I was never a great fan of the late Robin Williams, at least not
as an actor. Preferred his comedy. On film I thought he was a
bit saccharine. “Patch Adams”, the doctor who used humour to
heal his patients - yuk.
But did get nominated for an Oscar for “Dead Poets Society”. He
played a teacher who inspired his students (you never get Oscar
nominations playing uninspired teachers) via the Latin motto “Carpe
diem” - seize the day.
And that’s not a bad motto for us. Mental health is “in”
at the moment. Two Prime Ministers devoted full speeches to
it. All of the parties in the election included it in their
manifestos. The younger Royals have claimed this for their
own, even if the Queen apparently still sees some merit in the oft
derided essence of Englishness, the “stiff upper lip”, which by the
way was originally an American attribute. Before the
Victorian era the British were if anything more likely to be seen
as a nation of cry-babies.
And back in the present, last year every TV channel had a mental
health week, and just how many more celebrities are there left to
share their mental health stories?
Playing our part
We have played our part in this. We have achieved fantastic
coverage in the last 12 months, pushing good news, combatting
errors and myths and highlighting injustice and failures. We
now produce a daily summary of “RCPsych in the News” - because we
I said when I took over that I wanted us to be the calm
authoritative voice people turn to when it comes to psychiatry and
mental illness. We are well on the way to achieving that.
And our political impact has likewise increased
dramatically. Of the Royal Colleges only the GPs get more
mentions in Hansard - and they are five times our size.
Work to do
But it’s not all gone well. When I took office I also
spoke about improving recruitment. And I might as well confess now,
we haven’t. OK, we have stopped the decline, and in the
context of what is going on across medicine that’s an
But I think we have created the foundations (pun intended) to
improve on this. We have achieved the target of 45% of junior
doctors doing a foundation post in psychiatry. If that recruits not
a single psychiatrist, it will still have done good. But I
believe the strategy will pay dividends in time.
But we must do better, and so it’s time to seize another day.
Before the General Election we did our best to influence all the
parties to make commitments to improving mental health
So when we read their election manifestos we quietly
congratulated ourselves our efforts were not in vain. Now I am not
naïve, and I know that a manifesto is not the Ten
Commandments. But having something there increases the
likelihood it will happen, and not having it there does the
The new government - whatever, whoever and wherever it might be
(who knows, it might be Belfast) - will be committed to finding
ways to ensure that the expansion of medical places is linked to
what the NHS needs (and I know for a fact this means general
practice and psychiatry), and several of the ways they plan to do
this are a direct lift from our own manifesto for mental
We can also see some of our handiwork in other commitments as
well, for example around schools and mental health. These
things don’t just happen, they are the result of a lot of hard work
by a lot of people - and many of them belong to your College.
Prod and push
But we cannot rely on government, of whatever political
persuasion, to do our work for us. We can and will prod, push and
occasionally kick, but it’s not enough.
We all need to work hard in schools, universities and in the
media to see that that the interest in mental health of the new
generation of students is translated into career choices.
And how we do that? By telling the truth - that psychiatry
is a great profession, with a great future. It’s on the up -
if you are academically inclined and want to crown your career with
a trip to Stockholm, join us.
A privileged job
If you want to practise mind/body medicine, by all means think
about clinical psychology, but remember you have more chance of
success if you do this via medicine. And whatever you do,
there are few more privileged jobs around than one in which people
will tell you things that they have never ever told anyone else
Yes, we have problems. But it’s important that we don’t paint an
unduly negative picture.
If you want to get to know someone better in a bar or at a
party, you don’t kick off by saying how generally miserable, put
upon, stressed and ignored you are. It never worked for me, and I
doubt it works when persuading people to think about a career in
medicine in general or psychiatry in particular.
So Carpe Diemi. But that’s not the full quote - it’s
“carpe diem, quam minimum credula postero”. In other words, "Seize
the day, but put very little trust in tomorrow”.
Doing more than simply raising awareness
And there are concerns for the future.
Evidence now suggests that most people are aware of mental
health and what that means. Most of those who had diagnosable
mental health disorders identified in the last Adult Psychiatric
Morbidity Survey knew that they had.
True, many remained unwilling to do anything about it for a
variety of reasons. But they were aware.
But if that’s all we have done - raise awareness - but nothing
to actually help, then expectations will be replaced by
disillusionment and anger. I propose that next year we replace
Mental Health Awareness Day with Mental Health Delivery Day.
And then there’s the money. There always is. Or to be more
precise, perhaps there won’t be. There is a consensus that
NHS finances will drop of a cliff in 2018/19. And then there
will be covetous glances thrown at us.
Joined up approach
I am convinced that the senior voices in NHS-E are serious about
achieving real gains for mental health services. But will that
survive a sustained assault from other parts of the service,
especially if the anarchy introduced by the discredited but still
extant 2012 Act continues.
Between now and then we must use every effort to continue to
build alliances across our sector - charities, think tanks, media,
politicians - we need a united front.
Next, integration. My career has been partly about better
integration of the physical and mental. And a lot has been
achieved. New RCPsych data confirms that we are taking
the physical health of our patients more seriously. And across the
road we even more of a presence in A and Es and general hospitals
than before, with more expansion coming.
But it would be a sad irony if at the same time we permit a
greater separation of the physical, social and psychological in our
own back yards.
IAPTS has been an amazing success, achieved partly by a
remarkable single mindedness and desire to disrupt a system that
was not delivering psychological treatments on anything like the
necessary scale. But in the future we need also to ensure
that we don’t permit the development of silos within mental
In the large consultation before the start of the Five Year
Forward View which occupied much of my Presidential time the
commonest thing that people told us that they wanted their physical
and mental health care together.
They minded less where it was, more that it was in the same
place, delivered by people who worked together. We have made
progress on this, but success will depend on continued
So many days seized
Carpe diem. Seize the day. And as I look the last three
years have been full of many days that we have seized. The day we
launched the Crisp Commission into Acute Care, and the days we
spent on implementing it.
The days spend on the Five Year Forward View, and the days
working with NHS-E on how to make it a reality. Days plotting how
to shame CCGs lagging behind on mental health spending.
Evenings at the College listening to so many talented speakers,
reflecting the breadth and depth of our profession. Mornings
hearing about our fantastic plans for modernising our approach to
the promise of neuroscience.
Early mornings getting up to do battle on the Today programme.
Evenings spent in the devolved administrations and countries
hearing the different paths they are taking, and trying not to be
And the days spent with your staff here at the College and your
Officers - two Registrars, two Deans and two Scrooges.
Democracy has had a bit of a bad press recently. Last year it
delivered two results that try as we might, many of us find
difficult to believe will turn out well. But when it comes to our
RCPsych democratic process, it resulted in the best colleagues I
could have hoped to have.
One of them, Wendy, is about to take over. We are in good
And now my favourite last words. When Ramón Maria Narváez,
Spanish General and political leader, was on his death bed, the
priest asked him if he forgave his enemies. His last words
were “I do not have to forgive my enemies. I have had them all
[i] Pedanticus retired last month, but I am afraid I was unable
to prevent him staging one final bow. “Carpe diem” comes from the
Roman poet Horace, one of his Odes. But he says that readers might
think my title “Ave Atque Vale” - translated as “greetings and
goodbye” is also from Horace. I told him he was being silly, and
that you would all know this is Catullus mourning his dead brother,
but he insists that I point this out. He does have a bit of a
temper, so I am doing what I am told.
Professor Sir Simon Wessely
Read the June 2017
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