Tuesday, 22 May

Last week was hard work, so I was pleased to spend the weekend at home. All the family are with me in Manchester at the moment. Over the weekend, I visited the FutureEverything festival, which celebrates the latest developments in art, music and technology.

The festival took place at many venues across Manchester, including the Victoria Baths, an Edwardian swimming pool and Turkish Baths complex which has been lovingly restored through grants and dedication from the local community.

I sat in the grandeur of the Turkish baths knitting with the Crossacres group. This group is a practical example of how elder isolation can be avoided, and also how older people can transfer their skills, memories and wisdom to younger generations. Members of the public had been able to make suggestions for items to be knitted via Twitter, and the group diligently met their requests. The pictures I took say it all – the art of craft, and the tangible links between art, resilience and well-being. Not the political mantra, but the community really functioning as a big society.

This week I’m planning lots of one-to-one catch-ups with colleagues who carry out vital roles within the College, including Dr Michele Hampson about public health, and Dr Helen Miller and Professor Richard Williams about the International Congress. I’m also very much looking forward to Professor Edgar Jones giving the next evening lecture on Wednesday night, entitled Military Psychiatry: a significant contribution or a worthless distraction?

Finally, I’m pleased to see the return of sunshine at long last. At least it has put a temporary end to the constant drip drip in the corner of my room.

Sue

If you would like to post a response to Sue's blog, please email your message to the Website Manager, who will be pleased to upload it to website.

Friday, 18 May

Earlier this month, I used this blog to express my concerns about an HSJ article indicating that NHS London planned to cut its mental health research and analysis budget. I thought you might like to see that HSJ ran a follow up story yesterday with some of my comments.

I was pleased to hear today that Health Minister Simon Burns has written to ACCEA asking them to launch the 2012 round of Clinical Excellence Awards. The Chairman of the Academy of Medical Royal Colleges, Professor Sir Neil Douglas, has put out a statement welcoming the decision and saying that they look forward to the publication of the independent DDRB report in due course.

Since becoming President, I've enjoyed finding new ways of communicating with members - such as through this blog. On Wednesday I met Dr Chrissy Boardman, co-editor of our College eNewsletter, who introduced me to the world of podcasting. Chrissy asked me lots of questions about the work I do, and you can listen to our discussion here (just click on the 'Download' icon on the right-hand side).

Sue

If you would like to post a response to Sue's blog, please email your message to the Website Manager, who will be pleased to upload it to website.

Wednesday, 16 May

On Tuesday, Paul Burstow made a written Ministerial statement in relation to relation to Winterbourne View private hospital and other services for people with learning disabilities. In it, he said that the Department intends to publish an interim report before summer recess, based on the findings of the Care Quality Commission summary report and other evidence from the engagement with key partners, which will set out proposed actions and solutions.

There is work for the College to do around this issue, and I’m sure that our Faculty of the Psychiatry of Intellectual Disability will have a major part to play in how we can drive positive and safe user-empowered care and treatment for this vulnerable group of individuals.

I’ve been interested to see all the work the RCN has done this week around cuts to services – they reported the results of a new survey indicating that cuts are hitting the most vulnerable in society, and warned there is ‘nowhere to turn’ for patients as cuts hit the community. I am asking the RCN if they have specific data on whether the staffing cuts they’ve described includes mental health nurses, whether in inpatient or community settings.

But it’s clear that it’s not only nursing that’s being affected. I’m receiving feedback from our psychologist colleagues that they are also facing problems with posts and, as I go round the country talking to our members, I’m hearing that the 2 for 1 phenomenon is increasing. This is when a consultant psychiatrist retires, and a locum is put in place. A few years later, a second consultant psychiatrist retires and only one consultant post is kept. The RCN have shown that they can collect data that counts, and is important that we do the same. Please do let me know what’s happening to you on the ground.

I was also interested to read the reports this week that parents are to be given more financial control over support for children with special educational needs. It is clear that children with emotional and behavioural disorders should have their needs identified and met much earlier. For this to happen, it’s vital that child psychiatrists, GPs, paediatricians and public health doctors work together to, especially in times of shrinking resources.

Sue

If you would like to post a response to Sue's blog, please email your message to the Website Manager, who will be pleased to upload it to website.

Monday, 14 May

If you read this blog regularly, you’ll know I was in Philadelphia last week for the American Psychiatric Association congress. My predecessor, Dinesh Bhugra, has an amazing stamina for travel which I think I lack! There were many long waits in airports, but these were improved by chatting to international associates living across the world who hold fond memories of their time spent in training or on secondment in the UK. Their interest in what is happening in the UK is genuine, and I found their experiences of working in places like South America and Africa fascinating. We can learn a great deal from them.

On Friday morning, after an overnight flight, I arrived bleary-eyed at Paddington station to meet a very bright-eyed and bushy-tailed Clare Gerada, en route to Cardiff. It made me think that many of the royal colleges have a strong female leader – Clare at the GPs and Lindsay Davies at the Faculty of Public Health, and we’ll soon be joined by Hilary Cass who will take office at the Royal College of Paediatrics and Child Health at their annual conference next week. I hope that we will all be able to make a strong alliance around helping families.

While I was away, I made quite a few taxi journeys. I often wonder how other psychiatrists deal with the “And what do you do?” question. Over the years, the silence that often used to follow my answer, “I’m a psychiatrist”, has lessened. And, no doubt like many of you, giving such an answer has meant I’ve listened to many taxi drivers’ woes, concerns about family members and, of course, a stock set of psychiatrist jokes.

But the response I had from a taxi driver the other week intrigued me. He said that 30 years previously, he’d “worked in submarines”. On the submarine, they had a psychiatrist observing the behavioural patterns of humans living in confined spaces under the sea. Apparently this psychiatrist honed in on the submarine’s engineer, who had a daily habit of washing and hanging up to dry one sock each day. The psychiatrist was totally fascinated and baffled by this – no one told him that the engineer only had three socks. So if this was your PhD (or that of someone you know!), please tell me!

On Saturday, I attended a UK meeting of the World Association for Psychosocial Rehabilitation, which was hosted by Lancashire Care NHS Foundation Trust. This meeting is always well attended by colleagues from across the UK, and we had a very interesting presentation from Scandinavia about models of rehabilitation. It was interesting to hear how cuts are being made in mental health even in countries which we may regard as being well-resourced.

The meeting was a good opportunity to catch up with colleagues and friends from the north west, including members who are very active in the work of the College. Over lunch, we had discussions about how staff grade psychiatrists would like to be more involved in the College, and how they would like their important work to be better recognised within the College, by colleagues and by government. I will follow through on this.

On Sunday morning, I enjoyed listening to Sheila Hollins on Desert Island Discs (if you missed it, you can listen again). She is the second female psychiatrist to appear on the programme recently – many of you will remember Gwen Adshead’s appearance in 2010.  It is fantastic for our specialty to have members appear on this iconic programme, sharing who they are, giving insight into how diverse and creative psychiatrists are, and what psychiatrists can contribute to society.

In the afternoon, we found some distraction activities while we waited for the football results. We visited the beautiful Tatton Park for their Biennial 2012, an exciting exhibition of contemporary art. The theme is ‘Flights of Fancy’ so there were lots of rockets and UFOs to be found throughout the gardens (see this photo of a rocket complete with our very own Jedi warrier).

I was of course delighted to hear the final scores, before hearing not very tuneful renditions of Blue Moon float across the streets of the city.

On a less positive note, the solution to the leaking roof did not work. I am now strangely resigned to the water feature in the corner of my living room. But, as I’m attempting to downsize, I don’t think the estate agent shares my perception.

Sue

If you would like to post a response to Sue's blog, please email your message to the Website Manager, who will be pleased to upload it to website.

I've left the APA conference in Philadelphia now, and will be stopping by the College before heading back home. I attended so many interesting sessions and talks, some of which I blogged about earlier in the week. Another highlight was the Convocation Lecture given by Edward Kennedy Jr, who gave an impassioned and informed delivery on how, why and what we should be doing to ensure the needs of those people with physical and learning disabilities and mental illness are met. 

But perhaps the most valuable part of the trip was the opportunity to catch up with so many fellow psychiatrists from across the world, especially those I had only previously been in contact with by email. The challenges we face are very similar to those being faced in the US. It is also apparent that ways of working (if I can use that phrase) that have been commonplace in the UK (i.e. multi-disciplinary and cross-agency working) are, in many places in the USA, still in their infancy.

I managed to squeeze in a bit of sightseeing, including a visit to Liberty Bell, the symbol of American independence. As you can see from the photograph, it was surrounded by people - mainly teenagers - keen to take photos and have their photos taken in front of it. The pageantry of yesterday's state opening of parliament did make the American news and received a deal of coverage - but not necessarily a great deal of understanding!

Listening to the Queen's Speech, I was pleased to see the inclusion of legislation looking at adult social care, albeit only in draft form which will mean that a full bill will not see the light of day for some time, and hope that the issue is not kicked into the long grass. I hope that the forthcoming White Paper on the same subject will include the issue of funding for social care, an area which was somewhat lacking in yesterday's speech.

The Mental Health (Discrimination) Bill is due to reintroduced to the House of Lords, following support from the government last year and is likely receive its first reading on 15 May, before beginning its journey through Parliament. The College has been committed to the anti-stigma aims of this Bill from its outset and look forward to continuing to work closely with Lord Stevenson and others to ensure it reaches the statute book.

Sue

If you would like to post a response to Sue's blog, please email your message to the Website Manager, who will be pleased to upload it to website.

Tuesday, 8 May

Since Saturday, I’ve been at the American Psychiatric Association’s annual meeting in Philadelphia. The first symposium I was involved in was about cross-cultural issues in the use of psychotropic medications in children. There was a great deal of discussion, and colleagues from the US, Canada and New Zealand gave their perspectives on the cultural and policy influences on prescribing.

Next, I was guest at the Assembly of the APA where business is conducted. Of particular interest was a presentation from Paul Summergrad MD on the role of psychiatry in health reform, integrated care and how psychiatrists can work with primary care colleagues. It is interesting how we share many of the same issues with the US – the need to protect funding for the most vulnerable populations, and not allowing monies for our patients to be swept off into other fields of medicine.

John Oldham MD, outgoing President of the APA, gave a very touching talk about the work he had done over the last 12 months to ensure psychiatry is part of the "house of medicine”. He talked about the patient’s right to quality treatment, the importance of integrated care, and how we have to maintain a high quality of education and research.

The new APA President is Dilip Jeste, a psychogeriatrician. His theme for his presidency will be pursuing well-being across the lifespan. Both Dilip and John stressed the importance of the Mental Health Parity Act which was passed in 2008 in the USA, and how subsequently they have been able to use this as a powerful lever to halt policy or practice that would have a negative impact on mental health users and carers, and to deliver better services. It’s encouraging to hear that, given what has been achieved over here with parity of esteem through the Health and Social Care Act, and I hope that this will ensure we achieve the best for our patients – whatever the challenges and challenges in health care commissioning.  

I also attended a really positive meeting of European leaders and APA leaders. The emphasis was on integrating better with primary care and public health, and brain migration across the world.

In between lectures and meetings, I’ve had the opportunity to observe Philadelphia society. It is a city full of history (see my photo of Benjamin Franklin!) but like every city it has its problems – including homelessness. The hotel I am staying in is next to the equivalent of one of our magistrates’ courts so, as a forensic psychiatrist, I feel quite at home! Through the window I’ve been watching life outside the court unfold – people hovering  outside and waiting, some entering and not returning, and relatives pacing up and down outside.

I’ve also had time to watch a bit of television. At least half of the adverts seem to be about prescription medication, inviting you to go to your doctor and ask for a named drug, and all accompanied by a roll call of a long list of side effects. It’s interesting to watch, as I suspect few of us read all of the small print on leaflets accompanying medication in the UK. Then the rest of the adverts seem to be from lawyers, telling you how to sue the doctors that have prescribed the medication that’s given you one of these side effects!

It’s interesting how much the APA Congress has changed over the years. In times past, the exhibition hall resembled the set of a 1930s film extravaganza – lights, curtains and glamour to advertise pharmaceutical companies and medications. Now it is a more subdued affair, with many of the stands occupied by competing health providers eager to show why working for them would be better than working for their neighbour. There are also some amazing NGO stands, which aren’t very flashy but show how they are providing life-changing support for those with serious mental illness and acquired brain damage.

Sue

If you would like to post a response to Sue's blog, please email your message to the Website Manager, who will be pleased to upload it to website.

Friday, 4 May

The All Party Parliamentary Group (APPG) on Social Mobility launched an interim report this week titled Seven Key Truths about Social Mobility. At the heart of this topic – which the APPG acknowledge is often co-opted by those on both the left and right of the political spectrum – is the question of to what extent a person’s background (in terms of income or social class) influences where they end up (measured in the same way). The United Kingdom scores badly in comparison with other OECD countries – 50% of children here can have their prospects accurately predicted on the basis of their parents’ circumstances. This compares with 41% for France, 17% for Australia and 15% for Denmark.  I was surprised to see that the UK scores even worse than the USA (47%).

I was pleased to see that developing ‘personal resilience and emotional wellbeing’ is one of the seven ‘key truths’ that the report suggests can break the cycle of low mobility. The College has recently launched a broad campaign centred on recovery and resilience and I will write to the APPG Chair to offer our advice on this aspect of their work. I note that mental health also underpins another ‘key truth’ mentioned in the report, namely the significance of a child’s life experiences between the ages of 0-3 (or perhaps that should even be -9 months and 3) where good parental mental health is rightly mentioned as a key factor.

Wishing you all a good Bank Holiday weekend. And, after yesterday's blog, a Happy Star Wars Day today to all those those Star Wars fans out there (including my grandson) – May the fourth be with you.

Sue

If you would like to post a response to Sue's blog, please email your message to the Website Manager, who will be pleased to upload it to website.

Thursday, 3 May

I spent yesterday in Manchester. My grandson’s school held a ‘dress as who you are’ day. It’s a very multicultural school, and most children went in dress to reflect their culture and roots. But my grandson, who’s 6-years-old, went a Luke Skywalker. He sat next to his ‘girlfriend’ who was dressed (yes, you’ve guessed it) as Princess Leia. His parents were a bit surprised, but I showed them a photo I had of the two of them, aged 15, when they started going out together, at a fancy dress party. And yes, you’ve guessed it, they were dressed as Luke Skywalker and Princess Leia. So is this nature or nurture? Do send me your thoughts!

There was a great turnout at the North West Division spring academic conference, a day that focused on mental health and the law.

I also attended the Forensic Child and Adolescent Mental Health (F-CAMHS) Network conference with the theme ‘Everyone’s Business’. The conference was a great collaboration between the College, Greater Manchester West Mental Health NHS Foundation Trust where I work, and the British Psychological Society. Over 180 people attended, across a wide range of professions, and the conference was opened by health and criminal justice tsar Louis Appleby. The day gave us lots of examples of best practice and pragmatic research. And the challenges of how services will be commissioned and ensuring the pathway of care is not fragmented.

I’m staying in Manchester today, before flying to Philadelphia for the 165^th Annual Congress of the American Psychiatric Association tomorrow. I’ll update you from the US next week.

In the meantime, may the force be with you.

Sue

If you would like to post a response to Sue's blog, please email your message to the Website Manager, who will be pleased to upload it to website.

Wednesday, 2 May

I had a really good experience at the Eastern Division’s spring meeting in Cambridge yesterday. This is a large Division, and there are lots of different challenges across different parts of the region. I had dinner with the Executive Committee the night before, and enjoyed their good company and informed and stimulating discussion. The Division certainly knows how to pick beautiful but affordable venues for their meetings, and I very much enjoyed waking up to the view of the topiary gardens and long vistas of Madingley Hall – even on a rain soaked day!

Today, I’m in my home town of Manchester for the North West Division spring meeting. I promised myself I wouldn’t mention this, but Manchester City 1 Manchester United 0! Hope that doesn’t jinx the remaining matches. Although my allegiance is to City, both clubs deserve credit for having huge social enterprise arms helping young people out of the social determinants that put them at risk of poor mental and physical health.

In other news, I’m delighted to say that Dr Helen Bruce has been appointed Associate Dean for Equivalence. She will be responsible for overseeing all aspects of the College’s work related to applications for Specialist Registration via CESR (Certificate of Eligibility for Specialist Registration).

Sue

If you would like to post a response to Sue's blog, please email your message to the Website Manager, who will be pleased to upload it to website.

Tuesday, 1 May

Last week, I was very concerned to read an article in the HSJ, titled: ‘SHA's plans “disgraceful” mental health cuts to boost cancer care'. According to the report, NHS London has asked staff to plan for a cut of nearly two-thirds in its mental health research and analysis budget (from £3.5m down to £1.3m) to make up a shortfall on cancer budgets.

All yesterday, we were trying to verify the accuracy of this story, to find out when a decision is likely to be taken and, if the story is accurate, what can be done to remedy it.

We all understand the huge challenges faced by NHS organisations to deliver all that is expected of them. But can you imagine the public outcry if it was the other way round – if money was being taken off cancer services, audit and research to fund mental health services?

We all have huge respect for cancer services, and recognise the need for timely treatment. But not at the expense of mental health services. What is the point of gaining parity of esteem for mental health and physical health services through the new Health and Social Care Act, if it means nothing in practice?

As you know, I am a tempered person who always seeks solutions to problems. But this is a very concerning situation and it’s important we speak out. I will update you as I hear more.

On a more positive note, at the end of last week I read through the 2012/2013 MPET (Multi Professional Education and Training) budget Service Level Agreement between the Department of Health and Strategic Health Authorities.

The agreement states that SNA should indicate what plans they are putting in place to provide at least 22.5% of F1 doctors with a four-month F1 placement in psychiatry from August 2013, and 22.5% of F2 doctors from August 2014.

This is great news for recruitment to our profession, and great news for patients.

Sue

If you would like to post a response to Sue's blog, please email your message to the Website Manager, who will be pleased to upload it to website.