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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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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.

 

Sue

 

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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.

Sue
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.

Sue

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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 Care.data 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.

 

Sue

 

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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.

Sue

 

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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.

 

Sue

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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.

Sue

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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.

Sue

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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.

Sue

 
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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!

Sue
 
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