Thursday, 23 May 2013

I flew back from the APA conference in San Francisco yesterday, so am still feeling the effects of the time difference. There has been lots going on in the UK while I've been away, and I've been keeping in close contact with the College via my blackberry.

Work Capability Assessment ruling

Yesterday, while browsing the BBC News website, I read the news story saying judges at the Upper Tribunal ruled the Work Capability Assessment puts people with mental illness, autism and learning difficulties at a substantial disadvantage. The Department of Work and Pensions has said they will appeal the decision, so we'll continue to watch this case with interest.

New mental health commission

Yesterday also saw CentreForum launch a 12-month mental health commission chaired by former care minister Paul Burstow MP. I am delighted to be a member of this commission, which will examine the progress made by the coalition government's mental health strategy in ensuring parity of esteem between physical and mental health. I will keep you updated.

Tackling the crisis in emergency departments

Over the last week, I'm sure you can't have missed the numerous media reports of the 'crisis' engulfing A&E departments. These reports are of great concern to all doctors, and particularly psychiatrists as emergency departments play a vital part in the care and treatment of people with mental health problems. But problems and pressures in A&E departments can mean the needs of vulnerable people are overlooked.

I believe there are two simple solutions to help tackle the problems of overcrowded wards and overstretched staff:

1.    Urgently implement a minimum unit price for alcohol at the earliest opportunity. Approximately 1 in 3 of all A&E attendances are alcohol-related – doubling at weekends. There is strong evidence that increasing the cost of alcohol will reduce consumption and harm among the heaviest drinkers.

2.    Ensure all emergency departments have access to a comprehensive liaison psychiatry service, providing immediate and specialist mental health support for people being treated for physical health problems. Recent research suggests liaison services can save an average hospital £5 million a year by freeing up beds, reducing readmissions and improving outcomes for patients.

Our emergency departments are facing desperate times. Tackling the problem requires immediate measures, and this is an issue I will be raising with parliamentarians.

I wish you all a very enjoyable Bank Holiday weekend.

Sue

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Monday, 20 May

At the APA

Last Thursday, I flew to San Francisco for the 2013 Annual Meeting of the American Psychiatric Association (APA). It has been a fascinating conference - the first part of which was dominated by publication of DSM-5. 120,000 copies left the shelves in the first few hours. And it is not only DSM-5 that is rising quickly up the Amazon sales charts - so, too, are copies of those publications opposed to DSM-5!  

At the conference, there have been many impressive keynote speakers - including Bill Clinton (see right). I've also been pleased to see so many speakers and presenters from the UK. The College stand is also proving very popular - displaying a wide range of RCPsych Publications and information leaflets, of which the College, our authors, and our Communications and Publications departments can be rightly proud. 

Yesterday, I attended a very good session about progress with the revision of the International Classicfication of Disease (ICD). As many of you know, ICD-11 is due out in 2015. I would urge you all to look at the website, so as to be prepared by understanding the principles upon which this classification will be based. Please also join in the field trials, as this will shape our practice for years to come.

At the session, we heard that ICD-11 will especially look at differentiation from normal. Every disorder will have a 100 word summary definition with details of essential features, boundary with normality and boundary with other disorders.

I am looking forward to the International Reception on Tuesday evening, where there will be an opportunity to meet up with colleagues and College members from across the world.

Although the programme here is extremely busy, I am finding a few spare moments to explore the city. The streets of San Francisco are, I guess, like many large vibrant coastal cities across the world - a rich mixture of busy people, homelessness and street performance artists. I've been enjoying the amazing seafront vistas of the Golden Gate and (closer to my clinical world!) Alcatraz. I hope my Grandson likes his Alcatraz t-shirt that I'm bringing back for him.

The big mental health debate

Last Thursday saw the second backbench Commons debate on mental health, following the one that took place in June 2013. It was a five-hour debate with input from MPs of all parties, and, following our briefing, many interesting topics ranging from stigma, crisis care, BME communities, welfare reform, alcohol and the need for parity of esteem between mental and physical health.  A number of MPs have called for the debate to become an annual event as a way of “reducing the stigma that is attached to mental illness, increasing understanding of it, and also, quite correctly, holding the Government to account on how their policies develop”.

Former Care Service Minister Paul Burstow MP, who led the debate, highlighted the work of the College in relation to parity, and Kevan Jones MP thanked the College, and others, for "doing a great job of raising the issue and tackling the stigma".

Former GP Dr Sarah Wollaston MP raised the issue of integration and the importance of liaison psychiatry as "greatly appreciated by patients and provide an excellent way for them to receive services; moreover, they are incredibly cost-effective".

It is good to see all our efforts in areas such as parity being used to shape debate, influence opinion and ultimately help us deliver for our patients. If you have time I would encourage colleagues to read the text of the debate or watch it online.

Investing in technology

Last week I received a letter from Health Secretary Jeremy Hunt, about launching the £260m technology fund for hospitals on Friday. The announcement formed part of the response to the Francis report, which called on the NHS to make better use of technology to improve care. I welcome this announcement, and hope it will fully include mental health services. We need integrated data which ensures that vital information is shared - allowing patients with mental illness to receive high quality and timely care, while ensuring appropriate confidentiality. The government has already acknowledged that we have good examples of health informatics in our sector. 

Sue

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Wednesday, 15 May

I’m looking forward to tomorrow’s debate in the House of Commons on mental health, which follows last year’s debate on the same topic. The previous debate in June 2012 was long overdue, and never before had parliamentarians spoken so openly about mental health issues that have affected them personally.

Nicky Morgan MP opened the last debate by saying: "Mental health comes at an economic and social cost to the UK economy of £105 billion a year, yet mental health has been a Cinderella service - poorly funded compared with other conditions and not spoken about nearly enough either inside or outside this House. It is the largest single cause of disability, with 23% of the disease burden of the NHS, yet the NHS spends only 11% of its budget on mental health problems."

I was overwhelmed by the honesty and openness with which mental health was discussed by MPs, which was one further step along the road to ensuring everyone can be open about mental health without fear of stigma.

This latest debate follows the enactment of the Mental Health (Discrimination) Act, which outlaws discrimination on mental health grounds against jurors, company directors and MPs. It is also timely because it follows the College's recent report, Whole-person care: from rhetoric to reality, which outlines ways to ensure parity of esteem for mental and physical health. We have welcomed the government’s commitment to parity for mental health but there is still more to be done to make this vision a reality.

The College has worked with Mind and Rethink Mental Illness to brief MPs in advance of tomorrow's debate, highlighting some of the key issues we hope will be discussed.

If you are a tweeter, you’ll be able to follow developments using the hashtag #bigmhdebate and the College will be tweeting live during the debate from our twitter feed @rcpsych.

The debate comes at an important time for mental health and I hope it is another step towards continued improvements in perception and care for those effected by mental health, their carers and families.

Sue

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Monday, 13 May

Support for carers

On Sunday I was pleased to see media coverage of the RCGP’s call for more support for carers. Our GP colleagues say carers should have routine appointments and checks for depression and other mental health problems. Although this is good to hear, the challenge is more than just helping carers maintain good mental and physical health. Will all the other support services they need be adequately resourced to help make high quality care in the community fact, rather than mantra? Last week I blogged about the Queen’s Speech, and hopefully some positives will come out of that for those with mental illness and their carers.

Celebrations in Northern Ireland

At the end of last week, I had the privilege of being part of the 10-year celebration of RCPsych in Northern Ireland. The conference was held beside the beautiful Mourne Mountains. In my clinical life, I have spent more than 30 years visiting Northern Ireland to work with child services and their complex, high risk young people. This visit reminded me that I have seen many changes there, through both troubled and good times.

The impact of their major health review, Bamford, is certainly now to be seen. Northern Ireland is facing the same challenges as in the rest of the UK – balancing the delivery of intensive community-based services and public mental health prevention, whilst improving the fabric and capacity of inpatient services for those who require them.

The RCPsych in Northern Ireland is a close-knit, thriving family – and meeting their many new members showed me that they are facing a very secure future. The health minister, Edwin Poots, addressed the meeting and was rightly praising of all that the College has achieved – thanks in no small part to the College staff over in the Divisional office, led by Nora McNairney.

We enjoyed many good presentations at the meeting, covering all ages and aspects of psychiatry. Creativity emerged as a key theme, through academic discussions, conversations and social events. It was particularly good to hear from a social media expert that blogging is an effective way of communicating. He was also very positive about the @rcpsych Twitter feed, where we aim to send out positive, informative messages about mental health and psychiatry, and engage in discussion.

The meeting was also an opportunity to bid farewell to Dr Philip McGarry, who has chaired the Division for the last four years and done a fantastic job. Although we are sad to see him go, I am very pleased to welcome the incoming Chair, Dr Diana Day-Cody.

Troubled waters

At the end of this week, I will fly to San Francisco for the 2013 Annual Meeting of the American Psychiatric Association. The meeting will be hit by the storms that are already building up around the launch of DSM-5.

The fifth version of the DSM has already received extensive media coverage here in the UK, with many people using its imminent publication to raise concerns about psychiatry and the classification and diagnosis of mental illness. Whatever your personal views of DSM-5, my concern is that its publication is providing the focus for ill-informed psychiatry bashing. In some areas, this is being turned into a ‘turf war’ between psychiatrists and psychologists.

But these arguments are distracting us from the real challenge – which is providing high-quality mental health services and treatment to patients and carers. At this time, we should all be immersed in advising on the new commissioning changes in England, and celebrating advances in neuro and social science research.

The issue of diagnosis and classification was raised at a recent meeting of our Service User and Carer Forums, and I was interested to hear their thoughts. “I like my label – I know what I’m up against” was one of the comments. There was a general feeling that receiving a diagnosis can be difficult to accept – but that it can also be helpful and bring about a better understanding of how to manage the illness. Some people also recognised the importance of diagnosis organisations (such as Depression Alliance and Bipolar UK) in offering hope, mutual support, and an opportunity to share experience and knowledge.

Our College has today issued a statement on DSM and the classification of mental illness. I would also urge you to read the excellent opinion piece by one of our Fellows, Professor Sir Simon Wessely, in yesterday’s Observer. As he so wisely says: "Psychiatry is the study of the brain and the mind. Psychiatrists look at the whole person, and indeed beyond the person to their family and to society... Most of those who are in the business of helping those with mental disorders will be less concerned with what is in [DSM-5] and what is out than with the reality of underfunded and overstretched services. The idea that we are part of a conspiracy to medicalise normality will seem frankly laughable as we struggle to protect services for those whose disorders are all to evidence under any classification system."

Sue

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Wednesday 8 May, 2013

The Queen's Speech

There was pomp and ceremony aplenty in Westminster today at the State Opening of Parliament and the Queen’s Speech in which the Government outlined its legislative programme for the coming session of Parliament.  

Following the Draft Care and Support Bill in the last Parliament, a Care Bill will be introduced combining existing care and support legislation. It introduces a duty on local authorities to meet carers’ support needs and introduces a new adult safeguarding framework.  

The College will also be taking a keen interest in how the Bill amends section 117 of the Mental Health Act, which gives local authorities and CCGs a joint duty to provide ‘after-care’ services when people leave hospital following detention under the Act, and people subject to Community Treatment Orders.

We have been campaigning with other Royal Medical Colleges and health stakeholders for the introduction of a minimum unit price for alcohol and, whilst I was disappointed not to see anything in today’s speech, I must take some heart from Jeremy Hunt’s radio interview on the Today programme this morning during which he emphasised that no final decision has been made. Hopefully when a final decision is made, it’s the right one.

Although not covered in specific legislation, in response to failings at Stafford Hospital Ofsted-style ratings will be introduced for hospitals and care homes, and the new Chief Inspector of Prisons will be given more power. On immigration, plans have been announced to regulate migrant access to the NHS, “ensuring temporary migrants make a contribution” and it will be interesting to see how this plays out in practice.

Achieving parity

Yesterday, I attended a meeting of the Ministerial Advisory Group on the Mental Health Strategy, and took the opportunity to feed in key points from our recent parity report, Whole-Person Care: From Rhetoric to Reality. This landmark report has been very well-received, and we are in constructive discussion with service users and carers, and key stakeholders from across health and social care, about how we can help make it a reality.

Dr Martin McShane, the NHS Commissioning Board’s lead for long-term conditions, responded with a packed list of actions that NHS England have pledged to deliver to help bring about parity. There will be an emphasis on how the new National Clinical Directors – across all specialties, geographies and groups – will work together to enable integrated care. Nowhere will this matter more than in mental health.

A time for celebration

It feels like celebratory events are all too rare these days, but last week I had the privilege of speaking at the launch of Rethink Your Mind, an exciting and creative arts and mental health project. Rethink Your Mind has published a book of poems, paintings an drawings, all created by individuals with mental health problems. Woven into the book are important messages about wellbeing, and positive ways to be resilient and flourish. I strongly encourage you to take a look at their website.

Later today I’m flying to Belfast, to take part in the RCPsych in Northern Ireland’s Spring Meeting. The meeting will mark the 10^th anniversary of setting up the Northern Ireland Division, and I very much look forward to joining the celebrations.

Sue

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Thursday 25 April 2013

It has been a week spent mostly at the Academy of Royal Medical Colleges. On Tuesday, all the Colleges came together to look at our top priorities to act on post Francis. The Colleges are already working on these individually, and with other health and social care professionals, including the NHS Confederation, so we now have some clear understanding of what others intend to do. The next step is to collate and analyse all we have learnt and then start working on a few priorities that are key to us as doctors. All the work done by Council in January when we held a World Café on this and other key issues, have been fed in. You can expect a paper shortly from myself and Professor Mike Crawford, Head of the CCQI, hopefully with a commentary from our service user and carer forums.  I am still, however, very open to suggestions.

We have a good basis for our work, drawing from the College publication, Intelligent kindness: Reforming the Culture of Healthcare, and some of the CCQI’s current initiatives, such as the kite mark for elderly wards across medicine. Messages from Francis, Winterbourne View and countless other earlier reports have to be taken into appraisal and revalidation. There is a strong view that if we restarted visits to services when looking at training that this would also act an early alert when things are going wrong. We need to look at how we can strengthen the role of Regional Advisors, as they have a great deal of knowledge about posts and how these are working in the context of best patient-centered care and treatment. So there is no shortage of routes in.

On Wednesday I attended a working group on 7 day working to which members have been actively contributing. This has UK wide implications and is focusing on how doctors will have to change their working routines. Some of you will shortly be receiving a survey, so please do respond. Some medical colleagues are under the impression that we do a Monday-to-Friday, 9-to-5 job, and they have little insight into the diverse range of work we do outside these hours.

Yesterday, Prof. Wendy Reid, Medical Lead in Health Education England (HEE), came to talk to the Academy. I feel that we are heading for challenging times. Good news: all Local Education and Training Boards (LETBs) have a Postgraduate Medical Dean on them and 2 LETBs will have 2 Deans. But it is clear that HEE will be kept on a tight rope up to the elections as they will be working to a shortly to be announced Mandate. Only time will tell!

With regard to the regulations on Section 75 of the Health & Social Care Act around competition and commissioning, we have been invited to meet with Monitor shortly. Our dilemma is that the regulations follow primary legislation, ie the Act. We still have concerns. Will Clinical Commissioning Groups (CCGs) factor in whether a provider provides education and training or will this be lost? Will they really be able to factor in risks of destabilisation, if one part of a service goes to one provider and the rest stays where it is?

We are currently generating case scenarios for Monitor to work with because we know that even in surgery a patient never arrives with one simple problem. We have generated psychiatry-specific ones, but we are working with other Colleges on across-medicine presentations.

The newspapers covered the defeat of a move to have the Regulations withdrawn during a Labour led debate in the House of Lords on Wednesday evening. The government won the vote and we now have to work with what we have - working with Monitor, the Care Quality Commission and those College members trying to get involved at some level on CCGs. We can still have influence, so please see what you can do. I know many of you are getting involved, so many thanks as it’s the best way to support our patients.

Today, Lord Willis of Knaresborough, Sense About Science and the Academy of Medical Royal Colleges are hosting the launch of a new report, ‘Evidence Based Medicine Matters’, at the House of Lords. Dr Paul Blenkiron in his capacity as a NICE Fellow,  contributed a chapter on our behalf on the effectiveness of CBT.

Thursday 18 April 2013

Am keeping my fingers crossed, but Spring finally seems to have sprung in what was another busy week in and out of the College.

I have to admit that I’m not a twitter user, but the College account is an active one with nearly 17,000 followers and I hope members that do follow us find it useful. I was interested to hear the Health Secretary Jeremy Hunt had taken to twitter to emphasise the need to parity of esteem between mental and physical health. We’ve had very good feedback on our recent report, especially on social media where there has been some good debate around the issues we’ve raised.

As you will have read in previous blogs, most of the Medical Royal College have been making representations regarding the latest versions of the regulations around competition in the new NHS structure, and the effect they may have on the commissioning process.

Following pressure from doctors and others in the health sector, the first regulations were amended. We continue to liaise with Ministers and the Department of Health to ensure patient care is not put at risk as we move forward.

The Labour Party have tabled a debate in the Lords next week in an attempt to get the new regulations debated and possibly annulled, and I will watch with interest to see what Peers have to say.

The College was invited to meetings organised by the Labour Party as they look to review their policies in advance of next election. It has been interesting to hear their thoughts on the direction of travel for the health and social care system, and the views of those that will work in it and use its services.

Turning to training, I was informed of a leadership programme called GenerationQ, being run by the Health Foundation. They are looking for senior leaders in healthcare or the voluntary sector who are in a position to influence improvements to care quality, and learn about the evidence base underpinning leadership for quality improvement.

The part-time programme will take between 18 months and two years to complete, and leads to a postgraduate certificate, diploma or Masters in Leadership (Quality Improvement). I would encourage members to look at the website if they are interested in applying.

All Colleges have also been invited to input into the ongoing reviews following the Francis Report and Officers will be discussing how best to ensure psychiatry is part of the process of improvements to patient care.

I’ll try to keep members updated here and via our newsletter as usual.

Thursday, 11 April 2013

Yesterday, The Times reported on a new mental health research charity, MQ, that has been set up to raise millions of pounds to transform the treatment of mental illness. The Chairman is Lord Denis Stevenson, who we worked closely with on the Mental Health (Discrimination) Act.

I am hugely excited by these plans. Having worked as an NHS psychiatrist for more than 30 years, I am sad to say that mental health still does not receive the same attention as physical health, and that psychiatry – and academic research into mental health – remains medicine’s poor relation.

In the UK, mental illness accounts for a third of all illnesses – the single largest source of burden of disease. But paradoxically it remains under-researched and under-funded, only receiving 6.5% of the total UK health research budget, compared to 25% for cancer, 15% for neurological diseases and 9% for cardiovascular conditions.

If this is to change, then we have to take a radically new approach. MQ is undeniably bold in its ambition – wanting to become a fundraising force every bit as powerful as Cancer Research UK or the British Heart Foundation. These excellent organisations were both founded by medical professionals wanting more research into the cause, diagnosis, treatment and prevention of disease. And thanks to these organisations, huge progress has been made in recent decades in developing new treatments for cancer and heart disease, and improving the lives of patients and their families.

People affected by mental illness deserve this support too. But the same amount of time and money has not been invested in them. It is shocking that people with severe mental illness have a reduced life expectancy of 15–20 years. This cannot be tolerated in the 21^st century.

If we believe in a society where we are all equal citizens, then those who experience episodes of mental illness must receive the best care, informed by the best evidence. We urgently need to invest in research that will improve the quality of mental health treatment, and help drive the development of new medications and all types of psychological interventions. We need to develop new strategies for diagnosing, treating and preventing mental illness, to help support people with their recovery and beyond.

We are entering an era of major advances in the field of neuroscience, and we have a growing understanding of the complex biological, psychological and social causes of mental illness. That’s why I am particularly pleased to see MQ’s commitment to using cross-disciplinary approaches to solving the problem of mental disorder. If MQ are to deliver on their ambition of solving global issues in mental health, they will need to commission both quantitative and qualitative research that brings together the neurosciences and social sciences.

The College is committed to achieving parity between mental and physical health - as you'll have seen from the report we published last month. It will take time, but I believe that the work of MQ: Transforming Mental Health will be a huge step in the right direction.

Monday 8 April 2013

Sorry not to have blogged for a little while. Since we launched the parity of esteem report on 26 March, we’ve had lots of encouraging responses. We will pull together all of the thoughts we’ve received from different organisations – including the NHS Confederation’s Mental Health Network – so we can move into implementation. I hope that many of you, as members, will volunteer to be involved.

Preparations are a seminar on mental health and the workplace, as well as a set of four seminars on building psychosocial resilience. These two projects will both lead to new Occasional Papers.

As well as the continuation of cold weather, the start of April has seen the launch of the new NHS, together with stringent changes to the welfare system and legal aid. It is hard not to be pessimistic about the combined impacts of all three of these on the most vulnerable groups that we care for.

In England, the debate around Section 75 regulations continues, and we are awaiting responses from both Monitor and the Department of Health. In the meantime, the Academy of Medical Royal Colleges is continuing to have dialogue with government on the issue.

On 26 and 27 March, the College and Royal Society of Medicine jointly organised a conference on global mental health. I was very heartened by the number f young psychiatrists involved in so many amazing projects, and I hope to showcase many of these are our International Congress in Edinburgh from 2-5 July.

I hope to see as many of you as possible in Edinburgh, where we have organised a meeting of mental health policy leads from the four countries. We will also host a meeting of Presidents from the European psychiatric societies again, and Professor Mike Crawford – Director of our College Centre for Quality Improvement – and colleagues have completed a survey of how and what different psychiatric societies are doing in the field of quality improvement. I am sure the findings and resulting discussions will be extremely interesting.

I am writing this blog from Nice, where I am attending the 21^st European Congress of Psychiatry. Their cold weather seems very hot to me! I'll blog about the action from the conference later in the week.

Sue

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Wednesday, 26 March 2013  (Response)

Today our College has published a landmark report on achieving parity between mental and physical health.

In April 2012, the Royal College of Psychiatrists was asked by the then Minister of State for Care Services, Paul Burstow – in partnership with the Department of Health and the NHS Commissioning Board Authority– to develop a definition and vision for ‘parity of esteem’.

I was honoured to be able to lead this work and the report that we’ve published today, Whole-Person Care: From Rhetoric to Reality, is the culmination of many months of hard work.

The long-standing and continuing lack of parity between mental and physical health - as  exemplified by lower treatment rates for mental health conditions, premature mortality of people with mental health problems and underfunding of mental healthcare relative to the scale and impact of mental health problems - falls short of government commitments to international human rights conventions, which recognise the rights of people with mental health problems to the highest attainable standard of health.  It is not only inequitable, but socially unjust.

The report makes over 30 key recommendations for government, policy-makers, service providers and health professionals, as well as the new NHS structures coming into force on 1 April including the NHS Commissioning Board, Clinical Commissioning Groups and Public Health England. The headline message is for all of the above (and ourselves as doctor psychiatrists) to always to think in terms of the whole person – body and mind – and to apply a ‘parity test’ not just to our activities but also to our attitudes.

The College is strongly committed to a continuing work programme focused on achieving parity. I’m pleased to say that many organisations – some working jointly with the College – have also committed to ambitious actions which will bring us closer to achieving parity, and I look forward to seeing the fruits of their labours.

I want to say a profound thank you to every single member of the parity of esteem working group and other expert advisors who contributed to the report. Contributors included representatives of Medical Royal Colleges, national clinical leaders, mental health charities, social care specialists, and service users and carers – you can see the full list of names in the report. I also want to thank Lucy Thorpe, our Head of Policy, and Greg Smith, our Policy Analyst, who drafted the report. 

The publication of this report really is a momentous occasion. But the work does not stop here. In fact, it should be seen as the first stage of an ongoing process over the next five to ten years that will deliver parity for mental health and make whole-person care a reality. I look forward to the journey.

Sue

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