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

Council update & Schizophrenia Commission

Thursday, 23 February

At our Council meeting last Friday, we were fortunate to have two excellent presentations. The first came from Professor Eileen Munro, who gave a most clear and concise overview of her review of social work and safeguarding. As she was presenting you could hear a rising tide of resonance from around the table. Try substituting the word 'psychiatrist' for 'social worker' - the same issues and challenges arise in this risk averse world we inhabit. Eileen has kindly agreed to come and speak at one of our evening lectures later in the year, on 23 October, and I hope she will become a friend of the College.

Dr Jane Marshall and Dr Max Henderson came to speak about the first three years of the work of the Practitioner Health Programme. Whilst they and others around the country are doing sterling work, there is still a deal more to be done. My action will be to ask for a further meeting with the GMC to find a way of involving psychiatrists more in the work of the GMC.

From both presentations it again struck me we need to negotiate harder with our employers, not only to release us to do college work for the wider benefit of the NHS, but also to encourage us to skill up in being able to support doctors with mental health problems; and further, to be able to go out to key players and parts of our local community, to explain about the importance of good mental health, what mental illness is about, and the role we play. This will serve for recruitment going into schools, and it will evidence the importance of mental health in improving public health. It will showcase trusts in this era of commissioning and competition and it will allow, I believe, members to use some of the undoubted creativity you all have, which at times is drowned in protocols. I also think it would be good for our own mental health!

They say there's no such thing as a free dinner. On Monday night, I was invited to a dinner held by the

Schizophrenia Commission, as the following day I was giving evidence at one of their sessions. The dinner was held in one of the most splendid buildings in the land - Manchester Town Hall, a tribute to gothic architecture and used by most TV companies producing any period drama that involves politicians and Victorian drama. One of the Commissioners is a user from my trust and the discussion over dinner was searching and thought-provoking.

On Tuesday I gave formal evidence on your behalf and many thanks to all the Faculty Chairs who at short notice contributed to this. We will be submitting detailed formal written evidence in due course. What was most sobering for me was questions raised afterwards. At this hearing, and in all evidence collected to date, users and carers had highly varying experience of treatment and care, not just geographically but across different wards in the same hospital.

There are two definite ‘take home’ messages for us:

1) How do we sit with patients and explain carefully and fully the risk benefits of the medication we prescribe, not just at first point of contact, but as over time we may change medication? And how do we set this in the context of overall interventions and all the often unmet need in their lives?

2) Why is it that the atmosphere, routine, and ethos on two wards with the same function, sat across the corridor from each other can be so different? Could it be about how doctor psychiatrists lead in such settings working with senior staff? I have heard the College Centre for Quality Imrovement (CCQI) comment on this, but the real question is what can and are we doing about it? 

Today I am meeting with our Communications and Policy department to make sure we are pulling together all the varying strands of work we are doing, and making sure we are using all efforts to best effect. The Health and Social Care Bill will clearly be one area of discussion.

On the subject of the Bill, I was watching the TV on Monday night with my grandson. It's clear he understands something of the reason why I spend time in London, because he asked me why I wasn't at the meeting at ‘that house in London where important people are’ (No. 10). Even grandma didn't have an answer for that one!



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