Case Studies

Physician Associates in Psychiatry


There are currently over 40 physician associates (PA) working in psychiatry in the UK. This is a speciality that has had PAs since about 2012 and the interest from PAs in the field is growing. Psychiatry is an MDT led speciality for each patient's management with support from consultants, nurses, community teams, social workers and occupational therapists.
Areas in Psychiatry include short-stay crisis management units, acute inpatient wards, PICU (Psychiatric ICU), liaison psychiatry, Children and Adolescent Mental Health Service (CAMHS), OCD, eating disorders, deaf services, forensics units and rehabilitation.

Working in Psychiatry
I currently work in a Mental Health Emergency Service Unit. This is an assessment unit that was set up in response to the Covid-19 pandemic and is an extension to the Liaison Psychiatry team in the Emergency Department (ED).

Patients are referred to us from the ED, ambulance service, police and street triage teams, mental health support line, community mental health teams and local GPs. We review a variety of patients who are in a mental health crisis and can be both well known to mental health teams and those who are presenting for the first time. Common presenting complaints are psychosis, suicidal ideation, depression, anxiety and mania.

The unit is predominantly nurse-led from triage to psychiatric assessments. My role is to support them with the physical health of the patients. It is well known that deterioration in physical health can greatly impact mental health and it is important to optimise the patient's physical health to support their recovery. An example of how I support patients is reviewing various symptoms such as headaches, pain and confusion. I review self-harm wounds and ensure there is no infection and dressed appropriately. I also do physical health assessments, ECG and phlebotomy for patients being admitted.
I also support the team by assisting in medication reconciliations, which can be tricky if a patient is very unwell and unable to communicate their history fully.

Consultant Perspective

'The PAs have always been extremely keen and enthusiastic with a broad knowledge base. On Orchid ward, an alternative to the ED for patients with primarily mental health needs, the PA has proved invaluable to the team. They are involved in providing a physical health overview and aiding the psychiatric assessment and formulating management plans, including consideration of the impact of any physical health needs on their mental health. They are a strong support to the nursing staff, particularly as it is a primarily nurse-led service. They provide a consistent presence in the team aiding stability, especially in challenging times for the NHS'

Dr Michelle Walke, Consultant Psychiatrist
Orchid Mental Health Emergency Service Unit at Springfield University Hospital