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

Help us to help you on the front line

It’s already more than two months since I took up the post of President. It has been a massively steep learning curve.

Having spent five years as Dean I thought that I knew the College, but it turns out there was a lot going on that I wasn’t aware of.  

I received a challenge earlier this week sent from the psychiatrist husband of a College committee member: “The College does nothing for jobbing psychiatrists”.

Having been a jobbing psychiatrist myself for over 30 years, I know why he said that.

 

On the front line

Out there on the front line it’s hard to know what the College is up to and all you see is resources dwindling away and demands and bureaucracy constantly increasing.

From my position now I can see exactly what the College is doing and how great the influence is.

Simon Wessely achieved a huge amount as President and psychiatry has been promised significantly more resources over the next few years.

What I have to do is to make sure those pledges are kept and that money does actually reach the services on the ground.

It was good to find out that in Leeds where I work new money for perinatal and liaison services has got through as promised. 

Something that has impressed me is the great esteem in which the College is held.

As its representative people in positions of power are keen to meet me and (apparently) willing to listen to what I have to say and be guided by it.

I now know that the College does have a major influence at a national level. This makes it really important that as many members as possible are directly involved.

 

How you can get involved

Some 1,880 of you already have some type of a role within the College and I hope this will grow. Please watch Posts for Members on the website.

We are currently advertising a number of interesting positions including Chairs of two Specialty Advisory Committees, General Adult and Child and Adolescent which oversee training in these specialities.

Involvement with training and trainees is fantastically rewarding, please consider applying.

You will be aware that the Government has announced that the Mental Health Act, covering England and Wales, will be reviewed in some way. This is as a result of the steadily rising number of detentions and the increased likelihood of being detained if you are black.

These aren’t issues that can be ignored and I’m pleased that they won’t be. It’s an area where I really do need to know what you are thinking and how to represent you so we are running a survey.

Members in England and Wales will have had a recent reminder email from me about this, please do try to complete it, I promise it only takes a few minutes. I also promise I won’t be constantly bombarding you with annoying surveys, it’s just that this is particularly important.

 

Our new campaign Choose Psychiatry

The final way in which I am asking for your help and involvement is with our recruitment campaign.

Recruitment has a been a problem for years now with unfilled core training posts each application round (although I’m hearing that the quality is improving if not the quantity). We are targeting doctors using social media so please share as much as possible.

We hope the campaign will help but what will make the biggest impact is you acting as role models.

Please forget the tedious computerised assessments and forms that you have to complete and concentrate on what you love about psychiatry.

Make sure that the medical students and Foundation doctors with you see how incredibly interesting the conditions that we deal with are, and what a huge difference we can make to people’s lives if we chose psychiatry as a career.

You can read more about the campaign in our article in this month’s eNewsletter, which also explains how you can support Choose Psychiatry.

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Comments

Re: Help us to help you on the
Dear Wendy and team,
the remodelled electronic Newsletter with the easy 'click through' topical 'panels' are so accessible it is difficult to improve on this, I think.

re Choose Psychiatry:
I should like to pick up on Wendy's (when do you find the time?) offer to visit various clinical academic sites and speak about Psychiatry, clinical research and academic careers.
I would like to formally invite Wendy to use her offer to visit Trusts and provide talks on RCPsych. We are (as she knows) in the process of developing a clinical neuroscience strategy integrating training in Neurology&Psychiatry, hope to become part of the NeuroscienceProject Implementation Executive Group, also.
We would like Wendy to please get in contact and I would discusse whether she might allow me to book the Norfolk & Norwich University Hospital NHS FT for one of our monthly major speaker mid-day time slots - Like a 'Grand Round', really.
Wendy would be presenting to our NNUH FT clinicians, including, amongst others, our:-
Departments of Neurology & Neuropsychiatry;
Newly commissioned Neuro-rehabilitation team,
General / LD / CAMHS psychiatry,
The jointly NNUH FT / UEA Med School appointed Prof for the integration of clinical research,
The national LifeSciences & Norwich Research Park teams, and members of the NNUH FT Executive / Non-Executive team, including our recently appointed (very senior) non-Exec Director and former Medical Director of one of the UK's largest MH&LD Trusts (Geraldine O'Sullivan), who has been very supportive of our / my developments in the East, too.
Speaker times are booked well into 2018, so I would love to hear whether Wendy might be able to come to Norwich next year - we are very hopeful!
Ekkehart Staufenberg (9243)
Re: Help us to help you on the
Hi Wendy, Please can I comment on the issues you raised, (these being entirely my own opinions, not that of my peers, employing organisations, CPN)

1. On trickle down funding of core services in the 5YrFdWv; unlike the Northern Powerhouse, we have seen none of the funding for Liaison, IAPT, Perinatal and most of all CYPS. This type of feudal funding is a bit like throwing money at Haiti by the shedloads, apparently only 50 cents in every 100 dollars reach the people affected by the hurricanes / earthquakes. This can be described legitimately as financial fraud and theft. The only realistic way to get money directly to users is to have a Mental Health / Chronic Disease charge card in to which the GP can attach e-vouchers for a patient to go to any NHS approved practitioner anywhere in England, to get the best quality and quickest access to packages of treatment (like IAPT, CBT, Mood disorder / Memory Clinic). That is the only way we can sort out waiting lists, which provides a perverse incentive for us to maintain our job security and whinging rights.


2. On getting involved in the college, I hear northerners find it difficult because often we don’t have juniors to do our work while we gad about doing college work and accruing national merit awards. Also, it seems to me that interviews for college posts are dependent on who you know (nepotism), to give insider knowledge about what the key issues are, and what is about to happen (for ex. The 5YrfwdVw components were known to a few in the College 6 months before the rest of us got to know). The Forensic group in the college seems to hold undue influence, despite wholesale closure of Forensic beds across England. People working with women, children and older people don’t seem to get a look in. Even when you get a job at the college, progress in implementing good ideas (such as suicide safety co-production) are blocked as it presumably undermines the institutional risk assessments inflicted on patients like HCR 20 and FACE. No wonder you have problems retaining good quality volunteers in college posts.

3. On your ‘new’ campaign to choose psychiatry, the problem is the consequence of the BMA selling us down the river by getting rid of early pension (MHO) rights. The oldies like me retired at 55, then got a portfolio job of our choosing with no on call. This delightful option is sadly not available to my younger colleagues (unlike the police service, the equivalent high stress public service). Until this wrong is righted, I cannot foresee recruitment patterns changing. In any case, most Trusts are rapidly moving to train up Non-Medical Prescribers (pharmacists), Physical Health Care Nurse Practitioners (who can do a much better Neurological Examination than I can) and RCs (who can write Tribunal reports based on a template, and provide a competent presentation in front of a Tribunal (having been more thorough in risk management and discharge planning). As you well know the 3 medical colleges have agreed (behind our backs) for a hybrid community consultant CCT involving 18 months in medicine and 18 months split between GP and Psychiatry. This leaves current psychiatric trainees in the lurch (as most of the N/E trainees are aware). Honest communication with our youngsters by the College is essential. You promised to update the curriculum to be fit for purpose for the 21st century, including neuroscience competencies such as sleep disorders, movement disorders, immune disorders relevant to young onset conditions, but I have not seen any moves in this area by the academic dean.

4. On the government wanting a new Mental Health Act, we need to accept responsibility for this through our malpractice of using the MHA with increasing frequency, despite (possibly because) of the ready availability of Crisis Resolution and Street Triage services. The issue about over sectioning black people might also be reflected in increasing detentions of PD, Dementia and LD challenging behaviour people. The government is (rightly) concerned about the massive financial wastage of excess detentions, appeals, tribunals, blocked beds etc., and will make sectioning much more difficult, taking in to account article 8 of the Human Rights Act, as they are worried that clever lawyers will use this to get lots of compensation from Trusts, rather than challenging the MHA process of detention.

5. An added issue I feel most strongly (!!) about is the misuse of antipsychotics (Risperidone) and Mood Stabilisers (Valproate) for incapacitious people with challenging behaviour, probably accounting for much of the physical health morbidity and mortality. Indeed the latest concern is Sepsis brought about by atypical antipsychotics which reduce our immune responsivity via hyper insulinaemia. I am particularly concerned as an Old Age Psychiatrist about the latest POMH audit of antipsychotic misuse in BPSD, but suspect similar things (not using non pharmacological options first, lack of discussion about harmful risks of drugs, inadequate physical health monitoring, poor documentation of rationale / duration of drug trials and attempts to stop one drug before starting another) is commonplace in other disciplines, for example use in the EUPD (Borderline) group; as there is continued belief (completely disproven in multiple studies) that the person has to be on an antipsychotic or mood stabiliser in order to engage in DBT / CAT etc. These are young people very much at risk of prolactin based side effects, akithesia, stroke, VTE and acute ketoacidosis / diabetes and, as I mentioned, Sepsis. As prescribers we are (justifiably) at risk of challenges via the human Rights Article 8, i.e. failure to maintain physical safety. Long waiting lists and non-treatment will also incur this challenge.

6. It will be easy for you (and Simon) to take this personally, but please try not to. I am way past my selfish career ambitions, and simply want remedies for things I have observed since getting my MRCPsych in 1989. Kind regards and Berakah Shola
Re: Help us to help you on the
Dr de Silva : you should write some articles or educational modules for GP s to improve our understanding of the ethical issues around psychiatry
Re: Help us to help you on the
Dear GP - please check out the current edition of British Journal of Hospital Medicine. 'How to improve psychiatric services - a perspective from critical psychiatry'.


Also, please check 'Looking back to the future: a personal reflection on the Francis Inquiry' Progress in Neurology and Psychiatry. Vol 18(4) July/Aug 2014 pp 4-6. Thank you for your interest; ethics in psychiatry is really important, our trainees and medical students are more conscious of this than we are. Shalom & Berakah Shola
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Professor Wendy Burn

   

Professor Wendy Burn FRCPsych

President


Professor Wendy Burn became a consultant old age psychiatrist in Leeds in 1990 and now works fulltime in a community post. Her main clinical interest is dementia.

She has held a regional leadership role in this area from 2011 and was co-clinical Lead for dementia for Yorkshire and the Humber Strategic Clinical Network between 2013 and 2016.

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