February 2008

1. Message from the President, Professor Sheila Hollins

Women’s Mental Health in Relation to Abortion

Dear members

The College has been asked by the Department of Health to update its statement on women’s mental health in relation to abortion. The Registrar and I are keen to invite anyone with a particular research or specialist interest in this topic to contribute to either a small meeting in London or an e-mail discussion.

The College statement will not address ethical dilemmas, but will be restricted to what is known from psychiatric research and practice.

Please e-mail my PA – ecook@rcpsych.ac.uk – to let me know if you would like to contribute and what your expertise is. We will also put the draft statement on the website for your comments.

Best wishes,

Professor Sheila Hollins President

2. Trainees and trainers urged to give their views on postgraduate medical education

You will be hearing from PMETB to take part in the trainers survey. Please do take time out to respond as this is one way of ensuring that trainers’ voice is heard by PMETB, and in this time of ongoing change the powers that be listen to the opinion of people who matter.

Professor Dinesh Bhugra

Dean

Trainees and trainers in postgraduate medical education have been given the opportunity to take part in national surveys aiming to give a picture of training across the UK.

The National Survey of Trainees 2007/08 and the first ever National Survey of Trainers are now underway. By completing the survey, trainees and trainers will help build a picture of the current state of postgraduate training across the UK. They will then be able to access the results of the surveys on a new website to be launched in April 2008.

For further information on how to complete either the National Survey of Trainees or the National Survey of Trainers, please go to: www.pmetb.org.uk/pmetbsurveys.

3. Payment by Results for Mental Health Services Project Update: Dr Martin Elphick

A new factsheet has been issued, the fourth in a series, to be found at http://www.dh.gov.uk/pbr%20(under the subheading ‘Projects in Development’).

The Department of Health has taken the decision to use the Care Pathways and Packages approach of grouping service users into clusters as the basis for developing mental health commissioning currencies. They are seeking to involve providers and commissioners from across England. The factsheet gives details of the sites so far involved.

The Department of Health has published the overall consultation on the future of PbR. It confirms that mental health is a priority area for development, having been identified as the service area that could most benefit by being included in an expansion of PbR. Respondents also emphasised that a purely activity-based currency would not be suitable for mental health. The response is at:

www.dh.gov.uk/en/Consultations/Responsestoconsultations/DH_082424

The Department of Health PbR team is hoping to organise a clinical conference with the College after Easter to gather clinicians from across the country to discuss issues such as good practice packages of care and a standard approach to needs assessment.

Linked to the mental health work is a payment by results development site focussing on learning disability services. Leicester Partnership NHS Trust working with Coventry and Warwickshire Partnership NHS Trust is leading on this work.

4. Northern Ireland Division raises public profile

The Northern Ireland Division has taken advantage of the devolved Assembly to ensure that mental health remains at the top of the political and public agenda.

The College lobbied widely for improved resources for mental health, responding to a Government consultation directly and through letters from members and the Joint Service User/Carer Committee, as well as through the media. Mental health fared unexpectedly well, with resources almost double what was expected. The College will use the relationships that it is building with politicians to garner support for the new College FAIR DEAL Campaign which will be launched later in the year. It is also a founding member of a new Mental Health and Learning Disability Alliance of a variety of voluntary sector and non-Government bodies with an interest in mental health.

The College will also host a two-day conference on Current Developments in Mental Health Services for staff from all sectors of multidisciplinary mental health teams, as well as service users and carers in March. Service users and carers will have an extra day focussed on building capacity.

The Northern Ireland Division is also looking forward to welcoming eminent psychotherapists from around the world to a conference on The Psychoanalytic Therapy of Severe Disturbance, on 26th and 27th June. Bursaries are still available. Contact: nmcnairney@nirelanddiv.rcpsych.ac.uk).

www.rcpsych.ac.uk/college/divisions/northernireland.aspx

5. Scoping Group in Undergraduate Education

One of the key aims of the Scoping Group in Undergraduate Education in Psychiatry was to develop Core curriculum guidance and ideas on how to deliver this.    The Scoping Group has produced a suggested core curriculum.    We wish to consult  on it  with members of the College. After that we hope to use the Delphi technique as a way of honing down the curriculum and achieving some consensus (depending on resources available)  while staying rooted in the evidence available. We will then make a final recommendation to the College Education and Training Standards Committee.

Please send any comments to dgoka@rcpsych.ac.uk.

6. Better support for emotional wellbeing in schools – 25 pilot areas announced

Minister for Young People Kevin Brennan has announced that 25 local authorities will begin the Targeted Mental Health in Schools project to help better support emotional wellbeing in schools.

The local authorities are; Luton, Norfolk, Suffolk, Leicester City, Lincolnshire, Hackney, Merton, Southwark, Gateshead, Northumberland, Sunderland, Blackburn & Darwen, Blackpool, Bury, Brighton & Hove, Kent, Reading, Leeds, North East Lincolnshire, Coventry, Shropshire, Wolverhampton, Gloucestershire, Swindon, Cornwall.

Kevin Brennan commented 'Good mental health and wellbeing are crucial to ensuring that all our children and young people can learn, achieve and fulfil their potential. Early detection and intervention through schools and nurseries is vital in doing this. I would like to congratulate each of the local authorities that will be taking part in these important pilots. Each pilot will be implementing innovative ways to ensure a better service to some of their most vulnerable children and families and their success will inform the national roll-out of this project.'

The schools, who have all chosen to be involved in the pilots, will develop innovative approaches to mental health support, bringing together professionals and relevant services to ensure holistic help and support is easily accessible to those children and their families who need it most.

Funding for the pilots will be available as part of the GBP60 million announced by Secretary of State Ed Balls in July 2007, to promote mental wellbeing in schools.

The pilots will be able to use the funding for:

• More practitioners: school based staff (such as learning mentors and family support workers); practitioners with mental health expertise i.e. primary mental health workers, therapists;
• Voluntary sector providers - to work in and close to schools;
• The development and delivery of effective training and support for practitioners.

Each pathfinder will employ a project manager. Further guidance for schools containing more detail on therapeutic interventions will be published in early 2008. The guidance will supplement the Social and Emotional Aspects of Learning (SEAL) programme and will summarise the key findings and emerging evidence from the pilots as well as providing suggestions on interventions which are consistent with the overall SEAL approach.

The pilots will be evaluated to identify successful models of mental health support and the findings will inform the roll-out of Targeted Mental Health in Schools nationally in 2009-10 and 2010-11.

7. Good leadership and management are keys to avoiding failings in patient safety, reports the Healthcare Commission on learning from 14 investigations

The Healthcare Commission has urged the boards of all NHS trusts in England to heed the lessons from serious failings in healthcare services. The Learning from investigations report reviewed all investigations undertaken by the Commission under its statutory powers from August 2004 to April 2007. Investigations are undertaken where patient safety is seriously at risk.

The report highlights common trends in the investigations the Commission has undertaken: poor leadership, ineffective management, inadequate teamwork with staff feeling unable to communicate problems and a lack of clarity about who was responsible for what across the trust. Another trend has been NHS trust boards concentrating on some of their activities, such as the delivery of targets or mergers, at the expense of others.

The Commission said all organisations face change and have to deliver on objectives. The message from the findings of investigations is that trust boards need to do this and deliver on the basics of quality of care and safety.

The Commission has carried out 14 investigations since August 2004. The report covers the first 13 investigations. The latest investigation into infection control at Maidstone and Tunbridge Wells NHS Trust, published in October 2007, highlighted many of the same concerns.

The Commission conducted two investigations into learning disability services, three into maternity services, two on infection control and two about bullying and harassment. Other investigations covered specific clinical areas such as gastroenterology, cardiac services, management of medicines and emergency care.

Following an investigation, the Commission makes recommendations to address immediate problems and to make improvements in the longer term, as well as recommendations on national practice where appropriate. The Commission works with the trust and the strategic health authority to ensure action plans are implemented and improvements are made. The Commission makes a follow-up visit after one year to ensure progress is on track and make further recommendations if necessary. The Commission aims to work cooperatively with trusts on improvements and avoid formal escalation to the Secretary of State unless absolutely necessary.

However, on three occasions, the Commission deemed that the trust was not capable of implementing the necessary change without outside help and formally recommended "special measures" to the Secretary of State.

Anna Walker, the Commission's chief executive, said: "Good leadership means not taking your eye off any aspects of the trust's activities - no ifs and no buts. In practice, this means ensuring staff are encouraged to speak up about concerns. Given that modern medicine involves risk, it means monitoring these risks and ensuring that issues such as infection control are high on the management agenda. It also means never underestimating what it takes to manage change, as well as ensuring those most in need are looked after properly. Above all, it means boards putting systems in place to turn their vision of quality care into a reality on the wards.

www.healthcarecommission.org.uk/_db/_documents/Learning_from_investigations.pdf

8. Cannabis: reclassication debate

The Advisory Council on the Misuse of Drugs (ACMD) (an independent expert body that advises government on drug related issues in the UK) met to review evidence examining whether tougher penalties should be introduced for cannabis, four years after the drug was downgraded from Class B to Class C.

For more information click here - drugs.homeoffice.gov.uk/publication-search/acmd/cannabis-review-agenda?view=Binary

Home Secretary Jacqui Smith has insisted she still has an open mind about whether cannabis should be reclassified, the head of the Government's drug advisers said. This will reassure members of the advisory council, as some members of the committee had said they would consider resigning if the Government ignored its conclusions. Asked if he had been reassured by the pledges in Ms Smith's letter, Professor Sir Michael Rawlins, Chair of the ACMD said: "Absolutely, yes."

Cannabis was reclassified in January 2004, making possession a largely non-arrestable offence, and placing it alongside some prescription anti-depressants and bodybuilding drugs.

Prime Minister Gordon Brown announced last July, within weeks of taking over at No 10, that he would demand a new review of the drug's legal position because of new emerging evidence about its effects and reports that stronger strains of the drug were becoming available.

Senior police officers are urging the government to reclassify cannabis as a Class B drug. The Association of Chief Police Officers said reclassification would end confusion over the status of cannabis. "We do support a re-classification back to B, and there's three reasons for that", Assistant Chief Constable Simon Byrne told BBC News.

However, the charity Rethink, who launched their (beautifully titled) 'Educating Reefer' campaign. This campaign calls on the Government to stop wasting time and money debating the classification of cannabis, and focus instead on educating people about the mental health risks. They advise putting the money into a public health campaign to educate people about the mental health dangers and state that King-size rolling papers should carry health warnings like those on cigarette packets.

http://www.rethink.org/how_we_can_help/campaigning_for_change/cannabis_and_mental_illness/index.html

Jackie Spencer

Project Manager - Mental Health

10. Suicide rate drops in young men

The rate of suicide among young men in England and Wales has fallen to the lowest level for more than 30 years, according to new research.

A study by the University of Bristol's Department of Social Medicine found the percentage of men aged 15 to 24 who take their own life has almost halved since a peak 18 years ago.

In 1990, there were 16.6 suicides for every 100,000 men aged 15-24 but by 2005 the rate had fallen to 8.5 per 100,000, the lowest level since 1974.

The study, published in the British Medical Journal, said catalytic converters on cars have reduced the number of lives taken using poisonous exhaust fumes but there has also been a fall in suicides by other methods including hanging - the most common method used by young men.

Researchers said factors which create an increased risk of a person committing suicide, such as unemployment and divorce, also decreased during the same period. In men aged 25-34, the rate fell by a third from the peak rate of 27.8 deaths per 100,000 men in 1998 to 15.7 deaths per 100 000 men, the lowest level since 1978. The report, entitled Suicide rates in young men in England and Wales in the 21st century: time trend study, said from 1950 to 1998 rates of suicide in men aged under 45 doubled in England and Wales, while rates in women and older men declined.

During the 1990s, suicide accounted for about a fifth of all deaths in young men.

Researchers said the suicide rate for young women had been more stable, remaining below four per 100,000 women for most of the period 1968 to 2004 and dropping to just above two per 100,000 by 2004.

The method women are most likely to use has changed, however, from self-poisoning to hanging.

http://news.bbc.co.uk/1/hi/health/7244486.stm

11. Birds Eye View Film Festival

The Birds Eye View film festival presents nine days of inspiration and celebration, showcasing the very best work from women filmmakers with over 70 events including screenings, workshops and parties at 7 London venues.  .

Her Name is Sabine is an intelligent, moving and beautiful potrait of Sabine, a 36 year old autistic woman, filmed by her actress sister, Sandrine Bonnaire. Through personal footage filmed over a period of 25 years, it is revealed that Sabine's growth and many talents were crushed by improper diagnosis and an inadequate care structure.

Hold me tight, let me go is the latest film from Kim Longinotto looks at Mulberry Bush, a boarding school for children excluded from the mainstream education system. Here, as traumatic histories are gradually revealed, the children's violent behaviour is met with compassion, communication and unending patience by their carers.

See www.birds-eye-view.co.uk.

12. Fellowships

The Griffins Society is a charity that supports research into the resettlement needs of women and girls in the justice system. We aim to support these projects and their workers by offering practitioners the chance to do part-time research into their own concerns or ideas about the resettlement needs of women and girls. For further information:
www.thegriffinssociety.org

What's New

• Book now for the College’s Annual Meeting 2008 in London
• College’s prestigious lecture series
• Child and Adolescent SpR Conference: London: 28th March 2008
• College events
• CPD Online – what’s new
• Fundraising Trip to Sri Lanka
• Find out more about the College Prizes and Bursaries
• Find out more about what is going on in your local Division