Addiction affects thousands of people in the UK and the NHS inpatient Units (IPUs), which provide residential detox treatment for severe drug and alcohol addiction, are often the last hope for recovery for some of our most vulnerable members of society.
While the inpatient units provide the care and treatment that those living with the most life-threatening addictions so desperately need, While the inpatient units provide the care and treatment that those living with the most life-threatening addictions so desperately need, they also offer crucial on-the-job experience and training for medical and nursing trainees in the field of addictions that just isn’t available anywhere else.
Trainees in all specialist fields, including medicine, nursing, and pharmacy, at various stages of their career may get the opportunity to work onsite at one of the six remaining units in the UK as part of their intensive training.
Rosa, a trainee psychiatrist who has worked at the Bristol Acer Unit, an NHS Inpatient Detox Unit, throughout the COVID-19 pandemic as part of her medical training. “A psychiatrist is a medically qualified doctor who deals with mental illness, as well as the interaction between physical and mental illness. My training covers lots of different specialities in psychiatry and working on the unit with the specialist team has been very relevant for all aspects of my psychiatry learning, specifically giving me in-depth insights into the complex and acute issues that addiction presents.”
The multi-disciplinary team of staff at NHS inpatient detox services include psychiatrists; psychologists; general practitioners; nurses; pharmacists; social workers, and pharmacists alongside physiotherapists, dieticians, and occupational therapists. “Having access to the enhanced skills amongst this professional team, as well as the general hospital that the unit is located on, is incredibly beneficial,” Rosa explained, “and has given me the necessary insights on why focusing on all patient medical and psychiatric needs, not just their current addiction problem, is so important.”
“Working on the unit with the specialist team has been very relevant for all aspects of my psychiatry learning, specifically giving me in-depth insights into the complex and acute issues that addiction presents.”
NHS IPUs care for people who have difficulty controlling or eliminating their drug or alcohol use, many of whom have tried and failed community-based drug or alcohol treatment programmes. And while the service offers a therapeutic programme involving group sessions for patients to share their experiences and support each other, there is also around-the-clock medical care, including emergency situations.
Rosa said: “Most routine work is done during nine to five Monday to Friday shifts, and during my training I would also get called in for out-of-hours emergencies. This could involve incidents when a patient wasn’t on the right medication and experiencing conditions like Delirium Tremens which is very dangerous and can easily be overlooked.”
Patients which present at NHS IPU services typically have highly complex needs and the majority experience severe and enduring mental illness such as anxiety, depression, or personality disorders. Such disorders can also be very difficult to assess and treat in a community setting, and there is often a tendency to separate out mental health issues from addiction instead of diagnosing and treating both at same time. “As a trainee, it has been extremely useful to gain an understanding of the intricacies of dual diagnosis, and experience working with patients who have both issues and to not be intimidated by this,” Rosa explained.
“It can be a complex patient group to work with; they often have poor physical health and may be on high doses of prescribed medications,” Rosa continued, “so learning how to develop and deliver an individualised, recovery-orientated care plan has given me the opportunity to not only build my confidence but also hone my interpersonal skills while getting to know the patients on an individual level; I know I will be more comfortable helping these people as a consultant.”
NHS IPUs are fundamentally different to all other detox and rehabilitation services in England, meaning that students cannot access medical training in alcohol and substance use detox and rehabilitation anywhere else.
“Patients are required to place their trust in doctors, and so it is absolutely necessary that psychiatrists, and other specialist staff, obtain the relevant and in-depth training."
Professor Julia Sinclair, Chair of the Addictions faculty Royal College of Psychiatrists, said: “Patients are required to place their trust in doctors, and so it is absolutely necessary that psychiatrists, and other specialist staff, obtain the relevant and in-depth training to provide clinical expertise and leadership, responsibility and accountability, and deliver constant quality in addiction treatment services.
“NHS IPUs are currently the only places in England offering training opportunities for psychiatrists and other specialist staff to enter this area of the medical field where they have the opportunity to provide the best care possible for the benefit of their patients. If uncertainty around funding these services continues there will no doubt be a loss of clinical expertise, so it is of utmost importance that the future of the IPUs is urgently secured.”
“Working under the supervision of a senior doctor-led ward is an incomparable learning experience that you simply can’t get anywhere else.”
The rigorous training also takes into account the wellbeing of the medical trainees by providing relevant supervision and support as well as allocated times for reflection.
“While I did learn a lot working in the community detox services, it would be much more difficult without the training I was given in the NHS IPU,” Rosa concluded, “working under the supervision of a senior doctor-led ward is an incomparable learning experience that you simply can’t get anywhere else.”