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

Chair's Update

June 2017

Edinburgh

At time of writing, I am not long back from the College’s International Congress which was this year held in Edinburgh from 26-29 June 2017.

It was, in my view, a great success. There was a real buzz in the venue and the programme had the correct mixture of cutting edge science, clinically relevant presentations and some very powerful input from Patients and Carers. Not only was it a great experience to listen to the many high profile speakers, but it provided the opportunity to interact with peers from many different services both within the UK and further afield. This cross fertilisation of ideas is really important for the development of services in the different regions as we can all learn from one another.

Perhaps for the wider College readership of this Update, it would be appropriate to insert here a word for Belfast as a venue for our International Congress in the very near future, given the new College Chief Executive’s emphasis on the overt inclusion of the devolved countries. Without wishing to advertise any particular venue, we do now have the attendance volume capability and capacity in Belfast for the last couple of years for such an International Congress…..others have led the way in Belfast, so why the RCPsych delay?! What about 2019?

During the Conference, we also had a useful meeting with the Chairs of the English Divisions and the Chairs/Vice Presidents in Scotland and Wales, as well as the Managers including Nora McNairney. This was going on just as the 26 June news of the Conservative and DUP Agreement and UK Government financial support for Northern Ireland came through, so there was much interest in the extra £10m per annum which will be allocated to mental health over 5 years as a result.

The words within the Agreement about this financial allocation are also encouraging: “The UK Government and Executive agree on the importance of support for mental health, particularly recognising the historical impact of NI’s past on its communities”. However, we have already begun to work to ensure that the money actually does reach priority front line mental health services! Any additional funding for mental health services in Northern Ireland is to be welcomed, but it is vital that such money provides tangible benefits to adults and children with mental health and learning disability needs. It is imperative that this funding is protected and targeted specifically at genuine mental health services and projects – not diverted to, for example, the Acute sector or even to our new Capacity legislation, the cost of which is to be shared with physical healthcare in the genuine pursuit of parity of esteem; also, there is surely doubt as to whether the current Parliament will endure for 5 years.

As a starter on this positive development, we issued a Press Statement on 28 June which was picked up by BBC NI, though its traction was limited due to the news dominance of yet another local political talks deadline. Moreover, I am encouraged by the following words in the House of Commons from DUP MP for North Belfast Nigel Dodds as he recognised some of what we have been saying over the years about the mental health effects of our troubled past: "Clinicians and others have pointed to the legacy of 30 years……and the awful effects of that. Part of the money we are investing this week goes to mental health care - extra investment in the health service”.

The extra sums within the Agreement of £50m and £100m per annum for two years for health/education immediate pressures and for health service transformation respectively, are also welcome. However, we still need our local Assembly back and functioning. It is at this stage to be hoped that this goal will now be realised at the end of the Summer…?

RCPsych International Congress 2017

The International Congress is the moment at which terms of office for College office bearers conclude and begin. We therefore give thanks to Professor Sir Simon Wessely as President and locally Dr Maria O’ Kane as Vice Chair and Dr Margaret du Feu as Chair of General Adult Faculty. Each have strengthened the College during their tenure and their skills in those particular roles will be missed. We welcome and look forward to continuity of their high standards from Professor Wendy Burn as President and locally Dr Michael Doherty as Vice Chair and Dr Rowan McClean as Chair of General Adult Faculty. Each are very worthy successors and custodians of great legacies of service. We are similarly very grateful to both Drs Heather Hanna and Heather Hawthorne for their roles on our Executive over recent years and we look forward to working with their successors Drs Annette Thampi and Margaret du Feu in the time ahead.

Speaking of appointments, Dr Lauren Megahey ST5 in Psychiatry of Old Age has been appointed as a NIMDTA Trainee Ambassador for Psychiatry, for the 2017 - 2018 training year. This is a new role, with overall objectives of promoting connections between trainees, highlighting benefits of training and strengthening the engagement between NIMDTA and trainees. Lauren, who is based in the Southern Trust, is happy to be contacted by Trainees who have any issues or suggestions.

Also at Congress, we had the launch of the RCPsych Insight publication, which is a new quarterly magazine for members. I was indeed delighted to see that our own Drs Ruth Barr (on the North Belfast Community Mental Health Team) and Tony O’Neill (on genetic research) are featured prominently within at pages 12 and 16 respectively. Overall, the College wants this magazine to be a celebration of what is best in psychiatry; consequently, there are features providing a fascinating window on the working lives of a diverse range of psychiatrists. Its editors would relish your feedback on the first edition – please email magazine@rcpsych.ac.uk or tweet using #RCPsychInsight with your suggestions, feedback or queries.

Poster presentations at RCPsychIC 2017

Finally on Congress, it was particularly reassuring to see so many poster presentations from NI Consultants and Trainees (…did I really count 15?); this is something we should definitely build on for next year’s conference in Birmingham from 24-27 June 2018. The posters were an excellent display of the hardwork and commitment of the Trainees and Trainers in Northern Ireland to improving services for our patients. Pictured is Dr Aimee Durkin flying the flag for the Northern Ireland CAMHS Regional Inpatient Unit at Beechcroft Hospital serving all five Trusts.

Prior to Congress, I had attended both the Regional Advisory (Bamford Monitoring) Group Meeting on 19 June and the Central Medical Advisory Committee Meeting on 21 June on behalf of the College. At the former, we discussed the recommendations of the “Building on Progress: Achieving parity for mental health in NI” June 2016 Report and the progress since then. Over the past year since launch, we have pushed the agenda set by this Report at meetings with the then Minister, politicians, DoH and HSCB, but it is fair to say that progress has been limited, given the current political situation. Whilst it is clear that there is a commitment to the recommendations and there is also some evidence of more joint working between Trusts, there is a degree of frustration about the lack of progress, in particular in the development of community specialist services which would relieve pressure on acute beds. The previous Health Minister had made mental health a priority, but it is difficult to see how much progress can be made given the current political vacuum. I think it important, however, that this Report is kept by us on the agenda of the Trusts as well as of the Commissioners and the Department. The latter meeting was very much focussed on the outworkings of the Bengoa Report entitled “Systems, Not Structures – Changing Health and Social Care”, as well as the follow up document “Health and Wellbeing 2026; Delivering Together”. Overall, it is vital that we ensure that mental health is kept to the forefront, as the programme of work set out in the “Delivering Together” document is taken forward. Finally, I had a very similar agenda when both myself and our Policy Administrator Thomas McKeever met with the Trust Medical Managers in Clifton House on 21 June. They have agreed to meet with me approximately every quarter to discuss the College agenda and I am very grateful to them for their time regarding this.

15 June was a particularly busy day in College life… it began with a meeting in Clifton House attended by myself, Dr Margaret du Feu and Thomas with Fergus Cumiskey (CEO) and Carrie Montgomery (Deputy CEO) of Contact NI to discuss College concerns re some aspects of their lobby for a Suicide Prevention Bill and the Zero tolerance approach to Suicide – as well as catching up with the All Party Group on Suicide. It was a useful exchange and one which needs to be repeated. On the question of the Zero Suicide approach, it is worth restating here that the College is supportive of all evidence based approaches to suicide prevention. It does not formally promote the zero approach. There is concern that what can helpfully be a mindset of zero suicide will be turned into a target. This is our former President’s succinct comment from January 2015 on the topic and I commend it to you. It is fair to say that while we certainly share the imperative of seeking to reduce the suicide rate as far as possible, the emphasis should be on properly resourcing mental health services and bearing down on the various mental illnesses which underpin our high suicide rates, as well as improvements on discharge and follow up, whilst also recognising and trying to address the many societal problems which contribute to suicide.

Indeed, prevention of suicide, not prediction, was the key message at the International Congress from Professor Louis Appleby in tackling the UK suicide rate. The National Suicide Prevention Strategy England highlights areas where effort should be increased to help reduce the suicide rate. In Northern Ireland, as we know, we have the highest rate within the UK and adopting a similar approach in Northern Ireland would be beneficial. A key focus in this strategy was more involvement of family members and carers in the care and management of our patients. The RCPsych Consensus statement on Confidentiality was highlighted at Congress.

RCPsych Concensus Statement on Confidentiality

Staying with our dialogue with Contact, Dr Phil Campbell kindly attended the Contact NI Suicide Prevention Conference: What works? Mid-Year Half-Day conference at the Stormont Hotel on 21st June on behalf of the College. Phil reports that Órlaithí Flynn MLA outlined her role as chair of the NI Assembly All Party Group on Suicide Prevention and Norman Lamb MP delivered a video message describing his experience with “zero suicide” in Mersey Care and Detroit. CEO Fergus Cumiskey said that learning from suicides was key, describing the negative impact of a “blame culture” following the death by suicide of a person in contact with services. He talked about what he saw as a pessimism around the preventability of suicides and his desire for a culture in which people can talk openly about suicide. Finally, Deputy CEO Carrie Montgomery presented the Contact NI Zero Suicide Manifesto. The Contact NI proposal for a NI Suicide Prevention Bill was also presented. The Zero Suicide pilots in England are still being evaluated; it will be interesting to see the outcomes. We need to consider whether the adoption of a zero suicide target could ironically contribute to the blame culture where it could be viewed that every suicide should have been prevented. In terms of the proposed Suicide Prevention Bill, perhaps the focus instead should be on measures with the best evidence – e.g. minimum unit pricing, National Confidential Inquiry into Suicide and Homicide by People with Mental Illness recommendations, as well as standards of care. The dialogue will continue as a matter of urgency, given the seriousness of this issue which so badly afflicts our society. Speaking personally, I remain to be convinced that putting suicide prevention into a legalistic framework has merit, and may, indeed, have significant disadvantages.

Dr Heather Hanna

Back to 15 June again… following the meeting in Clifton House with Contact NI, I hotfooted over to the Royal College of Nursing at Windsor Avenue, Belfast for the launch of Three Steps to Positive Practice: a rights based approach when considering and reviewing the use of restrictive interventions. This document, which has been approved by Central College Policy and Public Affairs Committee, was developed by a multi-disciplinary group involving Dr Heather Hanna (pictured above and below far right along with some of her co-authors) on behalf of our College, Royal College of Nursing, the Northern Ireland Association of Social Workers and the College of Occupational Therapists. It is designed to assist health and social care professionals who are involved in practices where people in their care may be restricted in some way. It is a very instructive and practical document. Clearly a lot of work has gone into it and I congratulate and thank Heather for undertaking this on our behalf. Please do read the document through, especially if your work involves you in this area. Along with Heather, the Guest Speakers were Dame Professor Donna Kinnair RCN Director of Nursing Policy & Practice, Professor Charlotte McArdle Chief Nursing Officer and Professor Rod Thomson RCN Deputy President.

Launch of Three Steps to Positive Practice

Meanwhile over at the Crowne Plaza, Shaw’s Bridge, our Child and Adolescent Faculty Chair, Dr Richard Wilson was representing us with another local Royal College on 15 June….this time with the Royal College of Paediatrics and Child Health who were hosting the launch of the Northern Ireland response to the RCPCH State of Child Health Report. This is a truly comprehensive Northern Ireland response to the equally comprehensive RCPCH UK-wide State of Child Health Report - the latter drawing together a range of data across 25 key indicators of child physical and mental health creating a snapshot of infant, children and young people’s health and wellbeing. The report follows the life-course of a child from conception to birth and throughout infancy, childhood and adolescence. The Northern Ireland response identifies specific recommendations across a range of themes, while taking into account how we compare to other regions. It is a very thorough Report and deserves study as to its full implications.

May I add that it is very heartening to witness us collaborating so well with the other local Royal Colleges.

Following these parallel events, the day concluded back at Clifton House with our Executive Meeting which was very well attended and which heard feedback presentations from both Drs Heather Hanna and Richard Wilson – and also from Dr Billy Gregg who shared with us his learning from his presentation (covered in last Month’s Update) at Central College in London on 22 May at the Public Mental Health Conference entitled “Rising Mortality among UK addicts” on the topic of “Transforming drug and alcohol public policies into better care – the NI experience”. My thanks to all three. There is a lot of really helpful material in all of this for our Clinical practice.

Dr Richard Wilson has also been very busy this month with a number of additional initiatives. Richard attended the Review of Regional Facilities for Children and Young People at the Crowne Plaza, Shaw’s Bridge, Belfast on 27 June. Dr Daniel Gboloo-Teye (pictured below centre also at Joint UPS/RCPsych event), Clinical Lead Belfast Trust was also in attendance. The aim is to rationalise the existing facilities in Northern Ireland across care, treatment, forensic and secure residential units. It is clearly important that this takes place in a joined up way. The main themes are increased integration, increased focus on outcomes and research, the prioritisation of an outward facing strategy of practice, improving the physical and therapeutic infrastructure for these units and making sure they function as part of a rationally determined network of provision, as well as aiming that there would be greater engagement with the users of these services to promote improvement via mutual learning exercises. In terms of the Action Plan the following were emphasised in the short term: Promoting co-operative leadership of change, as well as beginning to plan joint training and educational ventures on an inter-agency basis to improve mutual understanding and clarify goals. Richard as Chair of our Child and Adolescent Faculty will fully support this broad based approach to service improvement and looks forward to working at all levels of change. Richard has made it known that we would be particularly interested in co-developing inter agency learning initiatives and in the development of managed networks of care across the Region.

Dr Daniel Gbolo-Teye

Then on 30 June, Richard along with the other Trust Child and Adolescent Psychiatry Clinical Leads met with Ms Catriona Rooney CAMHS Commissioner, Health & Social Care Board (HSCB) regarding the Regional CAMHS Clinical Network ECHO (Extension for Community Healthcare Outcomes) Project and the possibility of a Partnership Board being set up to oversee Regional CAMH Service Development when the HSCB is stepped down in 2019. Very exciting potentially was the news that Ms Rooney has now applied to the DoH for funding to recruit a Consultant Clinical Director to take forward the work of the Project Board. This will hopefully provide an opportunity to provide clinical leadership at a Regional level, which would be progressive.

Next to the 7th Annual Ulster Paediatric Society and College Child and Adolescent Faculty Conference which took place in Riddel Hall on 6 June entitled “Beneath the surface – Exploring childhood anxiety, attachment and the power of relationships” – which attracted an audience of around 100… Dr Richard Wilson (pictured second from left) reports that this was the most collaborative Conference so far. The theme of Anxiety proved to be a connecting thread throughout the day and all of the presentations seemed to complement one another brilliantly. The Keynote Speaker was Professor Helen Minnis (pictured second from right) on “Double jeopardy: the roots of anxiety”. The event was opened and closed by Richard; also speaking were our Child & Adolescent Faculty Vice Chair Dr Lisheen Cassidy (pictured fourth from left) on “Medically unexplained symptoms – what lies beneath?” and Faculty Member Dr Anna McGovern (pictured third from left) on “Exploring anxiety in children and young persons with Autism”. The Conference was a great success and was described afterwards as “a stimulating and enjoyable day of learning”.

7th Annual Ulster Paediatric Society and College Child and Adolescent Faculty Conference

One of the interesting points made by Professor Minnis was that “Children who have been exposed to maltreatment are at a higher risk of having problems with emotional regulation and are also at much higher risk of having complex neurodevelopmental disorders which also affect their emotional regulatory capacity. This means that such children may be at “double jeopardy” of problems associated with the regulation of emotion. This in turn means that we need to assess and deal with neurodevelopmental problems in maltreated children to prevent and manage the emergence of problems like anxiety.” This dedicated approach towards moving the whole field of attachment out of the laboratory into clinical practice, the development of clinical confidence, of more practical assessment and of outcome tools - is impressive and bodes well for the future.

Following lunch, recognising that if attachment based anxiety has its roots in faulty relationships, then it is likely that such problems may find a solution through the promotion of learning and support provided in the context of nurturing relationships, Conference went on to hear of two possible approaches. The first presented by Janet McCusker (Nurse Education Consultant – pictured fourth from right) outlined the Wellness Recovery Action Plan Approach (WRAP). This method, developed by Mary Ellen Copeland emphasises the central importance of individual autonomy in the co-development of an evolving self-led management plan which has wide applicability across many areas in mental health practice. This was followed by an excellent talk by Annie Gordon (Nurse Therapist- pictured third from right) on her use of the cognitive therapy approach for patients with complex needs who present with anxiety. Our thanks to all who made the day possible, including Dr Shilpa Shah (Honorary Secretary of Ulster Paediatric Society -pictured on far right) and Denise Braniff (Administrator at Ulster Paediatric Society – pictured on far left).

Reflecting on all of the above just for a moment, we really do, as RCPsych in NI, collaborate remarkably well and extensively with our colleagues in other disciplines. Just looking at this one month’s activity alone is really impressive. It really is very striking. My thanks to all both inside and outside our College here in Northern Ireland for their time and efforts to improve services for our patients and maintain high standards.

An interesting and important half day Conference was held on 21 June in the Stormont Hotel entitled “Borders, Constitution and Money: an Expert Seminar” and our (then incoming and now) Vice Chair Dr Michael Doherty attended this on our behalf. This was important, given that the question of delivering key public services after Brexit if economic circumstances deteriorate or staffing problems become more acute, was on the agenda. It was the second seminar in a series examining Brexit from different perspectives, which is running for 18 months and visiting Northern Ireland, Wales, Republic of Ireland, England and Scotland. There were leading speakers from University of Glasgow, University College Dublin, Queen’s University and Ulster University. Dr Gordon Marnoch Reader in Public Policy Ulster University, spoke on “Brexit and public services – working through uncertainty” with the impact on the NHS and social care system as part of this. There is likely to be impacts on cross border workers, EU Nationals working in public services in Northern Ireland, as well as on all Ireland existing and proposed service developments. These issues will all require clarity as the exit negotiations move into the detail. Representation and input from Northern Ireland will be essential and this event was a welcome reminder that mental health services will also be impacted by the wider context of Brexit and all that it will entail.

…and that is not all! ...I am pleased to report that we hosted our Inaugural NI Psychiatry Summer School here at Clifton House on 16 June in association with Queen’s University Mind Matters. It was my pleasure to welcome everyone to the newly available McCracken Suite within the building and it worked well. We had a really good programme with interesting speakers lined up (pictured):

NI Inaugural Psychiatry Summer School programme

My thanks to all who were involved in this day (you will see their names on the programme), as well as our staff who made it happen. I would particularly like to thank Dr Caroline Donnelly (pictured fourth from left) who was the main promoter of this hugely important Recruitment initiative. I would certainly hope that we can build on this and perhaps make it an annual event as it offered such good insights to those who attended and all in the pleasant environment of the College.

NI Inaugural Psychiatry Summer School staff

Drs Joan McGuinness and Colin GormanAlso pictured (right) at our Inaugural Psychiatry Summer School were Drs Joan McGuinness and Colin Gorman.

…and now for another first… on 13th June the Public Health Agency held its inaugural meeting of the Maternity Strategy Implementation Subgroup on Perinatal Mental Health in Belfast. Represented on this group is psychiatry, nursing, midwifery, health visiting, psychology, AWARE/MMHA, PHA and allied health professionals – and reporting from this subgroup will be to the Strategic Midwifery Forum. An important point is that both GP and Service User representation have been invited to future meetings. The main purpose was to review the recommendations of the RQIA Review of Perinatal Mental Health services across Northern Ireland, which was issued in January 2017. Each of the 11 recommendations were discussed in some detail and an agreed plan of how to make progress towards achieving each of these was made. Chair of our new Perinatal Faculty Dr Julie Anderson attended to represent the College, along with other members of the Faculty.

Julie advises that the overarching desire to ensure safe effective and compassionate care was highlighted, together with the need to have a broad systems approach to consider prevention and early identification, right though to care at the severe end of the spectrum. The obvious issue of our current economic and political context was also discussed; clearly progress on the development of much needed specialist community perinatal mental health services and indeed a mother and baby unit will be significantly hampered by this in the meantime.

Points of discussion and agreement on required action were:

  • uniform approach needed across all acute inpatient psychiatric sites regarding appropriate equipment and facilities for the visiting of babies and other children of parents in hospital;

  • the issue of coding systems in Trusts which currently make it difficult to capture what is happening and so impacts on the ability to plan future services;

  • the good work which is occurring in some areas regarding peer support services was recognised, particularly in the Recovery College in the Northern Trust, but a recognition this needs to be available to all women regardless of where they live;

  • the challenge of communication both within services in a Trust and between Trusts was highlighted - the fact that this is an issue which is repeatedly highlighted in Serious Adverse Incidents, confidential enquiries etc. Within the small specialist perinatal service in Belfast Trust, communication is better than in other areas – so it was agreed that this further highlighted the need for the development of perinatal services across Northern Ireland;

  • a clear deficiency in the understanding and knowledge around perinatal mental health within front line mental health services was acknowledged and therefore the need for increased training.

…and a final first!.......Our new Faculty of Perinatal Psychiatry held its Inaugural formal Meeting in Clifton House on 27th June and members were pleased to welcome Theresa Nixon from RQIA to join them for this meeting. Julie has asked me to stress that new members are very welcome to this Faculty from within our membership.

Meanwhile on 29 June Dr Stephen Moore attended the Mental Health Informatics Project Team Meeting as Chair of our Informatics Committee. My gratitude to Stephen who continues to represent the College on the You In Mind Informatics workstream. Most of the work is information focussed, but will include looking at measuring outcomes as part of the mental health dataset.

…so, all told June 2017 will be remembered as being a very busy and productive month in the local College!

And finally some staff news… staff had the pleasure of welcoming Jonathan Woolcock College IT Service Desk Analyst, on 21 and 22 June to the office in Clifton House. Jonathan spent the two days working on our many IT issues and made great progress. We hope he will be able to visit again soon to assist us further. Later on 29 June staff also had the pleasure of welcoming Karla Pryce College Project Trainer (pictured with all staff beside the RCPsych in NI “Top Tips for NG” Noticeboard!) and Alethea Awuku College Trainer (also CPD and Revalidation Co-ordinator) for one day of Staff Training in the office on the newly introduced Integra New Generation (NG) Customer Relationship Management database. The fact that this training was on site made it much more useful. My thanks to all. Finally my congratulations to our Policy Administrator Thomas McKeever who was awarded a Staff Personal Recognition Award by the College on 13 June as he “diligently provided support and guidance… and direction” to staff and ”ensured that the high level of service we provide to our membership was maintained” over the course of recent staff changes.

RCPsych in NI staff showing NG Top Tips noticeboard

I leave you with an interesting initiative from a local school and a final thought:

Our Lady and St Patrick’s College, Knock has developed a six lesson Resilience programme for its students called “The Floreo Project”. The Latin verb ‘Floreo’ means to flourish, to bloom or to thrive. This programme aims to build resilience and mindfulness skills with Year 11 students. The school hopes that these skills can be utilised to promote positive emotional health, mental wellbeing and stronger academic and personal performance. The school further states that “research shows that resilience enables us to deal with difficult situations, to learn from them and to allow them to help us grow – in short, resilience helps us thrive”. This is a superb initiative. We fully support early interventions such as this and especially the promotion of resilience in our young people.

Speaking of resilience, our former President’s words in the RCPsych Insight publication strike a chord: “I’d hate to do a job that wasn’t stressful...” Our jobs as Psychiatrists are stressful (although perhaps not in the way that his was), but are enormously rewarding. I hope that the College can help to reduce the job stress and increase the satisfaction for us all, as its members.

Dr Gerry Lynch

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Dr Gerry Lynch

Dr Gerry Lynch, Chair RCPsychNI