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

RCPsych in Northern Ireland previous monthly updates

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August 2017

Sixteen CT1 trainees began their career in Psychiatry on Friday 18 August; we were very pleased to be invited by Drs Damien Hughes and Jo Minay, Head and Deputy Head of School of Psychiatry, NIMDTA, to meet them and present on the role of the College, an opportunity which we have welcomed now for over 10 years.

Drs Stephen Moore, Colin Gorman, John O’Hare, Julie Anderson, Maggie Kelly and Michael Doris provided an overview of the training path in the coming months and years. Welcoming them, Dr Damien Hughes said it was an exciting time to be joining the profession; there is growing acknowledgement of the importance of the Psychiatry; there are growth areas in children’s mental health, acute care and perinatal psychiatry; there is undoubtedly more acceptance about speaking out about mental health and we receive greater political attention now than ever before. 

However, there is much more to be done in terms of improving the physical health of people with mental illness who die on average 15-20 years earlier than the rest of the population.  And so, we very much welcome CT1 trainees to the family and assure them of the College’s support both locally and centrally.

 

Mental Capacity Act NI 2016

 

The round of Mental Capacity Act meetings continued in August when our Mental Capacity Working Group met to consider various scenarios which will help inform the draft Code of Practice. We now have a dedicated webpage for the MCA, which will serve as a local resource and a private Members’ Section, to keep track of our deliberations and provide access to the Draft Code as it progresses.  We attended a workshop hosted by the BMA on 21 August and the following day Drs Gerry Lynch and Catherine Taggart presented at a GMC roundtable discussion focussing on the challenges for the wider medical profession, at which it was gratifying to meet with colleagues from the Royal College of Surgeons, Physicians, GPs and the BMA.

Koulla Yiasouma and Richard Wilson

 

 

 

 

 

Dr Richard Wilson held a very productive meeting with Koulla Yiasouma, NI Commissioner for Children and Young People, to discuss issues in relation to the MCA which affect children under 16.  Dr Aimee Durkin, SpR, and Christine Irvine, Research and Policy Officer (NICCY), were in attendance.  Koulla and the NICCY office have initiated a project to improve baseline data around the mental health needs of young people in NI and she has invited Dr Wilson and Dr James Nelson to contribute to a roundtable event at Queen’s University in September.

You in Mind

 

 

Over the last number of years Members have been exercised by the You In Mind Regional documentation, which has been piloted across a number of Trusts.  A delegation including the Chair, Drs Michael Doherty, Saleem Tareen and Stephen Moore met with DoH officials on 11 August at which they reiterated our main concerns:

  • the uncertainty over the practical application of the forms (paper or IT solution);
  • the length of the form and potential volume of paperwork and time needed to complete;
  • the uncertainty around need for completion of every page where this may not be applicable;
  • the sense of over-inclusivity in an attempt to make the documentation suitable for all professions and all conditions; and
  • ­the above potentially creating a non-therapeutic process.

Everyone was in agreement for the need to find a solution which delivered on the first principles when embarking on this process, i.e., improved assessment and management of risk of people with lived experience and aligning these processes with the You In Mind Care Pathway across a variety of professions in the HSC sector.

The delegation left assured that any documentation would not lead to a counter therapeutic relationship with patients and that the documentation was drafted to record information and reflect practice rather than dictate it.  The documentation will be flexible and sections are to be completed as required, as per clinical judgement, and with regard to the expertise of the clinicians completing it.  Further guidance to accompany the documentation will be drafted in collaboration with ourselves and other professional bodies and more work is to be done in relation to IT and its compatibility across different systems.  It was pleasing that the meeting ended with general consensus on the future direction of travel.

Following from our meeting in July with Chris Matthews, Director of Mental Health, Disability and Older People, and his DoH colleague, Allan Chapman, regarding the potential £50m which is set to flow as a result of the Conservative and DUP agreement, Members met on 17 August to draft a paper outlining our strategic objectives for the funding stream.  We submitted this on 31 August.  Very many thanks to Drs Conor Barton, Michael Doherty, Daniel Gboloo-Teye, Tanya Kane, Dearbhail Lewis, Janine Lynch, Rowan McClean, Jo Minay, Ciaran Mulholland, Mark Rodgers, Deirdre Shields, Arun Subramanian, Peter Trimble  and Richard Wilson for all their contributions.

Gerry Lynch and the Policy team with Nigel Dodds

 

 

 

 

 

 

 

 

 

 

 

There then followed a meeting on 24 August with Nigel Dodds MP and his Parliamentary Assistant, Philip Brett, at which Drs Gerry Lynch, Peter Trimble and Michael Doherty gave an overview of the current funding position for mental health services and referred to the historic underspend in Northern Ireland, which had been identified within the Crisp Report. Nigel was briefed on issues including:

  • The status of Mental Health Transformation Programme Work Stream and how it was envisaged that it would be taken forward;
  • The Physical Healthcare Monitoring for those with Severe Mental Illness and Eating Disorders (Child and Adult);
  • RCPsych in NI’s concerns regarding the funding stream for the Mental Capacity Act (NI) 2016 and funding to ensure parity between physical and mental health;
  • The Crisp report, i.e., ‘Building on Progress: Achieving parity for mental health in Northern Ireland’ and its eight recommendations;
  • RCPsych in NI’s views on mental health services post the HSCB, particularly on the need for changes in the way mental health services are commissioned and funded,
  • RCPsych in NI’s concerns on the Zero Suicide and Suicide Prevention Bill proposals;
  • he NI Personality Disorder Strategy and the need for its full implementation.

He assured members that support for mental health services would remain one of his and his party’s priorities. He said the meeting had been informative and indicated that he was keen to remain in contact with the College and would be happy to meet again.

A few words of thanks to all the Medical Managers who fed into the College 2017 Census Return; we have a 100% return from Northern Ireland - much appreciated!.  Thank you also to Dr Deirdre Shields who, on behalf of the POA Faculty, responded to the Consultation on Continuing Healthcare in NI Introducing a Transparent and Fair System.  The consultation document and response can be found here. 

The month ended with the five health trusts unveiling plans to make £70m of cuts.  Together with 12 other Medical Royal Colleges we published a joint statement calling for a strategic approach to healthcare transformation.  The statement ran as the top story on BBC News NI and achieved coverage in the Belfast Telegraph, BBC Good Morning Ulster, BBC Radio Foyle, BBC Newsline and BBC Evening Extra.

 

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

“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.Anti-BASH

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...

June 2017

Edinburgh

At time of writing, I am not long back from the College’s International Congress which was this year held in Edinburgh from 26-29 June 2017.

It was, in my view, a great success. There was a real buzz in the venue and the programme had the correct mixture of cutting edge science, clinically relevant presentations and some very powerful input from Patients and Carers. Not only was it a great experience to listen to the many high profile speakers, but it provided the opportunity to interact with peers from many different services both within the UK and further afield. This cross fertilisation of ideas is really important for the development of services in the different regions as we can all learn from one another.

Perhaps for the wider College readership of this Update, it would be appropriate to insert here a word for Belfast as a venue for our International Congress in the very near future, given the new College Chief Executive’s emphasis on the overt inclusion of the devolved countries. Without wishing to advertise any particular venue, we do now have the attendance volume capability and capacity in Belfast for the last couple of years for such an International Congress…..others have led the way in Belfast, so why the RCPsych delay?! What about 2019?

During the Conference, we also had a useful meeting with the Chairs of the English Divisions and the Chairs/Vice Presidents in Scotland and Wales, as well as the Managers including Nora McNairney. This was going on just as the 26 June news of the Conservative and DUP Agreement and UK Government financial support for Northern Ireland came through, so there was much interest in the extra £10m per annum which will be allocated to mental health over 5 years as a result.

The words within the Agreement about this financial allocation are also encouraging: “The UK Government and Executive agree on the importance of support for mental health, particularly recognising the historical impact of NI’s past on its communities”. However, we have already begun to work to ensure that the money actually does reach priority front line mental health services! Any additional funding for mental health services in Northern Ireland is to be welcomed, but it is vital that such money provides tangible benefits to adults and children with mental health and learning disability needs. It is imperative that this funding is protected and targeted specifically at genuine mental health services and projects – not diverted to, for example, the Acute sector or even to our new Capacity legislation, the cost of which is to be shared with physical healthcare in the genuine pursuit of parity of esteem; also, there is surely doubt as to whether the current Parliament will endure for 5 years.

As a starter on this positive development, we issued a Press Statement on 28 June which was picked up by BBC NI, though its traction was limited due to the news dominance of yet another local political talks deadline. Moreover, I am encouraged by the following words in the House of Commons from DUP MP for North Belfast Nigel Dodds as he recognised some of what we have been saying over the years about the mental health effects of our troubled past: "Clinicians and others have pointed to the legacy of 30 years……and the awful effects of that. Part of the money we are investing this week goes to mental health care - extra investment in the health service”.

The extra sums within the Agreement of £50m and £100m per annum for two years for health/education immediate pressures and for health service transformation respectively, are also welcome. However, we still need our local Assembly back and functioning. It is at this stage to be hoped that this goal will now be realised at the end of the Summer…?

RCPsych International Congress 2017

The International Congress is the moment at which terms of office for College office bearers conclude and begin. We therefore give thanks to Professor Sir Simon Wessely as President and locally Dr Maria O’ Kane as Vice Chair and Dr Margaret du Feu as Chair of General Adult Faculty. Each have strengthened the College during their tenure and their skills in those particular roles will be missed. We welcome and look forward to continuity of their high standards from Professor Wendy Burn as President and locally Dr Michael Doherty as Vice Chair and Dr Rowan McClean as Chair of General Adult Faculty. Each are very worthy successors and custodians of great legacies of service. We are similarly very grateful to both Drs Heather Hanna and Heather Hawthorne for their roles on our Executive over recent years and we look forward to working with their successors Drs Annette Thampi and Margaret du Feu in the time ahead.

Speaking of appointments, Dr Lauren Megahey ST5 in Psychiatry of Old Age has been appointed as a NIMDTA Trainee Ambassador for Psychiatry, for the 2017 - 2018 training year. This is a new role, with overall objectives of promoting connections between trainees, highlighting benefits of training and strengthening the engagement between NIMDTA and trainees. Lauren, who is based in the Southern Trust, is happy to be contacted by Trainees who have any issues or suggestions.

Also at Congress, we had the launch of the RCPsych Insight publication, which is a new quarterly magazine for members. I was indeed delighted to see that our own Drs Ruth Barr (on the North Belfast Community Mental Health Team) and Tony O’Neill (on genetic research) are featured prominently within at pages 12 and 16 respectively. Overall, the College wants this magazine to be a celebration of what is best in psychiatry; consequently, there are features providing a fascinating window on the working lives of a diverse range of psychiatrists. Its editors would relish your feedback on the first edition – please email magazine@rcpsych.ac.uk or tweet using #RCPsychInsight with your suggestions, feedback or queries.

Poster presentations at RCPsychIC 2017

Finally on Congress, it was particularly reassuring to see so many poster presentations from NI Consultants and Trainees (…did I really count 15?); this is something we should definitely build on for next year’s conference in Birmingham from 24-27 June 2018. The posters were an excellent display of the hardwork and commitment of the Trainees and Trainers in Northern Ireland to improving services for our patients. Pictured is Dr Aimee Durkin flying the flag for the Northern Ireland CAMHS Regional Inpatient Unit at Beechcroft Hospital serving all five Trusts.

Prior to Congress, I had attended both the Regional Advisory (Bamford Monitoring) Group Meeting on 19 June and the Central Medical Advisory Committee Meeting on 21 June on behalf of the College. At the former, we discussed the recommendations of the “Building on Progress: Achieving parity for mental health in NI” June 2016 Report and the progress since then. Over the past year since launch, we have pushed the agenda set by this Report at meetings with the then Minister, politicians, DoH and HSCB, but it is fair to say that progress has been limited, given the current political situation. Whilst it is clear that there is a commitment to the recommendations and there is also some evidence of more joint working between Trusts, there is a degree of frustration about the lack of progress, in particular in the development of community specialist services which would relieve pressure on acute beds. The previous Health Minister had made mental health a priority, but it is difficult to see how much progress can be made given the current political vacuum. I think it important, however, that this Report is kept by us on the agenda of the Trusts as well as of the Commissioners and the Department. The latter meeting was very much focussed on the outworkings of the Bengoa Report entitled “Systems, Not Structures – Changing Health and Social Care”, as well as the follow up document “Health and Wellbeing 2026; Delivering Together”. Overall, it is vital that we ensure that mental health is kept to the forefront, as the programme of work set out in the “Delivering Together” document is taken forward. Finally, I had a very similar agenda when both myself and our Policy Administrator Thomas McKeever met with the Trust Medical Managers in Clifton House on 21 June. They have agreed to meet with me approximately every quarter to discuss the College agenda and I am very grateful to them for their time regarding this.

15 June was a particularly busy day in College life… it began with a meeting in Clifton House attended by myself, Dr Margaret du Feu and Thomas with Fergus Cumiskey (CEO) and Carrie Montgomery (Deputy CEO) of Contact NI to discuss College concerns re some aspects of their lobby for a Suicide Prevention Bill and the Zero tolerance approach to Suicide – as well as catching up with the All Party Group on Suicide. It was a useful exchange and one which needs to be repeated. On the question of the Zero Suicide approach, it is worth restating here that the College is supportive of all evidence based approaches to suicide prevention. It does not formally promote the zero approach. There is concern that what can helpfully be a mindset of zero suicide will be turned into a target. This is our former President’s succinct comment from January 2015 on the topic and I commend it to you. It is fair to say that while we certainly share the imperative of seeking to reduce the suicide rate as far as possible, the emphasis should be on properly resourcing mental health services and bearing down on the various mental illnesses which underpin our high suicide rates, as well as improvements on discharge and follow up, whilst also recognising and trying to address the many societal problems which contribute to suicide.

Indeed, prevention of suicide, not prediction, was the key message at the International Congress from Professor Louis Appleby in tackling the UK suicide rate. The National Suicide Prevention Strategy England highlights areas where effort should be increased to help reduce the suicide rate. In Northern Ireland, as we know, we have the highest rate within the UK and adopting a similar approach in Northern Ireland would be beneficial. A key focus in this strategy was more involvement of family members and carers in the care and management of our patients. The RCPsych Consensus statement on Confidentiality was highlighted at Congress. Another worthwhile document to read in this context is CR160. Good Psychiatric Practice: Confidentiality and Information Sharing (2nd edition).

RCPsych Concensus Statement on Confidentiality

Staying with our dialogue with Contact, Dr Phil Campbell kindly attended the Contact NI Suicide Prevention Conference: What works? Mid-Year Half-Day conference at the Stormont Hotel on 21st June on behalf of the College. Phil reports that Órlaithí Flynn MLA outlined her role as chair of the NI Assembly All Party Group on Suicide Prevention and Norman Lamb MP delivered a video message describing his experience with “zero suicide” in Mersey Care and Detroit. CEO Fergus Cumiskey said that learning from suicides was key, describing the negative impact of a “blame culture” following the death by suicide of a person in contact with services. He talked about what he saw as a pessimism around the preventability of suicides and his desire for a culture in which people can talk openly about suicide. Finally, Deputy CEO Carrie Montgomery presented the Contact NI Zero Suicide Manifesto. The Contact NI proposal for a NI Suicide Prevention Bill was also presented. The Zero Suicide pilots in England are still being evaluated; it will be interesting to see the outcomes. We need to consider whether the adoption of a zero suicide target could ironically contribute to the blame culture where it could be viewed that every suicide should have been prevented. In terms of the proposed Suicide Prevention Bill, perhaps the focus instead should be on measures with the best evidence – e.g. minimum unit pricing, National Confidential Inquiry into Suicide and Homicide by People with Mental Illness recommendations, as well as standards of care. The dialogue will continue as a matter of urgency, given the seriousness of this issue which so badly afflicts our society. Speaking personally, I remain to be convinced that putting suicide prevention into a legalistic framework has merit, and may, indeed, have significant disadvantages.

Dr Heather Hanna

Back to 15 June again… following the meeting in Clifton House with Contact NI, I hotfooted over to the Royal College of Nursing at Windsor Avenue, Belfast for the launch of Three Steps to Positive Practice: a rights based approach when considering and reviewing the use of restrictive interventions. This document, which has been approved by Central College Policy and Public Affairs Committee, was developed by a multi-disciplinary group involving Dr Heather Hanna (pictured above and below far right along with some of her co-authors) on behalf of our College, Royal College of Nursing, the Northern Ireland Association of Social Workers and the College of Occupational Therapists. It is designed to assist health and social care professionals who are involved in practices where people in their care may be restricted in some way. It is a very instructive and practical document. Clearly a lot of work has gone into it and I congratulate and thank Heather for undertaking this on our behalf. Please do read the document through, especially if your work involves you in this area. Along with Heather, the Guest Speakers were Dame Professor Donna Kinnair RCN Director of Nursing Policy & Practice, Professor Charlotte McArdle Chief Nursing Officer and Professor Rod Thomson RCN Deputy President.

Launch of Three Steps to Positive Practice

Meanwhile over at the Crowne Plaza, Shaw’s Bridge, our Child and Adolescent Faculty Chair, Dr Richard Wilson was representing us with another local Royal College on 15 June….this time with the Royal College of Paediatrics and Child Health who were hosting the launch of the Northern Ireland response to the RCPCH State of Child Health Report. This is a truly comprehensive Northern Ireland response to the equally comprehensive RCPCH UK-wide State of Child Health Report - the latter drawing together a range of data across 25 key indicators of child physical and mental health creating a snapshot of infant, children and young people’s health and wellbeing. The report follows the life-course of a child from conception to birth and throughout infancy, childhood and adolescence. The Northern Ireland response identifies specific recommendations across a range of themes, while taking into account how we compare to other regions. It is a very thorough Report and deserves study as to its full implications.

May I add that it is very heartening to witness us collaborating so well with the other local Royal Colleges.

Following these parallel events, the day concluded back at Clifton House with our Executive Meeting which was very well attended and which heard feedback presentations from both Drs Heather Hanna and Richard Wilson – and also from Dr Billy Gregg who shared with us his learning from his presentation (covered in last Month’s Update) 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”. My thanks to all three. There is a lot of really helpful material in all of this for our Clinical practice.

Dr Richard Wilson has also been very busy this month with a number of additional initiatives. Richard attended the Review of Regional Facilities for Children and Young People at the Crowne Plaza, Shaw’s Bridge, Belfast on 27 June. Dr Daniel Gboloo-Teye (pictured below centre also at Joint UPS/RCPsych event), Clinical Lead Belfast Trust was also in attendance. The aim is to rationalise the existing facilities in Northern Ireland across care, treatment, forensic and secure residential units. It is clearly important that this takes place in a joined up way. The main themes are increased integration, increased focus on outcomes and research, the prioritisation of an outward facing strategy of practice, improving the physical and therapeutic infrastructure for these units and making sure they function as part of a rationally determined network of provision, as well as aiming that there would be greater engagement with the users of these services to promote improvement via mutual learning exercises. In terms of the Action Plan the following were emphasised in the short term: Promoting co-operative leadership of change, as well as beginning to plan joint training and educational ventures on an inter-agency basis to improve mutual understanding and clarify goals. Richard as Chair of our Child and Adolescent Faculty will fully support this broad based approach to service improvement and looks forward to working at all levels of change. Richard has made it known that we would be particularly interested in co-developing inter agency learning initiatives and in the development of managed networks of care across the Region.

Dr Daniel Gbolo-Teye

Then on 30 June, Richard along with the other Trust Child and Adolescent Psychiatry Clinical Leads met with Ms Catriona Rooney CAMHS Commissioner, Health & Social Care Board (HSCB) regarding the Regional CAMHS Clinical Network ECHO (Extension for Community Healthcare Outcomes) Project and the possibility of a Partnership Board being set up to oversee Regional CAMH Service Development when the HSCB is stepped down in 2019. Very exciting potentially was the news that Ms Rooney has now applied to the DoH for funding to recruit a Consultant Clinical Director to take forward the work of the Project Board. This will hopefully provide an opportunity to provide clinical leadership at a Regional level, which would be progressive.

Next to the 7th Annual Ulster Paediatric Society and College Child and Adolescent Faculty Conference which took place in Riddel Hall on 6 June entitled “Beneath the surface – Exploring childhood anxiety, attachment and the power of relationships” – which attracted an audience of around 100… Dr Richard Wilson (pictured second from left) reports that this was the most collaborative Conference so far. The theme of Anxiety proved to be a connecting thread throughout the day and all of the presentations seemed to complement one another brilliantly. The Keynote Speaker was Professor Helen Minnis (pictured second from right) on “Double jeopardy: the roots of anxiety”. The event was opened and closed by Richard; also speaking were our Child & Adolescent Faculty Vice Chair Dr Lisheen Cassidy (pictured fourth from left) on “Medically unexplained symptoms – what lies beneath?” and Faculty Member Dr Anna McGovern (pictured third from left) on “Exploring anxiety in children and young persons with Autism”. The Conference was a great success and was described afterwards as “a stimulating and enjoyable day of learning”.

7th Annual Ulster Paediatric Society and College Child and Adolescent Faculty Conference

One of the interesting points made by Professor Minnis was that “Children who have been exposed to maltreatment are at a higher risk of having problems with emotional regulation and are also at much higher risk of having complex neurodevelopmental disorders which also affect their emotional regulatory capacity. This means that such children may be at “double jeopardy” of problems associated with the regulation of emotion. This in turn means that we need to assess and deal with neurodevelopmental problems in maltreated children to prevent and manage the emergence of problems like anxiety.” This dedicated approach towards moving the whole field of attachment out of the laboratory into clinical practice, the development of clinical confidence, of more practical assessment and of outcome tools - is impressive and bodes well for the future.

Following lunch, recognising that if attachment based anxiety has its roots in faulty relationships, then it is likely that such problems may find a solution through the promotion of learning and support provided in the context of nurturing relationships, Conference went on to hear of two possible approaches. The first presented by Janet McCusker (Nurse Education Consultant – pictured fourth from right) outlined the Wellness Recovery Action Plan Approach (WRAP). This method, developed by Mary Ellen Copeland emphasises the central importance of individual autonomy in the co-development of an evolving self-led management plan which has wide applicability across many areas in mental health practice. This was followed by an excellent talk by Annie Gordon (Nurse Therapist- pictured third from right) on her use of the cognitive therapy approach for patients with complex needs who present with anxiety. Our thanks to all who made the day possible, including Dr Shilpa Shah (Honorary Secretary of Ulster Paediatric Society -pictured on far right) and Denise Braniff (Administrator at Ulster Paediatric Society – pictured on far left).

Reflecting on all of the above just for a moment, we really do, as RCPsych in NI, collaborate remarkably well and extensively with our colleagues in other disciplines. Just looking at this one month’s activity alone is really impressive. It really is very striking. My thanks to all both inside and outside our College here in Northern Ireland for their time and efforts to improve services for our patients and maintain high standards.

An interesting and important half day Conference was held on 21 June in the Stormont Hotel entitled “Borders, Constitution and Money: an Expert Seminar” and our (then incoming and now) Vice Chair Dr Michael Doherty attended this on our behalf. This was important, given that the question of delivering key public services after Brexit if economic circumstances deteriorate or staffing problems become more acute, was on the agenda. It was the second seminar in a series examining Brexit from different perspectives, which is running for 18 months and visiting Northern Ireland, Wales, Republic of Ireland, England and Scotland. There were leading speakers from University of Glasgow, University College Dublin, Queen’s University and Ulster University. Dr Gordon Marnoch Reader in Public Policy Ulster University, spoke on “Brexit and public services – working through uncertainty” with the impact on the NHS and social care system as part of this. There is likely to be impacts on cross border workers, EU Nationals working in public services in Northern Ireland, as well as on all Ireland existing and proposed service developments. These issues will all require clarity as the exit negotiations move into the detail. Representation and input from Northern Ireland will be essential and this event was a welcome reminder that mental health services will also be impacted by the wider context of Brexit and all that it will entail.

…and that is not all! ...I am pleased to report that we hosted our Inaugural NI Psychiatry Summer School here at Clifton House on 16 June in association with Queen’s University Mind Matters. It was my pleasure to welcome everyone to the newly available McCracken Suite within the building and it worked well. We had a really good programme with interesting speakers lined up (pictured):

NI Inaugural Psychiatry Summer School programme

My thanks to all who were involved in this day (you will see their names on the programme), as well as our staff who made it happen. I would particularly like to thank Dr Caroline Donnelly (pictured fourth from left) who was the main promoter of this hugely important Recruitment initiative. I would certainly hope that we can build on this and perhaps make it an annual event as it offered such good insights to those who attended and all in the pleasant environment of the College.

NI Inaugural Psychiatry Summer School staff

Drs Joan McGuinness and Colin GormanAlso pictured (right) at our Inaugural Psychiatry Summer School were Drs Joan McGuinness and Colin Gorman.

…and now for another first… on 13th June the Public Health Agency held its inaugural meeting of the Maternity Strategy Implementation Subgroup on Perinatal Mental Health in Belfast. Represented on this group is psychiatry, nursing, midwifery, health visiting, psychology, AWARE/MMHA, PHA and allied health professionals – and reporting from this subgroup will be to the Strategic Midwifery Forum. An important point is that both GP and Service User representation have been invited to future meetings. The main purpose was to review the recommendations of the RQIA Review of Perinatal Mental Health services across Northern Ireland, which was issued in January 2017. Each of the 11 recommendations were discussed in some detail and an agreed plan of how to make progress towards achieving each of these was made. Chair of our new Perinatal Faculty Dr Julie Anderson attended to represent the College, along with other members of the Faculty.

Julie advises that the overarching desire to ensure safe effective and compassionate care was highlighted, together with the need to have a broad systems approach to consider prevention and early identification, right though to care at the severe end of the spectrum. The obvious issue of our current economic and political context was also discussed; clearly progress on the development of much needed specialist community perinatal mental health services and indeed a mother and baby unit will be significantly hampered by this in the meantime.

Points of discussion and agreement on required action were:

  • uniform approach needed across all acute inpatient psychiatric sites regarding appropriate equipment and facilities for the visiting of babies and other children of parents in hospital;

  • the issue of coding systems in Trusts which currently make it difficult to capture what is happening and so impacts on the ability to plan future services;

  • the good work which is occurring in some areas regarding peer support services was recognised, particularly in the Recovery College in the Northern Trust, but a recognition this needs to be available to all women regardless of where they live;

  • the challenge of communication both within services in a Trust and between Trusts was highlighted - the fact that this is an issue which is repeatedly highlighted in Serious Adverse Incidents, confidential enquiries etc. Within the small specialist perinatal service in Belfast Trust, communication is better than in other areas – so it was agreed that this further highlighted the need for the development of perinatal services across Northern Ireland;

  • a clear deficiency in the understanding and knowledge around perinatal mental health within front line mental health services was acknowledged and therefore the need for increased training.

…and a final first!.......Our new Faculty of Perinatal Psychiatry held its Inaugural formal Meeting in Clifton House on 27th June and members were pleased to welcome Theresa Nixon from RQIA to join them for this meeting. Julie has asked me to stress that new members are very welcome to this Faculty from within our membership.

Meanwhile on 29 June Dr Stephen Moore attended the Mental Health Informatics Project Team Meeting as Chair of our Informatics Committee. My gratitude to Stephen who continues to represent the College on the You In Mind Informatics workstream. Most of the work is information focussed, but will include looking at measuring outcomes as part of the mental health dataset.

…so, all told June 2017 will be remembered as being a very busy and productive month in the local College!

And finally some staff news… staff had the pleasure of welcoming Jonathan Woolcock College IT Service Desk Analyst, on 21 and 22 June to the office in Clifton House. Jonathan spent the two days working on our many IT issues and made great progress. We hope he will be able to visit again soon to assist us further. Later on 29 June staff also had the pleasure of welcoming Karla Pryce College Project Trainer (pictured with all staff beside the RCPsych in NI “Top Tips for NG” Noticeboard!) and Alethea Awuku College Trainer (also CPD and Revalidation Co-ordinator) for one day of Staff Training in the office on the newly introduced Integra New Generation (NG) Customer Relationship Management database. The fact that this training was on site made it much more useful. My thanks to all. Finally my congratulations to our Policy Administrator Thomas McKeever who was awarded a Staff Personal Recognition Award by the College on 13 June as he “diligently provided support and guidance… and direction” to staff and ”ensured that the high level of service we provide to our membership was maintained” over the course of recent staff changes.

RCPsych in NI staff showing NG Top Tips noticeboard

I leave you with an interesting initiative from a local school and a final thought:

Our Lady and St Patrick’s College, Knock has developed a six lesson Resilience programme for its students called “The Floreo Project”. The Latin verb ‘Floreo’ means to flourish, to bloom or to thrive. This programme aims to build resilience and mindfulness skills with Year 11 students. The school hopes that these skills can be utilised to promote positive emotional health, mental wellbeing and stronger academic and personal performance. The school further states that “research shows that resilience enables us to deal with difficult situations, to learn from them and to allow them to help us grow – in short, resilience helps us thrive”. This is a superb initiative. We fully support early interventions such as this and especially the promotion of resilience in our young people.

Speaking of resilience, our former President’s words in the RCPsych Insight publication strike a chord: “I’d hate to do a job that wasn’t stressful...” Our jobs as Psychiatrists are stressful (although perhaps not in the way that his was), but are enormously rewarding. I hope that the College can help to reduce the job stress and increase the satisfaction for us all, as its members.

 

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.

 

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

 

March 2017

Malone House, Belfast

Well… one year served as your Chair and during that time, we have been “round the houses” politically with no less than two NI Assembly Elections, two Health Ministers and two Health Committee Chairs… now a vacuum, but talks continue…

So it was that our Spring Conference went “round the houses” also, but in a good way! It was so well supported that we outgrew Clifton House and had to move it to Malone House (pictured)… and in the end we outgrew Malone House also as we were disappointed to have to turn down some members through lack of space in the final days leading in. In this regard, as far as practically possible, please do book early as it is so critical in our choice of venue, catering etc.

(Just as an aside, I am pleased to hear from staff that the online booking problems which had been encountered with the new database systems launched by the College centrally last year are resolving slowly but surely and I understand that about half of you were able to successfully book on line this time round. We are hopefully within sight of total resolution of these systemic issues which have been stressful for staff and members alike. Your patience and cooperation meantime are much appreciated).

Back then to the “Improving Services for Everyone” Spring Conference at Malone House on 29 March which was described as “a very successful day” and became a fitting way to mark the first anniversary! The venue was good with no car parking issues, the weather was favourable, the attendance was capacity, the topic was Quality Improvement, the speakers (both external and internal) were quality itself and needed no improvement! – and the organisation was excellent, thanks to all our three members of staff. We have received very positive feedback and there is a definite appetite for a continued focus on Quality Improvement issues relevant to Northern Ireland. Afterwards one of our invited guest speakers Dr Geraldine Strathdee had this to say in a note to our staff:

“…thank you for the very warm welcome this week and such an excellently designed and organised QI day. It was really enjoyable; I learned a lot; I made new friends and connections with fellow travellers. Please do remember that I have never forgotten my Northern Irish roots and am only too pleased if I can ever be helpful.”

RCPsychNI Spring Conference ProgrammeBy the reaction to Geraldine’s contribution on the day, we will certainly be keen to welcome her back home once again in the very near future.

Huge thanks to Geraldine and to Dr Kevin Cleary who also made the trip over to address us on the issue of culture change, which is critical if any initiative is to take root and prosper. We are also indebted to our three members Drs Catherine McDonnell, Conor Barton and Francess Doherty who together ensured that the afternoon programme was both lively and instructive. The local perspective on the morning’s stimulating programme was key and it is a tribute to all three that we held our audience right to the day’s end. It is fair to say that both Catherine and Francess employed intriguing titles (click right picture to enlarge) and Conor employed humour in order to hold the attention of all. Feedback was both positive and plentiful! Huge thanks to all three, to all our members who attended, to our staff and also to Dr Gavin Lavery, Clinical Director of the HSC Safety Forum who chaired the afternoon session. We hope the day’s thoughts will lead to improved services for our patients in the short, medium and longer term. Simple changes can make profound differences.

In above photo are Drs Francess Doherty, Geraldine Strathdee, Kevin Cleary & Gerry Lynch – with Dr Catherine McDonnell also featured in photo below.

While some of us enjoyed the Spring Conference in its totality, Drs Michael Doherty, Rowan McClean and Ryan O’Neill were also very usefully occupied for part of the morning at a meeting with Commissioner of Mental Health Services Kevin Keenan and his Team at the Health & Social Care Board offices in Linenhall Street, Belfast. They again raised the issue for us of the 5 Trusts’ October 2015 Strategic Outline Business Cases for Physical Healthcare Monitoring for those with Severe Mental Illness and Eating Disorders (Child and Adult). Whilst it was made clear that resolution of the current political impasse is a pre-requisite for real progress on this issue, there was comfort in the knowledge that this remains a top priority.

In terms of the political impasse, there is no doubt that it is having an effect both on existing services and initiatives and in this regard I was interviewed on 9 March by Marie Louise Connolly for BBC NI. It is precisely the physical healthcare monitoring campaign which I had in mind when doing these interviews which received significant coverage across the BBC News platforms including Radio and Television that day. We can only hope that it all has a cumulative effect for the sake of this vulnerable client group.

Dr Noel Crockett at Altnagelvin

We supported two events in relation to Recruitment and Retention during National Careers Week at the start of the month. The first took place on 7 March at the South West Acute Hospital led for us by Dr Pat Manley and the second was on 9 March in the Centre for Medical and Dental Education and Training at Altnagelvin led for us by both Dr Deirdre McGlennon and Dr Noel Crockett (pictured above with the stand and materials supplied by the College). I will focus here on the Altnagelvin one which was aimed at Sixth Form students from the local area interested in applying to Medicine following their A levels. It was part of the Annual Career Evening which is organised by the Medical Education Department in both Altnagelvin and the South West Acute Hospitals. The aim of the evening was to give the students information on the application process and the types of careers which are available within the medical field. There were several specialities in attendance including Maxillofacial surgery, Cardiology, Neurology, Obstetrics and Gynaecology, Paediatrics, General Practice, Radiology, Orthopaedics and Emergency Medicine, as well as ourselves. Representatives from each of these specialities were in attendance to answer any questions the students had about medicine in general or their speciality. My thanks to all three members for giving focus to this important area. Thankfully we do not face the same problems in this regard as colleagues in other regions, but that level of success can only be maintained by our constant vigilance and the commitment of members such as these.

Aware Mental Health eventI am pleased to report that our collaborative work with Aware continued throughout March with talks delivered at their 8, 9 and 22 March events at Queen’s University (flyer pictured), North West Regional College and Malone House (Impact of Domestic and Sexual Violence on Mental Health) respectively by Drs Maggie McGurgan, Maggie Kelly and Phil Campbell (pictured below) respectively. This continues to be such a worthwhile form of public engagement for us. My thanks to our three members and also to Tom McEneaney in Aware for facilitating this. I am particularly pleased to see third level students being addressed on depression and mental health by Drs Maggie McGurgan and Maggie Kelly, as this can be such a vulnerable time and an appropriate time therefore for early intervention.

Phil Campbell at Queen's University

I was pleased to attend and represent the College at the NI Association of Social Workers Celebration of World Social Work Day on 21 March in the Stormont Hotel. The need for leadership was much discussed and there was a very interesting presentation on how the systematic approach to quality improvement can make a difference in all parts of the health and social services, an idea which was very much in keeping with the theme of our subsequent Spring conference. The event was opened by Sean Holland, Chief Social Services Officer.

Social Work was well represented by Gavin Davidson and Bernadette Hamilton at two meetings which we held in Clifton House on 14 March and 4 April in relation to the Mental Capacity Act (NI) 2016 Code of Practice. In the first of these meetings we were joined by Gavin and Bernadette, together with Dr Louise Sands representing RCGP in NI and Dr Petra Corr representing Psychology – to consider how best to lobby for a change in the Consultation methodology in relation to the Code of Practice for the Mental Capacity Act (NI) 2016. As you know, I think it is essential that there is greater clinical involvement in the process. We then held the further 4 April meeting with Tomas Adell from the DoH Mental Health and Capacity Unit charged with Mental Capacity Implementation. Drs Ian McMaster and Michael Doherty kindly joined me in this meeting, along with Thomas. We were somewhat reassured that the next phase of Consultation will continue to be in the form of a pre Consultation, this time with Tomas Adell willing to attend at least some of our meetings to advise on the Act and to take back practical examples for consideration. It seems as though the aim is to have a shorter Code than England and to have an Annex with scenarios/working examples to run alongside. The Regulations and the Consultation on them will also flesh out the detail of who does what. There is an open awareness that Psychiatry will be a key stakeholder among few, with numerous other stakeholders using the Act less often or less directly. Subsequent to this meeting, on 6 April Thomas met with his Policy Administrator counterpart in RCGP in NI, Clare Higgins, to brief her on the meeting with Tomas Adell, as RCGP in NI representatives had been unable to attend.

The Act continues to dominate my time as Chair, with a request from Dr Jonathan Pimm this month to write on it for the BJPsych publication. In this task, I am pleased to say that I will be joined by Drs Catherine Taggart and Phil Campbell as we are trying to give a thorough overview of its implications. My thanks to them… and you will read more among those hallowed pages (and here!) in the fullness of time! We meet in April to achieve a first draft.

Back in November 2016 at the “Working Together” joint Conference with the College of Psychiatrists of Ireland in County Cavan, we resolved to establish closer links between our respective Faculties and Committees. I am grateful therefore to Dr Margaret du Feu who, as Chair of our General Adult Faculty, met her equivalent Chair of General Adult Faculty Dr Ciaran Corcoran in Dublin on 11 April. Both are keen to strengthen and develop links between their Faculties and share information, research and training. Dr Corcoran is to discuss the matter further at the College of Ireland Council Meeting late April, with further discussions thereafter planned between the 2 Faculties. I encourage similar initiatives to be taken please if possible by other Faculty/Committee Chairs as we will only achieve better links by small steps being taken which will build a collective momentum in this regard. Margaret will be remaining on our Executive (after she stands down as Chair of General Adult Faculty to make way for her successor later this year) – and she has kindly agreed to assist our focus on links with the College in Dublin, given her extensive practice in the Republic of Ireland and contacts there.

Margaret also represented us at the recent breakfast briefing organised by Contact on 30 March at the Crowne Plaza, Shaw’s Bridge, Belfast. Margaret reports that it was well attended by individuals and family members affected by suicide, as well as by relevant organisations – and discussions centred on their Zero Suicide Manifesto and lobby for a NI Suicide Prevention Bill. The latter would seek to implement clinical duties of candour, competence and co-operation. Contact will be presenting at our General Adult Spring Meeting which is scheduled for 27 April at Clifton House.

Our submission was lodged during the month in response to the Department of Education’s Consultation on their Children and Young People’s Strategy 2017-2027. Please see below and my thanks to Drs Maggie McGurgan and also Richard Wilson for their input into this:

Consultation Title Dept/Organisation Documents Deadline
Children and Young People's Strategy 2017–2027 Department of Education Response 31 March

My thanks also to Richard for his contributions to Central College consideration of the Child Abuse and Neglect Consultation and then the Scottish Mental Health Strategy, both being considered by relevant colleagues there. I also understand that Richard was contacted by Baroness Tyler in the House of Lords in respect of advice to Margaret Ritchie MP re Values Based Commissioning. We continue to have influence in many places.

We had a very useful meeting on 14 March in Clifton House with GMC Head of NI Affairs Alan Walker, GMC NI Affairs Officer Marion McCann and Mary Agnew one of the GMC Assistant Directors based in GB and responsible for Standards and Guidance on Ethics - to discuss MCA Code of Practice, confidentiality, Medical Licensing Assessments, Consent etc. Drs Peter Trimble and Michael Doherty kindly joined in this discussion. The GMC are consulting on the Medical Licensing Assessments and I hope to cover our response to this in April’s Monthly Update, as we are currently working on same. We also discussed the Sir Keith Pearson January 2017 Report reviewing medical revalidation entitled “Taking Revalidation Forward”, which is welcome… in particular the proposal that there should be clearer guidance on the information to be supplied to support revalidation and that systems to support appraisal should be better developed by Trusts. The bureaucratic burden of the process could be lessened by the development of good information systems. The recognition of the need to strengthen the system for locum doctors is welcomed. There is merit in the proposal to have a revalidation date approximately 2 years after appointment as a Consultant, as the transition from Trainee to Consultant can on occasions be a time of increased pressure and expectation. However, appraisal and revalidation must continue to be seen as a supportive process. I have communicated this view to the GMC on your behalf.

We were also both pleased and grateful to welcome the GMC to our Spring Conference at which they kindly took a stand. Thanks to Marion McCann who attended on the day.

In staff news, at time of writing we are very pleased to welcome back Nora McNairney in to her role as Division Manager. It is great to see Nora back. Barry has indeed done a great job as Interim Division Manager. In turn, we are sorry to lose in some weeks’ time Elaine Walker who has been acting as Temporary Division Administrator. Elaine has also done a great job for us and will be missed.

Since Paul Rees became the College Chief Executive, there has been a considerable effort made by Central College to reach out to the Divisions. So it was that on 7 March, Barry and Thomas participated in a Skype link up with the Communications Team in London to deliver, on behalf of the local College, a PowerPoint presentation to brief the Communications Team on Policy and our work more generally in NI. I am reliably informed… not by Barry or Thomas who are both reliable but also very modest!.....that the presentation was very well received and was very professionally delivered. The staff in RCPsych in both Wales and Scotland also participated in this link up. Thomas has also contributed on our behalf to the Editorial Working Group based in Central College who will be rolling out the new Membership magazine planned by Paul for launch in June at Congress. In addition, on 4 April Barry, Thomas and Elaine participated in a Skype Link with Central Office for a Staff Briefing from Paul Rees and on 10 April for a Staff Briefing on the way forward for the College’s new database system. Finally, on 7 April Fauzan Palekar, Director of Professional Standards in the College visited staff in Clifton House – along with Vivine Muckian, Head of Divisions.

Congratulations and welcome to our newly forming Perinatal Faculty which will be chaired by Dr Julie Anderson. It is great to see this development and will assist us in supporting lobbying for Perinatal services going forward. I am sure that Julie and other members will not mind me paying particular tribute to Dr Janine Lynch for her resolute determination over many years to look after this client group and represent their interests. Janine has been central to the forming of this additional local Faculty and will also be a member of same.

So as I conclude my special First Anniversary edition!!!! of my Monthly Update, can I leave you with two recommendations and one worthwhile quotation:

May I recommend to you this short animation which was prepared to mark the recent first anniversary of the publication of the English version of the Acute Adult Psychiatric Care Commission report, "Old Problems, New Solutions: Improving acute psychiatric care for adults in England". It contains a checklist of actions that we as psychiatrists can take to improve acute care in our area. It is really very practical therefore. The NI version of this report even gets a quick mention at the end!

May I concur with Dr Catherine McDonnell’s recommendation at our recent Spring Conference that it is important to find your tribe!!! if you want to do Quality Improvement (click to enlarge):

"Surround yourself with people on the same mission as you."

Finally... the quote used by Geraldine Strathdee at the Spring Meeting:

“If you don’t have the data, you are just another person with an opinion”. This should sum up our evidence based profession and practice, as well as providing a solid basis for Quality Improvement.

 

February 2017

With the 2 March 2017 Assembly Election just out of the way, let us hope that the emerging Spring in the grounds of Stormont is reflected inside the building as well… and soon. There are many Mental Health issues to progress, solutions are available too and we highlighted five of these in the excellent media coverage we achieved during the week of the Election, within 48 hours of the poll.

Further details can be found in our Press Releases section.

I hope we can build on this public prominence to push ahead with our agenda points with the incoming Minister for Health, Chair of the Health Committee, etc. My gratitude to our local College staff team for their very productive media output.

In other Election work, Dr Michael Doherty and Thomas McKeever represented us all at the important Hustings event on 13 February hosted by NICVA (NI Council for Voluntary Action), of which we are a member by virtue of our charitable status. Mental Health was well featured in the discussion with the 5 main party representatives (Stuart Dickson Alliance, Carál Ni Chuilin SF, Claire Hanna SDLP, Christopher Stalford DUP and Andy Allen UUP – all pictured below with NICVA host).

Consultation work has continued this month regardless of the Election and you will now additionally find the following in our Policy section:

Consultation Title Dept/Organisation Documents Deadline
Public Health Agency Corporate Plan 2017–2021 - Public Consultation Questionnaire Public Health Agency Response 17 February
Regulations restricting smoking in private vehicles when children are present Department of Health Response 3 March

I have recorded my gratitude last month in relation to the PHA Consultation above – and also in relation to the Department of Education Consultation on the new Children and Young Person’s Strategy (which is still being finalised at time of writing). I wish to record my thanks here to Dr Lisheen Cassidy for all the work she did in relation to the DoH smoking in vehicles carrying children Consultation. As the Consultation work rolled on pre-Election, it has sometimes felt as though we are living in a parallel universe or form of virtual reality!

My thanks also to Dr Michelle Francis Naylor who sent comments to Central College on behalf of our Rehabilitation and Social Faculty in relation to Guidelines for a draft multi-morbidity standard.

Now back to where I ended last month:

...Belfast Castle on 9 February was the location for our Strategy Day and later Executive Meeting. We were pleased to welcome to Belfast the evening before Peter Markham, Head of Digital, who kindly came over in advance to meet with our local College staff team to go through with them in the office the coming changes to the College websites and to seek dialogue and suggestions. We were pleased also on the morning to welcome the new Chief Executive Paul Rees to Clifton House for a quick tour before we headed up the road to the Castle. Paul (pictured above left with myself and Interim Manager Barry Flynn above right) was accompanied by Vivine Muckian Head of Divisions, who after one year in post is familiar with Clifton House, but this was Paul’s first visit and he was keen to get a sense of where we are based. Between both buildings, he was suitably impressed!

Other London based colleagues, apart from Paul and Peter, who assisted us throughout the day at Belfast Castle were Lucy Thorpe Head of Policy, Kim Catcheside Director of Strategic Communications and Zoe Mulliez, Policy Analyst. Significantly, Paul said that “going forward, we will need to make sure that the College provides the right level of support and recognition to our members - and employees - in all three devolved nations, to ensure an excellent membership and employee experience for all.” We look forward to developments in this direction. I hear from our staff that true to his word, Paul held a first ever all staff briefing (via Skype for Belfast staff) the following day in London.

The Strategy Day was a very important one, as it was a chance for us to learn from London and London to learn from us. This mutual exchange was very helpful for me as Chair and we passed on our message of autonomy with cooperation going forward. I would like to thank all the members who attended in such good numbers. Feedback afterwards included: "Congratulations on hosting such an excellent meeting", "Fabulous enthusiasm", "Feels really secure to have an almost fully thrashed out strategy now", "So pleased to be part of such a vibrant, professional meeting". My thanks to all.

Another significant event this month was the well attended Joint Meeting of the NI British Geriatrics Society and ourselves, organised under the auspices of our Faculty of Psychiatry of Old Age on 17 February at Riddel Hall, Stranmillis, Belfast. The event gave me a welcome opportunity to focus attention on the impact which the Mental Capacity Act (NI) 2016 is going to have on the care of older persons, once implemented – and I addressed the meeting on this basis.

Joint Meeting of the NI British Geriatrics Society and RCPsych

On this point, I would like to pay tribute to the Chair and Vice Chair of our Faculty of Psychiatry of Old Age, Drs Deirdre Shields and Conor Barton, who have both been faithful attendees at our Mental Capacity Act (NI) 2016 Working Group meetings in relation to the Code of Practice for this legislation.

The meeting continued with the highlighting of another major issue for older people – that of scams and rogue traders – and we heard a very illuminating and sobering presentation on this topic by Trading Standards Officer Beverley Burns. Dr Dearbhail Lewis gave a very interesting Case Study talk on the management of an older person with physical and mental health needs, illustrating the sometimes complex interaction between health and social care. We finally heard from Dr Anthony Lewis, Consultant in Diabetes and Endocrinology in Belfast Trust whose presentation entitled “Over Under Shorter Longer” alerted us to the prevalence and importance of thyroid issues in older people. All in all, it was a really worthwhile meeting and my thanks to all involved in its organisation.

We were pleased to welcome Professor Tim Thornton (pictured below left, right) to Clifton House on 22 February to deliver our first Masterclass of 2017 on the intriguing topic of “Why Psychiatry needs Philosophy (and vice versa)”. Tim is Professor of Philosophy and Mental Health from the University of Central Lancashire. The event lived up to its title and was a great start to the new programme. A lively discussion ensued from the floor, so much so that Tim has been in contact since with the office to explore the possibility of returning next year to deliver a further talk as part of our 2018 programme! My thanks and congratulations to Dr Tony O’Neill (pictured below left, centre) for securing Tim as a speaker.

Dr Gerry Lynch, Dr Tony O'Neill, Professor Tim Thornton

In the meantime we have ongoing significant collaborative work in progress with the Voluntary Sector, including in particular the new 2017 programme of “Let’s talk about it” talks on Depression which Aware are hosting at various venues around Northern Ireland. Aware leaflet on depressionThis is such a worthwhile initiative and opportunity for us as Clinicians to really make an impact in the community. So far, Dr Colin Gorman has represented the College at Ulster University Jordanstown to speak on Student Mental Health and Wellbeing and his contribution was described afterwards as “excellent”. Similar reports have come in regarding Dr Heather Mills (pictured below) who presented on Eating Disorders and Depression at the Europa Hotel on 2 March. There are three further such talks lined up for March and one for April... so more on that in future editions! Thanks to both Colin and Heather for their contributions to this important work and also to Tom McEneaney, Head of Business Development and Support Services in Aware for his foresight and collaboration.

Dr Heather Mills speaking on Eating Disorders and Depression

Another such initiative and invitation has come in from Anne Doherty, Deputy Chief Executive Officer in MindWise, who hope to host a NI-wide PD Conference, now provisionally scheduled for early 2018. For this the NI PD Network, MindWise and ourselves are proposed as being the principal partners and a small project team is being formed to work with Chambre Public Affairs to drive this forward. A College representative was being sought to join the project team and I am pleased to report that Dr Catherine McDonnell has agreed to represent us on this. My thanks to Catherine and I look forward to the work of the team bearing fruit next year for this important client group.

In this context, I was pleased to meet with both CEO Peter McBride and Director of Mental Health Services Billy Murphy on 7 February at Inspire Central Office, Lombard House, 10-20 Lombard Street, Belfast. Inspire Wellbeing is the new name for NIAMH (NI Association for Mental Health, previously of 80 University Street, Belfast). Our discussions included the Programme for Government and potential for joint working.

I met with Paula O’Kelly, Principal Consultant at HSC Leadership Centre on 21 February here in Clifton House to discuss what we might be able to work together on for new Consultants in their first five years. This goes back to the Startwell event which we held last October at Belfast Castle, when we were addressed by Dr Ellen Wilkinson, Associate Registrar. I said then that I hoped to build on this event by perhaps organising a follow up in 2017. So this is it! We are currently working on the basis that we will hold such an event here in Clifton House on 19 May…….so watch this space!

I also met with Drs Nail Quigley, Deirdre McGlennon, Jo Minay and Maggie Kelly here in Clifton House on 23 February to discuss in particular how we can improve liaison services across the Trusts. In this context, I commend to you the report by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) – Mental Health in General Hospitals: Treat as One (2017), which was published on the 26 January 2017. The report looked into the impact a patient’s mental health condition had on the care they received in hospital. A summary of the key findings and recommendations are set out below and they do bear repeating:

Key Findings and Recommendations

Among the key findings of the report are:

  • Inadequate mental health history was taken by non-mental health clinicians in 21.4% patients at initial assessment and 49.1% during consultant review
  • 46.3% (256) of patients in the study had a review by the liaison psychiatry team during their hospital stay
  • The first assessment by liaison psychiatry was delayed in a third of those seen according to the reviewers. This impacted the quality of care in 22 patients
  • Of those patients seen by the liaison psychiatry team, the reviewers judged that their input was adequate in 68.7% of cases
  • 185/231 hospitals had a liaison psychiatry team either available 24/7 in 51.1% hospitals and during extended hours in a further 16% of hospitals
  • 57.3% of hospitals had a policy/protocol specifying which patients should be referred to liaison psychiatry. The liaison psychiatry team was involved in writing/reviewing the mental health hospital policy in 143 hospitals
  • Only 21/190 (11%) hospitals shared complete access to mental health community records
  • 95/208 (45.7%) hospitals had mandatory training in the management of patients with mental health conditions. There were no hospitals that offered training covering all aspects of management of patients with mental health conditions
  • Healthcare professionals responding to a separate online survey stated that:
    • 11.4% (151/1323) had no training in basic mental health awareness
    • 38.9% (497/1276) had no training in management of self-harm
    • 21.2% (274/1295) had no training in assessing mental health capacity
    • 41.4% (523/1263) had no training on risk assessment
    • 58.9% (727/1234) had no training in psychotropic medications
    • 19.1% (248/1298) had no training in dealing with violence/aggression.

Key recommendations

In summary, the key recommendations from the report are:

  • In order to overcome the divide between mental and physical healthcare, liaison psychiatry services should be fully integrated into general hospitals. The structure and staffing of the liaison psychiatry service should be based on the clinical demand both within working hours and out-of-hours so that they can participate as part of the multidisciplinary team.
  • All hospital staff who have interaction with patients, including clinical, clerical and security staff, should receive training in mental health conditions in general hospitals. Training should be developed and offered across the entire career pathway from undergraduate to workplace based continued professional development.
  • Patients who present with known co-existing mental health conditions should have them documented and assessed along with any other clinical conditions that have brought them to hospital. And when seen by mental health services (liaison psychiatry) the review should provide clear and concise documented plans in the general hospital notes at the time of assessment.
  • National guidelines should be developed outlining the expectations of general hospital staff in the management of mental health conditions, such as the point at which a referral to liaison psychiatry should be made and what triggers the referral.
  • Record sharing (paper or electronic) between mental health hospitals and general hospitals needs to be improved. As minimum patients should not be transferred between the different hospitals without copies of all relevant notes being sent electronically or accompanying the patient.

I know that Dr Stephen Moore is looking into this latter point within the newly formed Informatics Group. I am looking at further ways in which we can push for increased Liaison services in the various Trusts.

Later on 23 February I attended a meeting with the newly appointed Chair of RCGP in NI, Dr Grainne Doran at their Ormeau Road premises to discuss the recommendations of the June 2016 Report by the Commission to Review the Provision of Acute Inpatient Psychiatric Care for Adults ("Building on Progress: Achieving parity for mental health in Northern Ireland”), the general lack of strategy in mental health currently and joint working between our respective Colleges. I wish Grainne every success in her new role with RCGP and thank outgoing Chair Dr John O’Kelly for his cooperation over the years with our College.

This month saw the publication of the Department of Health post Consultation Report regarding their Protect Life 2 Consultation, which we answered back in November. It is worth a read as an important contribution towards how we are going to better tackle this most urgent of problems.

We had a very useful further meeting on 3 March with Dr Joy Watson – and also Dr Peter Trimble - about the draft Alcohol and Brain Damage in Adults NI Report which both Joy and Dr Vanessa Craig have been working on over recent times. The Report will be a NI version of the similar CR185 Report in England. It has now received a Foreword from the Chief Medical Officer, Dr Michael McBride. Some finishing touches are currently being added to the document by Joy. Ultimately we would hope to place it before our local College Executive for endorsement in principle and thereafter have a small launch event with Commissioners, CMO, MLAs, etc. with a view to including this important issue within our lobbying agenda. It is an issue which Peter has campaigned on over very many years and I know that Peter is delighted with the work done on this by Joy and Vanessa. It was great for Joy to get Peter’s input into the final stage of drafting.

I would take the opportunity here to congratulate Dr Kate Latimer, Consultant Psychiatrist in the Young Peoples Centre in Belfast on the following initiative that she and her colleagues have co-produced in their own service. It seems that as part of their mission to improve service quality they established a focus group comprising young people in the age range 14 to 18 years who were already attending their Specialist Adolescent Mental Health Outpatient Service. The participants said that they would have loved to have been able to see the CAMHS building and staff before they first attended – and so it was that the idea for a short video about life in Belfast CAMHS was born. One of the young people involved with the service wrote a script for “Behind the Scenes of Belfast CAMHS”. A narrator was chosen and she speaks to the camera and takes the viewers on a tour of the building and observes snippets of an initial assessment, CBT session, Family Therapy and a group. I understand that the video is currently being edited and will then go online for people to view. This is such a simple but profoundly important initiative for users of that particular service.

I mentioned last month that the NI Commissioner for Children and Young People has identified mental health as one of her priority areas during her term in office – and that in order to progress this priority area, NICCY is planning a piece of work to capture children and young people’s experiences of accessing mental health services. Dr Maggie McGurgan kindly agreed to represent the College regarding this and Maggie has confirmed that following discussions this month with NICCY, she will now sit on their Professional Advisory Group. It is great to have this Clinician input and my thanks to Maggie.

Congratulations to Drs Michael Doherty, Margaret du Feu and Annette Thampi who succeeded in the recent Elections for the roles of Vice Chair and 2 Executive members respectively. Later in the year, they will replace Drs Maria O’Kane, Heather Hanna and Heather Hawthorne in these roles. My thanks to all members who take on these voluntary commitments on behalf of the College. We each benefit as a result.

BJPsych Advances March 2017Finally, may I commend to you Dr Margaret du Feu’s excellent article entitled "Deaf People: what every Clinician needs to know" which appears in the BJPsych Advances March 2017 edition. It really does provide a comprehensive reference point for Clinicians treating this client group. The purpose of the article is to highlight the following:

Deaf people, including culturally Deaf sign language users, have equal rights to full participation in society - and this should include access to and appropriate treatment by all healthcare services. However, gaps in the training and awareness of health professionals and frontline staff can lead to barriers and delays that disadvantage deaf people and can put them at risk. Deaf awareness and informed attitudes will lead to equal treatment for this significant proportion of service users.

The cover of the magazine is also interesting as it is an untitled painting by deaf artist Patrick Griffin. I know that Margaret is very pleased that Patrick’s work has reached such a wide audience and it is an uplifting image with which to close this month’s Update.

Untitled by Patrick Griffin

 
 
January 2017

Parliament BuildingsSad to relate, we are commencing 2017 with our Assembly in disarray, so last year’s lobbying successes and relationship building are now on hold until at least after the upcoming Election on 2 March... and possibly until some considerable time thereafter? Whatever happens, Michelle O’Neill MLA (photographed) will no longer be Health Minister, given her party promotion. Paula Bradley MLA (photographed) may or may not be Chair of the next Health Committee.

NI Chair's Update photo 2

We hope that the mental health agenda which Michelle O’Neill promised to champion at the Executive will be equally a priority for the next Health Minister of whatever party. We hope that the promised Health Committee Inquiry into Mental Health will remain a priority for the next Chair of the Health Committee. We also hope that the second annual Summit on Mental Health can take place later in the year, as we had been invited by the main organiser Action Mental Health, to play an enhanced role in this year’s event.

We had also been encouraged by the following response from Chris Matthews in the Department of Health received just as we closed for Christmas, in reply to aspects of our draft Programme for Government Consultation response:

“We appreciate the point in respect of GHQ-12, and intend to produce a wide range of underlying performance measurements, to provide a more complete picture of outcomes. We are happy to consult with the Royal College in the New Year on what might be included.

The draft delivery plan recognises that people with severe and enduring mental illness are a priority in terms of overarching policy development, and notes on page 19 an overarching aspiration to move towards parity of esteem between physical and mental health care, starting with initial investment in meeting the physical needs of people with mental health issues. This specifically takes account of the Trust business cases on physical monitoring, mentioned (by you).

We intend that in moving towards parity of esteem, focusing on recovery, early intervention and service developments where resources allow, it will eventually allow the HSC service to move to a position where resources can be targeted to where the greatest need arises – mainly people with severe and enduring mental health issues. As the Minister has said, this will have to be a long-term effort – realistically, ten years – taking account of the legacy of unmet need and historic underinvestment.”

Let us hope that all these conversations can be returned to and soon…

Having taken soundings from our peers within the Policy field, we will not be devoting as much financial, personnel or time resource to our pre-Election campaigning as we did last year. The prevailing wisdom is that the 2017 snap Election requires a lower profile response. The truth is that this Election is not about major policy issues such as mental health, which were aired in advance of the 2016 Election; rather it has come about for well publicised reasons which transcend policy and are rooted in relationships and issues within Government itself. So the plan is to publicise our 5 Asks once again – as sadly they are as unmet as they were last year – and to attend Hustings events where possible to promote these.

5 asks to improve mental health in Northern Ireland

So now for more heartening news where progress has been made since the New Year began…

I attended a meeting of Council in London on 13 January where colleagues are considering legislative changes to their Mental Health Act. It is fair to say that opinion is divided on just how far we in NI have gone in terms of our Mental Capacity Act (NI) 2016. The following was agreed by Council:

a. Agreement that the current legislation does treat those with mental disorder differently from those will physical illness but the proposed solution of capacity based legislation raised some concerns

b. A very large majority of those present thought the Mental Health Act was 'getting it right'

c. While autonomy is important so are other principles underpinning medical ethics.

57. Dr Chalmers reported that much can be learnt from the experiences in Northern Ireland, where a Mental Capacity Act (NI) 2016 had been made. The RCPsych NI Vice-President, Dr Gerry Lynch, reported concerns about its implementation due to a lack of engagement with the profession by civil servants in the drafting of a Code of Practice.

58. Dr Chalmers suggested that the College should wait to see how the implementation within Northern Ireland progresses, particularly with regard to the publication of a Code of Practice, before proceeding down a 'capacity-based' route. Dr Chalmers proposed establishing a small UK-wide 'start and finish' Group to oversee progress and report back to Council at a future date.

59. Council members AGREED the proposal.

…so no pressure then!

In terms of the Code of Practice, we held well attended meetings of the Working Group on 6th and 27th January to consider and respond to draft Chapters 13-20 on the topics of ECT, Second Opinion, Offences, Warrants, Money Valuables & Expenditure, Nominated Persons, Research, Advance Decisions and Emergencies. It has been really heartening to see how colleagues are responding to the request for help with this and our responses are improved by the breadth of specialties represented at the table – so thanks to all who have responded and attend – and if anyone else wants to be added to the circulation list, please contact Thomas at the office.

As I mentioned in London at Council, I still do have concerns at the arm’s length Consultation process employed currently by the Department to consult on the Code. I am having ongoing conversations with our GP, Social Work and Nursing colleagues in particular about this as I feel strongly that the drafting process needs to involve the professions, as opposed to us being presented with a fait accompli format for comment. So far the Department response has been that the intention is to provide early sight of draft material for comment via email. This in turn will provide the Department with the necessary input to formulate a first draft of the Code of Practice by the end of 2017, which will then be subject to formal consultation. My fear is that this process will leave us with a Code which is not real world proofed, not comprehensive enough and not fit to make a success of our Act.

Also at Council, I raised the issue of our successful meeting last November with the College of Psychiatrists of Ireland, pointing out the importance of establishing good formal lines of communication on the many matters of mutual interest across both jurisdictions – with the possibility that some services may be commissioned on an all-Ireland basis in the future. Council indicated their support for my subsequent request (sent on 18 January) to our local Faculty leads to make contact with their Dublin counterparts and to take this forward. So it is that I am pleased to report that Dr Richard Wilson, our Chair of Child and Adolescent Faculty has already been in contact with Dr Helen Keeley, his counterpart in College of Psychiatrists of Ireland - with a view to discussing cross border initiatives between their respective Faculties as a very useful learning experience with agenda items to include training, transgender services, eating disorders, MHID services, intensive treatment teams, inpatient services, access to beds and transitioning from CAMHS to AMHS.

In a further sign of the relevance of this co-operation, we are aware from Dr Stephen Bergin, Consultant in Public Health Medicine that there is a proposed North/South workshop on 3 May in Dublin focusing on alcohol misuse, mental health and risk of suicide / self-harm. This is under the auspices of The North South Alcohol Policy Advisory Group, which was established in February 2013 at the request of the CMOs in Northern Ireland and the Republic of Ireland. The aim of the group is to contribute to reducing alcohol related harm on the island of Ireland. In July 2014,the group produced a paper Reducing alcohol-related harm by addressing alcohol availability - maximising benefits for North South cooperation followed by a Knowledge Exchange Seminar on Using alcohol licensing data in public health research and policy. The group is now planning this second event on the subject of alcohol, suicide and self-harm.

Despite the political upheaval, the requirement to respond to Consultations has continued unabated with Ministers still in post until purdah. Our Ad Hoc Policy Committee met twice this month on 10 and 24 January to deal with the DoH Reconfiguration Consultation – please see our response below – and the Public Health Agency Consultation on their draft Corporate Plan 2017-2021 – which is still being worked on at time of writing. My thanks to all who contributed and attended. Thanks also to Dr Deirdre Shields for all the time and effort she put into drafting a response to the Draft Regional Dementia document issued by the Health and Social Care Board. (Please contact Thomas if you want access to a copy of our response to this). Further thanks to Dr Maggie McGurgan for all the time and effort she put into drafting a response to the Department of Education Consultation on the new Children and Young Person’s Strategy (which is still being finalised at time of writing).

Consultation Title Dept/Organisation Documents Deadline
Health and Social Care Transformation - Consultation on Criteria for Reconfiguring Health and Social Care Services Department of Health Response 3 February

I also wish to thank Dr Heather Hanna for all the work she has done over a prolonged period in collaboration with the Royal College of Nursing, College of Occupational Therapists and British Association of Social Workers in relation to the forthcoming Three Steps to Positive Practice document which Heather presented on at the Central College Policy and Public Affairs Committee on 26 January. As the Mental Capacity Act (NI) 2016 will not be in operation until 2020, this document has been produced to address the lack of understanding about safeguarding and human rights. It is felt that there is currently no framework/language to adequately address this. The group wanted to make it ‘future-proof’, positive and reflective and wanted to set out values and principles rather than ‘tick boxes’. Overall, I understand that there was a warm welcome for both the strong focus on human rights from the outset and the 'three steps' framework, which was seen as a very helpful way to structure multidisciplinary conversations and meetings. The Committee were happy that it is published as an RCN/RCPsych in NI document, without formal endorsement from them. They agreed that, once launched, it should be formally disseminated across the Scottish, Welsh and English Divisions to ensure people are aware of the document. They were pleased that the RCN is going to make it available nationally. However, the examples within the document were described by the Committee as shocking and there was a clear view that it reflects very out-of-date and unacceptable practice still happening in NI. They felt that the release of the document should be accompanied by a strong statement from RCPsych in NI endorsing the need for practice to change. While the document was prompted by our members coming across unacceptable practice on a frequent basis and our overarching goal would be to send out a positive message about the need for change and informing and equipping people to lead that – the Committee felt that we should not shy away from the fact that the current culture and practice needs to be addressed at a high level. I hope to return to this in the coming months therefore as we move towards publication and launch.

Turning to media, my thanks also to Dr Maggie McGurgan who spoke on the topic of Insomnia on the Frank Mitchell programme on U105 on 16 January. Michelle Francis Naylor was featured by Anne Hailes in her Irish News weekly article on 6 February. It is important that we have a visible leadership presence and this is all important work.

Gerry Lynch, Pat Sheehan, Eileen ShevlinI was pleased to have been invited last year by Policy Forum for NI to address their Conference in the Stormont Hotel on 17 January 2017 entitled Improving mental health provision in Northern Ireland: prevention, treatment and developments in care. When first mooted we had a functioning Executive, but unfortunately the Assembly fell the day before the event! Nonetheless it was a very useful day with a large audience and plenty to discuss, with the hope that progress can be made in the near future. On the platform were Robbie Butler MLA Ulster Unionist Party Spokesperson for Mental Health and Member Committee for Health, Dr Iris Elliott Head of Policy and Research Mental Health Foundation, Professor Siobhan O’Neill Professor of Mental Health Sciences Ulster University, Oscar Donnelly Divisional Director Mental Health Learning Disability and Community Wellbeing Northern Health and Social Care Trust, Emma Quinn Acting Principal Rathcoole Primary School Newtownabbey, Dr Louise Sands Council Member RCGP NI Associate Director GP Career Development Scheme and GP Training Programme Director NIMDTA, Pat Sheehan MLA Member Committee for Health Northern Ireland Assembly (photographed), Gary Middleton MLA Deputy Chair Committee for Health Northern Ireland Assembly, Mairéad McCafferty Chief Executive Northern Ireland Commissioner for Children and Young People, Paschal McKeown Head of Policy & Influencing Age NI, Judith Thompson Commissioner The Commission for Victims and Survivors, Eileen Shevlin Expert by experience (photographed), Amanda McFadden Assistant Director Adult Mental Health and Disability Services Western Health and Social Care Trust, Dr Raman Kapur Chief Executive and Consultant Clinical Psychologist Threshold, David Babington Chief Executive Action Mental Health, Sean Cudmore Deputy Editor Policy Forum for Northern Ireland and yours truly! My contribution (summarized below) represented an overview of where we are and where we want to get to.

It began by me addressing the fact that:

“We have come a long way in terms of where we are now compared to where we were when I started as a Consultant well over 20 years ago - and I think that is a tribute to Bamford and to everybody who put so much work into Bamford. I think services, although there can be much improved, are significantly different - more community focussed, more User and Carer focussed, more recovery focussed than they were a few years ago. So this is all a tribute to people who work in the service and who have delivered on the Bamford vision. However, there are of course a number of new and emerging challenges and we have to think about the delivery of mental health services in a post-Bamford world.

The Bengoa report is current and I have to say there is a degree of disappointment and frustration when I read the Bengoa report about the relative lack of emphasis on mental health and the mental health needs of the population. Having said that, although the agenda is so much focussed on acute services, we can actually use the mental health agenda to improve the mental health of people in acute hospitals. We all know there is a huge amount of un-met need of patients who present in acute hospitals, in patients with dementia and delirium who occupy so many beds in acute hospitals and cause so much pressure on services. This is something we really need to drive to improve.

Also we need to highlight that there is a waste of resources in the acute sector. We know that there are very many people who are presented to acute physicians and nursing staff and GP practices who have very significant mental health difficulties, but are endlessly investigated for potential organic illnesses when actually what they need is a good mental health service.

We are all very aware that there are very significant pressures in the system and the Crisp Commission which reported last June with a focus on acute beds, nonetheless did emphasise the importance of the relative lack of spending on mental health as a proportion of the overall health and care budget in Northern Ireland compared to GB. Further, not only is the proportion smaller but the spending does not either reflect the high levels of poverty, deprivation and the legacy of the Troubles.

We have to acknowledge the underspend on mental health as a proportion of the overall healthcare budget and we have to think about the best way to deal with that. The Crisp Commission pointed out that the answer is not to develop more beds, but to develop more community and more specialist services so that we can use the beds that we have more effectively. We do need good quality inpatient provision and the new build in Belfast is very welcome. I would make a plea for the Northern Trust, where we are still looking after patients in buildings that were opened in 1898, so we do need to invest in the infrastructure as well.

The Crisp Commission talked about the need for a single mental health service. We have to acknowledge where we are in terms of our not having a single mental health Trust (and there would, I think, have been advantages in us organising ourselves along the lines of a single mental health Trust some years ago). We are where we are, but there is an onus on us all across the voluntary and statutory sector to work much more closely and cooperatively together. We need a consistent approach across the five Trusts and there are some very good examples of how we can deliver in terms of eating disorder, forensic services etc. We also have some good regional networks and we need to do much more of that if we are to be efficient in the use of our resources, given that we are clearly resource limited.

The high rates and the early rates of death of patients with schizophrenia and bipolar disorder, which I have to say is approaching a scandal, needs highlighting. That is something that we really do need to deal with and I welcome the emphasis on parity of esteem for mental health, as well as physical health, in the Programme for Government.

I think overall that we need a clear five to ten year strategy for what we want our mental health services to look like. I think we do have policies; we do monitor what changes have been made through Bamford - but I get a sense we need a clear forward vision of where we want mental health services to be over the course of the five to ten years. Such an overall strategy must address promotion of mental health and prevention, but it also must deliver evidence based care pathways for people who have mental illness, for people who have schizophrenia, bipolar disorder, severe depressive episodes, dementia, younger people with ADHD, with emerging psychosis, with at risk mental states, dual-diagnosis, substance misuse and severe mental illness. We need to deliver for all of these. There is some hopeful evidence there, but I am not sure we are clearly delivering evidence based treatment for patients who have established mental illness - and I think a strategy has to deliver on that. The other thing which the five year or ten year forward strategy needs to deliver on is the quality agenda. Services have to be safe, effective, and person-centred. Overall, we should have a shared purpose with our Users and Carers in the delivery of safe and effective mental health care.

My contribution ended with: “…a mention of the Mental Capacity (NI) Act 2016, which really is a very, very interesting, innovative and unique piece of legislation. It is on the Statute books. The world is watching and I think we have to get this right. We are going through the process of developing the Code of Practice. Clinicians need to be absolutely engaged in the writing of that Code of Practice because this legislation could go very wrong, but it could go very right if we get the Code right.

All told, it was a very useful exchange and I am grateful to the Policy Forum for NI for bringing us all together.

NI_Jan17_5

Along with RQIA, we jointly hosted the Annual Workshop for Part II/IV Practitioners at Riddel Hall on 3 February entitled “Driving Service Improvements in Mental Health and Learning Disability”. We had a big turnout and the event was described as extremely interesting and worthwhile. Speakers included Professor Siobhan O’Neill from UU, Dr Peter Aitken, Professor Tim Kendall and also Andrew Dawson from DoH. The remarks made by Professor Tim Kendall in relation to reducing bureaucracy and the uninspiring evidence base for risk assessment outcomes were very well received, just to highlight one issue under discussion. Unfortunately, I was unable to attend myself due to unforeseen circumstances at the last minute. My thanks to one of our former Chairs, Dr Philip McGarry for standing in for me on the programme at short notice.

Turning now to You in Mind, I understand that at this stage, the acute assessment documentation has been piloted within different teams in each Trust. Feedback has been given to the Project Team and further consultation with Trust Leads regarding the most important changes has by now been completed. Medical representation at these meetings has consistently repeated our concerns and misgivings and this was reflected in the feedback from a number of professions across each Trust. My thanks to Drs Jo Minay and Saleem Tareen for their ongoing work on the You in Mind process, which is proving to be a major concern for members.

Our joint working with Aware is recommencing shortly for February to April 2017 with Student Mental Health and Wellbeing on the Agenda at Public talks on 22 February at UU Jordanstown and on 8 March at QUB, followed by Domestic and Sexual Violence being discussed on 22 March at Malone House. This is a really important alliance whereby we provide Clinician input into the discussions. My thanks to our members who volunteer for this and also to Tom McEneaney in Aware who recently said that he very much appreciates the time and support we provide in delivering the talks and the close partnership established with us.

In other initiatives, I met Christine Irvine at the 17 January event in the Stormont Hotel. Christine is the Mental Health Lead in the Policy and Research Team for the NI Commissioner for Children and Young People and the current Commissioner has identified mental health as one of her priority areas during her term in office. To progress this priority area, NICCY is planning a piece of work to capture children and young people’s experiences of accessing mental health services. It is planned that the work will also include engagement with professionals and practitioners who work within or alongside the system. My thanks to Dr Maggie McGurgan for agreeing to represent the College regarding this.

We had a very useful meeting on 2 February with Dr Joy Watson about the draft Alcohol and Brain Damage in Adults NI Report which both she and Dr Vanessa Craig have been working on over recent times. The Report will be a NI version of the similar CR185 Report in England. It is now at the proofing stage. Ultimately we would hope to place it before our local College Executive for endorsement in principle and thereafter have a small launch event with Commissioners, CMO, MLAs, etc. with a view to including this important issue within our lobbying agenda. It is one of the many issues which escapes the attention of the mainstream Mental Health lobbyists and for that reason we need to give voice to this cohort of patients.

Belfast CastleNext the focus turns to our Strategy Day which will take place in Belfast Castle (photographed) on 9 February. We look forward to welcoming our Central College visitors, to productive discussions and positive structures within which to frame and guide our work going forward as the voice of the College and profession in NI.

 

 

 

 

November – December 2016

The impressive clock which adorns the Tower here at Clifton House has recently been repaired on behalf of Belfast Charitable Society and it is great to see it working once more. Tempus fugit and this is the last Chair’s Update for 2016. So where to begin?

A good place to start is Ballyconnell, County Cavan, where collaborating with our colleagues in the Republic, we had an excellent programme for the Winter Conference on 10 and 11 November. RCPsych in NI was well represented and my thanks to all who travelled over. The theme was “Working Together” - and we did! And we did it well! And we need to do more of it going forward! One of the things we discussed was for the various Faculties to develop improved communication channels between the jurisdictions. I hope to contact our Faculty Chairs in the New Year to request that each makes contact with his/her counterpart in Dublin and begins to develop those important relationships. Joint Faculty meetings are one possibility; this could potentially be done with the help of technology. Joint training events or sharing of speakers is another possibility.

The relevance of our working together is given added impetus by the following reply from the Minister for Health, Michelle O’Neill MLA to an Assembly Question AQO 754/16-21 at the end of November:

To ask the Minister of Health for her assessment of all-island solutions to mental health issues.

A - My Department has submitted a paper to the North South Ministerial Council with a view to agreeing a health and social care work programme. Mental health is included as an area for consideration. Specifically, I consider that perinatal mental health and eating disorders services are potential key areas for all-island collaboration. There is no comprehensive regional perinatal mental health service in the North and, I understand, a similar position in the South. I am currently considering options to establish a service in the North, and I consider that this is presents a good opportunity to look at options for all-island collaboration. Eating disorders services in the North and the South are delivered using similar service models, primarily in community services with specialist in-reach to inpatient settings where necessary. My Department is leading a study on the feasibility of establishing a specialist unit in the North, and this will report to me in December. I will be happy to share the findings with Ministers in the South in order to determine whether an all-island service might be an option. The work of organisations such as Cooperation and Working Together, which have progressed a number of mental health-related projects such as the cross-border eating disorders project under INTERREG IV, is also instructive for the future. One issue to bear in mind in all-island mental health service development is that mental health legislation differs in the two jurisdictions, which could complicate issues such as compulsory admission for assessment or treatment, and patient transfer between jurisdictions. This would be an issue for discussion in the future. There are also opportunities for all-island staff training and development opportunities across the range of mental health services. Suicide prevention continues to be a key priority both North and South. (RoI Minister for Health) Simon Harris and I launched the joint Concerned About Suicide leaflet at the November 2016 North South Ministerial Council meeting. There has also been recent collaborative working in relation to the Flourish! churches suicide prevention initiative; and roll out of the GAA Health and Wellbeing project which has a focus on the promotion of mental health awareness. Senior officials from my Department and the Department of Health in the South are scheduled to meet in January 2017 to discuss areas of mutual interest.

Congratulations to Dr Joe Kane who won the Joint Conference prize for the best poster, which was entitled “Clinical Diagnosis of Dementia with Lewy Bodies in routine secondary care clinical services: Results from the Diamond-Lewy Study”.

Dr John Hillery takes up the baton as President CPsychI and I wish him every success in his new role and look forward to working closely with him in the time ahead. I thank Dr Ruth Loane as outgoing President CPsychI for her leadership and emphasis on joint working.

 

 

Workshop facilitated by Dr Tony O Neill, along with Dr Aoibhinn Lynch

 

 

 

 

Delegates Drs Ruth Thornbury, Maggie Kelly and Bronagh Sproule

 

 

 

 Professor Steve Cooper:

 

 

 

 

 

 

 

 

 

 

Delegates Drs Michael Doherty and Ian Bownes along with Professor Steve Cooper

 

 

 

Included here are Dr Ruth Loane, outgoing President of CPsychI, Lord John Alderdice, Dr John Hillery, President Elect of CPsychI and Dr John Tobin, Vice President CPsych

 

 

 

Meanwhile, back in Belfast also on 10 November, Drs Keira Walsh and Graeme Young along with Dr Damien Hughes were promoting our profession at the NIMDTA Foundation F2 Careers Evening:

 

Both Graeme and Keira took the lead for us again on 22 November at the Annual QUB Careers Fair:

Both reported “several budding psychiatrists showing lots of interest”, with “lots of eager and interested student and foundation doctors potentially coming through”. This augurs very well for our future as a profession in Northern Ireland and would be music to the ears of our colleagues in England for whom Recruitment and Retention remains a particular challenge. Neither will we assume our future is secure here in terms of this issue and I thank Keira and Graeme for keeping the focus on this issue locally. It is work of critical importance.

Also on 11 November back in Belfast our Policy Administrator, Thomas McKeever attended a College of Occupational Therapists Launch event at the Long Gallery, Parliament Buildings, Stormont entitled “Improving Lives, Saving Money” at which he extended an invitation to Chair of the NI Assembly Health Committee Paula Bradley MLA to visit RCPsych in NI in her North Belfast Constituency, for an informal meeting. We were very pleased then to welcome Paula Bradley, along with the Clerk to the Health Committee Éilis Haughey, to Clifton House on 9 December. We discussed physical healthcare monitoring for those with severe mental illness and eating disorders (child and adult), the recommendations of the “Building on Progress: Achieving parity for mental health in NI” June 2016 Report with a particular emphasis on Commissioning, the Code of Practice Consultation method for the Mental Capacity Act (NI) 2016 and how we in the College could work with the Health Committee going forward in this mandate. It was encouraging to hear that the Health Committee plans to focus on mental health in 2017 and we are certainly now in prime position to assist them with this. We will be forwarding questions to both Paula Bradley in her role as MLA and to the Health Committee to hopefully take forward our agenda items. Paula remarked at the conclusion that she was so glad that the meeting had taken place and that she had learned a lot from it which would assist her as Chair. We organised a tour at the end for both Paula and Éilis with Belfast Charitable Society Chief Executive Paula Reynolds and they heard all about the use of Clifton House for assisting the mentally ill in previous generations.

 

RCPsychNI Executive Members and Staff

Paula Bradley MLA & Chair of the NI Assembly Health Committee with RCPsych in NI Executive Members and Staff

Now to another meeting at Clifton House - along with Dr Jo Minay, I met with representatives of HSCNI on 4 November 2016 to discuss the You In Mind “My Mental Health Consultation” Pilot. The trial has started and is ongoing with each Trust having to complete a set of ten documents and provide feedback. At our meeting, we conveyed the negative views which are widespread among our membership. I am grateful to both Jo and to Dr Saleem Tareen for taking forward our presence and views within this process on behalf of us all.

We were proud to be associated recently with the launch of a Regional Exhibition entitled “My Journey”, which was a collaboration between CAMHS across the 5 Trusts and Artscare. The images portray part of the young people’s personal journey as expressed through the media of painting and collage. It is the first of its kind in NI and the plan is for it to tour to all Trusts. Dr Richard Wilson, Chair of our Child and Adolescent Faculty spoke and Dr Hilary Boyd, Co-organiser with Artscare read a poem which she wrote for the event. Both are pictured. The exhibition offers an opportunity to convey a positive message about Youth Mental Health, which so often is overshadowed by the more tragic associations of suicide and stigmatisation. Access to understanding and thus recovery can often be through creative channels alongside more evidenced based treatments. I recommend the tour to you.

On 16 November I attended the Western Trust Psychiatrists Division meeting in Strabane at the invitation of the Chair, Dr John Brady. Our discussions included the Masterclass programme, recruitment difficulties and the Mental Capacity Act (NI) 2016. I would hope during 2017 to maybe visit all the Medical Staff Committees in the Trusts. It is important that we all work together as a profession and I am keen to encourage cross Trust support networks and College interaction.

In College office news, we welcomed Barry Flynn as a permanent staff member following his appointment to the role of Administrator on 17 November. In Nora’s absence, Barry will continue to act up as Manager and I join with the many members who continue to send their good wishes to Nora for a speedy recovery. I would take this opportunity to thank Allison Brownlee, who was our Temporary Administrator for a couple of months, for all she did to assist us during her time with us. I would also like to thank Elaine Walker for her assistance. The College centrally went live with its long planned NG data system and office staff look forward to being trained in this early in 2017. It is hoped that the new system will bring benefits for members and staff alike once it is fully functioning.

The Policy staff across the College met on 22 November – in the case of Thomas and his Scotland and Wales counterparts, via Skype - to discuss with the Registrar and others a range of current overall College issues. I will highlight just two. The first is that the Communication priorities which will be taken forward by the newly appointed Director of Strategic Communications, Kim Catcheside, have been identified as:

  • Positive narrative about psychiatrists
  • Being credible and evidence-based – best available evidence with College as first choice for informal communication, first choice for decision-makers
  • Recruitment and retention
  • Standards
  • Influence policy and decision-makers, stakeholders, new models of care, funding allocation.

We will hear much more about these from Kim Catcheside at and following our forthcoming Strategy Day, which has been rescheduled for 9 February 2017.

Additionally, it was decided that a recommendation should go to the College Policy & Public Affairs Committee in January that the College should no longer produce Faculty Reports and Occasional Papers. Going forward, the idea would be that Opinion pieces can be published in journals/press and less formal documents (ie not Reports) can be hosted, as now, on Faculty web pages.

Spike Milligan Annual Public Speaking Competition winnersOn behalf of us all, I would like to extend my congratulations to QUB Medical Students Catherine Eves, Swati Vara and Mairead McFadden (pictured) who won the Spike Milligan Annual Public Speaking Competition in Dublin on 23 November. The title this year included reference to “All Changed, Changed Utterly 1916-2016 Mental Illness and Recovery.” I also want to thank both Drs Holly Greer and Graeme Young for all their input and time in advance working with the winning team. I am told that the win was secured by way of a very unique angle in terms of the format they used – no doubt something which the late Spike Milligan would have relished. Now visiting our website, why not check out a flavour of it on our Twitter feed 25 November posting?!

 

 

RCPsych in NI is proud of you and well done!

My congratulations also go to one of our local trainees, Dr Joy Patterson, who was awarded the Douglas Bennett Prize at the Rehabilitation and Social Psychiatry annual conference in Cardiff mid November. The Douglas Bennett prize is an annual award for a trainee who presents either research or significant audit relevant to Mental Health Rehabilitation. Joy presented the study on outcomes in inpatient rehabilitation. Competition was of a very high standard, including from the Maudsley. My further congratulations this month go to Shauna Wood who won a Pathfinder Fellowship award from the College……for medical students in the penultimate year and interested in Psychiatry. All are great achievements…….very well done!………RCPsych in NI is proud of you all!

Healthy MeAnother good news story is the launch on 2 December of “Healthy Me”, which took place at Carrick Primary School, Sloan Avenue, Lurgan, Craigavon. "Healthy Me" was attended by Drs Claire McKenna and Hilary Boyd, as well as Thomas as part of his work with our Public Engagement Committee.

All are pictured along with David Babington CEO of Action Mental Health, Colin Loughran Service Manager of Craigavon and Banbridge Action Mental Health and pupils from St Oliver Plunkett’s Primary School in Belfast who took part in the Belfast pilot of the programme.

This is a great initiative and I am delighted to see us play our part in intervening as early as Primary School level, as well as collaborating with our local voluntary sector in a real and meaningful partnership by inputting clinical expertise. I am equally delighted to see that this programme in no way medicalises mental health, which it is critical that we avoid doing in work with young children in this context. In previous Update postings, I have congratulated our members involved in this and I renew this here.

25 November found me over in Wales at the invitation of the College there where I addressed their & The Welsh Psychiatric Society joint meeting at Chepstow, Monmouthshire entitled 'Capacity, Consent and Compulsion'. Once again I am struck by the intense interest everywhere on these islands and further afield in our Mental Capacity Act (NI) 2016. We need, however, to get to the stage of having a Code of Practice which will allow us to effectively work within the new dispensation once it goes live in 2020 approximately. To that end, we had a really useful meeting on 2 December of the Mental Capacity Act Working Group. It was really encouraging to see the numbers now attending and our response was the better for the broader range of members present. This time we were responding to Chapters 6-12 as well as Community Residence Requirements Associated Regulations. The Chapters themselves concerned Deprivation of Liberty, Attendance Requirements, Community Residence Requirements, Restraint, Trust Panel authorisation of certain serious interventions, Short term detention authorisation for detention in hospital for examination or examination followed by treatment – also Extensions. Our next meeting is planned for 6 January. Please do involve yourself by attending and let us all have the benefit of your input into the next section of the Code of Practice. All enquiries on this to Thomas at the College Office. I have to say that I have concerns about the process employed to draft the Code as it is unfolding (see reference to this below in the context of our Executive meeting) and I have written to the Department to express these concerns. I will keep you informed of any developments on this, but in the meantime please give this important area as much attention as you possibly can.

A particularly busy and productive day was 1 December. First up was a meeting at Action Mental Health New Horizons Antrim in relation to the NI Executive Draft Programme for Government Consultation where I was accompanied by Drs Peter Trimble and Margaret du Feu. Action Mental Health CEO David Babington had kindly included us in this event, which was principally a “Together For You” partners’ initiative to meet with Department officials to discuss the new methodology behind and informing the draft Programme for Government. We heard from Geoffrey Simpson (NI Executive Office) on the process involved and then from Andrew Dawson (DoH) as regards the Delivery Plan on Improving Mental Health. It led to a healthy discussion and more importantly assisted us later with our own RCPsych in NI response to this demanding and pivotal Consultation. More on this below!

I then hotfooted back to Clifton House for a meeting headed by Professor John Middleton President of Faculty of Public Health of the Royal Colleges of Physicians of the UK, Dr Judith Ewing Specialist Registrar and Dr Stephen Bergin Consultant in Public Health. This time I was joined by Drs Jo Minay, Helen Toal, Maggie McGurgan, Niall Corrigan and Graeme Young. This was a great opportunity for us to input the mental health agenda into their thinking as they had spent their day in NI mainly with a focus on physical health. I am very grateful to Dr Stephen Bergin who orchestrated this meeting and it is indicative of the importance he attaches to a comprehensive look at all aspects of public health, inclusive of mental health. We made some useful contacts and I hope to organise an event in the area of public mental health in the near future.

The day then concluded with our Executive Meeting in Clifton House, which was very well attended and I am also pleased to report a number of key outcomes from same. We agreed to lobby for the eight recommendations of the “Building on Progress: Achieving parity for mental health in NI” Final June 2016 Report with a particular emphasis on Commissioning. We also agreed to lobby for a Mental Health Champion. We agreed to accept the kind invitation from Action Mental Health to play a more prominent role in the second Mental Health Summit which is scheduled for May 2017. Finally, we agreed to officially raise our concerns about the ongoing methodology being used to consult on the Code of Practice for the Mental Capacity Act (NI) 2016. We believe that the current emailing out of substantial numbers of Chapters within weeks of each other with quick turnaround response times is proving problematic and is not likely to lead to the drafting of a successful Code. Busy Consultants are trying to balance their Trust duties with their voluntary time with the College to attend meetings and contribute to the consultation process. It is clear that the success of this unique legislation will depend on the drafting of a successful Code of Practice but the drafting of such a Code is a complex and time consuming piece of work and it is therefore vital that there is specific clinical time devoted to it, say by way of sustained and dedicated input from a Consultant who can ensure its workability in practice. It is of critical importance that the Code is written as comprehensively and effectively as humanly possible, given its significance in practical terms for the time ahead. So the agenda for RCPsych in NI Chair during 2017 is already taking shape!

Patient Safety is a key issue for us going forward and so it was that I, along with Dr Catherine McDonnell (in her role as Safety Forum Mental Health Collaborative Chair), met with HSC Safety Forum personnel Dr Gavin Lavery Clinical Director and Janet Haines Wood Regional Patient Safety Advisor on 6 December at Clifton House. We discussed the various quality improvement initiatives in mental health which are happening in the different Trusts. It is clear that there will be greater focus on the area of quality improvement in mental health, which is, in my view, to be welcomed. Our forthcoming Spring Conference (hopefully on 29 March – so hold this date in your diary please!) will examine this area further.

Three Consultations have been submitted during these months and I invite you to read our Responses on the website:

Protect Life 2 - A Strategy for Suicide Prevention
in the north of Ireland
Department of Health Response 4 November
Consultation on proposals for the withdrawal of two compendia official statistics publications -
‘A profile of older people in Northern Ireland’ and ‘Gender Equality Statistics’ annual publications
Executive Office Response 22 November
Consultation on Draft Programme for Government Northern Ireland Executive Response 23 December

I wish to thank all the members and Service Users and Carers who assisted us with these. For fear of omitting anyone, I will not list their names. However, I trust I will be forgiven for highlighting the time which Dr Michael Doherty invested in the Draft Programme for Government Consultation response. The Programme for Government reminds me of Lord Palmerston’s view on the Schleswig-Holstein question; “it is so complicated, only three men in Europe have ever understood it! One was Prince Albert, who is dead; the second was a German Professor who became mad: I am the third and I have forgotten all about it!” However, Michael does seem to understand what it means to be “ahead of the curve” (which is a critically important concept in our draft PFG)! Not only did he attend the main meeting for the drafting of this on 9 December, but he also returned for additional meetings with me and with Thomas on 13 and 15 December at Clifton House in order to perfect the response and draft the separate comments on how to improve the three particular Delivery Plans which we regard as key to our agenda. If any member wants to see those separate three e mails which were sent to the three relevant Senior Responsible Officers in the Departments of Health and Communities respectively, please contact Thomas at the office.

One of the early commitments in 2017 will be a meeting on 10 January of our Ad Hoc Policy Committee along with our Service Users and Carers Joint Committee to consider our response to the Health and Social Care Transformation – DoH Consultation on the 7 Criteria for Reconfiguring Health and Social Care Services in NI. This is the Minister’s follow up proposals to the long awaited Professor Bengoa Report. I attended a BMA meeting in relation to the Bengoa Report on 28 November and am disappointed about the lack of emphasis on mental health within that document, though there is some encouragement in the Minister’s subsequent setting out of her mental health priorities (see my October 2016 Update).

I am pleased indeed to hear from Dr Stephen Moore that the inaugural meeting of our new Informatics Group was held in Clifton House on 8 December with interested members representing the five Trusts all involved. Improved Data is the eighth recommendation in the “Building on Progress: Achieving parity for mental health in NI” Final Report, June 2016. The third recommendation is Improved functioning of the whole system. It cannot be denied that the two are linked and I know that Stephen is passionate about the possibilities for our mental health services which can flow from improved data sharing as a result of the technological strides taken in recent years. Stephen is equally passionate about patient privacy issues; we are very fortunate to have him heading up this important work on behalf of all of us and I thank him for this.

Buffet Reception Belfast Charitable SocietyOn 14 December staff and I were pleased to attend a lunchtime Buffet Reception at the kind invitation of our Landlord, Belfast Charitable Society, here in Clifton House. The occasion was the Reception following the Society’s 134th Annual Benn Dinner for the residents of the Nursing Home aspect of the building. It is so special for the College to be located here and to be a part of this fine building’s present with all its associations with mental health in the past. Pictured here is the Chairman of Belfast Charitable Society David Watters addressing us with Lord Mayor of Belfast Brian Kingston to the right of the picture.

My last meeting of 2016 was with Professor Hugh McKenna at University of Ulster Belfast Campus on 22 December. We had a very interesting discussion about his proposal of a Graduate Entry Medical School to be located in Derry/Londonderry. He is very keen that this will focus on mental health, as well as primary and community care. I think this will be a very interesting development.

Notification of elections for positions on the Executive of the Royal College of Psychiatrists in NI will be posted on the website at the start of January. I would like to express my appreciation to all those members of the Executive whose terms of office will expire in 2017 and encourage members to consider standing and also to vote.

You will also have received by now notification for election of our President. I have been very impressed with Professor Sir Simon Wessely and particularly during my short time as Chair of the College in NI. He has been very supportive of us and will be a hard act to follow. As above, I would encourage all members to vote.

A number of events for 2017 will be going live shortly on our Website and I would urge you to book early in order to avoid disappointment and so that we can honour our commitments to the various organisations with whom we work. I am hoping that in 2017 we can foster a culture of earlier (if not early) booking so as to retain good relations with all our fellow organisers and stamp out wastage of funding and food, as well as the strain which comes with floating numbers.

It remains for me to wish all our Members, Service User representatives, Carer representatives and Staff a great Christmas holiday and good health in 2017; also to thank you all for your support since I assumed the Chair earlier this year. I look forward to us promoting further the needs of our patients in the coming year.

 

October 2016

Our new Mental Capacity Act (NI) 2016 continues to attract much attention! On 2 November, I participated in a Conference call with colleagues in London who are considering whether the England/Wales legislation needs changed to incorporate capacitous refusal of treatment for mental illness. I look forward to continuing these discussions when I visit colleagues in Wales on 25 November, when I will be presenting on our new Act. Meantime back at home suggested text for the important Code of Practice is being sent to us as Consultees every 3 weeks or so by the DoH Implementation Team. We have a working group which met on 4 and 28 October 2016 to respond to these consultations. So far we have given views on protection from liability, supported decision making, capacity, best interests, serious interventions, treatment with serious consequences and independent mental capacity advocates. Our next meeting is scheduled for 29 November when we will be considering and responding to the latest material in from the Department on Deprivation of Liberty, Attendance Requirements, Community Residence Requirements - and their associated Regulations - and Restraint. I cannot stress enough the importance of as broad a view as possible from the membership, so please do take part in this important work as we are literally laying the foundations for how our profession will work with our patients in the coming decades. It is our legacy for the future and it is both challenging, but also exciting work, when seen in that light. Please do contact Thomas McKeever at the College Office if you want to get involved. We need as many as possible in order to share the work, but also to ensure that we are authoritative and comprehensive in our stated view. If you cannot get to the meetings in person, I would be very happy to receive any written thoughts or comments.

Speaking of the future, it was a great privilege to welcome our New Members at an Evening Reception in Clifton House on 10 October 2016. We aptly chose World Mental Health Day for the occasion. I wish all our new members well in their future careers. The Mental Capacity Act (NI) 2016 will feature very much in those careers. Currently it is scheduled to go live in 2020.

New Members

Also with regard to the new Mental Capacity Act (NI) 2016, on 4 October I met in Clifton House with PhD student Susan Peukert, who travelled all the way from Australia to research our ground breaking world first legislation. We had a wide ranging conversation over all the principles underpinning the Act and I wish Susan well with her task. When she departed the College, she was heading to see Professor Roy McClelland next and I know that the College staff had directed her to a number of key personnel. It was interesting to hear from Susan that from her reading of the literature, patients experiencing severe mental illness and indeed physical illness tend to have their capacity assessed when they refuse treatment; if a patient agrees to treatment their mental capacity tends not to be assessed, but if they refuse treatment, then their capacity may be questioned and assessed. This troubles me. If we are to have genuine rights based legislation, we will need to guard against falling into this trap.

Our 2 World Mental Health Day events on Monday 10 October went really well and were very well received. The first involving members of the Public Engagement Committee in Forestside Shopping Centre mall had input from a number of very dedicated Trainees and also 3 Consultants. Dr Maggie McGurgan estimates that there was interaction with over 200 people across the 2 hours. People spoken with were all very keen for information and to talk about mental health and stigma. College leaflets on named conditions were available and College videos were on display. Our gratitude to both those who took part and also to Forestside who gave us the space for free.

Public Engagement Committee Pictured left to right are Drs David Bell, Holly Greer and David Mongan with the stand prepared and ready for passing shoppers - Drs Mark Rodgers and Maggie McGurgan with screen in background.

This was followed in the afternoon by the event here in Clifton House entitled “Public Health & Suicide Prevention - International, national and local perspectives” Our 3 speakers in Professor Rob Poole (Bangor University), Iris Elliott (Mental Health Foundation) and Gerard Collins (Department of Health) indeed provided this range of perspective. It was, as I had hoped, thought provoking - and a healthy discussion ensued, leaving us in prime position to respond to the DoH Protect Life 2 Suicide Strategy Consultation. Days earlier, on 6 October the publication of The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness had emerged. Sadly, we in Northern Ireland still have the highest rate of suicide in the UK and Ireland. Professor Appleby’s publication has some very interesting perspectives.

Feedback following our Suicide Prevention afternoon has been really positive. It proved a worthwhile forum for many. The event itself was oversubscribed and unfortunately we had to turn away delegates who had not pre booked. Again, therefore, I would encourage everyone to book as early as possible for any of our events which you are hoping to attend, so as not to be disappointed. This will also enable us to retain our excellent relationship (in terms of health and safety, catering etc) with Belfast Charitable Society whose tenant we are in Clifton House. We were assisted on the day by Vivine Muckian, College Head of Divisions and Jennie Duggan, Temporary Administrator and my thanks to both of them.

Changing Minds competitionMy thanks also to Dr Eleanor Higgins who represented the College by acting as Judge this year at the Belfast Trust Annual Schools Mental Health Debate competition entitled “Changing Minds”. Dr Eleanor is pictured on the right at the event which was held in The Chinese Welfare Association premises. St Mary's, De La Salle, Mercy College and St Louise's participated and general themes were: challenges teenagers face in regard to mental wellbeing, fighting stigma and ways to address stress and mental health issues. I understand that De La Salle won the competition with an excellent talk entitled 'Mental Health-Would you keep it a secret?'. They discussed the impact social media, culture and stigma can have on mental health. Our congratulations go to them. Thanks also to Joe Canavan, Health Promotion (Mental Health) of Belfast Trust whose commitment to this event - and indeed to our inclusion - over many years has been much appreciated.

Returning to our response to the Protect Life 2 Suicide Strategy Consultation from the DoH, this occupied our attention and effort at a very worthwhile joint meeting between our Ad Hoc Policy Committee and members of our Joint Service Users and Carers Committee on 28 October. The response we submitted by the deadline was described by one of the Joint Committee members as “constructive” and certainly I found the entire process very much characterised in that way. I look forward to working with members of our Service Users and Carers Committee next month when we together consider the next phase of the Programme for Government currently under Consultation from The Executive Office.

Due to unforeseen circumstances, our Strategy Day on 21 October in Belfast Castle was postponed - so more about that in 2017 when we reorganise same. However, we hosted a really important event that morning in Belfast Castle on the topic of StartWell. Dr Ellen Wilkinson, Associate Registrar, kindly attended and illustrated this really worthwhile initiative for Consultants in their first 5 years. I hope to build on this event by perhaps organising a follow up in 2017. We were assisted on the day by Marc-Andre Weiss, South Eastern Division Co-Ordinator and Allison Brownlee, Temporary Administrator and my thanks to both of them.

I would take this opportunity to welcome both Allison Brownlee as our Temporary Administrator and Barry Flynn as our Temporary Manager – and we all send our sincere good wishes for a speedy recovery to Nora.

During October, I had a couple of meetings with Dr Jo Minay, our Liaison Faculty Chair to discuss the ongoing problem of significant variations across NI and uncertainty about funding streams in relation to Liaison services. We hope to meet with the Clinical Directors/Associate Medical Directors in the Trusts in the time ahead to look at current baseline services and also examine what level of investment would be required to develop the service in each locality. Liaison Mental Health will be one of the subjects which we will be discussing at the forthcoming joint meeting with RQIA planned for February 2017 and we are hopeful that Dr Peter Aitken will be attending that event.

I also attended the College Council meeting in London on 14 October. I had previously attended the Autumn meeting of the College in Scotland, where I presented on the challenges we face here in NI. This was part of a wider discussion about how, with devolution, the health services in the nations of the UK have diverged, and the implication this divergence has for the work of the College. At the Council meeting on 14 October, the Chairs of the College in Scotland, Wales and NI presented a paper which described an option for the future relationship between the College in the devolved administrations and centrally. Essentially, we are seeking to have a greater degree of autonomy so that we can respond quickly and flexibly to our local politicians and civil service, whilst still maintaining strong links with the Central College and across the jurisdictions of the UK. It was also useful to hear, at the Council meeting, about England’s 5year forward plan; there is plenty to learn from developments across the UK.

Great news was received during the month in relation to our Public Engagement Committee related activities. First is that the Healthy Me project with Action Mental Health has received funding from AMH. Current and past members of our Public Engagement Committee and particularly Drs Claire McKenna and Clare Bleakley will be very pleased to see their work on this initiative arrive at this point.

Additionally, our Public Engagement Committee are continuing to collaborate with Aware & the Northern Trust CAMHS Primary Mental Health Team towards development and roll out of a 'Crash Course in Mental Health for Teachers and Primary School Staff' - with add on of Aware's established 'Mood Matters for Teachers' programme. Two successful pilots have been achieved, with another two planned. My thanks to Drs Keira Walsh and David Mongan, who have been instrumental in the development and delivery of this work to date…..supported by Drs Maggie McGurgan and Holly Greer.

On 25 October, informed by the Bengoa Report entitled “Systems, Not Structures – Changing Health and Social Care”, the Health Minister Michelle O’Neill MLA announced the publication of the document “Health and Wellbeing 2026; Delivering Together”. This document represents the outworkings of the Expert Panel's recommendations.

The Minister’s document contains the following references to Mental Health and it is important to focus on these words, as they illuminate the Policy context for us going forward. We need to be fully aware of the Minister’s current thinking if we are to craft an effective strategy for our various lobbying initiatives:

In the most deprived areas, 30% of people report a mental health problem - double the rate in least deprived areas. Rates of suicide are also higher, and leave a devastating impact on people, families and those communities.

There is also growing evidence that children who experience adversity in childhood are far more likely to experience health issues in adult life. Specifically, these children are more likely to adopt health harming behaviours during adolescence which can lead to mental health illness and diseases such as cancer, heart disease and diabetes later in life.

Provide more support in primary care to enable more preventive and proactive care, and earlier detection and treatment of physical and mental health problems;

We will maximise the potential for developing social prescribing models in the multi-disciplinary primary care teams, through the embedding of social workers and building linkages to the range of early support services available to service users, such as Mental Health Hubs and other early help initiatives. Additional funding for primary care will be focussed on developing these teams, with more funding for mental health interventions in primary care and funding to test the impact that specialist allied health professionals, such as physiotherapists, can have when working alongside the primary care team.

Mental Health

The North has a particular challenge with mental health, having the highest rates of mental illness in these islands. There are many talented and hardworking professionals in the system and the voluntary and community sector, who do excellent work in the services they provide. It is clear that our services need to continue to evolve and improve, building on the Bamford reforms from the last decade.

Mental health is one of my priorities as Minister of Health, and it is an issue that I will champion at every opportunity. I want better specialist mental health services. This would include further support for perinatal mental health and inpatient services for mothers, with potential to address the need that exists across the island. We will expand services in the community and services to deal with the Trauma of the past. Underpinning all of this, I am committed to achieving a parity of esteem between mental and physical health to ensure that we are tackling the true impact of mental health on our communities.

Building on the good practice which already exists in the HSC, such as the Mental Health Recovery Colleges, we will work collaboratively in the spirit of openness and trust to deliver agreed outcomes.

Co-production - a new approach to the design and development of mental health services

An example of how co-production can make a big impact on our services is the design and delivery of Mental Health Recovery Colleges. This is an innovative model that assists individuals in their personal and collective journey of recovery. This recovery focussed approach creates opportunities for those with lived experience to contribute as volunteers and in paid roles. These peer educators assist those with mental health problems to discover personal talents and develop life skills which can help them enter the labour market.

A number of people with lived experience have and continue to be developed to become peer educators and are now making a contribution to care delivery. Over 236 sessions of peer education have been delivered.

College of Psychiatrists of IrelandSo all in all, a busy month - other matters we were involved in over the month included looking into whether it would be viable to have an Academy of Medical Royal Colleges here in NI - and we will continue to work on this with our colleagues in the other Medical Royal Colleges who have a local presence. It may be a useful vehicle for providing, where possible, a unified professional voice to our local administration……We participated in a tele conference with colleagues Centrally in relation to the Acute Care Commission Report and its implementation here in NI………I participated in a teleconference with the Working Group examining the potential for legislative change in the area of fatal foetal abnormality……….We were pleased to host a Masterclass on 19 October on Compulsory Community Treatment: Ethics, Evidence and Essential Elements of Practice given by Professor Richard O’Reilly, which proved to be an excellent presentation.

I am now off to Ballyconnell, County Cavan, where collaborating with our colleagues in the Republic, we have an excellent programme for the Winter Conference on 10 and 11 November. It is very pleasing to hear the numbers who have registered from RCPsych in NI and I am really looking forward to welcoming all the delegates, along with Drs Ruth Loane (President CPsychI ) and John Tobin (Vice President CPsychI). The theme is “Working Together” - and much more on that in the November Update.

 

September 2016

September 2016 After a Summer break in August, the update blog is back! However, even though there was a print break, the work of the College continued apace throughout August as well as this month.

August saw staff up at the Assembly to distribute a NI Mental Health Survey to all 108 MLAs re them, their staff and their constituents. We have had a moderate feedback response of approximately 25%, which is a finding in itself ! – but this figure is nonetheless higher than some years ago when a similar survey was carried out by the local College, so that is encouraging in terms of the importance of mental health to our local representatives. I look forward to the results of the survey once these are collated and compared with our previous survey. This work is being handled by Drs Ruth Thornbury, Claire Potter and Zoe Moore, who have all risen to the task with great enthusiasm.

We said goodbye to our temporary and permanent Administrators, Michelle Newell and Lisa Losty in August also. I would like to thank them both for all the work they did to assist with the smooth running of College life here in recent times – and to wish Michelle well in her new post with RCGP and to wish Lisa well as she stays on in China. We hope to appoint a successor towards the end of the year.

September saw us turn a lot of our attention to the implementation of the June 2016 Report by the Commission to Review the Provision of Acute Inpatient Psychiatric Care for Adults ("Building on Progress: Achieving parity for mental health in Northern Ireland.”) Having had the launch in June, we now need to focus on how to secure the practical local impact of its eight recommendations. Together with staff and colleagues in the General Adult Faculty, I have been working on an implementation plan which we will fine tune and discuss, subject to our Executive’s consent to adopting the Report, at our forthcoming Strategy Day in October. I have been struck by how much we are already doing which fits so well into this agenda and also by how the focus of the Report should serve us well as we develop a cohesive lobbying plan for 2017.

We took the messages from the Report directly in principle to our Minister for Health, Michelle O’Neill MLA when we met her on 22 September:

Michelle O'Neill MLA - Minister For Health

The Minister definitely has a mental health focus but we were reminded also that resources are finite and competition for even relatively small pots of money is fierce. It was a further opportunity for us to promote the physical healthcare monitoring agenda for those with severe mental illness and eating disorders (both child and adult). The Minister made it clear that she is entirely persuaded by the argument and it therefore remains for us to keep up the pressure for progress on funding. Other topics discussed were suicide, perinatal and eating disorder services, psychological therapies, mental trauma service, potential for all island services where cheaper, Bamford Review, Professor Bengoa report, funding for the Mental Capacity Act (NI) 2016 implementation, early intervention etc. It was a good first meeting and we hope to build on this access in order to further our agreed strategy in the time ahead.

On the subject of the new legislation, we have begun to receive from the Department some early text relevant to the all important Code of Practice. This will be the subject of a meeting in October which I have convened here in the College for us to look, not only at what the Department is sending us and give them our views – but also start to drill down ourselves into how the legislation will play out in terms of our practice by using a scenario based approach. This will maximise the level of detail in our responses to the Department, help us to secure any essential changes to the proposed Code by providing an evidence base for our comments – and will also serve to familiarise ourselves with the coming changes. This will in turn induce confidence---and dare I say it, resilience!

Annual Research and Audit Day

It was a great pleasure for me as Chair to open the Annual Research and Audit Day. We had a full capacity attendance with the event booked out in advance. Apologies to anyone who could not gain admittance, but we have catering and health and safety obligations in relation to Clifton House – and I would encourage everyone to book as early as possible for any of our events which you are hoping to attend, so as not to be disappointed. This will also enable us to retain our excellent relationship with Belfast Charitable Society whose tenant we are in Clifton House. The standard of presentation was extremely high and I would commend all the runners up (Drs Joy Patterson, David Bell, John O’Hare, Michael Doris, Michael McMorran, Amy Grimason and Nicola Duggan) for their dedication and role in making the day the success it was. Thanks go to our Judges, Drs Peter Trimble, Caroline Donnelly and Aidan Turkington, who had the unenviable task of picking the winners; thanks also to Professor Ciaran Mulholland who chaired the event, to Professor Danny Smith (University of Glasgow) who spoke to us about mood disorder and overlap with cardiovascular disease, to Dr Tony O’Neill for securing such an excellent speaker and to Dr Janet Corry for her presenting role.

 

Thomas Freeman Award

 

 

 

 

 

Special congratulations to our winners Drs Niall Corrigan and David Mongan (pictured above) -Research and Audit prizes respectively and to Drs Ruth Thornbury (pictured left) and Phil Anderson (in absentia) who were declared joint winners of the Thomas Freeman Award.

 

 

 

 

 

 

 

Action Cancer LaunchWe continue to be involved in a number of very effective collaborations, one of which is with local charity Aware, in relation to depression. This work is set to widen to also include Action Cancer - and Dr Phil Campbell (pictured right) was on hand on 12 September to help with its launch and will be speaking at the first of these events on 5 October in Malone House, Belfast. The idea is to talk about depression in the context of a cancer diagnosis.

 

 

World Mental Health Day 2016Now to upcoming events for which we need your support

We are organising no less than 2 World Mental Health Day events on Monday 10 October! First from 12 noon to 2pm in Forestside Shopping Centre where Drs Maggie McGurgan, Holly Greer and the members of the Public Engagement Committee will take up a central position in the mall in an inaugural (possibly the world over? !) Pop up Psychiatry event. The idea is to tackle stigma, encourage shoppers to talk about mental health and also establish in the minds of shoppers that Psychiatrists are approachable medical Doctors trained in mental health. I am told that there may be some free cups of coffee, thanks to local traders and Maggie’s negotiation skills with them! There will also be College leaflets and films on display.

 

 

This is followed by our afternoon event here in Clifton House entitled “Public Health & Suicide Prevention – International, national and local perspectives” which runs from 1.50pm to 5pm. Early booking is again recommended to hear from an impressive line up of speakers in Professor Rob Poole (Bangor University), Iris Elliott (Mental Health Foundation) and Gerard Collins (Department of Health) who will lead us to think first world picture, then narrow to national and finally focus us on the Suicide Prevention Strategy (Protect Life 2) Consultation which is live until 4 November. I have chosen this theme as we prepare to learn the latest figures for Northern Ireland from the forthcoming National Confidential Inquiry. We have a major public health problem and we need to give it our urgent focus. I hope that this afternoon event will be thought provoking and enable us to better feed in to this important Consultation.

 

WMHD Regional CAMHS “My Journey” Art Exhibition We are also associated with 2 other World Mental Health Day events….the Chinese Welfare Association (NI) Offices, Stranmillis Embankment, Belfast is the venue for the Belfast Trust Annual Schools Mental Health Debate competition entitled “Changing Minds” at which Dr Eleanor Higgins will act as Judge this year and which we co sponsor…. and the Royal Belfast Hospital for Sick Children is the venue for the World Mental Health Day Regional CAMHS “My Journey” Art Exhibition event in partnership with an organisation called Arts Care. The latter is an event which will celebrate CAMHS across the five Trusts in Northern Ireland and I wish to thank Dr Hilary Boyd for her work in bringing about this collaboration for us.

 

We have a really good record of collaborative working with the statutory and voluntary sectors and it is great to see how joining forces to intervene early and tackle stigma, increases the power of our common messages in these regards.

21 October, which is our Strategy Day, will be a really important and busy day when we adjourn to the Ben Madigan Suite in Belfast Castle to reflect and then prioritise for the coming year. The day includes addresses from Central College staff: Vivinne Muckian - Head of Divisions, Lucy Thorpe – Head of Policy, Peter Markham – Head of Digital and Kim Catcheside – Director of Strategic Communications. By the end of the day, I hope that we have a Strategy for the coming year, both agreed and ready to action, with clarity on how we hope to implement, communicate and achieve it!

Also on 21 October we have an early morning parallel session in the Ashley Room in Belfast Castle on the topic of StartWell. Dr Ellen Wilkinson, Associate Registrar, has kindly agreed to attend and speak at this event. StartWell is made up of six elements to support Psychiatrists in their first five years in a Consultant role, the intention being to form good career habits from the outset. We will explore how this initiative could work for us in the Northern Ireland context.

Collaborating with our colleagues in the Republic, we have developed an excellent programme for the Winter Conference on 10 and 11 November. The programme and booking information can be accessed through the College of Psychiatrists of Ireland website. I encourage as many as possible from our membership to attend this event in the beautiful surroundings of the Slieve Rusell Hotel, Ballyconnell, County Cavan in order to make this a conference which is true to its theme of “Working Together.”

There are many other items of work and membership engagement which I would like to highlight, but I will return to those hopefully in future months. Having addressed Central College back in July on the subject of Capacity and our new Act, I now find myself enlisted to speak to the College in Scotland on that theme – and I am on my way there now! As I leave, I hear that the College in Wales are seeking a similar commitment from me for November! There is absolutely no doubt that our new legislation is attracting considerable attention and let us hope that the money will be found to implement it at a reasonable pace for all concerned, over the course of this new Assembly mandate. As discussed above, it is vital that we, as psychiatrists, have a strong input into the drafting of the Code of Practice which will inform our day to day working of the Act for many years to come.

 

July 2016

This month, I will focus mainly on where I left off last month……….we had a very useful meeting on 22 July 2016 with Dr Michael McBride Chief Medical Officer, Dr Anne Kilgallen, Andrew Dawson and Gerard Collins. Our delegation comprised myself, Dr Peter Trimble, Dr Michael Doherty and Thomas McKeever. It was an opportunity for us to promote the physical healthcare monitoring agenda for those with severe mental illness and eating disorders (both child and adult). This was extremely well received and we are hopeful of progress in time on this, dependent on the availability of funding. We left convinced that the argument had certainly been won in principle, with elusive funding now the priority in order to secure fulfilment of this key Manifesto ask for us.

Also on our agenda were the implementation plan for the Mental Capacity Act (NI) 2016 and the 8 recommendations contained within the Commission to Review the Provision of Acute Inpatient Psychiatric Care for Adults final June 2016 Report "Building on Progress: Achieving parity for mental health in Northern Ireland.”

On the former, we look forward to receiving early text of portions of the Code of Practice come the Autumn and a very useful pilot of Capacity forms is pending. Again there are funding issues to the fore of all this, so the Department’s current intention is that implementation will be stretched over the course of this new mandate in stages. The officials are certainly keen to keep going on the major job of implementation and we will maintain contact with them as we monitor progress. We stressed our availability to assist with this process.

On the latter, we were pleased to learn that the Commission report is assisting with the Bamford Review and Action Plan which is currently being drafted and should hopefully emerge in the Autumn. It was pleasing to hear from the Chief Medical Officer that both the timing of the Commission report and its content have proven to be highly valuable to the Bamford process. This time the Bamford Review is looking both forward and back, so the new Action Plan will be a very significant document mapping out our path in mental health services for the next number of years and will need to be tied in with the ultimate outcome flowing from the Professor Bengoa report which is already with the Minister.

Dr Michael McBride, Chief Medical Officer at Clifton House June 2016

Additionally, the view expressed by the Chief Medical Officer was that a single Mental Health network operating consistently across the existing five Trusts and seeking to eradicate the injustice of provision inconsistencies dependent on location – is something which is preferred by him to the idea of a single Mental Health Trust. The College in Northern Ireland will need to arrive at a settled view as to whether we wish to argue for the creation of a single Mental Health Trust for Northern Ireland. I would hope to use the forthcoming Strategy Day to discuss this further. In any case, we must develop a vision which is consistent with the Commission’s call for a single service with less fragmentation.

The issue of a Mental Health Champion received a mixed response in that there is a fear that it leads to others stepping back and not taking responsibility – whereas a co- production approach may better break down barriers and ease solutions. Certainly the new Minister has indicated her desire to champion Mental Health at the Executive table and we look forward very much to meeting with her on 22 September for a detailed discussion in order to maintain momentum and build on our progress to date.

Finally, it was very useful to meet Dr Anne Kilgallen, Andrew Dawson and Gerard Collins and to hear from them in detail as to their specific roles within the Department. Dr Anne reminded us that Mental Health services have in many ways already done the shift left required by Transforming Your Care and can showcase the benefits of this approach as we enter the Professor Rafael Bengoa debate era. Andrew explained that our voice and visibility do assist the Department officials in bids for funding etc – so all of this was very encouraging and instructive to hear. Gerard advised us to expect an Autumn Consultation on the new Suicide Prevention Strategy. All of them and the CMO wish to maintain these important contacts and conversations in the time ahead. Our input is certainly valued and valuable and we will continue with these top level discussions going forward.

In other news………..back and forward to London these last weeks…..first for the International Congress at the end of June and then back again to present to Council on 15 July as regards our new Capacity legislation (and also the Commission Report on NI). Colleagues in Central College are very interested in legislative developments here, with some envious of the approach we are taking and others a little concerned about the potential, as they see it, inability to detain mentally ill people who retain capacity, with possible consequences for the prisons. In truth, we have heard similar concerns here. Dr Peter Trimble reported the same interest and similar profile of views from the Central Policy & Public Affairs Committee meeting which he participated in on 6 July. The Mental Capacity Act (NI) 2016 is seen as an unique piece of legislation which will attract much attention both in the UK and internationally. It is vital that we, as Clinicians, have a strong influence on the development of the Code of Practice and I am proposing that we begin to do this work now so that we will have a fully informed position as this work is taken forward by the Departments of Health and Justice.

Central College does not currently have a formal position on whether capacitous patients should be able to refuse treatment for mental illness – and this is now on the agenda from the parity of esteem viewpoint. The Registrar has been extremely interested in our legislation’s progress and enactment and is keen to see further progress on implementation. The President has recently co-authored an article articulating a personal view. I understand that Central College Special Committee on Human Rights, takes a similar view thus far.

In summary, Central College awaits Northern Ireland developments with interest as we may inform future legislation in the other jurisdictions. At time of blogging, we have a meeting pencilled in from a PhD student in Australia who is studying the unique approach of our legislation with a view to its influence extending down under! Dr Catherine Taggart and I look forward to sharing our learning in that forum in October.

The International Congress was very successful and it was gratifying to see that there were poster presentations from our NI Senior Trainees at the Congress. Of particular interest was the cross-jurisdiction meeting on 28 June which explored issues relevant to the relationship between the College centrally and the College operating within the devolved administrations in Scotland, Wales and Northern Ireland. Our role seeking to influence policy makers in the devolved administrations means that we have very different needs from the Divisions in England.

More locally, after a couple of meetings and some head scratching we successfully submitted the RCPsychNI response to the Draft Programme for Government Framework 2016-2021. We will keep members up to date with developments from this Consultation over the coming months. I would like to thank Drs Michael Doherty, Peter Trimble, Rowan McClean, May McCann and staff for all their hard work in putting our submission together. The NI Executive at Stormont plans to use an outcomes based approach, following the lead from Scotland and other jurisdictions around the World.

I also had an informative and useful meeting on 27 July with Dr Janine Lynch and Tom McEneaney from local Mental Health Charity, Aware. Both Janine and Tom sit on the NI Perinatal Mental Health Forum, which is part of the UK Maternal Mental Health Alliance. A briefing paper has been produced by the NI Forum on behalf of the UK Alliance’s Everyone’s Business campaign - for use in lobbying for improved service provision across Northern Ireland. All of this is timely, given that RQIA are currently undertaking a review of services in Northern Ireland and will be speaking with a range of professionals including Psychiatrists.

 

Earlier on 27 July, Staff and I met with Beverley Burns, Trading Standards Officer to discuss the issue of scams and their prevalence, especially targeted at our older age population. This was both a salutary and instructive meeting and we hope to further this contact and try to assist this important work in the time ahead.

 

To conclude, there are a number of upcoming events to note in your diary:

We are looking forward to welcoming Dr Peter Byrne to the next General Adult Faculty meeting on 24 August. Dr Byrne will speak on “What disorders take 17 years life expectancy from your patients? – and what you can do about it”. Please contact Nora McNairney if you would like to attend.

 

On 21 September the annual Trainee Presentation Day will take place at Clifton House. The excellent submissions this year for Research, Audit and Dr Thomas Freeman prizes will make for an exciting day of presentations………. more information on booking a place will be available soon.

Kim Catcheside, the new Director of Strategic Communications for the College, will be involved with our Strategy Day on 21 October. I am very pleased that we will be working with Kim to develop a RCPsychNI communications plan that will be tailored to our needs.

 

The plans for World Mental Health Day on 10 October are being finalised so watch this space...

 

Finally, collaborating with our colleagues in the Republic, we have developed an excellent programme for the Winter Conference in November. The preliminary programme and booking information can be accessed through the College of Psychiatrists of Ireland website.

 

June 2016

Another busy month on the CPD front: a number of excellent speakers presented at my first Spring Meeting on 13 May 2016.  Professor Max Marshall, Medical Director of Lancashire NHS Foundation Trust provided an overview on the benefits of mental health trusts. We were also joined by Dr Jon Wilson, Consultant Psychiatrist with Norfolk and Suffolk NHS Foundation Trust who presented on the Norfolk Youth Mental Health Service.  With the range of topics covered it proved to be a thought-provoking day – find out more from our CPD Blog. On 17 May I attended a ‘Musical Supper’ to recognise the Child & Adolescent Faculty annual joint meeting with the Ulster Paediatric Society. A fabulous evening was had by all, especially with entertainment from a local tenor and piano accompaniment.  The joint meeting was a very successful event with the theme of ‘Neuropsychiatry in Partnership’. Delegates heard from a number of local colleagues from different disciplines on tics and Tourette’s, as well as our keynote speaker Professor Mary Robertson who is a recognised authority on Gilles de la Tourette syndrome. I would like to thank Dr Richard Wilson, Chair of the Faculty and also our wonderful speakers. Finally, I introduced the ‘Psychiatrists in Training’ annual summer meeting on 15 June with an overall ‘Out of Programme Experiences’ focus. There was a great level of discussion amongst delegates and speakers on opportunities available for out of programme experiences.

Lord Crisp and Commissioners visited Clifton House on 20 May as part of the Commission to Review the Provision of Acute Inpatient Psychiatric Care for Adults in Northern Ireland. The Commission met with a number of groups, including Department and Trust leads, to discuss the report’s intended recommendations. Lord Crisp and the Commissioners returned to Clifton House on 17 June for the very successful and well supported launch of the report itself. The hard work of College staff to secure media interest in the launch paid off; we were busy for 2 days with interviews! You can view some of the coverage here. We were pleased to hear from the Chief Medical Officer, Dr Michael McBride, who welcomed the report as a contribution to the understanding of the challenges of mental health provision in NI.  Dr McBride discussed the excellent opportunity that ‘exists to make sure that improving mental health is an essential part of all policies to improve social and economic wellbeing’. The College will work with the Department to take advantage of this opportunity to improve mental health in Northern Ireland. Sincere thanks to our Registrar, Dr Adrian James and College staff from London for their support on the day.

 


RCPsychNI Members with Dr Adrian James, Lord Nigel Crisp and Dr Gerry Lynch 

 

La Mon Hotel on 22 June 2016 saw staff and I attend the Together for You Final Conference which brought to a close this very worthwhile three year collaborative venture between nine leading charities in Northern Ireland focussing on mental health. We had a stand at the event and I took part in the panel discussion, sharing the platform with (among others) the newly appointed Ulster Unionist Party spokesperson on Mental Health, Robbie Butler MLA – the creation of whose portfolio is warmly welcomed by the College. Our association with this Big Lottery funded project was generously acknowledged by David Babington, Chief Executive of Action Mental Health (the lead Charity for this initiative). David made the point that the College had been a shoulder to lean on throughout the three years. I do hope that the collaborative working legacy between the charities will endure and I would be keen to continue to facilitate the critically important clinician input to projects such as this. Both the evaluation report carried out by the relevant professionals and the client experiences shared that day, bore witness to the important outcomes achieved by this investment.

 


Dr Gerry Lynch with Health Minister Michelle O'Neill MLA

 

On the fringes of this event, College staff facilitated a hugely important preliminary meeting with our new Minister for Health, Michelle O’Neill MLA, who was the opening speaker. I took the opportunity to further the discussion already begun with the Chief Medical Officer, in relation to the Commission Report and its eight recommendations. The Report was clearly of great interest to the Minister, who indicated that she would like to meet with the College for a more detailed discussion in the time ahead. It was very heartening also to hear the Minister speak of her commitment to championing mental health at the Executive table. This augurs well for us progressing our agenda in the coming mandate.

 

The NI Executive have produced a draft Programme for Government Framework 2016-2021 which is out for public consultation until 22 July. Our Policy Committee has already met once to consider our response and we hope to conclude our discussion at a further meeting on 8 July. It is encouraging to see mental health listed as an indicator for change – our lobbying work to increase the profile of mental health has certainly been worthwhile. However, we have concerns and reservations about the overall direction of the document. Our consultation response will ultimately be placed on the website.

We have a number of noteworthy upcoming events. The trainees will take part in our Research and Audit Presentation Day on 21 September. Further developments have been made to finalise the programme for the Joint Meeting with the College of Psychiatrists of Ireland on 10 & 11 November in Cavan. Booking information will be available on our website soon. A further meeting with the Chief Medical Officer is planned for 22 July, but more on that later ……

 
May 2016

At time of writing Northern Ireland’s newly-elected Assembly members are straight into Programme for Government talks before deciding which ministerial portfolios to take. The share out of the ministries under the d’Hondt formula is not expected to take place until Monday 23 May.  Of course, we’re waiting and watching to see which party plumps for Health, or, if as is in the 2011 election, this somewhat poison chalice is left to the last!  So, we’re post-election and with only six weeks before the 10 week summer recess not too much business or legislation is expected to be completed.  We will, however, use the opportunity to congratulate the new incumbents, re-introduce ourselves, raise awareness that mental health is every Departments’ business and, once again, bring our 5 Manifesto Asks to the attention of all who will listen.  An unprecedented number of references to mental health was evident across all the parties’ manifestos and indeed some parties published specific action plans whilst others cited our manifesto word for word. As I’ve said before the ultimate acid test will be how embedded our Asks become in the PfG but it is gratifying to know that mental health over the last year has never been so prominent both with government and the general public.  We’ll be working hard to keep up the pressure.

The Budget process and the 2016 PfG were the subject of a recent NICVA information session attended by staff; the NI Executive is committed to a more outcomes-based approach for PfG with action points that will shift key indicators and this has obvious implications for those of us trying to monitor progress.  In terms of a timeline we expect consultations of the PfG and development of Actions Plans to take place between June and end of September with Executive and Assembly Approval processes running to the end of December. 

Of particular interest to our POA colleagues will be the report on the Fiscal Implications of an Ageing Population which details the economic impact of our changing demographic landscape – it’s great we’re all going to live longer but scary since with age inevitably comes some level of disability – dramatic increases and real challenges ahead for services.   

 
 

On Monday 9 May the Mental Capacity Bill received Royal Assent and will be known as the Mental Capacity Act (Northern Ireland) 2016.  With much work to do before implementation the Department of Health has sought our assistance in participating in testing (for costing and practicality), in various real life settings, how capacity and best interests assessments would be carried out. All relevant Faculties are involved in this extremely important exercise – a huge thank you to our volunteers – Dr Saleem Tareen, Dr Arun Subramanian, Dr Paddy Moynihan, Dr Rick Bunn, Dr Catherine Taggart, Dr Rachel Smylie and Dr Deirdre Shields.

I am constantly impressed by the number of members actively involved in College activities; towards the end of last month around a dozen trainees and SAS & Affiliate members met and agreed to conduct a survey to help inform the Commission to Review the Provision of Acute Inpatient Psychiatric Care for Adults in Northern Ireland. We managed to cover all the relevant wards in the space of 3 days – and again a huge thank you to all of you who undertook the leg work on this!  Lord Crisp is updating me on the progress this Thursday and we are looking forward to his visit on 20 May when he’ll brief Department and Trust leads, prior to the launch on 17 June.  Our job then will be to work to ensure the Report’s recommendations are realised.

 

On Friday last our Adhoc Policy Committee met to begin to compile our response to the Improving Health within Criminal Justice Consultation; it was helpful to have input from Noel McKenna from our Service User and Carer Committee, who has spent over 10 years visiting prisons in his role on what was the Mental Health Commission.  This consultation calls for input from all specialisms so please do take some time to consider this and give us your thoughts.

 

Separately, but not unrelated, I met with Mark Cavanagh the newly appointed mental health lead for the PSNI.  Whilst setting the world to rights on how to avoid criminalising people with mental health problems, he and I agreed that we’ve been doing the same thing for many, many years and perhaps a new approach, such as the Street Triage System operating within the West Midlands -they report an 80% fall in mental health detentions since employing mental health professionals working alongside police officers and working in a more joined up fashion.  I was impressed by Mark’s enthusiasm and hope to explore further over the coming months.

 

Last week I met with Dr John O’Kelly, Chair of the Royal College of GPs, and together we want to host some meetings to raise awareness of mental health issues for GPs and to give some consideration as to how our professions might collaborate more effectively.

 

I then attended an event organised by the GMC; this was examining the difficult topic of suicides among doctors who are under investigation by them. There was a clear commitment to improve their procedures so as to minimise as much as possible the effects of under such investigations on doctors.  The GMC also acknowledged there was an urgent need to improve communication with, and uptake of, Occupation Health Services within Trusts.

 

Two very successful CPD events took place over April and May; our first ECT Training Day was very well received and very many thanks to all our speakers and our ECT group for convening this. 

We also had a stellar line up of speakers at our Hot Topics in General Adult Meeting on Friday 22 April with Dr Asif Bachlani and Wellington Makala, North East London NHS Foundation Trust.  Asif and Wellington presented on their services for a population of 1 million which was highlighted as a centre for excellence in the report on Old Problems New Solutions – Improving Acute Psychiatric Care for Adults in England.   This service has proactively developed over 10 years to provide timely, appropriate and seamless interventions for 10,000 referrals per year.  The discussions were lively and useful; if you missed this event, the speakers have kindly provided us with a copy of their presentations.

 


L-R Dr M du Feu, Dr A Bachlani, Dr J McConville, Wellington Makala and Dr A Lewis

 

Members have been asking for more physical health topics and this was included in two sessions over the morning period. Dr John McConville, Consultant Neurologist presented on Autoimmune Encephalitis and Dr Anthony Lewis, on Diabetes and Endocrinology.  The afternoon brought out the best in our trainees’ acting skills with an excellent mock Mental Health Tribunal session facilitated by Anne Fenton, Claudine Quinn, Bernadette Hamilton and Dr Paul Bell. 

 

We’re working to finalise our programme for the Joint Meeting with the College of Psychiatrists of Ireland 10 & 11 November in Cavan.  This is an excellent opportunity for trainees to present their work with both oral and poster presentations and our Research and Audit Presentation Day on 21 September offers a solid rehearsal platform. 

 

I attended my first meeting of the College Council; there was a very interesting presentation from the Chief Executive of MIND, Paul Farmer, on the Mental Health Taskforce and there was also a summary of the findings of the final report of the Commission to Review the provision of Acute Inpatient Care for Adults in England. This will clearly be of relevance to ourselves as NI was part of this Commission.  

 

It’s count down to the International Congress – there’s a rich and broad programme over the 3 ½ days; the theme, Psychiatry: Brain, Body and Mind, covers a range of subjects from core science to clinical psychiatry to policy areas and offers 13 keynote lectures and about 70 parallel sessions including a session with Jo Brand in conversation with the President!

 

 

April 2016
 

Plenty of energy has been expended this month again in the local College. Evidencing this was Medfest 2016 co-ordinator Dr David Bell and College staff who lent their support on 16 March 2016 to the launch of the NI Mental Health Arts and Film Festival which involved an energetic walk up the steep one mile Avenue leading to Parliament Buildings, Stormont, Belfast. Anyone familiar with Stormont will attest to the commitment involved!

 
 

Work also has intensified in recent weeks in relation to the Independent Commission to Review the Provision of Acute Inpatient Psychiatric Care for Adults in NI. Here at the College in NI, we are working closely with Central College staff on this project. A survey will be carried out between 20th and 22nd April 2016 in the Acute Inpatient Units across NI; Lord Crisp and the Commission will visit NI and the College here on 20th May for the second time – this time to discuss their findings; finally, the NI Report itself will launch on Friday 17th June 2016. We very much hope that it will lead in time to positive outcomes for local patients and carers. The local College will do its utmost to ensure that the Report has an enduring and positive legacy.

Following our response to the recent Department of Health, Social Services & Public Safety Consultation on Reform of Health and Social Care Structures, I hosted an exploratory meeting at the College on 10 March 2016 with Andrew Dawson, Head of Mental Health Policy Unit and Mental Capacity Bill Project in our Department of Health, Social Services and Public Safety – and also attended by Dr Peter Trimble our Policy Lead, Dr Michael Doherty and College staff. This meeting was drilling down into the best way forward post Board abolition and looking at the merits or otherwise of a single Mental Health Trust for NI being introduced in tandem with the change in the governance arrangements. The single Mental Health Trust idea had been floated in our Consultation response, which had sought a discussion on the idea without commitment from the College at this stage as to its merits. Structure is important but ensuring that the funds for mental health are actually spent on mental health is the critical goal. The Department’s level of interest in our Consultation response is a measure of the influence of the local College and has impressed me in my initial months in this Role. Responding to Consultations is important work as our views are taken into account. It was heartening at the meeting to receive a positive hearing in relation to our manifesto ask seeking funding for the physical health needs of our patients with serious mental illness. Dr Michael Doherty is to be commended on the time and energy he has devoted to this vital project.

 

The window of opportunity for promotion of our Manifesto document (but not our five asks!) has now drawn to a close. Its purpose was to influence political party Manifestos (which are now being issued as the NI Assembly Election campaign gets underway). It is gratifying to see that our work has paid off, with mental health specific asks now featuring in party manifestos. The ultimate acid test will be how embedded they become in the Programme for Government for the next Assembly mandate, which will be negotiated in the fortnight following our election – as part of our mandatory coalition system. As I write, we are already witnessing the inclusion of mental health and our asks in the political party manifestos and broadcasts as they emerge in the run up to our 5 May 2016 Election. I will return to this gratifying development next month…….

 

Welcome news is that our new Mental Capacity Bill completed its journey through the Assembly in March 2016, just in time before purdah commenced in advance of the Election. Further process takes it to the NI Attorney General and later for Royal Assent. A detailed associated costing process is at present underway within the Department of Health and a number of our members will be assisting the Department with their working group on this issue. The concern is that the Bill will remain on the statute book without implementation. The hope, however, is that it will at the very least be introduced in stages over a 4-5 year period. Since budgetary finances are at a premium, the costings process will therefore be fundamental to obviating political concern as to the implementation cost. The local College will play a pivotal role in this important work.

 

Trainee Psychiatrists continue to take part in a roadshow event travelling throughout NI in relation to Depression, in association with local Charity, Aware. It involves our members providing the Clinician analysis and viewpoint at each session, with a different member speaker on each occasion. It has proven to be an extremely effective and successful venture. Recent roadshows have taken place in Newcastle and Enniskillen.

 

I was particularly delighted to see an evaluation of one of our Public Engagement Committee initiatives – ie the "Healthy Me" NI Primary Schools mental health promotion – appear in the Adoption & Fostering 2016 Volume 40 publication. It is written by 2 of our members, Drs Claire McKenna and Clare Bleakley, who deserve a lot of credit for their work. The project itself is a collaboration between our Public Engagement Committee, local Charity Action Mental Health (MensSana) and Step 2 CAMHS in the Southern Health and Social Care Trust. Thanks are also due to Drs Maggie McGurgan and Peter Sloan, Chair and past Chair of our Public Engagement Committee and Dr Hilary Boyd who have all put a lot of time and effort into this worthwhile initiative as well.

Discussions are at an advanced stage with the College in Dublin with a view to a joint Conference in the Slieve Russell Hotel, Co Cavan, Republic of Ireland on 10 and 11 November 2016. The final line up of speakers is currently nearing conclusion. The call for Abstracts for oral and poster presentations has been issued with a closing date of 9 September 2016 and I would encourage Trainees to make submissions. Watch this space for further developments!

 

On 18 March 2016 College staff attended the official opening of the local Charity Mindwise new offices at Pinewood House, Newforge Lane, Belfast where the Mental Health Guide for Criminal Justice Professionals, commissioned by our Department of Justice and developed by Mindwise and entitled Mental Health & Wellbeing and Personality Disorders was launched by our outgoing Minister of Justice, David Ford MLA. This links very well with the words of our host Alastair Ross MLA and our main speaker Dr Geraldine Strathdee CBE, National Clinical Director Mental Health NHS England at our recent Manifesto launch when both stressed the critical importance of mental health issues being flagged and given practical support right across all aspects of society.

 

On 21 March 2016 I participated, along with College staff, RCPsych in NI Service User representative/Independent Acute Inpatient Psychiatric Care for Adults Commissioner Robert Milligan and other members of RCPsych in NI including the Chair of RCPsych in NI Old Age Faculty Dr Deirdre Shields – in a Workshop to discuss the findings of the Regional Audit of Assessments under the Mental Health (NI) Order 1986 in the Lanyon Building at Queen’s University, Belfast. This was an instructive event with important learning to be derived for mental health services in NI.

 

On 31 March 2016 College staff attended local Charity Aware 20th Anniversary event entitled “Depression – What works? For You, Your Workplace and NI” at the Exhibition Centre, Europa Hotel, Great Victoria Street, Belfast and addressed by a number of speakers including my predecessor as RCPsych in NI Chair, Dr Diana Day-Cody and also Terry Waite. Depression and Bi-Polar disorder were examined in detail and Dr Cody provided a very useful explanation of both and their usual treatments. This was a fitting high profile conclusion to Dr Cody’s term of office and Terry Waite commended Aware for their collaboration with Clinicians. Another important document was launched at this event entitled Work in Progress – Improving Employment Outcomes for People with Depression UK Report. Its content has been developed by Aware, Depression Alliance, Action on Depression and Gofal and it is another important contribution to widening consciousness of the impact of mental health.

We brought an important local focus to the issue of Recruitment by supporting Dr Noel Crockett, who in March 2016 again attended the annual Medical Information Evening in Altnagelvin Area Hospital on behalf of the local College. This event is aimed at school students from the final years Derry/Londonderry City and County schools and the full range of medical careers is represented. My sincere thanks to Dr Crockett for his commitment to this vital work over the years and I am very pleased to pass on his confirmation of a healthy interest in Psychiatry, with good numbers interested in talking through with him Psychiatry as a career.

 

My thanks also to Dr Margaret du Feu, our Chair of General Adult Faculty, who attended

a meeting in London on 4th April 2016 about young carers in her capacity as NI representative on the Central College General Adult Faculty Executive. The document under discussion was The Triangle of Care for Young Carers and Young Adult Carers – A Guide for Mental Health Professionals. The document makes it clear that although the terminology and legislation referred to in this guide applies to England the standards and rationale are applicable across the whole of the UK. It is worth a read.

 

We hosted a very successful and well attended Interdisciplinary Conference on Functional Neurological Disorders in association with the Association of Chartered Physiotherapists interested in Neurology and the British Psychological Society NI Branch, on 11 March 2016 at the Wellington Park Hotel, Belfast. A lot was gained from the collaborative day and if you missed the event, you can catch up with its content by going on to Dr Ajwad Mobayed’s blog on our Website. My thanks to Dr Peter Trimble and all involved in planning and hosting this major event.

 

 

So…..another busy month all told……I am off to attend the GMC Workshop on changes to reduce the impact of fitness to practise processes on Doctors. This follows from an independent review commissioned by the GMC of cases where Doctors completed suicide while under investigation (-the review was published in December 2014).  The GMC is expressing a commitment to reduce the impact of its procedures on Doctors, which is to be welcomed. I will report on the workshop next month…….

Finally……really looking forward to attending the International Congress in London from 27-30 June 2016. The programme looks wide and varied with lots of interesting events and speakers.

 

Dr Gerry Lynch

 
 
 
March 2016

First a word of sincere thanks to outgoing Chair and Vice President, Professor Diana Day Cody, for all her labours for the College over the last three years. It is an exciting time to take over the role of Chair of the College in Northern Ireland and Vice President of the College, with Mental Health ever more firmly rooted in public discourse.

 

Another important word of thanks to Dr David Bell who led Medfest both internationally and locally this year. The Belfast event on 17 February 2016 at Queen’s Film Theatre was a resounding success, helped in no small way by the attendance and participation of the College President, Professor Sir Simon Wessely. I am grateful to all involved in this.

 

MedFest Organisers 2016

 

The promotion of our Manifesto for the 2016 Assembly election remains at the top of our Policy agenda here in NI for so long as the window of opportunity still exists to influence political party Manifestos and ultimately the Programme for Government for the next Assembly mandate.

 

So it was that a significant number of our members and staff participated on 24 February 2016 in the inaugural Summit on NI Mental Health, which was hosted by local Charity, Action Mental Health. This highly influential event saw 250 people packed into the ballroom of the Stormont Hotel to hear, among others, from Minister for Health, Simon Hamilton MLA and from Andrew Dawson who heads up the Department of Health’s Mental Health Policy Unit and Mental Capacity Bill Project.

 

Our Manifesto asks were heavily promoted at our stand at the event, in numerous networking opportunities and also in the afternoon breakout sessions which involved Department officials. It was gratifying to discover that our asks are resonating so well among the politicians who attended from the 5 main parties – and also within the sector in general.

 

One fruit from the event will be a working document, which will be submitted to the Department of Health and the Health Minister, pointing the way towards how to prioritise mental health and service provision in the next Programme for Government for the life of the new Assembly.

 

One of our asks is a Champion for Mental Health and the experience shared by Natasha Devon MBE from her Mental Health Champion work with schools in England, was very instructive. The event received a special message of support from former No 10 Spokesman and Press Secretary Alastair Campbell.

 

The month also saw members and staff at All Party Groups at Parliament Buildings, Stormont. We had the inaugural meeting of the All Party Group on Suicide on 29 February 2016 where the Zero Tolerance on Suicide models in Merseyside and Detroit were explored. Very insightful and important Clinician contributions were made from the floor by former Chair, Dr Philip McGarry. The discussion was led by Maeve McLaughlin MLA as an exploration of the principles involved in these schemes and whether some or all of them would be appropriate in the NI context. We learned that the zero approach would apply only to those already involved with services and operate on a consequent duty of care basis.

 

The following day we had the All Party Group on Mental Health addressed by Dr Janine Lynch, Chair of RCPsych in NI Perinatal Faculty and seeking a dedicated facility for Perinatal Services in NI. The fact that no such facility exists on the island of Ireland was highlighted and a Service User spoke in glowing terms about the specialist work Dr Janine Lynch had done with her and its critical importance to her recovery. The All Party Group meeting added further momentum to the issue following on from the BBC NI Health Correspondent interview of Dr Janine Lynch here at Clifton House and broadcast both on BBC Radio Ulster and on BBC NI Television on 24 February 2016.

 

College staff were also present at the inaugural Child Health Debate, also in Parliament Buildings and also on 1 March 2016, which featured 4 of the 5 main political parties. Also in attendance was Dr Richard Wilson, Chair of RCPsych in NI Child and Adolescent Faculty. The question and answer session with our politicians was a useful pre-election exploration of many issues common to our members who work in CAMHS. We were also very keen to support our staff and member colleagues in RCPCH in NI whose NI office was set up a couple of years ago. In that regard staff had hosted a pre debate meeting with the RCPCH in NI staff here at Clifton House on 23 February 2016, which is part of a regular networking and shared learning with them.

 

We put a high value on the benefits of collaborative working, particularly with our Policy counterparts in membership health organisations based in NI, and so it was that 1 March was rounded off with a meeting with the newly appointed Policy Officer in RCGP in NI, Clare Higgins. This engagement has already led to contact being made to set up an early meeting between myself and Dr John O’Kelly, who is Chair of RCGP in NI.

 

College staff similarly valued a teleconference engagement on 2 March 2016 with their Policy staff colleagues in Central College, Scotland and Wales. Thanks to the initiative of the Registrar, Dr Adrian James, we are looking closely at improved collaborative working with a special focus on cohesion, avoidance of duplication and optimum use of staff time.

 

As newly elected Chair, I have already been involved in detailed briefing meetings here in Clifton House, as well as playing a key role at our well attended Policy Committee meeting on 5 February 2016 convened by Policy Lead, Dr Peter Trimble. Its main focus was the DHSSPS Consultation on Reform of Health and Social Care Structures and from that meeting our College response was drafted and later submitted. The abolition of the Health and Social Care Board recently announced by Health Minister, Simon Hamilton MLA, will continue to dominate my agenda in my initial months in office. We were pleased to be invited by DHSSPS to a meeting of representatives from different professional groups and specialties about getting the structures right post Board abolition, at Castle Buildings, Stormont on 10 February 2016. Dr Peter Trimble and Dr Paddy Moynihan Chair of Rehabilitation and Social Faculty, represented the College. The meeting explored the Consultation responses and encouragement was taken from the potential for an emerging consensus on the way ahead. Linked to this is a forthcoming exploratory meeting to focus on the idea of a single Mental Health Trust for NI…………….but more on that next month!

 

More too next month…………… on the work associated with the Commission to review the provision of acute inpatient psychiatric care for adults in NI…………with the agenda to take us to its June 2016 launch in NI being finalised as this is penned.

 

We will also have news on the Medical Careers Fair in Altnagelvin where we focus on local Recruitment…………..

 

Dr Gerry Lynch

 

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Dr Gerry Lynch

Dr Gerry Lynch, Chair RCPsychNI

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