Sir: Academic overseas visits are usually the undertaking of senior psychiatrists. Recent articles have tended to focus on service provision (Kennedy, 2005) or to have reported on the struggles of mental health services in low- and middle-income countries (Feinstein, 2002).
In May 2005, a group of six senior house officers on the St George’s Hospital Scheme in London visited the Karolinska Psychiatric Institute in Huddinge, Stockholm. The inspiration came after a group of Swedish doctors visited our trust at the invitation of Dr Najmeddine Al-Falahe, a Stockholm-trained local consultant. Our self-funded visit was planned to coincide with a bank holiday. Whereas Friday and Monday were academically oriented, we used the weekend to discover Stockholm by day and night.
On arrival, the educational coordinator, Dr Maria Starssjo, our excellent host for our stay, escorted us to the faculty’s breakfast meeting. We were allocated residents to shadow on various in-patient units and community facilities. The wards, run by dedicated doctors with no community commitments, were in pristine condition. They consisted of individual rooms and a communal area that featured a large aquarium, reading lounge, small library and table tennis table. The doctors wore white coats over casual clothes and the atmosphere was generally relaxed. Despite a policy of separating patients who were severely psychotic from those who were less disturbed, in-patient units faced familiar pressures of bed shortages and social problems delaying discharge. While general, forensic and child and adolescent psychiatry had equivalents in Sweden, the management of organic illnesses such as dementias was left to medical teams. Separate drugs and alcohol services were based in central Stockholm. As might be expected, we found similarities with the bio-psychosocial and multidisciplinary approach adopted in the UK, but were impressed with the quality of administrative and logistical support. Trainees had access to individual computers, modern on-call facilities and trendy quarters. A tour of the laboratories revealed common monitoring of psychotropic blood levels and the availability of metabolic profiling.
Recruitment into psychiatry had traditionally been difficult. The number had peaked from the late 1990s and stood at 1400 in 2002 (Silfverhielm & Stefansson, 2006). After 5 years of medical school and 18 months as house officers, doctors enrol on a 5-year training programme that leads to recognition as specialists. Many trainees we met had recently joined following a successful recruitment campaign based on financial and academic incentives. These included encouragement and funding to train in a range of psychotherapy modalities, a flexible on-call system and research opportunities. In contrast to their British counterparts, residents became actively involved in research early on and were given appropriate time and resources.
We found our visit extremely informative, enjoyable and productive. It highlighted some of the positive aspects of our own clinical practice and provided valuable lessons for the future. We strongly recommend that international visits be incorporated into training at an early stage. They broaden horizons and encourage reflection. They also further links between institutions and professionals that can only benefit service users and the National Health Service.
Joseph El-Khoury and Claire Dillon
Senior House Officers, St George’s Training Scheme, London, UK, email joelkhoury@yahoo.com
References
- Feinstein, A. (2002) Psychiatry in post-apartheid Namibia: a troubled legacy. Psychiatric Bulletin, 26, 310–312. [Google Scholar]
- Kennedy, P. (2005) Lessons from and for Japan on service delivery. Psychiatric Bulletin, 29, 309–311. [Google Scholar]
- Silfverhielm, H. & Stefansson, C. G. (2006) Country profile. Sweden. International Psychiatry, 3(1), 9–12. [PMC free article] [PubMed] [Google Scholar]