November 2007

1.      Message from the President: Professor Sheila Hollins

Over the last month I have had a variety of high level meetings. These included a discussion with the Secretary of State for Health, Alan Johnson about mental health services in England where the focus was on health inequalities. We considered the need to move from a concern with inequalities as they affect populations to one concerned with individuals - a concern that recognises the inequities faced by many people with severe mental illness and people with learning disabilities.

I also met Lord Ara Darzi about the NHS Review in England and am pleased that eight senior psychiatrists are leading the Regional workstreams on mental health.

I met Martin McGimpsey, Minister of Health in Northern Ireland as part of the Learning Disability Faculty residential meeting and heard about his concern for mental health in older people.  I made the opening comments at a seminar on comprehensive diagnosis held jointly with the Department of Health in London and the WPA, and participated in a meeting with the CMO for England about careers for women in Medicine.

I joined other Royal College presidents to discuss changes to postgraduate education with the postgraduate deans.

Finally the Department of Health has informed us that British Association of Physicians of Indian Origin (BAPIO) won their appeal against the department.  This means that International Medical Graduates will be able to compete for postgraduate training posts with UK and EEA graduates in 2008 as they did this year (www.bapio.co.uk). However, the department has stated its intention to appeal the decision and there will be a drive to change the immigration laws for subsequent years. In the 2007 entry to postgraduate training the proportion of IMGs securing posts in psychiatry was stable at 60%. 

  College response to the consultation on future training in the UK for IMGs.

  More news from the president

2.      Professor Dinesh Bhugra: the College’s President-Elect

Professor Dinesh Bhugra has been elected unopposed and will begin his term of office as President during the Annual General Meeting on Wednesday 2 July 2008. 

Professor Dinesh Bhugra is Professor of Mental Health and Cultural Diversity at the Institute of Psychiatry, Kings College London and Honorary Consultant at the South London and Maudsley Trust. He has been Dean of the College since his election in 2003.

His research interests include professionalism in psychiatry, decision-making by psychiatrists, depression, schizophrenia, pathways into psychiatric care, deliberate self-harm, primary care, cross-cultural psychiatry, spirituality, psychosexual medicine and diversity.

Dinesh has published widely, including books on cultural psychiatry, management and religion and psychiatry. In 2006, he wrote a book on ‘Mad Tales from Bollywood: Portrayal of Mental Illness in Conventional Hindi Cinema’ following receipt of a Wellcome Trust grant.

He has been active in the College since 1985. He chaired the Collegiate Trainees Committee (1987); the Overseas Doctors Training Committee (1996 - present); and the Faculty of General and Community Psychiatry (1997-2001).

“It is an honour and a privilege to be elected to the Presidency of the Royal College of Psychiatrists.  I am very excited to have received such overwhelming support from the members and fellows of the College. From my arrival in Cork nearly three decades ago, my journey through clinical and academic services in Leicester, Eastbourne, Guy’s and the Institute of Psychiatry at the Maudsley in London has been thoroughly enjoyable.  My medical training was at the Armed Forces Medical College in Pune in India and my psychiatric training was here in the UK.  After gaining clinical experience, I have devoted much time to training.  As a result, the links between service development, standards of healthcare delivery and research has been my passion.

The profession of psychiatry must be at the core of all medical care, ensuring that we meet the mental health needs of all patients.  The medical profession is at a cross-road, with serious threats to professionalism.  We must strengthen our role and identity and the College must take a lead in defining professionalism for the 21^st century.  The debate has already started, and my fervent hope is that within the next 12 months we will be able to delineate our roles and boundaries, and define our contract with society.

The College must continue to strengthen its international position and standing by forging close partnerships with international bodies. This will enable them to raise standards of practice wherever they may be.  We must reward excellence, and I propose to create new structures and strengthen existing ones in order to deliver this.

Most importantly, maintaining good standards for the delivery of psychiatric services, and aspiring to excellent services which psychiatrists themselves would be willing to use, is the paramount challenge for the profession. To achive this I will work with key stakeholders, including patients, carers, mental health professionals, voluntary sector, and primary care across all the devolved administrations.

We need to be honest about what we can and cannot deliver.  I aim to rediscover the profession’s sense of purpose and to continue to be accessible to members and fellows and to our partners.

My priorities are to:

Once again, thank you for your overwhelming support. I look forward to an exciting, energetic and enthusiastic term of office serving the profession and our patients.”

3.      Early Detection in Psychosis - New guidance launched

The Royal College of General Practitioners (RCGP) and the RCPsych have launched guidance to help front line practitioners achieve earlier diagnosis of psychosis in young people. The guidance, designed to support practitioners from primary care, relevant community agencies and specialist mental health services, was formulated following a report commissioned by the National Institute for Mental Health in England (NIMHE). This report highlighted a growing evidence base that early symptom recognition can reduce the progression to psychosis.  It so states that with early intervention, the suicide risk is halved and over 50% of those affected will go on to find employment.

Containing advice for GPs and listing key symptoms which may signal the onset of psychosis, the guidance aims to create a smoother pathway between primary care practitioners and mental health services to ensure early detection and provide support for young people with psychosis and their families.

Dr Huw Lloyd, Chair of the RCGP Mental Health Group, says:

"This guidance sets out a different dynamic between generalists and specialists in which earlier GP recognition supports different access routes to a specialist assessment and treatment service - in this case a youth-orientated specialist assessment and psychological treatment service."

Dr Roger Banks, RCPsych Vice-President with a remit for developing the College's links with primary care, says:

"This vital initiative, firmly and enthusiastically supported by the Royal College of Psychiatrists, is indicative of a developing and strongly collaborative approach and the erosion of artificial boundaries between primary and secondary, or more aptly, generalist and specialist mental health care."

  'Early Detection in Psychosis' and guidance.

4.      Alcohol Health Alliance UK launched

The Royal College of Psychiatrists has joined with 23 other organizations to form a ground breaking new coalition, called the Alcohol Health Alliance UK. At the launch, the Alliance called on the Government to do more to prevent the rise in alcohol-related diseases.

The mission of the Alliance is to reduce the damage caused to health by alcohol misuse and it will campaign for:

• Dedicated funding for alcohol treatment and prevention strategies
• Increased taxation on alcohol
• A ban on alcohol advertising before 9.00 pm and in cinemas apart from  with 18 rated films
• Promotional material to carry information on health related harm
• Reducing drink driving limit to be reduced to the EU standard of 0.5g/l and a near zero limit for new drivers

Dr Mike Farrell, chair, Addictions Faculty at the RCPsych said:

"Alcohol misuse not only affects people's physical heath. There is a strong link between heavy drinking and mental health problems, in particular depression and self-harm. The Royal College of Psychiatrists hopes that the government will listen to the tough messages from the Alcohol Health Alliance UK and addresses our calls for change in terms of education and funding."

5.      DoH - £31million for child and young people's psychiatric wards

Health Minister Ivan Lewis has announced £31 million of investment in psychiatric wards for children and young people. The funding will support 17 different projects.

Mr Lewis commented

"In November 2006, I made it clear that within two years no child under 16 would be treated on an adult psychiatric ward. Vulnerable children deserve age appropriate services that recognise, irrespective of their condition, that they are first and foremost children. The 31 million pounds worth of investment I am announcing today will help us deliver this commitment and obligation by creating more than 150 new or upgraded in-patient beds and enhanced community facilities for children with the most complex mental health needs."

Chief Executive of Pennine Care NHS Trust, John Archer, added

'I am delighted that we are finally going to be able to provide expert care to young people in an appropriate environment.  There is an increasing prevalence of mental illness in older adolescents. Adolescence can be a difficult period of transition from childhood to adulthood for most young people, but particularly for those with mental health needs. Mental health services endeavor to manage such people at home with their families. However, an admission to an inpatient unit is required for young people with more serious mental illness who cannot be managed in the community.'

Prof Sue Bailey, Registrar of the College and a CAMHS psychiatrist working in the North-West, commented

“This investment and commitment to services will help to ensure that children and adolescents will receive the care and treatment they need at this critical stage in their lives.  As with adolescents who have long-term physical illness we hope the government will strengthen and develop transitional services for those adolescents who continue to require services in adulthood. Building on the early intervention services in psychosis but also including all other forms of mental disorders including services for children with learning disabilities.”

  More info.

6.      Scottish Division representatives attend the SNP Party Conference 26-28 October 2007

For the first time the Scottish Division of the College attended a Scottish Party Conference and the SNP event held in Aviemore in October was a good place to start.

Our Policy Manager, Karen Addie and Dr James Hendry, a member of the Scottish Division Public Affairs Committee, and Secretary of the Cross Party Group on Mental Health, had a College stand throughout the conference.  They also attended a number of fringe events including a speech by the Cabinet Minister for Health, Nicola Sturgeon, and meetings organised by the Scottish Association for Mental Health and by the Long Term Conditions Alliance.

Before the Conference a Parliamentary Liaison company had set up a number of meetings for the Division representatives with key MSPs.  The liaison company's involvement proved invaluable as they have experience and expertise in this field.  We met with the Minister for Public Health, Shona Robison MSP, members of the Health Committee and other MSPs who have shown an interest in mental health.

The conference provided an excellent opportunity to raise the profile of the College with key politicians and to raise the profile of mental health in a wider sense.  Overall, there was an atmosphere of optimism and buoyancy - to be expected from a party recently elected to run the country.

7.      Student Mental Health in Higher Educational Institutions: Dr Lenny Fagin

Being a student can be very stressful, and often the experience exposes personal vulnerabilities, particularly for those who have to make major adjustments leaving their families, and sometimes their own countries, during their period of study.

A 2003 College report (CR112) 'The mental health of students in higher education' concluded that the extent of mental health problems among students had been increasing, and that this trend was likely to continue; this is not surprising given the increase in the student population and with access to those from a broader range of backgrounds that before.  The report stated that, at best, services available to students in Higher Educational Institutions (HEIs) in the UK were patchy.  This is a preventative opportunity gone to waste, as many students with mental health problems are often in the prodromal phases of their illnesses, and are ready to receive help.  At this stage, a little help can make a great deal of difference.

A group of psychiatrists linked with HEIs in London recently organized themselves into a network to discuss these issues and explore ways in which they could contribute to improving student mental health: Leonard.Fagin@londonmet.ac.uk.

Concerns raised in discussions included the following:

• Although mental health issues are prevalent among the student population, they have not been effectively addressed by the psychiatric profession as a whole, and the Royal College in particular.
• Many of the mental health problems presenting to psychiatrists among the student population are of a serious nature and degree, but are disguised or not immediately obvious, and pose difficulties for students who face strenuous academic targets and postgraduate future responsibilities.
• For undergraduate medical students, there is the question of what role psychiatrists play in determining admissions and fitness to practice.
• Psychiatrists are often in an invidious position when they have to address conflicting pressures from the University, professional bodies and the students themselves.
• Psychiatrists do not seem to carry much influence in decision-making within the University; very often the Disability Discrimination Act 1995 exercises an inhibitory effect which prevents taking necessary action to safeguard student mental health and others likely to be affected by their problems.
• The need to establish protocols for psychiatrists working in this arena which matches the mental health policy of Higher Educational Institutions.
• The lack of clarity so far as lines of accountability depending on the employing organisation, which may be different from the University or counselling service.  This sometimes leads to boundary role confusion with other colleagues in student services.
• The lack of a supportive network for psychiatrists working in student counselling services.
• The need to establish peer review structures and CPD appraisal arrangements with colleagues with similar experiences.
• The need to share difficult cases, perhaps using an internet forum.
• The need for appropriate administrative support.
• The need to understand the HEI milieu and academic policies.

The College has established links with other groups concerned about mental health, especially the Universities UK Guild/Higher Education Committee for the Promotion of Mental Wellbeing in Higher Education and the newly formed Mental Health Advisors Network, which offers support to staff with a mental health background who will co-ordinate aspects of mental health care required when identified students become unwell.

The College is due to review the CR112 report and will consider, among other things, the need for specialist psychiatric services in student mental health.  If you would like to contribute your views, please contact the review chair Dr John Callender at John.Callender@gpct.Grampian.scot.nhs.uk.

8.      College to host prestigious lecture series

Starting in the New Year, the College will host a series of lectures by eminent psychiatrists from around the world.

Professor Norman Sartorius. Globalisation and the future of psychiatry.  8th January 2008

Globalisation, the development of science, socio-economic changes, the evolution of the ethos of medicine and of social support systems present challenges and opportunities for psychiatry. The lecture will examine these factors and their impact on psychiatry and outline a possible set of priorities for the specialty.

Professor Sir David Goldberg. Where is psychiatry going? March 2008.

Further details to follow in the new year.

Both lectures will be at the Society of Chemical Industry, 15 Belgrave Square, London SW1X 8PS.

Places for both these events are limited and we will allocate tickets on a first-come-first-served basis.

For more information, or to book a place, please email nboyce@rcpsych.ac.uk