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

Past President Sue Bailey's Blog

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26/06/2014 08:57:06

My last blog as President

Thursday 26 June 2014

Across the world communities face austerity, organisational change and social upheaval. All the more reason for the family of psychiatry to hold in mind why we are privileged to work in this complex and fascinating field of medicine that uniquely bridges the gap between social science, mental health and neuroscience. Our speciality is a unique blend of science and humanity. Every day we work closely with individual’s families and communities providing leadership in mental health at every point of the 'web and weave' of a patient's pathway of care.

 

Building on the work of my predecessors who introduced and promoted  No Health without Mental health and No Public Health without Mental Health I have been fortunate enough  to be able to seize the opportunity to lobby  for Parity of Esteem between mental and physical health. (Parity report).

 

The challenge remains to deliver parity in practice and parity of outcomes. Progress is being made to close  the belief gap that mental health really matters. The building blocks are in place to close the mortality, treatment and funding gaps, to mitigate against and reduce the negative impact of stigma and discrimination, but this progress will rapidly be reversed unless policy makers and those who hold the purse strings turn "fine" words into resources. Resources that would enable us to strengthen mental health service delivery at the interfaces of primary care, acute emergency care and across into secondary care for the benefit of the whole of medicine (Bridging the gap report).

 

Doctors come into medicine to make people’s lives better. Underpinning all we do is the art of communication, listening to patient’s stories in order to deliver patient centred care. Failure to do so risks dire consequences as highlighted in the Francis Report when the voices of patients and carers went unheard. Practitioner voices have also gone unheard. Hence the College focus on a comprehensive response to the Francis report (Francis report response), for which we need the ongoing active involvement of all psychiatrists whatever stage in their career and whatever their role in service delivery.

In difficult times psychiatry has to stand as one, to support all parts of society, across the lifespan, across the spectrum of health. Whether health promotion, prevention, acute care, supporting recovery and building psychosocial resilience in those with and at risk of developing mental illness.

 

Our voice needs to be better heard and acted upon. Within the family of medicine we have always been at the vanguard of how to deliver care in the community, we understand shared clinical decision making and we have a good evidence base. We are adept at taking advantage of new technology, be it social media or telehealth. To deliver, however, we need a rebalancing of resources no matter how limited the total health care pot of any country. Without this we are heading to, and in some places we are in, crisis.

 

You have to be the brightest and the best to do psychiatry. We should be proud of this, spread the word amongst aspiring and current medical students. Who better to do this than our own trainees.

 

The role of President has been a unique experience, one where everyone Council, Honorary Officers, Members, fellow mental health professionals, users, carers, and above all the staff, who give life to the work of the College, have been unbelievably supportive.

This has left me with enough energy reserves and learning to move on to new interconnected roles.

 

As Chair of the Children and Young People’s Mental Health Coalition I will continue to lobby for the voice of young people with mental health problems (CYPMHC).

A lifelong pursuit, (which arose from the experience of being raised in a milltown in an era of social decline), has been how to reduce inequalities across society. As Chair of the Academy of Royal Medical Colleges Inequalities Forum I hope to support the Academy in how we can contribute to reducing health inequalities.

 

Where I will definitely need all your continuing support is in my new role as Senior Clinical Lead at HEE (HEE) to support Mental Health Delivery, Workforce, Education and Training. So how can we help all health professionals become more psychologically minded? How as psychiatrists can we improve the physical health care of our patients? How in the future can the psychiatric workforce attain and retain the skills and knowledge we need to deliver best care? By psychiatrists leading and supporting teams.

 

The serendipity of life has taken me on interesting pathways. I have learnt that life is predictably unpredictable, to adapt to new situations and know how, when, where, and which battles to fight.

 

Looking at the world today as the lens of the media daily penetrates our living rooms with the reality of poverty, rising mental health problems, social upheaval, natural and man made disasters, I can't help but reflect that Mental Health has a part to play in sustainability in particular disease prevention and patient empowerment and self care.

 

The pursuit of sustainability over the pursuit of GDP might leave us all in a better place. Policy makers may even want to consider that "Nations that invest in women's employment, health (including mental health) and education are just more likely to have better outcomes. Their children will be healthier and better educated" (Hillary Clinton)

 

Gradually the Cartesian view of the separate components of body and mind is being replaced with that of the ‘whole person’ whose mental health and physical health are co-dependent. Are the College leadership and our members ready to, prepared to be bold and brave enough to move the ‘whole person’ discussion from rhetoric to reality?

 

As I know you will, please continue to give the wonderful support you have shown to me in the role of President to Simon as he takes on this role.

 

That's all folks!


Sue

 

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25/06/2014 15:33:44

RCPsych International Congress

Wednesday 25 June 2014


How brilliant that nearly a quarter of attendees at this year's congress are from overseas.  Psychiatrists attending from 66 countries.

It was great to see so many at the international reception on Monday night. And good to see the new building being used for this and especially the EFPT meeting.

Mental health is having a voice in the news this week, following an interview I gave with Michael Buchanan from the BBC. The headline 'Mental Health Services a Car Crash' seems to have struck a chord.

Money has been confirmed for the College working with all stakeholders to Run a Children's Commission. Peter Hindley is taking this forward and am very grateful that John Black, a past president of the Royal College of Surgeons, in his role as a Trustee of the Dinwoodie Trust,  has given his support.  It's an opportunity for a child trainee to carry out research on values-based CAMHS.  This is a real example of how the rest of medicine is starting to understand our "value" and "worth". John was a supportive colleague when as president of this college I joined the Academy of Medical Royal Colleges.

I had a good meeting yesterday with cross jurisdiction civil servant leads for mental health and our shortly to be vice presidents in Northern Ireland, Wales and Scotland.   Diverse systems but same core challenges and hopefully opportunities.

It was an exciting honour to open this year's  congress, and really exciting to launch the joint project with the Royal College of General Practitioners together with their chair, Dr Maureen Baker CBE.

I was pleased to see the launch by the Secretary of State for Health of Sign up to Safety - a campaign to strengthen patient safety in the NHS. The campaign has set out a 3-year shared objective to save 6,000 lives and halve avoidable harm as part of a journey towards ensuring patients get harm free care every time, everywhere.

The Secretary of State has an absolute determination to tackle safety and quality for which he is to be rightly applauded. Part of the solution is to develop a psychologically minded workforce and also let us reduce the estimated 100,000 unavoidable deaths per year. Reducing them by improving the physical health of our patients.

In mental health and learning disability are we clear enough about our understanding of what constitutes an incident? A key issue is variability - and the key question is are there different levels of safety across different services, or are there nuances in how different providers and individuals set thresholds - especially with "less serious" incidents? How can the College help?

As I clear my desk, Simon is hitting the ground running. Today I start my transition into new roles whilst continuing clinical and research work back at base. I am very grateful to both my Trust and University for allowing me to take on the role of president, and especially to my clinical colleagues for making this possible.

Tomorrow I will sign off with my last blog.  So for those who have, thanks for reading my blogs.

 

Sue

 

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20/06/2014 16:29:35

Welcome guidance to help teachers identify young people with underlying mental health problems

Friday 20 June 2014

Good to see the new guidance published by the government to help teachers better identify underlying mental health problems in young people.

Mental health and behaviour in schools – departmental advice for school staff  could mean fewer pupils will wrongly be labelled ‘trouble-makers’.

Education Minister Elizabeth Truss says the guidance will help ensure pupils with unmet mental health needs will get the help they need at an earlier stage.  We know that from a 2012 Centre for Mental Health report around 15% of pupils aged 5 to 16 have mental health problems that put them at increased risk of developing more serious issues in the future.

This guidance, which has been created by the Department for Education in consultation with head teachers, mental health professors and the Department of Health, has been designed to help teachers to feel confident about finding help for at-risk pupils.

The guidance suggests schools could use pupil questionnaires, teacher training toolkits and mental health factsheets to help identify potential issues. This could be a way of ensuring that problems are tackled before they become more serious, as well as helping schools know when to refer pupils to mental health professionals, such as CAMHS.

I was also pleased to see that the guidance includes measures to help schools provide a stable environment for pupils, such as clear bullying and behaviour policies, working with parents and carers as well as pupils, and discussing mental health issues as part of the wider curriculum.

This approach is a welcome recognition of the importance of early intervention, and will hopefully help young people with mental health problems to get the support they need.

Sue

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19/06/2014 11:51:18

Valuable research well worth a read

 

19 June 2014

 

A study led by Professor Louis Appleby, from the University of Manchester, is well worth reading.

Patients with mental illness are two and a half times more likely to be victims of homicide than people in the general population, according to the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCI).

 

In this study, published in The Lancet Psychiatry journal, NCI looked at data on the victims and perpetrators of all homicides in England and Wales between January, 2003 and December, 2005.

 

The researchers found that during the 3-year study period, 1496 people were victims of homicide, and 6% (90) of them had been under the care of mental health services in the year before their death. A third (29) of these patient victims were killed by other patients with mental illness.

 

In 23 homicides in which the victim was a mental health patient killed by another mental health patient, the victim and the perpetrator were known to each other either as partners (9, 35%), family members (4, 15%), or acquaintances (10, 38%). In 21 of these 23 cases, both the victims and perpetrators were undergoing treatment at the same National Health Service Trust.

 

Alcohol and drug misuse (victims 66%, perpetrators 93%) and a history of violence (victims 24%, perpetrators 24%) were common among both patient victims and perpetrators. The study also found that in the three years to 2005, 213 mental health patients were convicted of homicide - accounting for 12% of all homicide convictions.

 

Homicides committed by patients with mental illness receive much media attention. Patients’ risk of being victims of homicide and their relationship to the perpetrators has been rarely examined. So Professor Appleby’s work offers a valuable insight and the opportunity to have a greater understanding of risk factors for patients.

 

Also this week, Sarah Wollaston MP has just week been elected as Chair of the House of Commons Health Select Committee. Sarah is a former GP and is very much an advocate for mental health, previously speaking out in Parliament of her own personal experience of post-natal depression, and we wish her well in her new role.

 

Sue

 

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17/06/2014 17:24:32

The dead end of public policy obsession

Wednesday 18 June 2014

The non-appearance of legislation in the recent Queen's speech on the regulation of health and social care professionals did not prevent a Westminster Forum event going ahead on the UK-wide Bill proposed by the Law Commission.

Speakers, including the Rt Hon Stephen Dorrell MP, Nicholas Paines QC, and Niall Dickson (Chief Executive and Registrar of the GMC) spoke on the role of a Regulator as an effective voice for professionalism, defined as taking ownership of safety and quality, through the "compact" between the Professional, the Regulator and the Public. They emphasised the personal and collective responsibility of professionals for understanding the depth of this obligation, described in this meeting as the pursuit of "divine discomfort" - the need always to reflect on your practice and the practice of those around you.

However, instead of this we have the "dead end" of public policy obsession with changing bureaucracy as a substitute for individual responsibility. 

Users' and carers' organisations stressed that a single emphasis on professional or group responsibility can help avoid the cracks that patients can fall down when whole systems are able to avoid collective responsibilities. There was consensus that, over time, if systems are strong enough they will identify problems earlier, making educational remediation possible.

In the meantime, we are left with a system whose origins date back to 1858, where the Fitness to Practice process still has to follow a complaint, without which proceedings cannot be initiated, and the GMC has not yet been able to tell the profession how many doctors have taken their own lives whilst going through the Fitness to Practice proceedings.

Also today sees the election in Parliament of a new Chair of the Health Select Committee, as Stephen Dorrell stands down from the role.  In his role he has taken a deep interest in mental health, especially that of children.

Last Friday and Saturday saw our first two new members’ receptions being held in our own College. It felt right, was a great occasion, and I hope new members and their families had an enjoyable time - one that befits the hard work and great achievement of each of those who came from across the UK and Ireland and as far away as Singapore.   They had a wide range of interests, and intentions to specialise across all diverse and exciting fields of psychiatry. 

And now the College is full of activity, packing of crates ready for the International Congress in London next week. As ever, it promises to be a fantastic event, and I’m looking forward to meeting with fellow psychiatrists there.

Sue

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13/06/2014 11:27:57

Taking responsibility for all patients' care

 

Friday 13 June 2014

The Academy of Medical Royal Colleges has today highlighted the absolute importance of patients and families knowing in all times the name of their senior responsible doctor and what they should expect from this doctor in its report Guidance for Taking Responsibility: Accountable Clinicians and Informed Patients.

This is an important issue on which all college presidents are in agreement.  We know this goes beyond the "name over the bed" and must run through wherever a patients care sits at any one point in time - especially where, as in real life, a patient has a complex range of diseases being dealt with by a myriad range of services and health care professionals.

In tackling 24/7 care in psychiatry I know the specialities are looking at what this means in reality in the now complex, ever changing services configurations (usually driven by the "need" to cut costs) that exist for those adults who risk falling between various "intensive" community service provision.

For us, this is about not only the right for a patient to know who their second care doctor is, but that they should expect to have continuity in their care. We all know this is what patients want and what their "family" primary care doctor wants for them.

This Academy work stream is but one example of work I have been privileged to be involved in as Academy Vice Chair.

As I step down from the role of President of our college I take up the role of Chair of the Inequalities Forum at the Academy. I would welcome your thoughts and practical examples of projects you are involved in that reduce inequalities wherever they arise across the family of medicine.

I would also welcome your ideas on how together we can best help reduce the inequalities gap.  We know it’s large in mental health, but this happens across the rest of medicine as well. So your thoughts would be welcomed as I start work on this new task.

I also need your help in one of my other new roles as Senior Clinical lead at HEE for delivery of mental health workforce education and training.

Following an initial meeting with HEE we have a real opportunity to help make all doctors and health professionals more psychologically minded from their first day at medical school to their last day in clinical practice.

Whilst we are all in our own area of clinical practice, it is also important to look at how we enable all the work force to receive fit for purpose education to carry out their roles in clinical teams up and down the country.

Please share your thoughts with me now, and once I start my new role in July via the HEE.  

Sue

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04/06/2014 16:02:25

One more worrying piece in the jigsaw

Wednesday 4 June 2014

By now you will have heard of the sombre findings from the trainees ‘on call’ survey. I want to thank all of them for their valuable input. The findings add up to one more worrying piece in the jigsaw, where the overall picture is of a mental health service in crisis.

We warned those that hold the purse strings and the power to make decisions about these services that we were heading to a tipping point.  Now I fear this point has been reached. All of us, whatever our role, need to speak out.

The Mental Health Collaborative, psychologists, nurses, occupational therapists, social workers and ourselves are as one on this. Our patients deserve better and we need to speak out now before the ‘system’ drives mental health services into a car crash.

Some positive news has come out of the Health Education England Mandate for 2014-15. Section 4 of the Mandate, which focuses on mental health features some welcome strategic objectives of the Government in the areas of workforce planning, health education, training and development.

I was pleased to see that the mandate recognises all health professionals need to have an understanding of mental health conditions, and that HEE should develop training programmes that will enable health and care employers to ensure that all staff have an awareness of mental health problems and how they may affect their patients by January 2015.

 

It was good to see that the Mandate states HEE will work with the College to develop bespoke training courses to allow GPs to develop a specialist interest in the care of patients with mental health conditions. And also that by next January HEE will be working with us to develop an e-learning package to support continuing professional development for GPs.

The section outlines objectives on dementia, including stressing the need for all NHS staff that look after people with the condition to go through a dementia awareness programme. This would enable staff to spot the early symptoms, know how to interact with people with dementia and signpost staff to the most appropriate care.

This is all good news - but we must make sure it happens, and we need to hold HEE to account to ensure that the Mandate becomes a reality.   

Meanwhile the Academy of Medical Royal Colleges has a new member - The Faculty of Intensive Care Medicine. Established in 2011, the faculty is responsible for the training, assessment, practice and continuing professional development of Intensive Care Medicine consultants in the UK and has over 1,900 members. Welcome to the fold.

Finally, this Tuesday I attended an interesting meeting with colleagues from the Picker Institute Europe. The institute’s annual report Moving Beyond Measurement highlights its continued success in promoting patient-centred care, and its drive to realise the aims of founder Harvey Picker – that ‘good patient experience is everyone’s experience’.

Sue

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03/06/2014 11:30:27

UEMS meeting in Berlin

Tuesday 3 June 2014

 

I’ve just returned from Berlin and a UEMS event hosted by child psychiatry colleagues from Germany.  The event was held to mark the twentieth anniversary of the establishment of Child and Adolescent Psychiatry as a section of UEMS. It was a celebration, combined with hard work.

We are in the unusual position of having two people from England holding key roles on the UEMS board. RCPsych Fellow Dr Brian Jacobs is chair of the section and deals with all matters educational, while I lead on policy service development.

We were able to report back to the founding mothers and fathers of UEMS who attended the meeting about how we are endeavouring to build on all their work, for example Brian, along with the education and training group, has developed a new "Chapter Six" for training of child and adolescent psychiatry.

We saw presentations from our German and Austrian colleagues on how UEMS was set up despite opposition, and how today's child psychiatry is organised and delivered in Germany with MDT teams - many of whom are working in independent practice within an insurance scheme where they seem to be able to offer a service for all with real choice. Across medicine there are more doctors per head of population in Germany than in the UK. We learnt of work on strengthening academic child psychiatry and work on quality assurance quality improvement and the utility of having and using robust outcome measures. We will publish this information in a forthcoming UEMS Newsletter and report back to our Child and Adolescent Faculty.

What was a deeply moving and disturbing experience was a visit to the Topographie of Terror. exhibition. This new exhibition is part of a permanent exhibition, situated next to the remains of the Berlin wall, built on the site of the main Nazi headquarters where people were arrested, interrogated, tortured, executed and/or despatched to death camps. The new exhibition, supported by the National German Psychiatric Association, described the pathway to the annihilation of those with mental illness and learning disability proceeded by the practice of sterilisation. The latter was not just a German phenomenon at the time.

We were privileged to have a guide who had been born in East Germany and was a philosophy and mathematics graduate who went on to read history. He acted as a true scientific historian and gave a balanced, hugely insightful account of how doctors who had trained to heal learnt to murder on a mass scale.  There are too many anecdotes and factual archives and histories to put in a blog, but in the midst of all the horror stories he told of how a visitor to a prior exhibition on how doctors killed physically and mentally handicapped children. Now in older age the visitor recalled how when on holiday in Italy in the 1960s she had been totally taken aback by a group of people on the beach because they looked so different.  As a child and young woman growing up after the war she never saw anyone in Germany with a mental and/or physical handicap. Those individuals had all been ‘removed’ as part of the 'final solution’.

So does this link back to our world of day-to-day practice? No-one can fully absorb the impact of man’s inhumanity to man, woman, and child at such a gross level, and with such a distorted sense of justification that would result in wiping out whole sections of a nation. But as doctors we can think each day about why we became doctors, the ethical code through which we underpin our practice, and how we can never allow drift in this code or practice to happen.

Sue

 

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27/05/2014 14:21:18

Focus on the future of training

Last Tuesday I hosted the Honorary Fellows dinner – an absolute privilege as ever. Many of the guests were seeing the new College for the first time and were impressed with the building. The evening featured a film by the East London Trust film club, which included commentary from a forensic psychotherapist – a good example of how psychiatry is, after all, at its heart the art of science.

On Thursday the College hosted the first implementation meeting of the Crisis Concordat.  It was good to be there round the table with a partnership of professionals, organisations and user carer groups. There is so much to be done in improving crisis care for our patients. But to me the real answer lies in better resourcing for earlier intervention and more wraparound care for our patients 365 days a year.

Then on Friday I was fortunate to be part of the child and adolescent higher trainees event in Cardiff.  We need to listen and act on what they want from their training. To equip them to be consultants in a multi-agency disciplinary world they are asking for more opportunities to spend time with social services and in primary care so they can understand how these services work and how in turn CAMHS can best work with them. They also want more training in paediatrics.

Their training requirements should hopefully fit well with the Shape of Training and is something I will be looking at in my new role at Health Education England. I know the Dean and her team are already on the case.

As a bonus Cardiff Bay has a really impressive seascape - especially in the wind and rain. And of course it’s the home of Dr Who. So I had two happy grandsons when I got back to Manchester and presented them with Daleks and Tardis’s!

Sue

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22/05/2014 13:45:27

Promoting mental health in children and young people from BME communities

Wednesday 22 May 2014

 

A welcome briefing paper by Paula Lavis, Coalition Co-ordinator Policy and Campaigns, has just been released by the Children and Young People’s Mental Health Coalition.

 

The importance of promoting mental health in children and young people from black and minority ethnic communities looks at the policy framework for mental health service provision and provides examples of existing practice which promote mental health for black and minority ethnic children and young people.

 

The author highlights the impact of poor or incomplete data on commissioning and provision of mental health services for BME children and young people. And it also looks at specific factors that put children and young people from BME at risk of developing mental health problems, and protective factors that can help build resilience.

 

Key messages that came out of the paper which strike a chord include the need for more research into the nature and prevalence of the mental health problems of young people from BME communities, and the need for wellbeing boards and commissioners to develop cultural sensitive services. And, a crucial message, is that it is important to recognise the specific needs of different BME groups and individuals, including those of mixed heritage backgrounds, rather than viewing them as a homogeneous group. This would help identify what services or interventions will best provide support, the author suggests.

 

By raising awareness of these issues, hopefully more will be done to encourage BME children and young people and their families to engage with services that could intervene early – and could prevent mental health problems escalating.

 

Sue

 

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