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

Chair's Update

April 2017

...So since my last Update, talks have now been suspended at Stormont and we have a snap General Election. This will be the seventh time voters will get their say at polls across Northern Ireland in just three years! Let us hope that in the three weeks post poll designated for the purpose, political progress locally is achieved so that we can return to the devolved health issues which we want to see addressed and progressed at Stormont...

Scrabble letters spelling out 'VOTE'

The College centrally has put out its Manifesto for the General Election entitled Five Steps to Fairness. Even though we have Health devolved to Northern Ireland, it is worth a read in terms of direction of travel in England. When I see reference to “Five Year Forward View” and “ambition”, I lament the current absence of both here, even when we had a functioning Executive. Still this should galvanize us in our lobbying, if only currently for the minimum restoration of our locally accountable Executive.

Regardless of the political vacuum, it has been a busy month for Consultations with three being submitted as set out below. My thanks to Dr Richard Wilson in respect of the DoH one (...Richard advises that it is a fairly radical change in Children's Law in Northern Ireland and will require resourcing through the Trusts to deliver on the process and supports in order to achieve the hoped for improvements in outcome...), to Drs Michael Doherty and John Sharkey who assisted me with the GMC one and to Dr Conor Barton in respect of the COPNI one.

Consultation Title Dept/Organisation Documents Deadline
Adoption & Children (NI) Bill Department of Health Response 28 April
Securing the licence to practise - introducing a Medical Licensing Assessment GMC Response 30 April
Draft Disability Action Plan 2017–2020 Commissioner for Older People for NI Response 5 May

The Spring Meeting of our General Adult Faculty was held at Clifton House on 27th April 2017 and was very well attended.

RCPsychNI General Adult Faculty Spring Meeting

Dr Gerry Lynch, Dr Peter McKenna and Dr Margaret du FeuDr Peter McKenna (centre and left of below photos [click to enlarge] – both photos also featuring Dr Margaret du Feu) from the FIDMAG (which translates to Foundation for Research and Teaching Maria Angustia Gimenez, who was one of the important early figures in the Hermanas Hospitalarias) Research Foundation in Barcelona presented a comprehensive update on the structural and functional changes in Schizophrenia discovered by modern scanning. In reviewing the research, he explained the complexity of analysing the results. Nonetheless it is an important task as the results will, with neuropsychological investigations, continue to explore the nature of schizophrenia and its symptoms.

Dr Peter McKenna, Dr Margaret du Feu and Carrie MontgomeryCarrie Montgomery, Deputy CEO of Contact NI (right of photo [click to enlarge]) then spoke on "A Suicide Prevention Bill – A Case for Northern Ireland". Her presentation described the urgency of this subject, given that suicide rates in Northern Ireland continue to increase. A good discussion followed. The College will continue to work with Contact NI and other agencies which are seeking to develop policies and initiatives to address this scourge. There may be issues of confidentiality which would need further discussion if we are to ensure that trust is maintained, leading to the essential core preservation of Service User openness with their Doctors, not just in the immediate term, but also in the longer term.

Dr Graeme YoungOur collaboration with Aware’s current phase of public talks throughout Northern Ireland drew to a conclusion this month with a collaborative event between Aware and Arthritis Care in Cookstown. This time Dr Graeme Young represented the College as invited speaker. Graeme reports that the event was a great opportunity to engage with the public, to increase awareness of depression and mental illness in general - and to help reduce the stigma of depression. There was great audience participation and this provided a vital insight and opportunity to speak about key issues which affect people with co-morbid arthritis and depression. My thanks to Graeme (pictured right).

Tom McEneaney Head of Business Development and Support Services in Aware, advises that they are in the process of planning further events for later this year, which will take in Ulster University, Queens University and Colleges NI. Tom sends his thanks to members and staff for all our support over the last couple of years in supporting the events. We certainly appreciate the opportunities for engagement which Aware have offered us and we look forward to lending our further assistance in the time ahead.

I was pleased to attend the Central Advisory Committee meeting on 6 April at Castle Buildings, which was devoted mainly to the outworkings of the Bengoa Report and to examining the responses to the Consultation on the Criteria for Reconfiguring Health and Social Care Services. It was clear to me that the College Response had made an impact in terms of the overall conclusions being derived from the process. This is very encouraging in terms of the time and effort which we regularly devote to these Consultation exercises. Also on the agenda was the GMC response to the Sir Keith Pearson January 2017 Report reviewing medical revalidation entitled “Taking Revalidation Forward”. I dealt with this Report in last month’s Update.

As also mentioned last month, I received a request from Dr Jonathan Pimm to write on the Mental Capacity Act (NI) 2016 for the BJPsych publication. This month has seen me collaborating with both Drs Catherine Taggart and Phil Campbell on this task. I met with Catherine on 13 and 28 April, with Phil joining us for the latter meeting. My gratitude to them both and more on this nearer to publication!

In further engagement with the MCA, I addressed our Trainees on the topic at their class which was held in Clifton House on 10 May. It tied in well with Dr Dearbhail Lewis’ presentation to them on the current legislation, which preceded my whistle stop tour!

The timeline for the work on the Code of Practice and the ultimate going live of the Act itself will never be a certain science as it depends in part on political events. However, we have been advised of the following loose timeframe by the Department of Health. Phase 2 of the Consultation on the Code is currently underway and we have a meeting coming up in this regard with Tomas Adell from the DoH Implementation Team on 16 May, which will be entirely scenario based. In this regard, if you wish to be added to the mailing list for our Mental Capacity Act Working Group, please do not hesitate to contact Thomas in the office.

The Phase 2 informal consultation with Reference Group members will last until the end of September 2017. It is then the ambition of the Department to publicly consult on the Code and Regulations at the end of 2017 or early 2018. This will be a formal (likely 8 week) Consultation. Thereafter the Department will analyse responses and, depending on the outcome, the hope is to lay the Code and the Regulations before the NI Assembly in the second half of 2018, subject to Assembly and political processes.

Once the Code of Practice and Regulations have been provisionally completed, it is intended to develop training packages, awareness raising and other implementation workstreams, such as Informatics and cross-jurisdictional issues, which all have to be completed. It is acknowledged that it is difficult to provide a clear timeline for this. Only when all these aspects have been completed, will the Act commence – hence it is likely that this will be a number of years into the future. However, this timescale should not in any way distract us from the urgency of the current task to prepare it for going live in a workable manner.

Repair work at Clifton HouseOver the next few weeks, extensive repair works to windows, pointing etc. are being carried out to Clifton House. Some meetings have had to be relocated and other meetings will go ahead in Clifton House, but you will need to follow the signs and enter by the back door! – i.e. the one nearest to Clifton Street (as there are two back doors). Your co-operation will be much appreciated and Belfast Charitable Society, who own the building, are sorry for any inconvenience. We look forward to seeing the building looking even better still in due course.

Congratulations to Dr Rowan McClean, who will be the new Chair of the General Adult Faculty post Congress, following in the footsteps of Dr Margaret du Feu. My thanks to Margaret for the energy and commitment which she has given to making the Faculty a key component of our local College. We have yet to fill Rowan’s former role of Vice Chair of the General Adult Faculty and Helen Toal’s role as Chair of Addictions Faculty. Please do consider putting yourself forward for these roles which are notified via Dotmailer to you.

Congratulations also to Dr Damien Hughes on his appointment from 1 April as Head for the School of Psychiatry at Northern Ireland Medical & Dental Training Agency (NIMDTA), having previously served as Deputy to Dr Brian Mangan who retired on 31 March. I wish Brian all the best and thank him for his collaborative work with the College over many years. Congratulations also to Dr Jo Minay on her appointment as Deputy Head for the School of Psychiatry, having previously served as Training Programme Director for General Adult Psychiatry. All the best to both Damien and Jo in their new roles and I look forward to continuing to work with them for the benefit of our Trainees.

Speaking of Jo, a further meeting of the You in Mind Project Team was held on 11 April, which was attended by both Jo and Dr Saleem Tareen on our behalf. Further discussions about the format of the assessment form were held and centred on the feasibility for the document to form part of a continuing assessment process. The prospect of incorporating the document within PARIS was also discussed, with the Western Trust taking a lead on this. A mini pilot of ‘My Wellbeing Plan’ was agreed and this should have been completed by the end of May. Saleem is going to trial it and feedback to the Team. The next Project Team meeting is scheduled for June. Meantime, we are pursuing with the Department’s Mental Health and Capacity Unit a College meeting with the Department of Health, Health & Social Care Board and the Public Health Agency to discuss in detail the negative feedback which is widespread among our membership on this topic. More on this in future editions therefore...

Returning to our Trainees, a useful document which emerged this month was Supported and Valued? - a Trainee-led review into morale and training within psychiatry, which includes reference to Northern Ireland. It is well worth a read. Drs Colin Gorman, Maggie Kelly and Graeme Young are acknowledged in the document for their help with the NI portion and I add my thanks to them here. The Dean of the College, Dr Kate Lovett had this to say about it:

“The report Supported and Valued is our national review into psychiatric trainees’ morale and training. We had 750 responses out of a population of 3500 trainees, and we ran focus groups. This was led by the psychiatric trainees’ committee because there was a sense that there were issues beyond contractual details that were causing discontent.

Trainees were keen to identify the good bits about their training. Having the support of seniors really makes a difference to junior doctors. And good multi-disciplinary team working was something they appreciated.

The other thing that they mentioned was psychiatric supervision. It has been enshrined in our curriculum for a long time that all trainees are mandated to have an hour a week of face-to-face supervision with a consultant. We are re-ally keen that we protect that time. It’s different from clinical supervision and educational supervision as it’s a way thinking carefully about the dynamic aspects of relationships with patients, processing distress, building up resilience, and developing leadership skills.

Our online survey showed that 23% of respondents weren’t getting their regular supervision and that really worries us: it’s an important part of training.

The other big theme was support for the annual review of competence progression [ARCP]. This is something that trainees in all medical specialties have highlighted—that requirements around ARCPs can be unclear and there can be regional variation.

Trainees also identified challenges in the wider political landscape. They had worries about the lack of parity of esteem for mental health compared with physical health, and the impact of low investment in mental health and social care. Our trainees put their patients first and are worried about the impact of a lack of resources – they notice it and they care about it.

The trainees identified some things that shouldn’t be difficult to fix, such as having access to hot drinks when they are on call. They also wanted better administrative support, such as expenses paid in a timely way and rotas produced on time.

This is a report for every psychiatrist to pay attention to: there are things that supervisors can do, and trainees can use the report to effect local change. We are disseminating it to medical directors and chief executives of mental health trusts, and we are particularly keen that there is direct communication with trust boards through the enhanced junior doctor forum.

The College is keen to work closely with our heads of schools throughout the UK to improve ARCP processes, to standardise those as much as we can. And, of course, the college is working with partners in government and using every opportunity to campaign for funding to reach the front line.”

I intend to discuss this at our next Executive meeting. Since taking office as Chair, I have sought to address regional variations which are seen as of detriment to our Trainees here in Northern Ireland. I am keen to eradicate as far as possible any such geographical disadvantage.

In terms of media, I was interviewed by UTV as part of their daily features for Mental Health Awareness Week running from 8-12 May. The topics covered were the recommendations of the “Building on Progress: Achieving parity for mental health in NI” June 2016 Report, underfunding of mental health services, Perinatal services, together with Physical healthcare needs of those with severe mental illness. At time of writing, this is set to broadcast on Friday 12 May.

At the request of Dr Stephen Bergin Consultant in Public Health Medicine, Dr Stephen Moore gave a brief presentation on current and future ways in which IT can be used in Psychiatric practice at the eMen day in the Hilton Hotel, Belfast on 28 April. eMEN stands for e-mental health project, funded through the Interreg North West European Innovation Programme. eMEN is a six country e-mental health project, which will run until November 2019. This project is being led by Arq in the Netherlands with partners in Belgium, France, Germany, Ireland and the UK who combine technological, clinical, research, and policy expertise. The project has as its focus developing an evaluation tool for e-mental health interventions - and using this then to test options. The partners hope to shape a tailored policy agenda to embed e-mental health in each partner country and convene expert working groups, seminars and conferences on key aspects of e-mental health. The day in Belfast was the first of four such events, the others scheduled for Paris in June, Amsterdam in July and Berlin in October - and was entitled “Achieving mental health for all: how do we ensure equitable access to e-mental health?”. It was hugely relevant to our newly formed Informatics Group and was well attended by clinicians, service users, IT staff and providers. It provided a good look at how IT can inform mental health treatment and was very productive. Stephen will feed back on this to the Informatics Group to help inform their work in the time ahead.

Work continues on the draft Alcohol and Brain Damage in Adults NI Report which both Joy and Dr Vanessa Craig have been working on over recent times. As previously discussed here, the Report will be a NI version of the similar CR185 Report in England. A further meeting in respect of this was held in Clifton House on 28 April involving Joy, Dr Peter Trimble, Bernie Kelly from Belfast HSC Trust and Barry. We would hope to place it before our local College Executive for endorsement in principle soon and in the Autumn perhaps hold a small launch event with Commissioners, CMO, MLAs, etc. with a view to including this important issue within our lobbying agenda.

On the 3rd May the North South Alcohol Policy Advisory group held a seminar at Pearse Street, Dublin exploring the relationship between alcohol, self-harm and suicide. Marcella Corcoran Kennedy Minister of State for Health Promotion in RoI, opened the meeting by describing the impact of alcohol on the individual, society and services. The keynote address was by Ulster University's Professor of Mental Health Sciences Siobhan O Neill, who summarised the available research on alcohol, self-harm and suicide in Ireland. Our own Dr Michelle Gilmore from the Southern Trust described an established Dual Diagnosis Service which utilises a person centred approach to integrate the management of mental health and substance misuse. Eamonn Keenan from the HSE provided a vision for future services and Bobby Smith Adolescent Addiction Services and Connor Mc Cafferty from Zest NI described gender specific needs for this client group. I understand that the event was well attended and interactive with facilitation of Panel discussions by Patient and Carer groups, as well as Brendan Bonner from the Public Health Agency. My thanks to both Michelle for bringing Psychiatry to the table – and also to Dr Margaret du Feu who attended in advance of assuming her Executive role for us liaising with our colleagues in RoI.

Professor Daniel SmithOur second Masterclass of the year was again very well attended in Clifton House on 10 May. It is very gratifying to see the membership responding so well to these keynote speakers and thanks again to Dr Tony O’Neill and our office staff for securing a CPD event of this calibre. Our speaker this time was Professor of Psychiatry Daniel Smith from University of Glasgow, but a native of Belfast, who is a Medical Advisor to Bipolar Scotland and chairs the Bipolar Disorder Clinical Research Group funded by the Scottish Mental Health Research Network (SMHRN). In 2016 he was awarded a Lister Prize Fellowship. He has a longstanding clinical and research interest in the causes and treatment of bipolar disorder and more recently has been developing a research programme on the genetic interface between serious mental illness and medical comorbidity.

Daniel was asked to consider the challenges to making a correct diagnosis of bipolar disorder, to summarise recent discoveries on the genetic and non-genetic causes of bipolar disorder and to discuss the optimal treatment of bi-polar disorder from both a pharmacological and psychological perspective. His talk did all of these things and was of very real assistance to how we should approach this particular mental illness in the course of our clinical practice.

...To finish then with a counter to all the political doom and gloom... I leave you with the image from Dooagh, Achill Island, after a freak tide recently restored its beach which had been “missing” for 33 years! ...This is surely a testament to patience and time...!

Dooagh Beach, Achill Island

 

Dr Gerry Lynch

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Dr Gerry Lynch

Dr Gerry Lynch, Chair RCPsychNI