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

RCPsych in Northern Ireland monthly update

September 2017    

               Gull 6

September this year saw an early Autumn and apart from the falling leaves, we said a prompt farewell to our friendly gull who had faithfully turned up to the office window at Clifton House on most days over the summer months! Its company will be missed, but perhaps not its loud squawking!

Public Engagement

September 2017 also saw a reopening of the schools and, in advance of that, on 30th August 'The Crash Course in Mental Health for Teachers & Primary School Staff © ran as a hugely successful all day partnership event incorporating the College, Northern Trust Children’s Early Intervention Service, Aware and the Public Health Agency in Mount St Michael’s Primary School, Randalstown to 104 teachers across more than 10 Primary Schools - as well as additional school support staff. The day included interactive education on mental health, common mental health issues in children, how to identify a child in need of support and how to access support. It also covered looking after personal mental health and resilience building for staff.

Randalstown

Example case studies were used and anonymised case examples were brought by the audience for small and large group discussion. The feedback was very positive and this large event model will be repeated at future teaching staff development days. It was felt to be an excellent use of multi-agency resource. My thanks to Drs Keira Walsh, Maggie McGurgan and David Mongan (pictured left to right with Nadine Kane, Lead for Children’s Early Intervention Service Northern Trust) for their continued input with this important initiative via our Public Engagement Committee. Thanks also to David Price from CRIS – Community Relations in Schools – who, on the audience side, managed to bring all the schools together. This type of practical early intervention is so important if we are going to improve the mental health of our children and young people as they grow towards adulthood.

Mental Capacity Act

During the month, our focus on the new Mental Capacity Act (NI) 2016 (MCA) and currently, in particular, on its Draft Code of Practice, continued apace. First, I was invited by Dr Carson to speak to the BMA Consultants’ Committee about the Act and its Code, which I gladly did on 21 September, as I feel it is vitally important that we raise awareness among our medical colleagues about both documents. It is certainly not the case that we, as Psychiatrists, will own this Act. On the contrary, I think that awareness raising is vital if we, as a profession, are going to be able to establish, under the Act, that capacity and its assessment will fall to most, if not all medical specialisms - and many other associated professions - not just to Psychiatry.

The future success of the Act and the reasonableness of our future workload as Psychiatrists, will in part depend on the establishment of this fact in advance of implementation. This was followed on 22 September by our MCA Working Group meeting with Tomas Adell from DoH for the second time, to work through scenarios from real practice with him. Once again Tomas was skilled in clarifying matters for us, either by way of ready answers or a commitment to take points away for further clarification in the draft Code as it continues to evolve under his careful eye.

Our on-going thanks to Tomas for all his assistance and his commitment to this hugely important collaborative process. In turn this was followed by a MCA Workshop on 26 September at Queen’s University, convened by Senior Lecturer in Social Work Dr Gavin Davidson and attended, for the College, by Drs Catherine Taggart and Rowan McClean. My thanks are extended to each of them. Also represented were GPs, Nursing, Social Work, Psychology and Service Users. Tomas Adell from DoH was in attendance once again for this event and he outlined emerging issues and this time some multi-disciplinary scenarios were discussed.  Ongoing issues included who does what, best interests, attendance requirements and appreciation. There was discussion around how much will depend on training and how the Code is used in practice - for example when asking for ambulance/PSNI assistance when patients need admission. There was also useful discussion around apparent capacitous decisions either to refuse treatment for serious illness such as cancer, or even to complete suicide -also the effect of delusions.

CAMHS

Meanwhile, on 11 September Drs Richard Wilson and James Nelson attended a roundtable discussion workshop at Queen’s University, again convened by Dr Gavin Davidson along with his colleague Dr Lisa Bunting, on the data needed on children and young people’s mental health to best inform policy and practice. The event was introduced by Ms Koulla Yiasouma, Northern Ireland Children's Commissioner, who gave an update on her office’s Speak Your Mind Survey of 11-21 year olds’ experiences of mental health services in NI which runs to November 2017 – with a linked survey for parents and carers.

The event brought together a wide range of researchers and data experts. Dr Geraldine Strathdee, former National Clinical Director NHS England, now Strategic Mental Health Adviser NHS Improvement , was also in attendance. Two strong emerging themes were that the current model of public service provision is unsustainable, echoing perhaps Dr Bernadka Dubicka's recent BMJ editorial that services need to be more joined up and “it takes a whole village to raise a child” - and that we also need to develop more connected data systems between physical and mental health, resonating with the policy work focus of our Vice Chair Dr Michael Doherty and our Informatics Committee Chair Dr Stephen Moore. My thanks to Richard and James for representing us at this important discussion forum.

Thanks and congratulations also to Richard who was asked to present at the College Child and Adolescent Psychiatry Annual Scientific Conference in Nottingham University on 14 September, where he gave an update on developments in Northern Ireland in this specialty. I understand that Richard pointed out the challenges of practice in a divided, post conflict society. He also emphasised the role of our local College in promoting professional cohesion and high standards of practice, perhaps indeed as a role model of how services should connect, inform and mutually potentiate practice across agencies leading to improved outcomes for patients. Reflecting on this could be an important focus for all we do locally in the College. Finally, it has been suggested that we host the 2019 Conference in Northern Ireland, which would be a great honour and let us hope that this will become a reality in due course.

Consultations

Next to College responses/Consultations during the month – and I wish to first thank Drs Deirdre Shields and Conor Barton who worked on our response to plans for the exciting and innovative Dementia ECHO Project 2017/18 and 2018/19. Deirdre provided initial comments and steer and Conor did a lot of work on our overall draft response. In essence, these are the proposals for the new regional operating model for the delivery of dementia services in Northern Ireland. We welcome very much their emphasis on increasing diagnostic and management skills in primary care and the use of innovative methods such as Project ECHO. In summary, we as a College welcome this project and wish it every success. Conor has indicated that he would be happy to liaise further with the Network Lead, as Vice Chair of our Faculty of Old Age Psychiatry on behalf of the College, and it would be important to see this development happen.

Forensic Faculty

My thanks also to Dr Adrian East who devoted a lot of time and effort to draft our response to the NI Prison Service Consultation entitled Prisons 2020. We look forward to the emergence of our Forensic Faculty’s position paper on Prison Psychiatry in Northern Ireland (referred to in our response) and I know that Adrian as Chair of that Faculty is currently busily engaged on the finer details of that document, along with other colleagues.

Adrian East

Thanks are also due to Adrian for the Masterclass which he delivered on 6 September here in Clifton House on the subject “Fit for Interview? – Assessing the Mental Health Patient for Police Interview”. This turned out to be one of our best attended Masterclasses, attracting a lot of interest from well beyond the Forensic Faculty. We also got to use the newly trialled McCracken Suite on the ground floor of Clifton House and it worked out very well indeed.

Policy

Our Policy Administrator Thomas McKeever attended a BREXIT engagement event at NICVA on 28 September addressed by La’Verne Montgomery, Director of Corporate Management in our DoH. This is the first time our DoH has engaged on the issue and they promised more such contact. I am told that La’Verne spoke of how she was just back from a similar event in Dundalk which marked the DoH in RoI’s fifteenth such engagement event on the topic! The other key difference in Dundalk was that it was attended by their Minister for Health, who apparently delayed his departure in order to visit every table and take on board the concerns of all delegates.

In any event, Senior Civil Servants such as La’Verne are to be commended on engaging on the topic in the absence of our Executive here in NI. A key issue which emerged was the absence of workforce data to help us ascertain the extent of the challenge BREXIT will pose to mental health services here. The meeting heard from the Royal College of Midwives representative who indicated that they know anecdotally of 40 Midwives who cross the border each day and who are encountering problems with mortgages etc., given the uncertainty, and who are at risk of no longer working in NI due to the implications of BREXIT– and if they are lost, this will present major challenges to that particular service. Another key issue would be the fact that the DoH is not represented at all on the main EU Exit Project Board at Stormont which is dealing with BREXIT, yet DoJ is represented, for example. The DoH instead is relying on information being fed up to this Project Board via various channels. La’Verne took back with her this concern as well from all present that Health should be a centre stage BREXIT consideration. Once again, if any members have any BREXIT concerns about their practice or service, please do let me know, via Thomas in the office.

Research, Audit and Quality Improvement Day

Congratulations to Drs Ruth Thornbury, Patrick Renshaw, Claire Potter, David Mongan, Lizzy Donaghy, Pam Hamlyn, Michael McMorran, Stuart Brown, Camille Hart, Colin Gorman, Clare McGivern and Maggie Kelly who presented at our Research, Audit & Quality Improvement Presentation Day in Clifton House on 20 September. As ever it was difficult to pick winners from such an able field and particular congratulations go to Drs Claire Potter and Colin Gorman who won the Research and Audit/QI prizes respectively and also to Dr Aimee Durkin who won the RCPsych in NI/NIASP Dr Thomas Freeman award. Claire and Colin are pictured below with (left to right) Drs Ruth Barr and Aidan Turkington, who joined Dr Catherine McDonnell and I as Judges – and also Professor Ciaran Mulholland (right) who so ably chaired the event as ever. Aimee is pictured below with Ciaran. Thanks also to Professor David Cotter Psychiatrist, Royal College of Surgeons in Ireland (pictured above with Ciaran) for his featured talk on insights into the effects of altered plasma complement proteins. 

Research Audit

 

 

Careers

Thanks are also due to Aimee who attended the NIMDTA Careers Fair along with Deputy Head of School of Psychiatry Dr Jo Minay on 14 September to encourage all comers to “Choose Psychiatry”. This is a key College campaign which is particularly important to our colleagues in the other nations. We must not be complacent in NI about recruitment, but our problems here are thankfully not as acute as elsewhere, at least in this regard anyway! The thanks of all, therefore, to Jo and Aimee for keeping a focus on the future of our profession in NI.

Jo and Aimee

“Choose Psychiatry” was also the thinking behind the Irish News feature of me as your Chair in their 21 September edition, where I made the point that Psychiatry is an utterly fascinating medical specialty and I continue to find it so.

My thanks to Thomas for securing this media attention for our local College strategy. Speaking of the future, we were delighted to welcome back again on 6 September to the College, the MRCPsych students who we host each Wednesday afternoon at Clifton House.

Annual Medical Education Conference 2017

We also welcomed to Clifton House on 22 September the College Treasurer Dr Jan Falkowski. Jan was interested to get a brief tour of Clifton House from the Belfast Charitable Society staff and their assistance to us on the day was much appreciated. We greatly appreciated Jan taking the time to give us a call when he was over in Belfast for the College Annual Medical Education Conference 2017 based at the Hilton Hotel on 21 and 22 September. The Conference Dinner was held on the evening of 21 September at Crumlin Road Gaol and I was pleased to welcome our guests to Belfast as after dinner speaker.

 Gerry Lynch

It was particularly my pleasure to welcome our new President Professor Wendy Burn (pictured  left) to Belfast and to welcome back College Dean Dr Kate Lovett once again to Belfast. My thanks to Barry for his background historical research work for my speech. Thanks to Kate for her follow up Tweets. Love Belfast. Such a brilliant welcome here @RCPsychNI Look forward to coming backLove Belfast. Such a brilliant welcome here @RCPsychNI Look forward to coming back.

SAS and Affiliates Group

I was also pleased to be invited to address our SAS and Affiliates Group meeting here in Clifton House on 8 September, by their Chair Dr Liz Dawson. Dr Paul Darragh, who is BMA SAS representative for NI, was also in attendance and he provided an update on recent negotiations regarding the Associate Specialist Grade. I addressed the July 2017 BMA Proposal to DoH in NI on “Training, Development and Career Management of Staff, Associate Specialists and Specialty Doctors”. It is clear to me that this Group has a very strong skill set and knowledge level which is not always fully valued and appreciated. I intend to raise this issue going forward and try to improve the profile and career development prospects of these valued members.

Student Mental Health

RCPsych in NI Vice Chair, Dr Michael Doherty, has drawn our attention to two reports recently published on Student mental health. The first is the Framework Document Step Change produced by the Universities UK, on whose Advisory group Michael represents the college along with Dr Clare Lamb from CAMHS executive. The UK programme has now established a working group on which Michael and Clare represent the College on Professional Guidelines and Commissioning Guidelines for Student Mental Health which will hopefully report next Spring. The second report Not by Degrees: Improving Student Mental Health is an independent report produced by the Institute for Public Policy research (IPPR).

These Reports are both going to be very influential in the future direction of this increasingly important issue. Michael also asks that you contact him if interested in this topic as he would like to form links around the UK in preparation for the next phase of the work and also in order to see the interest that is present for possibly establishing a Special Interest Group for Student Mental Health. This work is surely an important early intervention step towards addressing our high prevalence of Suicide.

ADEPT

Congratulations to Drs Niall Corrigan and Emma Cunningham who are the two Psychiatry Trainees involved in the Achieve Develop Explore Programme for Trainees (ADEPT) this year. Thanks and congratulations also go to Drs Judy Curran and Ruth Thornbury who were the two representatives for Psychiatry on the programme for last year. It is worth setting out here the background and purpose of this programme. It was launched by the Northern Ireland Medical and Dental Training Agency (NIMDTA) in August 2015. It is a programme which offers Senior Doctors in training the opportunity to develop leadership and organisational skills by working in an apprenticeship model with senior leaders in host organisations within Northern Ireland. There has been a strong psychiatry representation from its inception with two specialty Trainees being appointed each year. I would encourage Trainees to avail of this fantastic opportunity next year and in subsequent years.

You in Mind Project

My ongoing thanks to our representatives on the HSC Public Health Agency You in Mind Project, Drs Jo Minay, Saleem Tareen and Stephen Moore. The Project met again on 26 September. I understand that there are two concurrent regional Project Teams running at present. The first of these is the You In Mind Care Pathway Documentation Project Team, which is taking forward the development of standardised documentation for the YiM Care Pathway, including developing the specifications for electronic solutions. The second one is the Mental Health Informatics Regional Project Team, which is finalising the Service Framework for Mental Health and Wellbeing and developing the evidence required to meet the standards set out in the Framework. It has been concluded that there is considerable overlap between both projects at present and therefore it has been suggested that they need to be more closely aligned to each other, to ensure both consistency of approach and more effective communication flow and actions outwith each meeting.

To this end, I understand that both Project Teams have been asked to come together for a joint meeting in November to take stock of where they are and to set out a road map for their future progress. On foot of our Executive meeting here in Clifton House on 19 September, I am currently writing to the You in Mind project to bring further clarity to our position on the documentation aspect of this initiative. In essence we support the aims of the project, but believe the documentation currently proposed to be counter therapeutic. That said, we are happy to work with the Project on a Guide as to how Clinicians can appropriately use the documentation, which we urge must recognise the primacy of clinical judgment. In this way, it is our hope that the documentation will in time become an aid to clinical assessment, not a hindrance. Our crucial argument is that the documentation should be used as an aid to clinical judgement and not as a document which has to be completed in all its parts in all situations.

Finally, my thanks to Dr Billy Gregg for representing us here in NI and giving of his expertise as a member of the Working Group in the drawing up of the 2017 Update of Drug Misuse and Dependence – UK Guidelines on Clinical Management – known as the Orange Book. This really useful and practical publication for assisting clinical practice is commissioned by the Chief Medical Officers of England, Scotland, Wales and Northern Ireland and is supported by Public Health England. 

And finally, finally and with much cajoling from 'Those in the Know' your Chair finally embraced Twitter during September! You can find me @DrGMLynch1 Please feel free to follow me?!  I began with the departing gull………and so I conclude with this! TWITTER

 

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Dr Gerry Lynch

Dr Gerry Lynch, Chair RCPsychNI

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