Making Scottish psychiatry sexy again

Chair of the RCPsych in Scotland, Jane Morris, reflects on the efforts this year and discusses what's ahead for the College and members in Scotland.

In this time of massive world change, my own world has utterly changed since summer, when I found myself unexpectedly acting Chair of the College in Scotland. Thankfully, Queen Street staff are amazing and I’ve been helpfully haunted by the lively ghosts of Chairs past. Peter Rice spoke at our recent Council meeting, I met Alastair Cook in his role as PMO, John Crichton is Treasurer at the UK College and of course I still have Linda Findlay on speed-dial. God bless them every one.

As Vice Chair I told John my greatest achievements involved throwing spanners into works to avert potential disasters. He said the best things we do are the invisible ones that no one knows about – not to mention the negative capability that means wisely refraining from behaving like a loose cannon.

In fact, though, at the latest UK Council I had to declare an embarrassingly long list of the visible achievements of Scotland’s College Staff, Officers and members over the few months I have been in role. Does this reflect an over-enthusiastic leadership style? I believe we must respond in these worrying times. I also worry, though, that the burden of external priorities could overwhelm the very small staff and member capacity available to us.

Addressing the Challenges

These are just some of our responses to the challenges in Scottish psychiatry:

• Our monthly Legislative Oversight Forum has consulted extensively about Scottish Mental Health Law Review (SMHLR) and continue to engage with the Scottish Government’s response and reform programme. In September, the Scottish Eating Disorders Faculty Chair met with Government leads to discuss the national specification for Eating Disorders care and treatment, now out for consultation. Next month the Addictions Faculty will meet the Minister for Drugs and Alcohol Policy to plan for a more responsive and coherent treatment system and the Chair of our Scottish ID faculty will meet with the Minister for Social Care, Mental Wellbeing and Sport to discuss the service issues facing intellectual disability services, as well as the impact of delayed discharges on people with intellectual disabilities and other matters.

• We engaged with the development of different quality standards for Adult Secondary Mental Health Services, Eating Disorders, CAMHS and Psychological Therapies. We have advised on the new National Dementia Strategy, Suicide Prevention Strategy, Self-harm Strategy, the upcoming ID, Autism and Neurodiversity Bill and Assisted Dying Bill, and the continued battle for parity with physical health within acute-focused Health Boards.

• We’ve supported the resurrection of live Faculty activities as well as virtual resources, prioritised efforts to rebuild the beleaguered General Adult Faculty, and restructured other groupings. For instance, we clarified that the Senior Medical Managers in Psychiatry (SMMP) group has a distinct role from the College, whilst forming a new College Scottish Leadership and Management Group, with a widened focus on nurturing the next generation of leaders.

Priorities as Chair

My agenda as Chair, however long I serve, is ‘workforce, workforce, workforce’. It’s a 3-part focus:

1. I will fight for the retention and recruitment of a high-quality psychiatric workforce

2. I will fight for that workforce to enjoy greater public respect and self-respect

3. I will strive to represent the voice – or choir of voices – of that workforce in all our dealings with other bodies.

In doing this I have the invaluable support of some of the leading psychiatrists of this generation. Not only staff and Officers but many of our 1400+ members are intensely engaged with College business. Even ex-members continue to dispute constructively with us. As we approach Christmas, the spirits of the present Scottish College are very much alive and kicking. I really admire these charismatic and knowledgeable leaders who work so generously with us for the profession.

Inspired by Linda Findlay’s ‘Roadshows’, and Lade Smith’s Presidential drop-ins, I’ve started my own monthly drop-in slots to let all College members (‘members’ in the fullest sense, not only those with MRCPsych) bring questions, complaints, suggestions and reflections. We hold Council Meetings in the same spirit of interaction with our membership. Linda began the process of trimming agendas to allow longer discussion on key issues, and it’s allowed me to hear the range of opinion and experience directly from members and to digest it into a harmonious body of opinion rather than a Babel. This was especially useful in building good relationships with Police Scotland recently.

As I write this, two particular documents dominate our conversations. Thanks to Laura Varney they also receive considerable attention in the media.

Scotland's Mental Health and Wellbeing Strategy

The Mental Health and Wellbeing Strategy and corresponding Delivery Plan continue to concern us. There’s too little consideration to severe and enduring mental illness, absence of early intervention and prevention for this group, and scant acknowledgement of the role of inpatient care. Alcohol and drugs are inadequately addressed. We worry that current financial challenges constrict long term plans and ambitions, and Government has not yet met its commitment to spending 10% of the NHS budget on mental health. This is a proportionate, not an absolute issue, so whatever the financial climate it could be honoured, but Public Health Scotland data shows that over the last ten years Scotland has moved further away from this target, and recent cuts appear to have been disproportionately harsh to mental health.

We are trying to arrange a Meeting with the Minister, but her portfolio is for Social Care, Mental Wellbeing and Sport, and no longer mentions even mental health, let alone mental illness. However, Maree Todd’s background as a Mental Health Pharmacist leads me to hope that she will at least understand.

'State of the Nation' Scottish Psychiatry Workforce Report

The second document is more hopeful. Ihsan Kader’s ‘State of the Nation’ Scottish Psychiatry Workforce Report felt like an early Christmas present– a timely piece of work, starting a series of 18-monthly workforce action reviews. It came with two wee ‘stocking fillers’, shorter reports on attrition from core to higher training, one with objective statistics, the other a qualitative survey drawing on the experiences of ST colleagues. Ihsan’s work has been unanimously acclaimed for its clarity, thoroughness, provision of constructive solutions, and for debunking the myth of a recruitment crisis (thanks of course to ‘Choose Psychiatry’) when we need to focus on bottlenecks in training and the retention of expensively trained experts.

30th Anniversary of the RCPsych in Scotland

What is yet to come? Our Vice Chair, Pavan Srireddy, rightly warns of a mental health apocalypse, but we hope and intend that the ‘death spiral’ can be averted. We even have cause for celebration. The International Congress returns to Edinburgh in 2024, corresponding with the 30th Anniversary of the College in Scotland. The Congress Advisory Committee has already received many excellent proposals submitted by Scottish colleagues. Alongside the main event, the Congress Fringe includes Stand-up comedy from eminent Professors of Psychiatry, Highland Dancing lessons and the launch of the new College tartan. Watch this space for details of the competition to design the Tartan and prepare to model the results on the Congress catwalk.

Look out too for the campaigns and actions of our new President – ‘Laddie’, as we call her in the Highlands. At her recent Presidential Strategy day she proposed relaunching the tired old ‘medical model’ as the proud ‘biopsychosocial model with formulation’. A great plan, but Pavan, our wordsmith, feels the phrase lacks mass appeal in what he describes as the campaign to ‘make psychiatry sexy again.’

In this context, then, can I recommend that you revisit Jim Crabb’s ‘Shrink Rethink’ paper 1 from 2017. It concludes:

“Psychiatrists are doctors who feel with their mind and think with their soul. They are just as comfortable with poetry as pathology…They are doctors who want to make a radical and transformational difference to the whole life of their patients. Psychiatrists are people who have the rare ability to treat the person, not the problem. Psychiatrists save lives.”

And some of us, I should add, do so stylishly, in tartan.

Jane Morris, November 2023