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The Royal College of Psychiatrists Improving the lives of people with mental illness

Chair's Update

July 2017

May I start this month’s Update on an important note: Providing a service to members is at the very core of College raison d'être and a key component of this is the Psychiatrists’ Support Service – which is a free, confidential support and advice service for us at each and every one of the stages of our careers (including retirement) if we find ourselves in any difficulty or in need of support. The service is available during office hours Monday to Friday.

Psychiatrists' Support Service

It is important to pause this month and draw attention to the availability of this service. It may be that one of you reading this will need to make contact and I have no doubt you will benefit from doing so.

We spend so much of our time looking after our patients and often times to the neglect of ourselves, but in the words of Benjamin Franklin: “When the well’s dry, we know the worth of water.”

Perhaps linked to the above and also linked to our Inaugural NI Psychiatry Summer School which I highlighted in last month’s Update, there is evidence of “psychiatry bashing” in medical schools which often puts students off considering psychiatry. The truth is that the stigma surrounding psychiatry does not begin and end with the experiences of patients; doctors also experience stigmatisation – for deciding to become psychiatrists, as detailed in the 2016 paper in BJPsych Bulletin: BASH: badmouthing, attitudes and stigmatisation in healthcare as experienced by medical students. This needs to be challenged as it stymies recruitment, stigmatises both our patients and ourselves - and in doing so can lead to greater mental health problems for our patients and indeed affect the mental health also of ourselves as Clinicians.

We are all very familiar with the more general discussions on mental health stigma, but this is a more subtle form of it, but equally devastating in effect. That is why our past President Sir Simon Wessely back in February 2016 launched the Anti-Bash campaign to challenge this stigma. His words at that time are instructive and worthy of quoting from directly, delivered as they are in his own inimitable style (click image to enlarge):

BASH or Banter World Cafe Poster

Anti-BASH“This is a grassroots campaign, where medical students are involved in challenging stigma among seniors against mental illness and psychiatrists, and will be driven primarily by social media, with the Twitter hashtag #banthebash.  It will align to the College’s recruitment strategy and the Psychiatric Trainees Committee will be liaising directly with student psychiatry societies and medical students to drive the campaign forward.

Let’s be clear, a bit of humour is all very well. We have a sense of humour and can take a joke. Indeed, I have been known to make jokes about surgeons, neurologists, cardiologists and so on, based on their largely but not entirely fictional personality characteristics. But bad mouthing psychiatrists also introduces something different that is not present in jokes about surgeons. Our teasing does not involve directly or indirectly patients. Saying that surgeons can sometimes be arrogant, whether right or wrong, says nothing about cancer... but saying that “psychiatrists are as crazy as their patients” does, and likewise “you are too good a doctor to do psychiatry” implies that those with mental disorders don’t deserve good doctors. The best and brightest doctors are needed in psychiatry just as much as in oncology.

This has to stop, and this campaign is going to do that. We think that it should be unacceptable to make these comments directly or indirectly about psychiatry and those with mental disorders as it is now is to make similar derogatory comments about a person’s gender, ethnicity or sexual orientation.  Please lend it your support.  People with mental disorders - just like those with physical disorders - deserve the best minds to find new treatments and provide the best care.”

On 17 July, an article appeared in the Irish News which was highly critical of Electro Convulsive Therapy and which included the line: "The continued use of this procedure suggests that psychiatry is not an evidence-based profession." Following this, our Policy Administrator Thomas McKeever initiated a discussion among a number of our members interested in ECT, particularly with Dr Stephen Moore. Stephen drafted a document... with a lot of evidence in support! ...and from this we worked with the Irish News (and also with RQIA) on a response within the word limits given us by the paper. My thanks to all who commented as the comments received were very useful. I would particularly like to put on record my thanks to Stephen for the time he took to prepare the first draft, from which my version presented to the paper was extensively based. I reprint my letter in full here, which was published in the 27 July edition of the paper (click image to enlarge; online version available here):

Dr Gerry Lynch's letter printed in the Irish Times

Dr Maggie McGurgan can always be relied upon to combat stigma and so it was on 10 July 2017 when the U105 Frank Mitchell Show contacted the office looking for a member to speak within the half hour! ...on the sheep attacks which had been perpetrated around that time in County Down... Maggie agreed to go on air and tackled head on the broadcast assumption that the cruelty must have sprung from a mental illness. She said that it would be a dangerous default position to assume mental illness and this was her main message to emphasise... she stressed that there were multiple matters underpinning any diagnosis... she stressed that the acts were abhorrent to most reasonable people but challenged the assumptions. Frank Mitchell commended Maggie both during and after the interview for the professional response from her to every question which he was fair enough to contrast with his own emotional response and he stated that we needed voices like Dr McGurgan to balance matters out. It should also be recorded that Maggie was on leave at the time! I understand that Thomas and College Director of Strategic Communications Kim Catcheside both gave support and guidance at short notice behind the scenes. So well done and sincere thanks to Maggie who took on a difficult topic as Chair of our Public Engagement Committee.

This brings me back to our Strategy Day on 9 February 2017 when Kim spoke to us about striving to be a fast, responsive organisation, the local “go to” place re mental illness for the media. This is only possible, as Kim pointed out that day, if we as members – and particularly the Chairs and Vice Chairs of our Faculties and Committees – are prepared to include media work within our field of responsibility. We have the specialist knowledge and are uniquely placed to inform the public, to correct error and to battle stigma for the sake of all our patients and indeed ourselves too. Kim also spoke back in February about turning difficult media challenges into opportunities in order to reach a wide audience with a really vital message. The response to the Irish News ECT article is one example of this in action. It is hoped that Maggie’s radio work example will be followed therefore by others. Quite a number of members have received media training already via the College or via their Trusts. Also please note that if you are not currently a Faculty or Committee Chair or Vice Chair but would like to offer to assist with our media work, please contact Thomas at the office. Your assistance with this aspect of our profession would be very welcome indeed.

Now before you ask where I was on 10 July! ...I was actually in London attending an update on the Mental Capacity Act in England and Wales! It is clear that the issue of Deprivation of Liberty Safeguards in particular is very complex and the cause of much confusion. The Law Commission published proposals in March 2017 to replace Deprivation of Liberty Safeguards with 'Liberty Protection Safeguards'; it will indeed be interesting to see if proposed changes in England and Wales will affect the drafting of the Regulations and the Code of Practice for our own Mental Capacity Act (NI) 2016.

I also attended Council at Central College later that week on 14 July, chaired by our new President Professor Wendy Burn for the first time. I very much look forward to working with Wendy in the time ahead and know that you will join me in welcoming her to the position.  It was good to hear that the College is developing a strategy for promoting Quality Improvement using QI methodology - recognising that this methodology complements and enhances other methods of improvement such as accreditation. Dr Catherine McDonnell has been very active in promoting QI here and will take the lead on our Executive in promoting and co-ordinating this work. 

The Council also approved the proposal for the Divisions in Northern Ireland, Scotland and Wales to become devolved Councils.  This recognises the fact that, as health is fully devolved, our roles and responsibilities are different from those of English Divisions – with the College in the devolved nations having to engage with different governments, different health ministers and different NHS bodies – the reality in effect of four different health systems. The hope is that by having Devolved Councils, the College would recognise this new reality in our structures in a very practical way by creating a new tier of representation with perhaps more weight. What this actually means in practice is difficult to determine; no extra resources have as yet been identified.  The proposal has to go to the Privy Council and will be voted on at the College AGM next year. If the vote is in favour at the 2018 AGM, we will have a Devolved Council (instead of an Executive) which will give us a unique constitutional status in the organisation. I would be interested to hear members' views on this, or, indeed, on any other issues that might be of concern.

Dr Gerry Lynch, Chris Matthews, Allan Chapman

On 27 July, I had a very useful meeting with Chris Matthews (Director of Mental Health, Disability and Older People, Department of Health) and his DoH colleague Allan Chapman (both pictured above with me from left to right) in relation to the promise of £10m per annum over 5 years for mental health which is set to flow as a result of the Conservative and DUP Agreement and UK Government financial support for Northern Ireland. Also at this meeting were Vice Chair Dr Michael Doherty, Policy Lead Dr Peter Trimble, as well as Professor Ciaran Mulholland (given his work with the Regional Trauma initiative which is relevant to this funding) and Thomas. We were encouraged at this meeting in that we may have an opportunity to influence how this money will be spent. To this end, I have requested our Faculty Chairs/Vice Chairs to attend a meeting here in Clifton House on 17 August to draft a paper to send to the DoH outlining our strategic objectives for this funding stream.

It has been made clear to us that any proposal we include must have:

  1. a brief description of the project and its anticipated benefits;
  2. an estimate of the costs and
  3. an estimate of the potential recurrent revenue consequences (if any).

It also needs to be capable of ready answers to the following questions:

  1. Is the project transformative?
  2. Is it in keeping with strategic objectives?
  3. Will the revenue consequences be defensible?

It will not be possible for us to include any projects which do not rigorously stand up to scrutiny on these parameters.

I should stress that ours is not the only voice that will be seeking to be heard. In addition, there seems to be a degree of uncertainty about whether or not the money will actually materialise, given the uncertain political situation both here and in Westminster; we have no Executive and will this UK Government endure for 5 years? However, it is vital that we make our priorities known to the Department. At the very least, this will give us the opportunity to begin to shape a much needed mental health strategy for the next 5 years.

Also on the topic of this allocation of £50m, Thomas has secured a meeting for us with Nigel Dodds DUP MP for (our office constituency of) North Belfast, following his recent words in the House of Commons concerning this money: "Clinicians and others have pointed to the legacy of 30 years... and the awful effects of that. Part of the money we are investing... goes to mental health care - extra investment in the health service.

Thomas has also been in contact with the Sinn Fein Health Policy Team at Stormont and discussions are at an advanced stage in relation to an Autumn Meeting with them... so our lobbying work continues despite the local political stalemate.

I would stress that in all such engagements with politicians and key Civil servants alike, we continue to bring to the table the priority for the funding of the Strategic Outline Business Cases agreed in October 2015 by the 5 Trusts for physical health monitoring for those with severe mental illness and eating disorders (child and adult), reassurances needed as to the funding stream for the new Mental Capacity Act (NI) 2016 as between physical and mental health and also as between DoH and DoJ, the eight recommendations of the “Building on Progress: Achieving parity for mental health in NI” June 2016 Report, clarity required on Commissioning of mental health services in general in anticipation of the post Health and Social Care Board era– including how commissioning for mental health services links in with efforts to tackle suicide, our views on aspects of the Contact NI Zero Suicide Manifesto and Contact NI proposal for a NI Suicide Prevention Bill, as well as the NI Personality Disorder Strategy and its long awaited full implementation.

On 18 July Thomas attended the inaugural Meeting of local Medical Organisation Policy Officers instigated by RCPCH NI External Affairs Manager John McBride and held at Royal College of Midwives in NI, 58 Howard Street, Belfast. Such encounters are important, especially given the absence of an Academy of Royal Colleges in Northern Ireland. I understand that it was attended by Policy colleagues from Paediatrics/Child Health, Midwives, Pharmacy, Surgeons, GPs, as well as the GMC and BMA. A couple of useful findings which emerged were that the BMA would be a useful ally in relation to Minimum Unit Pricing if we are ever in a position to return to that issue being lobbied for in a meaningful way post the current Scotland litigation. Also, all of the organisations are actively engaged on Brexit... even if only in fear! This is an issue for us also and I hope to return to it in the time ahead. In the meantime a further request... I would welcome contact from any members who feel that a service they work in or their employment or indeed a wider health/policy issue will be adversely affected by us leaving the EU.

On Brexit, it is interesting to learn from the College Registrar that given that almost all Brexit issues are pertinent to all branches of medicine, it has been agreed by Central College that the main thrust of their engagement will be through the Academy of Royal Colleges in England; also to learn that Health Secretary Jeremy Hunt MP has indicated that any health related Brexit issues should go through him rather than through David Davis MP, the Brexit Secretary. Alas we have neither Health Minister nor Academy, but we do have a priority land border in the Brexit negotiations! The issues of Brexit, Bengoa and the Mental Capacity Act (NI) 2016 have brought home to me the potential advantage of having a unified voice for the medical profession here in Northern Ireland. The idea of having a local Academy of Medical Royal Colleges was mooted by the past Chair of RCGP in NI, Dr John O’Kelly. Not much progress has been made so far, but this is something which I intend to pursue with my colleagues from the other Colleges... what do others think?

Belfast Health and Social Care Trust

Now for some well-deserved congratulations first flowing from the HSJ Patient Safety Awards 2017; specifically their Patient Safety in Learning Disabilities award was won and presented this month to Belfast Health and Social Care Trust for Developing a Positive Behaviour Support ethos in an Assessment and Intervention Inpatient Unit (team pictured above). Iveagh is an eight bed assessment and treatment Unit for young people with a learning disability and challenging behaviour or mental health difficulties. Following a review of services within the Unit, concerns had been raised regarding the quality of care young people were receiving. Specifically, high levels of restrictive practices were in use and this had implications for the wellbeing and safety of young people within the Unit. Consequently, a positive behaviour support approach was implemented within the Unit. To do this, new behaviour governance structures were developed to ensure clear accountability and review of restrictive practices. Behaviour support plans were developed, which were accessible to staff, carers and young people. Staff training in positive behaviour support principles was developed and rolled out throughout the Unit to ensure staff had an understanding of the positive behaviour support culture. The rollout of this approach resulted in significant reductions in restrictive practices being used. Young people began accessing more community activities and families reported feeling involved in their child’s care. The judging panel felt that this project is an exemplar of the type of support and effective care that can be provided in an inpatient unit. Well done indeed to all concerned! This is an important success story.

Dr David Mongan and other new ICAT fellows

Similarly congratulations to member Dr David Mongan (pictured second from left) who will be starting as a Fellow in August in the Wellcome – Health Research Board Irish Clinical Academic Training (ICAT) Programme. This is a unique all Ireland cross-institutional, comprehensive national programme for Clinician Scientists based at six major Irish universities and their affiliated hospital groups. This is its first year in operation. 8 Fellows were selected across the island of Ireland - and David is the only one chosen from Northern Ireland! It is a 6 year programme with a PhD built in. David may be heading to RoI as the base for his PhD. What a great achievement for David, for Psychiatry and for RCPsych in NI. We are proud to celebrate his success so far and wish him continued success in his further studies.

Speaking of Fellows of a different kind... my thanks to all who recently made applications for Fellowship of the College. We are expecting to hear results back in the early Autumn from the College. My thanks to both our Manager Nora McNairney who initiated this process with me and also to our Administrator Barry Flynn who was of great assistance to all of the applicants with the formatting of their responses.

Finally my thanks to the outgoing College Head of Policy Lucy Thorpe who left the staff of Central College on 28 July and who I know was a great support to our local Office and staff over all her years in post. Most recently Lucy facilitated discussion at our Strategy Day on 9 February 2017 and those present that day will recall her skills in ensuring that all were heard, that proceedings progressed and that summary outcomes were identified from the session – all of which she delivered in her sensitive, unassuming style which was much appreciated. Lucy always strove to include the Devolved Nations and we look forward to her good work being continued in this regard once her successor is appointed.

The August calendar is already awash with meetings on the Mental Capacity Act (NI) 2016, on “You in Mind” documentation as well as regarding the £50m mentioned above... so more on all of that in the next edition as Autumn begins...

 

Dr Gerry Lynch

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

 

 

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Dr Gerry Lynch

Dr Gerry Lynch, Chair RCPsychNI