extremely friendly and knowlegable and will be happy to teach you / complete CBDs etc.

FY1's are not required to hold the day on-call bleep, but only on a few occasions. As FY1's are supernumary, this is always under supervisions and calls will mainly be for section 5.2's (which will require a senior colleague in any case), and the odd patient review or bloods if ward doctors are nor around for any reason. This is a good experience, especially if considering going into a career in psychiatry.

In Willow Ward: typical patient is over 65 and has schizophrenia, unipolar depression, bipolar disorder or an anxiety disorder; occasionally there is something else, or one of the above complicated by dementia / cognitive impairment. Discharge summary should be written before patient leaves, and the draft must be approved by the consultant.

In Denbigh Ward: dementia patients who are often difficult to manage due to wandering, calling out, or other bizarre behaviours. These patients are often those who will be placed in DEE nursing. Your non-verbal skills are very important on this ward, as patient interactions here can often be more challenging than on Willow. Start at 9am, try and get as many jobs done before ward round as it goes on for a LONG time and time to do these, plus the new jobs is limited. Typically jobs will be generated from the ward round (e.g. ECG, physical exam, ACE, discharge summaries) and from nursing staff (rewriting of drug cards, assessing medical issues arising on the ward-leg swelling, injuries etc). ECG-may need to call around other wards to find one which is working. Physical exam-always have a chaperone.

Mulberry 1: Lots of patients with: emotionally unstable personality disorder, depression, bipolar affective disorder, and a lot of psychosis (drug induced, schizophrenia). Detox admissions are mostly alcohol but some opiate. Patients presenting here have often come following a suicide attempt or psychiatric crisis e.g. serious damage to property, wandering naked outside. They are often very vulnerable and may have other social issues e.g. homelessness, drug and alcohol issues, financial difficulties or difficulties with relationships. Some may require assessment under the Mental Health Act.

The Liaison Psychiatry FY2 will see an enormous breadth of cases, including mood disorders, psychosis, traumatic brain injury, personality disorders, self harm and substance misuse, but also delirium, perinatal psychiatry and conversion disorders. The team may also be asked to assist with complex mental capacity assessments. Because Addenbrookes is a trauma centre you will see patients dealing with the consequences of major trauma, and people who have survived violent suicide attempts.

CRHTT – As explained above, these patients are generally ones who are experiencing an acute deterioration in their mental health but are deemed well enough to remain the community. Patients with psychosis, depression, suicidal ideation, emotionally unstable personality disorder, or anxiety are common. Also patients who have just been discharged from Fulbourn.

Mulberry 2 - Some examples include: Treatment resistant schizophrenic who has been tried on various antipsychotics over many years and is now on long term depot injections. Psychotic depression requiring ECT. First episode of mania. A lot of the admissions are transfers from Mulberry 1 who are too unwell to be discharged.

Mulberry 3 - This is the ward with patients who have generally been in hospital the longest. Most patients are under a Section 3 and have been here for months. The majority of patients are also on section. The most common patient is one with paranoid schizophrenia. There are 2 ward rounds a week, 1 on Monday - Dr. Jacob and 1 on Wednesday - Dr. Hafizi which usually take up the majority of the mornings. Each patient is brought upstairs and seen in the MDT room. Ward round days tend to be busier than other days.

CAMEO - Although an early intervention service for psychosis, the majority of patients referred are not psychotic and so not added to the caseload. The team are used to this, and it is felt that because this service is well-resourced and not overstretched, some challenging and unusual presentations that GPs face will be referred as they will be seen sooner by our service than others and we will then signpost or advise the GP on management. Many people with other diagnoses e.g. Mood and anxiety disorders, personality disorders, PTSD etc may have some psychotic phenomena which do not meet criteria for first-episode psychosis. Many of our patients suffer from an 'At Risk Mental State' and are simply receiving psychotherapy to prevent the emergence of psychosis. During your time at CAMEO, you will be able to be trained in the CAARMS assessment, and will be able to assess new referrals.

Willow - advice on admissions, how to an MDT meeting, discharge summaries can be found in the Willow Ward induction booklet, please ask Dr. Hatfield to email you a copy.

Mulberry 1 - admission and discharge paperwork, typing up notes during reviews, looking after the physical health of patients, taking bloods when the phlebotomist is away, performing ECGs, etc.. One of the SHOs takes responsibility for review of detox patients on Mondays and Fridays. Training on completing these tasks will be on Rio when starting. The ward review of detox patients includes checking for withdrawal symptoms, mood, general discussion around progress and plans after discharge. Any issues should be discussed with Dr Wood.

CRHTT - Typing up notes after medical reviews in the community (often wise to bring a pen/paper with you on visits), writing letters to GP's detailing salient points of the medical reviews, writing drug charts and medicine reconciliation and taking bloods in the community (seldom required)

CAMEO - Performing initial assessments (after a period of observations), Running the Physical health Clinic alongside a CNS (this will be your responsibility), Lots of liaison and correspondence/calls to GP's and service users and their families, writing out prescriptions.

On Willow Ward: consultants and registrars are happy to give out phone numbers and are very easily contactable. These numbers are in the induction handbook for Willow by Laura Massey.

Mulberry 1: Senior support is always available and present on the ward. To hand over, call the twilight SHO on the number obtained from the nurses' or doctors' office.

Denbigh: consultants are easily contactable via email or mobile and are happy for you to call them should there be an issue.

CRHTT: There are always multiple staff members around the CRHTT office to ask if you have any concerns, all the CRHTT doctors leave at 5/5:30, so any information to handover should be passed on to whichever team member is working the long shift and they will pass it on to the night team.

Liaison: Senior support is excellent and proactive. All patients should be discussed with a senior, and this will usually be at consultant level. If a case appears particularly challenging or complex you can discuss with a senior beforehand and request that they see the patient with you if necessary. Overnight cover is by the Addenbrookes SHO, who will only have time to see emergencies. If you are concerned there may be problems with a particular patient overnight, contact them via the bleep on the rota. If a patient needs review over the weekend (or the on call team needs to be aware of them), you can email the weekend team on Friday afternoon.

If you require any numbers for Addenbrooke's, call switch 100 as you would at Addenbrooke's.

On Willow and Mulberry 1 there is a sheet in the doctors' office with important numbers for Fulbourn.

Reception at Elizabeth House also often know who best to call within the trust, if the above doesn't have what you are looking for.

All staff members have a work email account (you will be assigned one at the start of your rotation) and addresses can be easily found in the outlook address book.

Willow Ward has a list of important numbers all over the doctor's office - but one that you should use concerning medical issues in the older population is RADAR (On-Call DME consultant at Addenbrooke's)- this is extremely useful 1st port of call if you are unsure on a medical issue.

As psychiatry is unbanded, the drop in income can be surprising, especially if coming from a 1A banded job. It is possible to supplement your income by doing a weekend locum shift here and there. The new contract means that the pay is variable and depended on your cash floor and will vary from person to person.

Good work-life balance.

Mulberry 1: Not as quiet and relaxed as other psychiatry rotations, but still very enjoyable.

Cameo - awesome work-life balance! This will almost certainly be the most chilled rotation of F1 and 2. Use this as an opportunity to reawaken your social life, train for a marathon or study for an exam.

Commonly used sections of the Mental Health Act (MHA) 1983

Section 5(4) - mental health nurses can use this to detain an informal patient who is trying to leave hospital for up to 6 hours before a MHA can take place.

Section 5(2) - a doctor can use this to detain an informal patient who is trying to leave hospital, this lasts up to 72hrs during this time a MHA should take place. This doctor must be the nominated deputy of the responsible consultant - in Cambridge this is the on call SHO on the rota (NB FY1 doctors CANNOT detain a patient under a 5(2) only FY2 or above)

Section 2 - lasts up to 28 days- the 'assessment' period. This is used to detain a patient under the MHA. During this time trial of medication, work up for a possible diagnosis takes place.

Section 3 - lasts for up to 6 months - the 'treatment' period. This is used to detain a patient under the MHA who remains unwell after the initial assessment period. The first 3 months treatment with 'any' medication can be tried. After the initial 3 months an agreement/ contract with the patient (if they have capacity) needs to be signed called a T2 form). If it is felt that a patient does not have capacity another opinion from a psychiatrist needs to look at the medication used previously and fill out a T3 form. http://www.mentalhealthlaw.co.uk/images/Form_T3_section_58%283%29%28b%29_-_certificate_of_second_opinion.pdf On this from is the medication a psychiatrist can use. THESE FORMS MUST BE KEPT WITH THE DRUG CHARTS. NO OTHER PSYCHIATRIC MEDICATION CAN BE USED THAT IS NOT ON THESE FORMS e.g. If haloperidol is on the PRN side of a drug chart but not on the T3 form it must be discontinued.

Section 17 leave- Section of the MHA which allows the Responsible Clinician (RC) to grant a detained patient leave of absence from hospital. It is the only legal means by which a detained patient may leave the hospital site. It applies to patients detained under Sections 2, 3, 37 and 47. It does not apply to patients detained under Sections 4, 5(2), 5(4), 135 or 136. Patients detained under Sections 35, 36 and 38 cannot be granted leave without the permission of the court involved.

Section 117 meeting - Under Section 117 of the Mental Health Act, free 'aftercare' is offered and provided to people who have been detained and given treatment under Sections 3, 37, 47 or 48 of the Mental Health Act. This includes people who have been discharged onto supervised community treatment. (CTO)

CTO- community treatment order- where a patient can be recalled back to hospital, often because of poor compliance with medication. http://www.mentalhealthlaw.co.uk/images/Form_CTO1_section_17A_-_community_treatment_order.pdf

On the Addenbrooke's intranet, there is a useful guideline on managing delirium.

On the CPFT intranet, there is a helpful guideline on antipsychotic use and an extensive guide on the use of clozapine (in case you needed to start someone on clozapine, but the seniors and pharmacists in Fulbourn are really helpful and you can always give them a ring for advice!)

There should also be a new Willow Ward specific induction pack made by Laura Massey, Drs. Hatfield and Welsh should have a copy of this. This also includes an appendix of how to do an old age psychiatry clerking, and further guidance on how to do an MSE.

For the FY2 doctor on Adult Liaison Psych & Mulberry 1 (detox) there is a handy guidline from Dr Wood that I have uploaded. Go to Media Manager (top RH corner of this page) > [root] > guide > specialties > other (click on this)

Website created by psych trainees as a junior doctor induction for the acute wards: https://sites.google.com/site/warddoctors/home

The ECG machines at Fulbourn Hospital are temperamental at best. Tip: Holding down on the ECG machine and pushing it in on the side can sometimes fix the issue if it is not printing a recording. Make sure there always is a supply of ECG stickers - ask the nurses and ward clerks for help in ordering new ones BEFORE the ward has run out! The same goes for blood cards, blood bottles, butterfly needles, etc..

If you are interested in psychiatry, ask to spend days on other Fulbourn wards or at the ECT clinic at Addenbrooke's.

CAMEO - Its no longer at Ida Darwin and although driving is not a requirement it is STRONGLY recommended, EPIC access is required but not provided before you start the job - make staffing aware of this on induction as this is often neglected. In the office you may be the only doctor requiring access as you are often the sole blood taker and assessor of results. The consultants, SHO and registrar are always handy to run some of the rarer tests (e.g. autoimmune encephalitis screens) past.