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The Royal College of Psychiatrists Improving the lives of people with mental illness

12550 miles later

When I sit down to write these blogs, I often wonder if anyone actually ever reads them. But finally, after 41 blogs, I have proof positive that someone does. I wrote recently about my Grand Tour of what was at that point 33 out of our 34 medical schools, with only Dundee to go. I mentioned in the blog, my preference for wine in glasses not plastic cups, and pepperoni spicy pizzas. So on Monday night I was doing my stuff, after which there was a party with staff and students. And guess what – yes, chilled white wine in glasses and really excellent spicy salami pizza. So I now know that I have at least one reader, and he/she lives in Dundee.

I don’t know if you noticed, but it seems like there is a General Election in the offing. As you know, we don’t “do” politics at RCPsych. Actually, that’s not true, we do a little on your behalf. I spend so much time in Whitehall that some of the policeman on the doors have started to call me Simon. One recently was positively effusive, saying that he had always been one of my greatest fans. I am not used to such a greeting, which became even more mysterious when he added that he loved my commentaries since I stopped playing. It finally dawned on me that he thought I was John McInroe, a mistake that has been made before, although never when I am playing tennis or indeed any sport.

So we do “do” politics. It’s our job. We try to influence all the political parties on an ongoing basis to keep them on the straight and narrow when it comes to psychiatry and mental health. This activity however comes to a climax when an election is called, because what we want to do is influence their manifestos. And the window for doing this is very short – the small number of days between the Prime Minister turning round and heading back inside Number Ten having dropped her surprise election bombshell in April and the manifestos being unveiled, which we are expecting next week.

Fortunately the folks here at RCPsych don’t believe in sleep, so we have already put together our list. We have quickly drawn up our wish list of absolute essentials that the next government must commit to in order to improve the nation’s mental health. Perhaps because of the 12550 miles I’ve on the train to medical schools over the past three years they feature strongly in this. Yes, 12 thousand. You read correctly.

As I have said before, and I will drone on about again countless times without apology, delivering grand plans to improve mental health services requires, above all else, people. Lots of them, well trained ones, led by consultants – or in other words us, psychiatrists. But in the last two years, numbers of psychiatrists in the NHS have dropped 4%, with drops as big as 10% in child and adolescent and older adult psychiatry. This picture looks set to worsen.

This is why we are making a strong call on the next government to commit to recruiting at least 1000 more psychiatrists, a figure which is based on those needed to deliver the Five Year Forward View which sets out priorities and policies that the NHS and Department of Health have committed to, more or less, for improving and increasing access to mental health services.

So we are saying that if you are serious on the Five Year Forward View – and all the main parties have said they are – then this is the minimum you need for now. In fact we will need even more than this if we are ever to treat all the people who need support for mental illness, rather than only helping one in three in need as we currently do.

Now you can’t just walk into your local job centre and ask if there are any psychiatrists kicking their heels there. It’s a long old road, usually 13 years between Fresher’s Week and emerging as a perfectly formed consultant psychiatrist.

You may have missed it, but the Prime Minister announced at the Conservative Party Conference in the Autumn that they are committed to recruiting an additional 1500 medical students per year, starting next year. I know – I was in the audience hiding at the back. Because I failed to leap to my feet at some of the carefully planned “applause lines” as they call it, a steward came up and asked who I was and where was my ID? When I declared my psychiatric allegiance, it was a little like I announced that I had Ebola, as those on either side of me visibly moved aside.

But as soon as I heard her commitment, it immediately occurred to me that we should lobby to ensure that this expansion was used to increase the supply of what the NHS really needs in its medical workforce –namely more doctors of whatever breed with more knowledge of mental health, and second, specifically more general practitioners and psychiatrists.

So we are calling for action to raise the knowledge of mental health of all students, and then measures that will lead to more choosing general practice or psychiatry.

We know that the variation in numbers of psychiatrists produced by different medical schools is pretty huge, almost three fold. What is going on in there? Teaching varies, some will include more elements of psychiatry in their syllabus than others. Some barely include mental health at all, which is a remarkable oversight in this day and age. So we are asking for action to ensure that the curriculae and teaching more accurately reflect the needs of the next generation of doctors.

We are also pushing for an increase in the amount of psychiatry that will be tested in the new National Licencing Exam coming soon to every medical school near you.

And then there is the Foundation Year. This year we hit the target of 45% of all medical students doing a Foundation Post in psychiatry. Great, but why stop there? Let’s go for 100%. And so that’s exactly what we’re calling for.

But we also need to go right back to when medical schools admit students, by calling for psychology A-level to be treated as on a par with traditional sciences. The very brightest of today’s school students, who are undoubtedly far more interested in and fluent in the language of mental health than my generation, must not be deterred from applying to become doctors due to stuffy attitudes that two biology, physics or chemistry A-levels are a must. Many medical schools, amongst which is my own, do not list A-level psychology as a science, which I have to say is nonsense.

There are some geographical areas and specialties within psychiatry where it is pretty darn difficult to recruit and keep doctors. Many of you work in these areas, you know what I am talking about. To solve this, we want to flatter the GPs enormously by pinching their successful recruitment campaign (after all, we have already pinched their Deputy CEO to be our new Chief Exec), and call on the Government to back a similar psychiatry recruitment drive with financial incentives to encourage more trainees to work in areas with recruitment difficulties.

And while we are calling for all stops to be pulled in order to grow the future psychiatric workforce, we need to be realistic that we can’t train people fast enough to fill the current gap unless we can hang on to the talent that we have. The opportunities for us to recruit doctors from outside the UK grow less and less – can I mention Brexit now? 41% of our trainees are non-UK graduates so we are particularly vulnerable to this. All of this means that we need to keep our experienced doctors and enable them to work flexibly as they approach retirement age.

Now why am I spending so much time on this? First, because it really matters. And second, because I am quietly confident that our work not just in the last few days, but in the months since Mrs May first announced the expansion of medical school places, will bear fruit. I am not making predictions – I remember well Tony Blair once telling Jeremy Paxman that “I don’t make predictions Jeremy, I never have and I never will”. Think about it for a second, trust me, it’s funny.

So I don’t make predictions, but I do think we may get somewhere with this.

Professor Sir Simon Wessely

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Comments

Re: 12550 miles later
Salute to your commitment & passion Sir Wessely
Re: 12550 miles later
I'm going to miss your blogs. They're always amusing, but this one said something really important: "what the NHS really needs in its medical workforce –namely more doctors of whatever breed with more knowledge of mental health". How do we achieve this? We need to get down and dirty with the "95%", that is the majority of medical students who will never enter a career in psychiatry. Summer schools and psychiatry societies are all wonderful, but as an intervention they aim only for those at high risk (of becoming a psychiatrist, that is). I was minded of a short on BBC Radio 4 - Marketing: Hacking the unconscious - that told how Nike almost came a cropper by targeting only elite athletes. Effective marketing means aiming at the majority, not at a committed few. Most medical students don't see a psychiatrist except on placement: they see physicians and surgeons all the time, in corridors, canteens, as well as clinics. So they - the students - feel part of something, and do a lot of learning informally. When psychiatrists moved out of the teaching hospitals it was good for mental health, but tough on psychiatry as a part of medicine. In psychiatry, as in the general election, we can't afford to pitch to a tiny minority and ignore the masses.
Re: 12550 miles later
Great point and great writing!

This issue is particularly salient at my medical school - Imperial - as very few students leave and become psychiatrists compared to other medical schools, as best as I know. With all the academic research centered on biological treatments and medical diagnostics, the importance of psychotherapeutic and especially social interventions is really forgotten in the milieu of our experiences as medical students. Biopsychosocial at Imperial really defers down to biomedical, and it is understandable, but not very beneficial I think for making empathetic, patient-centered thinkers. Moreover, most students are driven to medical and surgical specialties simply as a result of greater exposure and emphasis throughout our studies. I agree with you that the only remedy is a restructuring of medical school curriculae to place more focus on mental health and the psychological consequences of physical ailments. That would be more in line with a holistic 21st century medical model.

On that note, it would also be good to see more campaigning for social changes (poverty reduction, improved education, maternal assistance, better services for migrants) and public health prevention from RCPsych because the aetiology of many mental health issues is rooted in these causes. It is probably a bit un-PC, no doubt, but that voice for change, whether we see the benefits or not, is necessary especially in times like these.
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Professor Sir Simon Wessely

   

Professor Sir Simon Wessely

President


Sir Simon Wessely is Regius Professor of Psychiatry and Co-Director King’s Centre for Military Health Research and Academic Department of Military Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London.  He is a clinical liaison psychiatrist, with a particular interest in unexplained symptoms and syndromes. 

He has responsibility for undergraduate and postgraduate psychiatry training, and is particularly committed to sharing his enthusiasm for clinical psychiatry with medical students. He also remains research active, continuing to publish on many areas of psychiatry, psychological treatments, epidemiology and military health.

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