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

What Fresh Hell is This

My title comes from the words that Dorothy Parker used whenever she answered the phone. These last weeks I have felt the same, and suspect I am not alone. True, there have been the occasional pieces of good news. Wales lifted the spirits of anyone who likes football.  A Brit won Wimbledon and another one looks likely to take the most difficult prize in sport - the Tour De France. Having said that, as I write this in a café the TV screen on the wall is showing Chris Froome running up Mont Ventoux, lacking what one would have thought was essential for a cycle race - a bike. This is further proof that we have entered a space time continuum plunging us into a new world where the impossible has become the normal.

Such is the pace of events, that when I started to write this blog Jeremy Hunt was still Secretary of State. Half way through the first paragraph the BBC announced he was sacked, then going to another department, and as I now plod on he seems to be back where he started, still in charge of the Department of Health.  I have no idea if that will still be true when you read this. Perhaps Jamie Oliver will be in charge – or Katie Hopkins. In a world where Boris Johnson can lead us out of Europe on his personal journey to become Prime Minister, then be cast in the wilderness by a treacherous colleague only to end up as Foreign Secretary, and all in the space of a few days, anything is possible.

OK, back to the serious business. The results of the EU Referendum have precipitated a series of events that few, if anyone, could have foreseen and none can know the eventual outcome. When Zhou En Lai was asked by Richard Nixon in 1972 what he thought had been the impact of the French Revolution he replied “it’s too early to say” [i]. So no one can yet have the faintest idea of how our own turmoil will end.  Those who led the campaign to leave seem to have been following Napoleon’s maxim – “on s’éngage, et puit on voit” – loosely translated as “One gets into the battle, and then who knows?”

At the moment no one knows. Many, myself included, are worried about the future.  Here is what I wrote the day after the result and again today, concentrating on the impact on science and then psychiatry research.

And what about the wider NHS? The only people who still believe in the £350 million a week that will come to the NHS as a “Brexit Bonus” still believe in Tooth Fairies and Santa Claus. To their shame even those who promised this bonanza lost no time in admitting it was a mirage. The new boss of  NHS Improvement was closer to the truth when he said this week that the “NHS is in a mess” and one that is set to become even worse as we start to see - as we are already doing - signs of the economic down turn triggered by Brexit.

But it’s not just about the money. Immigration dominated the referendum debate, and what a nasty debate it was. The author Robert Harris tweeted at one point “How foul this referendum is. The most depressing, divisive, duplicitous political event of my lifetime. May there never be another”.

But I wouldn’t be here without immigration. My father would for certain have perished in the land of his birth, Czechoslovakia. And the NHS wouldn’t be here either, whilst British medical science would be infinitely poorer as well. Brexit or no Brexit, the NHS and science both can only flourish with immigration.

So we as Royal College of Psychiatrists celebrate the fact 25% of all NHS doctors were not born in this country – a figure that rises to 35% for psychiatry. We are delighted that 10% of all NHS doctors come from non UK EU.

Thus message is being echoed across the NHS, from the very top and throughout the organisation. But it is natural for those of you who are from the non UK EU to be directly concerned about your future, and I have received messages from several to this effect.  Frankly, I doubt very much that anyone already resident here has anything to fear.  The government has already acknowledged that anyone who has been resident for five years is protected by existing legislation, that this cannot change until we have actually left, and even the most ardent “leavers” made it clear that there was never any intention to interfere with EU nationals currently living and working here.

The problem will be whether or not we are permitted to recruit more of the doctors, nurses and scientists that we will continue to need for as long as we continue to fail to produce enough within this country – in other words for a very long time.  That we don’t know, and it may be a long time before we do.

But worse, even if they are permitted to come, will they want to?  And here is the most pernicious consequence of the campaign.  As the Lancet pointed out this week the increase in nationalistic sentiments “manipulated by some leaders of the leave campaign, is already reducing the attractiveness of working in the UK”.  The Lancet continued that “it is a bitter irony that the NHS was used so deceitfully as the very embodiment of a British institution in a struggle over sovereignty and control, and yet now the future of this great tradition is so under threat” [ii].  As Francis Urquhart, the anti-hero of the British “House of Cards” might have said, “you might very well think that; I couldn’t possibly comment”.

But what all of us in the Royal College of Psychiatrists can say loud and clear is that the reports of an increase in petty and not so petty intolerance and xenophobia directed against both EU and non EU migrants shame us all. I witnessed such an episode recently and it sickened me. Two young men started verbally abusing a man on a station platform opposite me who looked “foreign” (he was in fact a Mexican) - swearing, demanding to see his passport and saying it was time he “p***ed off home”. But what I also saw was that within a short space of time a far larger number of people had intervened to protect the man, prevented the abusers from leaving until the police arrived -  which they did - and made their abhorrence for the incident extremely plain. There is hope.

I openly campaigned for Remain (not wearing my Presidential hat I hasten to add in case the charity Commission is listening).  Along with most doctors and virtually all scientists I warned of the probable consequences for health, science and medicine should we vote to leave. Now we have left, all of us who supported Remain must work just as hard to prove ourselves wrong. This is a task for everyone, whichever way we voted.

I do not think we are doomed – and was cheered up by the wonderful science blogger Jenny Rohn only a few days ago.  As she says, there is a storm coming, but we can weather it. It will take hard work on our side and good will from the rest of Europe – something that might be in short supply at the moment – but perhaps as raw emotions settle will return. But most of all, I genuinely believe that after a campaign that spoke too much to division, fear and prejudice, we will again see the better angels of all our natures reasserting themselves and showing to the world that this is still a wonderful place in which to live and work.

So let me end with a French film. Made in 1966, it is called Le Roi De Coeur, the King of Hearts. Set in 1918, it takes place in an old mental asylum in the countryside, which then becomes engulfed by the Great War. As a result all the doctors and nurses flee, leaving the patients to their own devices. Cautiously they open the doors and gates and set off the first time in years to explore the countryside and town nearby. In a series of episodes they encounter the folly, stupidity, madness and absurdity of the world of the so-called sane. One by one they make their way back to the hospital. In the final scene a hand reaches out from inside the asylum to pull the door to the outside world shut again.

So may I wish you all a pleasant and happy holiday wherever you are going, and hope that you will have at least some respite from all the anxiety that so many of us are feeling, before we have to reopen that door and return to the chaos of the real world.

i] Pedanticus writes “it’s possible that Zhou En Lai’s most famous quote was not quite as wise as it sounds.  Some think he misunderstood Nixon’s question and thought he was being asked his views on the 1968 student riots and upheaval, not the 1789 revolution “  

ii] The lancet editorial also called on the government not to impose a contract on the junior doctors at this time, “rather than taking stock to re-evaluate the repercussions on a post-Brexit NHS.  I am afraid I very much doubt the government will heed this advice, but the world is so strange at the moment that one never knows. Anyway, I will return to the junior doctors’ dispute in my next blog.

Professor Sir Simon Wessely

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Re: What Fresh Hell is This
The Scottish referendum was a grim experience for those of us that are internationalist and also British. Now the rest of the U.K also experiences the misery of political division. Despite dire warnings the people of this country chose to vote for a future that seemed safer than the less than encouraging offering from the European Commission and its five presidents. As in Scotland, extremists have tried to take advantage of the result but they do not represent the majority of those that voted.
Our president needs to accept this democratic decision and lead the college through these turbulent times. It helps to remember that Dorothy Parker intended her words to raise a smile.
No matter what ones personal political views and opinions, I seriously question the appropriateness, for a President of the College, to write this kind of article/blog.
The College,without doubt , comprises Psychiatrists with a wide range of personal and political persuasions/ opinions/ stances, including, ones on the topics covered in this blog ; the College should not in my view, be used in this way to express and promote personal political views, as expressed in this blog, especially in the fashion and tone that they have been.
There is an apparent lack of respect shown to those who might disagree with him, whether with-in the government or those who think differently to him about, for example, Brexit and its potential benefits.
There is a danger here, of a restricted or narrow-minded political culture being generated within the College, which does not therefore permit a full and wide range of opinions being represented and expressed on matters which could be interpreted as incompatible with this blog, especially if it were to be regarded as a 'whipped' College party-line view, which it clearly is not, nor should it ever be, whether the President is wearing his presidential hat or not.
It is worrying that the President feels so bold to speak in this politicised way from his position as President , without any recognition that many of the members and fellows, may well disagree with his expressed, personal political persuasions.Talk of "most doctors" is potentially misleading and can become something quite other than it actually is in reality. The President may actually be contributing to the creation of an increasing 'silent majority' and hence, a more serious but deeper split or division than he anticipates.This is not the path to true unity or health, where real and genuine differences exist and can co-exist, ,whether in our individual ambivalence or in a collective and collegiate sense .
The President can surely not simply maintain that his statements as President are only his personal views, and choose to speak separately/individually, with such certainty or personal political certainty, on the College site,as if speaking on behalf of, or even to the membership of the College in this way.I think that the Charity Commission should take an interest here, as the President might be inviting them to , all be it unwittingly, by writing in this public way on a College site!
Worse still,I believe that the President seriously distorts and misrepresents some of the issues which he covers in his blog, concerning immigration/employment and the EU-Brexit. Manipulation of shame and guilt or even moralistic judgementaism , is also a method of avoiding open discussion of the real issues under consideration in the blog, which reads as quite manipulative in the name of persuasion or moral assertions.
Re: What Fresh Hell is This
Excellent, thoughtful and helpful blog in these uncertain times. Thanks.
Re: What Fresh Hell is This
I am somewhat dubious about working one's socks off to mitigate the damage. First, it may be very difficult to do this. Second, if partially successful it may simply enable the perpetrators to deny there was any problem in the first place. There may be an argument that is better to do nothing and let their perfidity be exposed for all to see. Then their heads can be served up on a plate at the next general election.
Re: What Fresh Hell is This
I couldn't agree with you on the subject of Brexit Bonus” still believe in Tooth Fairies and Santa Claus"; although I was qualified & trained from the UK, I'm a foreigner! It is hypocritical some friends say "we don't mind you, but we mind THEM"! What a world we live in!
Re: What Fresh Hell is This
Great post! Thank you for sharing. Hope to hear more from you.
Re: What Fresh Hell is This
Very much enjoyed this thoughtful blog
Re: What Fresh Hell is This
Good post! Thank you for sharing your views. I think it was an unexpected result!
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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.