February 2007

Psychiatrists working in new ways

I am intrigued by the stories coming to me about psychiatrists working differently, and seemingly doing things better for their patients, their colleagues and themselves.  I thought it worth inviting discussion on our College website using the experience of one such consultant who comments in his work diary.
Diary of a ‘New Ways of Working’ consultant psychiatrist

‘Things have certainly changed from the old days when I would feel a knot of tension in my stomach on a Sunday evening as my attempts to block anxiety about what faced me the following day failed.  I used to have a big caseload of 300 patients that I prided myself on seeing as regularly as possible.  Given how busy I was I used to constantly be looking over my shoulder for fear that something would go wrong, or that someone in the team might do something that reflected badly on me.  After all I had overall responsibility.  It was a relief as the rich web of myth and inaccuracy surrounding my role and responsibilities began to be unpicked.’

I believe that there are still many colleagues working under very arduous and stressful conditions.  I wonder if the potential for improving their professional lives is widely enough understood?  Do the achievements of some psychiatrists through New Ways of Working promise realistic prospects for many more?  What are the obstacles?  Your contribution to this debate on our website will help me to determine what more the College may need to do to promote and support the right kind of changes in our professional practice.

These new ways of working were not invented or imposed from outside our profession.  It was consultant psychiatrists themselves who started to describe innovative approaches that patients and other professions have welcomed, and Chief Executives backed.  Our immediate past President, Mike Shooter, concerned about the appalling burdens being carried by many members of the College, pressed government to set up a national steering group.  The final report (2005) describes how the other professions are now involved.  The GMC has revised its guidance.  The Department of Health has agreed model Trust board policies to support these changes.  Coroners are being educated about the implications.

I shall be very interested to see debate about how this one consultant’s innovative ways of working might apply more widely.  How are these principles for change being applied in the different subspecialties?  What concerns inhibit change?  What do I as your President need to tackle at national level to free up your creative drive to adapt clinical practice better to the enormous changes that have occurred in service design, public and patient expectations?

2. Find out more about the progress of the Mental Health Bill in the House of Lords

http://www.rcpsych.ac.uk/press__parliament/about_our_parliamentary_work/legislation_and_responses/2006-1/mhb_newsletter_0207.aspx

3. Department of Health Race Equality: What has the College been doing?

Following the Lawrence enquiry, which highlighted the issue of institutional racism in British society, the College set out to review its policies and procedures. It commissioned the University of Lancaster to undertake this work as the College considered the issue to be of such importance.  The College Special Committee on Ethnic Issues (SCEI), chaired by Dr Parimala Moodley, has overseen the review. The University of Lancaster is due to present its report at the College's Annual Meeting in June 2007.

The attention of the SCEI was drawn to the Department of Health's apparent disregard of the findings and impact of the Lawrence enquiry.  Initially this was related to the Department’s superficial and belated attempt to undertake a Race Equality Impact Assessment (REIA) on the first draft of the Mental Health Bill.  User organizations and professionals accused the Department of initiating a cosmetic and meaningless exercise and declined to engage in the process of undertaking a REIA.

The Department has again been publicly accused of disregarding the requirement to undertake a REIA, most recently by the judiciary. On this occasion, it is in relation to the requirements being imposed on non-EC doctors working in Britain who have visa or Highly Skilled Migrant Programme (HSMP) restrictions.  The Presidents of most of the Royal Colleges, including our President, were critical of Lord Warner's statement on the matter. The judicial review initiated by the British Association of Physicians of Indian Origin (BAPIO) clearly found the Department wanting in this regard as it had not considered it necessary to undertake a REIA before making changes which would have a differential impact that was not race neutral.  The College welcomes the Commission for Racial Equality investigation because the principle that the law applies equally to all public bodies needs to be firmly established as a reminder that there cannot be any exceptions in this highly sensitive area.

The European Commission has stepped up its campaign by issuing a consultative Green paper to promote smoke-free environments throughout Europe. http://ec.europa.eu/news/environment/070130_1_en.htm

In February 2007, Professor Louis Appleby issued a letter to all Mental Health Trust Chief Executives outlining how the Government’s plans for smokefree legislation will affect mental health Units.

http://www.dh.gov.uk/PublicationsAndStatistics/LettersAndCirculars/DearColleagueLetters/DearColleagueLettersArticle/fs/en?CONTENT_ID=4142561&chk=PCt7At

5. Mission Possible – Mental Health Acute Inpatient Conference, Crowne Plaza Hotel, Glasgow, May 16^th 2007

Scottish Division Events 

A conference with a difference.  Instead of the usual Scottish Division summer residential meeting in 2007 we are embarking on something new.  With the Scottish Association for Mental Health (SAMH) we will co-host a one-day event on acute inpatient services in Scotland.

Last year the Division co-chaired a working group with SAMH to look at acute inpatient care, which has been of concern to mental health professionals, patients and carers for some years.  The multi-professional group became known as the HOPE group.

The acronym stands for:

How it feels – the culture of the ward

Occupation – what there is to do

Physical environment, layout of the ward, furniture and fittings etc

Engagement (including management)

The group met over the summer and put together a paper for Delivering for Health, published in December 2006.  The group was pleased that one of the commitments in Delivering Mental Health is the establishment of acute inpatient fora throughout the country, the main recommendation of the HOPE report.  Following on from this work, the Division agreed to join with SAMH in holding a conference that would be a bit different.  In addition to SAMH, the other organisations involved in HOPE have also contributed to the programme.

The aim of the summer conference is to create an opportunity for participants to listen and contribute to shaping the ideal mental health environment for people in hospital.  It is a chance for delegates to be inspired as the event will showcase positive and innovative work being implemented in acute units throughout Scotland.  The focus for the day is on what is achievable (hence the title).

Speakers include Jack Black (not from School of Rock) and Professor Phil Barker.  Delegates will have an opportunity to step into a therapies room and throughout the day healthy food and drinks will be available.  Music will play an important part in the event and video and art will help people focus their thoughts.