A moment that changed me: my psychiatrist told me I could be one too | Linda Gask

During my years of medical training I was tense and wound up almost all of the time. Then, just before my finals, things got very much worse. I began to draw up a complex revision timetable, which I obsessed over. I was as fearful of failing as I had been with my A-levels, but there was also a terrible sense of unease about what was happening to me, to which I couldn’t put a name.

I convinced myself that the best way to stay in control of my world was to design a kind of map for my mind and contain everything within it by the time the exams arrived. I ruled out lines on sheets of paper to create a chart to govern every waking hour for the next few months. I did not want to acknowledge the obvious parallels with my brother, whose strange behaviour would later be diagnosed as obsessive compulsive disorder.

The idea of studying medicine had come to me quite suddenly around the age of 15. I had discarded my previous ambition of being a biology teacher, and when I received an offer from Edinburgh medical school I had been determined to make the most of it.

But my confidence was in short supply, and I felt out of place in Edinburgh from the start – like many students, I self-medicated with alcohol. As a working-class girl, the first in my family to ever think of going to university, I didn’t share the same background as most of my fellow students. My mother worked in a factory, assembling transistor radios, my father in an amusement park repairing fairground rides, and my relationship with both had been increasingly difficult in the years before I left home. As a result, I felt even more alone.

I also had problems with anxiety which began before my A-levels. I hadn’t made the grades that Edinburgh asked for in their offer, but unexpectedly they had still given me a place. As the tension built during my years at medical school I had a few appointments with a student counsellor, but didn’t find it very helpful. I couldn’t understand what the problem was, although I know now, having had psychotherapy many years later, that it had a great deal to do with unresolved problems with my family from my childhood.

As I prepared for my finals, with my mind map, and my chart of each available hour, there came a point when I couldn’t go on. I can’t remember exactly what happened. I wasn’t sleeping or able to work. Sometimes I didn’t bother to get dressed, and it felt as if everyone in my year knew that I was a complete failure. My head felt like it was splitting open and I was struggling to hold the pieces of my brain together. I finally went to see my GP and he referred me to a psychiatrist who did sessions at the university health centre. With some medication, a lot of tears, and support from him I managed to pass my final examinations.

I had no idea where to go next with my life. I had wanted to specialise in general medicine, but my attempts at getting a training post were unsuccessful, and deep down I knew I didn’t really have the right talent for it. I began to seriously question my ability once again. The real problem was that the specialty for which I seemed to have the most aptitude as a student now seemed closed to me. During my student attachment in psychiatry I had been able to imagine myself without too much difficulty in the world of the people on the psychiatric unit. However, the fact that I could relate only too well to some of the experiences described by the patients also worried me.

I needed to find out if my fears were warranted, and finally plucked up the courage to telephone the psychiatrist I had seen a few months earlier.

“I wanted to thank you,” I said, “and ask if you thought it would be out of the question, after what happened to me this year, for me to train as a psychiatrist?”

“No,” he said warmly, “I don’t think it would be out of the question at all.”

Those few words of encouragement set me off on a very successful career path in psychiatry. It’s not been without problems. I’ve had recurrent episodes of depression, and at times it’s been hard. But I would not have fitted in better anywhere else in medicine, and I think I’ve been a more empathic doctor because I know what it’s like from both sides. I’m determined that medical students who experience mental health problems and worry about the stigma that still exists in medicine should not assume that they are simply “weak”, or that the door into a career in psychiatry is closed to them. It certainly isn’t.

A moment that changed me: my psychiatrist told me I could be one too | Linda Gask

Linda turned up at A&E twice a day. A dedicated team now stops that

In a desperate effort to get relief for excruciating pain caused by osteoarthritis, curvature of the spine, and abdominal discomfort following surgery, Linda Douglas went to A&E twice a day.

The chronically ill 48-year-old, who lives near Sunderland, was “at the end of [her] rope” because of the constant pain and frequent hospital visits, and felt life “was not worth living”. That was until a new team of health and social care professionals took over her case and improved her quality of life from “six to 99%” in early 2016.

The team comprising her GP, consultant, community matron, social worker and paramedic worked together to come up with a care plan tailored to her needs. Now, she can largely avoid hospital and live a much more normal life, mainly because John, her husband and carer, has been trained to administer her daily medication. She says: “My life was driven by fear. I was terrified of being unwell and not being able to get the care I needed to control my pain. I don’t need to worry any more. It’s like a weight has been lifted.”

Douglas was helped thanks to the All Together Better partnership, part of NHS England’s Vanguard programme that was ushered in last year via chief executive, Simon Stevens’s Five Year Forward View blueprint policy. This same programme, which was expected to champion ways of providing better, more efficient care for heavy users of NHS services, has not been given as much money as originally hoped. According to Kerry McQuade, head of vanguard delivery in Sunderland, the £4.8m the partnership received in 2016/17 did not match the initial bid, although it received more than similar projects in other parts of the country.

Sunderland is one of the most deprived cities in England. On average, people born there start having health problems more than 10 years before those born in wealthier parts of the country, and die more than six years sooner.

The NHS is a big part of many lives there, but a small minority of long term sick, vulnerable or frail elderly locals account for a large proportion of health and social care resources. Six per cent of the population – those with long-term, multiple illnesses – are responsible for half of the city’s health spend. With the pressure on from NHS England to reduce costs by nearly £1bn by 2021 in the Northumberland, Tyne and Wear region as central funding is squeezed, the focus on the most needy patients makes sense.

Local GP Dr Fadi Khalil describes Sunderland’s scheme – one of 14 across England – as “massive” in scale. Covering nearly 300,000 patients at 50 GP practices across the city, it is focused on reducing hospital admissions via a series of initiatives designed to offer care that aim to keep patients well and cared for where they live.

In the past, despite the “best intentions in the world”, the most needy patients weren’t getting the best care because of a disjointed and fragmented set of services, says Khalil. Patients had to undergo repeat visits to A&E, repeat crisis admissions to hospital, and had to repeat their stories to a string of frontline primary, community, acute and social care staff.

This was not only bad for them but a tremendous waste of precious resources. Finally, under the vanguard programme, local authority and health commissioners and providers are being encouraged to work together with patients.

“In the past when someone [got] a chest infection, they would end up in hospital. Now we’ve got things in place that keep them at home where they’re safer and more familiar with their environment,” Khalil says. Such patients, who have been identified by their GPs as at risk of rapid onset of health problems, have access to their GP, and a nurse or paramedic out of hours who can visit them at home, and who make regular check-ups to prevent urgent, unplanned visits to hospital.

Five teams, created late last year, are at the core of Sunderland’s scheme, with community matrons, district nurses and social workers all were moved into the same office.

It was a shock to the system at first and “initially quite daunting”, according to adult social care team manager Rachel Daurat, particularly to the social workers who had to move out of their dedicated offices at Sunderland city council.

She says health and social care have traditionally worked to entirely different agendas. However, working together on a patient case has meant they have been able to learn from each other’s perspectives and ensure different providers are working in harmony to improve circumstances for those receiving their care.

Sue Hughes, a district nurse taking part in the initiative agrees: “We are just a team now,” she says. “We understand the pressures we each face day to day and we support each other. It’s hard to ever imagine us going back – and I don’t think it could work.”

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Linda turned up at A&E twice a day. A dedicated team now stops that