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

Ave Atque Vale

I was never a great fan of the late Robin Williams, at least not as an actor.  Preferred his comedy. On film I thought he was a bit saccharine.  “Patch Adams”, the doctor who used humour to heal his patients - yuk.

But did get nominated for an Oscar for “Dead Poets Society”. He played a teacher who inspired his students (you never get Oscar nominations playing uninspired teachers) via the Latin motto “Carpe diem” - seize the day.

And that’s not a bad motto for us.  Mental health is “in” at the moment.  Two Prime Ministers devoted full speeches to it.  All of the parties in the election included it in their manifestos.  The younger Royals have claimed this for their own, even if the Queen apparently still sees some merit in the oft derided essence of Englishness, the “stiff upper lip”, which by the way was originally an American attribute.  Before the Victorian era the British were if anything more likely to be seen as a nation of cry-babies.

And back in the present, last year every TV channel had a mental health week, and just how many more celebrities are there left to share their mental health stories?

Playing our part

We have played our part in this. We have achieved fantastic coverage in the last 12 months, pushing good news, combatting errors and myths and highlighting injustice and failures.  We now produce a daily summary of “RCPsych in the News” - because we need one.

I said when I took over that I wanted us to be the calm authoritative voice people turn to when it comes to psychiatry and mental illness.  We are well on the way to achieving that.

And our political impact has likewise increased dramatically.  Of the Royal Colleges only the GPs get more mentions in Hansard - and they are five times our size. 

Work to do

But it’s not all gone well.  When I took office I also spoke about improving recruitment. And I might as well confess now, we haven’t.  OK, we have stopped the decline, and in the context of what is going on across medicine that’s an achievement.

But I think we have created the foundations (pun intended) to improve on this. We have achieved the target of 45% of junior doctors doing a foundation post in psychiatry. If that recruits not a single psychiatrist, it will still have done good.  But I believe the strategy will pay dividends in time.

But we must do better, and so it’s time to seize another day. Before the General Election we did our best to influence all the parties to make commitments to improving mental health services.

So when we read their election manifestos we quietly congratulated ourselves our efforts were not in vain. Now I am not naïve, and I know that a manifesto is not the Ten Commandments. But having something there increases the likelihood it will happen, and not having it there does the opposite.

The new government - whatever, whoever and wherever it might be (who knows, it might be Belfast) - will be committed to finding ways to ensure that the expansion of medical places is linked to what the NHS needs (and I know for a fact this means general practice and psychiatry), and several of the ways they plan to do this are a direct lift from  our own manifesto for mental health.

We can also see some of our handiwork in other commitments as well, for example around schools and mental health.  These things don’t just happen, they are the result of a lot of hard work by a lot of people - and many of them belong to your College.

Prod and push

But we cannot rely on government, of whatever political persuasion, to do our work for us. We can and will prod, push and occasionally kick, but it’s not enough.

We all need to work hard in schools, universities and in the media to see that that the interest in mental health of the new generation of students is translated into career choices.

And how we do that?  By telling the truth - that psychiatry is a great profession, with a great future.  It’s on the up - if you are academically inclined and want to crown your career with a trip to Stockholm, join us.

A privileged job

If you want to practise mind/body medicine, by all means think about clinical psychology, but remember you have more chance of success if you do this via medicine.  And whatever you do, there are few more privileged jobs around than one in which people will tell you things that they have never ever told anyone else before.

Yes, we have problems. But it’s important that we don’t paint an unduly negative picture.

If you want to get to know someone better in a bar or at a party, you don’t kick off by saying how generally miserable, put upon, stressed and ignored you are. It never worked for me, and I doubt it works when persuading people to think about a career in medicine in general or psychiatry in particular.

So Carpe Diemi. But that’s not the full quote - it’s “carpe diem, quam minimum credula postero”. In other words, "Seize the day, but put very little trust in tomorrow”.

Doing more than simply raising awareness

And there are concerns for the future.

Evidence now suggests that most people are aware of mental health and what that means. Most of those who had diagnosable mental health disorders identified in the last Adult Psychiatric Morbidity Survey knew that they had.

True, many remained unwilling to do anything about it for a variety of reasons. But they were aware.

But if that’s all we have done - raise awareness - but nothing to actually help, then expectations will be replaced by disillusionment and anger. I propose that next year we replace Mental Health Awareness Day with Mental Health Delivery Day.

And then there’s the money. There always is. Or to be more precise, perhaps there won’t be.  There is a consensus that NHS finances will drop of a cliff in 2018/19.  And then there will be covetous glances thrown at us.

Joined up approach

I am convinced that the senior voices in NHS-E are serious about achieving real gains for mental health services. But will that survive a sustained assault from other parts of the service, especially if the anarchy introduced by the discredited but still extant 2012 Act continues.

Between now and then we must use every effort to continue to build alliances across our sector - charities, think tanks, media, politicians - we need a united front.

Next, integration. My career has been partly about better integration of the physical and mental.  And a lot has been achieved.  New RCPsych data confirms that we are taking the physical health of our patients more seriously. And across the road we even more of a presence in A and Es and general hospitals than before, with more expansion coming. 

But it would be a sad irony if at the same time we permit a greater separation of the physical, social and psychological in our own back yards.

IAPTS has been an amazing success, achieved partly by a remarkable single mindedness and desire to disrupt a system that was not delivering psychological treatments on anything like the necessary scale.  But in the future we need also to ensure that we don’t permit the development of silos within mental health.

In the large consultation before the start of the Five Year Forward View which occupied much of my Presidential time the commonest thing that people told us that they wanted their physical and mental health care together.

They minded less where it was, more that it was in the same place, delivered by people who worked together. We have made progress on this, but success will depend on continued vigilance

So many days seized

Carpe diem. Seize the day.  And as I look the last three years have been full of many days that we have seized. The day we launched the Crisp Commission into Acute Care, and the days we spent on implementing it.

The days spend on the Five Year Forward View, and the days working with NHS-E on how to make it a reality. Days plotting how to shame CCGs lagging behind on mental health spending.

Evenings at the College listening to so many talented speakers, reflecting the breadth and depth of our profession. Mornings hearing about our fantastic plans for modernising our approach to the promise of neuroscience.

Early mornings getting up to do battle on the Today programme. Evenings spent in the devolved administrations and countries hearing the different paths they are taking, and trying not to be jealous.

And the days spent with your staff here at the College and your Officers - two Registrars, two Deans and two Scrooges.

Democracy has had a bit of a bad press recently. Last year it delivered two results that try as we might, many of us find difficult to believe will turn out well. But when it comes to our RCPsych democratic process, it resulted in the best colleagues I could have hoped to have.

One of them, Wendy, is about to take over.  We are in good hands.

And now my favourite last words. When Ramón Maria Narváez, Spanish General and political leader, was on his death bed, the priest asked him if he forgave his enemies.  His last words were “I do not have to forgive my enemies. I have had them all shot.”

 

 

[i] Pedanticus retired last month, but I am afraid I was unable to prevent him staging one final bow. “Carpe diem” comes from the Roman poet Horace, one of his Odes. But he says that readers might think my title “Ave Atque Vale” - translated as “greetings and goodbye” is also from Horace. I told him he was being silly, and that you would all know this is Catullus mourning his dead brother, but he insists that I point this out. He does have a bit of a temper, so I am doing what I am told.

Professor Sir Simon Wessely

Read the June 2017 eNewsletter

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Comments

Re: Ave Atque Vale
Thank you Sir Simon for being an outstanding President. We have a lot to thank you for, particularly your commitment, energy and enthusiastic advocacy on behalf of Psychiatry and Psychiatrists in the UK.
Re: Ave Atque Vale
The trouble with young doctors today is that they don't study Latin. I think we should drop all this modern neuroscience nonsense from the curriculum and get back to what's really important.



(not really)
Re: Ave Atque Vale
Periculum nihil sine periculo vincitur.
(even in Belfast).
Vale dux optimus
Emeritus Professor
Five productive years, Simon. Well done. Always respected your honest, bold approach.

{"Data" is still plural !!}

David
Re: Ave Atque Vale
Thank you Simon! I will really miss reading these regular missives while enjoying the sunshine down under...
Ave Atque Vale
I have been a Member and Fellow of the College for many years and Sir Simon has been the best and most outstanding President ever. You have pushed the cause of Psychiatry further than any other leader and I congratulate you on your amazing energy and effort, in promoting the subject both in the UK and internationally.
Re: Ave Atque Vale
Plain talking in plain English may not be a bad strategy! I am sure Wendy will push it. Goodbye and many thanks, Simon.
Re: Ave Atque Vale
As a not-so-young doctor who did study Latin & Ancient Greek at school & one of whose youthful nicknames was 'Encyclopedius Brittanicus', I wish to dispute with Pedanticus regarding the origin of this phrase. Catullus certainly incorporated it in his poem, but I believe that it was a habitual phrase used at Roman funerals long predating him rather than an invention. I second both of the preceding comments!
Re: Ave Atque Vale
Thanks for your services during the last three years as our president. one aspect, which you have highlighted, about increased awareness about mental Health especially bringing this in the political arena is true but it means expectations on the part of public at large is also high. Unfortunately, the politicians have not followed up with their support with increased resources in Mental Health. In Walsall, we actually have cut in Mental Health budget and the expectation from Commissioners and public have put the clinicians in an unenviable position. Having said that we need to stand up for our patients and that's what colleagues are doing.
Re: Ave Atque Vale
Will miss your blogs and speeches. You btought a calming style to leadership. Thank you
Re: Ave Atque Vale
Thanks for the blogs - have been a highlight of the college website for the past years

cheers
Re: Ave Atque Vale
Simon tells me he is very grateful for the kind comments, and wants to pass on his best wishes to all. He has however asked me to reply specifically to Malcolm Kinnear's post. Hmmm. Instinctively I feel you may be right, but an evening in the archives has failed to find an earlier reference before Catullus. Millions after, but none before. Can you do better? Kind regards, Pedanticus
Re: Ave Atque Vale
This has been a wonderful blog,with exactly the right balance of realism,optimism and humour.
Please can Simon continue as college blogger?!
Re: Ave Atque Vale
You have been a source of optimism and confidence for me when I wondered if there's any point in keeping pushing for better services. Thanks.
Nullius in verba
I want to add my voice of thanks to Simon Wessely. I do not believe that we have had any other President who has reached out in the way that he has, and this along with his determination for level playing fields, will make him a hard act to follow.

"Nullius in verba" is the motto of the Royal Society, it translates roughly as "on the word of no one". The Society state that it is "an expression of the determination of Fellows to withstand the domination of authority and to verify all statements by an appeal to facts determined by experiment."

For medicine we must also, always consider "primum non nocere" - "first do no harm". Ethics and philosophy are always necessary in my opinion.

Please forgive me mentioning more Latin(!) but it as a campaigner for transparency of financially vested interests in medicine I would have liked to have seen my College support a Sunshine Act. This support has not been forthcoming. Though declarations of interest have improved albeit in a bureaucratic, overlapping, costly and unsearchable system. There is also no way of finding where and to who the £340 million paid last year by the pharmaceutical industry went to for "promotional activities".

I do not agree with the College that our relationship with the pharmaceutical and other industries is "puritanical".

If you are interested to read more please look at "Sunshine Act for Scotland" is on my website Hole Ousia. My latest post on this is called "The Law of the Few"

I wish all the very best to Wendy in her period of Presidency.

Kind wishes
Peter J Gordon
Scotland
Re: Ave Atque Vale
Prof Wessely in his posts ,has been entertaining and engaging and has always managed to Inspire. We will miss him very much.
Re: Ave Atque Vale
Well done Simon. You have really succeeded in getting mental health out there in a way that has broken new ground.

Best wishes
Mark
Re: Strictly Presidential
My choice of phrase for this amazing outgoing president is: 'Vivir con miedo es como vivir a medias' (Gatsby, Strictly Ballroom) - perhaps basis for a tattoo?
Re: Ave Atque Vale
Thank you for the work you do.

It is people like you, who dedicate their lives to making others' lives better that we should praise.

I'm just an ordinary teacher, but I certainly teach students to respect and admire scientists.

Thanks again for your work and voice.

Cheers,
Angharad
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Professor Sir Simon Wessely

   

Professor Sir Simon Wessely

President


Sir Simon Wessely is Regius Professor of Psychiatry and Co-Director King’s Centre for Military Health Research and Academic Department of Military Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London.  He is a clinical liaison psychiatrist, with a particular interest in unexplained symptoms and syndromes. 

He has responsibility for undergraduate and postgraduate psychiatry training, and is particularly committed to sharing his enthusiasm for clinical psychiatry with medical students. He also remains research active, continuing to publish on many areas of psychiatry, psychological treatments, epidemiology and military health.

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