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

Chair's Update

May 2017

Yes the above were available at the Ulster Reform Club on the 17 May 2017... and this is not a photo downloaded from the internet!

No less than three of our College events took place at this alternative venue all on 17 May – and my thanks to Dr Margaret du Feu whose good offices and membership of the Club saved the day, as Clifton House became unavailable to visitors in such numbers due to the building works there. My thanks also to Nora McNairney, our Manager and Barry Flynn, our Administrator for all the extra work they undertook with the moving and combining of 3 events on one day. (My thanks in addition to the Belfast Charitable Society, our Landlords at Clifton House, for dealing with the building closure issues so flexibly, along with our own staff).

So back to the three events then which linked the past with the present/future!

The Past first…To coincide with the centenary of the Medical Women’s Federation, the afternoon programme on 17 May took as its focus Celebrating 100 years of Women in Medicine with particular emphasis on the role of women in Psychiatry. My thanks to Dr Maria O’Kane for suggesting that we include this in our programme of events as it proved to be a great success and something different. Proceedings commenced with the Dean & Chief Academic Officer of the College Dr Kate Lovett and Dr Margaret du Feu outlining their experiences in the field of medicine and psychiatry. This was followed by Dr Sara Maguire chairing the Panel Discussion during which Dr Anne Montgomery, who pioneered the introduction of flexible working in psychiatry, discussed the challenges of balancing approachability and authority as a female Consultant. The future, in terms of how to maintain morale in increasingly isolated working conditions, was also considered. Finally, Dr Dearbhail Lewis led us through an entertaining and thought provoking interactive session considering the portrayal of Woman in Psychiatry by the media, which stimulated much discussion, particularly about the role of culture and social stigma when working in the field. Overall it was a great success... described by one participant as “a rigorous, stimulating and enjoyable discussion”. My thanks to all mentioned, as well as to Drs Clare Adams, Neta Chada and Paddy Moynihan for their Panel role. Thanks also to all who supported the event (see photograph with Dean) and I am sure that in all the circumstances, the presence of both Drs Michael Doherty and Richard Wilson will cement their long-established reputations for loyalty and commitment to all matters College related!

Before leaving this aspect of the day, congratulations to Dr Margaret du Feu who was, I believe, the only Psychiatrist working on the island of Ireland to feature (at page 26) in the Medical Women’s Federation souvenir edition of Medical Woman… chosen to be highlighted from among a small overall group of just 80, which is quite an achievement. Dr Kate Lovett is also featured at page 80.

Dr Eleanora FleuryI found it of great interest to learn about Dr Eleanora Fleury 1860-1940 (pictured right; click to enlarge) who was born in Dublin and was elected by 23 votes to 7 as the first female member of the Medico Psychological Association (which pre-dated the College) in 1893… quite an achievement back then! My thanks to Barry Flynn for sharing this gem with us from his own historical archive.

Next to the Present/Future… the morning of 17 May saw the Annual Trainee Summer Conference take “Psychiatrists as Leaders” as its theme, chaired by Drs Maggie Kelly (front row pictured nearest), Colin Gorman (pictured presenting) and Graeme Young (front row pictured nearest)– and my thanks to them for organising this along with our staff. I know that the last minute venue change complicated matters somewhat for all involved in organising and your agile response is very much appreciated.

Annual Trainee Summer Conference 2017

Dr Anne Kilgallen & Dr Maggie KellyAn excellent programme of distinguished speakers was lined up, with Dr Anne Kilgallen, Deputy Chief Medical Officer and newly appointed Chief Executive of the Western Health & Social Care Trust (pictured right with Dr Maggie Kelly) starting proceedings with a walk through her own personal journey as a leader. She then handed over to Dr Kate Lovett, who spoke candidly about some of the failures she encountered along her own journey, but the importance of the lessons we learn from those experiences. I am advised that the Trainees were particularly struck by the fact that both Speakers, with such impressive CVs, were prepared to share in all humility with them from their own experience and learned insight into being successful leaders.

Dr Francess Doherty continued with a focus on the importance of thinking outside the box and engaging our patients differently, respecting and taking account of their voice in order to shape practice and services for the future. Our ADEPT Trainees Drs Grainne Donaghy, Lauren Megahey, Judy Curran and Ruth Thornbury then spoke about their experiences in the ADEPT management and leadership programme, which has proven to be a wonderful opportunity in specialty training to experience the non-clinical side of working within the NHS. This event concluded with Dr Peter Sloan providing some solid advice on how to gain experience as a Trainee in Management and develop skills as a leader, followed by Dr Iain Mc Dougall rounding off the day with an insight into the dynamics of working within a multidisciplinary team. It was a hugely successful and well attended event for our Trainees, who are so vitally important to our mental health services in the present and going forward.

Finally in terms of the present/future... proceedings in the Ulster Reform Club concluded on 17 May with my welcoming, on behalf of us all, our new members...

…and since not everyone in that photograph qualifies as a new member! ...Here is the relevant group for 2017!

I wish each and every one success as you formally enter this great profession and may each of you impact the lives of your patients in a really positive and meaningful way, for therein lies the true measure of your success.

It is impossible to consider the future in our profession without being reminded of the Mental Capacity Act (NI) 2016 which, when it goes live in 2020 approximately, will inform our clinical practice. For the detail of that, we need a really practical based Code of Practice – and so it was that our Mental Capacity Act Working Group had a really useful (first of this type) meeting in this regard on 16 May with Tomas Adell from the DoH Mental Health and Capacity Unit, Mental Capacity Implementation Team. Much preparation had gone into this meeting beforehand and a booklet of scenarios from real life clinical practice had been prepared by our Policy Administrator Thomas McKeever, which Tomas was delighted to take away with him to further assist with the drafting process. My thanks to those members who attended in such large numbers – and special thanks to Drs Paddy Moynihan, Conor Barton, Richard Wilson, Heather Hanna, Adrian East, Catherine Taggart, Margaret du Feu, Arun Subramanian and Dearbhail Lewis, who sent scenarios in to Thomas. At the meeting we worked our way through some of the scenarios from different specialties; many questions were answered… many more remain…..but overall this was a really constructive engagement and leaves me more reassured than previously that our unique voice is being heard within this process of forming the Code. We will be engaging further with Tomas Adell during this informal phase of the Consultation on the Code, which runs to September inclusive. Tomas Adell has made it clear that Psychiatry has to be a key contributor to the Code formation and he has proven both keen to listen and willing to engage with us; my thanks to him also. One note of concern is that the Department of Justice has not yet started work on their aspect of the Code; I have written to them about this.

On 11 May, Dr Richard Wilson attended the DoH Start Up Workshop for Paediatric Managed Clinical Network which took place at the Lough Neagh Discovery Centre, Oxford Island. This was in Richard’s capacity as Chair of our Child and Adolescent Faculty and on the invitation of the Chair of the Royal College of Paediatrics in Ireland. The event brought together around 100 professionals from across Northern Ireland. The aim was to introduce the idea of a Regional managed clinical network for paediatric services across all of the steps of care. Richard, having been involved already in an identical process applied to CAMHS, found that much of the material was very familiar; it seems that the concepts and vision are quite new to paediatrics however. Richard was the only mental health specialist present and I understand that he felt greatly welcomed and encouraged by the recognition of parity of esteem between physical and mental health, as well as the willingness to promote partnership working and integration of services around the needs of patients. The event was opened by the Chief Medical Officer, Dr Michael Mc Bride and was chaired by Dr Patricia Donnelly, one of the prime movers in Health and Social care system improvement (and Richard tells me, coincidentally a greatly formative influence on his own professional development). Former Commissioner Catriona Rooney was also in attendance. A range of workshop activities from the day’s session will inform the development of an Action Plan to deliver the implementation of this integrated network over the next year or so. Such was the impression made by Richard that he was asked on the day to chair the start-up group comprising the Service User invitees along with a number of Senior Managers and Tertiary Specialists! My thanks to Richard for all this groundwork and building of contacts in this area – and also for continuing during the month to pursue links with the incoming Chair of the Child and Adolescent Faculty of the College of Psychiatrists of Ireland.

In other news, Addictions Consultant Dr Billy Gregg (pictured) presented at Central College in London on 22 May at the Public Mental Health Conference entitled “Rising Mortality among UK addicts” on the topic of “Transforming drug and alcohol public policies into better care – the NI experience”.

Dr Billy Gregg presenting at the Public Mental Health Conference

Representatives from all the four UK countries presented their regional data on deaths attributable to substance use, with Billy providing the input for us.

In 2015 drug related deaths across the UK were the highest ever recorded, with most deaths being primarily linked to opioids or cocaine use, often used in combination with other drugs including alcohol. During 2015 there were 258 recorded drug related deaths plus deaths due to drug misuse across Northern Ireland. There was a significant rise in alcohol related deaths in 2015 (310) in Northern Ireland, approaching the relative death rates in Scotland - and substantially higher than the rates in England or Wales. We know that around 2,300 people die from smoking related illnesses in NI each year. We also know that deaths from alcohol or drug use are commoner in males and in areas of social deprivation across the UK.

Some of the increase in drug related deaths has been linked to the failing health of an ageing cohort of UK drug users. Other possible explanations include a shift towards more risky drug use, the use of more potent opioids drugs, such as fentanyl or the use of new psychoactive substances… or lack of access to high quality addiction treatment services. Suicide may also be a factor. The most recent Confidential Inquiry into Homicides and Suicides (2016) reported that Northern Ireland had the highest rates of suicide in the UK. It also noted that “over half the patients who died by suicide had a history of alcohol or drug misuse”. There were national differences, with alcohol misuse a more common antecedent of suicide in Scotland and Northern Ireland. This inquiry also found that opioids were the most likely drugs to be used in fatal self-poisoning. Additionally, Northern Ireland has the highest relative prescription rates in the UK for most opioids as well as for pregabalin and gabapentin and this is contributing to our particularly striking levels of prescription drug misuse. Pregabalin misuse is now a serious problem and has been linked to deaths in individuals, particularly in those who are also using opioids or other sedatives.

Billy was and is keen to stress that Drug and Alcohol services need to be adequately funded to provide a comprehensive range of services across statutory, voluntary and community sectors to meet the needs of service users, some of whom are getting older and who have complex comorbidities.

Billy also feels that more care is required when prescribing opioids and gabapentenoids and particularly when it comes to those with a history of substance use or mental health disorders. He takes the view that these drugs should be prescribed in limited amounts and the benefits and risks of prescribing these medications should be kept under review; prescribing high dose opioids for chronic non-cancer pain (pain lasting more than 3 months) is not supported by the current evidence.

Finally, Billy believes that Mental Health, Addictions Service and Primary Care Services need to develop integrated care pathways which ensure that the physical and mental health disorders in individuals who misuse alcohol or drugs - are being addressed.

Billy can be contacted for more information at Addiction Psychiatry, Holywell Hospital, Antrim.

The month also saw our first ever StartΨell inspired event, which took place on 19 May in Clifton House. Since assuming the Chair, I have been keen to support our newly appointed Consultants, who often have to navigate their way through a multiplicity of matters while finding their feet. They can often find themselves very isolated….perhaps coming in as a first Consultant in a particular service. The College’s StartΨell initiative is a is a Consultant led initiative for Psychiatrists in their first five years as a Consultant or Locum Consultant. Back in February 2017, I met with Paula O’Kelly, Principal Consultant HSC Leadership Centre along with Barry Flynn and Thomas McKeever in order to enlist her experience with this project. I am pleased to report that, with the assistance of Paula, along with the personal perspectives of Drs Cathy Jack and Joan McGuinness on the day, we had a very useful all day programme which looked at Leadership, Resilience and Teamwork. Feedback from one of the participants was:

"I found the day highly beneficial in helping me to identify and understand my personal management and leadership styles. The course also presented an excellent opportunity to learn from the experience of speakers currently in higher managerial roles and I found the event inspirational in this respect. I would highly recommend StartΨell to other specialty doctors who are considering career progression and application."

I hope we can run a similar event on a fairly regular basis as this supportive environment is evidently important for our newer colleagues. My thanks to all who helped us make it happen.

...and now for a round up of other news to finish:

On 22 May, GMC published new standards and guidance for postgraduate curricula and assessment; GMC are taking the first steps to making UK postgraduate medical training more flexible for doctors, more responsive to patient and health service needs - and more able to meet the demands of modern, 21st century, practice.

The new GMC standards – Excellence by design – move towards a high-level outcomes approach to learning. The standards also set out an expectation that organisations responsible for training should engage with key partners from the four countries of the UK, including employers, government and patients, to ensure that future generations of doctors are trained to meet the needs of a changing population. GMC also published Generic professional capabilities (GPC) framework and new guidance – developed with the Academy of Medical Royal Colleges (AoMRC) - which explains how postgraduate curricula should include training in broader areas of professional practice that are crucial to safe and effective patient care, such as communication, leadership and patient safety.

All are worth a read…

My contribution on UTV on 12 May which I mentioned in last Month’s Update is now available online. I think as mental health professionals we have to argue the case that investment in mental health services will improve the overall health of the population and that it is not just a mental health based plea. I also again made the case that something must be done regarding patients with serious enduring mental illness, who die much younger than the general population. I urged that we invest in specialist services, improve the physical healthcare of patients who have serious and enduring mental illness and work much more coherently together as a mental health system in Northern Ireland –moving away from each Trust doing its own thing scenario, to a much more coherent service across Northern Ireland in order to maximise benefit to our patients. At time of writing, we await political developments at Stormont by the end of June…?

Our representative on the Mindwise Personality Disorder Conference 2018 Working Group , Dr Catherine McDonnell, attended a Thematic workshop on 10 May hosted by Mindwise to assist in its design. As well as involving us, Mindwise have also included representation from the NI Personality Disorder Network, Mindwise Personality Disorder Special Interest Group and PSNI. The agreed aim for the Conference is “to promote understanding, inform best practice and impact upon policy development to ensure the needs of people experiencing Personality Disorder are met”. The agreed outcomes are to increase awareness and understanding of Personality Disorders, to promote the voice of lived experience, to promote and share best practice and to secure commitment for increased funding. The target audience is broad and is to include policy makers through to frontline staff who provide services to individuals. The Conference content is still to be agreed, but alongside the key note speakers will have a range of breakout sessions tailored to meet the interests of the diverse audience. Catherine will keep us posted and I thank Mindwise for this important collaborative opportunity.

On 30 May, Thomas McKeever attended the second meeting of the Law Society of NI’s Elder Law Group to establish a link with them. Flowing from that, it is hoped that we will be able to work together on a discussion event around Capacity in due course. Also on 1 June, Thomas met again with his Policy counterpart in RCGP in NI, Clare Higgins; discussions about an Association of Medical Royal Colleges took place last year and in the absence of such a forum it is particularly important that we maintain close working links with our colleagues in the local Royal Colleges.

Clifton HouseI am glad to report that the refurbishment work to Clifton House is almost complete and access through the front door has been restored. The building looks better than ever and our small space within it up in the attic has benefitted from some window work. We now have a window in the Members’ Room which can remain open on a latch!

I have continued to explore the Part 2 Doctor issues raised by our Trainees – most recently chairing a further meeting on 2 June with NIMDTA representatives Drs Damian Hughes and Jo Minay –with RQIA representatives Theresa Nixon, Patrick Convery, Patricia O’Callaghan, Dr John Simpson and Claire Henry –with Drs Phil Anderson, Maggie Kelly – and with Nora McNairney and Thomas McKeever in attendance. Work continues on this issue.

Student Mental Health is a subject close to the heart of our incoming Vice Chair, Dr Michael Doherty as it is becoming an acute issue at third level institutions. It is a matter which hit the headlines during the month and I share this local positive 2015 story from the College website which is heartening to read in relation to one student’s recent experience at Queen’s University.

Speaking of Queen’s, it is with deepest regret that we have learned of the untimely passing of Professor Patrick Johnston (pictured below, along with QUB Winners of the Spike Milligan Competition 2012, at our Spring Conference that year in Titanic). On behalf of the Executive Committee and our members I wrote to Queen’s Registrar to express our sadness and support to his wife and family and the community at QUB. Paddy was a good friend to our College over many years, having presented at many of our meetings and celebrated the successes of Queen’s students on joint mental health initiatives. Paddy will be very much missed. May he rest in peace.

Professor Patrick Johnston with QUB Winners of the Spike Milligan Competition 2012

May I conclude this Update by congratulating Drs Tony O’Neill, Maggie McGurgan, Lauren Megahey, Graeme Young and David Mongan and all others within and without the College associated with the tremendous podcast initiative which Dr Maggie McGurgan steered through our Public Engagement Committee. Three very professional podcasts covering Memory Problems, Dementia and Schizophrenia are now available as a result and it is hoped that they will be of huge assistance to all those who view them. The concern had been that the internet contains a lot of misleading information and has very little to counter it. These podcasts are an effort to educate and engage in a constructive way; they are well drafted and superbly delivered. Well done to all concerned and I urge you to take the time to view them in their entirety. It represents the sort of educational initiative of which I feel sure that the late Paddy Johnston would have approved.

Dr Gerry Lynch

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Dr Gerry Lynch

Dr Gerry Lynch, Chair RCPsychNI