I'm really pleased to to say we have appointed a College Lead for the Military and Veterans Mental Health - Surgeon Captain Professor Neil Greenberg,  Defence Professor of Mental Health and Co Director of the Academic Centre for Defence Mental Health (ACDMH) at King’s College London.

I was very heartened that we had such a richness of applicants for this post. Although we could only appoint one Lead, I hope all applicants will help contribute to the tasks ahead for the College in this important field of work.

Yesterday, I attended the St George Healthcare Group National Conference 2013 in Manchester. This brilliant conference, called Only the Lonely: Deafness and Autism / Learning Disability, reminded me that there is so much to learn from professionals, patients and carers who are involved in Deafness, Autism and Learning Disability Services. My concern is are they, in the brave new commissioning world, going to be enabled, supported and understood.

What is clear is that, whatever branch of medicine we work in, there is so much to learn from them about the deceptively simply art of communication.

If you would like to post a response to Sue's blog, please email the Website Manager, who'll be happy to upload this for you.

Inequalities and action plans

Yesterday, there were media reports of a new statistics showing huge variations in early death rates across England. Health Secretary Jeremy Hunt described them as “shocking”.

While much of the focus was on variations in physical illness, it is clear that certain groups experience much greater variation in mortality than the general population. People with psychosis (serious mental illness), who represent 0.4% of the population in England, experience an average 20 years reduced life expectancy compared to the general population. The Public Health England community mental health profiles show that premature mortality in people with serious mental illness has a more than 8 fold variation between the worst area in England (score 1863) and the best area (score 210) compared to an England average of 921.

This inequality cannot be allowed to continue, and is exactly what we are seeking to address through the College’s work on parity. I hope that the Health Secretary will help ensure real progress in bridging the gap between these variations, and hold Public Health England, local authorities, CCG and NHS England to account in his commitment parity of esteem for mental and physical health by 2015. This is going to be even more challenging given the recent 1% real reduction in spend on mental health.

Looking internationally, there is optimism. On 27 March, the World Health Assembly adopted the Comprehensive Mental Health Action Plan 2013–2020. The plan has, at its core, the globally accepted – and much quoted - principle that there is “no health without mental health”.

The plan has four key objectives:

• to strengthen effective leadership and governance for mental health;
• to provide comprehensive, integrated and responsive mental health and social care services in community-based settings;
• to implement strategies for promotion and prevention in mental health;
•  to strengthen information systems, evidence and research for mental health.

According to an editorial published in The Lancet  “this action plan and the accompanying

resolution—a first in the history of WHO—represent a formal recognition of the importance of mental health for WHO’s 194 member states. It is also a commitment by all member states to take specified actions to improve mental health and to contribute to the attainment of a set of agreed global targets. This is to be applauded, and I hope health professionals and policy makers will work together in implementation.

Caring and Carers

Today, I felt privileged to be one of four speakers at an event organised by West London Mental Health NHS Trust, called Consultants Training on Carers, organised by Mahbub Khan.  I had spoken to members of our Carers Forum before attending, who had given me their key themes and priorities about how we can better listen to carers and deliver the best care. We also heard from two carers who spoke with informed passion about being a carer, and how we can better support them and their loved one, and reminded us of the triangle of care.

I was delighted to have the opportunity to meet new and old colleagues. It was good to meet up again with Steve Shrubb, who I had the pleasure of working with on many occasions when I was Registrar and when he was Director of the NHS Confederation's Mental Health Network/ He is now CEO at West London Mental Health NHS Trust. I heard of innovative projects the Trust is working on, including the growth of liaison psychiatry, and how plans for the new building at Broadmoor are progressing.

Tonight am going to a lifetime achievement award ceremony for Malcolm Rae. Malcolm has done more for mental health nursing than anyone else I know, and mentored many of the most senior nurses across the country. He even took me (a non-nurse) under his wing, and he invented intelligent kindness before we knew what he was. I hope he will be pleased  at how the Mental Health Collaborative (representing over 85% of mental health professionals from nursing, psychology, psychiatry, social work and occupational therapy) is developing into a cohesive group, ready to lobby for and influence mental health and social care through informed thinking and practical solutions. Watch this space for what we will be up to over the next few months. 

Sue

If you would like to post a response to Sue's blog, please email the Website Manager, who'll be happy to upload this for you.

On Saturday, I was privileged to be asked to attend the British Indian Psychiatric Association (BIPA) annual conference, where there is always a warm welcome with a great sense of family and community. There were fascinating speakers, a round table discussion on the Francis Report, and excellent trainee presentations. There was also a very thought-provoking presentation on marriage, women and mental illness in Hindu communities in India, given by Professor Indira Sharma who is the current President of the Indian Psychiatric Society. 

Today saw the publication of an important new set of Healthcare Standards for Children and Young People in Secure Settings. Work on these standards was led by the Royal College of Paediatrics and Child Health, in partnership with us, the Royal College of General Practitioners, Royal College of Nursing, Faculty of Forensic and Legal Medicine and Faculty of Public health.

Also today, I am attending a stakeholder event organised the Centre for Workforce Intelligence to share emerging findings from their review of the psychiatrist workforce in the England. Our workforce lead, Dr Aideen O’Hallorahan, has been doing sterling work on this. But for reasons I can’t comprehend, there seems to be a reluctance to accept the size of the treatment gap for all degrees of, and range of, mental illness. It both perplexes and irritates me that our evidence-based facts are disbelieved, and it really shows we have to push the facts out there (as we did in our recent parity report). This wouldn’t be an issue for illnesses like cancer, diabetes and coronary heart disease. And it really does matter when the modelling for our future workforce is being done on the basis of a 25% unmet treatment need.  I know it’s a difficult world out there, but when we pull together we get results. So we need to keep pushing for 4% more funding for the 1 in 4 people who experience a mental health problem. 

The Care Bill is currently being debated in the Lords. Last week, Baroness Wheeler praised our report on parity and its recommendations relevant to the remit and role of Health Education England (HEE). It is important that we push for HEE to ensure that all health professionals have an appropriate level of mental health training – especially medical students.

Our Dean, Dr Wendy Burn, has shared some good news with me about recruitment and CT1 posts - recruitment to the CT1 grade has resulted in a 95% fill rate with a 19% increase in the actual numbers appointed compared to last year. The combined efforts of Wendy, the chair of the National Recruitment Board, Damien Longson, and the Promoting Recruitment in Psychiatry committee (PRIP) appear to have borne fruit.

Finally, I reported in one of my blogs last week that my oldest grandson is developing my knowledge of Marvel comics. Well I’m pleased to report that my two-year-old grandson is now reintroducing me to the wonder of Bob the Builder (very helpful with my house repairs) and Thomas the Tank Engine (excellent training for my regular commutes from Manchester to London by train).

Sue

If you would like to post a response to Sue's blog, please email the Website Manager, who'll be happy to upload this for you.

There’s lots to celebrate this week – the long-awaited arrival of sunny weather, and some really positive meetings and messages about mental health, both here and across the pond.

Mental health and government

On Monday, I was delighted to see that Barack Obama hosted a conference on mental health at the White House. The conference was organised in response to gun violence and last year's shooting at a Connecticut elementary school, but had a bigger goal of reducing the stigma of mental health problems and encouraging those who are struggling to get help. Actors Bradley Cooper and Glenn Close, who have both done a lot to promote mental health awareness, attended the conference, generating media coverage over here as well as in the US. It really is great to see high-profile people bringing much-needed attention and focus to these important issues.

Yesterday, I met with James Morris MP at Portcullis House. He was instrumental in pulling together the collection of essays from Conservative MPs, Making up our minds: towards improving our approach to mental health. He was keen to discuss with me the project he is working on concerning mental health policy across government.  I was really excited to hear his thinking, with which I have complete resonance.  From my own clinical background, I can think of no other way of working than across all aspects of services that can come together to meet needs of citizens with extant mental illness or risk of developing mental illness, right across into prevention and public health. This has to translate into cross-government working.

The launch of Reading Well

Yesterday evening, I attended the launch of the Reading Well Books on Prescription, a new service to help people through self-help in book form. The College has been involved with the Reading Agency in helping in the development of this scheme and in particular with Dr Paul Blenkiron. It was interesting to meet with colleagues not only from the psychology and counselling sector, but also from Libraries across England. The launch was supported by two Ministers, Norman Lamb, but also Ed Vaizey, Minister for Culture,  Communications and Creative Industries.

Academy in call for NHS service change

As Vice-Chair of the Academy of Medical Royal Colleges, I was delighted to see coverage of a new report published today, Changing Care, Improving Quality . The report is the result of collaboration between the Academy, NHS Confederation and National Voices, and says the NHS needs to face up to the need to change how it delivers its service.

According to the report, rising demand and limited resources mean the reorganisation of services is essential for the NHS to remain sustainable and to continue providing safe, effective clinical care that meets patients' needs. It says that the term "reconfiguration" has become loaded with negative meaning, associated with making cuts and downgrading services, and that service changes are frequently viewed by the public as a threat rather than positive and necessary reforms. It sets out five recommendations for local and national health service leaders, which I hope will be taken forward.

Gaining more momentum for parity

And it’s good to see that the work we are doing on parity of esteem for mental health is permeating all areas of areas of legislation and is being used to make a difference for our patients. Yesterday, Labour Peer Baroness Wheeler mentioned our report during the Care Bill debate, during discussion around Health Education England. After praising the report, she said: "I would welcome the Minister updating the House on what action the Government plan to take on this important report, the timescale for the Government’s response, and how any of the report’s recommendations will be fed into the Bill."

Finally, I'm delighted to hear that refurbishment work on our new offices in Prescot Street is progressing well. I’d encourage you to take a look at our 21 Prescot Street blog for the latest updates.

Sue

If you would like to post a response to Sue's blog, please email the Website Manager, who'll be happy to upload this for you.

Yesterday  I had one of my regular catch-ups with the Children’s Commissioner for England Maggie Atkinson. Earlier this month they published a report called Basically... Porn is everywhere - A Rapid Evidence Assessment of the effects that access and exposure to pornography have on children and young people that is well worth looking at. Sadly, the impact of pornography is only too topical, and it opens up important discussions about modern technology and how we harness it for benefit - not harm.

This week, I’m sure many of you have seen media reports of the 83-year-old man with dementia who ended his life at Dignitas in Switzerland. According to the Daily Mirror, which broke the story, the man obtained a report from a psychiatrist stating he was mentally competent to make the decision.

While the circumstances are very sketchy, the General Medical Council has responded to requests for comment from the media by signposting its relevant guidance:

• A press release from January about new GMC guidance for investigating assisted suicide complaints.
• Guidance on when a patient seeks advice or information about assistance to die
• Guidance for the Investigation Committee and case examiners when considering allegations about a doctor’s involvement in encouraging or assisting suicide.

As always, it's important for psychiatrists to be aware of GMC good practice guidance.

Amid such challenging and diffcult issues, it was good to be able to attend a dinner at Apothecaries' Hall last night, during which the Galen Medal in Therapeutics and the William Farr Medal were presented. What a wonderful opportunity to mix with individuals from across the whole of medicine, and to learn of scientific advances in diverse fields of research and therapeutics, prevention and epidemic. And of course admire the Worshipful Society of Apothecaries in London's beautiful and ancient building.

I'm getting read for a number of meetings next week, on issues such as getting ready for seven-day consultant-led care, taking our College commissioning guidance work forward, strengthening academic psychiatry, improving health care for offenders, and playing our part in supporting our colleagues working in A&E. It will be another busy week.

Sue

If you would like to post a response to Sue's blog, please email the Website Manager, who'll be happy to upload this for you.

Putting mental health into public health

I'm slowing getting back into my routine after attending the American Psychiatric Association conference in San Francisco.

There has been considerable coverage about payday loans in the media recemtly, including reports that loans are being given to people who lack the mental capacity to enter into a contract, as well as potentially the ability to have any chance of repaying the debt. The College has been concerned about this issue for some time. Dr Julie Chalmers, our Lead for Mental Health Law, and Chris Fitch, our Research Fellow, have already worked with the Office of Fair Trading to publish ground-breaking regulation for the creditor sector on the issue of loans, with this regulation carrying stringent penalties for consumer-credit licence holders who do not abide. In addition, work to support agencies ranging from Citizens Advice's campaign on payday lenders, through to the British Banker's Association programme on vulnerable customers has also taken place. 

The College's programme of work on debt, financial difficulty and mental health has also continued to intervene into the relationship between personal debt and mental health by providing direct mental health/mental capacity training and practice audits to banks, debt collection agencies, and bailiff companies, and this has been delivered to over 1500 frontline staff in around 25 different creditor organisations. At a time of recession, this work has a heightened importance given the financial difficulty that so many people currently find themselves in, and I look forward to sharing further developments as these arise.

If you combine the impact of financial stress, shops selling cheap booze, and the growing problem of obesity, it's clear that the challenge to public health and public mental health remains great. For those of you who want to be kept updated on public health issues, I recommend you look at the webpage of Duncan Selbie, Chief Executive of Public Health England, where he posts his weekly messages.

I'm delighted that Professor Kam Bhui is continuing to push the public mental health message for the College. I very much hope that those of you attending the International Congress in Edinburgh will come to the session I'm chairing on Thursday, called 'Putting Mental Health into Public Health'.  But I am left reflecting that if government really want us to be healthy, wealthy and wise, then they should start taking their own medicine and tackle the toxicity currently on our high streets. 

How the Light Gets In

Meanwhile, at the weekend, I entered the very beautiful but ever so slightly surreal world of the Hay-on-Wye philosophy and music festival How The Light Gets In. I was delighted by the good debate, music, food and company,  and enjoyed listening to the Mind, Madness and Power session - a lively discussion on psychiatry between our very own Professor Sir Simon Wessely, sociologist Steve Fuller and clinical psychologist Richard Bentall.

I was also very honoured to be on the panel for two sessions. One a discussion about memory and forgetting, alongside the fantastic brains of biographer Hermione Lee and neurobiologist Steven Rose. The other was provocatively titled Are Doctors Bad For Us?, and I survived a lively debate with CEO of patients' organisation National Voices Jeremy Taylor, and Professor of Psychiatry and Pharmageddon author David Healy. It made me realise how much further on we are in mental health when it comes to shared decision making and working in partnership with users and carers - but also that there is always so much more to be done. As is so often the case with debates like these, the real gems of sense and wisdom came from the audience.

On Sunday evening, my journey back home on the train took me cross-country, passing through the most beautiful scenery, and it was very interesting to observe the set of changing demographics between Hereford and Manchester. I spent Bank Holiday Monday engaging in some high-level learning about Marvel comics from an excellent teacher - my grandson.

Sue

If you would like to post a response to Sue's blog, please email the Website Manager, who'll be happy to upload this for you.

I flew back from the APA conference in San Francisco yesterday, so am still feeling the effects of the time difference. There has been lots going on in the UK while I've been away, and I've been keeping in close contact with the College via my blackberry.

Work Capability Assessment ruling

Yesterday, while browsing the BBC News website, I read the news story saying judges at the Upper Tribunal ruled the Work Capability Assessment puts people with mental illness, autism and learning difficulties at a substantial disadvantage. The Department of Work and Pensions has said they will appeal the decision, so we'll continue to watch this case with interest.

New mental health commission

Yesterday also saw CentreForum launch a 12-month mental health commission chaired by former care minister Paul Burstow MP. I am delighted to be a member of this commission, which will examine the progress made by the coalition government's mental health strategy in ensuring parity of esteem between physical and mental health. I will keep you updated.

Tackling the crisis in emergency departments

Over the last week, I'm sure you can't have missed the numerous media reports of the 'crisis' engulfing A&E departments. These reports are of great concern to all doctors, and particularly psychiatrists as emergency departments play a vital part in the care and treatment of people with mental health problems. But problems and pressures in A&E departments can mean the needs of vulnerable people are overlooked.

I believe there are two simple solutions to help tackle the problems of overcrowded wards and overstretched staff:

1.    Urgently implement a minimum unit price for alcohol at the earliest opportunity. Approximately 1 in 3 of all A&E attendances are alcohol-related – doubling at weekends. There is strong evidence that increasing the cost of alcohol will reduce consumption and harm among the heaviest drinkers.

2.    Ensure all emergency departments have access to a comprehensive liaison psychiatry service, providing immediate and specialist mental health support for people being treated for physical health problems. Recent research suggests liaison services can save an average hospital £5 million a year by freeing up beds, reducing readmissions and improving outcomes for patients.

Our emergency departments are facing desperate times. Tackling the problem requires immediate measures, and this is an issue I will be raising with parliamentarians.

I wish you all a very enjoyable Bank Holiday weekend.

Sue

If you would like to post a response to Sue's blog, please email the Website Manager, who'll be happy to upload this for you.

At the APA

Last Thursday, I flew to San Francisco for the 2013 Annual Meeting of the American Psychiatric Association (APA). It has been a fascinating conference - the first part of which was dominated by publication of DSM-5. 120,000 copies left the shelves in the first few hours. And it is not only DSM-5 that is rising quickly up the Amazon sales charts - so, too, are copies of those publications opposed to DSM-5!  

At the conference, there have been many impressive keynote speakers - including Bill Clinton (see right). I've also been pleased to see so many speakers and presenters from the UK. The College stand is also proving very popular - displaying a wide range of RCPsych Publications and information leaflets, of which the College, our authors, and our Communications and Publications departments can be rightly proud. 

Yesterday, I attended a very good session about progress with the revision of the International Classicfication of Disease (ICD). As many of you know, ICD-11 is due out in 2015. I would urge you all to look at the website, so as to be prepared by understanding the principles upon which this classification will be based. Please also join in the field trials, as this will shape our practice for years to come.

At the session, we heard that ICD-11 will especially look at differentiation from normal. Every disorder will have a 100 word summary definition with details of essential features, boundary with normality and boundary with other disorders.

I am looking forward to the International Reception on Tuesday evening, where there will be an opportunity to meet up with colleagues and College members from across the world.

Although the programme here is extremely busy, I am finding a few spare moments to explore the city. The streets of San Francisco are, I guess, like many large vibrant coastal cities across the world - a rich mixture of busy people, homelessness and street performance artists. I've been enjoying the amazing seafront vistas of the Golden Gate and (closer to my clinical world!) Alcatraz. I hope my Grandson likes his Alcatraz t-shirt that I'm bringing back for him.

The big mental health debate

Last Thursday saw the second backbench Commons debate on mental health, following the one that took place in June 2013. It was a five-hour debate with input from MPs of all parties, and, following our briefing, many interesting topics ranging from stigma, crisis care, BME communities, welfare reform, alcohol and the need for parity of esteem between mental and physical health.  A number of MPs have called for the debate to become an annual event as a way of “reducing the stigma that is attached to mental illness, increasing understanding of it, and also, quite correctly, holding the Government to account on how their policies develop”.

Former Care Service Minister Paul Burstow MP, who led the debate, highlighted the work of the College in relation to parity, and Kevan Jones MP thanked the College, and others, for "doing a great job of raising the issue and tackling the stigma".

Former GP Dr Sarah Wollaston MP raised the issue of integration and the importance of liaison psychiatry as "greatly appreciated by patients and provide an excellent way for them to receive services; moreover, they are incredibly cost-effective".

It is good to see all our efforts in areas such as parity being used to shape debate, influence opinion and ultimately help us deliver for our patients. If you have time I would encourage colleagues to read the text of the debate or watch it online.

Investing in technology

Last week I received a letter from Health Secretary Jeremy Hunt, about launching the £260m technology fund for hospitals on Friday. The announcement formed part of the response to the Francis report, which called on the NHS to make better use of technology to improve care. I welcome this announcement, and hope it will fully include mental health services. We need integrated data which ensures that vital information is shared - allowing patients with mental illness to receive high quality and timely care, while ensuring appropriate confidentiality. The government has already acknowledged that we have good examples of health informatics in our sector. 

Sue

If you would like to post a response to Sue's blog, please email the Website Manager, who'll be happy to upload this for you.

I’m looking forward to tomorrow’s debate in the House of Commons on mental health, which follows last year’s debate on the same topic. The previous debate in June 2012 was long overdue, and never before had parliamentarians spoken so openly about mental health issues that have affected them personally.

Nicky Morgan MP opened the last debate by saying: "Mental health comes at an economic and social cost to the UK economy of £105 billion a year, yet mental health has been a Cinderella service - poorly funded compared with other conditions and not spoken about nearly enough either inside or outside this House. It is the largest single cause of disability, with 23% of the disease burden of the NHS, yet the NHS spends only 11% of its budget on mental health problems."

I was overwhelmed by the honesty and openness with which mental health was discussed by MPs, which was one further step along the road to ensuring everyone can be open about mental health without fear of stigma.

This latest debate follows the enactment of the Mental Health (Discrimination) Act, which outlaws discrimination on mental health grounds against jurors, company directors and MPs. It is also timely because it follows the College's recent report, Whole-person care: from rhetoric to reality, which outlines ways to ensure parity of esteem for mental and physical health. We have welcomed the government’s commitment to parity for mental health but there is still more to be done to make this vision a reality.

The College has worked with Mind and Rethink Mental Illness to brief MPs in advance of tomorrow's debate, highlighting some of the key issues we hope will be discussed.

If you are a tweeter, you’ll be able to follow developments using the hashtag #bigmhdebate and the College will be tweeting live during the debate from our twitter feed @rcpsych.

The debate comes at an important time for mental health and I hope it is another step towards continued improvements in perception and care for those effected by mental health, their carers and families.

Sue

If you would like to post a response to Sue's blog, please email the Website Manager, who'll be happy to upload this for you.

Support for carers

On Sunday I was pleased to see media coverage of the RCGP’s call for more support for carers. Our GP colleagues say carers should have routine appointments and checks for depression and other mental health problems. Although this is good to hear, the challenge is more than just helping carers maintain good mental and physical health. Will all the other support services they need be adequately resourced to help make high quality care in the community fact, rather than mantra? Last week I blogged about the Queen’s Speech, and hopefully some positives will come out of that for those with mental illness and their carers.

Celebrations in Northern Ireland

At the end of last week, I had the privilege of being part of the 10-year celebration of RCPsych in Northern Ireland. The conference was held beside the beautiful Mourne Mountains. In my clinical life, I have spent more than 30 years visiting Northern Ireland to work with child services and their complex, high risk young people. This visit reminded me that I have seen many changes there, through both troubled and good times.

The impact of their major health review, Bamford, is certainly now to be seen. Northern Ireland is facing the same challenges as in the rest of the UK – balancing the delivery of intensive community-based services and public mental health prevention, whilst improving the fabric and capacity of inpatient services for those who require them.

The RCPsych in Northern Ireland is a close-knit, thriving family – and meeting their many new members showed me that they are facing a very secure future. The health minister, Edwin Poots, addressed the meeting and was rightly praising of all that the College has achieved – thanks in no small part to the College staff over in the Divisional office, led by Nora McNairney.

We enjoyed many good presentations at the meeting, covering all ages and aspects of psychiatry. Creativity emerged as a key theme, through academic discussions, conversations and social events. It was particularly good to hear from a social media expert that blogging is an effective way of communicating. He was also very positive about the @rcpsych Twitter feed, where we aim to send out positive, informative messages about mental health and psychiatry, and engage in discussion.

The meeting was also an opportunity to bid farewell to Dr Philip McGarry, who has chaired the Division for the last four years and done a fantastic job. Although we are sad to see him go, I am very pleased to welcome the incoming Chair, Dr Diana Day-Cody.

Troubled waters

At the end of this week, I will fly to San Francisco for the 2013 Annual Meeting of the American Psychiatric Association. The meeting will be hit by the storms that are already building up around the launch of DSM-5.

The fifth version of the DSM has already received extensive media coverage here in the UK, with many people using its imminent publication to raise concerns about psychiatry and the classification and diagnosis of mental illness. Whatever your personal views of DSM-5, my concern is that its publication is providing the focus for ill-informed psychiatry bashing. In some areas, this is being turned into a ‘turf war’ between psychiatrists and psychologists.

But these arguments are distracting us from the real challenge – which is providing high-quality mental health services and treatment to patients and carers. At this time, we should all be immersed in advising on the new commissioning changes in England, and celebrating advances in neuro and social science research.

The issue of diagnosis and classification was raised at a recent meeting of our Service User and Carer Forums, and I was interested to hear their thoughts. “I like my label – I know what I’m up against” was one of the comments. There was a general feeling that receiving a diagnosis can be difficult to accept – but that it can also be helpful and bring about a better understanding of how to manage the illness. Some people also recognised the importance of diagnosis organisations (such as Depression Alliance and Bipolar UK) in offering hope, mutual support, and an opportunity to share experience and knowledge.

Our College has today issued a statement on DSM and the classification of mental illness. I would also urge you to read the excellent opinion piece by one of our Fellows, Professor Sir Simon Wessely, in yesterday’s Observer. As he so wisely says: "Psychiatry is the study of the brain and the mind. Psychiatrists look at the whole person, and indeed beyond the person to their family and to society... Most of those who are in the business of helping those with mental disorders will be less concerned with what is in [DSM-5] and what is out than with the reality of underfunded and overstretched services. The idea that we are part of a conspiracy to medicalise normality will seem frankly laughable as we struggle to protect services for those whose disorders are all to evidence under any classification system."

Sue

If you would like to post a response to Sue's blog, please email the Website Manager, who'll be happy to upload this for you.

The Queen's Speech

There was pomp and ceremony aplenty in Westminster today at the State Opening of Parliament and the Queen’s Speech in which the Government outlined its legislative programme for the coming session of Parliament.  

Following the Draft Care and Support Bill in the last Parliament, a Care Bill will be introduced combining existing care and support legislation. It introduces a duty on local authorities to meet carers’ support needs and introduces a new adult safeguarding framework.  

The College will also be taking a keen interest in how the Bill amends section 117 of the Mental Health Act, which gives local authorities and CCGs a joint duty to provide ‘after-care’ services when people leave hospital following detention under the Act, and people subject to Community Treatment Orders.

We have been campaigning with other Royal Medical Colleges and health stakeholders for the introduction of a minimum unit price for alcohol and, whilst I was disappointed not to see anything in today’s speech, I must take some heart from Jeremy Hunt’s radio interview on the Today programme this morning during which he emphasised that no final decision has been made. Hopefully when a final decision is made, it’s the right one.

Although not covered in specific legislation, in response to failings at Stafford Hospital Ofsted-style ratings will be introduced for hospitals and care homes, and the new Chief Inspector of Prisons will be given more power. On immigration, plans have been announced to regulate migrant access to the NHS, “ensuring temporary migrants make a contribution” and it will be interesting to see how this plays out in practice.

Achieving parity

Yesterday, I attended a meeting of the Ministerial Advisory Group on the Mental Health Strategy, and took the opportunity to feed in key points from our recent parity report, Whole-Person Care: From Rhetoric to Reality. This landmark report has been very well-received, and we are in constructive discussion with service users and carers, and key stakeholders from across health and social care, about how we can help make it a reality.

Dr Martin McShane, the NHS Commissioning Board’s lead for long-term conditions, responded with a packed list of actions that NHS England have pledged to deliver to help bring about parity. There will be an emphasis on how the new National Clinical Directors – across all specialties, geographies and groups – will work together to enable integrated care. Nowhere will this matter more than in mental health.

A time for celebration

It feels like celebratory events are all too rare these days, but last week I had the privilege of speaking at the launch of Rethink Your Mind, an exciting and creative arts and mental health project. Rethink Your Mind has published a book of poems, paintings an drawings, all created by individuals with mental health problems. Woven into the book are important messages about wellbeing, and positive ways to be resilient and flourish. I strongly encourage you to take a look at their website.

Later today I’m flying to Belfast, to take part in the RCPsych in Northern Ireland’s Spring Meeting. The meeting will mark the 10^th anniversary of setting up the Northern Ireland Division, and I very much look forward to joining the celebrations.

Sue

If you would like to post a response to Sue's blog, please email the Website Manager, who'll be happy to upload this for you.

It has been a week spent mostly at the Academy of Royal Medical Colleges. On Tuesday, all the Colleges came together to look at our top priorities to act on post Francis. The Colleges are already working on these individually, and with other health and social care professionals, including the NHS Confederation, so we now have some clear understanding of what others intend to do. The next step is to collate and analyse all we have learnt and then start working on a few priorities that are key to us as doctors. All the work done by Council in January when we held a World Café on this and other key issues, have been fed in. You can expect a paper shortly from myself and Professor Mike Crawford, Head of the CCQI, hopefully with a commentary from our service user and carer forums.  I am still, however, very open to suggestions.

We have a good basis for our work, drawing from the College publication, Intelligent kindness: Reforming the Culture of Healthcare, and some of the CCQI’s current initiatives, such as the kite mark for elderly wards across medicine. Messages from Francis, Winterbourne View and countless other earlier reports have to be taken into appraisal and revalidation. There is a strong view that if we restarted visits to services when looking at training that this would also act an early alert when things are going wrong. We need to look at how we can strengthen the role of Regional Advisors, as they have a great deal of knowledge about posts and how these are working in the context of best patient-centered care and treatment. So there is no shortage of routes in.

On Wednesday I attended a working group on 7 day working to which members have been actively contributing. This has UK wide implications and is focusing on how doctors will have to change their working routines. Some of you will shortly be receiving a survey, so please do respond. Some medical colleagues are under the impression that we do a Monday-to-Friday, 9-to-5 job, and they have little insight into the diverse range of work we do outside these hours.

Yesterday, Prof. Wendy Reid, Medical Lead in Health Education England (HEE), came to talk to the Academy. I feel that we are heading for challenging times. Good news: all Local Education and Training Boards (LETBs) have a Postgraduate Medical Dean on them and 2 LETBs will have 2 Deans. But it is clear that HEE will be kept on a tight rope up to the elections as they will be working to a shortly to be announced Mandate. Only time will tell!

With regard to the regulations on Section 75 of the Health & Social Care Act around competition and commissioning, we have been invited to meet with Monitor shortly. Our dilemma is that the regulations follow primary legislation, ie the Act. We still have concerns. Will Clinical Commissioning Groups (CCGs) factor in whether a provider provides education and training or will this be lost? Will they really be able to factor in risks of destabilisation, if one part of a service goes to one provider and the rest stays where it is?

We are currently generating case scenarios for Monitor to work with because we know that even in surgery a patient never arrives with one simple problem. We have generated psychiatry-specific ones, but we are working with other Colleges on across-medicine presentations.

The newspapers covered the defeat of a move to have the Regulations withdrawn during a Labour led debate in the House of Lords on Wednesday evening. The government won the vote and we now have to work with what we have - working with Monitor, the Care Quality Commission and those College members trying to get involved at some level on CCGs. We can still have influence, so please see what you can do. I know many of you are getting involved, so many thanks as it’s the best way to support our patients.

Today, Lord Willis of Knaresborough, Sense About Science and the Academy of Medical Royal Colleges are hosting the launch of a new report, ‘Evidence Based Medicine Matters’, at the House of Lords. Dr Paul Blenkiron in his capacity as a NICE Fellow,  contributed a chapter on our behalf on the effectiveness of CBT.

Am keeping my fingers crossed, but Spring finally seems to have sprung in what was another busy week in and out of the College.

I have to admit that I’m not a twitter user, but the College account is an active one with nearly 17,000 followers and I hope members that do follow us find it useful. I was interested to hear the Health Secretary Jeremy Hunt had taken to twitter to emphasise the need to parity of esteem between mental and physical health. We’ve had very good feedback on our recent report, especially on social media where there has been some good debate around the issues we’ve raised.

As you will have read in previous blogs, most of the Medical Royal College have been making representations regarding the latest versions of the regulations around competition in the new NHS structure, and the effect they may have on the commissioning process.

Following pressure from doctors and others in the health sector, the first regulations were amended. We continue to liaise with Ministers and the Department of Health to ensure patient care is not put at risk as we move forward.

The Labour Party have tabled a debate in the Lords next week in an attempt to get the new regulations debated and possibly annulled, and I will watch with interest to see what Peers have to say.

The College was invited to meetings organised by the Labour Party as they look to review their policies in advance of next election. It has been interesting to hear their thoughts on the direction of travel for the health and social care system, and the views of those that will work in it and use its services.

Turning to training, I was informed of a leadership programme called GenerationQ, being run by the Health Foundation. They are looking for senior leaders in healthcare or the voluntary sector who are in a position to influence improvements to care quality, and learn about the evidence base underpinning leadership for quality improvement.

The part-time programme will take between 18 months and two years to complete, and leads to a postgraduate certificate, diploma or Masters in Leadership (Quality Improvement). I would encourage members to look at the website if they are interested in applying.

All Colleges have also been invited to input into the ongoing reviews following the Francis Report and Officers will be discussing how best to ensure psychiatry is part of the process of improvements to patient care.

I’ll try to keep members updated here and via our newsletter as usual.

Yesterday, The Times reported on a new mental health research charity, MQ, that has been set up to raise millions of pounds to transform the treatment of mental illness. The Chairman is Lord Denis Stevenson, who we worked closely with on the Mental Health (Discrimination) Act.

I am hugely excited by these plans. Having worked as an NHS psychiatrist for more than 30 years, I am sad to say that mental health still does not receive the same attention as physical health, and that psychiatry – and academic research into mental health – remains medicine’s poor relation.

In the UK, mental illness accounts for a third of all illnesses – the single largest source of burden of disease. But paradoxically it remains under-researched and under-funded, only receiving 6.5% of the total UK health research budget, compared to 25% for cancer, 15% for neurological diseases and 9% for cardiovascular conditions.

If this is to change, then we have to take a radically new approach. MQ is undeniably bold in its ambition – wanting to become a fundraising force every bit as powerful as Cancer Research UK or the British Heart Foundation. These excellent organisations were both founded by medical professionals wanting more research into the cause, diagnosis, treatment and prevention of disease. And thanks to these organisations, huge progress has been made in recent decades in developing new treatments for cancer and heart disease, and improving the lives of patients and their families.

People affected by mental illness deserve this support too. But the same amount of time and money has not been invested in them. It is shocking that people with severe mental illness have a reduced life expectancy of 15–20 years. This cannot be tolerated in the 21^st century.

If we believe in a society where we are all equal citizens, then those who experience episodes of mental illness must receive the best care, informed by the best evidence. We urgently need to invest in research that will improve the quality of mental health treatment, and help drive the development of new medications and all types of psychological interventions. We need to develop new strategies for diagnosing, treating and preventing mental illness, to help support people with their recovery and beyond.

We are entering an era of major advances in the field of neuroscience, and we have a growing understanding of the complex biological, psychological and social causes of mental illness. That’s why I am particularly pleased to see MQ’s commitment to using cross-disciplinary approaches to solving the problem of mental disorder. If MQ are to deliver on their ambition of solving global issues in mental health, they will need to commission both quantitative and qualitative research that brings together the neurosciences and social sciences.

The College is committed to achieving parity between mental and physical health - as you'll have seen from the report we published last month. It will take time, but I believe that the work of MQ: Transforming Mental Health will be a huge step in the right direction.

Sorry not to have blogged for a little while. Since we launched the parity of esteem report on 26 March, we’ve had lots of encouraging responses. We will pull together all of the thoughts we’ve received from different organisations – including the NHS Confederation’s Mental Health Network – so we can move into implementation. I hope that many of you, as members, will volunteer to be involved.

Preparations are a seminar on mental health and the workplace, as well as a set of four seminars on building psychosocial resilience. These two projects will both lead to new Occasional Papers.

As well as the continuation of cold weather, the start of April has seen the launch of the new NHS, together with stringent changes to the welfare system and legal aid. It is hard not to be pessimistic about the combined impacts of all three of these on the most vulnerable groups that we care for.

In England, the debate around Section 75 regulations continues, and we are awaiting responses from both Monitor and the Department of Health. In the meantime, the Academy of Medical Royal Colleges is continuing to have dialogue with government on the issue.

On 26 and 27 March, the College and Royal Society of Medicine jointly organised a conference on global mental health. I was very heartened by the number f young psychiatrists involved in so many amazing projects, and I hope to showcase many of these are our International Congress in Edinburgh from 2-5 July.

I hope to see as many of you as possible in Edinburgh, where we have organised a meeting of mental health policy leads from the four countries. We will also host a meeting of Presidents from the European psychiatric societies again, and Professor Mike Crawford – Director of our College Centre for Quality Improvement – and colleagues have completed a survey of how and what different psychiatric societies are doing in the field of quality improvement. I am sure the findings and resulting discussions will be extremely interesting.

I am writing this blog from Nice, where I am attending the 21^st European Congress of Psychiatry. Their cold weather seems very hot to me! I'll blog about the action from the conference later in the week.

Sue

If you would like to post a response to Sue's blog, please email the Website Manager, who'll be happy to upload this for you.

Today our College has published a landmark report on achieving parity between mental and physical health.

In April 2012, the Royal College of Psychiatrists was asked by the then Minister of State for Care Services, Paul Burstow – in partnership with the Department of Health and the NHS Commissioning Board Authority– to develop a definition and vision for ‘parity of esteem’.

I was honoured to be able to lead this work and the report that we’ve published today, Whole-Person Care: From Rhetoric to Reality, is the culmination of many months of hard work.

The long-standing and continuing lack of parity between mental and physical health - as  exemplified by lower treatment rates for mental health conditions, premature mortality of people with mental health problems and underfunding of mental healthcare relative to the scale and impact of mental health problems - falls short of government commitments to international human rights conventions, which recognise the rights of people with mental health problems to the highest attainable standard of health.  It is not only inequitable, but socially unjust.

The report makes over 30 key recommendations for government, policy-makers, service providers and health professionals, as well as the new NHS structures coming into force on 1 April including the NHS Commissioning Board, Clinical Commissioning Groups and Public Health England. The headline message is for all of the above (and ourselves as doctor psychiatrists) to always to think in terms of the whole person – body and mind – and to apply a ‘parity test’ not just to our activities but also to our attitudes.

The College is strongly committed to a continuing work programme focused on achieving parity. I’m pleased to say that many organisations – some working jointly with the College – have also committed to ambitious actions which will bring us closer to achieving parity, and I look forward to seeing the fruits of their labours.

I want to say a profound thank you to every single member of the parity of esteem working group and other expert advisors who contributed to the report. Contributors included representatives of Medical Royal Colleges, national clinical leaders, mental health charities, social care specialists, and service users and carers – you can see the full list of names in the report. I also want to thank Lucy Thorpe, our Head of Policy, and Greg Smith, our Policy Analyst, who drafted the report. 

The publication of this report really is a momentous occasion. But the work does not stop here. In fact, it should be seen as the first stage of an ongoing process over the next five to ten years that will deliver parity for mental health and make whole-person care a reality. I look forward to the journey.

Sue

If you would like to post a response to Sue's blog, please email the Website Manager, who'll be happy to upload this for you.

In England, we’re all revving up for 1 April when the new NHS structures come into force. We’re publishing our report on achieving parity between mental and physical health next week – so keep your eyes peeled for that.  

This week I attended an a farewell event for Professor Sir Michael Rawlins, who is leaving his post as Chair of NICE. It made me realise just how far medicine has travelled in the last 10 years, when it comes to guidance and clinical practice.

On Thursday, I met with the Confederation of British Industry’s health policy lead, George McFarlane. As a lobbying organisation they represent around 24000 businesses. It was a positive meeting with some shared interests on health and business initiatives.

We plan to map out these principles in order to link key drivers such as sustainability of integrated health provisions, the work place health agenda and the engagement of jurisdictions.

In order to launch a key initiative for working age adults, we're holding an event in London on mental health and employment in late June 2013. At this stage, we're looking at mental health in the work place in its broadest sense. Key stakeholders linked to the relevant issues from inside and outside the College will be invited to attend, and discuss ideas to help further the initiative.

This work is in development but watch this space for further news.

Sue

If you would like to post a response to Sue's blog, please email the Website Manager, who'll be happy to upload this for you.

Yesterday, the media was full of speculation that plans for a minimum unit alcohol price may be dropped. This is extremely concerning because as we believe, as do many others, that of all the potential price control mechanisms, minimum pricing is the best way of reducing the harm from alcohol to drinkers, their families and the rest of the population.

The government’s Alcohol Strategy was published a year ago this month and in the foreword Prime Minister David Cameron makes this pledge: "We are going to introduce a new minimum unit price. For the first time it will be illegal for shops to sell alcohol for less than this set price per unit."

I wrote a letter to The Times that was published today. It said:

The Royal College of Psychiatrists is extremely concerned by reports that plans for minimum pricing of alcohol may be dropped.

The UK has seen a dramatic increase in alcohol consumption and alcohol-related harm over the past 30 years. Much attention is given to the effects of excessive drinking on the body. But we must not forget about the emotional, mental and physical harm it can cause to individuals, children and families. Alcohol dependence affects our moods, judgement and behaviour, and contributes to violence, including domestic abuse, self-harm and suicide. Alcohol therefore also affects the health and wellbeing of people’s partners, children, other relatives, colleagues and the wider community.

We believe minimum pricing is the best way of tackling our nation’s unhealthy relationship with alcohol. This is about more than the price of a single drink – it is about the cost to people’s lives.

It is clear that the debate around the possible dropping of alcohol minimum pricing shows no sign of quieting down, following David Cameron’s remarks during Prime Minister's Questions yesterday and today’s statement in the Commons on the same issue.

Today, Lib Dem Crime Prevention Minister Jeremy Browne  (rather than Home Secretary Teresa May) stood up in the House to tell MPs that the results of the consultation on the Government’s alcohol strategy (that we as College responded too) would be published in due course and did not give much else away.

David Cameron said much the same yesterday when he outlined that he wanted to stop cheap alcohol being sold in supermarkets but did not commit to a minimum unit price. I await the response to the consultation with interest and will continue to pursue the issue.

Sue

If you would like to post a response to Sue's blog, please email the Website Manager, who'll be happy to upload this for you.

As regular readers of my blog will know, I had an excellent meeting with Professor Richard Frank at the college on Monday. Yesterday morning, I was delighted to hear him talk again about early intevention work in the US - this time at a round table event organised by the Centre for Mental Health, of which I'm a Trustee.

After this I, as Vice-Chair of the Academy of Medical Royal Colleges, went with the Academy's Chief Executive to see Health Minister Earl Howe at the Department of Health. The meeting was arranged following correspondence around the Academy's concerns about the Section 75 regulations dealing with competition in the NHS.

Earl Howe sent us this letter and, as you have probably seen, following a statement yesterday in Parliament, the controversial regulations have been withdrawn and will now be redrafted. Hopefully the new version will answer and address the concerns of health professionals, patients and carers. The Academy has formally welcomed the withdrawal and I echo this sentiment. It is at times like this that I see how hard and well the Policy and Communications staff at the College work to get our messages out and influence real change.

There was a huge amount of public health news yesterday, badged around a report on UK health performance published in The Lancet. My frustration is that the absolute importance of good mental health and improved physical health of those with mental illness still isn't understood - or, if it is, seems sidelined. I wrote a letter to The Times in response, which unfortunately wasn’t published in the paper. However, I thought I would share it with you here:

Dear Sir

Yesterday’s report (‘Failings in NHS cost 30,000 lives every year’, 5 March) reveals worrying data on levels of premature mortality in the UK. The Royal College of Psychiatrists believes that any effort to reduce premature mortality must include a strong focus on increasing the life expectancy of those with mental health problems – which is on average 20 years less for men and 15 years less for women with severe mental illness.

Mental illness is associated with increased risk of physical illness. Depression almost doubles the risk of developing coronary heart disease, and is associated with a 50% increased mortality from cancer. Physical illness can also lead to mental illness, impeding recovery and increasing mortality rates.

Much of this is preventable. However, only a minority of people receive interventions for mental illness and even fewer receive interventions to prevent mental illness.

It is time to radically rethink health care, and pay proper attention to both the physical health of people with mental health problems and to the mental health of people with physical health problems. We ignore mental health at our peril.

After my busy Tuesday morning, I met with the Care Quality Commission and discussed how we can best work together in our respective roles. I will report on this in more detail again soon.

Sue

If you would like to post a response to Sue's blog, please email the Website Manager, who'll be happy to upload this for you.

Over the last week, I have continued to focus on concerns raised by members of our Eastern Division at the proposed changes to services in Norfolk and Suffolk. Feedback from our colleagues at the Royal College of Nursing is that their concerns closely mirror our own. I have raised the issue with Norman Lamb, both as a local MP and also the Minister responsible for mental health services, and am writing to the Trust’s Chair. Our Registrar has written to the Trust’s Medical Director. Our Dean will also be liaising with the General Medical Council to ensure that the quality of training is safeguarded in any proposed changes.

Many of you will have seen the article in The Observer on Sunday about the Academy of Medical Royal Colleges' concerns over Section 75 regulations. The Academy’s letter to Lord Howe was leaked to the paper. Although it is unfortunate that this timely and reasoned letter was leaked, I believe the coverage it received was positive in that it shows that the voice of the medical profession is being listened to by both the media and the public. It puts us where we should be – as leaders who advise on and raise concerns about circumstances in which we believe the quality of care and safety of patients are being put at risk. We now await the government’s response, and our College’s Communications & Policy Department will continue to monitor events closely. It is plain that the regulations do need a rewrite, and the Academy and ourselves will ensure we are well advised on what the regulations mean in day-to-day practice for the consistency and continuity of care for mental health service users and carers.

This morning, I had a positive meeting with Richard Frank, Professor of Health Economics in the Department of Health Care Policy at Harvard Medical School. From 2009 to 2011 Richard Frank served as the Deputy Assistant Secretary for Planning and Evaluation at the US Department of Health and Human Services directing the Office for Disability, Aging, and Long-Term Care Policy.  He also significantly contributed to American legislation giving parity of esteem to insurance coverage of mental illness.

Professor Frank met with me, and the College Policy and Communications team, to talk about the College's work on advancing parity of esteem. Despite the American and British healthcare systems being funded very differently we found much common ground to talk about, including the tricks that can be used to limit access to services (known in the States as 'non-quantitative treatment limits'), how to design intelligent payment systems which discourage both over- and undertreatment, being clear about what we expect from high quality services and the importance of practicing as doctor psychiatrists who don't leave their patients' basic physical health checks and care to someone else.  I went away feeling confident that the College's forthcoming report on achieving parity of esteem will strike the right note, and will stay in touch with Professor Frank to discuss potential future projects such as how to accurately measure and reduce preventable mortality in our patient group. Despite the differences in our respective health systems, we share common challenges and hopefully shared solutions.

Professor Frank will be giving a lecture at the Centre for Mental Health tomorrow night on many of these issues.

Sue

If you would like to post a response to Sue's blog, please email the Website Manager, who'll be happy to upload this for you.

This is a slightly belated blog about an excellent lecture held at the College on Tuesday night - part of our prestigious evening lecture series.

Dr Jed Boardman delivered a heartfelt lecture to an enthusiastic audience, entitled ‘Social Security or Welfare? The case for Welfare Reform for People with Mental Health Problems’. ver recent years there has been a drive to reverse the increasing numbers of people receiving sickness benefits.  This has been promoted through a discourse that highlights the health benefits of work and the negative effects of remaining in the ‘benefits trap’.  This has implications for the lives of people with disabilities, including those with mental health problems or learning disabilities. 

Current reforms are controversial and are likely to be damaging to the lives of people with mental health problems, rather than providing them with security in times of vulnerability.  Jed reviewed the problems associated with marginalisation and inequality that are faced by people with mental health problems and examined the implications of these for mental health professionals and for social reform.

If you would like a copy of Jed's excellent presentation, please email Thomas Kennedy, in our Communications Department.

Sue