Combining medicine and mental health: the consultant old age liaison psychiatrist

A love of people and their life stories inspired Raja Badrakalimuthu to specialise in old age psychiatry.

“Working with older people, you get to have conversations about their lives,” says Badrakalimuthu, a consultant old age liaison psychiatrist at Royal Surrey County Hospital in Guildford. “Their generation built our society, and we’ve inherited the legacy of their hard work. I find it satisfying to be able to do something for them—to thank them, and show my gratitude.”

Old age psychiatry is “the perfect blend of medicine and mental health,” he says. “Older people can have multiple physical conditions and you have to take this into account when diagnosing dementia.”

With new dementia drugs becoming incorporated into clinical practice, and new cognitive assessments and scans becoming readily available, “it’s an exciting time to be doing old age psychiatry,” Badrakalimuthu says. Old age psychiatrists also have to be aware of what kind of support is available for older people in the community, such as respite care, he says. “You’re not just intervening at an illness level, you’re also trying to make life as good as possible for the person and their family.”

Growing up, he was more interested in languages and history than medicine. Both his parents were doctors who ran a general practice in Tamil Nadu in southern India. “There was a huge assumption that as their son I would take up medicine. But I was contemplating a career as an historian or writer.”

Good at science, and with huge respect for the work his parents were doing, in 1996, he chose to go to Coimbatore Medical College—just as they had done in the 1970s. On finishing medical school and while doing house officer jobs he became interested in the workings of the brain and psychology, and chose psychiatry as his specialty.

He spent a year learning about psychiatry as a senior resident at the Institute for Mental Health in Chenai, southern India. Encouraged by a retired professor he was assisting in research, he came to the UK in 2003 and worked at the Maudsley Hospital as a senior house officer in old age psychiatry. “Working with older people made me feel fulfilled. I felt warmth and respect for them. I decided that this is what I wanted to do.”

After working in various training posts across the country he qualified as a consultant old age psychiatrist in 2012. During his training and early years as a consultant, two role models influenced his career. While training in Norwich he met Daphne Rumball, a now retired consultant in drug and alcohol services, “who had an ability to move between clinical psychiatry and working in research,” which he learnt from. “I worked with her on some projects, and she became a close friend and godmother to my son,” he says. While working as a newly qualified consultant in Basingstoke, Tracey Eddy, a senior old age psychiatry consultant, now retired, “gave me the opportunity to act on my ideas to make services better for people.”

Badrakalimuthu spent three years as an associate medical director for older adult services in Surrey before taking up his current post as an old age liaison psychiatrist in 2022. Shortlisted for awards for improving old age psychiatric services, he continues to develop ways to make services better. “When I go home after work and can tell myself I’ve made a difference to a person with dementia or their family, that makes my day,” he says.

As academic secretary for the south eastern division of the Royal College of Psychiatrists, he is involved in “providing teaching, training, and education to psychiatrists of all grades.” And whether it’s medical students, junior doctors, nurses, or allied healthcare professionals, he says senior clinicians need to “take every opportunity to teach them.”

“If I hadn’t had such good role models I wouldn’t be where I am now. And if I’m not a good role model, then I’m failing the next generation,” he says.

A specialist trustee of the charity Dementia Carers Count (dementiacarers.org.uk) he believes that we all need to take responsibility for the care and support of people with dementia and their families—“the NHS and social care cannot do this alone.”

Outside of work, Badrakalimuthu uses his interest in running and trekking as a way of raising money for dementia charities, which has taken him to Everest base camp and Kilimanjaro.

While he may have chosen to follow in his parents’ professional footsteps, “I didn’t give up on my writing.” His book A Way With the Fairies gives the perspective of an 8 year old boy whose father is diagnosed with dementia.

If he was telling his 8 year old self about his life now, he says, “I wouldn’t change anything. The successes, disappointments, highs, lows—they’ve all led to amazing moments where I’ve been able to make myself useful to people. What more could I want?”