1. Message from
the President: Professor Sheila Hollins
December is often called the festive season
but its traditions are rooted in several different religious
festivals, including Hannukah which began on 5th December for 8
days, Advent which began on 2nd December and ends on Christmas Day
and Eid al-Adha on 20th December. The College is a secular
organisation with members from many different traditions and our
patients likewise share in this diversity. During my recent visit
to New Zealand and Australia I had the chance to visit some mental
health services. In Auckland I particularly enjoyed a Maori welcome
in one of the Forensic inpatient services where I was impressed by
the success they are having with a cultural programme which values
the Maori heritage. I would be interested to know if any similar
cultural programmes are on offer in services in the UK.
I also attended the WPA Regional Congress and
met the RANZCP officers to discuss training issues. The reciprocity
agreement we have had with RANZCP is no longer valid as both
Colleges have changed our curricula substantially. Work will
commence soon to look at our curricula afresh and to seek a new
reciprocity agreement. I was also invited to lecture on health and
mental health in people with intellectual disabilities in three
cities and am aware how much the lack of a specialism in
intellectual disability in Australasia hampers the mental health
care of this population.
On my return I was delighted to host a meeting
with representatives of the Iraqi Kurdistan regional government to
sign a Memorandum of Understanding (MOU) about a programme of
training to take place in Kurdistan in the New Year with volunteer
trainers identified by the Iraqi subcommittee of the Board of
International Affairs. The MOU is on the
College website.
As part of my commitment to
international psychiatry, I am a consultant to the World
Psychiatric Association’s Task Force on “Brain Drain”. The Task
Force is keen to hear about the experiences of International
Medical Graduates. If you are an International Medical Graduate I
would urge you to complete a short questionnaire in confidence
which the Task Force has put together and encourage others to do
so. The questionnaire is available on our website -
http://www.rcpsych.ac.uk/college/internationalaffairsunit/questionnaireforimg.aspx)
I have recently joined the
Standing Commission on Carers which was set up by Gordon Brown, and
this reminds me of a commitment I made when I became President to
consult with other Members and Fellows of the College who are
'carers'. If you are providing significant support to a family
member or friend because of illness or disability and would like to
meet me and other colleagues to think about informal caring and
support roles from the added perspective of being a psychiatrist,
then I would be pleased to hear from you.
With best wishes for the holiday season
Part of the work of External Affairs, Public Affairs and Policy
is to scan legislation and new policy from government and other
public bodies. The Divisional offices in Ireland, Northern Ireland
Scotland and Wales do parallel work. In the e-newsletter, we plan
to share with you policies which are of direct relevance to day to
day practice.
We have recently set up a system to track policy as it comes out
to ensure that our responses are consistent, timely and most likely
to have impact. We need to shape and influence government policy,
and not just react to changes.
The new central policy committee, which I chair, allows our
member countries to compare policies, so members can share and
learn from each other.
We are delighted to have had an overwhelming response for
applications for our new patient and carer forums. The first
meeting will be at the end of January. One of the most popular
ideas to come from our annual patient and carer meeting was to
produce quarterly newsletters to promote the sharing of new ideas
and good practice.
With best wishes for the holiday season
3. Association of Chief Police Officers (ACPO)/RCPsych Liaison
Group by Dr Jason Payne-James, Vice-President (Forensic Medicine)
Faculty of Forensic and Legal Medicine, Royal College of
Physicians
The ACPO Liaison Group at the College was set
up on the advice of the College's Patient’s and Carers’
Committee (PCC). It is an informal group and as such does not
have a formal remit or mission statement. It has a
multi-professional membership, and apart from members of the
Royal College of Psychiatrists (it is chaired by Professor Sue
Bailey) includes representatives from the Metropolitan Police
Service, the Independent Police Complaints Commission (IPCC), the
Police Service of Northern Ireland, the Mental Health Act
Commission and the Faculty of Forensic & Legal Medicine of the
Royal College of Physicians.
Issues discussed and explored are wide and all
have direct impact on the health and welfare of those detained in
police custody. Recent topics for discussion have included:
- potential effect and implications of the
Mental Health bill on the workload of police services whose
officers may be involved in the application of community treatment
orders
- proposals for increasing the use of Tasers
beyond firearms officers in circumstances of serious violence or
threat of violence
- assaults on NHS staff and the need (or
otherwise) for involvement of police – and the need for and
appropriateness of diversion strategies
- management of acute behavioural
disturbance
- standards of places of safety under s136
MHA
- IPCC report on the use of police cells as
places of safety
- review of healthcare issues of detainees in
police custody.
This a very relevant group as there is
increasing recognition of the importance of ensuring high quality
and professional healthcare delivery to the many vulnerable
individuals in short-term custody. This close
collaboration between the police and mental health and other
healthcare professionals is able to identify problems and provide
advice, cascading it out to the relevant personnel.
4. Lord Darzi’s Review by Dr Mike Hobbs, Medical Director,
Oxfordshire & Buckinghamshire Mental Health Partnership NHS
Trust and Chair, South Central SHA Mental Health Clinical Pathway
Group
The aim of this DH initiative, led by Health Minister Lord
Darzi, is to set out a vision for the development of the NHS over
the next 10 years. Publication of the vision will be at the centre
of the NHS 60th anniversary celebrations next June.
The review will cause further reorganisation
of the NHS, but should shape further improvements. The review
process emphasizes the engagement of NHS staff, service users and
carers, other key stakeholders and the public.
In the first stage of the review, NHS staff
have joined a number of clinical pathway groups (CPGs) within each
Strategic Health Authority. There are eight CPGs, one of which
focuses on adult mental health. There is also a children's CPG
which will address children's mental health, and significant
overlap with the CPGs for acute healthcare, long term conditions,
maternity and new life, and end of life. Each CPG has
identified local examples of good practice and priorities for
further development.
Each SHA will consult widely in the first
three months of 2008 through a number of high profile stakeholder
events as well as local meetings. We hope that psychiatrists will
contribute actively to the consultation process.
The chairs (eight of whom are psychiatrists)
of the 10 mental health CPGs have collaborated to identify a set of
common proposals which should maximize the impact of the mental
health contribution when each SHA's output is distilled into a
single national report.
On the basis of this consultation, the DH will
publish national proposals next June. We anticipate that this
will affirm the improvements achieved in mental health services
over recent years and set out a programme for future service
development.
5. 14th Annual Census of Psychiatric Staffing
2006
The results of the Annual Census of
Psychiatric Staffing for 2006 are now available. The census covers
England, Wales and Northern Ireland. Scotland carries out its own
census which will be reported separately on the College
website.
The return rate from Trusts was the highest
ever – 92% for England 91% for Wales and 100% for Northern Ireland.
In the presentation the figures have been extrapolated to 100% to
enable easier comparison with earlier years.
http://www.rcpsych.ac.uk/training/census.aspx
6. PMETB National Trainers’ Survey by Dr Chris
Murphy
PMETB is launching the first UK-wide survey of
all postgraduate medical educational trainers in January
2008. The online survey is for all GP trainers and
consultants, including those not currently involved in
training. It was developed by a working group with
representation from the colleges and contributions from medical
education researchers at the Northern Deanery. It should take
no more than five minutes to do.
This month PMETB is asking deaneries to
nominate survey points of contact for each of their main
organisations. This is likely to involve the Schools of
Psychiatry where they are best placed to identify and contact all
consultant psychiatrists within their geographical area. In
January the nominated individuals will email their consultant
colleagues with information on how to access the survey. Any
consultant not receiving this information by 18 January, please
contact trainer.survey@pmetb.org.uk.
PMETB will use the results for quality
assurance and the deaneries will be able to focus their quality
management activity on areas of concern, where for instance the
survey results indicate that trainers do not get the support and
time they need to deliver training.
Outcomes from this work will be available
online from April 2008.
For any queries regarding this survey see
www.pmetb.org.uk/trainersurvey
7. On the Edge: an interactive mental health education
programme for schools by Dr Glenn Roberts
On the Edge is an interactive mental health
education programme for schools based on applied drama. It
arose from a collaboration between psychiatry and performance arts
in Exeter. This process of co-working, drawing together
psychiatric concerns with arts based methods of communication, grew
out of earlier work for the College Campaign, '2001 a Mind
Odyssey'.
In 2004/5 the programme went on a national
tour of schools and colleges involving 124 performances to 2,500
students and as many mental health professionals, teachers and
community leaders. It demonstrated that it can fulfil its
aims of supporting students in developing knowledge and
understanding about first episode psychosis, reducing stigma and
discrimination and supporting help seeking attitudes and knowledge
of where to turn. It has also been a means for first episode
teams to develop valued relationships with their local
schools. Having been adopted by the National EI development
programme and won regional and national prizes for innovation and
positive practice, it is on the move again.
On the Edge: Devon has been established as an
independent charity, and the programme recently gained support from
the All Party Parliamentary Mental Health Group who tabled an Early
Day Motion (no 110) in support of mental health education in
schools and OtE in particular. Currently this has been signed
by 82 Members of Parliament. Our aim is to pull together this
political support with that offered by national and international
leads and to apply for grant funding to make the programme
available to 15 year olds in schools in Devon annually for three
years. This is in fulfilment of the international standard
for public mental health education on early psychosis, the
Newcastle Declaration. Through further development and
evaluation we also hope that this local model would offer lessons
that could be valuable nationally. If you wish to support it
please ask your MP to sign the EDM - and wish us luck.
Progress of the EDM (no 110) can be followed
at:
http://edmi.parliament.uk/EDMi/EDMList.aspx
Evaluation of On the Edge can be seen at:
<http://www.spa.ex.ac.uk/drama/exstream/ontheedge/ote_report.pdf>
Or contact us on: mail@ontheedgedevon.org.uk
8. National Audit Office (NAO) publishes Helping people through
mental health crisis: The role of Crisis Resolution and Home
Treatment services
The report says that many people with
psychosis, severe depression or anxiety could avoid the stress and
stigma of admission if they had appropriate care at home. In 2002
the government promised to set up 335 multidisciplinary crisis
resolution home treatment (CRHT) teams across England to assess
everyone in the early stages of an acute psychiatric illness.
The NAO found the NHS spent £183m on providing
the service in 2006-07, but it failed to reach half the 84,700
people admitted to in-patient care. Although there were 335 CRHT
teams, almost a third had no consultant psychiatrist and more than
half did not include any approved social workers.
Lord Patel of Bradford, chair of the Mental
Health Act Commission, commented: "I am deeply concerned about the
continued high levels of admission and detention suffered by some
black groups." The problem was especially pronounced among young
men in second and third generation black British families. "There
are some very serious questions that need answering about the way
these people are being treated," he added.
To read more, click here -
http://www.guardian.co.uk/society/2007/dec/07/mentalhealth.publicservices
To read the report, click here - http://www.nao.org.uk/pn/07-08/07085.htm
9. Healthcare Commission -State of Healthcare
Report 2007 - Improvements have been made but services must
do more to be world class
The Healthcare Commission has published its
fourth report into the state of healthcare in England and Wales.
The report sets out the main improvements in healthcare during
2006/7 and six key challenges for service providers:
- improve the
planning and commissioning of services
- improve access
outside the waiting time targets
- promote a
culture of safety more effectively
- improve
healthcare for children and young people
- demonstrate
more sensitivity to the needs of the individual
- use
information better
Particular areas the report highlights that
relate to mental health include:
4) NHS trusts
are performing better overall on quality of services, but the
performance of primary care trusts (PCTs) has declined, with many
not getting to grips with the needs of their communities so as to
provide services to match
Where there is a known need, PCTs are not
always providing the services required. Some 60,000 people with
serious long-term conditions did not get the care from community
matrons that was originally planned. 41% of PCTs failed to purchase
sufficient crisis services for people who are seriously mentally
ill, resulting in 5,000 fewer people receiving the service than
planned. Some 85% of PCTs did not have arrangements for providing
education programmes for patients with diabetes in their
area. And 2,000 GP practices did not fulfil their PCT's plans
to establish registers for people at risk of coronary heart
disease, designed to help prevent these patients from becoming
seriously ill.
(7) The NHS
often fails to meet the needs of children and young people and
there are concerns about other groups requiring specialist care,
such as people with mental health problems and with learning
difficulties
Transition from child to adult services is not
managed well in services for people with mental health problems,
diabetes and disabilities, and those requiring palliative care
services. Vulnerable children such as those with disabilities,
those in care and young offenders face particular problems in
getting appropriate care. One in 20 NHS trusts is not yet
compliant with child protection standards.
On specialist wards for people with mental
health problems and people with learning difficulties, more than
half of the inpatients were in mixed-sex accommodation.
Levels of violence in mental health services
remain high, although there are signs that staff manage it
better. The report includes new data from an audit into
violence in the sector, which found that almost one in 20 patients
reported being assaulted. 46% of nurses reported being physically
assaulted, and 72% said they had been threatened or made to feel
unsafe. On older people's mental health wards, almost two-thirds of
nurses reported physical assault by patients.
The full report is available on
http://2007ratings.healthcarecommission.org.uk/patientsandthepublic/stateofhealthcare2007.cfm
Kathryn Hill, Director of Mental Health
Programmes at the Mental Health Foundation has responded to the
Healthcare Commission's fourth State of Healthcare report. She
said: "What stands out in the report is the number of incidents in
mental health services that resulted in severe harm or death - they
are disproportionately high. The figures, reported via the National
Patient Safety Agency, show that more patients die as a result of
an incident in a mental health service
than in any other setting, including acute and general hospitals
where there are five times as many
reported incidents. These statistics require urgent investigation
and
action."
10. Extra £520 million of ring fenced funding to
transform social care
The Health Secretary, Alan Johnson, has announced an extra £520
million of ring fenced funding to transform social care through the
introduction of personal care budgets in England. In 'Putting
People First' central Government, local Government, and the
professional leadership of adult social care and the NHS have
jointly committed to a radical transformation of care services over
the next three years. The Health Secretary Alan Johnson said:
"One of my top priorities is to develop a new care system which
gives people maximum control over their own support services." In
addition to Alan Johnson, five cabinet members have also signed
'Putting People First' as lead partners with involvement in the
reform process.
Councils will receive the extra £520 million as a social care
reform grant over the next three years. The grant includes some NHS
resources in recognition of the impact social care can have on
improving people's health and well-being.
Key elements of the transformation programme in every community
will include:
- Giving the vast majority of people who receive funded care
their own personal budgets so they can choose the support services
they want for themselves or a family member. An increasing number
of people to utilise direct payments.
- High quality care homes, home care and day services to be
rewarded; poor performers failing to respect people's dignity no
longer used by local councils and the NHS.
- Initiatives such as first-stop shops becoming common place so
that everyone, including people who do not have support from social
services, will have access to advice and advocacy about community
services, such as local community equipment providers, fall
services or domiciliary support and transport links.
- Investing in support that keeps older people healthy and
tackles loneliness and isolation.
- Closer collaboration between the NHS and local government so
that people receive more coordinated and efficient support in the
community.
“Individual budgets could bring ‘huge change’ to personal care,”
said Lord Adebowale, Chief Executive of Turning Point.
11.
Events
- Educational
supervisors workshop: 24th January
2008
- New
Tutors Induction Day: 13th February
2008
- Faculty
of Academic Psychiatry Annual Conference: 21/22nd
February 2008
- CPD
Online – what’s new?
- Education and
Training Centre events
-
Community of Communities
-
Events held by other organisations