Tuesday, 21 February

As you know, we surveyed our membership at the end of January to gauge psychiatrists’ opinions on the Health and Social Care Bill. We swiftly anaylsed the quantitative responses to help us formulate a College statement clarifying our position on the Bill.

It’s taken us a bit longer to analyse the many qualitative responses, but I’m pleased to say this work has now been completed. I'd encourage you to take look at the full findings.

As you’ll see, the qualitative responses reinforce what we already know from the quantitative responses. But they provide a much richer dataset, and show exactly where many of our members’ concerns lie – particularly around privatisation, fragmentation, and the impact of competition.

Last week, many of you will have seen Dame Shirley Williams calling for the government to drop the most contentious part of the Bill  – the chapter on competition. I’d be very interested to hear what you think of her suggestion. As always, you can let me know using the feedback form below.

Sue

Monday, 20 February

To all those members and others who emailed me over the weekend asking if the College was attending the summit taking place at Downing Street today, I can confirm that I've not been invited to attend the meeting on behalf of the Royal College of Psychiatrists. I continue to have meetings with care services minister Paul Burstow MP, particularly on the specific issue of parity of esteem between mental and physical health.

In the meantime, whatever the outcome of the Bill, the College Policy Unit is working with clinicians to develop developing commissioning guidance for whoever in the future commissions mental health services, in whatever legal structure.

For the rest of today, I'll be focusing on my clinical work. Tomorrow, with the advice from Chairs of the Faculties of Rehabilitation and Social Psychiatry, General and Community Psychiatry, and Forensic Psychiatry, I will be giving evidence on behalf of members to the Schizophrenia Commission.

Finally - should Number 10 happen to be reading this blog - I'd like to remind them that there is no health without mental health.

Sue

Wednesday, 15 February

I am part of the Academy of Medical Royal Colleges' working group on transparency and working with the pharmaceutical industry and other providers of services, such as devices used in medicine. As part of this, we visited the Netherlands yesterday, to look at the work that the Netherlands pharmaceutical industry and medical profession are doing. This was really informative, as they have been able to work successfully with their Ministry of Health, and will be reaching a point in 2013 of very clear declarations of payments made to doctors and any form of sponsorship for work done for the pharmaceutical industry, with a single point access data system for this.

The Academy working group will shortly be sending out a consultation document, and I intend to deal with this by sending it out to our members as a formal survey.  I think this is a very important issue, and we must get the views of as many members as possible.

In the meantime, life around the Health and Social Care Bill changes from day to day. I will keep you informed as and when there are developments. But although the Bill is occupying much of our time, I'm still finding space in my diary for meetings with people with whom we have shared interests. Earlier today, I had the pleasure of meeting Juliet Lyons, Director of the Prison Reform Trust. I also talked to Profsesor Cornelius Katona about immigration and children, an issue that Juliet Lyons is equally interested in.

Sue

I watched yesterday's events in the House of Lords with great interest. And was of course delighted when Peers backed - by a margin of 4 votes - an amendment to place an explicit dury on the Secretary of State to promote parity of esteem between mental and physical health services. I'd like to thank all those Peers who spoke so eloquently about the need to recognise the importance of mental health, and those who voted in favour of the amendment.

I recently wrote to the American Psychiatric Association, asking for information about mental health "parity" in the United States. They sent me a memorandum prepared for a meeting at the White House in 2009 and a presentation on the 2008 Mental Health Parity law. Although the situation here is very different to that in the US, I thought you may like to see the documents and reflect on what American psychiatrists have been fighting for.

It has been an extremely busy week. On Tuesday I joined clinicians and academics at the Warneford Hospital, where Professor John Geddes chaired a meeting on ‘Leadership’. Dr Phil Davison gave an entertaining and informative account of the role, purpose and function of the College, and I presented a few thoughts on leadership. Then followed a very informed discussion and debate on key issues, ranging from - inevitably - the Health and Social Care Bill, but more particularly the future of academic psychiatry and how there could be a clearer, more certain pathway for trainees and young consultants to have an academic career. There was also discussion about where future postgraduate education would be placed.

On my way out of the grounds, it was great to see the new build emerging for the Tier 4 adolescent inpatient CAMHS unit. Phil Davison is always one to keep you busy, and therefore I was able to meet him and colleagues at the railway station to discuss further ideas about the College’s sustainability plan, and in particular how we might be able to find and fund a Clinical Fellow to take this work forward within the College.

I was also in Parliament this week to be part of the Joint APPG (All Party Parliamentary Group) on reform of care and support, where the joint care APPGs, although having different focuses, had reached a consensus on top priorities. It got me thinking about the way we work across Faculties and Divisions, because although the groups were different they have things in common. So what are the APPGs? Well there is one on Aging and older people; Complex needs and dual diagnosis; Carers; Dementia; Disability group; Housing and care for older people; Learning disability; ME; Multiple sclerosis; Parkinsons; and Social care. It struck me that across the Faculties we could be doing more work on key areas that we have in common, in particular around the dilemma on housing and how such groups could have more of their medical care in their home rather than being hospitalised.

Tuesday evening saw me at a dinner at the Royal College of Anaesthetists. As well as being a good dinner, we heard from the QC, who has been leading the West Staffordshire investigation and inquiry, that the report is due soon. But it was indeed a very sobering and thoughtful after dinner speech.

Yesterday, I went to a medicine sector roundtable on social mobility. Alan Milburn was appointed the independent reviewer on social mobility and child poverty, and he will be reporting in the spring on what progress government, employers and professional bodies have made in improving access to professional careers, since the publication the 2009 report Unleashing Aspiration by the Panel on Fair Access to the Professions. This was a good opportunity to tell him about the work that many of you are doing as part of the recruitment drive in secondary schools, where we are trying to reach out to those young people who may never have considered a career in medicine, and certainly not in psychiatry.

Sue

It’s great that our first clutch of mental health commissioning guides have hatched today. The guides have been produced by the Joint Commissioning Panel for Mental Health, a partnership between us, the Royal College of General Practitioners, and 15 other organisations.

Congratulations to all of those who have worked so tirelessly on these practical guides, and for bringing together the expertise of so many stakeholders.

Yesterday, Emma Harrison – the government’s “welfare-to-work Tsar” – spoke to BBC Radio 5 Live about her concerns about the welfare reform plans. She told John Pienaar that the benefits cap could hit the wrong people, such as seriously vulnerable families caring for one or more disabled children. Emma Harrison is, of course, the person chosen in 2010 to lead the government’s efforts to return hundreds of individuals back to work. Can I safely assume that the sorts of families she is thinking of also include families with children with severe learning disabilities and/or mental illness and developmental disorders?

This afternoon, I’m off to an All Party Parliamentary Group meeting in Westminster which will hear from Care Services Minister Paul Burstow MP as he presents the finds of the ‘Caring for Our Future’ consultation and looks at the next steps.

Over the last few weeks, I have seen the development of a rare medical disorder within myself, known as ‘creeping cynicism disorder’. Please do let me know if you have a remedy.  Meanwhile, we’ll continue battling for changes to the flawed Health and Social Care Bill – in particular the battle of parity of esteem between mental and physical health.

Sue

Every day, something new occurs to do with the Health and Social Care Bill. As you've probably seen, today the Royal College of General Practitioners has called for the Prime Minister to withdraw the Bill.

As far as we are concerned, we stand by the statement the College issued on Wednesday. For the next two weeks, I will be working extra hard with our Policy team on a plain English version of what parity of esteem between mental and physical health means, and why we must have absolute evidence that it should appear across the face of any Bill.

In the meantime, I’d like express our great thanks to those Peers in the House of Lords who have been supporting amendments to the Bill that would improve the health and care of people with mental health problems.

Sue

Thanks to all of you who have contacted me with your responses to our new statement on the Health and Social Care Bill. There is a very solid consensus coming back from you, with obviously a small number of people having different and diverse views.

On a different note, I attended a breakfast meeting recently with the Chief Medical Officer, Dame Sally Davies, in which Professor Graham Thornicroft talked about the scandal of mental health. I asked his permission to blog his words, which are as follows. I have unusually also included the references, as they look like a must-read.

A new mental health scandal?

Professor Graham Thornicroft, King’s College London, Institute of Psychiatry

Two critical issues in mental health care are hardly ever talked about:

1. That most people with mental health problems receive no treatment whatsoever, and that

2. Such people die up to 20 years earlier than people without a mental illness.

1. The ‘mental health gap’

Most people in the world who have mental illnesses receive no treatment¹. The proportion of people with mental disorders who receive health care (so called ‘coverage’) is at best between 27%-30% across the Europe² and the United States³, and at worst the treatment rates is as low as 2% in Nigeria^4-6. The existence and the significance of this ‘treatment gap’ is increasingly appreciated worldwide^7-12. The Department of Mental Health and Substance Abuse at the World Health Organization has recognised this challenge by launching the Mental Health Global Action Programme (mhGAP)¹³. In the UK we do not know exactly how what percentage of people with mental illness receive treatment - our best estimates are that this is only about a quarter of all cases. Is this acceptable?

2. Vastly reduced life expectancy

Compared with people with no mental health problems, men with mental illness lives 20 years less, and women 15 years less. A combination of life style risk factors (such as smoking and diet), higher rates of unnatural deaths (such as suicides and accidents), and poorer physical health care contribute to this scandal of premature mortality¹⁴. What needs to be done? If such a disparity in mortality rates were to affect a large segment of the population with a less stigmatised characteristic, such as diabetes, then we would witness an outcry against a socially unacceptable decimation of this group. The fact that life expectancy remains so much lower for people with mental illness denotes a cynical disregard for these lost lives, and shows in stark terms by just how much people with mental illness are categorically valued less in our societies than other people¹⁵. This can justifiably be seen as a violation of the ‘Right to Health’ as set out in Article 12, “The right to the highest attainable standard of health” of the International Covenant on Economic, Social and Cultural Rights^16;17. Further, in 2006, the United Nations General Assembly adopted the Convention on the Rights of Persons with Disabilities (CRPD) which explicitly applies to people with mental health problems as well as people with intellectual disabilities¹⁸.Such lower life expectancies imply , according to the CRPD, a wholesale ‘failure of social policy and health promotion, illness prevention and care provision.’

Are these two issues the real mental health scandal?

References

  (1) Thornicroft G. Most people with mental illness are not treated. Lancet 2007; 370(9590):807-808.

  (2) Alonso J, Codony M, Kovess V, Angermeyer MC, Katz SJ, Haro JM et al. Population level of unmet need for mental healthcare in Europe. Br J Psychiatry 2007; 190:299-306.

  (3) Kessler RC, Demler O, Frank RG, Olfson M, Pincus HA, Walters EE et al. Prevalence and treatment of mental disorders, 1990 to 2003. N Engl J Med 2005; 352(24):2515-2523.

  (4) Wang PS, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Borges G, Bromet EJ et al. Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet 2007; 370(9590):841-850.

  (5) Kohn R, Saxena S, Levav I, Saraceno B. Treatment gap in mental health care. Bull World Health Organ 2004; 82:858-866.

  (6) Ormel J, Petukhova M, Chatterji S, guilar-Gaxiola S, Alonso J, Angermeyer MC et al. Disability and treatment of specific mental and physical disorders across the world. Br J Psychiatry 2008; 192:368-375.

  (7) Prince M, Patel V, Saxena S, Maj M, Maselko J, Phillips MR et al. No health without mental health. Lancet 2007; 370(9590):859-877.

  (8) Saxena S, Thornicroft G, Knapp M, Whiteford H. Resources for mental health: scarcity, inequity, and inefficiency. Lancet 2007; 370(9590):878-889.

  (9) Patel V, Araya R, Chatterjee S, Chisholm D, Cohen A, De SM et al. Treatment and prevention of mental disorders in low-income and middle-income countries. Lancet 2007; 370(9591):991-1005.

  (10) Jacob KS, Sharan P, Mirza I, Garrido-Cumbrera M, Seedat S, Mari JJ et al. Mental health systems in countries: where are we now? Lancet 2007; 370(9592):1061-1077.

  (11) Saraceno B, Van OM, Batniji R, Cohen A, Gureje O, Mahoney J et al. Barriers to improvement of mental health services in low-income and middle-income countries. Lancet 2007; 370(9593):1164-1174.

  (12) Chisholm D, Flisher AJ, Lund C, Patel V, Saxena S, Thornicroft G et al. Scale up services for mental disorders: a call for action. Lancet 2007; 370(9594):1241-1252.

  (13) World Health Organization. mhGAP : Mental Health Gap Action Programme : scaling up care for mental, neurological and substance use disorders W.H.O. Geneva: W.H.O. Press; 2008.

  (14) Wahlbeck K, Westman J, Nordentoft M, Gissler M, Laursen TM. Outcomes of Nordic mental health systems: life expectancy of patients with mental disorders. Br J Psychiatry 2011; 199(6):453-458.

  (15) Thornicroft G. Shunned: Discrimination against People with Mental Illness. Oxford: Oxford University Press; 2006.

  (16) Thornicroft G. Physical health disparities and mental illness: the scandal of premature mortality. Br J Psychiatry 2011; 199:441-442.

  (17) Callard F, Sartorius N, Arboleda-Florez J, Bartlett P, Helmchen H, Stuart H et al. Mental Illness, Discrimination and the Law: Fighting for Social Justice. London: Wiley Blackwell; 2012.

  (18) United Nations. Convention on the Rights of Persons with Disabilities. New York: United Nations; 2006.

This morning I had the real pleasure of meeting with Professor Neil Greenberg, who is the Defense Professor of Mental Health. His Chair came about, and was granted, by the College. He told me of the fascinating work that he is carrying out in primary, secondary and tertiary prevention, working with those serving in the armed forces and their families. I am looking forward to regular meetings with Neil, and taking issues of common concern forward.

The rest of my morning was spent on the Health and Social Care Bill.  Many thanks to all of you who responded to the survey on the Bill we sent out last week. You can see a breakdown of the survey results here. We have not had time to analyse the qualitative responses yet, but will do so this week and post the results on the website next week.

We've used your responses to help us produce a new College statement clarifying our position on the Bill. I hope you will all take the time to read this statement in detail, and feedback to me with your comments if you wish - as always, you can use the comments form below.

But, in short, we believe the Bill is fundamentally flawed and will not improve the health and care of people with mental illness. The College is therefore not able to support the Bill as it currently stands.

In the statement, we’ve stopped short of calling for the Bill to be withdrawn. But we believe that it is wrong for the government to continue without making the significant changes that we and other medical professionals have been calling for now for many months.

We understand that the government is due to publish a large number of amendments to the Bill shortly. On behalf of our members and patients, we will scrutinise these amendments carefully in order to make an informed decision on whether or not they address the very real concerns of psychiatrists.

Thursday, 26 February

As politicians reflect, what an ‘interesting 24 hours this has been’. First and foremost, I am really grateful to everybody who is feeding back via the survey, and for the emails I am receiving from members, as well as some very cogent and telling letters about their views on the Bill.

If you are following the BBC, the Guardian or the Telegraph, you will see the rather surreal events that have unfolded around the Royal Medical Colleges and the Academy.

I left the Academy building at 2.30pm on Tuesday afternoon in the honest and 100% belief that we had an agreed statement, which would absolutely acknowledge that the only College dissenting from this view was the Royal College of Surgeons in England.

As the document was leaked in full to The Guardian (I hasten to say that this was not me, as that would be a breach of trust), I am pasting the Academy statement document that I had signed up to verbatim, because I think this is the most honest thing I can do for members.

Statement 24/01/12

‘The Medical Royal Colleges and Faculties of the AoMRC continue to have significant concerns over a number of aspects of the Health Bill and are disappointed that more progress has not been made in directly addressing the issues we have raised.

The Academy and Medical Royal Colleges are not able to support the Bill as it currently stands. Unless the proposals are modified the Academy believes that Bill may widen rather than lessen health inequalities and that unnecessary competition will undermine the provision of high quality integrated care to patients.

As the Health Committee has highlighted the Academy is deeply concerned that the upheaval caused by the changes in the Bill will distract the NHS from the huge task of meeting the current financial challenges.

The Academy and Colleges retain these concerns but they will work with the Government and NHS organisations to ensure that the NHS provides the best possible care to patients should the Bill become law.’

*To be added a statement/note to make clear that the RCSEng do not support the second paragraph."

Turning adversity into advantage, I already had a meeting scheduled with Paul Burstow MP yesterday evening, where it was really helpful to have Lucy Thorpe, Head of Policy, and Kam Bhui, Public Health Lead, with me.The meeting had been arranged to discuss parity of esteem between physical health and mental health, how we would work with Public Health England, and the importance of mental health to public health.

Inevitably there was going to be discussion on the Bill. I said very straightforwardly that my view was the view of the Academy statement; that we were not able to support the Bill as it currently stands, but whilst retaining concern, we would continue to work with the Government and NHS organisations. I said that this remained the College view at the present time, but made the Minister aware that there was a survey in progress, and therefore once we had analysed the findings, this view may change.

On an entirely positive note however, we did present our thoughts about public mental health, and how we aligned these thoughts against the outcomes framework and indicators. This was well-received by the Minister and the civil servants.

Since then, events have moved on. On your behalf, I am attending another Academy meeting this evening, Lucy Thorpe will be attending the forum meeting between the RCN, the BMA and the Academy, as I am off to Glasgow later tonight – because life does have to exist beyond the Bill!

The Academy is the body that has Trustees and Governance structures, and we have to learn from what has happened over the last 24hours in that we must work within a robust governance process.

On your behalf, I went to a meeting with the Chief Medical Officer Sally Davies, who started the first of the Policy Breakfasts about public health. I found her direct and straight talking approach very helpful. I explained everything that we were already doing in this arena, and further the projects that the four female Presidents of the Colleges of Psychiatrists, General Practice, Obstetricians and Gynaecologists, and Public Health have in mind, i.e. that we were going to look at how we work across the four Colleges to ‘build resilience in families’. I highlighted that the College campaign would be on ‘Resilience and Recovery’.

I had a separate discussion with her around what we are going to do to move forward academic psychiatry and mental health research. I will be sending an email out to key academics today to clarify their position as to what they want me to do on increasing the recognition, value and worth of mental health research. I did pledge this in my election statement, therefore a relative lack of response to date will not put me off. We now have the chance to move this on with Sally Davies, and this is not an opportunity I want to miss.

You will be pleased to hear that at yesterday’s Medical Programme Board (England) meeting, everything we wanted for psychiatry was finally agreed. I would just like to say that Tom Brown and Stuart Carney were brilliant, and the Chair of the Academy and the Royal College of Physicians were very supportive.

Most importantly, the Board endorsed the College's recruitment strategy. There was broad support for a phased approach to expand the number of psychiatry posts in the Foundation Programme and we all need to work together to ensure that we provide the best possible experience for trainees.

As part of the recruitment strategy, we will be promoting tasters for foundation doctors. I am grateful to Faculties and Divisions for sharing good practice. There needs to be a major drive over the next few months to ensure that as many foundation doctors as possible can undertake a taster in psychiatry.

Tomorrow I also will blog about what I am sure will be a positive day in Scotland, and I am really looking forward to listening and learning.

Just to brace those of you who are getting ready for it; I would not usually blog about personal matters, but thought I should let you know in case somebody sees me there: I will be going to the ‘On Tour: Strictly Come Dancing’ in Liverpool on the weekend of 4^th February,

Monday, 30 January

Great meeting on Friday of the Royal College of Psychiatrists in Scotland, with the hugely important topics of medical leadership and recruitment. Both the Registrar and the Treasurer spoke at the meeting, and Professor Sir Lewis Richie gave a particularly inspiring call for leadership and talk on the meaning and role of the general practitioner.

As you are aware, the member’s survey seeking your views on the Health and Social Care Bill closes at midnight tonight. We will get the results analysed very quickly, and will formulate a new position statement on the back of it. I will keep in contact with you via this blog and on the website about how we are moving forward. As of now, our position remains that of the Academy statement that was leaked to the Guardian last week.

I am beginning to see common themes across the UK and now intend to invite the leaders of our offices in Scotland, Northern Ireland and Wales to meet with me. I hope to discuss issues around the role of the psychiatrist, alcohol addiction and suicide prevention.

Sue