1) From the Faculty Chair: Together we
stand
Dr Michele Hampson
Times of financial difficulty can be a time for creative new
solutions, not simply cuts. How do we make this happen?
The dramatic increase in NHS
funding in recent times did not produce the anticipated
productivity gains and work-related stress persists. The share of
funding for mental health services did not increase
proportionately. We are still not resourced to deliver the NSF
standards of 10 years ago and NICE guidance, the latter being a
right under the NHS Constitution. So what are we doing with the
extra resources?
We respond to a bewildering number
of national policies and guidance, which paradoxically may reduce
patient care. Instead we sit in policy implementation meetings to
determine how we would improve services, if only we had the time to
do so! Copying letters to patients is a good of example of
this. Darzi’s “High Quality Care for All” with its
laudable aspiration of a bottom up approach to quality indicators,
can be transformed into yet more standard setting and data
collection for clinicians, determined at Trust, PCT and SHA level.
These tiers will seek extra staff for the data analysis to produce
the Trust quality account and the SHA Quality Observatory; with
little left for the frontline services. If meaningful
comparative data is not provided to the teams, how likely is this
process to improve performance? How hard it is to remove the target
culture in its many guises? Yet without reliable outcome
measures, how do we ensure that we develop commissioning in mental
health and evaluate service changes?
With the New Horizon’s agenda of
mental health and well-being, how do we ensure that those with
greatest need do not lose out, as the new agenda comes with no
additional resource?
The NSF teams of EIP, CRHT and AO
were welcomed and improved access and quality of care, notably at
the earliest stages of severe mental illness, where it may have
greatest impact. Without the “new” we would not have seen the major
funding increases in adult mental health and the ability for some
to receive the quality of care we would aspire to for all in
secondary care services. Research has focussed on outcome measures
of the individual services. What we now need is systems evaluation.
What has been the impact of efficiency within the care pathway and
the patient experience in the “pass the parcel” service delivery
model? How do we get the right balance between functionalisation
and continuity of care?
The College has a key role to play
in monitoring the impact of changes nationally, with comparisons
across the jurisdictions, arguing for the fair share of resources
for mental health, including that needed for research and service
evaluation, and to support its members individually through the
Psychiatrists’ Support Service.
How can you help?
- Contact the General and Community
Faculty Executive to let us know what is happening locally. You can
find out who your regional
representative is on this website.
- Come to the Faculty Conference.
You get a wonderful training experience in seminars and workshops.
You also get a chance to talk directly to the Faculty Executive,
the President and Dean as well as to each other – the best national
networking opportunity for adult psychiatrists.
What is the Executive doing?
- We are working with the College
Registrar on a consultant survey about factors affecting job
satisfaction, so you will here more about this.
- We are arguing for a review of service configuration. What
determines the best model in a given area? Is the future around
amalgamation to improve efficiency and quality of care?
- We are seeking to ensure that there is evaluation of any
service changes so that future service changes are
evidence-based.
- We are looking to work more closely with the College Research
Unit and to enable our members to develop quality indicators for
national benchmarking.
- We will press for the availability
of all NICE guidance for our patients – our medical colleagues will
be doing no less!
- Our users and carers are our greatest allies in identifying
service shortfalls and offering suggestions, so we will work more
closely with them. We propose to work with them to develop guidance
on what our users and carers can expect from services.
- We are most effective when working with all our partner
professionals and organisations and are seeking to strengthen these
links.
We need you to help us support you as together we stand.
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2)Faculty Conference: Evolving Services,
Evolving Treatments 15 – 16 October 2009, Hilton Hotel,
Cardiff
Plenaries:
- ‘The evidence behind diagnosis in ICD 11
and DSM V’
- ‘Bad Science’ and ‘Good Science, or is
NICE nasty?’
Symposia:
- National Clinical Networks (CRHT, Primary
Care and EIP)
- A range of topics
covering different conditions, treatment and settings, and an
opportunity to question the President and Dean of the College
- A wide range of ‘How to…’ and ‘Masterclass
in…’ Workshops
- Research Prize
- Trainee Meeting
Delegate numbers are filling up but there are
still a few places available for this high quality educational
meeting. A full
programme is available on the Faculty website. To book a place,
please see the relevant information on the events section of the College website.
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3) News from the
Networks
Two Networks, Primary Care Liaison
and Crisis Resolution and Home Treatment were launched at the
Faculty conference last year. There are active discussion fora for
both of these Networks which members of the College are welcome to
join by emailing. Both of these
Networks will continue to have their own session at the Faculty
conference.
There are now around 130 members of
the CRHT Network and around 70 members of the Primary Care Liaison
Network. Two further Networks will be launched at the Faculty
conference on 14 and 15 October. One is the Prison Inreach Network
which will be the first cross-faculty Network with leads from both
the Forensic and General and Community Faculties. A survey of
specialist mental healthcare in prisons has been completed and will
be presented at the Faculty conference in Cardiff on 15 October.
The other new Network is the Early Intervention Network which has
also arranged an exciting programme for the Faculty conference. To
join these Networks, please email.
Further information on the sessions
that the Networks have arranged at the Faculty conference is
available on the Faculty website.
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4) CRHT
Network
Mary-Jane Tacchi, CRHT
Network Lead
What a great year it has been for the CRHT
Network!
We have 130 people signed up for the CRHT
network but there is plenty of room for more….
The discussions have been
wide ranging and incredibly useful and we have learnt from each
others’ experience and have shared good practise. A number of
visits have been set up via the network which is great!
The threads have covered three broad
areas:
1. The CRHT
model: it’s future and the challenges of integration of
older people and LD patients, crisis houses, day hospitals, in
patient and CRHT models
2. Logistics: skill mix, night cover
arrangements, gatekeeping, medication, documentation, physical
treatment
3. Topical issues: CTOs and their impact,
particular interventions eg systemic therapy, outcome measures
We have a great seminar
at the Faculty residential meeting which will be chaired by myself,
Maria Atkins from Wales and Mark Taylor from Scotland and promises
to be a great afternoon out!
Hope to see you there!
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5) Higher trainees' update
Elena Baker-Glenn, higher
trainee representative
The first General and Community
Faculty higher trainees conference took place on 4 September and
went very well. There was a lot of positive feedback from trainees
about the conference and further details can be found on the
higher trainee section of the Faculty
website. Sessions included starting research as a trainee and
how to get published, leadership: using the national agenda to your
advantage, dealing with a serious untoward incident as a senior
trainee/ new consultant and experience as a new consultant. Two
thirds of delegates rates their overall experience of the day as
excellent and one third felt that it was a good experience. All
felt that it was good or excellent value for money.
There has been elections for a new
higher trainee representative as Dr Elena Baker-Glenn is stepping
down as representative on 15 October 2009. The new representative
is Dr Rakesh.Magon who is an ST6 in general adult psychiatry.
There is a discussion forum for
higher trainees. To join, simply email indicating that
you wish to join the forum.
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6) Funding the work of the Faculty
Frances Burnett, Finance
Officer
As Finance Officer it’s
my job to prepare an annual business plan for the Faculty, set a
budget and ensure that our income covers the costs of our
objectives. Faculties, Divisions and Special Interest Groups of the
College are self financing and therefore don’t receive any income
from membership fees. However, they do get administrative support
and input from the CRTU and the Conference Office. We contribute
15% of any financial profit that we make to the College Development
Fund, and this year we donated £860 to the launch of the Fair Deal
Campaign.
Our current objectives
include increasing the involvement of members and trainees in the
work of the Faculty, developing networks within General Adult and
Community Psychiatry, and addressing low morale and the perception
of de-professionalism within the profession. Over the last few
years we have made considerable progress in the involvement of
users, carers and regional representatives in the work of the
Faculty. We have successfully established two clinical networks and
are about to launch two more at the forthcoming Conference. We have
quadrupled attendance of trainees at the Conference and held a
highly successful Higher Trainees Day. We have made a very active
contribution to national policy development, and to training. Our
2009 budget is set at an expected annual expenditure of
£12,310.
To date we have relied on
income from our annual Faculty Conference to fund all of our
activities. The challenges we face include reduced study leave
budgets, increased requests for expenses, reduced availability of
industry sponsorship (and likely restrictions on this sort of
income in the future) and not least our own increased expectations,
and those of the College.
For the past 3 years our
annual opening balance has been approximately £31,000. This
indicates that profit we have made from the Faculty Conference has
been approximately equal to our running costs. Our aim is to keep a
reserve of approximately three times our running costs to offset
any unforeseen disasters such as the necessity to cancel the
Conference.
|
Year
|
Full Paying Conference Delegates (daily
average)
|
Conference
Sponsorship and Sales Income
|
Total Out Turn from Conference
|
Total
Faculty Expenditure
|
|
2007
|
168
|
£10,444
|
£ 9,311
|
£ 8,933
|
|
2008
|
172
|
£11,000
|
£11,079
|
£ 10,342
|
After paying speaker
expenses, hotel costs, etc, our breakeven point for making a profit
starts at an average daily attendance of 140 paying delegates. We
believe that one of our greatest strengths as a Faculty is our
size. Forty percent of College members belong to our Faculty. We
would really like to involve more of them. We have had consistently
excellent feedback from the Conference. Last year 95% rated it as
excellent (35%) or good (60%), and the year before 44% said it
exceeded or greatly exceeded expectations. So come along, and bring
your friends.
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7) Medical students
essay
This years essay topic was: Anorexia Nervosa is a
disorder of the 21st and late 20th centuries
and confined to the developed world
The winner was Akshay Nair,
Oxford Univeristy Medical School, and the runner up was
Emma Eade, St Bartholmew’s and
the Royal London Medical School. The full essays can be viewed on
the Faculty website and summaries can be found below.
Winning essay by Akshay
Nair:
The statement in question reflects
a prevalent but imprecise opinion that anorexia nervosa is a
disease of the modern “Western” world. Although classification of
anorexia nervosa has occurred within the last 50 years there is
ample evidence that the disease itself has been prevalent for
centuries. Emerging and intriguing data from the “developing” world
is also forcing many psychiatrists to rethink what constitutes the
core of anorexia. Historical accounts from as early as the ninth
century demonstrate cases of extreme self-starvation. From detailed
accounts we can see a striking resemblance between the behaviour of
medieval Saints who fasted themselves to death and modern patients
with anorexia. The principal difference lies in the absence of “fat
phobia”, replaced instead by extreme religious servitude. Equally
in emerging data from “developing” countries one finds a high
proportion of non-fat phobic patients who clearly demonstrate the
core pathology of a self-motivated, uncontrollable desire to self
starve. By appreciating that “fat phobia” may be a cultural
manifestation of a non-culture bound disease we can begin to
identify risk factors for the core disorder and consider cultural
influences that endanger “at risk” individuals. By targeting both
the “at-risk” and the respective cultural pressure we can begin to
reduce the prevalence of anorexia nervosa. Click here to view the full essay.
Runner up essay by Emma
Eade:
An eating disorder, such as
Anorexia Nervosa (AN) is defined as abnormal feeding habits
associated with psychological factors. The Western world has
traditionally had a higher incidence and prevalence
1 but recent epidemiological studies have revealed
that less developed countries such as India, Mexico and Nigeria
have started to report a rise in AN cases2. The fact
that an increase in AN seems to correlate with an increase in
affluence, urbanisation and spread of Western culture has prompted
the argument that AN may be a disorder confined to the developed
world. Historically AN is thought to be have recognised as early as
the 13th century but the prevalence was relatively
negligible compared to current figures. Whether this reflects poor
medical records and lack of scientific research, or a true
epidemiological change is debatable, but statistics show it was not
until the late 20th and 21st centuries that a
dramatic increase in number of AN cases was detected 3
4.
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8)
Public Mental Health: the future for
psychiatrists?
Kamaldeep Bhui MD
FRCPsych, Wolfson Institute of Preventive Medicine, Queen Mary
University of London UK & Public Health Lead, Royal College of
Psychiatrists
Several recent
developments in mental health policy are driving a vision of a
future relationship between mental health professionals and service
users. Firstly, there is a review of inequalities in health care
already underway under the leadership of Professor Sir Michael
Marmot. This will surely adequately address structural causes of
inequalities, including poverty, education, unemployment, and
ethnic inequalities. A common feature of inequalities is that power
and status and wealth are patterned by certain demographic or
personal characteristics. Stigma and discrimination have their role
to play, but so does a lack of knowledge about mental illnesses and
health in the wider population. If ill informed people are unlikely
to seek help for illness, or indeed encourage relatives, friends
and loved ones to do so, much morbidity will remain hidden and only
present in crisis. The role of the media in more accurate and
considered reporting is also important to emphasise. There have
been substantial gains in recent years but much more needs to be
done.
Secondly, the National
Service Framework has come to an end, and New Horizons is now
promoted as the way forward. This takes a drastically different
approach, emphasising preventive actions at various stages of the
life course to effectively prevent the development of health
problems, including mental illness alongside other illnesses. Often
mental illness accompanies other forms of illness and associated
disabilities. An approach that tackles risk factors and
protective factors throughout the life course is attractive for its
promise of a simple over arching framework, but the details of
which illnesses and which interventions needs further work. One of
the concerns about a public mental health strategy is that
specialist services will be neglected or overlooked, and resources
will cease to be provided and modernisation will cease. Indeed,
perhaps in order to make efficiency savings in the current
financial climate it is a risk that previous policy initiatives are
ignored and specialist teams are not seen as useful but as too
expensive; perhaps this may even erode the gains made over the last
ten years. The work around transitions from child and adolescent
services to adult services is welcome, as is the vision that mental
health literacy and self management skills will improve over time.
However, New Horizons is lacking substance and detail on what the
balance of priorities will be between services, public mental
health, social interventions and social policy.
Should we also, given the recession, be teaching people how to
manage financial strain and not only social and interpersonal and
psychological strain? If New Horizons does not attend to the needs
of most disempowered, the policy will simply increase inequalities
as those least able to benefit previously will continue to lag
behind those most able to make use of public mental health
interventions. The evidence base is being reviewed, although the
Foresight report on ‘mental capital’ alone makes for compelling
reading. Public health strategies are necessarily complex and
multi-level in nature. Interventions that show the most promise
include interventions targeting schools, parents of school children
and parents to be, populations at risk of physical and sexual
violence, and the management of violence in general; people with
at-risk social circumstances and mental states are important to
engage early, and identifying people at risk through family
histories is perhaps under utilised. Family therapies, and
psychological interventions are valuable but rarely applied as part
of a preventive action. Various strands of work will report over
the coming months. The college has already been involved in
discussions on the recession, linking up public health and training
of psychiatrists, the role of sport in health and well being,
social inclusion and recovery.
What implications are
there for psychiatrists? Should we all train in public mental
health and commit some time to working in schools, with local
employers, and in perinatal and parenting services? Should we
refocus on liaison with primary care and with specialist hospital
services for physical illness rather than community mental health
teams? New roles for psychiatrists will leave fewer psychiatrists
to work with the severely mentally ill in inpatient and community
settings; perhaps this is appropriate and welcome, given the
greater diversity of the workforce and new roles for all
disciplines. Should psychiatrists be more active in advising
commissioners and local service planners, such that commissioning
and implementation are more relevant and likely to yield effective
services more efficiently. A vision is that psychiatrists will
indeed be more active in local communities, schools, work places,
in policy making and commissioning, and in gathering evidence of
effectiveness and need in local populations. This will be part of
the overall contract with society and local communities, and within
specialist services, psychiatrists will be more active in highly
specialised roles associated with risk, legal and ethical dilemmas,
uncertainty and co-morbidity.
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9) The fourth plinth: a
tourist’s eye view
Candace Gillies-Wright, Committee
Manager, RCPsych
At 4pm on 01 October, a
brave and possibly slightly barmy SpR who may wish to remain
anonymous rode the big yellow lift up to the fourth plinth in
Trafalgar Square, armed only with some cardboard boxes, a handful
of RCPsych posters and a large roll of sticky tape. A small
delegation of College staff sent along to provide moral and
leafleting support joined the ever-changing throng of tourists
strolling around. Whenever someone stopped and said ‘what is he
doing?’ we pounced, leaflet in hand, and explained that he was
drawing attention to the stigma associated with mental health
problems. He had 4 boxes, representing the one in four people
who will experience mental health issues during their lifetime, and
also symbolising the way people get put into boxes which are hard
to get out of. He demonstrated this nicely by getting inside
the boxes and then fighting his way out with a pen – good choice, I
thought, even if it was clearly jolly hard work to make any sort of
hole in the cardboard. I was surprised and pleased by the
number of people who did stop to look and listen. Given the
location, there were plenty of tour groups and foreign visitors;
our leaflets, and, I hope, our message, will travel back all over
the world with them. You can see the full hour of our hero’s
escapade (and any others you may care to view) on the Plinthers’
website.
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10)
Twitter
The College has a profile
on Twitter. The Conference team
began tweeting before the Annual Meeting about sessions, changes to
the programme, etc. Since then, tweets have announced new College
reports, position statements and press releases, and also promoted
media coverage about the College, College spokespeople, and the
journals. The College aim to tweet at least once a day and the
number of followers is increasing steadily. Followers include
College members, other health and mental health organisations, and
journalists, as well as interested members of the public. To join
twitter, please sign up here.
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11)World Mental Health Day 10 October 2009
The world mental health day for
2009 was on Mental health in primary care: Enhancing treatment and
promoting mental health. Further
information can be viewed at here.
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12) Future newsletters
If you would like to submit articles for further e-newsletters
or newsletters, please contact us. Our next
newsletter will be a printed copy and we will be able to include
longer articles in that edition.
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Contact
information
Faculty of General and Community
Psychiatry,
c/o Candace Gillies-Wright,
Royal College of Psychiatrists,
17 Belgrave Square,
London SWIX 8PG
Tel: 020 7235 2351 ext 234
Fax: 020 7235 6051
Email: gandcfaculty@rcpsych.ac.uk
Website: General and Community Faculty
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