A career shaping Shetland's psychology services

Dr Emily Pathe will be the first to admit she didn't know much about Shetland before she applied for the job. She hadn't even seen the TV series.

What caught her eye was the role itself: the chance to help shape a psychology service in a remote and rural setting, where the impact of good mental health support is visible in ways that simply aren't possible in a larger health board.

That instinct has proved right. Having relocated from Glasgow to Voe with her partner, young child and Labrador Annabelle, Emily is now leading Psychological Services at NHS Shetland, and she hasn't looked back.

Emily's base is at Harley Street in Scalloway, with clinics also held at Lerwick Health Centre.

A typical day might begin with in-person appointments or an online group intervention, followed by – weather permitting – a brief walk down to the harbour. Afternoons often involve supervising colleagues, reviewing complex cases with multidisciplinary teams, or working on service development.

That last part is central to her role. "A big part of my role is building a sustainable workforce, which is crucial for remote and rural areas."

She aims to ensure that high-quality, accessible, trauma-responsive psychological care reaches people right across Shetland. It's a goal that requires clinical skill, strategic thinking, and a fair amount of creative problem-solving, all things Emily clearly relishes.

Between appointments, she's an enthusiastic advocate for informal conversations.

"Perhaps because a lot of my clinical work involves being quiet while listening intently and reflecting with patients, I love light-hearted chit-chat with colleagues between appointments. It is almost a form of self-care for me because it helps bring balance to my working day when I am supporting people through distress."

Emily's path into the role was unconventional. She began working for NHS Shetland while still on maternity leave, joining remotely before relocating to the islands in July. It wasn't without its challenges: a new health board, a new baby, and a move to an island she'd never visited. But she found real value in the remote start.

"Around half of our team members work remotely, and it has been valuable for me to experience that myself, so it can help me support them to deliver person-centred care," she explains. Working at a distance also meant that by the time she arrived in Shetland, relationships were already forming and foundations were in place.

Pressure on accommodation in the islands – finding a suitable home takes time – made the relocation more stressful than it might have been, and Emily is honest about that.

But she's equally honest about the upside: "I try my best to be self-compassionate where I can, a skill I have learned through my role."

One of the things that struck Emily most on arrival was how readily colleagues across health, social care and the third sector work together. She's involved in work streams around trauma-informed practice and suicide prevention that span multiple organisations, and she's noticed something different about how collaboration happens here.

"There's less of a tendency for people to work in silos," she says, "and more of a sense of everyone pulling in the same direction." In a community as interconnected as Shetland, that spirit isn't just good practice; it feels like a natural extension of how people relate to one another.

Support from senior leadership has made a difference, too. Resources can be stretched, and Emily is clear that feeling backed in her work to drive improvements has had a tangible impact on what her team can achieve.

Psychological Services at NHS Shetland offers a genuinely blended model of care: in-person appointments in Scalloway and Lerwick, video therapy via the Near Me platform, and digital interventions like Silvercloud for anxiety, depression and other conditions. Offering that choice, Emily says, is essential to reaching people where they are.

"I cannot picture our service without this flexible model anymore," she says. Video therapy, she points out, can achieve equal outcomes to in-person sessions. Digital exclusion and connectivity issues are real considerations, but overall the blended approach means more people can access support in their own communities, in their own time.

For any psychologist or mental health professional considering a move, Emily is both encouraging and clear-eyed about the practicalities. Securing accommodation can be difficult, and the island context takes some adjustment. But the professional rewards, she says, are significant.

"Remote and rural practice in mental health is some of the most meaningful, creative, and professionally rewarding work one can do as a psychologist. The strong team culture in NHS Shetland, community impact, the broad clinical experience to be gained, leadership opportunities and the chance to live in such a beautiful place with amazing people make it an incredibly enriching career choice."

And she has found her own slice of that life beyond work, too. "I have met so many interesting people over a cuppa and a few fancies," she says of the Sunday teas tradition she has wholeheartedly embraced since arriving in Shetland.

For Emily, it has all added up to exactly what she hoped for: a leap worth taking.

Discover why Shetland is an excellent place to develop your healthcare career.