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Psych report

Psych report

By DQ
May 21, 2025

SCENE STEALERS

Malpractice creator and writer Grace Ofori-Attah reveals why she wanted to explore the world of psychiatry in season two of the ITV medical thriller, which she hopes will help remind viewers that doctors are human too.

After the success of Malpractice’s debut season in 2023, ITV’s medical thriller returned for a second run this month. But while S1 centres on an A&E doctor caught up in a scandal, the new five-part season shifts the focus to the world of psychiatry.

Written and created by former A&E doctor and consultant psychiatrist Grace Ofori-Attah, Malpractice S2 sees the return of Helen Behan (The Virtues) and Jordan Kouamé (Scoop) as Dr Norma Callahan and Dr George Adjei of the Medical Investigation Unit (MIU), who are once again called in to investigate a doctor accused of malpractice.

When on-call psychiatric registrar Dr James Ford (Tom Hughes) finds himself caught between an anxious new mother’s postnatal check-up and the sectioning of a psychotic patient, it results in a tragic outcome that nobody could have predicted. But as the MIU begins to investigate Dr Ford’s actions, Norma and George find that what appears to be a series of bad choices by one doctor spreads beyond the psychiatric unit to a hospital seemingly at war with itself.

Ofori-Attah is among the executive producers on the series, which is filmed in Belfast and produced by World Productions (Line of Duty). ITV Studios is the distributor.

Here, Ofori-Attah, who is represented by Casarotto-Ramsay, reveals how she chose the arena of medicine on which season two would focus, and how the world and atmosphere of the show’s psychiatric unit was created.

Grace Ofori-Attah

Ofori-Attah: When it came to choosing a new medical specialty to focus the second season of Malpractice on, psychiatry was the obvious choice. Prior to becoming a scriptwriter, I worked as a doctor for more than a decade, doing jobs in various specialties (like A&E, the setting for season one of Malpractice), eventually becoming a consultant psychiatrist.

It’s an area of medicine I love because it’s still relatively unknown compared to other specialties – a complex mixture of biology, psychology and sociology, where the doctor is as much a part of the therapeutic process as any physical medication prescribed.

In the world of TV drama, the scarcity of accurate depictions of severe, debilitating, acute and chronic mental illness, and the settings in which they are treated, is something I’m very conscious of. The most authentic depictions of psychiatry units on British TV are several years old (such as the fantastic Channel 4 series Psychos from 1999, and season three of The Fall on BBC Two in 2016, where the flawless characterisation of patients and staff in a secure forensic psychiatric unit was so mesmerising, it has stayed with me for years as one of the best depictions of psychiatry on TV or film I have ever seen).

This was, therefore, always at the forefront of my mind when writing the scripts and on set in my role as medical advisor and executive producer.

There are several reasons why it’s hard to portray hospital treatment of mental illness accurately on TV. While the general hospital setting is familiar to most people, psychiatric wards and the process of hospital admissions are not. Often, patients are too unwell when they are admitted to recall what it was like, and documentary-style filming is made almost impossible by the complex myriad of capacity and consent issues. As such, I felt a huge responsibility to depict psychiatry with as much authenticity as possible, in order to do justice to the many people affected by these conditions.

Hannah McLean plays Rosie, a new mother experiencing puerperal psychosis.

Hannah McLean gave an incredible, nuanced performance as Rosie Newman, a mother experiencing puerperal psychosis. When we first meet her in Obstetric Outpatients, Rosie is masking and containing her psychotic symptoms, but there are subtle clues in Hannah’s understated performance that all is not well. We were incredibly fortunate to be able to film at Queen’s University Medical School, Belfast, during the students’ summer holiday, which added an extra layer of realism to the shoot. It was here that we filmed some of the most emotionally searing and tense scenes of the show – Rosie’s psychotic breakdown, restraint and eventual death.

I had detailed discussions with Anthony [Philipson, director] about the look and feel of the 136 Suite, and our production designer, Gillian Devenney, created something so true to my experience that I felt stressed whenever I stepped on set. Anthony previously directed 24 hours in A&E, including the first season at King’s College Hospital, where I had worked as an A&E junior doctor, and also at the Maudsley psychiatric hospital across the road.

Our shared experience of working in the same A&E and psychiatric hospital, and Anthony’s experience of filming several medical presentations, meant he was fully able to understand the journey of an acutely psychotic patient from A&E through to the 136 Suite.

I vividly remember the first time I stepped onto the 136 Suite set. It’s a testament to the ability of our fantastic crew and cast that I found these scenes so harrowing to be on set for. Particular praise must go to Tom Hughes as Dr James Ford, who I talked through the internal thinking of a psychiatric doctor at each stage of the admission, and Hannah McLean, who conveyed the distress of a mother in the grips of a psychotic episode so realistically and with such delicacy, without it ever becoming sensationalised. Watching from the monitors took me right back to my days as the on-call psychiatrist, like Dr Ford, except this time I had to stand back and watch the tragedy unfold, overriding my medical instinct to intervene and assist the medical team.

Helen Behan and Jordan Kouamé return as a pair of MIU investigators

Psychiatric nurse Precious Danso (played by Naana Agyei-Ampadu) later transports Rosie to the Psychiatric Unit when she escapes and runs away. Our locations manager, Gareth Hogan, found the perfect location for our psychiatry unit – a former convent. It matched exactly the description I’d written in the very first outline for the season back in December 2022, and in the script for episode one: a visibly neglected Victorian building, decaying on the inside.

Gareth showed this to our block one director, Anthony, and producer Chrissy Skinns, and they were sold. In Britain, there is a legacy of crumbling Victorian asylum-style psychiatric units tucked away behind more modern general hospital buildings. We were fortunate that the building, due to be completely renovated, was ours to do what we wanted with, so we were able to get in there and design a complete ward with a patient lounge, clinic rooms, doctors’ and nurses’ offices, and patient bedrooms.

Because we were filming there for a number of weeks and because psychiatric inpatients are often admitted for several weeks, Anthony came up with the idea of giving each supporting artist a psychiatric diagnosis with specific traits to help them stay in character throughout. We wanted to recreate the ‘home’ environment specific to psychiatric wards.

The tension the cast and crew created felt real. Watching the miscommunication and misunderstandings build up to their traumatic conclusion made me anxious about past decisions I’d made. There are so many things that can go wrong in any one shift when you’re a doctor. It left me feeling it’s a wonder any of us make it through our medical careers without being investigated.

The doctor at the centre of the case is psychiatric registrar James Ford, played by Tom Hughes

We had police advisers, intimacy coordinators and psychological support for anyone on set affected by what we were filming. The restraint and full-face hood [worn by one patient] might look controversial and excessive but, in practice, I’ve seen worse. I talked Tom through the symptoms a psychiatrist would be trying to illicit from Rosie with each question and what techniques would be employed to try to engage her attention.

The role of the psychiatrist is to try to understand Rosie’s mindset, questioning without leading her or distressing her further, while also trying to stay immune to the fear and stress of the staff around you. You have to appear calm and confident, even if inside your heart is racing and you are terrified.

But really, it’s like Dr Ford says in such a powerfully understated way to Rosie when they’re alone on the roof: “I get scared too,” because at the end of the day, what I hope Malpractice shows is that doctors are human. We might make mistakes but, when we turn up for work, we’re trying to do the best for our patients.

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