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

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29/06/2017 10:43:45

RCPsychiS June 2017

Our blog this month is written by our outgoing Chair, Dr Alastair Cook.

 

Dr Alastair Cook - October 16

Dear Friends and Colleagues,

As I write the International Congress is in full swing in Edinburgh once again. This year at least it is taking place before the schools break up for the summer holidays. Scottish Psychiatrists are prominent as both speakers and delegates and so far the event appears to be going very well and 2400 psychiatrists from around the world will leave Edinburgh with a very positive impression.

The last time Congress came to Edinburgh was 2013. At that time I took over as Chair of the Royal College of Psychiatrists in Scotland from Peter Rice. On this occasion I am handing that privilege to John Crichton, who will lead the College in Scotland over the next four years as Chair in Scotland and Vice President (Scotland) of the UK College.

 

A handover seems like a good time for reflection. Being Chair for the last four years has been one of the most enjoyable experiences of my career to date. Working with the other Officers, Faculty Chairs, Regional Advisers and Executive Committee Members has been fun and I hope also productive.

 

We started out by agreeing a work programme that included a continued focus on recruitment and retention, trainee engagement and ongoing support for consultants through mentorship and training. Our progress on recruitment has been limited but mirrors experiences in other parts of the country and other specialties.

 

We initiated a working group to look at perinatal and infant mental health resulting in the Healthy Start Healthy Scotland campaign and have followed that up with a working group on personality disorders that will report this year.

 

There is now recognition in the central College that the offices in the devolved nations can no longer be regarded as regional divisions and that a new constitutional arrangement is necessary. A paper proposing the creation of devolved councils of College for Scotland, Wales and Northern Ireland will come to Council in July and is expected to be implemented in 2018. Greater autonomy for the College in Scotland will need to be matched by improvements in resources and there is commitment to build on this within the College, helpfully supported by the new Chief Executive, Paul Rees and our new President, Wendy Burn.

 

I have particularly enjoyed working with our third sector colleagues to build the Scottish Mental Health Partnership. The Partnership has had some influence in the early stages of the new mental health strategy but needs to build a greater role in the monitoring and ongoing development of new commitments and describing a new framework for mental health services in our integrated world.

 

Being Chair can be a challenge, especially when trying to fit the College role into an already busy job. All College roles add to our workload but in my experience the rewards far outweigh the costs. This is only possible because the College in Scotland is supported by an amazing group of staff in our Queen Street Office.  My own personal highlight of the four years will be the 20th anniversary dinner we held during the autumn meeting in 2014. The 20 year celebration marked not only 20 years of a College office in Scotland but 20 years of Karen Addie as manager of our office. Karen has been supported by many staff over the years but Angela Currie, Susan Richardson, Rebecca Middlemiss, Laura Hudson and latterly Elena Slodecki have all been crucial supports during my time in office. The team do so much to make the job of the Chair and other officers possible. I can’t thank Karen and the team enough for their support over the last four years.

 

Would I do it again? I would recommend a College role to anybody who is willing and interested in contributing. The rewards are great and the work well supported by the team. I’m looking forward to continuing to contribute from the sidelines as John and Linda Findlay, our new Vice Chair take over and hope they have as much fun over the next four years as I have over the last four.

Dr Alastair Cook, Outgoing Chair of the RCPsych in Scotland

 

09/03/2017 10:18:41

RCPsychiS March 2017 Blog

 

This month we are delighted to welcome guest blogger Dr Stephen Potts, Chair of the Liaison Faculty in Scotland. Dr Potts is a liaison psychiatrist who has also worked part time for many years to pursue a parallel career as a writer, initially as an author of adventure fiction for children, and latterly as a screenwriter specialising in historically set adaptations. He has written eight feature films and one TV drama. He is now acting as an independent writer/producer to make a feature film based on the book Anatomy of Malice by Professor Dimsdale. We were lucky enough to have Dr Potts speak at the recent RCPsychiS Winter Meeting in January this year.  The theme for the meeting was "Fear and Psyche" and  Dr Potts presented on "Antomy of Malice: A psychologist and psychiatrist compete to understand the minds of Nazi war criminals on trial at Nuremberg".  In this months blog Dr Potts provides us with an overview of this fascinating project.

 

For more than 20 years I have worked part time in psychiatry to pursue a parallel career as a writer, latterly of screenplays. These worlds did not intersect until I went to a medical meeting in Nuremberg, then sweltering in a July heatwave.

I knew of Nuremberg’s notorious pre-war history as a centre of Nazism, the setting for huge rallies, and I wandered round the Zeppelin fields where they were held, which still felt sinister and forbidding.

I also knew about the post-war Nuremberg trials, where leading Nazis were prosecuted for war crimes by the victorious allies. But I did not know about the part played by mental health specialists in the first and best known of these trials, in which the surviving political and military leaders of Nazi Germany were held to account.

A very eminent American psychiatrist, Professor Joel Dimsdale, of the University of California in San Diego, has been researching this subject for some years, and he presented his findings at a keynote address which opened the conference — and which was held in the very building where the Nuremberg trials took place 70 years earlier.

He recounted the story of Dr Douglas Kelley, a US Army psychiatrist assigned to the trial, and Dr Gustave Gilbert, who translated for him and acted as the prison psychologist. Together and separately they assess all the leading Nazi defendants, with repeated interviews over an extended period.

They were assigned several roles: to prevent the defendants committing suicide; to advise on any use of the insanity defence; and to guide the tribunal (ie the prosecution) in the conduct of the proceedings. They had unique access to the men responsible for the war and some of the worst atrocities committed in it. They saw an opportunity, indeed a duty, to understand, and then explain to the world, the workings of that they called “the Nazi mind.”

They began by co-operating, and planned a jointly authored book, but tensions soon emerged, and they fell out spectacularly. Kelley left the trial early, with Gilbert alleging he had taken some of his records. Each then published their own books, delayed by arguments about intellectual property and threatened  lawsuits. The work they did together did not feature prominently in either publication.

As to their roles: one of the defendants (Robert Ley) killed himself before Gilbert took up his role but after Kelley had warned of the risks in his particular case. Another, the most senior, Hermann Göring, took cyanide the night before he was scheduled to be hanged. In just one case, that of Rudolf Hess, a special hearing was held to determine his fitness to plead, in view of very obvious memory problems. Before the Tribunal came to a decision, Hess, who had been warned by Gilbert he might be found unfit, shocked the world by announcing he had been feigning amnesia. He was judged fit, along with all the other defendants. Gilbert’s recommendation that Göring be separated from the other defendants successfully undermined his attempt to rally them  — and a defeated Germany  — behind him as he mocked and browbeat the lead prosecutor.

The conflict between Kelley and Gilbert may have been intensified by the pressure-cooker atmosphere of Nuremberg, where the trial was closely followed by the world media.  There were many elements to it: but in some ways the most interesting is the apparent contradiction between their professional disciplines and their understanding of the ideology of Nazism.

Gilbert, the psychologist, placed the Nazi leaders in a separate category, distinguished from the rest of the population by extreme abnormalities of personality. Kelley, the psychiatrist, took a different view, arguing that they displayed personality characteristics which could be found throughout the public, and especially among those in positions of power and responsibility.  Kelley’s message was unpalatable at the time, but it might find greater acceptance these days.

I was fascinated to hear this, and it immediately struck me as a story crying out to be dramatised. After trying to make myself memorable to him at the conference dinner by donning a kilt in 100 degree heat, I asked Professor Dimsdale if I could review in advance the manuscript of the book he was about to publish. He kindly agreed, and when it came, I read it in a single sitting. (I recommend it highly.)

Having then optioned the screen rights to the book, I began writing the screenplay. Before it was complete I pitched the project at the American Film Market in LA, where I hooked up with a producer. I finished the script at the turn of the year, and the producer likes it enough to want to make the film!  All we need now is $15 million…

 

Dr Stephen Potts, Chair of the RCPsych in Scotland Liaison Faculty

 

15/12/2016 10:59:19

RCPsychiS December 2016 Blog

The mince pies are starting to appear at meetings and turkey is on the menu for team lunches and ward night outs. The Christmas hysteria seems to start a little earlier each year and all the old favourite festive songs start to dominate the airwaves.Dr Alastair Cook - October 16

It’s a time for reflecting back on the previous year and hopefully looking forward to fresh starts, new commitments and new plans.

It is hard to be positive about the year that has just passed. Big events such as Brexit, the US election, political uncertainty in the rest of Europe and the awful situations in Syria, Yemen and Iraq make the world feel a very uneasy and uncertain place.

Closer to home the junior doctor’s dispute in England, ongoing recruitment and retention problems and the emerging crisis in General Practice reflect a sense of unhappiness in our profession as a whole. We have lived with “austerity” for 9 years now and the impact is really beginning to bite. Efficiency savings have trimmed any fat that could be found and we are all facing the reality of real cuts to front line services, even in the supposedly “protected” NHS.

Austerity has had bigger effects on our new colleagues in the integrated world. The pressures on social services are making headlines as I write and there is a real sense of inevitability about rising demand for social care as our population lives longer with more long term conditions. People with greater complexity of need are spending shorter periods in hospital and our society demands that discharge is supported by higher levels of input by both paid staff and the huge army of unpaid carers that we need to support to continue doing what they do.

For our patients the real stresses of an unsympathetic benefits system, cuts to social services and third sector supports and difficulties in Primary Care make it more difficult to see where the light at the end of the tunnel can come from.

So where can we find glimmers of hope for 2017?

We will have a new mental health strategy for Scotland in early 2017. There will be a focus on prevention, early intervention, an improved range of options available to manage mental health difficulties in primary care settings and hopefully a commitment to begin to address the scandal of premature mortality amongst those with severe and enduring mental illnesses. The politicians “get” the need for more parity between mental and physical health and we have to hope that the review of targets by Sir Harry Burns will result in a shift away from the obsession with access to unscheduled care and more emphasis on good holistic outcomes.

For all the potential risks in Health and Social Care Integration there are real potential benefits if we can use this as an opportunity get closer to our GP colleagues as well as those in Social Work and other services. The potential to shift the balance of care from acute to community will only be realised if those of us with experience of delivering this successfully in mental health and learning disability services can influence the wider health and social care system and help them learn from our mistakes and our successes.

As for the big picture..... we can only hope that common sense prevails over some of the rhetoric and that 2017 brings a new sense of hope and optimism in the word.

To quote a festive favourite: “A very Merry Christmas, and a Happy New Year, Let’s hope it’s a good one, without any fear”

Alastair

Dr Alastair Cook, Chair of the Royal College of Psychiatrists in Scotland

27/10/2016 12:06:36

RCPsychiS November 2016 Blog

Our Blog for this month is written by Ella Robertson. Ella is one of the Service User members of the Child and Adolescent Faculty of the College in Scotland. As part of our programme of engagement with Scottish Political Party Conferences we organised a joint Fringe meeting at the SNP Conference in the SECC in Glasgow on the 14th October with our friends and neighbours, the Royal College of Paediatrics and Child Health. Despite our Fringe meeting being in the furthest venue from the main auditorium (truly on the “Fringe”) we had a reasonable number of delegates attending. We were very grateful to Maree Todd MSP for the Highlands and Islands who Chaired the meeting and, of course, to our excellent panel of speakers. I will let Ella tell you about her involvement.
Karen Addie, Manager, RCPsych in Scotland.

 

SNP Party Conference Speakers at Fringe

This month I was lucky enough to be invited along to the Scottish Nationalist Party’s Conference to discuss why prevention is better than a cure for young people’s mental health. I joined Dr Anne McFadyen Consultant Child and Adolescent Psychiatrist and Dr Shiuli Russell, Consultant Paediatrician to make up the panel.

 

Each of us did a small individual talk; I focussed mine on education and what can be done in schools to improve young people’s mental health which is, as we all know, a growing and very current issue. I advocated an approach of transparency and honesty around mental health based on a three prong approach:

 

1.   Providing young people with the facts about Mental Health 

2.   A school culture of openness around Mental Health

3.   Links between schools and Mental Health services to improve knowledge of what help is available

 

The hope is that by following these three themes an environment can be created in schools where nobody is afraid to discuss their own mental health, or caringly enquire as to how someone else is mentally. In addition, awareness of the facts around mental illness, as well as exposure to the treatments and staff who are in place to support anyone experiencing issues, will hopefully provide a large knowledge base; reducing confusion, and with that fear.

 

My hope is that through developing these areas we can create a world where there is no stigma or fear around mental health and young people are empowered to ask for the help they need, and know where to get it.

Ella Robertson, Service User Member, Child and Adolescent Faculty, Royal College of Psychiatrists in Scotland

 

22/09/2016 13:11:44

RCPsychiS October 2016 Blog

 

Personality Disorder - Raising awareness, raising expectations and raising hope

I am beginning to realise just what the College in Scotland means to me, as I look forward to a range of events and projects in various stages of planning with some excitement. I have served on committees in the college at different times as a trainee and a consultant, and recently as chair of the Medical Psychotherapy Faculty in Scotland. I have helped organise many interesting psychotherapy conferences, secure in the knowledge that the organisational and planning skills of the college staff are behind me to keep things on track. I could easily lapse into thinking that this kind of internal professional focus is the main purpose of belonging to the college and trundling along to meetings. I am aware, however, that I have been increasingly impressed over recent years by the ambition of the executive committee to engage in a more public and political way with subjects to do with mental health in Scotland. I am not sure my own performance during media training singled me out as destined for the limelight – but the aim of putting ourselves into a more vocal position on subjects that perhaps do not get the attention they should on behalf of our patients seems to me to be absolutely right.

 

 

A lot has been made recently about the issue of parity of esteem for mental health (“No Health without Mental Health”). My own area of interest throughout my career has been working with people with a diagnosis of personality disorder, who could be said to be one of the least well provided for groups of patients within mental health. This puts them at the bottom of the list twice over; the least deserving patients in the least deserving end of healthcare! It can often feel that way as a clinician too, when trying to advocate for better care and treatment services, but feeling at the bottom of everyone’s priority list. It has felt at times over the past 10 years in my clinical job like a losing battle to engage managers and colleagues to take a sustained interest in this group of patients, even though our knowledge and understanding about these conditions has continued to grow, alongside some therapeutic optimism and pockets of expertise in some of these therapies.

 

There have been some rays of light in the gloom in Scotland, like the Scottish PD Network, which has brought together clinicians, service users and carers to share experiences and expertise in a lively conference format, and the progress in some health boards with developing and implementing better care pathways for people with personality disorder. Now, it feels as though a bit of momentum is gathering, as the college in Scotland has chosen personality disorder as a theme to pursue following the last strategy day. Rather suddenly at the end of last year, I found myself agreeing to chair a Short-life Working Group on personality disorders for the college. I had fears that this might involve me sitting in a room with Karen, waiting for anyone who might turn up. I have been extremely pleasantly surprised by the level of enthusiasm so far, with many people from across the college faculties coming forwards with interest and ideas, wanting to identify themselves with this work, and bringing a wide range of experience and knowledge. We have met several times since the start of the year, with representatives from service users, nursing, social work, police, psychology, AHPs all contributing.

 

We have started on a number of strands of work, including a survey of the current status of specialist and general services for people with PD in Scotland (this is being led by 2 higher trainees, and is based on a similar survey in England by kind permission of its authors), and a survey of training models for staff. I have a bit of a passion for engaging people’s interest and enthusiasm through training about personality disorder, and will be interested to gather views about what are thought to be the core components that are important. My guess is that improving understanding of the development of personality difficulties, and consequently improving staff’s capacity for empathy might be key.

 

We have been offered the next forum of the Scottish PD Network on Wed 19th October to present some of the progress so far, and to gather in a wider stakeholder group’s opinions. The day will be a combination of talks and opportunities to feed in to the process, and I would encourage anyone with an interest to come along. https://www.eiseverywhere.com/ehome/184866

 

We plan to work on a document next year for the college, to describe the current status of care for people with personality disorder in Scotland, and a good practice guide. My hope is that this piece of work raises the profile of this group of patients and encourages discussion and engagement within the profession, as well as in the public domain.

I am in awe of the campaign “Healthy Start; Healthy Scotland”, and hope that we can in some way emulate the success of this. We would all support the work that should be targeted on preventing mental health problems by early intervention, but we must not neglect those for whom difficulties persist into adolescence and adulthood.

 

Andy Williams, Consultant Medical Psychotherapist, Chair of Medical Psychotherapy Faculty in Scotland

 

20/07/2016 11:42:49

RCPsychiS July Blog

International Congress: a Pathfinder Fellow's perspective

 

The Royal College of Psychiatrists held its long-established International Congress in the ExCeL International Convention Centre in London in at the end of June. Spanning over 4 days, with hundreds of lectures from countless distinguished speakers giving talks based on this year’s theme of ‘Brain, Body and Mind’ and around 3000 international delegates in attendance, the sheer scale and scope of the Congress was hugely impressive and very exciting to be a part of.

 

Day 1 of the Congress kicked off with a key note lecture from President of the College, Professor Sir Simon Wessely who discussed some of the challenges psychiatry as a specialty faced. This was followed by a lecture from the highly eminent winner of the Nobel Prize for Medicine Professor Sir John O’Keefe who discussed the function of the hippocampus as a cognitive map. As a final year medical student who is extremely interested in psychiatry, I am still shocked to find that psychiatrists and their patients are often stigmatised by other doctors and students within the medical profession. I thus chose to attend a parallel session exploring recruitment of medical students into psychiatry and the innovative strategies which have been developed in order to maximise recruitment into this fascinating and constantly evolving speciality. Finally, the day closed with an extremely memorable discussion on Scientology and psychiatry.

 

The remaining 3 days of the Congress continued to be as interesting and diverse as the first. Particular highlights for me included lectures on concussion and CTE, an area of neuropsychiatry which is becoming increasingly controversial and gaining greater recognition in the public domain as a result of its recent portrayal in the film Concussion. Other highlights included discussions on functional disorders in neurology and a conversation with the comedian Jo Brand to name but a few. 

 

The International Congress was a hugely stimulating and fascinating experience and is something I thoroughly enjoyed. The sheer variety and breadth of the Congress and the findings discussed at various research presentations emphasised that there has never been a more exciting time to be a psychiatrist and confirms psychiatry’s place at the forefront of medicine.

 

Clare Langan

Royal College of Psychiatrists Pathfinder Fellow & Student Associate  

 

 

 

 

08/06/2016 11:20:46

RCPsychiS June Blog

Dougie Pickering The meanings & learnings of experience (and life, not Monty Python style), and how we can all develop in our own journeys and still be an ‘aid’ to those around us, and to ourselves at times.

 

These ramblings are brought about as I head to the end of my Term of Office as Co-Chair of the Colleges UK Service User Forum, which is in effect, a Special Committee of Council.  This is a group of wonderful, committed (though I shall resist mentioning names of the one that do need committed), and passionate people around Service User Involvement & engagement.  It is a 30 strong Committee, and on a good day I like to describe it as ‘being worthwhile Chairing a Committee of ‘Activists’, and on a poor day the narrative may change to ‘Trying to Chair a bunch of bloody militants’.  Have I enjoyed it? Oh yes, and I have also learnt a great deal, from my own acquired ‘skills’, to how others ‘operate’, and the joys of trying to work with the processes, egos & politics of the College.

 

By the end of my Term, I shall have completed three years & six months as Co-Chair, as I seem to have had an added sentence somewhere along the way.  Actually, it was the (surprise) takeover of the ‘job’ in January 2013 that added to my time.  Like all those elected within the College, you get a nice wee letter saying you were elected, and in my case it said ‘from Congress’.  And so, though gobsmacked at being elected (there were 5 five Nominees), I turned up to the January Meeting in the sure and certain knowledge that I had 6 months to ‘learn’…. only to be told 15 minutes before the Meeting started that we ‘were in the Chair’ with me thinking that’s not all I’m in! 

 

I started my ‘work’ with the College with the Exec Committee in Scotland, and as I sat there quivering, I was at the same time hugely impressed with the knowledge, passion & commitment within (the sunken room) of the BMA in Queen Street.  I thank each & every one of those members of the Exec, both past & present.  You have all, one way or another, helped, supported and encouraged my involvement.  I can only be pleased about that, and also pleased my own Consultant never turned up/became a member, as that may have caused me to run looking for another ‘shrink’ if I could find one in such a place.

 

From there, I was invited to join what was in those days, SURF, The Services User (&) Recovery Fora , and from there to the elected elevated Co-Chair, a hugely rewarding and fascinating experience (most of the time!).  I did need the ‘elevated’ part, as I stand all of 5ft 5 (and a bit) inches, and at my size and age, all little bits count.  I was for making changes (o the power), and one of the first changes was the Committee’s wish to get rid of the word Recovery, as even back then, there was a feeling that it had been ‘hijacked’, not least by the political elite, and so it was duly struck from the name.

 

If, just if, I have any ‘doubts’, it would be around future Service User & Carer engagement by the College.  For many years we/you were streets ahead of the other Colleges, but with all the massive changes in Prescot St, and personnel, I do have some fears that there may be changes afoot, be it to ‘budget better’, or to change the make-up of the way things have been previously done.  I believe that would be a mistake.

 

I have been hugely honoured and pleased to have done the job in London, and it is/was done with the aid of those on Council (and other people on other bits). A huge thanks has to go to them all.  But the biggest thanks has to go to all those in Scotland, who have aided, encouraged & helped me come forward on my journey.  I’m an unsocial wee git at the best of times, hence why I probably got elected, as everyone knew I wouldn’t be looking to grab the limelight and hear my own voice all the time, so well done.

 

Thank You all

 

Dougie Pickering -  Service User

(and occasional Doctor when I am recorded wrongly on the Minutes of meetings)

 

PS  Like all good Service Users, I of course reserve the right to change my mind at any time.  Have fun, and keep up the good work

 

03/05/2016 13:01:04

RCPsychiS April Blog

Despite all the negative headlines surrounding the junior doctors’ contract in England, there has never been a more exciting time to be a trainee doctor in psychiatry.  New discoveries are being made about the pathophysiology of mental illness; for example through advanced neuroimaging techniques.  Experts predict significant advances in the treatment of mental illness during the lifetime of current trainees in psychiatry.  This is likely to spur increased investment in the research of mental illness.

With such exciting advances in the field of mental health, psychiatrists will remain in high demand by healthcare providers to deliver much-valued care to some of the most vulnerable members of our society.  In an effort to promote recruitment into psychiatry, the Royal College of Psychiatrists in Scotland is holding a Foundation Doctors’ Evening on Tuesday 10th May 2016 (to which medical students are also warmly welcomed) in order that those considering a career in psychiatry can find out more about the field, how to apply, and how to maximise their application score!  Foundation Doctors who are considering a career in psychiatry, but who were unable to get a Foundation rotation in psychiatry, may find this particularly appealing and attendance certificates are available for your portfolios. 

Anti-BASHSimultaneously, along with the scientific developments in the last great social taboo, mental illness is rightly being more frequently discussed in the public domain, along with the dispelling of many of the myths surrounding mental illness; and helped by high-profile campaigns and celebrities discussing their experiences of mental illness.  In 2016, stigmatisation of psychiatrists and their patients still exists by other doctors in the field of medicine.  This is most disappointing as in my experience society tends to look to doctors as role models.  A recent survey has suggested this stigmatisation and negative comments about psychiatry impacts adversely on medical student recruitment into psychiatry: whilst on the converse, as a psychiatrist, I was interested to read that 27.1% of survey respondents agreed with the statement that doctors who ‘badmouth’ other specialties ‘are insecure in their own career choice’! 

In order to help tackle the stigma of mental illness within medicine, The Royal College of Psychiatrists is supporting the Anti-BASH (Bad-mouthing, Attitudes and Stigmatisation in Healthcare) campaign. You can find out more and get involved here.

Although perhaps these are not reasons alone for becoming a psychiatrist, the specialty has many other attractions: it allows for the treatment of both mental and physical health (psychiatrists are responsible for the medical care of their inpatients); the further development of professional communication and team working skills (a highly sought-after transferable skill by employers); the opportunity to work closely with consultants; weekly release for teaching; mandatory weekly supervision (think of this as mentoring with your consultant supervisor); the chance to help very vulnerable people; the potential for research and academia; the many different psychiatric sub-specialties; and the many challenges associated with diagnosis, treatment resistance, behavioural management; and enjoy the excellent work-life balance!

However, by far the most interesting aspect of psychiatry for me is the variety found in patient presentations to psychiatry.  Mental illness can present in so many different ways, and patients can present with such varied and interesting delusions and hallucinations, while others may be, for example, rescued in crisis at the top of a bridge. Each day I go into work not knowing what to expect, other than to expect to be challenged and interested!

If this stimulates your interest to learn more, then please come along to the Foundation Doctors’ Evening on Tuesday 10th May 2016.

I look forward to meeting you there!


Dr Allan Campbell M.B.Ch.B.
Core Psychiatric Trainee (LAT)

08/03/2016 13:59:37

RCPsychiS March Blog

RCPsychiS Lib Dem HSHS Fringe MeetingBeing Chair of the Child and Adolescent Faculty of the RCPsychiS comes with many challenges, the main one being that there aren’t enough days in the week. Enhancing the profile of the Faculty, of child and adolescent psychiatry, and of CAMHS in general is one of my many missions. Why? Well, to debunk some myths for a start. A lot of people including politicians and other professionals have some rather interesting ideas about us. I am also keen to promote the idea that everyone has a role in promoting mental health and tackling stigma. And to let young people know what a great career it is. Yes, that old ‘recruitment’ chestnut.

 

Our Faculty has been delighted to welcome our 2 Service User Reps, Ella and Jack, who are now well engaged and contributing a lot to our Executive Committee. Both have written pieces for the UK Faculty’s Newsletter and Ella gave a presentation at our AGM in November which was well received. Her focus was first, on her own experience, what worked, what didn’t and why; second, on how to improve awareness of issues and services; and third, to develop links between service users and the reps with the aim of getting good feedback and taking forward other initiatives such as developing programmes for schools.

 

I was really pleased that Ella was able to join Ereni Skouta and me last week, 1 March 2016, at the Scottish Parliament for the Child Health Debate. The format was basically a ‘Question Time’ one, with Peter Fowlie, Chair of the Royal College of Child Health and Paediatrics, in the role of David Dimbleby. Five parties were represented, Green, SNP, Libdem, Labour and Conservative, and MSPs answered questions, some of which had been tabled in advance. Lots of the questions were about Child Mental Health. This was great for us and we had an opportunity ourselves to ask questions. Ella was one of 3 young people given the floor. Her question “What changes would you be willing to make to the PSHE course in the Curriculum for Excellence to ensure young people have a better understanding of mental health?” got a positive response and maybe even some commitment to support changes to the PHSE (Personal, Health and Social Education) curriculum in schools. My own question about parity of esteem was also met with positive comments, and afforded the panel an opportunity to reflect on progress so far and their affirmed commitment to further developments in CAMH Services. Of course there were also comments about waiting times and I had a sense that the idea of stepped services with appropriate interventions by a range of professionals working at different levels was not well understood. I went away excited and energised, but also a bit despondent at the lack of opportunity to develop some of the themes, or correct some misunderstandings. But that’s Question Time for you …

I had had a busy couple of Saturdays prior to this debate, in between which I was giving evidence at the Values-Based CAMHS Commission in London (more about that some other time I think).

 

Our Faculty is working on developing links with schools to promote mental health awareness, support resilience building and also make young people aware of psychiatry as a career. Elaine Lockhart is working with some trainees and former trainees to build on the work that Mallika and Fiona did when developing their SafeSpot app. Ella and Jack have good ideas for this project too and separately will be trying to build a network to give young people a voice and connect.

 

On 20 February I met with some young people from the Young Scot organisation Youth Investigation Team. They had invited me, Aileen (from the British Pharmaceutical Society) and Sally (from the BMA) to talk about young people’s health. Young Scot has been commissioned by the government to contribute to the ‘National Conversation’ on ‘Creating a Healthier Scotland’ and the young people we met had already carried out a Scotland-wide survey and embarked on a more in-depth investigation into health and social care. The format was conversation interspersed with some specific questions which we were asked to respond to there and then in writing. They were keen to know how to influence services and what was delivered, starting with what is taught in schools. We discussed Stigma and debated the name CAMHS, reaching a consensus that calling mental health services of any sort by obscure or ‘friendly’ names actually increased stigma, as the key issue was avoided and myths perpetuated. They felt that stigma continues to be a huge issue. They were also concerned about inequality, and the challenge they had to engage young people from all backgrounds, which is mirrored in issues around access to services and to health promotion. They were interested in linking this to resilience building and the development of ‘Health Literacy’. I had the chance here to put in a plug for Healthy Start Healthy Scotland and the young people were very interested in hearing some of the evidence on the importance of early years’ experience for the development of empathy and understanding. One of the investigators was planning to study medicine and I had a good shot at trying to divert him from a plan to be a trauma surgeon and encouraged him to embrace psychiatry as his chosen profession. Overall I have to say that I was very impressed by how these young people were really getting to grips with articulating the challenges for youth today and I look forward to seeing their report in the near future.

 

Roch Cantwell has previously blogged about the Launch of Healthy Start Healthy Scotland at the Parliament last September. Elaine Clark, Roch and I, ably supported by Laura Hudson, held a fringe meeting at the Scottish LibDem Conference on 27 February. The session was chaired by Jim Hume and attracted a lot of interest (not just for the free sandwiches). In addition to very pertinent questions about perinatal and infant mental health there was some debate about shifting the balance of healthcare, an idea reflected in the newly published ‘A National Clinical Strategy for Scotland 2016’ and likely to form the bedrock of the new Mental Health Strategy 2016-19, which won’t be published until after the elections.

 

For those of you who are not yet familiar with the College’s campaign you can access information here. Please also bring it to the attention of colleagues within your own Boards and partner agencies too.

 

Dr Anne McFadyen

Chair of RCPsych in Scotland Child and Adolescent Psychiatry Faculty

 

7 March 2016

 

02/02/2016 11:03:38

RCPsychiS February Blog

 

What makes a good blog?  The Chief Nursing Officer for Scotland was recently on the front page of the Herald after writing a blog that criticised some nursing staff for making inappropriate comments to patients.  The example given was a nurse saying to a patient ‘If you wet yourself we will call you pishy pants’.  Unison were upset and saw this as being critical of the vast majority of nurses who turn up at work and do a good job.  This raises a fundamental question of whether we improve behaviour by praising good behaviour or punishing bad behaviour. Learning theory would suggest that praise is more effective but it often feels as if the stories in the media focus on the negative.  There are good news stories but they often get hidden on page 5.  ‘Pishy pants’ got the issue on page one and consequently more people read the blog.  Is a good blog one that is controversial enough to be read?  If so you are likely to be disappointed with this blog as I have no desire to be disparaging to psychiatrists. 

 

The blog did make me think about times that I have used inappropriate language.  I can remember having to consciously avoid describing a person as a ‘Schizophrenic’ or saying that they ‘committed suicide’.  People are more than their illness and suicide is no longer a crime that is ‘committed’.  As doctors and psychiatrists we are influential and our behaviour is important (even if it does not always feel that way).  If we use inappropriate language then it may have a disproportionate effect on others.  When I was a trainee, nobody paid much attention to what I said but when I became a Consultant, I was aware that people suddenly started listening to me.  Even worse they copied my words.  Shortly after I became a consultant I remember referring to a patient disparagingly in an off the cuff remark.  I can’t remember my exact words, but was embarrassed the next day to overhear a junior member of staff repeating my comments with all the weight of an ICD diagnosis.  I have had similar experiences as a parent.  I remember coming home and my son saying, ‘uck, uck’ after he had been out for a drive in the car.  I might want my children to do as I say rather than do as I do but I know that the later will always be more influential. 

 

It’s a new year and a time for resolutions.  I have no desire to be perfect or never make a mistake.  My resolution instead will be about remembering to give positive feedback when I see my colleagues acting in a caring or person centred manner.  There will always be ‘pishy pants’ articles in the media, so I want to make sure that this is balanced with a little praise.                

 

John

 

Dr John Taylor, Vice Chair of the Royal College of Psychiatrists in Scotland

 

 

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With this new feature we are bringing you a guest blogger every month. The aim of the blog is to inform people about the work the College undertakes in Scotland and to highlight the different activities our members are involved in. We invite members in Scotland to write a blog, perhaps on a project they are working on, a recruitment initiative, engagement with the third sector, teaching, training or just day to day working in mental health services in Scotland. The Chair will have the final say on which ones we publish. There will be an invite for readers to comment.

If you have something that you feel might be of interest to members and would like to write a future guest blog then please contact  Angela Currie at the RCPsych in Scotland.