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

All I want for Christmas is some good data

It’s not been a great year, has it? If there was an award for “Worst Year Ever”, 2016 would be up there in the Top Ten. OK, 1914 and 1939 are above it – 2016 hasn’t heralded the start of a World War. In 1347 the Black Death reduced Europe’s population by a third - so things could be worse.

But for my lifetime at least, 2016 is going to get the Oscar. It has been rubbish, hasn’t it? We had the referendum which doesn’t seem to have magically released millions a week for the NHS.

Then there is that man with the terrible haircut. Yes, our American friends have elected a bull and placed him in the china shop. Perhaps it will all be all right on the night. And perhaps it won’t.

We had the junior doctors dispute, from which no one emerged a winner. A Secretary of State who finds it difficult to visit front line medical services because of the welcome he might receive. Junior doctors demoralised and still angry. A host of issues around the workforce that are nothing to do with the contract unresolved.

And England lost to Iceland [i].

OK, I feel I am about to succumb to what the poet Horace called “laudatory temporis acti”, loosely translated as “it was better in my day”. And in some ways, it was. But it’s not all been bad. Yes we lost to Iceland - but I was spared watching the ignominy because I was at a dinner celebrating our Pathfinders - 50 of the best and brightest medical students being supported by a generous donor to help them kick start a career in psychiatry. And that dinner took place on the first day of our International Congress at the Excel - our biggest and best yet. Yes, John Sweeney made me demonstrate my inner dancing Ed Balls on stage, a ghastly sight. But apart from that, it was plain marvellous. We had the serious - I don’t think anyone who saw the exhibition bringing back to memory those murdered by the National Socialists for the sole “crime” of being mentally ill or learning disabled, would not have emerged moved to the point of tears by the experience. We had the playful - interviewing the magnificent Jo Brand being my favourite. We had the spectacular - dinner in the Painted Hall at Greenwich Naval College as part of our send off for the longest serving Admiral in our fleet - Vanessa Cameron. And throughout it all a steady stream of exciting, challenging, thought provoking, entertaining and informative symposia, lectures, debates and more.

Congress is but once a year, but the work of the College goes on. And there is much to cheer us up. Now I am not going to give you all the Xmas presents at once, as I think we will all need a bit more cheering up in the months to come. So instead I will wrap a couple of successes in Christmas tinsel and keep back some others for later, perhaps when TIDS really starts to bite (Trump Induced Depression Syndrome).

So let’s talk data. The boring boffin that lurks in me gnaws at my conscience over the issue of data in all shapes and forms. We need reliable and transparent data so that we can make the right decisions about how to shape our services and so that the public and their representatives can hold those who make the decisions to account. That’s why we have worked collaboratively to get a system in which everyone can see how much and on what their local CCG is spending our money on mental health services in particular. In NHS Speak, this means a “dashboard”. And last month we finally got one. We immediately started analysing the mental health spends, current and projected, and naming and shaming those CCGs not pulling their weight. We used what the military would call a “combined arms” operation - using policy to get and analyse the figures, our parliamentary liaison to let local MPs know who was being naughty, and then our media and digital teams to get in touch with local media. In CAMHS for example, the spend per person varied from a low of £2 to a high of £144 - a massive variation. The squeals from those at the bottom of the class was a joy to hear and it turns out that some of them hadn’t supplied NHSE the correct numbers, and omitted to check their entries for accuracy either pre or post publication. This transparency lark is clearly a bit new to some of them, but hopefully they are on a steep learning curve because we’ll be checking, analysing and publishing our findings every quarter.

Over the lifetime of my career, it has become harder and harder to get good data for research. Nearly 30 years ago I needed to obtain the criminal records of over 1,000 patients known to have had schizophrenia in Camberwell over the previous 50 years. I wrote to the Home Office with the request, and a few months later the data arrived, all hand written by some poor junior civil servant. I think I had to sign a form, but frankly it wasn’t much more onerous than that. Looking back, I can see that system was probably too slack, but in the intervening years more and more barriers have been erected to the sharing of clinical data for bona fide purposes. But the good news is that over the summer we managed to prevent the erection of yet another barrier that would have had a very serious impact on mental health research and much else besides. NHS-Digital decided with the best of intentions that special safeguards were necessary to protect mental health data flows within the NHS, because these were seen as particularly sensitive and vulnerable to re-identification or hack attacks. We disagreed, arguing that it would hinder vital research and further disadvantage the already disadvantaged and marginalised. I made the case at the Board that if parity meant anything, it meant that we should treat mental and physical data the same. And I am pleased to say that NHS Digital did not dig in their heels, rather the opposite, and our suggestion is now policy.

Yes, I am indeed a boring boffin when it comes to data. But boring boffins are important, because data is important. Access to good quality data is fundamental to understanding our health care system. I would go further and say that it is a pre-requisite for a functioning democracy and civilised society. If you don’t believe me, check out Andrew Dilnot’s “A History of Britain in Numbers” or follow the marvellous “More or Less” Radio 4 series.

OK those are your Xmas presents for the moment. But if you were struggling to curb your excitement as they were unwrapped, I promise I have a few more bits of good news to see you through to the Spring.

But for the now, best wishes to one and all. Have a good break if you can. Notwithstanding some pieces of good news for us, there is no point in hiding the fact that overall it’s tough at the moment in the Health Service, and it’s going to get tougher. So as Sgt Esterhaus said at the start of every episode of the best cop show of all times, Hill Street Blues, “let’s be careful out there”.

[i] Pedanticus writes “not everyone reading this blog supports England, Simon. And the Welsh really did well."

Professor Sir Simon Wessely

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Re: All I want for Christmas i
Spot on Sir Simon. You're probably the finest President we have ever had.
Re: All I want for Christmas i
Virchow rightly allied medicine and politics but TIDS takes the biscuit. TIDDS (Therapist Invalidation of a Democratic Decision) is becoming all too common in elitist psychiatric circles.
Re: All I want for Christmas i
"data is important" yes I agree Sir Simon. But I would add that "correct" data is even more important. Unfortunately Psychiatry is built on false data and unscientific understanding. Nothing bona fide about disabling people for whom the drugs don't work.

Psychiatric survivors prove the labels are false and mental illness needn't be lifelong. All it takes is a healthy dose of scepticism and a strong belief in yourself. Having faith in God helps, in my experience, that this life isn't all there is. Worth taking a risk, tapering the psych drugs, getting off, getting back on with life, free spirited.

Wishing you a happy Christmas and a guid new year fae Scotland. Here's tae us, wha's like us! Damn few an' they're a' deid.

The data we have
On outcome data for physical health, we do have the data to compare age, sex and disease specific data comparing the general population in a local authority area with the cohort accessing mental health services. So we can calculate statistically significant differences,including performance of different.mental health trusts. Perhaps closing this physical health gap should should be the main objective for psychiatric doctors,especially consultants instead of targeting the less frequent and more slippery suicide prevention which may be we shola leave to public health risk minimisation?
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Professor Wendy Burn

Professor Wendy Burn FRCPsych


Professor Wendy Burn became a consultant old age psychiatrist in Leeds in 1990 and now works fulltime in a community post. Her main clinical interest is dementia.

She has held a regional leadership role in this area from 2011 and was co-clinical Lead for dementia for Yorkshire and the Humber Strategic Clinical Network between 2013 and 2016.