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

Chair's Update

February 2017

With the 2 March 2017 Assembly Election just out of the way, let us hope that the emerging Spring in the grounds of Stormont is reflected inside the building as well… and soon. There are many Mental Health issues to progress, solutions are available too and we highlighted five of these in the excellent media coverage we achieved during the week of the Election, within 48 hours of the poll.

Further details can be found in our Press Releases section.

I hope we can build on this public prominence to push ahead with our agenda points with the incoming Minister for Health, Chair of the Health Committee, etc. My gratitude to our local College staff team for their very productive media output.

In other Election work, Dr Michael Doherty and Thomas McKeever represented us all at the important Hustings event on 13 February hosted by NICVA (NI Council for Voluntary Action), of which we are a member by virtue of our charitable status. Mental Health was well featured in the discussion with the 5 main party representatives (Stuart Dickson Alliance, Carál Ni Chuilin SF, Claire Hanna SDLP, Christopher Stalford DUP and Andy Allen UUP – all pictured below with NICVA host).

Consultation work has continued this month regardless of the Election and you will now additionally find the following in our Policy section:

Consultation Title Dept/Organisation Documents Deadline
Public Health Agency Corporate Plan 2017–2021 - Public Consultation Questionnaire Public Health Agency Response 17 February
Regulations restricting smoking in private vehicles when children are present Department of Health Response 3 March

I have recorded my gratitude last month in relation to the PHA Consultation above – and also in relation to the Department of Education Consultation on the new Children and Young Person’s Strategy (which is still being finalised at time of writing). I wish to record my thanks here to Dr Lisheen Cassidy for all the work she did in relation to the DoH smoking in vehicles carrying children Consultation. As the Consultation work rolled on pre-Election, it has sometimes felt as though we are living in a parallel universe or form of virtual reality!

My thanks also to Dr Michelle Francis Naylor who sent comments to Central College on behalf of our Rehabilitation and Social Faculty in relation to Guidelines for a draft multi-morbidity standard.

Now back to where I ended last month:

...Belfast Castle on 9 February was the location for our Strategy Day and later Executive Meeting. We were pleased to welcome to Belfast the evening before Peter Markham, Head of Digital, who kindly came over in advance to meet with our local College staff team to go through with them in the office the coming changes to the College websites and to seek dialogue and suggestions. We were pleased also on the morning to welcome the new Chief Executive Paul Rees to Clifton House for a quick tour before we headed up the road to the Castle. Paul (pictured above left with myself and Interim Manager Barry Flynn above right) was accompanied by Vivine Muckian Head of Divisions, who after one year in post is familiar with Clifton House, but this was Paul’s first visit and he was keen to get a sense of where we are based. Between both buildings, he was suitably impressed!

Other London based colleagues, apart from Paul and Peter, who assisted us throughout the day at Belfast Castle were Lucy Thorpe Head of Policy, Kim Catcheside Director of Strategic Communications and Zoe Mulliez, Policy Analyst. Significantly, Paul said that “going forward, we will need to make sure that the College provides the right level of support and recognition to our members - and employees - in all three devolved nations, to ensure an excellent membership and employee experience for all.” We look forward to developments in this direction. I hear from our staff that true to his word, Paul held a first ever all staff briefing (via Skype for Belfast staff) the following day in London.

The Strategy Day was a very important one, as it was a chance for us to learn from London and London to learn from us. This mutual exchange was very helpful for me as Chair and we passed on our message of autonomy with cooperation going forward. I would like to thank all the members who attended in such good numbers. Feedback afterwards included: "Congratulations on hosting such an excellent meeting", "Fabulous enthusiasm", "Feels really secure to have an almost fully thrashed out strategy now", "So pleased to be part of such a vibrant, professional meeting". My thanks to all.

Another significant event this month was the well attended Joint Meeting of the NI British Geriatrics Society and ourselves, organised under the auspices of our Faculty of Psychiatry of Old Age on 17 February at Riddel Hall, Stranmillis, Belfast. The event gave me a welcome opportunity to focus attention on the impact which the Mental Capacity Act (NI) 2016 is going to have on the care of older persons, once implemented – and I addressed the meeting on this basis.

Joint Meeting of the NI British Geriatrics Society and RCPsych

On this point, I would like to pay tribute to the Chair and Vice Chair of our Faculty of Psychiatry of Old Age, Drs Deirdre Shields and Conor Barton, who have both been faithful attendees at our Mental Capacity Act (NI) 2016 Working Group meetings in relation to the Code of Practice for this legislation.

The meeting continued with the highlighting of another major issue for older people – that of scams and rogue traders – and we heard a very illuminating and sobering presentation on this topic by Trading Standards Officer Beverley Burns. Dr Dearbhail Lewis gave a very interesting Case Study talk on the management of an older person with physical and mental health needs, illustrating the sometimes complex interaction between health and social care. We finally heard from Dr Anthony Lewis, Consultant in Diabetes and Endocrinology in Belfast Trust whose presentation entitled “Over Under Shorter Longer” alerted us to the prevalence and importance of thyroid issues in older people. All in all, it was a really worthwhile meeting and my thanks to all involved in its organisation.

We were pleased to welcome Professor Tim Thornton (pictured below left, right) to Clifton House on 22 February to deliver our first Masterclass of 2017 on the intriguing topic of “Why Psychiatry needs Philosophy (and vice versa)”. Tim is Professor of Philosophy and Mental Health from the University of Central Lancashire. The event lived up to its title and was a great start to the new programme. A lively discussion ensued from the floor, so much so that Tim has been in contact since with the office to explore the possibility of returning next year to deliver a further talk as part of our 2018 programme! My thanks and congratulations to Dr Tony O’Neill (pictured below left, centre) for securing Tim as a speaker.

Dr Gerry Lynch, Dr Tony O'Neill, Professor Tim Thornton

In the meantime we have ongoing significant collaborative work in progress with the Voluntary Sector, including in particular the new 2017 programme of “Let’s talk about it” talks on Depression which Aware are hosting at various venues around Northern Ireland. Aware leaflet on depressionThis is such a worthwhile initiative and opportunity for us as Clinicians to really make an impact in the community. So far, Dr Colin Gorman has represented the College at Ulster University Jordanstown to speak on Student Mental Health and Wellbeing and his contribution was described afterwards as “excellent”. Similar reports have come in regarding Dr Heather Mills (pictured below) who presented on Eating Disorders and Depression at the Europa Hotel on 2 March. There are three further such talks lined up for March and one for April... so more on that in future editions! Thanks to both Colin and Heather for their contributions to this important work and also to Tom McEneaney, Head of Business Development and Support Services in Aware for his foresight and collaboration.

Dr Heather Mills speaking on Eating Disorders and Depression

Another such initiative and invitation has come in from Anne Doherty, Deputy Chief Executive Officer in MindWise, who hope to host a NI-wide PD Conference, now provisionally scheduled for early 2018. For this the NI PD Network, MindWise and ourselves are proposed as being the principal partners and a small project team is being formed to work with Chambre Public Affairs to drive this forward. A College representative was being sought to join the project team and I am pleased to report that Dr Catherine McDonnell has agreed to represent us on this. My thanks to Catherine and I look forward to the work of the team bearing fruit next year for this important client group.

In this context, I was pleased to meet with both CEO Peter McBride and Director of Mental Health Services Billy Murphy on 7 February at Inspire Central Office, Lombard House, 10-20 Lombard Street, Belfast. Inspire Wellbeing is the new name for NIAMH (NI Association for Mental Health, previously of 80 University Street, Belfast). Our discussions included the Programme for Government and potential for joint working.

I met with Paula O’Kelly, Principal Consultant at HSC Leadership Centre on 21 February here in Clifton House to discuss what we might be able to work together on for new Consultants in their first five years. This goes back to the Startwell event which we held last October at Belfast Castle, when we were addressed by Dr Ellen Wilkinson, Associate Registrar. I said then that I hoped to build on this event by perhaps organising a follow up in 2017. So this is it! We are currently working on the basis that we will hold such an event here in Clifton House on 19 May…….so watch this space!

I also met with Drs Nail Quigley, Deirdre McGlennon, Jo Minay and Maggie Kelly here in Clifton House on 23 February to discuss in particular how we can improve liaison services across the Trusts. In this context, I commend to you the report by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) – Mental Health in General Hospitals: Treat as One (2017), which was published on the 26 January 2017. The report looked into the impact a patient’s mental health condition had on the care they received in hospital. A summary of the key findings and recommendations are set out below and they do bear repeating:

Key Findings and Recommendations

Among the key findings of the report are:

  • Inadequate mental health history was taken by non-mental health clinicians in 21.4% patients at initial assessment and 49.1% during consultant review
  • 46.3% (256) of patients in the study had a review by the liaison psychiatry team during their hospital stay
  • The first assessment by liaison psychiatry was delayed in a third of those seen according to the reviewers. This impacted the quality of care in 22 patients
  • Of those patients seen by the liaison psychiatry team, the reviewers judged that their input was adequate in 68.7% of cases
  • 185/231 hospitals had a liaison psychiatry team either available 24/7 in 51.1% hospitals and during extended hours in a further 16% of hospitals
  • 57.3% of hospitals had a policy/protocol specifying which patients should be referred to liaison psychiatry. The liaison psychiatry team was involved in writing/reviewing the mental health hospital policy in 143 hospitals
  • Only 21/190 (11%) hospitals shared complete access to mental health community records
  • 95/208 (45.7%) hospitals had mandatory training in the management of patients with mental health conditions. There were no hospitals that offered training covering all aspects of management of patients with mental health conditions
  • Healthcare professionals responding to a separate online survey stated that:
    • 11.4% (151/1323) had no training in basic mental health awareness
    • 38.9% (497/1276) had no training in management of self-harm
    • 21.2% (274/1295) had no training in assessing mental health capacity
    • 41.4% (523/1263) had no training on risk assessment
    • 58.9% (727/1234) had no training in psychotropic medications
    • 19.1% (248/1298) had no training in dealing with violence/aggression.

Key recommendations

In summary, the key recommendations from the report are:

  • In order to overcome the divide between mental and physical healthcare, liaison psychiatry services should be fully integrated into general hospitals. The structure and staffing of the liaison psychiatry service should be based on the clinical demand both within working hours and out-of-hours so that they can participate as part of the multidisciplinary team.
  • All hospital staff who have interaction with patients, including clinical, clerical and security staff, should receive training in mental health conditions in general hospitals. Training should be developed and offered across the entire career pathway from undergraduate to workplace based continued professional development.
  • Patients who present with known co-existing mental health conditions should have them documented and assessed along with any other clinical conditions that have brought them to hospital. And when seen by mental health services (liaison psychiatry) the review should provide clear and concise documented plans in the general hospital notes at the time of assessment.
  • National guidelines should be developed outlining the expectations of general hospital staff in the management of mental health conditions, such as the point at which a referral to liaison psychiatry should be made and what triggers the referral.
  • Record sharing (paper or electronic) between mental health hospitals and general hospitals needs to be improved. As minimum patients should not be transferred between the different hospitals without copies of all relevant notes being sent electronically or accompanying the patient.

I know that Dr Stephen Moore is looking into this latter point within the newly formed Informatics Group. I am looking at further ways in which we can push for increased Liaison services in the various Trusts.

Later on 23 February I attended a meeting with the newly appointed Chair of RCGP in NI, Dr Grainne Doran at their Ormeau Road premises to discuss the recommendations of the June 2016 Report by the Commission to Review the Provision of Acute Inpatient Psychiatric Care for Adults ("Building on Progress: Achieving parity for mental health in Northern Ireland”), the general lack of strategy in mental health currently and joint working between our respective Colleges. I wish Grainne every success in her new role with RCGP and thank outgoing Chair Dr John O’Kelly for his cooperation over the years with our College.

This month saw the publication of the Department of Health post Consultation Report regarding their Protect Life 2 Consultation, which we answered back in November. It is worth a read as an important contribution towards how we are going to better tackle this most urgent of problems.

We had a very useful further meeting on 3 March with Dr Joy Watson – and also Dr Peter Trimble - about the draft Alcohol and Brain Damage in Adults NI Report which both Joy and Dr Vanessa Craig have been working on over recent times. The Report will be a NI version of the similar CR185 Report in England. It has now received a Foreword from the Chief Medical Officer, Dr Michael McBride. Some finishing touches are currently being added to the document by Joy. Ultimately we would hope to place it before our local College Executive for endorsement in principle and thereafter have a small launch event with Commissioners, CMO, MLAs, etc. with a view to including this important issue within our lobbying agenda. It is an issue which Peter has campaigned on over very many years and I know that Peter is delighted with the work done on this by Joy and Vanessa. It was great for Joy to get Peter’s input into the final stage of drafting.

I would take the opportunity here to congratulate Dr Kate Latimer, Consultant Psychiatrist in the Young Peoples Centre in Belfast on the following initiative that she and her colleagues have co-produced in their own service. It seems that as part of their mission to improve service quality they established a focus group comprising young people in the age range 14 to 18 years who were already attending their Specialist Adolescent Mental Health Outpatient Service. The participants said that they would have loved to have been able to see the CAMHS building and staff before they first attended – and so it was that the idea for a short video about life in Belfast CAMHS was born. One of the young people involved with the service wrote a script for “Behind the Scenes of Belfast CAMHS”. A narrator was chosen and she speaks to the camera and takes the viewers on a tour of the building and observes snippets of an initial assessment, CBT session, Family Therapy and a group. I understand that the video is currently being edited and will then go online for people to view. This is such a simple but profoundly important initiative for users of that particular service.

I mentioned last month that the NI Commissioner for Children and Young People has identified mental health as one of her priority areas during her term in office – and that in order to progress this priority area, NICCY is planning a piece of work to capture children and young people’s experiences of accessing mental health services. Dr Maggie McGurgan kindly agreed to represent the College regarding this and Maggie has confirmed that following discussions this month with NICCY, she will now sit on their Professional Advisory Group. It is great to have this Clinician input and my thanks to Maggie.

Congratulations to Drs Michael Doherty, Margaret du Feu and Annette Thampi who succeeded in the recent Elections for the roles of Vice Chair and 2 Executive members respectively. Later in the year, they will replace Drs Maria O’Kane, Heather Hanna and Heather Hawthorne in these roles. My thanks to all members who take on these voluntary commitments on behalf of the College. We each benefit as a result.

BJPsych Advances March 2017Finally, may I commend to you Dr Margaret du Feu’s excellent article entitled "Deaf People: what every Clinician needs to know" which appears in the BJPsych Advances March 2017 edition. It really does provide a comprehensive reference point for Clinicians treating this client group. The purpose of the article is to highlight the following:

Deaf people, including culturally Deaf sign language users, have equal rights to full participation in society - and this should include access to and appropriate treatment by all healthcare services. However, gaps in the training and awareness of health professionals and frontline staff can lead to barriers and delays that disadvantage deaf people and can put them at risk. Deaf awareness and informed attitudes will lead to equal treatment for this significant proportion of service users.

The cover of the magazine is also interesting as it is an untitled painting by deaf artist Patrick Griffin. I know that Margaret is very pleased that Patrick’s work has reached such a wide audience and it is an uplifting image with which to close this month’s Update.

Untitled by Patrick Griffin

 

Dr Gerry Lynch

If you would like to post a response to Gerry's blog, please email the editor, who'll be happy to upload this for you.

 

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Dr Gerry Lynch

Dr Gerry Lynch, Chair RCPsychNI