my brilliant career - mental health

Former army psychiatrist Adrian Gillham had a varied career while trying to find out which area of medicine to specialise in. He tells Lyn Whitfield why mental health is right for him

Name: Dr Adrian Gillham

Title: Consultant psychiatrist and medical director, the Priory Hospital, Woking

Age:53 Earnings: c£140,000 a year

Describe your job

I am a consultant psychiatrist and also medical director of the Priory Hospital, Woking, which is a new job for me. With the hospital director, it involves being responsible for the clinical governance agenda and the continuing appraisal of medical staff. I also represent doctors to the senior management team.

What was your career path?

I always enjoyed medicine but found it difficult to know what to specialise in. I did the normal house jobs in surgery and medicine and a stint in casualty. I then did the MRCP postgraduate diploma and a trainee GP year in a singlehanded practice in West Meon in Hampshire.

After more hospital-based training, I went into GP practice in St Albans. I became interested in building up the primary care team and became a GP trainer. By then I was interested in the psychiatry of what presented in GP practice.

By this time I was 35 or 36, and I learned on a course that the army was looking to train psychiatrists. That is what got me into the army.

I spent a year in Germany, and then did my formal training. After a period as a lecturer, I went to the Gulf as commander of a field psychiatric team and spent three months in the Saudi Arabian desert. I completed my senior registrar training and became a consultant at the Cambridge Military Hospital in Aldershot. I left the army in 1996, worked as an NHS consultant and then came here in April.

What did you like and dislike about the army?

The attractive thing about the army is that you become part of a larger organisation - and the organisation has aspects that bear on your work.

It is very good training in terms of the relationship between individuals, their environment and stress. However, people joining the army go through a rigorous screening process, so you see much less of the major mental illness that you see in the NHS. However, some people in the army should not be there, and part of your job may be helping them to leave, which is more of a personnel issue.

Why did you move into the private sector?

I suppose the difficulty of working in the NHS is that my interest has been in the sort of problems present to a GP - the more 'ordinary' and 'everyday' morbidity caused by depression and anxiety. But resources for dealing with that were cut, leaving the NHS as a major mental illness service. These are people the private sector can look after quite well, as long as they can get to us.

I felt tremendous loyalty to the NHS ideals, but it was becoming more and more difficult.

What was the high point of your career?

I loved being a casualty officer and enjoyed being a GP. I also enjoyed the Gulf War in terms of being able to put theory into practice. The principle of dealing with combat stress casualties is that people need a break and a rest, but also that they signed up and so need help to do their duty and overcome their fears. I had read a lot about this and wondered if I could do it. The fact that we could do it, and that people would be grateful we had done it, was very interesting.

And the low point?

The lowest point was having to go to staff college to be taught the principles of being a staff officer.

Learning how tanks work was not something that I felt very inclined to do.

What do you do to relax?

Just at the moment, I do not do enough, because I am very busy. But I go to the theatre, I play tennis and I like running. I also watch a lot of rugby and cricket, read and go on holiday.

Do you have any remaining ambitions?

I would like to do some research, perhaps into whether our interventions are helpful - though the people we see seem to do very well. And I would like to do something on the neurobiology of post-traumatic stress disorder, because it seems to me that people who have been through very stressful situations have something different about their neurobiology.

Do you have any career advice?

I think it is important to find out what interests you, which can take a long time. If you do not know, do not to give up. And if you are stuck in something you do not want to do, there are ways of switching - even though it can be difficult, and it helps to have an understanding partner.

Just the job

Title: Medical director, Priory Hospital Salary: Earnings as a consultant, plus a relatively small sum (around£10,000) for taking on the medical director role.

Numbers: Priory Healthcare is the largest player in private mental health provision, with 1,200 beds in 16 psychiatric hospitals, two rehabilitation hospitals and a number of smaller units. About half of its overall revenue comes from NHS work.

Distinguishing features: Medical directors in the private sector are dealing with many issues their NHS colleagues would recognise - clinical governance and continuing professional development are high on the agenda.

Prospects: Though mental health services were excluded from the NHS-private sector concordat, business is booming. Analyst William Laing says the NHS spent£161m with acute independent psychiatric hospitals in 1999-2000, up from£104m the year before. In some areas, the private sector is a majority supplier - it provides more than half of the country's medium-secure places, for example.