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27 April 2022

UK psychiatry couple find NQ paradise

Dr Andrew Livingstone and Dr Susannah Bond arrived as psychiatry registrars with their young family from the United Kingdom in 2017 for what was to be a 12-month Australian adventure.

“A friend of ours did a year in Sydney and came back with glowing reviews of Australia. We were very excited by the prospect of doing the same,” says Dr Livingstone, a Townsville University Hospital psychiatry consultant. “It was meant to be a year out, but then we chose to stay because we very much enjoyed Townsville and the lifestyle.”

Dr Livingstone is building psychiatry services for people with intellectual disability in the Townsville region, while Dr Bond is supporting junior doctors in the conjoint appointment of Deputy Director of Clinical Training (James Cook University/Townsville Hospital and Health Service).

Intellectual disability psychiatry

With his UK specialist training in intellectual disability psychiatry, Dr Livingstone has been embraced as a regional expert in the field in Australia. “Intellectual disability (ID) psychiatry is a specialism that's recognised in a lot of European countries,” he says. “However, there isn't so much a development of this specialty in Australia. There's an intellectual disability service in every region in the UK, and there isn't here.

“In Townsville, we have a subspecialty clinic called the IDDC, which has grown enormously, supporting people with disabilities and autism. I’ve had the opportunity to train colleagues involved in the clinic and to present at the RANZCP Congress on this clinic and approaches to addressing this gap in service in Australia.”

The clinic’s holistic care approach is geared towards enabling people with an intellectual disability to live a happy life. “Often people with autism or communication difficulties can present in a certain manner that might meet the criteria superficially for, say, a psychotic illness, but there may be something else going on from an organic perspective, like a physical health change or care setting change, which presents differently,” Dr Livingstone says.

“There's a thing called diagnostic overshadowing, which is where a disability gets blamed for everything. So someone can have appendicitis, but when they present to ED they just appear behaviourally disturbed and no one presses their abdomen to find what is a relatively common and potentially fatal illness. That's where you need an expert who's got time to look at the bigger picture. You need a psychiatrist who understands psychiatry, but you also need a specialist who understands disabilities because the overlap is so high.

“Sometimes it's about being a doctor, sometimes it’s about being a specialist psychiatrist, sometimes it's about being a social worker or an occupational therapist. The role of an ID psychiatrist is being a bit of all of those things wrapped into one.

“It's a really interesting specialty. I think those who experience it properly would be very much attracted to the specialty even if they've never thought of it before. That's what happened to me. It's a different approach to medicine; it's a different approach even to psychiatry.”

Nowhere we’d rather be

Transferring their training from the UK to Australia was a costly and complicated process, but Dr Livingstone and Dr Bond see the sacrifices as worthwhile for their family’s long-term prospects and lifestyle.

“Within a few months of moving to Townsville, I realised I didn’t want to leave,” Dr Bond says.

“The lifestyle was unreal and I loved the beautiful scenery, the weather, the friendly people. I was anticipating a tough few months after moving to a new town, but the reality was we fitted in quickly and Townsville became our home. Five years later, we feel really established here – we’re part of the community.”

Dr Livingstone says, “When we arrived, we got a flat on Castle Hill and were woken up by the sunrise over the Coral Sea. It was absolutely spectacular. The cost of living was completely within our budget, and the lifestyle was immediately apparent, that we would be able to live by the beach and take our children to play and build sandcastles, as well as being active with sport and exercise.”

Dr Livingstone plays in three soccer teams and closely follows the fortunes of Manchester United on late-night telecasts. “I've got a good social life here through sport, which is an important part of Townsville. It's a big fitness town and it didn't take long at all for me to find like-minded people who love sports and exercise,” he says.

“But if you wanted to, you could just be there with your family on your balcony and make a little paradise around you. In the UK, we simply could not afford a detached house, let alone what we're aiming for with views of the ocean and space for the kids to run around. I don't think there are many places in the UK where you could do that and have no traffic, and all of those things that are glorious about Townsville.”

Developing the specialty

The couple both lecture with JCU and love being at the forefront of developing the specialty of psychiatry at Townsville University Hospital. “Much as there's an adventure with us changing countries, setting down roots and trying to build something for our family, we're also trying to do the same for our specialty,” Dr Livingstone says.

ID psychiatry is only part of Dr Livingstone’s role at Townsville Hospital and Health Service. “My consultant psychiatry job is one of the most special ones – I do weekly clinics in Ingham and on Palm Island. I fly into Palm Island every week on a tiny plane. It's a privilege and an honour to have that role. If you're accurate, sensitive and culturally safe, you can make a lot of change. That is definitely a reason for sticking to a place like Townsville.”

Dr Bond says the role of Deputy Director of Clinical Training is an exciting opportunity to work alongside the medical education team, with a major role in support and advocacy for the most junior members of the medical workforce: “This could include anything from career progression through to wellbeing which I hope, with my background in psychiatry, I will be well placed to support.”

Psychiatry training in NQ

Dr Bond says, “The support and opportunities I have been given during training have been incredible. It has gone beyond the need to merely get through training – there’s a willingness to really get to know and understand our circumstances. Our colleagues have become, in many ways, a surrogate family. We look out for each other.”

Dr Livingstone says, “There is a wide variety of specialists here and you will have expert guidance.
There's expertise from all over the world, and that experience of different healthcare systems is invaluable.

“The great thing about Townsville is that it is an urban hub. It has urban-centric issues that you'd see in inner cities, but then you also get the rural and remote care, where you have to think outside the box, and you see a lot more of Aboriginal and Torres Strait Islander cultures.

“You’re a quick flight from Brisbane or you're a quick flight to the most remote and rural places. It's both rural and urban in equal measures, so for a psych experience it's fantastic.

“The hospital has excellent telehealth services. You can do a video assessment for someone 1000 kilometres away. It's innovative, it's modern, it's evolving and, similar to my experience with ID psychiatry, you're at the forefront. You can make it what you want, and you can develop the service.

“When you choose psychiatry, you're actually opening up more options because there are so many subspecialties you can choose from, and you can get that experience in Townsville. We have specialty clinics which allow that variety of training in areas such as eating disorders, neuro psychiatry and perinatal care.

“It's very easy to talk to the neurologist and to link in with the other specialties because it's a city but with a small-town vibe. There are infinite options for lifestyle balance in psychiatry, which I don't think you get in any other specialty. Townsville, especially, is the perfect place for that balance of lifestyle.”

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NQRTH is an initiative of the Australian Government's Integrated Rural Training Pipeline (IRTP) and is facilitated by James Cook University in partnership with public and private hospitals, Queensland Aboriginal and Islander Health Council (QAIHC), health services, Aboriginal Community Controlled Health Organisations (ACCHOs) and GP clinics.

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