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

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24/04/2014 15:41:47

Cutting denials

Thursday 24 April 2014

So NHS England and Monitor continue to deny central cuts to mental health services (Mental health services need targeted investment, not even more cuts, 26 March.) Yet a new Freedom of Information request has found that 77% of CCGs are applying the 1.8% cuts to their CAMHS budgets in 2014/15.

NHS England was reported in Pulse magazine as stating: “There has been no central cut to mental health services”. And yet they go on to refer to mental health services being subject to a tougher “efficiency target” and that “efficiency targets reduce the overall amount of money per patient head”.  Surely an “efficiency target” is another way of saying “cut”?

NHS England has justified the difference in the cuts between acute and mental health services in order to implement the recommendations of the Francis report. It claims these cuts only apply to acute services. However, the Care Quality Commission has issued a warning notice to a Trust for failing to meet the so-called post-Francis inspection criteria. So clearly the CQC think this criteria applies to mental health trusts.

Robert Francis himself has spoken out about the disproportionate cuts to mental health services, telling HSJ of his surprise that any costs associated with the implementation of his report, and the Keogh review, should be limited to the acute sector.

Take all these comments into account and where does this leave mental health? Far removed from the ideal of parity of esteem it would seem.

For NHS England and Monitor to continue to claim that mental health services are not suffering from cuts and are on an equal footing with the acute sector is not only misleading – it’s beyond disingenuous.


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17/04/2014 10:13:38

Simple but effective change

Thursday, 17 April 2014

News about the changes to trainee doctor rotations proposed by The Academy of Medical Royal Colleges.

The idea is to have all Foundation Year 1 posts beginning on the first Wednesday in August, but for other training posts to start later. This means new Foundation Year 1 Trainees will be working with Core/Specialty Trainees who have already been in post for several months.


It’s a simple idea – but it should prove effective at helping to enhance patient safety and quality of care.




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16/04/2014 12:25:07

New connections

Friday 11 March 2014

Yesterday I had a really interesting meeting with the lead from Autism medical research charity Autistica, whose ethos is "with knowledge comes understanding".

The charity is developing and delivering on a wide range of research projects across the field of autism working with the NGOs in this field. This includes research projects in Newcastle that are looking at autism and older people. The charity also stresses the need for adult psychiatrists to have solid training in autism.  

I then met with Dr Gordana Milavi, one of the Child and Adolescent Section leads at the World Psychiatric Association (WPA) to look at the key issues psychiatrists around the world are facing in this area, particularly that of vulnerable groups of children impacted on by war and abuse.

I’m absolutely delighted - if not a bit surprised - that after an interview last week I will be taking up the role shortly as Chair of the Children and Young People’s Mental Health Coalition (CYPMHC), which is based at the offices of the Mental Health Foundation. I’m really looking forward to the opportunity to continue to play a part in championing mental health - in this case child and adolescent mental health. 


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Royal College of Psychiatrists’ parliamentary update

15/04/2014 13:50:42

Women in medicine more news

Tuesday 15 April 2014

So the Royal College of Surgeons, Pathologists and now Medicine will have a female president. Professor Jane Dacre has just been elected president of the Royal College of Physicians. This will take the Academy of Royal Medical Colleges back to a situation that existed - albeit briefly - when I was privileged enough to be voted into the role of President of this College and first joined the Academy.

I had a good meeting at the UEMS Council in Brussels on Friday and Saturday. The UEMS have asked me to prepare a briefing on how to achieve parity in medical education - a start to enabling all doctors across Europe to be given fit for purpose training in mental health. Dr Brain Jacobs, who leads on medical education and training for the council, presented the new competency based curriculum in child psychiatry, which was well received.

This week I’m back to my roots talking to the National Association for Youth Justice(NAYJ) about progress being made in raising the age of criminal responsibility - work that is being undertaken in partnership with the Magistrates Association and Lord Carlile.

Later I’ll be attending the Parity advisory group at NHS England. I hope this may help progress the current unacceptable decision about the Monitor Deflator - especially since Robert Francis spoke out about this decision.

Later this week I’ll be meeting with the Health Education England (HEE) advisory medical group, which I co-chair with its Director of Education and Quality Dr Wendy Reid. Really important changes are taking place - ones I believe will be supportive of mental health and primary care.

I’m also really looking forward to this evening’s lecture at the College, at which the artists who created the visual arts installation in the reception area will speak about their works.

NHS financial crunch getting closer says latest quarterly report from the King’s Fund – but no mention of mental health at all – so what are we to make of this?

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Royal College of Psychiatrists’ parliamentary update


11/04/2014 14:46:04

Women in Medicine

Friday 11 March 2014

As I prepare a paper for a meeting in June with the Chief Medical Officer and the NHS Confederation on women leaders and the work our College is doing, I am pleased to say there are two women presidents joining the small, but growing fold of female presidents in the Academy of Royal Medical Colleges.

The first female President has been elected to the Royal College of Surgeons in its 214-year history. Orthopaedic surgeon Miss Clare Marx was made President-elect to the RCS during Council elections, and will take up her appointment in July 2014.  And Dr Suzy Lishman (1986 Medical Sciences) has been elected President of the Royal College of Pathologists, which will take effect from the Annual General Meeting in November 2014.

This news, after attending the great Women in Medicine conference run by Health Education North West on 8 April was, by serendipity, the focus of last week.

I have also been in Brussels at the UEMS Council Meeting where there is, under current leadership, a real sense of common purpose and practice for all doctors.  The meeting included a really good discussion about informed consent across medicine. This goes to the heart of our Duty of Candour report, post Francis.


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08/04/2014 14:31:50

Building psychosocial resilience

Tuesday 8 April 2014

There’s a great article in the Times today about taking depression in our elders seriously. (‘Depression in old age is the next big health crisis', p4, 8 April).  It features some hard hitting truths from Dr James Warner, Chair of the Old Age Faculty, about the importance of looking beyond dementia when it comes to the mental health of the elderly.

I was also pleased to have the opportunity to air my views about finance becoming a bigger driver than care and compassion in the current NHS climate in the letters pages of today’s Guardian ('NHS's psychiatric stresses' p31, 8 April).

Yesterday saw the fourth of a series of seminars on Psychosocial Resilience. I will then be attending one final meeting which will bring the findings to users, carers and citizens. Then the breadth and depth of evidence we have heard from across the worlds of veterans, attachment, social isolation, asylum seekers and sustainability, and from leading UK and international academics from across the fields of social sciences, public health, disaster medicine and individual trauma, will be distilled into a report. This is being compiled by Professor Richard Williams, College lead for disaster management, and Verity Kemp, director of Healthplanning Ltd, who is a specialist in emergency planning, response and resilience. 

Little did we realise when this project was conceived that in creating an imaginary town of ‘Prescotville’, where ordinary people facing everyday challenges are hit by floods, that fiction would be mimicking reality!

The report will be out in June, and will hopefully start an evidenced based conversation about how, whatever the adversity, it is possible to build psychosocial resilience across and within communities - communities that are supportive to all citizens including those with mental illness.

There’s still no progress on the Monitor Deflator and there are reports of 8% cuts in some trusts.  So is seems NHS England is not for changing. I’m awaiting a response from the Health and Social Care Minister. We have posed him some challenging questions so I understand these will take time to answer.

The data sharing debate continues and people are now asking: “Can there be a real pause in this process?” The public as patients are suspicious of how data will be used, so the question is how can the government gain the trust of the public and the medical profession? With a robust safe system for data sharing we can move forward with very pragmatic research which would benefit patients and close risk gaps in their care. This is an across medicine matter, and hopefully the Academy will speak out on the issue.

I’ve also met with the NHS England lead for choice. Despite the obvious concerns about choice, what choice is there when we’re struggling to find beds for our patients? Choice is now the law and we have to make choice work for our patients, by seizing the benefits and ensuring the patient voice is heard.

We know from our users and carers that what they want is consistency and continuity of care – not having to reach crisis point. We know GPs want their patients to be seen by a consultant psychiatrist to receive a thorough and timely assessment with pathway into appropriate care and treatment. So have asked all of Council on their views about draft consultation guidance. All these things take time and effort on the part of your elected council members and fellows across divisions and faculties. They need to hear your views on all these issues.

At the end of the day, the person privileged to hold the role of president can feed back your expert views to policy makers and commissioners. This plays out in very similar ways in the four countries where the chairs of the division in Wales, Scotland and Northern Ireland, who will now become Vice Presidents, with their executives, have such a positive impact on shaping mental health policy in their jurisdiction.   


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04/04/2014 10:51:17

The case for a change in cigarette packaging is plain

'Friday 4 April 2014

The case for a change in cigarette packaging is plain

Congratulations to the coalition government on its support for the idea of selling cigarettes in plain packaging as a way of helping reduce smoking rates.

As a child psychiatrist working with young people in trouble at home, at school and in the community, I see real harm caused in my group of patients who start to smoke so young and move on into a range of addictive behaviours that contribute to their premature mortality. Hopefully the government's backing of plain packaging will help to discourage them from a starting a habit that can lead to a lifetime of addiction. And the switch to plain packaging should also help to discourage people who are trying to quit from relapsing and to reduce people’s exposure to smoke from tobacco products.

Last night I attended an event in Norwich held by Headucate, which is student society at the University of East Anglia that runs mental health workshops in local schools, with the aim of raising mental health awareness and tackling stigma.

Entitled ‘Mad, Bad or Misunderstood’ this keynote event was also attended by consultant forensic psychiatrist Dr Trevor Broughton who spoke about dilemmas in risk assessment in current psychiatric practice, while I gave a talk about understanding young offenders and how they are demonised. Congratulations to Headucate, not only for organising such a great event, but also for the worthwhile work they are doing.

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26/03/2014 07:54:27

Health service failing deaf people

Wednesday 26 March 2014

What a brilliant event ‘Sick of It’ was. The conference held by SignHealth, shared the results of its scientific study into the health of deaf people. Sick of it: How the Health Service is Failing Deaf People.

Most people there were deaf people. Their message is plain - they want government, the NHS, doctors and other healthcare workers to change their ways. They want sign language to be easily available in medical settings, to make access to healthcare for Deaf people equivalent to the access that hearing people get. Hopefully, the report and SignHealth’s accompanying campaign will help to get these messages out to the whole of the health community, and in particular to NHS England and CCGs.

A bitter irony on the day ‘Sick of It’ was launched is that the deaf community were told the psychological therapies for deaf people delivered in BSL would not be commissioned nationally through specialist commissioning, but put out to the vagaries of CCG commissioning locally. Is somebody out there not listening?  Maybe an answer would be embedding Improving Access to Psychological Therapies (IAPTs) for deaf people into specialist services as with ChildIAPTS.   

While at the conference it was great to meet up with colleagues from the neighbouring unit at my Trust (Greater Manchester West Mental Health NHS Foundation Trust) who deliver services for people with mental health problems. Also, my thanks to Helen Miller, a consultant psychiatrist at South West London and St George’s MH NHS Trust, for helping me to say half sensible things in my presentation.

During the last two days I’ve been impressed by the contribution from members of Healthwatch, both at a data sharing event I attended and at the SignHealth conference. These Healthwatch members know what’s happening on the ground and speak using evidence, and with brevity and clarity.  

Today is the grand opening of the RCGP building.  And I’m also really looking forward to the lecture on ‘Sustainability in Psychiatry’ which will be given by Dr Daniel Maughan, the College’s Research Fellow in Sustainability, at 6.30 pm this evening.

Meantime, I’m still pursuing the Monitor Deflator, and what can be done to redress the wrong that has been done.

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25/03/2014 15:30:19

Landmark judgment for protection of vulnerable people

Tuesday 25 March 2014

Today sees the launch of MindEd, a new website to give adults the knowledge and confidence to identify and understand children and young people with mental health problems (This has involved a great deal of work by many people. Consultant child and adolescent psychiatrist Dr Brian Jacobs, has done a huge amount of work to populate this education tool. Wouldn't it be good if we could have such a comprehensive tool for adult mental health for all health practitioners?

The launch is deservedly receiving a lot of media attention, and has already included an interview with Dr Peter Hindley, chair of the Child and Adolescent Committee on LBC radio this morning.

So the long-awaited judgment by the Supreme Court in P v Cheshire West and Chester Council and P and Q v Surrey County Council has been made public. The decision clarifies how to determine whether care arrangements for a person who lacks capacity to decide where to live amount to a 'deprivation of liberty'.

Mind and the National Autistic Society (NAS) both provided evidence to show that there is widespread confusion about when a deprivation of liberty exists, which means the safeguards are not always used and people are left unprotected.

Previously the Court of Appeal decided that none of the individuals associated with the case were deprived of their liberty because of the 'relative normality' of their lives compared either with their previous circumstances or with others with disabilities. So the starting point for deciding whether they were being deprived of their liberty was that their freedom was already inherently restricted by the nature of their disabilities.

However, the Supreme Court has overturned the Court of Appeal's approach which has prompted comments and concerns from our members about what this means for our profession regarding the use of Deprivation of Liberty Safeguards (DoLS).

In response I contacted the Department of Health and have helpfully received the following statement. The DH says: ‘The Department of Health and Ministry of Justice are currently examining the implications of the Supreme Court judgment in "P v Cheshire West and Chester Council" and "P and Q v Surrey County Council". Guidance shall be issued by the end of this week (Friday 28th March 2014).

‘In the meantime, local authorities should re-familiarise themselves with their obligations under the Mental Capacity Act, particularly the need for least restrictive care plans. The first step following the identification of any potential deprivation of liberty should be to consider how an individual's care plan might be adapted to remove the deprivation of liberty. Where deprivations of liberty cannot be authorised under the DoLS process, the Court of Protection provides a means by which a deprivation of liberty can be lawfully authorised.’

The College’s mental health lead will be involved in any ongoing discussions as part of the DH group. If you have any concerns or comments on this issue please send them to me via our policy lead Lucy Thorpe ( so we can learn as we go and feed back to the DH.

In other news, parity of care for mental health services remains a major concern. I am pursuing the Monitor Deflator, and it is also encouraging that the issue of parity is being raised in Parliament.

In Prime Minister’s Questions last week, Ed Milliband highlighted how the mental health budget has fallen for the first time in a decade. He also commended mental health charities for joining together to warn of deep concerns about mental health services, noting they had ‘spoken bravely’ about this subject, including about the impact on those who have experienced these problems.

David Cameron has agreed that mental health ‘should have parity of esteem with other forms of healthcare’. He also urged commissioners to focus on the importance of mental health services but the money is there, the legal priority is there and we need the health service to respond.

Last week, I was privileged to be part of the Northern and Yorkshire Divisional meeting. It was a great turn out with excellent presentations from trainees and posters, and a tour de force from Peter Tyrer, professor of community psychiatry in the Centre for Mental Health in the Division of Experimental Medicine who, as ever, ‘says it the way it is’.

I am also taking part in an important conference held by SignHealth, which today publishes its report ‘Sick of it: How the Health Service is Failing Deaf People’.

Tomorrow sees the grand opening of the RCGP building.  

And for those of you in the North West, look out for the ‘Furiously Mad - 300 Years of Legal Insanity’ exhibition (2-6 April, Peoples History Museum.   This exhibition reveals the legislative history relating to the lives of people described as ‘furiously mad’ in a legal document in 1714 through to the more recent treatment of the ‘mentally ill’. 


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06/03/2014 10:03:04

All happening in Belfast

Thursday, 6 March 2014

IClifton House was delighted to be invited to take part in the Annual Forensic Residential Conference in Belfast this week. The programme was excellent and covered important forensic issues and much more.

There were two extra bonuses. First and foremost, I was able to meet with the chair of the RCPsych in Northern Ireland, Dr Diana Day-Cody, and members of the Executive Committee. We had a really good "conversation" about future work in Northern Ireland.

I was very impressed by the beautiful building in which the offices are situated. Photographs of past-chairs of the Division line the staircase walls and it reminded me of the photographs of ex-prime ministers at 10 Downing Street.

Bill Clinton in Europa Hotel, Belfast


The second bonus was an unexpected celebrity sighting which shows it always pays to expect the unexpected. I was standing in the lobby of the Europa Hotel, where the conference was being held, when who should walk in but Bill Clinton?


In relation to the rest of week, I am hoping to hear of better news for mental health.  There are debates yesterday in the House of Commons one year on from Francis. The motion for debate was 'That this House has considered the matter of the Francis Report: One year on.', and there were questions about the risks to mental health services, as a result of the Monitor deflator which effectively takes money from mental health to pay for Francis implementation in acute trusts.

I always enjoy hearing from our members, and last week I was pleased to receive an email from Dr Gary Wannon updating me on two motions relating to psychiatry that were debated at the BMA’s UK Consultants Conference 2014.

The first motion was that this conference:
(i) welcomes the Government’s intention to give mental health parity with physical health in the NHS;
(ii) is concerned however that mental health is seeing greater financial cuts than physical health services;
(iii) calls on the Government to back their large number of recommendations made to improve mental health services with the appropriate resources.


According to a BMA report, the conference welcomed the government’s intention to put mental health on a par with physical health services, but said this needed to be matched with appropriate resources. 


The second motion related to services for adolescent mental health patients – a subject that has been in the media a great deal recently. The conference deplored the harm being caused by sending young people many miles for treatment, and agreed that patients need to be treated closer to home.




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03/03/2014 16:10:23

Mental health payment systems - have your say

Monday, 3 March 2014

The College is organising a mental health tariff programme 'stock-take day' on 19 March. I am therefore using this blog to ask all members to feed back to me their views on the opportunities and challenges presented by the current payment by activities work.

This topic sits in the top three things members always want to discuss with me, so I am really keen to hear from you. You can send your thoughts in via our Policy Unit.

I am grateful for the continued listening to us and work of Dr Geraldine Strathdee, NHS England's National Clinical Director for Mental Health , and the ongoing efforts of the Payment by Results (PbR) group  at the College which produced this helpful College position statement in January.

It is really important that your views and ways forward are fed into this day in March.  I want to hear views and ideas that reflect all the work that we undertake as psychiatrists, leading teams across specialities, settings and lifespan.

We all know we were invited late to the PbR party. I know many of you are finding what you are now expected to do in reporting your activities time consuming, cumbersome, and not reflecting what you actually do, but we have to work with whatever is the extant system and influence it for the better. I have personally tried to stress that, for many of us, we are  de facto not working with a  neat circumscribed single acute episode of mono morbidity mental disorder but complex, real world, multi morbidity, long term conditions (including in childhood). I believe ‘year of care’ would better reflect the work we actually do and capture the changes in outcomes across the domains of a patient’s life over time. 

And there is also the myriad of other work we all carry out to ensure we have a well-trained next generation of psychiatrists, a well informed public and a system where safeguarding and quality improvement are at the fore of everyone's thinking and practice.

So if you have been invited to this stock-take day please try and attend.  If not, feed in your views so our lead College members can attend on your behalf and be well informed about  both continued problems and your suggested solutions. 

This is all taking place in the very negative context of the Monitor’s ‘tariff deflator’ - a  decision which will and is already resulting in money being taken from mental health and community care to fund the implementation of the Francis report in acute trusts. This is in the further unhelpful context of messages put out by NHS England that can be and are, out on the ground in the land of CCG pressures, interpreted six ways to Christmas, but not in favour of mental health. This is a fundamentally flawed decision that ignores the fact we have ‘parity’ enshrined in legislation.  I am working hard with the mental health charities and the NHS Confederation Mental Health Network to achieve a meeting with those who have been party to this decision across Monitor and in particular NHS England.

I will keep you informed but if there is not a significant shift in the current response, this is a matter of such fundamental importance to mental health I will  be asking you to lobby your MPs.  This is a real betrayal of what we were promised about parity which  mental health professionals, patients and carers thought would, after so many years, make us equal partners in health. Neither I nor the President Elect will  give up on this.

I know how busy everyone is and the pressure you are under, but to influence the direction of services we believe will best serve our patients we have to be and remain  involved, so make sure you have your say.

25/02/2014 11:11:12

Moving forward on education

Tuesday, 25 February 2014

Today, the GMC has published its report of the Review of Quality Assurance of Medical Education and Training.

The Academy of Medical Royal Colleges has worked closely with the GMC on this work and welcomed the recommendations. A statement on the Academy's website says they are particularly pleased to see the proposal for “joint badging” of specialty representatives on visits by Colleges and the GMC support for the Academy’s work to professionalise the role of external advisors in the quality management process. The Academy is also pleased that the GMC has committed to support Colleges in implementing a new approach to Annual Specialty Reports by 2015.

It is good news that we are heading forward on education, and that the Academy and GMC are working supportively on these important issues.


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24/02/2014 16:49:18

A world of contrasts

Monday, 24 February 2014


Apologies for neglecting my blog a little recently, but I’ve been putting my time into writing a report on the physical restraint of children.


After returning from Las Vegas last week, I quickly repacked my suitcase for a trip to see psychiatric services in East Lille. I visited with Paul Burstow MP, the former minister for mental health and social care, and the trip was organised as part of the CentreForum Mental Health Commission chaired by Paul.


I set out in the hope that I would, at long last, find the utopia of fully-integrated citizen psychiatry across a whole town. I didn’t – but what I did find was still fascinating. I found an ethos and way of working in partnership with citizens across East Lille. It presented a model that would help us in delivering real community mental health, while at the same time changing social attitudes.


Like many good things, the way of working sprang from the determination, vision and creativity of one individual who, as a young consultant, inherited many beds in the “local” asylum well away from Lille. That individual was Dr Jean-Luc Roelandt who – no doubt like others back in the 70s – went out to see the innovation that was taking place in Trieste, in Italy, at this time.


Once, there were 300 asylum beds serving Lille. Today, there are 10 inpatient beds serving a population of 90,000. The beds are nested in the local general hospital, with no locks on doors and walls full of works of art created by patients.


Colourful artwork on the walls in Lille


An example of the colourful artwork decorating the walls of the general hospital in Lille.



There are many elements to the overall service which is embraced by a local mental health council. The role of the local mayor is particularly important. Lille has also taken advantage of a government-wide initiative offering service users on the pathway of recovery to set up their own “shopfronts”. We visited two of these shopfronts – very different from each other but both inspiring in their own way. One was more like a “family” who come together each day and involve themselves in creative activities – both within their shopfront home and out in, and with, the local community. On the afternoon I visited, the group were going to respond to a new art work in one of the town’s art galleries.


An example of the Lille 'shopfront' project - an initiative offering service users on the pathway of recovery to set up their own 'shopfronts'


Lille 'shopfront' project

I was most impressed by the way that social care, social landlords and mental health services come together to create and deliver housing suited to the needs of service users at their stage of recovery.


As in any other busy town, all those involved have to live and deal with crises and challenges, which we witnessed on arrival at the in-patient unit. What struck me was the quietness and lack of invasion of space that helped a young man accept admission without recourse to restraint or to the emergency use of medication. Across all 12 components of the service, the sense of each component knowing and understanding the others led to a responsivity and flexibility, and ensured  that  services really did work in partnership with patients.


Lille has developed connections with projects in England, in particular with psychiatric services in Birmingham and Nottingham. Especially now, with clinical commissioning groups, and local health and wellbeing boards driving how services will be commissioned, I believe the Lille experience has much to offer – particularly around supporting patients lives in the domains of housing, the world of work, and in regaining a sense of self and purpose. It also helps that a World Health Organisation Collaboration Centre in Mental Health, CCOMS, is based in Lille. #


Meanwhile, back at home, we are still trying to discuss with those in high places the huge concerns we have about setting a lower tariff for mental health and community providers. We have also just given evidence to the review group tasked with looking at how Duty of Candour can be made a reality in day-to-day practice. I believe, at its heart, this is about patient-carer enablement and how we ensure patients fully understand what is happening to them at every stage of their clinical encounter.


Finally, you will have seen that the media has been focusing on the current debate on and data sharing.  I know there are mixed views about it across the membership. I think the best thing is to discuss these views openly, and come to a true consensus on what is best for all our patients, and on how data can be safely used to take forward mental health research for the sole purpose of patient benefit.




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19/02/2014 09:59:50

Thoughts from Disneyland for grown-ups

Wednesday, 19 February 2014

Last week, I attended the Nevada Psychiatric Association’s 19th Annual Psychopharmacology Update conference in Las Vegas – an event that was interesting at many different levels.

The title of my talk was ‘Ensuring the physical health of children who require the use of medication for their mental illness: Working within an ethical framework'. The format was to allow keynote speakers to talk for 45 minutes, and questions from the audience were collected in while you are speaking. You are then moved to a ‘Mastermind’ style chair, where a moderator poses the questions to you. It’s a model that works well, I think.

The state of Nevada has one of the poorest levels of funding for mental health in the USA, and high rates of suicides. I was pleased to be able to meet some really innovative clinicians working there in the public sector.

I learnt a great deal from the many excellent psychopharmacology speakers who were there. I was also interested in the number of exhibition ‘stands’ offering psychiatrists pharmacogenetic testing for their patients. The costs, which are around $650, are covered by Medicaid. This testing is becoming prevalent in the USA, Canada and now Brazil, which made me wonder will this become the norm in Europe. And if so, how in the UK will it be paid for?

My grown-up children told me to “embrace” Las Vegas during my visit. But to be honest, it was more of a reluctant “peck on the cheek”.  The conference itself took place in Paris, a hotel that is easily identified because of the giant Eiffel Tower that emerges through the roof. Inside the hotel, you can dine on a Parisian street under a painted sky. I found it very strange when waiters asked me if I wanted a table inside or outside, and had to be very careful in my response!

Yesterday, I was pleased to see the publication of the mental health Crisis Care Concordat. Our College is one of 22 national organisations signing this document, which is a vital step in ensuring the police, NHS, health professionals and the voluntary sector come together to improve the care available for people in mental health crisis.



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05/02/2014 07:50:28

From here to community

Wednesday, 5 February 2014


Yesterday, in my capacity as Vice Chair of the Academy of Medical Royal Colleges, I attended the GMC’s Education and Training Advisory Board. There were a wide range of people around the table from across the UK, including representation from medical schools, Health Education England, the Care Quality Commission etc.


As the morning unfolded, I started to try and tease out what it is we all really want from our young doctors and consultants of the future. These wants aren’t always the same. In my head, I think it is for them to be Able and Ethical. But, in a changing world of scientific progress, and more services being led by patients, they also need to be Flexible.


There have always been challenges to face up to if you choose to become a doctor, including stressors of all kinds. But I believe there has never been a time when it has been more important to help doctors at all stages of their careers to build internal Resilience. So the question is how to take the fear out of being Flexible, Able, Ethical and Resilient, and help young doctors have the hope, courage and determination they need to become clinicians who service their patients and local communities well.


Part of this is how we shift the way we perceive our roles.. However specialist the service we work in, we need to be (in the modern parlance) “change agents” for preservation of mental capital and individual growth through the early years. We need to push for the achievement of parity of esteem for mental health – both in medical treatment and in the perceptions of society at large.


While we need to push for change in the world of national politics, we also need to look closely at – and help galvanise – local government into action. To see how far we need to travel, we need look no further than the findings from the Centre for Mental Health’s recent review of the strategies of 100 health and wellbeing boards. They found that most of England's health and wellbeing boards are prioritising at least one mental health issue in their joint health and wellbeing strategies but almost one in ten has ignored it entirely. There are some early seeds in germination, but no prospect as yet of any real harvest.


So we need to process less, and influence more. It’s time to talk about what good mental health services can deliver for local communities.



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29/01/2014 16:16:32

A dinner with Jeremy Hunt

Wednesday, 29 January 2014

Last night, for the first time in the College's history, the Secretary of State for Health came the College for dinner and a discussion. We had a lively group, and Jeremy Hunt heard from a number of our officers including: Dr Peter Hindley, Chair of our Child and Adolescent Faculty; Dr James Warner, Chair of our Old Age Faculty; Dr Peter Aitken, Chair of our Liaison Faculty; Dr Wendy Burn, our Dean; and Professor Sir Simon Wessely, our President-Elect.

It was a frank and helpful discussion, covering all of mental health - in particular, the role and place of psychiatrists, how psychiatrists can develop their role within the community and primary care services, and better use of IT. He listened to our ideas for the better delivery of whole-person care, and our concerns.

What is clear is that we have evidence of what psychiatrists can contribute to an improved health service. Now we need to prepare a more robust business case, so that all clinical commissioning groups know what we can do - and that we can make a real difference across health care.


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27/01/2014 16:20:04

A memorial and a statement

Monday, 27 January 2014

A celebration of the life of Dr Jim Birley

This afternoon, we held a memorial event at our 21 Prescot Street offices to celebrate the life of one of our Past Presidents, Dr Jim Birley, who died in October last year at the age of 85. 

Delving into the archives of the British Journal of Psychiatry, I found a paper Dr Birley wrote more than 20 years ago titled 'Psychiatrists and citizens'. 1991 was a time of major NHS reform, and he wrote of there being "a wider and in my view a more long-lasting change going on, namely the relationship between the medical profession and the public - the citizens of this country".

His words hold an uncanny resonance with, and for, the dilemmas we face today. And his predictions about the major challenges we would be facing in the future were also spot on. In the paper, he says said that "satisfactory psychiatric services can only be achieved by a joint enterprise between psychiatrists and other professionals on the one hand, and the citizens on the other". Importantly, he states that "we must not forget that we learn most from our own patients and must listen to their views about what they see as important for their care" and that "we must, as psychiatrists, make sure that we are properly trained and remain so".

These wise words still ring true today, and are reaffirming of what the College continues to do to place psychiatry and psychiatrists in a strong place to provide safe and values-based care for those with mental illness. 

New position statement on mental health payment systems

Also today, we published a new College Position Statement on Mental Health Payment Systems (formerly Payment by Results). This remains a difficult and tricky area for us. As it stands we can't afford not to be at the "PBR" ball - but we all know it is not working as expected across the rest of medicine. I only hope that as mental health payment systems do evolve, we can capture the intricacies of diagnosis, functioning of the individual in complex social circumstances, and individual variance over time and parts of the illness cycle. 

I hope alongside other long term conditions we can move to Year of Care and a system that does not over occupy the time of clinicians but reflects accurately the work we do in helping patients return to functioning and positive lives - not withstanding all the social factors over which we have limited control but which mitigate so heavily against overall good outcomes.


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24/01/2014 15:10:24

A good week for mental health

Friday, 24 January 2014


It’s been a busy but, I think, good week for mental health. On Monday, the Deputy Prime Minister launched the government’s Closing the Gap report which led to positive media coverage for mental health. I was delighted to be invited on both Radio 4’s World at One and Radio 5 Live’s drive-time discussion show to talk about the issue.

On Tuesday, I had a really productive meeting with the new Chair of the Royal College of General Practitioners, Dr Maureen Baker, and their chief executive, Neil Hunt. Our Colleges hope to produce a joint position statement in the next few weeks about how we can work together to deliver the best services for those with mental illness. The focus will be on premature mortality and early intervention, which fits well with the RCGP’s excellent Putting Patients First campaign.

In my role at Health Education England, I am beginning to hear about what the Shape of Training Review could bring for mental health. While I understand those members who doubt that it will be taken forward, and those who fear it will hit supra-specialty training, I believe it gives those specialities who work so much in community-based services a real chance to improve what we can deliver – while ensuring in-patient and supra-specialty parts of mental health can also be strengthened.

On Wednesday I attended a meeting with the Secretary of State for Health, Jeremy Hunt, and the Minister of State for Care Services, Norman Lamb, along with representatives from the voluntary sector. What I took from this is how we have to sharpen up and use our powerful evidence about why mental health matters, and the difference that psychiatrists and mental health professionals can make, to turn it in to a robust business case. We intend to follow through on the joint Bridging the Gap report produced by us and the Centre for Mental Health, and do some detailed costings and plans that will be listened to all levels.

On Thursday, I had a good meeting of the Inter-Professional Mental Health Collaborative, which has representation from ourselves, psychology, nursing, occupational therapy and social work. Again, we plan to produce a position statement shortly on our acute concerns about access to beds.

Looking ahead of next week, the College is hosting a memorial event on Monday to celebrate the life of our Past-President Dr Jim Birley. He was a man who epitomised intelligent kindness, and had the most canny understanding of health and social care politics. I’m sure it will be a very memorable event.


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20/01/2014 15:16:30

Taking action on mental health

Monday, 20 January 2014

This morning, I attended a conference to mark the launch of the new mental health action plan, Closing the Gap: priorities for essential change in mental health. The plan highlights 25 areas of mental health care, and the conference brought together well over a hundred mental health experts, charities and users of mental health services to talk about how mental health can be improved.

Deputy Prime Minister Nick Clegg gave a speech emphasising the importance of mental health, how it is part of people’s everyday lives in one way or another, and that we need to accept this. He talked of the need to make more difference to more people, and how a lack of wider understanding can make it so much harder when people have a mental health problem.

Care Services Minister Norman Lamb also spoke.  Particular emphasis was placed on providing better care and support for children and young people in the form of more money for psychological therapies and better transition services, introducing access standards for mental health services and improving crisis care. 

Questions were then invited from the floor. A wide range of issues were raised, including the need for mental health to be considered in policy across government, a call for people with mental health problems to have the same ease of access to NICE-recommended therapies as people with other conditions, and particular concerns about Monitor and NHS England advising the system to give more protection to funding  of acute hospitals than to mental health and community services.

Dr Geraldine Strathdee, NHS England's National Clinical Director for Mental Health, emphasised the importance of good information, that a move to action will require informed leaders at all levels to understand what mental health really means. They are now setting off the 211 mental health commissioning leads across the country, who will take action based on facts. The real enemy is variability in services across the country, and we need to ensure that we share the knowledge of how to build resilience in communities, the benefits of psychological robustness and the value of kindness, empathy and respect.

Paul Jenkins, Chief Executive of Rethink Mental Illness, also spoke and stressed the point that was made most during the morning – the challenge of variability and scaling up best practice, the need to  ‘raise the bar of ambition’ and ‘industrialise best practice’.

The GP view was expressed by Dr Caroline Dollery, who said that we have to deliver easy access to non-judgemental, excellent treatment for everyone with long-term conditions. The Royal College of General Practitioners has made mental health an enduring priority, which is very encouraging.

Dr Peter Fonagy, of UCL, said there is no mental health without children’s mental health. He emphasised that we can’t deliver parity for children’s mental health without the involvement of families and young people.

The user and carer perspective also came across very strongly during the conference, particularly the need for whole-person care because of the range of problems people experience that straddle both mental and physical health.

The media has covered the action plan extensively today, and I was delighted to be invited on BBC Radio 4's World at One programme at lunchtime to talk about it. This really is a positive day for mental health and another important step towards parity. What a good start to the new week!

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17/01/2014 10:39:27

A blog from Pune

Friday, 17 January 2014

I am attending 66th Annual National Conference of the Indian Psychiatric Society (ANCIPS) in Pune, along with our Chief Executive Vanessa Cameron. The theme is 'Mental Health, Media and Legislation: Bridging the Gap' and is every bit as fascinating as I had hoped. I particularly enjoyed a session exploring the impact of media on mental health.

While I've been here, we've visited the Armed Forces Medical College here in Pune. I had this opportunity because our Immediate Past-President, Professor Dinesh Bhugra, undertook his medical school training at the College. I've gathered some good ideas to bring back to the UK and to the College around teaching and training methods.Armed forces, Pune

Major General Nair (left) gives College President Professor Dame Sue Bailey (second left), Chief Executive Vanessa Cameron (second right), and Immediate Past-President Professor Dinesh Bhugra (right) a tour of the Armed Forces Medical College in Pune.

Being in India brings home to me that, while the two countries and cultures are different, the challenges we face in preventing mental illness early on and providing better services for older people with mental illness and dementia, are very similar.

Our College is also exploring the possibility of holding the MRCPsych examinations in India (we already have written paper centres in Dublin and Hong Kong). Our Dean, Dr Wendy Burn, will be visiting India in the spring to try to finalise how we move forward.

Although I am overseas, I am keeping a close eye on what's happening in the UK. I am very pleased to see the Department of health publishing its first annual report on the suicide prevention strategy for England today. The report is accompanied by a consensus statement on information sharing and suicide prevention that has been drawn up by our College and seven other organisations. I encourage you to take a look.

Tomorrow, I will be visiting a local psychiatric hospital, which I am very much looking forward to. Wishing you all a good weekend.


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14/01/2014 13:33:20

Welcoming the next President

Tuesday, 14 January 2014

Earlier this afternoon, we announced the results of the Presidential Election. I want to thank all the members who voted, as it's so important that we use the democratic system this College has in place for elections.

We had two excellent candidates, and I am delighted that Professor Sir Simon Wessely is now President-Elect. I look forward to a positive and constructive handover with Simon at the Annual General Meeting in June - as was the case with my predecessor, Professor Dinesh Bhugra, back in 2011.  I am also delighted that we have the benefit of Dr Laurence Mynors-Wallis carrying on the very important work that he undertakes as Registrar.

When I introduce myself at meetings and events, I always say my name and then that I am there "in the role of President of the Royal College of Psychiatrists". Some of you may think this slightly odd, but I have always believed it's important to remember that I've been entrusted with the position through a democratic process and it is this responsibility that I am carrying out.

There is lots I still need to do between now and June. I'm fortunate in that I've been given the opportunity to advise on both the future strategy in mental health at NHS England, and for the wider NHS across medicine. The College's lobbying also continues on a range of issues, including our severe concerns about the decision to remove mental health indicators from the Quality Outcomes Framework for 2014/15. We are lobbying against this with other organisations, including Rethink Mental Illness, NHS Confederation, Mental Health Foundation and Centre for Mental Health, and I will keep you updated on progress.

Tonight, I fly to Pune for the 66th Annual National Conference of the Indian Psychiatric Society (ANCIPS). I am very much looking forward to taking part in a joint symposium between our College, the British Indian Psychiatric Association and the Indian Psychiatric Society. 


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13/01/2014 10:10:17

Reaching out through our website

Monday, 13 January 2014

The College's website - which underwent a revamp last year - is one of the main ways we communicate our work to the outside world. And, crucially, it is the way we provide support to the public by making our excellent mental health information leaflets freely available.

Our website team, supported by the Website Working Group, work incredibly hard and the latest website statistics show their commitment is paying off.

Google gives websites a world ranking according to its popularity. In this list, our site is among the 150,000 most popular sites - the highest ranking of all the UK medical royal colleges. We are also the second most visited mental health website - just behind Mind.

In total, between 1 October and 31 December 2013, we received over 1.1million visits to our website - of which almost 800,000 were unique visitors. Unsurprisingly, the majority of our visitors come from the UK, but we also receive huge numbers of visitors from the USA, Iran, Canada, Australia and Poland.

Interestingly, we received 31,000 visits from Japan in the last quarter of last year - up from only 6,000 visits during the same period in 2012. We think this is because of our excellent new Japanese translations of our most popular mental health information leaflets, which have been kindly put together by Dr Nozomi Akanuma, a member of our Public Education Editorial Board.  

I am very proud of the work our College does to increase mental health awareness and understanding, and to equip people with reliable and evidence-based information. This is the real way to break down barriers.

So congratulations to all staff and members who put such continued effort into our website - a really good way to start 2014.


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08/01/2014 15:16:14

More A&E

Thursday, 9 January 2014

Another A&E story

A new year, and a new report about the problems facing our A&E departments. A BBC investigation has found that some patients are going to emergency departments more than 50 times a year, and the story has been picked up by other media outlets including the Daily Mail, Daily Telegraph, Independent and Metro.

Dr Cliff Mann, of the College of Emergency Medicine, has been quoted as saying there are a range of reasons why patients are becoming repeat visitors - including problems mental health problems and substance misuse.

This comes as no surprise.  We know that around a third of the people in a typical A&E waiting room have a mental health problem. And although it may not be the main reason for their visit, it is often an underlying factor.

As the College has repeatedly argued, we need better resourced mental health services in A&E. Just before Christmas, we published a new College report, Liaison psychiatry for every acute hospital: Integrated mental and physical healthcare, which I encourage you to read. We also need more funding for community mental health services to help reduce A&E re-attendance - it is frustrating that psychological therapies are still excluded from the national 18-week treatment target.

Despite the heath budget being ring-fenced and the demand for services increasing in these times of austerity, spending on mental health services has been cut over the past two years. This falls short of the Coalition Government’s pledge that mental health will have ‘parity of esteem’ with physical health, and contributes to bottlenecks within the wider health system. Commissioners of health services should carefully consider this and be wary of the false economy of cutting mental health services.


Liaison and diversion

On a more positive note, I was pleased to see Monday's announcement of an extra £25 million of investment in liaison and diversion services. It is encouraging to see the government paying attention to this important issue, and I look forward to seeing the evaluation results for the 10 areas in due course.

The start of a new year

While it was good to have a break over Christmas and New Year, it is has also been good to get back to College business.  So far, it's been a stimulating and unusual week, in that the meetings I've been to have been enabling.  They've given me the opportunity to stop, pause, think and listen to a very wide range of people from diverse fields of policy, social science, clinical practice, research and the voluntary sector.

I would like to finish this blog by thanking all of you who, after seeing that I received a DBE in the New Year Honours, sent me such kind messages and words. When the letter dropped through my letterbox in mid-November, I was totally surprised to be asked if it would be "agreeable" for me to accept the honour. I just hope I can use it to keep fighting the fight for mental health, help us do our jobs as psychiatrists, and work with users, carers and the wider voluntary sector.

I owe a great deal of thanks to everyone who has given me so much support over the years. Your advice on choice of hat is gratefully received!


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19/12/2013 11:38:47

Season's greetings

Thursday, 19 December 2013

It’s been a busy week, with lots of constructive meetings.

On Wednesday, I attended a meeting called by Norman Lamb MP, the Care Services Minister, to discuss how to improve transitions from child and adolescent mental health services to adult services. This is certainly a priority for the College, and there are many examples of good practice around the country. The challenge is to ensure that it happens everywhere, for all groups of young people, whatever their mental health problem. This will require real partnership working across all sectors.

In the afternoon, I attended a meeting of NHS England’s mental health patient safety group. Real challenges here around data collection, and how it is understood and acted upon.

I also had a really good chat with Dr Howard Ryland, the new Chair of our Psychiatric Trainees Committee. They have forumulated a response to the Shape of Training Review, and Howard and I have set some tasks together that we will work on over the next few months. Trainees have to set their own future working lives, and we have to support them so they can give their best to our patients.

Yesterday, I had a meeting with the Royal College of Ophthalmologists about sustainability, and caught up with Dr Alan Cooklin about the Who Cares? project and the excellent work he’s doing with young people.

Although there are only a few working days left before Christmas, the College is still a hive of activity to make sure everything gets done that needs to, and that we can hit the ground running when we return in 2014.

Can I ask each and every one of you to please exercise your democratic right and vote in the Presidential elections – you should have all received your ballot papers by now. We are one of the few remaining Colleges to have a real democratic election process. I was grateful to everyone who voted in the elections last time – whether you voted for me or not! The important thing was that you did vote and, in doing so, took ownership of your College.  

Tomorrow, I am travelling to Cardiff to take part in a joint meeting of RCPsych in Wales and the Welsh Psychiatric Society, titled: 'No One Gets Out of This Career Alive:  Winterbourne, Francis and The Age of Anxious Practice'. I cannot think of a better way of rounding off my College working year.

It will be good to be back in clinical work on Monday and Tuesday, before our family starts its traditional preparation for Christmas. We will have four generations at the Christmas table, ranging in age from 2 to 96. I hope that what you are doing over Christmas – and wherever you are – it is a peaceful and happy one.

RCPsych Christmas 2013

I also want to take this opportunity to wish you a happy and successful 2014. I have great hopes of making more progress for mental health next year, and that is thanks to all of you members and all of the College staff. It really is a great privilege to hold the role of President of this College.



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13/12/2013 10:49:26

A splendid night

Friday, 13 December 2013

A splendid night

Wednesday was a splendid night at the college. We had a packed house for our Prestigious Evening Lecture given by Honorary Archivist Dr Fiona Subotsky. Her lecture - the first we have held at 21 Prescot Street - was intriguingly titled 'Jack the Ripper's Psychiatrist: Dr Lyttelton Forbes Winslow (1988-1913)'.

Our new offices are very near the sites of the Jack the Ripper murders, and it was fascinating to hear Fiona report on a psychiatric link. We heard that Lyttleton Forbes Winslow made a name for himself in the late nineteenth century as a controversial early forensic psychiatrist. He produced a continual flow of sensational publications about his views on Jack the Ripper and made many suggestions to the police - some quite bizarre. In his memoirs, he modestly noted:

"To recall the history of the famous Jack-the-Ripper murders in London slums, it should be remembered that there in all eight victims. This frightful list began at Christmas 1887, and the monster laid down his knife in July 889, after the eighth victim. There is good reason to believe that the hand of the murderer was stayed by my revelations..."

After the lecture, I attended the annual dinner held for our Public Education Committee. and Public Education Editorial Board.  Members of these committees do a huge amount of work for the College during the year, such as answering media queries, recording podcasts, delivering media training and producing our award-winning information leaflets. The dinner really is a wonderful way of thanking them for their hard work.

Medical professionalism

Yesterday, I attended a conference in Manchester organised by the GMC called 'Medical professionalism: who's job is it anyway?'. I was relieved to hear that other parts of medicine still don't believe it's safe to whistleblow - something I often hear from our members. Hearing this message from you is what's made me extend the College's dialogue, debate and consultation with the membership about our official response to Francis. I realise our response has been a long time coming, but I'm pleased to say it will be out next week.

I also plan to write to Professor Sir Peter Rubin, Chair of the GMC, about this issue again, as I still don't feel they have gone far enough practically in supporting whistleblowers.

In the afternoon, the Rt Hon Jeremy Hunt, Secretary of State for Health, gave a keynote address in which he talked about duty of candour. In the airline industry (as I understand it) pilots who report concerns will not have legal action taken against them if negative events do subsequently occur. Mr Hunt also told us how he had recently visited a temple in China. The advice he was given there was "always lead by morals". So I hope this is a vote for values-based medicine.

A Mental Health Challenge

Today, my letter to The Guardian in response to their report on Wednesday about the G8 dementia summit was published. While it is fantastic to see a commitment to more investment in research funding for dementia, it is important that other mental health problems are not ignored - a Mental Health Challenge, not just a Dementia Challenge. We need better funding for research into both the repurposing of drugs and improving understanding of the genomics of mental health.


The changing seasons

I am back in the College today, but planning to finish early to visit my daughter at the Centre for Chinese Contemporary Art in Manchester, where she works. The centre is full of wonderful art, discourse and a community of artists from mainland China, Taiwan and Hong Kong.

To get there, though, I will need to battle my way through the Christmas market. And before we know it, the market stalls will have been packed away and we can look forward to Chinese New Year at the end of January (it will be the Year of the Horse), and then Easter eggs arriving in the shops. It's not only the climate that has lost sense of the seasons.


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09/12/2013 08:20:17

A trip to Hong Kong

Monday, 9 November

The President's BlogI am currently at the 20th anniversary meeting of the College of Medicine in Hong Kong. It was fascinating to see how they run their Fellowship ceremony. Timed to perfection; it was an enjoyable event for those who have worked so hard for their Fellowship, and a truly proud moment for their parents. My highlight was to see the President of the College of Psychiatry, Professor Linda C.W. Lam, introduce so many young psychiatrists to the Academy President, Donald Li.

The theme of the conference has been 'Manpower Needs in Medicine: Moving with the Times'.  This is very apt in the context of the future Shape of Training. There is good representation from across the UK Medical Colleges at this conference.

Professor Dame Carol Black gave the Halnan Lecture on "Is the present medical workforce fit for purpose?"  A thought-provoking delivery, challenging us to face up to the impact of changing demographics, roles and economies. This was preceded by a very informed discussion by key leaders in the field of medicine in Hong Kong, including the Director-General of the World Health Organisation (WHO), urging us to both task and mind-set a shift to prevention.

Fascinating perspectives in a session on the generalist versus the super specialist. Dr Roger M.K. Ng spoke about Hong Kong going through several iterations involving all stakeholders as they revamp their psychiatric specialist training programmes.

I also heard a call for improved medical leadership, with a fundamental shift in the epistemological basis of medicine, where "systematization of medical knowledge" has enabled measurement of medical work and strategies to define how doctors could, and should, deliver care by using protocols and patient pathways. The 21st-century doctor should be leading to improve quality of care within their practice; this demands a need for system-wide leadership by doctors.

My reflections are that medical care has become ever more complex in a "knowledge era". This demands leadership that enables learning, but above all a creative and adaptive capacity in complex systems and interventions, and an ageing society with complex multi-morbidities.  The young are living longer and eventually die of different illnesses than their grandparents. As psychiatrists. we have a major role in supporting the whole of the health workforce, to cope with these changes.

As always we come back to the need for intelligent kindness and how the essence of this conceptual framework should be more embedded into leadership programmes.   

So more learning tomorrow. The sun is shining, but shortly will set and there are beautiful flowering shrubs and trees that seem to have forgotten it's winter, not spring.

Dr Margaret Chan, Director General of WHO, has also given a brilliant address to the 20th anniversary meeting of the Medical Academy of Hong Kong. She addressed the need for a shift from acute medicine to delivering a workforce fit to deal with populations with chronic long-term conditions. 

Throughout this talk, she mentioned mental health on each and every occasion, as one of the major non-communicable diseases needing more investment, especially in those parts of the world were one psychiatrist has a population of over 200,000 people.

Each time that world leaders in health specifically mention mental health alongside cancer, diabetes, COPD and CHD, it moves on our cause forward. Cinderella has arrived at the ball - it's down to us to do the rest  to ensure she gets her prince! This will ensure that our patients receive the services they need, and all individuals, families and communities can be helped to grow psychosocial resilience in order to live positive healthy productive lives.


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06/12/2013 08:31:36

Falling leaves, The Sun and reflections on Madiba

Friday, 6 December 2013

Falling leaves

 As the last of the leaves are blown away by gales in the North, the bleak weather was reflected in a day dominated, whether intentionally or not, by pitching generation against generation, with the announcements of differentiated ages for receipt of pensions - whether frail elderly, baby boomers, generation X, Y and Z.

It was a timely reminder for our day-to-day work; whichever generation we are caring for, our own practice needs to be embedded in understanding families, and how they can support the individual patient.  Living proof of the importance of this was a energetic and vibrant patient/service users' and carers' day at the College with a number of empowering presentations, including one from the World Health Organisation Lead for the revision of ICD 11, Dr Geoffrey Reed

Following on from The Sun newspapers' recent misreporting of the Homicide and Suicide Inquiry findings on homicide trends in people with mental illness, I wrote to the paper and yesterday, with Deborah Hart, Director of Communications & Policy, and Greg Smith, Policy Analyst, we had an interesting telephone conversion with their Editor, Stig Abel.

Deborah will be following through on how we can feed into the Sun's coverage of mental health, to ensure that the Sun are provided with accurate and informed opinion and information; this is core to the Communications Department's work on a daily basis, working with a wide range of the media, both national, regional, international and professional.  We need to be ambitious and work with a mind set to ensure that we can influence, for the better, the whole spectrum of media and social networks.

Last night, I attended an excellent dinner at the College with the Associate-Deans and Associate-Registrars who all do a great deal of valuable work on your behalf.

Reflections on Madiba 

I have, and no doubt many of you have as well, been following the breaking news of the death of  Nelson Mandela - the greatest son and father of a nation, and leader for world peace. Among his many great characteristics was his huge capacity for forgiveness which enabled him, against the odds, to lead the rainbow Nation into an era of social and financial stability.

Today, I am thinking of colleagues whom I met two years ago at the College of Medicine in South Africa. I was truly honoured to become a Fellow of their College, all the more so because amongst their list of Fellows was Nelson Mandela.

I also have images of his long walk to freedom, his inaugural speech as leader, and latterly as a frail elder. My lasting image is when, as Registrar of the College, I was walking through a London Park, I encountered him in the park whilst on his visit to London, planting a tree surrounded by excited and awed children.  


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04/12/2013 09:01:57

Good news for looked after children

Wednesday, 4 December 2013

The Children & Young People’s Mental Health Coalition have launched a new report today, Overlooked and forgotten: children and young people’s mental health neglected by local authorities, These are the findings of how children and young people’s mental health is being prioritised in the current commissioning landscape. The report offers support and recommendations to health and wellbeing boards on how they can prioritise and address children and young people’s mental health.

The report addresses the needs for financial support for those fantastic foster parents to enable the young people they foster to be supported through that the mist that challenges their lives in the transition 18 to 21.  

Now can we really work out, and have funded, a model of services so that all young people with on-going needs, both physical and mental health, have a safer transition in their move from child to adult mental health care. 

Where do the members of this College and others stand on 16- to 24- year-old services in mental health?  What should these services look like, not just for early onset psychosis, but for all mental and developmental disorders?

And whilst thinking about this, are student mental health services being well supported or do they risk erosion in the new commissioning arrangements?

Answers on a postcard please.


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02/12/2013 15:14:41

Launch of mental health champions

Monday, 2 December 2013

I am having a really exciting day looking out from Rethink's Headquarters over the Thames towards Big Ben.

Mental Health Champion eventToday (2 December), we have had the first meeting of the 'mental health champions', together with representatives from the main mental health charities.  I believe I have been privileged to attend this very important event, together with fellow psychiatrists, Drs  Adrian James, Michele Hampson and Jonathan Campion, together with the College's Public Affairs Manager, Will Pickering. It has been very exciting for us all to be part of a ground breaking, and I suspect even historic, moment. 

We will only change attitudes towards people with mental health problems by taking a local community approach, street-by-street, ward-by-ward. In order to achieve this, the real catalysts for change are local councillors.

At the Labour Party Conference a couple of years ago, Kevan Jones MP  gave us the light bulb moment on how to develop local mental health champions. Those Councillors present at today's event, I know will be a real force for health and for checking  services on their patch.  Kevin asked them to think about mental health and employment as they link with major businesses, and critically in starting early, and thinking of mental health of children.

Today was living proof of how resilience in mental health can be built up from the ground. Local  Councillors are the guardians of local communities and having them on our side is a major move forward. So let's hope this new and growing group will continue to network, to grow and to meet on an annual basis to share best ideas and innovation.

Cllr Michael Bevan told his own very moving, but empowering, story of his own mental health  problems and how he used this experience to help others overcome their mental health problems. He achieved this by influencing and educating local councils, by bringing agencies together across Dorset to a conference, and have them make real-time pledges to better understand mental health - and hence the start of the mental health champion movement. So thanks to the first mental health champion Michael Bevan.

Cllr Edward Davies, a local Councillor in Lambeth who also sits on the Ministerial Advisory Group, told us he has used his rightful powers as a local councillor to ensure mental health services act as they should, and listen and learn from those who represent their local community. In his usual indomitable fashion - which he has used to real effect on the Ministerial Group - he stressed the challenges in providing timely accessible services for those from BME communities.

For me, today has been an enormous highlight of my time in role of President of the College as I see this as the start of a whole movement that can help deliver psychosocial resilience across communities and generations.

Other bits of news

The Royal Pharmaceutical Society recently launched a new report, Now or Never: Shaping pharmacy for the future from an independent Commission into Future Models of Care delivered through pharmacy.

On Friday 29 November, the Care Quality Commission unveiled changes in the way it will inspect specialist mental health care services, putting a greater emphasis on inspecting the care that people with mental health problems receive in the community.


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02/12/2013 14:39:19

Adversity, resilience and respect

Sunday, 1 December 2013

I don't usually pen a blog on a Sunday, but amidst the build up to Christmas, Manchester is - like other villages, towns and cities across the UK - in festive mood with lights, Christmas markets and heaving streets and shops.

Adversity, resilience, respectThis mood has now been broken in Glasgow by the still somewhat surreal fact of a helicopter embedding itself into the fabric of a public house. No doubt like many others, my youngest daughter, who spent happy years at university there, was contacting her many friends to seek reassurance they are all OK.

I was at a Manchester University alumni event last night to hear the Halle orchestra. At the pre-event drinks reception, images of the many scientific successes of the University were flashed up on screen. Amongst them popped up a picture of Tony Redmond. We both worked many years ago on a then innovative detox unit in the city centre. He is now out in the Philippines "dealing with disaster aftermath."

Both events in Glasgow and the Philippines, on differing scales and corners of the world, demonstrate the resilience and best of the human spirit. Hearing of the instinct of the Glaswegians to rush towards and or back into disaster to help fellow Glaswegians I think sums up what Communities that Care are really all about.

This is core to why have with our 'Disaster Lead', Professor Richard Williams. We have set up a series of seminars to look at how, as mental health professionals, we can play a fuller part in building psychosocial resilience in communities, whatever the nature and degree of adversity we could and can face, whether now or in the future.

In the meantime I am thinking of those in Glasgow and Philippines who have lost life, limb, family and friends.


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29/11/2013 15:37:21

Recognising excellence and European connections

 Friday, 29 November 2013

As I reported in my blog on 21 November, I attended the 30th anniversary meeting of the European Psychiatric Association with Diane Goslar, a service user representative, and Evelyn Bitcon, the Chair of the College's Carers' Forum. i've already posted Diane's account of the conference. Here, you can read Evelyn's excellent report:


Evelyn Bitcon: Our trip to the EPA on 15-16 November

Attending the RCPsych Awards ceremony the day before travelling to Strasbourg was very humbling and inspiring, especially when listening to the winners of various categories and how they work tirelessly - both personally and in their teams - towards service improvements, understanding the needs of service users and carers, and towards positive outcomes which can benefit all in their 'not so easy line of work'. 

Having been around health and social care for many years, before becoming a family carer and advocate, I was very impressed with the high standards and for 2014 say “follow that”! I would also like to personally say that I found the atmosphere electric and “very well done” to all those who were shortlisted also!

My head was still buzzing with RCPsych pride when the President, Professor Sue Bailey, Diane Goslar, a service user, and I headed off straight after the reception at the Royal Society of Medicine for our journey to Strasbourg to attend the 30th Anniversary of the European Psychiatric Association.


After a long train journey, with few hours sleep, we arrived at the offices of the Council of Europe just in time for the start of the day at 10.00am. We were immediately made to feel “welcome” by the EU President and Chair, Danula Wasserman and others, and Diane was invited into the 'Round Table' to put the case for service users which she did “admirably”.


I was obviously not going to lose the opportunity to put the case for carer’s saying that carers/families, if supported, informed and involved, could be effective in assisting psychiatrists, medical teams and the patient to improve their health and well-being. I also mentioned the value of parity and the need to look at the “whole person’s needs”, stopping short of mentioning saving money though!!


I am looking forward to receiving copies of the interesting presentations from Switzerland, Denmark & Germany around human rights in relation to vulnerable groups such as people with mental illness; the interaction between culture, mental illness and human rights; community treatment and psychiatry; and how to support self-determination of patients in psychiatric practice. 


My conclusions from listening to these presentations, and hopefully learning, was that trust, social skills and Inclusion, good communication, early intervention, easy access to relevant information, education, advocacy (including family advocacy), training and revalidation, appropriateness of service provision etc... seem high on the EU agenda! So, let’s now watch this space for anything coming through in the near future, including any possible EU financial resources eh?


My grateful thanks to RCPsych for this opportunity and I think that both Diane and I did leave a positive mark, with “food for thought” about co-production, involvement, listening and hearing the lived experience stories which should be a powerful tool towards positive change! Supported by a super humanistic President of the RCPsych - Sue Bailey!


I was also impressed at the comfortable two-tier train journey from Strasbourg to Paris reaching 320km per hour (over 200mph) which I would not have guessed, except that it was registering speeds on the carriage wall.

25/11/2013 13:51:04

Learning, recovery and hope

Monday, 25 November 2013

Last week I was privileged to attend and speak at two mental health conferences.  At both I learned so much about innovative services. These included Host families in Hertfordshire, who literally provide a home for someone with mental illness who is at risk of readmission to hospital and the on-going work of the Implementing Recovery through Organisational Change (ImROC) and the Recovery Colleges.

There was an interesting talk from the South Essex Partnership Foundation University Trust about  different approaches to working with patients increase compliance and patient satisfaction with outcomes of care and treatment . Dr Neil Deuchar spoke supporting Commissioners to provide good quality and integrated mental health services, and Sophie Hodge from the College’s Centre for Quality Improvement presented the work of ‘The Home Treatment Accreditation Scheme: Improving the Quality of Crisis Resolution and Home Treatment Teams’.

A bright crisp sunny day in Liverpool and a vibrant conference with many social workers, users and carers and a local mental health champion, Cllr Claire Glare, was also there. Thursday night, it was lovely to pop in to the College at Prescot Street and to meet with the Old Age Faculty Executive who seemed genuinely pleased with the new building.

Watch out for over the next few months for forthcoming evening lectures, film nights and hopefully some exciting on-going art projects. We are also gradually inviting our local neighbours into the new building, so we can become embedded in the local community.

I am excited about this Monday (25 November) as NHs England are hosting a meeting on parity in Manchester on ‘Valuing mental and physical health equally’.

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21/11/2013 17:02:39

More celebrations - and a reflection

Thursday, 21 November 2013

On Monday night, I was pleased to attend the Mind Media Awards 2013.  Their ceremony followed hot on the heels of our own hugely successful RCPsych Awards on 14 November - it really is lovely to attend celebratory events like this.

It was great to so many different depictions and portrayals of mental illness there have been on TV, radio, print and online over the last year.  Many of them I had seen, but others I had missed.  You can see all the winners and shortlists on the Mind website, and I do encourage you to take a look.

in the News and Current Affairs category, I was pleased to see three excellent Newsnight specials shortlisted on male suicide (featuring the former chair of our Public Education Committee, Dr Peter Byrne), anorexia, and postpartum psychosis (which featured Dr Margaret Oates, the winner of our Lifetime Achievement Award 2013which a number of psychiatrists had inputted to). The winning entry was the one on postpartum psychosis, and it's available to watch in full on the BBC website (scroll down to the bottom of the page).

In my last blog, I reported about my trip to the European Psychiatric Association 30th anniversary symposium in Strasbourg. I travelled with Diane Goslar, a service user, and Evelyn Bitcon, Chair of our Carers Forum. Diane has written an excellent blog of her own reflecting on the conference, which I've produced below.



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Diane Goslar: Our trip to the EPA on 15-16 November

I spent the afternoon of 15 November at the  fifth annual RCPsych Awards ceremony (how time flies) at the home of The Royal Society of Medicine in Wimpole Street – a very grand building for an auspicious yet jolly occasion. Straight after the ceremony finished, I had to leave with Sue Bailey and Evelyn Bitcon (Chair of the Carers’ Forum) as we were off to Strasbourg to the European Psychiatric Association’s 30th Anniversary Symposium entitled “Are people with mental illness truly citizens of Europe?”.

We took the Eurostar to Paris where we gratefully collapsed on to comfy beds at a small hotel near the Gare de l’Est. Not for long though, as we were up at 4.30am (at least we weren’t disturbed by the cleaning of Paris streets at about 5am) to grab a quick coffee and croissant before staggering off to get the train to Strasbourg. Bit of a problem at the station which we had to sort out – seems more difficult managing things at that hour- then triumphantly boarded the TGV. Perfect timing as we arrived at our venue with 20 minutes to spare before the Symposium started.

It was held at the Council of Europe in Strasbourg’s European quarter. Not that we had any time to look around Strasbourg’s delights European or otherwise. As soon as we sat down in Room 11 Marianne Kastrup, the Chair of the EPA Committee on Ethical Issues, approached us and asked if we could help with a huge problem. Two of the speakers on the Round Table in the afternoon session were not able to attend so she asked would the Service User sit on the panel to give the patient’s point of view? Oh dear – well I said yes alright I would. At this Marianne showed me the questions I would be answering. As the other speakers included the President of the EPA as well as Politicians, Heads of Units etc., I thought it may have been a mistake to agree but if you don’t try....

There was no time to look at the questions either, really, as the morning presentations now took place and I thought I’d better remember what was said, as apart from anything else the points would be useful to refer to at the Round Table. Anyway, I would have a chance to pick brains when the three of us had our sandwich lunch in the cafeteria before the afternoon session. That didn’t happen as I was rather worryingly whisked away to have lunch with the other speakers in the formal dining room. Hmm – that was a bit difficult as all the other speakers knew each other very well – how would they take to having an (unexpected) Patient amongst them? It wasn’t an ideal entry either as when I walked in I was poured what looked like a glass of rather good French white wine... Oh dear – I politely said to the waiter “no thank you” at which he stopped pouring and looked at me in amazement and said what a pity before sadly leaving the table.

Now what do I do – I can’t touch the glass myself (one of my “rules” to take away the temptation that I’ll start to drink alcohol again) but I’m not very keen on having a full glass a couple of inches away from my grasp throughout the lunch. So I call another waiter and ask her to remove my tempting glass of wine. By now the rest of the speakers who are already sitting chatting around the table are looking on with interest and so I mention to one of them that it will become clear later why I have sent my wine away. To be honest I’m not sure that they knew how to interact with me and so there was silence for a few minutes. This was broken by my saying that it would be interesting to see if that, when I spoke giving my views from the panel in the afternoon, they would voice any disagreements or whether they would treat me gently because I was a service user and they didn’t want to upset me. I urged them to disagree with me if they thought what I was saying was wrong as it wasn’t a problem for me, and they replied that they would do so. That seemed to break the ice and we had a very nice lunch and some interesting and humorous conversations.

In the afternoon there were five of us on the Round Table and I gave answers as to what I thought regarding services, availability, resources, priorities etc. By now I’m sure everyone realised that my problem was acute alcohol addiction (a simple explanation for the luncheon scenario) but I didn’t get the opportunity to say as much as I would have liked because it was time to leave the Symposium (a pity as it was going well) and be ferried to Strasbourg train station and the long journey home began.

An excellent trip in more ways than one. I learned a lot, met some very erudite and welcoming EPA people and perhaps also gave one or two pertinent messages. I hope so. It was all so very worthwhile.

15/11/2013 13:32:11

A week to celebrate

Friday, 15 November 2013

This truly has been a week to celebrate the achievements of psychiatrists and mental health tams - as well as a week to seize opportunity from government announcements to make resourced mental health interventions a key priority.


Grants and celebrations

On Tuesday night, I attended a the BMA's 2013 research grants awards, which awards grants totalling over £500,000 to encourage and further medical research. It was particularly great to see Dr Tony James receiving the Margaret Temple grant for his stem cell project in adolescent schizophrenia. Our Past President Baroness Sheila Hollins now Chairs the BMA's Board of Science, so it was good to see her there.

On Wednesday, we saw the New Members' Reception being held for the last time at Kensington Town Hall. From now on, we will be able to hold these receptions at our new offices in 21 Prescot Street. It is always very enjoyable to see new members celebrating with their families, and this year - for the first time - everyone wore College gowns which are black, blue and silver.


RCPsych Awards 2013

Yesterday, we held the fifth annual RCPsych Awards ceremony. This is always a fantastic opportunity to celebrate the achievements of researchers, psychiatrists, mental health teams, and service users and carers.

We had brilliant entries from individuals and teams from across the UK and across the specialties. This year, we presented awards right across the career path - from the brand new Medical Student of the Year award (which went to Nicholas Deakin who studied at Bristol University) through to the Lifetime Achievement Award (which was presented to the indomitable Margaret Oates).

We also presented President's Medals to Professor Gillian Baird, Rt Hon Paul Burstow MP, Bruce Calderwood and Charles Walker MP. These Medals are designed to recognise those from across medicine, policy, government and research who have been pivotal in advancing psychiatry and the cause of mental health.

I would like to say a special thanks to Allison Pearson, the writer and journalist, who hosted the ceremony for the second year in a row with such talent, humanity and humour.


Mental health in Europe

Unfortunately I wasn't able to stay for the celebrations after the Awards ceremony, as I had to leave early to catch a train to Strasbourg. I travelled with a service user and carer to attend a European Psychiatric Association (EPA) anniversary symposium to improve the human rights to citizens with mental illness. Hopefully, by this evening, an EPA declaration will have been made at the Strasbourg Council of Europe about de facto rights-based parity.

While reading the train line's magazine, I noticed that they had a whole section dedicated to how they have worked to employ people with disabilities and mental illness. Our train lines could take note.

Being in Europe has got me thinking about how EU monies come into the UK, and what comes to mental health and learning disability. I will start looking into it, but if anyone out there knows - or has benefitted from EU monies, please let me know by sending in your comments below.


Government announcements

It has been a busy week for government announcements. First, we saw the "refreshed" NHS Mandate, which had plenty of references to mental health. Then, we saw NHS England's plan to deal with urgent and emergency care. Both give us an opportunity to argue the case for strengthening liaison psychiatry services, and for parity in commissioning both at local and national level.  But it does mean we need to work out across the specialities how we can deliver what is being asked whilst dealing with day to day pressures.  Only by being actively involved in change can we hope to influence.

The College's response to the Francis Report is almost complete, and it will be interesting to see the Department of Health's second response shortly. I am still worried by how many of you email me individually to say you don't feel it's safe to whistleblow. This cannot be allowed to continue, as we need you - as clinical leaders - to feel able to speak out without fear or favour. I can assure you that the College is continuing to work on this issue.

So shortly nhs england are running a meeting on parity in manchester to see how we really get local commissioners to understand what needs to be done prioritised and delivered


And finally...

I have an exciting weekend coming up. Tomorrow, I am attending the AGM of the British Association for Counselling and Psychotherapy, where I will be pleased to become a Vice President.

I spend Sundays at the cinema with my grandsons - who are now eight and two. The youngest is absolutely lost in amazement as the character from the big screen look out and talk to him. Our fellow cinema goers are very tolerant of him having animated conversations back!




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13/11/2013 16:41:41

Standing up for schizophrenia

Wednesday, 13 November 2013

Who's standing up for schizophrenia?

This week, Rethink Mental Illness is ‘Standing Up for Schizophrenia’ during the first ever Schizophrenia Awareness Week.  Their Chief Executive, Paul Jenkins, explains more about it in his blog. The key message of the week is sharing understanding, which is key to breaking down the stigma and discrimination surrounding the illness.

A survey of over 2,000 adults carried out by the charity to mark Schizophrenia Awareness Week reveals that more than 3 in 4 (77%) of people wouldn’t tell their neighbours if they had schizophrenia. Only 35% would tell their boss, while less than a third (31%) say they would tell their work colleagues.

Although these findings are troubling, sadly they are not surprising. I hope this Awareness Week goes some way to increasing public understanding, and I applaud Rethink for all their efforts.


RCPsych Awards 2013

I am very excited that tomorrow we are holding the fifth annual RCPsych Awards ceremony. It feels like a cliché to say that each year the awards get bigger and better - but it really is true!  This year, we have seven new categories - including four Team of the Year awards, Medical Student of the Year, Foundation Doctor of the Year, and Specialty Doctor/Student Associate of the Year.

We are delighted that award-winning journalist and author Allison Pearson is returning to host the Awards for the second year in a row. Last year, she hosted them with enormous enthusiasm and good humour, and I'm sure she will be just as popular with our audience again this year.

I wish all the shortlisted nominees the very best of luck for tomorrow. Keep an eye on our Twitter feed @rcpsych for the winners as they're announced.




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06/11/2013 14:46:26

Leadership and being a female in medicine

Wednesday, 6 November 2013


Over the last week, I’ve been to a series of meetings that have common themes and solutions to improving the quality of health services. The Academy of Medical Royal Colleges hosted an event with the GMC to discuss how medical royal colleges can work appropriately alongside the Care Quality Commission, Monitor, Health Education England and its local education and training boards. I was very pleased that Dr Nick Brown was there to represent the College.


There is common ground, especially around the benefits of colleges being involved in site visits to services which have trainee doctors. The tricky part is how best to do this while staying within our own roles and responsibilities. And, of course, working out how busy clinicians can carve yet more time out of their day-to-day practice to do this.


Yesterday, I attended a meeting of the GMC’s Education and Training Advisory Board, the main focus of which was the Shape of Training report. I think the report is a real opportunity for psychiatry, and the prospect of having all medical students from day one being equipped to be more psychologically minded has to be welcomed.


But with opportunities there are always challenges. And the biggest challenge is how we, across psychiatry, play our part in making this happen. I hope Council and the specialities will be able to work with the Dean to see how we deal with the reality of moving towards there being fewer specialties across medicine, thinking about what will constitute psychiatry, and what this will mean for our College.


I am really grateful to all those College members who have done work on the Winterbourne concordat and the acute care crisis concordat. It’s when we can show that we are part of the solution to the big health and social care challenges that we will be more likely to be listened to, and can start bridging the gap and making the rebalancing of health and care resources a reality.


Women in medicine

Tonight, I’ve been invited to a Women’s Leaders round-table event at the Department of Health. I still find it a bit strange to be invited to these sorts of events – they always make me think about what qualities we need in any leader, irrespective of their gender. It also makes me reflect on why I ended up in leadership roles.


I realise I fell into leadership as a young consultant when I encountered negativity towards my patient group, who are mentally-ill, high-risk adolescents. I felt I had to discover what the systemic reasons for this were – apart from the obvious stigma that “bad people don’t deserve help”. So I went on a search-and-seek mission and discovered strategic meetings for all sorts of different things, and started to work out who makes decisions and who has influence. My involvement stemmed from wanting to stop the service I ran – and the patients I cared for – to stop hitting brick walls. As I became more involved, others started to notice this rather odd female from the north who occasionally said something sensible at meetings – and more and more invites came.


So, for me, the simple answer to why doctors become leaders is because they want to improve services for their patients. But what qualities does a good medical leader need? It always amuses me that so many businesses give a range of psychological tests to their prospective leaders. Surely the qualities that these tests identify are not the ones likely to deliver what is actually needed.


Here are a few facts for you:

UK total workforce – 47% female, 53% male

NHS workforce – 80% female, 20% male

NHS Boards – 37% female, 63% male

NHS Chairs – 30% female, 70% male

NHS Chief Executives – 38% female, 62% male

NHS Finance heads – 25% female, 75% male

NHS Medical Directors – 20% female, 80% male.


So, to go back to the question of what sort of leaders do we need? Recent business research suggests we need leaders who are inclusive, persuasive, open communicators, talented at risk management, willing to see all sides of a situation, strong on empathy and relationship-building, creative, innovative, able to learn from failure, and have a clear strategic vision.  I will leave this to you to ponder on.


Radio 4


Regular listeners to Radio 4 may have heard me on Woman’s Hour last Friday. I really enjoyed the experience – especially the wise questions put to me by Jenni Murray, which are so rare these days. I hope we can engage the programme in hearing more from our College and its members about mental health issues.


The little grey cells


This morning, I was in Nottingham at the Institute of Mental Health’s Foundation Anniversary Event. The Institute is a partnership between Nottinghamshire Healthcare NHS Trust and the University of Nottingham, and is a real interdisciplinary partnership of research and practice.

I thoroughly enjoy attending events like this as they always get the little grey cells stimulated. Talking of which, I can’t believe there are only two more Hercule Poirot stories to be told on television. At least I’ll still have Sunday morning cinema with my grandson to help keep my little grey cells active.




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31/10/2013 12:07:02

College approved as MTI sponsor

Thursday, 31 October 2013


I’m delighted to report that the College is now an approved sponsor for International Fellows looking for training posts in psychiatry. The Medical Training Initiative (MTI) is a national scheme designed to allow a small number of doctors to enter the UK from outside the EU for a maximum of 24 months, so that they can benefit from training and development in NHS services before returning to their home countries.


The Academy of Medical Royal Colleges (AoMRC) has the role of National Sponsor, while the RCPsych is now an approved MTI sponsor. Under the scheme, we will link up suitable International Fellows with Trusts in the UK that have available training posts.


Other medical royal colleges have been running their own schemes successfully for a few years now, and we are looking forward to running our own MTI scheme at three pilot sites from August 2014.


For more information about this scheme, please email Elen Cook, our International Liaison Manager. The AoMRC has produced some helpful guidance for applicants and for Trusts which can be downloaded from their website.




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28/10/2013 15:55:31

Settling in

Monday, 28 October 2013


Last week, it was great to see our new building at 21 Prescot Street being used for so many meetings. On Friday, the London Division held their Academic Event and AGM here. The event was titled ‘Mental Health in the Community’ and – as always – there was a fantastic line up of speakers.

It is always good to hear from Professor Graham Thornicroft, who fed back on progress with the Time to Change anti-stigma campaign. We also saw a preview of their next hard-hitting TV advertisements, which focus on young people returning to education.

Talking of stigma, Thorpe Park was in the media last week, defending its Halloween ‘Asylum’ attraction. So far, they have resisted calls by mental health campaigners to close it down. I co-signed an open letter to Thorpe Park with eight others. So far, we have received the same response from the theme park as others, but I hope they will engage with further dialogue with us.

Life is a frenzy of meetings at the moment. Last week, I had a meeting with a BBC producer and Dr Peter Hindley, Chair of our Child and Adolescent Faculty, about the pressures on in-patient CAMHS beds. We will be sending a survey out to the Child and Adolescent Faculty soon, so please fill it in.  It is clear that the cuts in services is beginning to hit home with the media.

Also last week, I had another good chat with a taxi driver, while travelling between meetings in London. The driver, with intuitive common sense, was telling me what he thought was needed to reduce the stigma and discrimination associated with mental illness. He was one of those individuals who was getting out there – outside his working hours – supporting young people to get into sport and other social activities. I wish I could give a President’s Medal to taxi drivers like that!

This week, I am attending the World Psychiatric Association International Congress in Vienna, where I will be pushing the parity message.



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23/10/2013 12:14:54

The Sun listens

Wednesday, 23 October 2013

On 7 October, the headline on the front page of The Sun declared '1,200 killed by mental patients’. Not only was this headline alarmist and stigmatising of people with mental illness, but the article misquoted the figures on homicide by people with mental illness as published by the National Confidential Inquiry into Homicide and Suicide.

Today, The Sun has published a clarification on the headline which states:

"Further to our article '1,200 killed by mental patients' (October 7), we would like to make clear that the 1,200 figure was related broadly to victims of homicide by people with mental illness. This encompassed both those who were being actively treated at the time of the offence and those who were subsequently judged to have symptoms of mental illness".

Time to Change met with staff from The Sun last week and have issued a statement in response to the clarification.

After reading the story on 7 October, I too wrote to the newspaper and am due to meet with their managing editor on 19 November. I hope to discuss the paper's general coverage of mental health issues. If you have any suggestions of things you'd like me to raise, please do get in touch.

Today's clarification is an important step from a national newspaper. But the question remains, how will they act in the future when reporting on mental health issues?


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22/10/2013 10:13:46

Working across Europe

Tuesday, 22 October 2013

I spent the weekend at the UEMS (European Union of Medical Specialists) meeting in Paris. I attend this meeting as a representative of the Academy of Medical Royal Colleges, and in my new role as President Elect of UEMS Child and Adolescent Psychiatry Section (UEMS-CAP).

Over the last two years, UEMS has become a far more dynamic, action-oriented and transparent organisation, with evidence of palpable progress in improving medical education across Europe. The organisation’s headquarters in Brussels now has planning permission to develop and provide space and accommodate for all UEMS activity, such as Section meetings. National organisations will also be able to rent space from which to lobby in the European Parliament.


Much progress has been made on corporate social responsibility and sponsorship in particular. However UEMS did not succeed in their lobbying of the EU with regard to the professional qualifications directive. UEMS was fighting for a minimum of five years training and a competencies-based common training test. However, work on the European Association of Centres of Medical Ethics (EACME) continues, with accreditation of courses from across Europe and beyond.


On a more personal basis, this meeting saw Professor John Tsiantis step down as President of UEMS-CAP.  John has fought tirelessly for improved services and standards of medical education to help improve mental health care for children and adolescents across Europe. I will take on John’s role in January, while Professor Brian Jacobs continues to lead on medical education and training – having just finished preparation of a new competency-based curriculum with colleagues.


Key to empowering the voice of psychiatry across medical education in Europe will be how the UEMS Section of Psychiatry, and UEMS-CAP, work together in common cause. So I look forward to working with Marc Hermans (the President of the UEMS Section of Psychiatry, from Belgium) and his Executive which includes UK psychiatrist Andy Brittlebank. 


I guess that, to many of our College members, events in Europe seem distanced from the day-to-day heat and burn of clinical practice in the UK. But I believe it is important to be aware of them, as we really are stronger working together if we have a shared voice for mental health in Europe.


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16/10/2013 11:39:39

Mental health services 'in crisis'

Tuesday, 16 October 2013

Today, a BBC investigation claims that England’s mental health services ‘are in crisis’.  The College has been warning about cuts and a lack of investment in mental health services for many years. So, are we finally being believed?

We know there is a treatment gap that urgently needs to be bridged, and we know that services are being cut. While we have parity of esteem for our patients in statute (thanks to the Health and Social Care Act (2012)) we don’t have parity of esteem in practice.

Care services minister Norman Lamb MP has repeatedly pledged his commitment to parity – but will his statement be acted on? Are commissioners (whether at local or national level) prepared to act so we aren’t shipping ill patients in need of care up and down the country – causing huge unnecessary distress to patients who are already unwell and vulnerable? Or will we, in 12 months time (as history has shown before), find further erosion of intensive care mental health services in order to prop up other acute health services?

If this was happening to patients with a physical illness, such as cancer, there would be daily outcry and action. We need the 1 in 4 people who will experience an episode of mental illness, and their families, to speak out to future-proof their right to adequate service.   

It really is time to make change.




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15/10/2013 14:25:19

Death of a Past President

Tuesday, 15 October 2013


Last week, I received the sad news that Dr Jim Birley – one of our former Presidents – passed away on 6 October at the age of 85.


Dr Birley was a remarkable man who is remembered fondly by the College and everyone who he worked with.


Educated at Winchester College, Oxford University and St Thomas’ Hosiptal, London, he first became interested in psychiatry while working in Germany, in the army, as a (conscript) Junior Medical Specialist.


After obtaining the MRCP (London) he worked for a year with Dr William Sargant. In 1960, he went to the Maudsley Hospital where he stayed for the rest of his career.


He was actively involved in the work of the College for many years. He was Dean from 1982-87, and President from 1987-90. He was made Honorary Fellow of the College in 1991. That same year, he retired from clinical work but he remained active in medical circles and was elected President of the British Medical Association for 1993-1994.

Dr Jim Birley, RCPsych President 1987-90

I will always remember Jim as a man who truly epitomised intelligent kindness. If you have any memories of him, please share them with us by emailing the Website Manager, who will upload your thoughts to this blog.



10/10/2013 09:08:18

Conversations about mental health

Thursday, 10 October

Yesterday, I had a really stimulating day in Cumbria at a 'No Health Without Mental Health' conference delivered by Cumbria Action for Health. I was honoured to be asked to deliver a talk at this event, which looking at key issues within the No Health Without Mental Health Strategy and at how others across the country are using this to work together to improve mental health services.

I was particularly pleased to see such a wide range of professionals, providers (both from the NHS and the vountary sector), patients and carers come together to seek solutions. It just goes to show that, with true partnership working, it is possible to build primary and secondary services able to meet need and bed these within communities.

The 'growing voices' tree

I was very interested to see a 'growing voices' tree at the event, which is a project initiated by Carlisle Eden Mind. The project is all about giving people with experience of mental
ill-health a voice in their own community without risking exposure to stigma, and is based around the interactive 'talking tree' art installation. What a wonderfully creative and engaging way to have important conversations about mental health.

World Mental Health Day

And talking of having important conversations about mental health, I hope you've all remembered that today is World Mental Health Day. World Mental Health Day is trending on Twitter, and the College is joining in by sharing positive messages about mental health via @rcpsych.

Today, I have issued a joint statement on treating physical and mental with equal importance with Professor John Ashton, President of the Faculty of Public Health, and we are pleased to see the official launch of their online resource for public health professionals, Better Mental Health for All.


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07/10/2013 14:22:59

Taking stock & new beginnings

Monday, 7 October 2013

Political changes

Following tours of Glasgow, Brighton and Manchester, this year’s round of party political conferences has finally finished – but while the conferences themselves are very busy, it’s when we get back to the College when the real work begins following up leads and taking forward plans and agreements.

During conference season we’ve been working closely with the voluntary sector and NHS Confederation, as well as other medical royal colleges and the GMC. This is really effective, and gives us as psychiatrists much better understanding of both how we are perceived, and of the absolute need for us to be clinical leaders and agents for positive change.


There were various roundtables, one to one meetings as well as the various fringes on relevant topics ranging from the role of doctors to the negative effects of alcohol. We certainly covered a lot of ground and met many interesting people, pushing the messages around the importance of psychiatry and the need for true parity of esteem for mental health.


On the day that the College has moved into our new family home at 21 Prescot Street (more about this below), Whitehall is in the midst of its own moving day with a reshuffle - the first for some time. It always takes a while to see exactly who’s gone where and as yet the Department of Health seems unaffected but current changes of note include Nicky Morgan’s appointment as Economic Secretary to the Treasury and Esther McVey’s move from within the DWP to Minister of State for Employment .

The round of party political conferences has finally finished – but while the conferences themselves are busy, this is when the real follow-through work begins. During conference season, we’ve been working with the voluntary sector and NHS Confederation. This is really effective, and gives us as psychiatrists much better understanding of both how we are perceived, and of the absolute need for us to be clinical leaders and agents for positive change.

Building healthy, active lives

I’ve spent the last two days in Leuven, Belgium, at the EuroHeAL conference, an international seminar discussing the Healthy Active Lives (HeAL) declaration. Clinicians from across the world and across medicine have joined together with the shared goal of improving the physical health of young people with psychosis.

It was a truly inspiring couple of days, and it was so good to focus on improving clinical practice in partnership with diabetologists, early-onset psychosis experts, neuroscientists, psychologists, nurses, dieticians and many more. Working together, we can improve care for our patients, reduce the likelihood of weight gain, reduce rates of smoking, and help prevent the subsequent onset of diabetes and cardiovascular disease.

There is much to be done, but this work goes to the heart of the most basic principle of medical ethics – first do no harm. Watch out for more information and action from HeAL at conferences and events worldwide, and them pushing out helpful information and guidance. But while HeAL is focused on improving the physical health of young people with psychosis, we must not see this just as the preserve of youth mental health services. We all need to become better at reducing weight gain and minimising the risk of premature mortality for patients of all ages who develop, or already have established, psychosis.

A weekend of launches

On Saturday, I was privileged to be able to speak at the Annual General Meeting of the Nurture Group Network, the international umbrella organisation for nurture groups. Their work typifies what can be done to improve the incredibly valuable work they do to improve the life chances of our most vulnerable and disadvantaged children and young people, and in particular identify and support those with mental health problems.

Also at the weekend, we launched published a joint report with the Centre for Mental Health. Called Bridging the Gap, the report makes the financial case for a reasonable rebalancing of health and care resources to ensure no one is denied the mental or physical health care they need. I strongly encourage you to take a look at it.

And on Sunday, the Academy of Medical Royal Colleges shared its blueprint for seven-day services in hospitals with The Sunday Times. The article is behind a paywall, but if you have access then take a look.

Stigmatising reporting

Today, I was both shocked and saddened to see the front page of The Sun, with its headline '1,200 killed by mental patients- and I'm sure many of you have felt the same.

Not only was it extremely disappointing to see such a widely-read paper making mistakes with the figures it quoted (see the National Confidential Inquiry into Suicide and Homicide website for the real facts) but such headlines and articles perpetuate the myth that people with mental illness pose a violent threat to society. In reality, we know that people with severe mental illness are much more likely to take their own lives (sadly 10% of everyone with schizophrenia will end their life) or be a victim of violence. And people who misuse alcohol are between 10 and 15 times more likely to be violent than people with schizophrenia.

There has been much discussion and condemnation of The Sun's article on Twitter, and representatives from the major mental health charities have given many media interviews on the issue today. While this has been very helpful, we really need the media to stop peddling these myths and inaccuracies in the first place - only then can we really start fighting the stigma.

Moving home

And finally, as many of you know, the College moved offices today – and we are busy settling in to our new home at 21 Prescot Street, E1. Our beautiful chandelier from Belgrave Square has been installed in our huge new reception area, and staff are busy unpacking the hundreds and hundreds of crates which came with us. All our staff have worked so hard over the last couple of weeks to ensure we move in with as little disruption as possible to members – so I hope you will join in me thanking them.


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26/09/2013 10:41:58

Always expect the unexpected

It was really good to gain airtime on BBC Breakfast this morning. I was invited on to talk about today's new report from Rethink Mental Illness, Lethal Discrimination, for which I wrote the Foreword.

This powerful report reveals the shocking statistic that over 30,000 people with mental health problems in England are dying needlessly every year.

But who would have expected another shocking mental health story to break at the same time - about supermarket giant Asda selling a 'mental patient' Hallowe'en costume. BBC Breakfast asked me to stay on and give an interview about this as well - which I did, after first checking  my time travel machine to make sure I was still in the 21st century!

I was very grateful to the BBC for giving me, and a service user, the opportunity to explain how thoughtless acts like this serve to set back mental health at every level. There has been a huge outcry on Twitter about the costumes, and Asda has rightly withdrawn the costumes from sale. Tesco, who stocks a similar outfit, has also followed suit.

But while it is positive to see such an outcry, what a slap in the face things like this are for all the campaigners - including many College members - who have been working so hard to end discrimination and bust the stereotypical myths about those who have a mental illness. We've done so much over the years, but the battle needs to continue.


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25/09/2013 14:42:44

Shouting for mental health

I’ve just got back from the very active Labour Party conference in sunny Brighton, where we met various parliamentarians and stakeholders. Our joint round table on mental health – organised by us, Mind, Centre for Mental Health, NHS Confederation and Rethink – had a very good attendance from MPs, Peers and, in particular, local councillors.


It is definitely well worth letting your local councillor know why mental health services are important for all their constituents. Following the launch of the Mental Health Challenge last week, more local councillors are signing up to become mental health champions. While centrally the College can keep them well briefed, only you can tell them what is needed for the local population you care for.


Over the last few days, I’ve started losing my voice from so much talking. While it’s made it harder for me to shout for mental health and learning disability, it has made me realise that getting the voice of mental health heard and acted on is an ongoing battle.


I was delighted that Labour leader Ed Miliband talked about mental health in his speech yesterday.  Addressing the conference, he said: "Mental health is a truly one nation problem. It covers rich and poor, north and south, young and old alike and, let's be frank friends, in the privacy of this room, we've swept it under the carpet for too long. It's a bit of a British thing isn’t it; we don’t like to talk about it. If you’ve got a bad back or if you’re suffering from cancer you can talk about it but if you’ve got depression or anxiety you don’t want to talk about it because somehow it doesn’t seem right – we’ve got to change that. It's an afterthought in our National Health Service."


What we need is a government who will deliver across prevention, early identification, access and treatment – underpinned by well-funded research. We should expect the same level of service for a 17-year-old girl with first episode schizophrenia as for a 17-year-old girl with cancer. Only when this happens will we truly have parity.


Meanwhile, there are lots of excellent reports coming out from the mental health charities in the run-up to World Mental Health Day on 10 October. For example, this report from the Mental Health Foundation on the future of mental health services, which is the result of a year-long inquiry co-chaired by our former President Professor Dinesh Bhugra. Our own report on the economic case for investing in mental health – produced jointly with the Centre for Mental Health – will be out soon, so watch this space.

The Academy of Medical Royal Colleges is also speaking out in support of seven-day working in the NHS. On Sunday, I co-signed a letter from the Academy to The Sunday Times, backing the paper’s seven day services campaign called Safe Weekend Care. Expect to see more coming out about this issue soon from all Colleges.

Now it’s time for me to start preparing for the this weekend’s Conservative party conference  – which for me has the bonus of being in Manchester, so on home ground.


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16/09/2013 15:04:26

Party conferences & farewells

Monday, 16 September 2013


Party conference season begins

With a drop in temperature and falling leaves, the party conference season has well and truly begun. Dr Adrian James, Chair of our Westminster Parliamentary Liaison Committee, and Will Pickering, our Public Affairs Manager – together with a small group of members, patients and carers – have started their annual visit to all three party conferences.


This really is a valuable opportunity to get our voice heard, and share important messages about parity of esteem and closing inequality gaps. As always at the party conferences, we work closely with the major mental health charities, the NHS Confederation and other medical royal colleges including the Royal College of General Practitioners and the Royal College of Paediatrics and Child Health. Yesterday, Adrian spoke at an event entitled 'Why are children dying? Preventing excess child deaths in the UK', alongside paediatric neurologist Dr Martin Kirkpatrick and Liberal Democrat peer Baroness Jolly.


This year, we have a particular drive to work with local government, and our Local Authority Mental Health Challenge – a joint project with the Centre for Mental Health, Mental Health Foundation, Mind, Rethink Mental Illness and YoungMinds – is working well. We will also be briefing MPs about the financial case for reinvesting in mental health. Hopefully my being a member of both political party taskforces on mental health will have helped to impact on their forthcoming pledges for the next election – but only time will tell.


Department of Health and NHS England meetings

Meanwhile, I am attending ever more meetings with the Department of Health and NHS England. Although it can be frustrating as these meetings take up a lot of time – and I am having to present and represent the same information to different parts of the system – I do sense that the NHS reform (whatever we felt or still feel about it) is starting to bed in. NHS England, through their National Clinical Director of Mental Health Dr Geraldine Strathdee, is knowing more about real quality improvement out on the ground in services. The Care Quality Commission is feeling their feet after launching their consultation on a new inspection regime, and the CQC’s new Chief Inspector of Hospitals, Professor Sir Mike Richards, has seen the need to have someone lead specifically for mental health.

Farewell to Belgrave Square

Here in the College, new members of Council who came into post following the International Congress are settling in. And we are all looking forward to moving into our new offices at 21 Prescot Street in three weeks time. Today we've uploaded a short film to our website, which gives you an idea of how the building is shaping up for the final countdown. Across the College, things are starting to get packed up – with the exception of my office (entirely my fault, I hasten to add!).


Last week, we held two evening events at the College to bid farewell to Belgrave Square, which has been our HQ since 1974.  It was great to be joined by so many members, from near and far, and of all ages and from all stages of their careers. One member I spoke to said she had never been to Belgrave Square before, but decided to come along to say goodbye – and I am very pleased she did. So how, in the future, can we make sure that members will want to come and visit us in our new home at 21 Prescot Street? How can we make it a place where members will want to spend time, and where they will have a sense of ownership? Do let me know if you have any thoughts.


I was interested to see an article in The Metro today about World Green Building Week and the importance of designing buildings that have a positive effect on people. We are hoping to have a roof garden at 21 Prescot Street, to enhance the environment for staff, visitors and local residents. Drawings have been produced, and now the hurdles of securing planning permission and a successful bid for funding lie ahead of us.


Talking of roofs, mine is hopefully watertight again – but only time will tell as I now hope to move home. Clearing out a lifetime of clutter is proving to be a challenge. If you have any tips of how to be firm about getting rid of belongings – and how to stop your adult children filling the loft and garage with their belongings as soon as you clear space – please let me know!  As always, you can send me your comments below.




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11/09/2013 10:28:06

Breaking the stigma of suicide

Wednesday, 11 September 2013

Yesterday (10 September) was a very important day - World Suicide Prevention Day.  Held every year, this year's theme was 'Stigma: A Major Barrier for Suicide Prevention’.

One of our Members, Dr Alys Cole King, who is co-founder of Connecting with People training, spent weeks spreading the word and encouraging people across the UK to support a World Suicide Prevention Day social media campaign. It was fantastic to see Twitter abuzz with people sharing positive messages, tackling stigma and increasing public understanding, and the hashtag #WSPD was trending.

I encourage you to look at the Connecting with People website, which has an excellent short film about breaking down the stigma of suicide, and read Alys' very powerful blog on the BMA website. RCPsych Fellow Professor Louis Appleby has also written an important article about the stigma of suicide among young men for the Department of Health's website.

Although World Suicide Prevention Day is over for another year, we mustn't sit back and relax. As health professionals, we need to continue to spread the message.

Don't forget that we have a range of practical and compassionate self-help resources on our website - available to anyone in need of advice and support. Developed by the College in partnership with Alys and Connecting with People, the three leaflets share hope, promote appropriate self-help and inform people regarding useful strategies, how to create a ‘safety plan’ and how they can access help and support:


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09/09/2013 14:04:18

Positive news and a farewell

Monday, 9 September 2013


There was lots of good stuff about mental health out last week. Last Wednesday, I was pleased to see the Mental Health Foundation’s new report Crossing Boundaries: Improving integrated care for people with mental health problems, looking at how we can provide better integrated care for people with mental health problems. The report claims that current support for people with mental health problems is based on the flawed idea that physical and mental health care are separate issues, and identifies staff as being the key to providing integrated care.


I could not agree more with this sentiment as it reflects the work that our College is doing around parity of esteem for mental health.


Also last week,, Charles Walker MP was interviewed in Society Guardian. In a powerful article, he said: "Mental health, for too long, has been a poor relation of healthcare...but there is a genuine appetite for change."


Before standing down in July as Chair of the All-Party Parliamentary Group on Mental Health, he set us, Mind and Rethink the challenge of finding five areas of concern that don’t require a huge amount of work, and telling the three main political parties. I believe five key areas are:

  • Enhancing and expanding liaison psychiatry services across primary care, secondary care and especially A&E.
  • Listening to those with mental illness and harnessing their knowledge and experience.
  • Putting more effort and resources into early intervention and prevention of mental illness - roughly half of all lifetime mental disorders start by age 14.
  • Challenging mental health professionals to help improve the physical health of our patients.
  • Persuading medical schools to ensure all medical students receive sufficient mental health training.

Mental health is everyone’s business, and it is hugely heartening to see it beginning to get more political attention. But there is still a long way to go until there is true parity of esteem between mental and physical health. 


And last week we also heard that we'll be bidding farewell to Dr Andrew McCulloch, who has been Chief Executive of the Mental Health Foundation for over 10 years. In that time, Andrew has steered the organisation from being a small research organisation to one of the leading mental health charities in the UK - a charity which is a good friend of the College. Andrew will be replaced by Jenny Edwards at the end of October, and I very much look forward to working with her.


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29/08/2013 13:54:28

Singapore and Commissioning

Thursday, 29 August 2013

I have just returned from the 47th Singapore-Malaysia Congress of Medicine, that was held in Singapore - such a beautiful country. The meeting was also the 2nd Tripartite Congress of the Academy of Medicine of Malaysia, Academy of Medicine, Singapore and the Hong Kong Academy of Medicine. I think it’s very healthy to attend these sorts of across-medicine events. Usually, I find that the challenges are the same across medical specialities and geographies, and sometimes others have found solutions that you’ve not thought of in your own family.

It was particularly good to meet with mental health leaders in Singapore. I heard about a recent stratified population survey of mental disorder in Singapore, which shows the country has similar prevalence rates to the rest of the world. The one nuance, though, was higher rates of OCD.

I was very interested to hear a keynote address from the Singapore Finance Minister, who gave a scholarly but very understandable account of the state of world finances. He was painfully accurate about dilemmas in the UK ,and interesting about growing concerns in high GDP Scandinavian countries.

There was a very good debate about the future of medical education, and I gave a presentation on parity of esteem between physical and mental health. The audience was very receptive for what parity could deliver for both mental and physical health outcomes.

Finally, some of you may have seen that NHS England have announced three opportunities in relation to the direct commissioning of specialist services in England. These are for:

  • The Chair of the Mental Health Specialised Clinical Reference Group.
  • Stakeholder registration for the eleven Clinical Reference Groups in the ‘Mental Health Programme of Care’.
  • An ‘innovation fund’ to identify and evaluate innovations in specialised, and to inform commissioners of their potential.

These are excellent opportunities to directly influence the commissioning of specialist services in England, and I encourage people to consider applying, registering or engaging with the programmes above.

If you do, don’t forget to contact the Policy Unit and tell them about your involvement – this will help us better support this strand of important work.


21/08/2013 10:26:53

Summer holidays ending

It is always good to stay with friends and  I much enjoyed a break with some old school friends on the Isle of Wight. There is nothing better than a room with a view and watching other people sailing by. 

The Independent on Sunday carried an article on 18 August which describes a different life on the first ever eco village, Solheimar, which was set up 80 years ago in the south west of Iceland. I was vaguely aware of its existence but what I didn't know is that the "majority of residents have mental health issues, tackling prejudice, and teaching us all a thing or two about how to live."

Back into the round of meetings and decision-making this week, with increasing anticipation about the new home for the College, and as September kicks in, the round of party political conferences. I wonder which leader of which party will be really brave and bold enough to make mental health one of their top 3 priorities? 

We will soon have more evidence to share with them about what resourcing mental health could deliver across health social care education, justice and the world of work  So watch this space!

08/08/2013 10:28:52

US advice and writing letters

Thursday, 8 August 2013

Advice from the USA

This week, the media has reported on Professor Don Berwick's independent review into patient safety. The former Obama aide's remedy for the NHS - and specific aspiration to zero harm - is a sensible read. It also chimes closely with what is contained in Intelligent Kindness: Reforming the Culture of Healthcare, the excellent book by John Ballatt and Penny Campling that we published in 2011. 

But the question is, will those who make policy and commission services really follow what he suggests? There is growing concern over the overall health and well-being on the NHS's 1.3million-strong workforce. Sadly, we are seeing growing numbers of doctors in the middle of their careers leaving the UK – fed up of being stereotyped as not working hard enough or being compassionate enough. And many young doctors are reporting that they can't spend enough time with their patients and that they're considering leaving the profession. 

So while it’s great to see those in high places express their support for Professor Berwick’s recommendations, yet again the proof will lie in what actions will follow. Will Professor Berwick’s recommendations he be empowered to track and monitor the recommendations he has made, or will it be left to the myriad of newly-created systems to do this? I want to hear what policy makers and employers will do to improve the wellbeing of the workforce - which will in turn make the workforce more likely to deliver safe, effective and compassionate care.


Writing letters


As I reported in my blog last week, I've been writing a series of letters to the editors of national newspapers. I've been delighted to have letters published on minimum pricing for alcohol, plain packaging for cigarettes, internet pornography, payday lenders, and child abuse and neglect. Today', I've sent another on the £500m bailout for A&E departments and what I believe is the real problem behind the crisis - the lack of investment in mental health services and the demise of liaison psychiatry services. This means there is less support for vulnerable groups, including older people with dementia, those with addictions, people who self-harm or are in distress, and those with long-term mental illness at risk of relapse. Unable to access the care they need, these people often present at A&E departments in need of urgent help.

Mental health services were – and still are – an easy target for NHS cuts. Mental illness is responsible for the largest proportion of the disease burden in the UK (22.8%), but only receives 11.9% of the NHS budget - which is why our College has been doing so much work around parity of esteem for mental health. The government and decision-makers need to increase investment in mental health services, which will go some way to taking the pressure off our beleaguered emergency departments.

And it's not just me who's putting pen to paper. I was very interested to read the numerous letters from psychiatrists and services users in today's Guardian, written in response to Will Self's controversial article in Saturday's Review section - 'Psychiatrists: The Drug Pushers'.

I encourage all of you to consider adopt the "pen and quill" approach too, and write to your local, regional or national paper when you see coverage of an issue that sparks your interest. It is a great way of getting positive messages about psychiatry and mental health out there - and I believe it will get a response.


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05/08/2013 12:35:50

The good and the bad

Monday, 5 August 2013

I had a really interesting series of back-to-back meetings last week. It was only spoilt by the conversation of my neighbours on the train back to Manchester – a group of “professionals” from across the pond talking about how to extract profit out of the NHS. I exercised every ounce of control I had, and did not make a comment!

But, to regain my composure...I enjoyed a brilliant set of meetings and events. I met with two visual arts leads from the Wellcome Trust, who are working on a forensic science exhibition to be held next year. They had looked at the usual suspects, but did not know about the breadth and depth of work undertaken by many psychiatrists in the forensic field. Following our meeting, they are planning to visit some forensic services, to listen and learn about the court work that many psychiatrists do, and to talk with some of our members who have written about the history of forensic psychiatry. I’ve also encouraged them to meet with some of our members who lead in medical ethics in psychiatry. So, if you are contacted, I hope you don’t mind – it’s my fault! I just see it as a really good opportunity to get out there, and explain the diverse and exciting range of work we do to help improve lives both within and without mental health.

Last Wednesday, I was really privileged to be part of the Liverpool Undergraduate Psychiatry Summer School. It was packed with bright, thoughtful medical students and excellent speakers from Merseyside, including our Associate Registrar for Recruitment Dr Tom Brown. I could not wish for better, and it’s always good to be in Liverpool in the summer with its season of visual arts exhibitions in full swing.

In the afternoon I travelled back to London on the train (much better travelling companions this time!) to attend a symposium at the Institute of Psychiatry on restraint. Patients and staff shared their experience of restraint, and we discussed and debated what is a difficult topic. But we were left with positive hopes for the future of psychiatry, as long as well pull together in partnership with patients.

The symposium was accompanied by a photographic exhibition by artist Jane Fradgley, held, which was a striking display of images of restraint garments and strong clothing from the Bethlem collection. This is such a difficult subject, but the images had both beauty and poignancy in equal measure. The exhibition runs until 27 September and I urge you to visit. The evening was a fantastic example of what a good partnership mental health and the arts makes. And I hope, when we move to our new offices at 21 Prescot Street later this year, that we will be able to forge closer links with the Bethlem Royal Hospital Archives and Museum.

On Thursday I had lots more meetings with positive outcomes. In particular, I am hoping for a follow-through event from the recent joint meeting on global mental health held by the College and the Royal Society of Medicine.  

I also gave two telephone interviews about being a woman doctor and a leader. I think I am a bit of a disappoint to those who interview me as I don’t see – and never have seen – being a female as an obstacle to what I have managed to do with my life. I’ve also never seen myself as a leader, but instead as an enabler and someone who works as part of a team. I have pondered why, and think it’s to do with my determination (which is no doubt irritating to others!) to re-frame problems as opportunities, and see barriers as things that can literally be circumvented. I have to put that down to having inherited the resilience gene from my parents!

I rounded off the day on Thursday in a meeting with the Department of Health about the latest Caldicott review into information sharing. I was wearing my Academy of Medical Royal Colleges hat at the meeting, but would like to say that I am personally very supportive of the report and very much respect our former President for persevering with this difficult task of how, when and where we share information.

My strong view is that this will only really work when the GMC and medical defence bodies step up to the plate and give us a plain English version of how they will interpret this report. Employers also need to square up to being less risk averse when it comes to data sharing. No one says this is easy, but it’s critical to our work with patients in carers, and in particular in social care. We have a Secretary of State for Health who is very much interested in new technology and information sharing for best outcomes, and that’s why it’s good that our college has such a good Mental Health Informatics committee.


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25/07/2013 17:20:35

A great week for mental health on TV

Thursday, 25 July 2013


Mental health and psychiatry on the small screen


What a week it’s been for mental health and psychiatry on TV. On Wednesday, BBC Three broadcast Rachel Bruno: My Dad and Me, a powerful and thought-provoking documentary in which the 26-year old daughter of boxer Frank Bruno set out to discover the truth about her father’s bipolar disorder. Dr Mark Salter, one of the College’s long-standing media experts, took part. You can watch again on BBC iPlayer – keep an eye out for mark at 24 minutes and 50 minutes.

And last night, Newsnight aired a special report on electroconvulsive therapy (starts 18 minutes in). Professor Ian Reid, Chair of our Special Committee on ECT and Related Treatments, took part in what was a really excellent and balanced report on the treatment.

And that’s not all. In recent weeks, I’ve enjoyed watching the programmes aired as part of BBC Three’s It’s a Mad World season, including Diaries of a Broken Mind and the three-part series Don’t Call Me Crazy set in Manchester’s McGuiness Unit.

Perhaps at last we are seeing signs of a change - with an growing number of TV programmes tackling some of these really difficult issues in an thoughtful, open, and balanced way. Not only are they giving time to mental health, they are giving time to psychiatrists to explain what mental illness is, how it can be treated, and how decisions can be made by health professionals working I partnership with patients and carers. I very much hope there will be more to come.


A series of meetings

I had many good meetings this week, including two governance meetings for the College Centre for Quality Improvement (CCQI) and the National Collaborating Centre for Mental Health (NCCMH). These both emphasised how much really positive work they undertake under the umbrella of the College. I also had meetings of both political party taskforces on mental health (which are always fascinating) as well as meetings on restraint in mental health settings with the Royal College of Nursing and Mind. I also had a great catch up on the Reading Well: Books on Prescription scheme.


Letters to the Editors

Over the last few weeks, I've had several letters accepted in a number of national newspapers on minimum pricing for alcohol, plain packaging for cigarettes and internet pornography. I've written another letter to The Independent praising the Archbishop of Canterbury's plans for an alternative to payday lending, which should be published in Saturday's paper. Payday loan shops- along with fast food shops and cheap booze outlets - are another part of our toxic high streets. We know that debt and vulnerability can often walk hand in hand, and we need all financial service companies to prioritise the needs of vulnerable people.

No doubt some people will see me as a reincarnation of Mary Whitehouse for writing these letters. But I believe it is part of our role as doctors to speak out when we know the special vulnerabilities of some of our patients. And in my area of work as a child psychiatrist, I am particular concerned about the impact that ready access to violent, sadistic and pornographic images on the internet is having on young people's minds - to say nothing of the child victims whose images appear and whose lives are so blighted.


Other news

In other news, I've been following through on our employment and mental health seminar to deliver some useful outcomes. Together with the Centre for Mental Health, we have started our economic modelling of the value (in terms of both improved patient care and value for money) in shifting more resources into mental health.  So let's wait and see how strong a case we can really build, and then how we can get politicians, and those now controlling health, to listen and act. Nothing ventured nothing gained.

I also see that NHS England and the Health and Social Care Information Centre (HSCIC) have published NHS Hospital Data and Datasets: A Consultation to explore how better extraction of information from hospitals’ data systems could help raise standards, improve safety, and reduce inequalities in patient care. I very much encourage you to take a look at this.

Finally, I am looking forward to the medical student Psychiatry Summer School in Liverpool next week. And, outside work, I'll be enjoying some celebrations as my family prepares to celebrate birthdays from across four generations.



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22/07/2013 14:49:15

ACCEA and eavesdropping

Monday, 22 July 2013

Today, the Advisory Committee on Clinical Excellence Awards (ACCEA) opened the latest round of National Clinical Excellence Awards. I am also delighted to hear that child and adolescent psychiatrist Professor Richard Williams has been appointed at interim Medical Director for ACCEA. I’ve worked closely with Richard over many years, and I warmly congratulate him on the appointment.

Last week I walked back and forth between the College, Parliament and various government departments – and unfortunately managed to get sunburnt! It made me think back fondly to 12 months ago, when the streets of London were filled with the Olympic buzz.

On Thursday, I attended the ‘opening’ of the Royal College of Radiologists’ new building at 63 Lincoln’s Inn Fields (though they won't actually be open for business until Monday 29 July). It reminded me that it's only a few months until we move buildings ourselves. Don’t forget to keep an eye on the 21 Prescot Street blog for updates.

On Friday, we had a good Council meeting. We spent the morning completing our final thoughts post-Francis, and will be putting together our action plan over the summer. There is much we are already doing – but it needs pulling together to make a coherent strategy across the entire College. We need to ensure that – in everything we do – we put patients first, we are supportive to our members when things are not going well, and that we speak out and be part of solutions for safe care and service improvement.

I try not to listen to other people’s conversations on the train (most of the time, at least!) but last week I was on Virgin trains and the sardine-style seating made it impossible for me not to overhear the polite conversation that was struck up between two young men sitting in front of me. After chatting about sport, along came the inevitable question from Man 1: "And what do you do?" Man 2 replied: "I’m a community psychiatric nurse."

In these situations, such an answer is often met with silence. But, on this occasion, I’m  delighted to say that the reply was: “That’s cool, really cool.” And there followed an animated conversation about what a great job it was, the difference it can make to people’s lives, and how no two days are ever the same.

I resisted the temptation to cheer out loud – but inside I was greatly cheered!




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19/07/2013 10:55:24

Double blow for public health

Friday, 19 July 2013


Urgent action needed on alcohol and tobacco

It has been a disappointing week from a public mental health perspective – with news that the government has shelved plans to introduce both minimum unit pricing for alcohol and plain packaging for cigarettes.

On Wednesday, I – together with fellow psychiatrists Dr Owen Bowden Jones (Chair of our Addictions Faculty), Dr Peter Rice (Immediate Past-Chair of RCPsych in Scotland) and Dr Rob Poole (Chair of RCPsych in Wales) – were co-signatories to a letter published in The Guardian.  Along with other members of the Alcohol Health Alliance, we voiced our concern that the decision on alcohol pricing will cost lives and pledged to continue to fight for minimum unit pricing.

And today, I wrote to The Independent expressing dismay at the ‘double blow’ that politicians have dealt to relieve the current burden on the NHS and improve the health of the nation. It is frustrating to hear the government repeatedly talk about the need to reduce premature mortality – but that when they have an opportunity to make a real difference they fail to take action.


Inequality and mental disorders


Today, a comment article I co-authored with Dr Jonathan Campion, Professor Dinesh Bhugra and Professor Michael Marmot was published in The Lancet - ‘Inequality and mental disorders: opportunities for action’.


We know that socioeconomic inequalities are associated with increased risk of mental disorders in two ways. Our article states: "First, more pronounced income inequality within wealthy countries is associated with increased prevalence of mental disorders. Second, the degree of socioeconomic disadvantage that people experience is associated with proportionately increased risk of developing a mental disorder."


Our article identifies several actions that can reduce the effect of inequalities, including interventions to prevent childhood maltreatment and promote healthy early attachment, early intervention for mental disorders and associated health-risk behaviours, and public health campaigns to draw attention to symptoms of mental disorders and address stigma encourage early recognition and help-seeking.

Addressing the inequalities that lead to and arise from mental disorders is a challenge not only for psychiatrists and other health professionals, but our colleagues in public health and government too.


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15/07/2013 15:47:13

From Scotland to Ireland

Tuesday, 16 July 2013

The International Congress in Edinburgh was really a great success, followed by a busy, but enjoyable and productive week in Dublin.  This was the first ESCAP Congress hosted by the Irish College of Psychiatrists. Whilst the opening of the Congress was going on, so was a young people's River Dance, but with a modern twist. Outside in the heat, the youth of Dublin jumped from the bridges into the river below - a risk-taking activity which has been carried out across the world by generations of young people when the hot weather sets in.

The conference was excellent and the staff and senior members of the Irish College did a fantastic job. 

Back to London for a packed day at the Academy of Medical Royal Colleges where the 7-day consultant-led report is shaping up well, but cannot be resourced and/or cost neutral.  In the afternoon, we heard from the new chair of NICE, David Haslam.  I have subsequently written to him about our hope that NICE will do an acute mental health care pathway guidance for primary care, A&E mental health and secondary care, and that they will think beyond HTA methodologies.

I then went back to Dublin for UEMS CAP. I am delighted to have been elected as their next President.  I hope to push the Parity agenda, and in particular working with the psychiatry UEMS, I am determined to push the central European Union of Medical Specialists (UEMS)  to support us in asking all medical schools across Europe to increase the exposure of medical students to psychiatry. The dilemmas are the same across the whole of Europe, whether in well-resourced countries, or those with sparse resources.  In all European countries, in child psychiatry there is a push towards prevention and in working directly with local communities.

For this week, a complete diversity of meetings are planned.

Meanwhile at home, I became the family mobile sun cream application unit, but of course forgot myself. I sponsored my grandson for his school sports day forgetting that, whilst he has a little way to go in his running technique, he more than makes up for this in sheer determination. So at a pound a lap, say no more, but for a good cause. 


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08/07/2013 13:50:59

An excellent week

Monday, 8 July 2013


Last week there was a real buzz at our International Congress 2013 in Edinburgh.  Although my social media skills don’t extend to Twitter, I know there was a lot of tweeting going on – so even those of you who couldn’t be there would have had a flavour of some of the many excellent sessions.


It was so good to see members soaking up the science, while having time to chat, learn and enjoy. Itis  the psychiatry family at its very best, so I want to say a huge thank you to all the staff, Members and Fellows who put in so much effort to make everything such a success.

As always, it was a real privilege for me to greet the new Fellows, and to hand out President's Medals to people from all walks of life who have made, and continue to make, a difference to the lives of people with mental illness.


This year, we awarded President's Medals to: psychiatrist Dr Gwen Adshead; paediatrician Professor Gillian Baird; MPs Paul Burstow, Kevan Jones and Charles Walker; Centre for Mental Health chief executive Sean Duggan; and American psychiatrists Dr Ken Busch and Dr Sidney Weissman. At the beginning of the year, I was also honoured to be able to award a Medal to Professor Helen Lester, who died recently following a short illness.

I was also delighted to award Honorary Fellowships to Dr Denise Coia, Professor Sir Neil Douglas, Dr Clare Gerada, Professor Sir Michael Marmot, and Professor Rutger Jan van der Gaag.

During the Congress, I had meetings with fellow Presidents from across the world, and really positive action stemmed from this.  I was delighted that we had over 240 international delegates representing 35 countries – from Argentina through to the USA. I am always interested in hearing news from our International Divisions, and it was particularly humbling to hear of the projects that our members are doing in war-torn and dangerous places.


The Gala Dinner was held on Thursday evening, and I should say a special thanks to our new in-house musicians. Comprising Dr Phil Davison, Dr Chris Fear, Dr David McDonald and Dr Theodoros Bargiotas, the group performed three wonderful songs including one about the College’s move to 21 Prescot Street! I hope that once we are in the new building, we can build on the really extensive musical and arts talents that so many of our members hold.


After the Gala Dinner was over, I went to the station to catch a sleeper train to London. It’s the first time I’ve been on a sleeper and I wished I’d had my grandson with me – he would have loved it! It wasn’t quite the Orient Express, but the Caledonian Sleeper did the job and I had a good night’s sleep.


Once back in London, I attended my first European Psychiatric Association board meeting, as an elected member. I then made a quick dash for a meeting at Number 10 Downing Street to discuss transforming mental health services in England. Wouldn't it be great if the leaders of the coalition stood together and spoke of the pivotal importance of good mental health for society. Who knows?


This week, I will be in Dublin for the 15th International Congress of the European Society for Child and Adolescent Psychiatry (ESCAP) 2013. I have the privilege of supporting a group of child psychiatry trainees from across Europe, especially Eastern Europe, so I am looking forward to hearing the presentations they are giving on their innovative services and excellent research.




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01/07/2013 18:19:12

From Edinburgh

Monday, 1 July 2013

Yesterday, I was very honoured to be given the Fellowship of the Royal College of Physicians of Edinburgh. It was a fascinating day in all ways. I was particularly pleased to see Dr Peter Rice, the outgoing Chair of RCPsych in Scotland, also receive his Fellowship for all the work he has done in partnership with physicians around alcohol and its impact on peoples lives. Dr Denise Coia was my guest at the dinner, who is leading innovation in quality improvement across medicine in Scotland.  

It was humbling to hear the citation of other Fellows, many of who are deliivering amazing medical services in countries with very few resources. I also had the chance to literally pop next door to see the new additional accommodation that RCPsych in Scotland has acquired. It will enable them to hold more meetings at their base, and hugely improve the service to members.

Today, I went back to Manchester to speak at an event organised by Papyrus, the national UK charity dedicated to the prevention of suicide in young people. Through my university, we have had ongoing contact with Papyrus, and have conducted research on their behalf. My fellow speaker was a Manchester coroner. A trainee working in our College's Policy Unit is currently finishing a review into coroners' inquests, which will outline what we can learn to help to reduce number of suicides. We will feed this research back to the Chief Coroner.

So my suitcase is in overdrive, returning this afternoon to Edinburgh for the start of our International Congress 2013, which I am very much looking forward to. Tonight, before Congress begins, we are holding  a reception for our international colleagues at the Royal College of Surgeons of Edinburgh.

I hope to see as many of you as possible this week.


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28/06/2013 15:22:54

Employment round-table

Friday, 28 June 2013


Yesterday, we held an all-day round-table event on mental health and employment at the College, as part of my Presidential Recovery and Resilience campaign.


Mental health and employment roundtableWe successfully assembled a broad group of people that included service users, carers, clinicians, academics, employers, government departments and private industry. The photo shows us packed into the Council Room, and I'm delighted that a very fruitful day followed. The statistics on the working economy and mental health were particularly fascinating.


Chaired by Professor Dame Carol Black, the discussion in the eclectic group focused on the NHS workforce’s mental health and wellbeing at work generally, as well as how we can help people with mental health problems gain and stay in employment. The wider implications for public health were also explored.


The results of the action points will inform future initiatives on mental health and employment – most likely just after we’ve moved from Belgrave Square to the more socially and commercially diverse environs of Prescot Steet.


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25/06/2013 12:00:25

Putting patient safety first

Tuesday, 25 June 2013


Today, I am very pleased to see that the Academy of Medical Royal Colleges and NHS Employers have published joint Recommendations for Safe Trainee Changeover. The guide is designed to offer simple, practical recommendations to help mitigate the problems associated with simultaneous trainee changeover.


And last week, we saw the Care Quality Commission launch its consultation, A New Start, on changes to the way they inspect, regulate and monitor care services. These two documents are all about putting patient safety first – crucial in providing the types of service that our patients need and deserve.


This time next week, I’ll be in Edinburgh for our International Congress 2013.  If you haven’t booked already, there’s still time. We really do have a fantastic programme this year, and Edinburgh is always a wonderful venue.  I look forward to seeing you there.


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20/06/2013 10:44:28

Best day for parity

Thursday, 20 June


Putting parity into action


Yesterday, I had great pleasure in hosting a ‘Parity in Action’ event at the College. The event marked the publication of our recent parity report Whole-Person Care: From Rhetoric to Reality, and focused on the actions that are needed to achieve some of its key recommendations for marking parity between mental and physical health a reality.


I found it hugely inspiring to sit in our Council Room, surrounded by almost 50 people who are so totally focused on driving forward the parity agenda. Clare Gerada, my counterpart at the RCGP, was in attendance, as were representatives from the Department of Health, Rethink Mental Illness, Mental Health Foundation, Centre for Mental Health, Royal College of Physicians, College of Emergency Medicine, Foundation Trust Network, NHS England, NICE, Public Health England, Welsh Assembly Government, Association of Directors of Adult Social Services, British Association of Social Work, and of course service users and carers.


Professor Sue Bailey and Minister Norman Lamb

The morning began with an address from Care Services Minister Norman Lamb, who described achieving parity of esteem for mental health as a personal aim of his.


He said parity must sit at the heart of the health and social care system, and emphasised his passion for integrated care.



I was very pleased that Dr David Shiers chose our parity event for the UK launch of the Healthy Active Lives (HeAL) international consensus statement.

HeAL aims to reverse the trend of people with severe mental illness dying early by tackling risks for future physical illnesses pro-actively and much earlier, and reflects international consensus on a set of key principles, processes and standards.


Dr David Shiers and Professor Sue Bailey launch the HeAL statement

HeAL has come about following collaboration between clinicians, service users, family members and researchers from the UK, Australia and nine other countries. David, along with his colleagues in Australia, have worked extremely hard and should be very proud of their achievements. I encourage you to look at the iphYs website to find out more.


After parity

After the parity event at the College, I went to West London Mental Health NHS Trust for a meeting dedicated to the excellent projects they have got underway to improve the physical health of those with mental illness. What a wonderful example of real parity in action.

I finished the day at the Royal College of Obstetricians and Gynaecologists, where their President Dr Tony Falconer (who has made a pledge of embed training in mental health in their members' training and CPD) hosted a dinner for the Secretary of State for Health. The dinner was an opportunity for frank and full discussion by College Presidents from across medicine about how we see the future of health and social care, and our role as leaders.

I sat next to the Secretary of State, and relayed our three key priorities about parity to him. These were: how enhanced mental health services can help the Secretary of State to achieve his stated intent to reduce premature mortlity; to deliver integrated care pathways to all patients and better support those with dementia; and, of course, how enhanced liaison services in secondary care, primary care and A&E can relieve the current 'crisis' in A&E. It was a long, but very worthwhile day!

Physical restraint

In other news, I see Mind released figures on physical restraint yesterday and called for an end to face-down restraint - see my response. This issue should not just be about face-down restraint. I believe there is a need for a root and branch review of how, through positive behaviour support, we deal with patients in acute distress who present a physical risk to self and others. I was disturbed to hear from the President of the Royal College of Anaesthetists that young doctors in this specialty are being asked to prescribe intravenous medication to agitated patients in A&E, so I will be looking into this.

Where we need to 'control' any patient, first and foremost we need to all work within an ethical governance framework. That means that, however, acute the crisis of the moment, we first practice no harm. Having spent so much time in my other clinical and advisory roles working on issues relating to the physical restraint of children, I am determined that what I have learnt - and changes I have helped to introduce - can be used to inform better practice in mental health and any health settings.


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14/06/2013 10:02:13

Veterans - and a conference

Friday, 14 June

I'm really pleased to to say we have appointed a College Lead for the Military and Veterans Mental Health - Surgeon Captain Professor Neil Greenberg,  Defence Professor of Mental Health and Co Director of the Academic Centre for Defence Mental Health (ACDMH) at King’s College London.

I was very heartened that we had such a richness of applicants for this post. Although we could only appoint one Lead, I hope all applicants will help contribute to the tasks ahead for the College in this important field of work.

Yesterday, I attended the St George Healthcare Group National Conference 2013 in Manchester. This brilliant conference, called Only the Lonely: Deafness and Autism / Learning Disability, reminded me that there is so much to learn from professionals, patients and carers who are involved in Deafness, Autism and Learning Disability Services. My concern is are they, in the brave new commissioning world, going to be enabled, supported and understood.

What is clear is that, whatever branch of medicine we work in, there is so much to learn from them about the deceptively simply art of communication.

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12/06/2013 15:44:04

Inequalities and action plans

Wednesday, 12 June

Inequalities and action plans

Yesterday, there were media reports of a new statistics showing huge variations in early death rates across England. Health Secretary Jeremy Hunt described them as “shocking”.

While much of the focus was on variations in physical illness, it is clear that certain groups experience much greater variation in mortality than the general population. People with psychosis (serious mental illness), who represent 0.4% of the population in England, experience an average 20 years reduced life expectancy compared to the general population. The Public Health England community mental health profiles show that premature mortality in people with serious mental illness has a more than 8 fold variation between the worst area in England (score 1863) and the best area (score 210) compared to an England average of 921.

This inequality cannot be allowed to continue, and is exactly what we are seeking to address through the College’s work on parity. I hope that the Health Secretary will help ensure real progress in bridging the gap between these variations, and hold Public Health England, local authorities, CCG and NHS England to account in his commitment parity of esteem for mental and physical health by 2015. This is going to be even more challenging given the recent 1% real reduction in spend on mental health.

Looking internationally, there is optimism. On 27 March, the World Health Assembly adopted the Comprehensive Mental Health Action Plan 2013–2020. The plan has, at its core, the globally accepted – and much quoted - principle that there is “no health without mental health”.

The plan has four key objectives:

  • to strengthen effective leadership and governance for mental health;
  • to provide comprehensive, integrated and responsive mental health and social care services in community-based settings;
  • to implement strategies for promotion and prevention in mental health;
  •  to strengthen information systems, evidence and research for mental health.

According to an editorial published in The Lancet  “this action plan and the accompanying

resolution—a first in the history of WHO—represent a formal recognition of the importance of mental health for WHO’s 194 member states. It is also a commitment by all member states to take specified actions to improve mental health and to contribute to the attainment of a set of agreed global targets. This is to be applauded, and I hope health professionals and policy makers will work together in implementation.


Caring and Carers

Today, I felt privileged to be one of four speakers at an event organised by West London Mental Health NHS Trust, called Consultants Training on Carers, organised by Mahbub Khan.  I had spoken to members of our Carers Forum before attending, who had given me their key themes and priorities about how we can better listen to carers and deliver the best care. We also heard from two carers who spoke with informed passion about being a carer, and how we can better support them and their loved one, and reminded us of the triangle of care.

I was delighted to have the opportunity to meet new and old colleagues. It was good to meet up again with Steve Shrubb, who I had the pleasure of working with on many occasions when I was Registrar and when he was Director of the NHS Confederation's Mental Health Network/ He is now CEO at West London Mental Health NHS Trust. I heard of innovative projects the Trust is working on, including the growth of liaison psychiatry, and how plans for the new building at Broadmoor are progressing.

Tonight am going to a lifetime achievement award ceremony for Malcolm Rae. Malcolm has done more for mental health nursing than anyone else I know, and mentored many of the most senior nurses across the country. He even took me (a non-nurse) under his wing, and he invented intelligent kindness before we knew what he was. I hope he will be pleased  at how the Mental Health Collaborative (representing over 85% of mental health professionals from nursing, psychology, psychiatry, social work and occupational therapy) is developing into a cohesive group, ready to lobby for and influence mental health and social care through informed thinking and practical solutions. Watch this space for what we will be up to over the next few months. 



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10/06/2013 11:56:11

New standards & pushing parity

Monday, 10 June 2013

On Saturday, I was privileged to be asked to attend the British Indian Psychiatric Association (BIPA) annual conference, where there is always a warm welcome with a great sense of family and community. There were fascinating speakers, a round table discussion on the Francis Report, and excellent trainee presentations. There was also a very thought-provoking presentation on marriage, women and mental illness in Hindu communities in India, given by Professor Indira Sharma who is the current President of the Indian Psychiatric Society. 

Today saw the publication of an important new set of Healthcare Standards for Children and Young People in Secure Settings. Work on these standards was led by the Royal College of Paediatrics and Child Health, in partnership with us, the Royal College of General Practitioners, Royal College of Nursing, Faculty of Forensic and Legal Medicine and Faculty of Public health.


Also today, I am attending a stakeholder event organised the Centre for Workforce Intelligence to share emerging findings from their review of the psychiatrist workforce in the England. Our workforce lead, Dr Aideen O’Hallorahan, has been doing sterling work on this. But for reasons I can’t comprehend, there seems to be a reluctance to accept the size of the treatment gap for all degrees of, and range of, mental illness. It both perplexes and irritates me that our evidence-based facts are disbelieved, and it really shows we have to push the facts out there (as we did in our recent parity report). This wouldn’t be an issue for illnesses like cancer, diabetes and coronary heart disease. And it really does matter when the modelling for our future workforce is being done on the basis of a 25% unmet treatment need.  I know it’s a difficult world out there, but when we pull together we get results. So we need to keep pushing for 4% more funding for the 1 in 4 people who experience a mental health problem. 


The Care Bill is currently being debated in the Lords. Last week, Baroness Wheeler praised our report on parity and its recommendations relevant to the remit and role of Health Education England (HEE). It is important that we push for HEE to ensure that all health professionals have an appropriate level of mental health training – especially medical students.


Our Dean, Dr Wendy Burn, has shared some good news with me about recruitment and CT1 posts - recruitment to the CT1 grade has resulted in a 95% fill rate with a 19% increase in the actual numbers appointed compared to last year. The combined efforts of Wendy, the chair of the National Recruitment Board, Damien Longson, and the Promoting Recruitment in Psychiatry committee (PRIP) appear to have borne fruit.

Finally, I reported in one of my blogs last week that my oldest grandson is developing my knowledge of Marvel comics. Well I’m pleased to report that my two-year-old grandson is now reintroducing me to the wonder of Bob the Builder (very helpful with my house repairs) and Thomas the Tank Engine (excellent training for my regular commutes from Manchester to London by train).



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05/06/2013 11:06:00

Good news and sunny weather

Wednesday, 5 June 2013


There’s lots to celebrate this week – the long-awaited arrival of sunny weather, and some really positive meetings and messages about mental health, both here and across the pond.


Mental health and government


On Monday, I was delighted to see that Barack Obama hosted a conference on mental health at the White House. The conference was organised in response to gun violence and last year's shooting at a Connecticut elementary school, but had a bigger goal of reducing the stigma of mental health problems and encouraging those who are struggling to get help. Actors Bradley Cooper and Glenn Close, who have both done a lot to promote mental health awareness, attended the conference, generating media coverage over here as well as in the US. It really is great to see high-profile people bringing much-needed attention and focus to these important issues.

Yesterday, I met with James Morris MP at Portcullis House. He was instrumental in pulling together the collection of essays from Conservative MPs, Making up our minds: towards improving our approach to mental health. He was keen to discuss with me the project he is working on concerning mental health policy across government.  I was really excited to hear his thinking, with which I have complete resonance.  From my own clinical background, I can think of no other way of working than across all aspects of services that can come together to meet needs of citizens with extant mental illness or risk of developing mental illness, right across into prevention and public health. This has to translate into cross-government working.

The launch of Reading Well

Yesterday evening, I attended the launch of the Reading Well Books on Prescription, a new service to help people through self-help in book form. The College has been involved with the Reading Agency in helping in the development of this scheme and in particular with Dr Paul Blenkiron. It was interesting to meet with colleagues not only from the psychology and counselling sector, but also from Libraries across England. The launch was supported by two Ministers, Norman Lamb, but also Ed Vaizey, Minister for Culture,  Communications and Creative Industries.

Academy in call for NHS service change

As Vice-Chair of the Academy of Medical Royal Colleges, I was delighted to see coverage of a new report published today, Changing Care, Improving Quality . The report is the result of collaboration between the Academy, NHS Confederation and National Voices, and says the NHS needs to face up to the need to change how it delivers its service.

According to the report, rising demand and limited resources mean the reorganisation of services is essential for the NHS to remain sustainable and to continue providing safe, effective clinical care that meets patients' needs. It says that the term "reconfiguration" has become loaded with negative meaning, associated with making cuts and downgrading services, and that service changes are frequently viewed by the public as a threat rather than positive and necessary reforms. It sets out five recommendations for local and national health service leaders, which I hope will be taken forward.


Gaining more momentum for parity


And it’s good to see that the work we are doing on parity of esteem for mental health is permeating all areas of areas of legislation and is being used to make a difference for our patients. Yesterday, Labour Peer Baroness Wheeler mentioned our report during the Care Bill debate, during discussion around Health Education England. After praising the report, she said: "I would welcome the Minister updating the House on what action the Government plan to take on this important report, the timescale for the Government’s response, and how any of the report’s recommendations will be fed into the Bill."


Finally, I'm delighted to hear that refurbishment work on our new offices in Prescot Street is progressing well. I’d encourage you to take a look at our 21 Prescot Street blog for the latest updates.


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31/05/2013 10:06:38

Light and shade

Friday, 31 May

Yesterday  I had one of my regular catch-ups with the Children’s Commissioner for England Maggie Atkinson. Earlier this month they published a report called Basically... Porn is everywhere - A Rapid Evidence Assessment of the effects that access and exposure to pornography have on children and young people that is well worth looking at. Sadly, the impact of pornography is only too topical, and it opens up important discussions about modern technology and how we harness it for benefit - not harm.

This week, I’m sure many of you have seen media reports of the 83-year-old man with dementia who ended his life at Dignitas in Switzerland. According to the Daily Mirror, which broke the story, the man obtained a report from a psychiatrist stating he was mentally competent to make the decision.

While the circumstances are very sketchy, the General Medical Council has responded to requests for comment from the media by signposting its relevant guidance:

As always, it's important for psychiatrists to be aware of GMC good practice guidance.


Amid such challenging and diffcult issues, it was good to be able to attend a dinner at Apothecaries' Hall last night, during which the Galen Medal in Therapeutics and the William Farr Medal were presented. What a wonderful opportunity to mix with individuals from across the whole of medicine, and to learn of scientific advances in diverse fields of research and therapeutics, prevention and epidemic. And of course admire the Worshipful Society of Apothecaries in London's beautiful and ancient building.


I'm getting read for a number of meetings next week, on issues such as getting ready for seven-day consultant-led care, taking our College commissioning guidance work forward, strengthening academic psychiatry, improving health care for offenders, and playing our part in supporting our colleagues working in A&E. It will be another busy week.




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28/05/2013 12:03:45

Contrasting worlds

Monday, 28 May 2013

Putting mental health into public health

I'm slowing getting back into my routine after attending the American Psychiatric Association conference in San Francisco.

There has been considerable coverage about payday loans in the media recemtly, including reports that loans are being given to people who lack the mental capacity to enter into a contract, as well as potentially the ability to have any chance of repaying the debt. The College has been concerned about this issue for some time. Dr Julie Chalmers, our Lead for Mental Health Law, and Chris Fitch, our Research Fellow, have already worked with the Office of Fair Trading to publish ground-breaking regulation for the creditor sector on the issue of loans, with this regulation carrying stringent penalties for consumer-credit licence holders who do not abide. In addition, work to support agencies ranging from Citizens Advice's campaign on payday lenders, through to the British Banker's Association programme on vulnerable customers has also taken place. 

The College's programme of work on debt, financial difficulty and mental health has also continued to intervene into the relationship between personal debt and mental health by providing direct mental health/mental capacity training and practice audits to banks, debt collection agencies, and bailiff companies, and this has been delivered to over 1500 frontline staff in around 25 different creditor organisations. At a time of recession, this work has a heightened importance given the financial difficulty that so many people currently find themselves in, and I look forward to sharing further developments as these arise.

If you combine the impact of financial stress, shops selling cheap booze, and the growing problem of obesity, it's clear that the challenge to public health and public mental health remains great. For those of you who want to be kept updated on public health issues, I recommend you look at the webpage of Duncan Selbie, Chief Executive of Public Health England, where he posts his weekly messages.

I'm delighted that Professor Kam Bhui is continuing to push the public mental health message for the College. I very much hope that those of you attending the International Congress in Edinburgh will come to the session I'm chairing on Thursday, called 'Putting Mental Health into Public Health'.  But I am left reflecting that if government really want us to be healthy, wealthy and wise, then they should start taking their own medicine and tackle the toxicity currently on our high streets. 

How the Light Gets In

Meanwhile, at the weekend, I entered the very beautiful but ever so slightly surreal world of the Hay-on-Wye philosophy and music festival How The Light Gets In. I was delighted by the good debate, music, food and company,  and enjoyed listening to the Mind, Madness and Power session - a lively discussion on psychiatry between our very own Professor Sir Simon Wessely, sociologist Steve Fuller and clinical psychologist Richard Bentall.

I was also very honoured to be on the panel for two sessions. One a discussion about memory and forgetting, alongside the fantastic brains of biographer Hermione Lee and neurobiologist Steven Rose. The other was provocatively titled Are Doctors Bad For Us?, and I survived a lively debate with CEO of patients' organisation National Voices Jeremy Taylor, and Professor of Psychiatry and Pharmageddon author David Healy. It made me realise how much further on we are in mental health when it comes to shared decision making and working in partnership with users and carers - but also that there is always so much more to be done. As is so often the case with debates like these, the real gems of sense and wisdom came from the audience.

On Sunday evening, my journey back home on the train took me cross-country, passing through the most beautiful scenery, and it was very interesting to observe the set of changing demographics between Hereford and Manchester. I spent Bank Holiday Monday engaging in some high-level learning about Marvel comics from an excellent teacher - my grandson.


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23/05/2013 16:31:08

Back in the UK

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.


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20/05/2013 10:05:39

Greetings from San Francisco

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!  

Bill Clinton - keynote speaker at APA 2013

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. 


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15/05/2013 12:47:38

The big mental health debate

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.




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13/05/2013 13:29:54

Carers, Northern Ireland & DSM

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."




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08/05/2013 15:11:09

Queen's Speech & celebrations

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 10th anniversary of setting up the Northern Ireland Division, and I very much look forward to joining the celebrations.



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25/04/2013 11:52:52

A week spent mostly at the Academy of Royal Medical Colleges

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.

18/04/2013 13:37:10

Has Spring Sprung?

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.

11/04/2013 11:27:23

New charity will pour millions of pounds into mental health research

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 21st 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.

08/04/2013 10:35:30

Parity, changes and conference

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 21st 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.


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26/03/2013 06:51:30

Achieving parity report

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.


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22/03/2013 16:35:36

The curious House of Chatham

For much of this week I’ve been living in the curious House of Chatham – so I can’t tell you anything about some of the meetings I’ve attended. However, it’s worth keeping an eye out next week for lots of happenings in Parliament before the recess...  


In England, we’re all revving up for 1 April when the new NHS structures come into force. We’re publishing our report on achieving parity between mental and physical health next week – so keep your eyes peeled for that.  


This week I attended an a farewell event for Professor Sir Michael Rawlins, who is leaving his post as Chair of NICE. It made me realise just how far medicine has travelled in the last 10 years, when it comes to guidance and clinical practice.


On Thursday, I met with the Confederation of British Industry’s health policy lead, George McFarlane. As a lobbying organisation they represent around 24000 businesses. It was a positive meeting with some shared interests on health and business initiatives.


We plan to map out these principles in order to link key drivers such as sustainability of integrated health provisions, the work place health agenda and the engagement of jurisdictions.

In order to launch a key initiative for working age adults, we're holding an event in London on mental health and employment in late June 2013. At this stage, we're looking at mental health in the work place in its broadest sense. Key stakeholders linked to the relevant issues from inside and outside the College will be invited to attend, and discuss ideas to help further the initiative.


This work is in development but watch this space for further news.




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20/03/2013 13:54:36

The Budget and Commons People

Wednesday, 20 March 2013

Yesterday, I went to the House of Commons for the launch of a fascinating new book called Commons People, subtitled ‘MPs are human too’. Authored by Tony Russell, the book looks at the day-to-day lives of our MPs, examining what motivates them, who inspires them, what they do to relax, what keeps them awake at night, and their hopes and aspirations for the future. Among the MPs featured in the book are shadow health secretary Andy Burnham and former health secretary Stephen Dorrell.

Proceeds from sale of the book are being donated to Reflections Art in Health, a very worthwhile charity charity dedicated to showcasing the creative talents of people with health – and specifically mental health – problems.


And all eyes were on the Commons again today, as we watched George Osborne deliver the Budget. We were wondering if there would be an announcement on minimum pricing for alcohol. But, following Osborne’s statement, is seems as if we will have to wait for the results of the Home Office consultation to be published.


The Chancellor did announce that April's 3p rise in beer duty will be scrapped. Instead, beer duty will be cut by 1p. Interestingly, the duty escalator will remain for wine, spirits and cider.

And he did say that the government is “looking at plans to stop big discounts of cheap alcohol at retailers” – from which we must take some encouragement.


Most government departments will see their budgets cut by 1% in each of the next two years. However, I was reasonably pleased to see that the NHS – along with schools – will be protected.


And on an additional point, I see the Chancellor has announced that further awards from the LIBOR banking fines have gone to good military causes – including money for Combat Stress and funds for Christmas boxes for troops on operations both this year and next. As ever, do let me know your views.


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14/03/2013 13:46:50

All about alcohol

Thursday, 14 March 2013


Yesterday, the media was full of speculation that plans for a minimum unit alcohol price may be dropped. This is extremely concerning because as we believe, as do many others, that of all the potential price control mechanisms, minimum pricing is the best way of reducing the harm from alcohol to drinkers, their families and the rest of the population.


The government’s Alcohol Strategy was published a year ago this month and in the foreword Prime Minister David Cameron makes this pledge: "We are going to introduce a new minimum unit price. For the first time it will be illegal for shops to sell alcohol for less than this set price per unit."


I wrote a letter to The Times that was published today. It said:


The Royal College of Psychiatrists is extremely concerned by reports that plans for minimum pricing of alcohol may be dropped.

The UK has seen a dramatic increase in alcohol consumption and alcohol-related harm over the past 30 years. Much attention is given to the effects of excessive drinking on the body. But we must not forget about the emotional, mental and physical harm it can cause to individuals, children and families. Alcohol dependence affects our moods, judgement and behaviour, and contributes to violence, including domestic abuse, self-harm and suicide. Alcohol therefore also affects the health and wellbeing of people’s partners, children, other relatives, colleagues and the wider community.

We believe minimum pricing is the best way of tackling our nation’s unhealthy relationship with alcohol. This is about more than the price of a single drink – it is about the cost to people’s lives.


It is clear that the debate around the possible dropping of alcohol minimum pricing shows no sign of quieting down, following David Cameron’s remarks during Prime Minister's Questions yesterday and today’s statement in the Commons on the same issue.


Today, Lib Dem Crime Prevention Minister Jeremy Browne  (rather than Home Secretary Teresa May) stood up in the House to tell MPs that the results of the consultation on the Government’s alcohol strategy (that we as College responded too) would be published in due course and did not give much else away.


David Cameron said much the same yesterday when he outlined that he wanted to stop cheap alcohol being sold in supermarkets but did not commit to a minimum unit price. I await the response to the consultation with interest and will continue to pursue the issue.


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06/03/2013 09:56:30

Another eventful week affecting genuine change

Wednesday, 6 March 2013

As regular readers of my blog will know, I had an excellent meeting with Professor Richard Frank at the college on Monday. Yesterday morning, I was delighted to hear him talk again about early intevention work in the US - this time at a round table event organised by the Centre for Mental Health, of which I'm a Trustee.

After this I, as Vice-Chair of the Academy of Medical Royal Colleges, went with the Academy's Chief Executive to see Health Minister Earl Howe at the Department of Health. The meeting was arranged following correspondence around the Academy's concerns about the Section 75 regulations dealing with competition in the NHS.

Earl Howe sent us this letter and, as you have probably seen, following a statement yesterday in Parliament, the controversial regulations have been withdrawn and will now be redrafted. Hopefully the new version will answer and address the concerns of health professionals, patients and carers. The Academy has formally welcomed the withdrawal and I echo this sentiment. It is at times like this that I see how hard and well the Policy and Communications staff at the College work to get our messages out and influence real change.

There was a huge amount of public health news yesterday, badged around a report on UK health performance published in The Lancet. My frustration is that the absolute importance of good mental health and improved physical health of those with mental illness still isn't understood - or, if it is, seems sidelined. I wrote a letter to The Times in response, which unfortunately wasn’t published in the paper. However, I thought I would share it with you here:

Dear Sir

Yesterday’s report (‘Failings in NHS cost 30,000 lives every year’, 5 March) reveals worrying data on levels of premature mortality in the UK. The Royal College of Psychiatrists believes that any effort to reduce premature mortality must include a strong focus on increasing the life expectancy of those with mental health problems – which is on average 20 years less for men and 15 years less for women with severe mental illness.

Mental illness is associated with increased risk of physical illness. Depression almost doubles the risk of developing coronary heart disease, and is associated with a 50% increased mortality from cancer. Physical illness can also lead to mental illness, impeding recovery and increasing mortality rates.

Much of this is preventable. However, only a minority of people receive interventions for mental illness and even fewer receive interventions to prevent mental illness.

It is time to radically rethink health care, and pay proper attention to both the physical health of people with mental health problems and to the mental health of people with physical health problems. We ignore mental health at our peril.


After my busy Tuesday morning, I met with the Care Quality Commission and discussed how we can best work together in our respective roles. I will report on this in more detail again soon.


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04/03/2013 14:24:54

Concerns continue but like-minded thinking

Monday, 4 March 2013


Over the last week, I have continued to focus on concerns raised by members of our Eastern Division at the proposed changes to services in Norfolk and Suffolk. Feedback from our colleagues at the Royal College of Nursing is that their concerns closely mirror our own. I have raised the issue with Norman Lamb, both as a local MP and also the Minister responsible for mental health services, and am writing to the Trust’s Chair. Our Registrar has written to the Trust’s Medical Director. Our Dean will also be liaising with the General Medical Council to ensure that the quality of training is safeguarded in any proposed changes.


Many of you will have seen the article in The Observer on Sunday about the Academy of Medical Royal Colleges' concerns over Section 75 regulations. The Academy’s letter to Lord Howe was leaked to the paper. Although it is unfortunate that this timely and reasoned letter was leaked, I believe the coverage it received was positive in that it shows that the voice of the medical profession is being listened to by both the media and the public. It puts us where we should be – as leaders who advise on and raise concerns about circumstances in which we believe the quality of care and safety of patients are being put at risk. We now await the government’s response, and our College’s Communications & Policy Department will continue to monitor events closely. It is plain that the regulations do need a rewrite, and the Academy and ourselves will ensure we are well advised on what the regulations mean in day-to-day practice for the consistency and continuity of care for mental health service users and carers.


This morning, I had a positive meeting with Richard Frank, Professor of Health Economics in the Department of Health Care Policy at Harvard Medical School. From 2009 to 2011 Richard Frank served as the Deputy Assistant Secretary for Planning and Evaluation at the US Department of Health and Human Services directing the Office for Disability, Aging, and Long-Term Care Policy.  He also significantly contributed to American legislation giving parity of esteem to insurance coverage of mental illness.


Professor Frank met with me, and the College Policy and Communications team, to talk about the College's work on advancing parity of esteem. Despite the American and British healthcare systems being funded very differently we found much common ground to talk about, including the tricks that can be used to limit access to services (known in the States as 'non-quantitative treatment limits'), how to design intelligent payment systems which discourage both over- and undertreatment, being clear about what we expect from high quality services and the importance of practicing as doctor psychiatrists who don't leave their patients' basic physical health checks and care to someone else.  I went away feeling confident that the College's forthcoming report on achieving parity of esteem will strike the right note, and will stay in touch with Professor Frank to discuss potential future projects such as how to accurately measure and reduce preventable mortality in our patient group. Despite the differences in our respective health systems, we share common challenges and hopefully shared solutions.


Professor Frank will be giving a lecture at the Centre for Mental Health tomorrow night on many of these issues.




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01/03/2013 11:44:53

Welfare reform lecture

Friday, 1 March 2013

This is a slightly belated blog about an excellent lecture held at the College on Tuesday night - part of our prestigious evening lecture series.

Dr Jed Boardman delivered a heartfelt lecture to an enthusiastic audience, entitled ‘Social Security or Welfare? The case for Welfare Reform for People with Mental Health Problems’. ver recent years there has been a drive to reverse the increasing numbers of people receiving sickness benefits.  This has been promoted through a discourse that highlights the health benefits of work and the negative effects of remaining in the ‘benefits trap’.  This has implications for the lives of people with disabilities, including those with mental health problems or learning disabilities. 

Current reforms are controversial and are likely to be damaging to the lives of people with mental health problems, rather than providing them with security in times of vulnerability.  Jed reviewed the problems associated with marginalisation and inequality that are faced by people with mental health problems and examined the implications of these for mental health professionals and for social reform.

If you would like a copy of Jed's excellent presentation, please email Thomas Kennedy, in our Communications Department.


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  • Also catch up on our 21 Prescot Street blog explaining how the relocation process of the College is progressing.