Mental Health Tribunal Scotland - RMO/MHO Forum CANCELLED
1 April 2020
The next RMO/MHO forum was scheduled to take place on Monday 27 April 2020 in Hamilton House. This has now been cancelled.
The Tribunal is trying to adapt its processes as the current position evolves, to ensure that day to day business is maintained as much as it possibly can be, and is posting regular updates on the News section of the MHTS website, where you can monitor the situation as it develops in relation to the Tribunal.
The next RMO/MHO forum is scheduled to take place on Monday 26 October 2020. Further details will be provided in due course.
Letter from Chair to all Members of the RCPsych in Scotland
27 March 2020
The new stethoscope I recently ordered has been requisitioned by the resident General Practitioner in the household. That part of me which was pleased that it was fulfilling a primary care need was troubled by that part of me which wanted to have the right kit for any contingency. As Psychiatrists we share with every other doctor in the country the same medical school training and experience working in hospital medicine. We take that knowledge, wisdom and leadership from the general setting and apply it to our learning and practice in psychiatry. Never has the knowledge, wisdom and leadership of doctors been more important or more valued.
Reflecting on the response to the crisis, I imagine a bell shaped distribution of how people cope. Some are naturally anticipating what is to come and have been preparing. Most of us still have a sense of unreality but are adjusting speedily and flexibly to the new normal. A small number are really struggling, waiting to be told what to do and trying to keep to the letter of guidance already out of date. Our medical background has prepared us for this time. As doctors we are experienced in responding to complex and changing situations where there is no textbook answer.
As I set up the space at home, which is now where I phone patients who already had complex needs, I found my old stethoscope. It had been a prize given following my elective in a psychiatric hospital in Tanzania. As someone set on a career in psychiatry I was a bit disappointed at the time. I’m not disappointed now.
Professor John Crichton
Letter from Chair to all Members of the RCPsych in Scotland
16 March 2020
When we look back on the events of 2020 in years to come what will be remembered? I am confident we will remember the
extraordinary work of colleagues in extraordinary circumstances. As psychiatrists we all started our careers as doctors used to working under pressure and making clinical decision in circumstances not envisaged in standard treatment protocols or guidelines. I think we will also see the world in slightly different ways. We will be more comfortable with remote working and teleconferencing. More comfortable for our patients in secure settings to have access to mobile phones and the internet. We will also find ways to support our community patients with phones and other means. We will value home working and question the travelling around the country for meetings. We may be more wary of international travel. Some things will remain the same. We will still need to meet and have that ordinary human interaction.
As you will be aware all College events have been cancelled or postponed. Fortunately, we took action early with the Working Retired Psychiatrists Group, General Adult, Intellectual Disability, and Old Age and Forensic joint events which have been rearranged to the autumn. Currently the International Congress in Edinburgh is still on but as you have come to realize these matters change rapidly. We have prepared the office team in Edinburgh for home working. To test how our systems will work the team have recently trialed working from home and I expect we will move to that method of working shortly. Our usual small group work looking at the Scott review, recruitment, responding to consultations, etc. I expect to become teleconference meetings – although much of that work will simply be postponed.
Behind the scenes the Queen Street team are responding to consultations all the time – one such last August was for a contingency mental health act in the event of civil emergency. How can we operate with shortages of staff? Last weekend I scrutinized our response which has now influenced similar planning across all four UK jurisdictions. In coming days I expect a raft of measures coming from the Scottish Parliament including contingency measures for mental health legislation. The College will distribute updates on these topics to members but in the meantime it may be helpful to look at Public Health Scotland Act 2008.
Already Colleagues are thinking about how their teams will function and how their workplaces will adapt. We have received confirmation of support from Scottish Government, GMC and NES should we be asked to work in different ways from normal. Recently retired colleagues and senior medical students may have a valuable role. The budget made an import change to the pension annual allowance tapering threshold which should help future colleagues avoid the worst of the annual allowance tax penalties. There were also important changes to VAT on electronic publications which take away disincentives for electronic journal publishing (Section 1.52).
Communication may become problematic and already I have had reports of overwhelming numbers of emails. I have spoken to Government and Health Boards about information flow and possibly setting up text alerts to secure websites. Local colleagues are also using WhatsApp groups to keep in touch – both with local updates and for mutual support. I suggest if you are remote working for a time, you find a way each day to touch base with colleagues over a virtual coffee.
Perhaps the most stressful thing in my professional life has been balancing competing family and work demands simultaneously. Part of our mutual support to each other is that recognition that school children and students may be at home and elderly relatives vulnerable. Part of my new regime is to phone my 95 year old Mum in the afternoon. Her care home closed to visitors on Friday but luckily she can still use a phone during her afternoon bed rest. How long will it last? What will happen if she becomes unwell? Questions we all have in different contexts whilst simultaneously working for our patients and calming their anxieties.
I found the below advice chart from the WHO helpful about managing anxiety at the current time. I especially thought that the advice not to obsessively watch the news is something I should take to heart. We are working with SAMH to create some common sense advice to patients about managing stress and I am working closely with out mental health partners and mental health directorate at Scottish Government. We have a virtual meeting this week and I will share what information I can.
Earlier this year we had a family health scare. Overnight life was turned upside down. Work rearranged, trips cancelled, a hectic diary of events replaced by uncertainty and waiting. I was supported by the generosity and understanding of those around me. Kindness from others, ordinary routines and simple pleasures were our greatest friends. We are all in that uncomfortable place now. Our winter meeting seems a long time ago but it was one of our most successful. We had a late cancellation as the Chief Medical Officer was urgently called away for a meeting about Coronavirus. Any of us who have worked with Catherine Calderwood would know we do not have a better person at this time to lead us.
Finally my advice it to be forgiving – everyone is working in unexpected and uncertain circumstances. We will need to be flexible and apply our experience and training to unfolding events. I am looking forward to that time we can all look back at 2020 and be grateful for some of the ordinary things in life we sometimes take for granted.
Professor John Crichton
Additional documents: Health Protection Scotland update on COVID-19
Choose Psychiatry in Scotland Funding
19 December 2019
The College in Scotland is delighted to announce it has been successful in securing substantial financial support from NHS Education for Scotland to continue its work in promoting the profession of psychiatry around the country in 2020. This follows on from the great start made by the Choose Psychiatry in Scotland campaign in 2019, assisted by a Scottish Government grant awarded in late 2018. Read the full announcement.
Laura Hudson and Angela Currie (Interim Managers of the RCPsych in Scotland) have commented on our activities and achievements in 2019 which has been another extremely busy and productive year.
My Psych App
4 December 2019
The new MyPsych app, developed by NHSGG&C in collaboration with colleagues from across NHS Scotland, launches on Thursday 12 December with an event at the Queen Elizabeth University Hospital in Glasgow. The app, designed with the modern mental health practitioner in mind, includes a variety of information toolkits including one for medical students on their psychiatry placements. Please see the programme for further information.
More support needed for people with autism and complex needs
30 October 2019
The Mental Welfare Commission has published its first themed visit report looking at support for people with autism.
Commission visitors met 54 people living in a hospital or in the community across Scotland and spoke to medical and care staff along with families and carers.
- A wide variation in assessment and post-diagnostic support across the country. Sometimes having another diagnosis, such as a learning disability, was seen as a barrier to a proper assessment of autism.
- Of the 54 people met by the Commission, 45 were prescribed psychotropic medication on a regular basis, with 40 of those being prescribed regular antipsychotic medication.
- Thirteen of the 28 people who were living in hospital were ready to leave, but were on delayed discharge, waiting for suitable accommodation.
- For those living in the community, their environments were well designed and appropriate. In hospitals, thought had been given to how to make changes to the environment for the particular needs of the patient, but this was simply not possible in some wards.
- Families described the significant, distressing and ongoing negative effects that the diagnosis and care has had, making it difficult to maintain a family unit. Most of these family carers had not been directed to support for themselves and had not had an assessment of needs.
Responding to the latest report, Dr Eleanor Brewster, chair of the Faculty of Intellectual Disability Psychiatry at RCPsych Scotland, said: “People with autism need access to appropriate services before and after diagnosis.
“Unfortunately, Scotland continues to see significant difficulties around recruiting and retaining sufficient numbers of medical, nursing and other staff who specialise in learning disabilities, meaning some areas are better provided for than others.
“We’re concerned there is a lack of high-quality community accommodation and daytime opportunities for people with autistic-spectrum disorders and complex needs.
“Better community provision would help people to be discharged from hospital as soon as they are ready, so that they can live closer to their families and communities.
“Good community support should also mean that medication is only used for the small number of people with complex needs who still experience difficulties after psychological and social approaches are in place.”
Guidance for members in No-deal Brexit scenario
18 October 2019
With the possibility of a no-deal Brexit occurring on 31 October, Senior officials have sent guidance to NHS Scotland staff on a no-deal Brexit. This includes information on medication supplies and contingency plans in place.
The College has recently produced a Briefing paper on the impact a no-deal Brexit scenario may have on Psychiatry in Scotland.
Welcome boost for trainee doctor posts
27 September 2019
Scotland’s medical workforce is due to by bolstered by 105 more places by 2022 for new graduates on the Foundation Training programme – including the specialism of psychiatry.
Medical students graduate from medical school after five years and move into a two-year Foundation Training Programme.
The first 51 training posts will be available under this scheme in 2021 for students to continue their training to become qualified doctors.
RCPsych in Scotland have been campaigning on this issue for several months.
Professor John Crichton, chair of the Royal College of Psychiatrists in Scotland, said: “We welcome this announcement as currently around a quarter of foundation year doctors have training in psychiatry compared to about half of new doctors in England.
“This move will improve the medical workforce and a general understanding of mental health and will attract more people to choose psychiatry as a career.
“We look forward to finding out about the implantation of this exciting new development and it will be essential there is ongoing monitoring to ensure we are on track and the quality of placements is high.”
Announcing the move on a visit to Glasgow Royal Infirmary, Health Secretary Jeane Freeman said:
“With a programme that is 99% full, our Foundation training is a testament to the popularity of Scotland as a training destination and the high-quality education we offer.
“We need confident, skilled and committed doctors to meet the needs of patients, particularly as we face an ageing population with multiple conditions.
“With the offer of an exceptional quality of life for young doctors in Scotland, I am committed to providing attractive training and career prospects to ensure as many medical graduates from Scottish medical schools stay in Scotland to train, progress and realise their career ambitions.”
These additional Foundation posts will create a greater range of placements for trainee doctors particularly in general practice, psychiatry and in remote or rural parts of Scotland.
Welcome news for patients as more junior doctors take up psychiatry
10 July 2019
The number of junior doctors taking up psychiatry in Scotland is steadily on the increase, according to official figures.
New statistics from N HS Education for Scotland (NES)reveals that in 2019, 41 of the 57 posts advertised have been filled – a rate of 72 per cent.
This is compared to 67 per cent last year where 40 junior doctors took up psychiatry from 60 posts advertised.
Although figures have increased by 4 per cent, 2015 had the highest increase infill rate, with 53 posts advertised and 50 accepted places – a total of 94 per cent.
But doctors have welcomed the news that the numbers are steadily on the increase again.
Dr John Crichton, chair of the Royal College of Psychiatrists in Scotland, said:
“This is welcome news for both patients and mental health services.
“But we must not be complacent. People will always need psychiatrists and working with the Scottish Government, we need to do all we can to continue to promote it as an excellent career choice for all junior doctors.
“Being a psychiatrist is a rewarding and brilliant career choice and in Scotland we are world-leading in many aspects of mental health.
“We should be working towards increasing the rates to an all-time high again.”
After medical school, trainees undergo a two-year foundation training programme to bridge the gap between medical school and further specialist training. After Foundation School, junior doctors choose to follow either general or specialist medicine.
The six-year specialist psychiatry training programme is the final step in the journey to become a consultant psychiatrist – the most senior doctor specialising in mental health.
The Royal College of Psychiatrists is currently running a #ChoosePsychiatry campaign to encourage more people into the profession.
College responds to the latest suicide statistics in Scotland
26 June 2019
Statistics released today by the Scottish Government show that 784 people died by suicide in Scotland in 2018. This compares to 680 deaths by suicide in 2017.
Commenting on the latest statistics, RCPsych in Scotland's Suicide Prevention Lead, Dr David Hall said:
“Although figures have improved overall in the last five years - it is disappointing that these latest statistics are looking like a backward step.
“The National Suicide Prevention Plan includes a number of important initiatives which are being actively developed and are based on the best available evidence to push suicide figures back down. They include further awareness-raising and training, a commitment to review every death by suicide in Scotland to allow a greater understanding of what causes these devastating events to occur, and to learn from them.”
College responds to Scottish Government funding on social media and mental health
23 April 2019
Scots school pupils are to be coached on how to use social media amid fears that sites such as Instagram and Twitter are contributing to a decline in mental health.
The Scottish Government are to invest £90,000 on official advice on how to cope with the pressures of social media. The move was welcomed by the Royal College of Psychiatrists, however the organisation warned that children are also suffering from a lack of mental health services due to council cuts.
Dr Elaine Lockhart, chair of the Child and Adolescent Faculty said:
“We welcome this focus on children and young people’s mental health as it highlights the importance to us all about the positive and negative aspects of using social media and why adequate, undisturbed sleep during adolescence is essential.
“We know from recent research that the most vulnerable young people with mental health disorders are more likely to be adversely affected by time spent on social media.
“Although the Scottish Government's ambitions are welcome, the reality is that right now many children and young people are not getting the help they need to stop falling into crisis.
“Scotland needs joined up services so that children and young people can access help when they need it. However, much of that early help has been provided through local authority budgets which have fallen in recent years, affecting what can be offered within schools, social services and the third sector.
“Specialist CAMHS need to be funded sufficiently so that children and young people can be seen quickly when needed, but also to allow for work with partners across children's services to support mental health promotion, prevention and care.”
Leading Scots Psychiatrist Advises Downing Street Summit
3 April 2019
A leading Scottish doctor visited 10 Downing Street today (Wednesday) - to advise on the best way forward in tackling youth violence.
Dr John Crichton, chair of The Royal College of Psychiatrists (RCPsych) met with ministers and other officials to talk about improving mental health services for those affected by serious youth violence at the Serious Violence Summit.
Recently, Dr Crichton was involved in research looking at “killer” kitchen knives and how the introduction of pointed kitchen knives could help reduce the number of fatal stabbings.
Research shows that many attacks, particularly in households where there has been a history of violence, involve kitchen knives because they are so easily accessible. The psychiatrist believes a switch from sharp-pointed, long-bladed kitchen knives to a new “R” point design could save lives.
Dr Crichton said: “These are very important discussions to have. I’m pleased the UK government is looking at how to tackle serious youth violence and how we target the most vulnerable. Improving and expanding services for people whose mental health may have been impacted by serious youth violence should be a top priority.
“In Scottish cities, we’ve seen some great work from the Violence Reduction Units which has resulted in a large drop in murders and the number of people admitted to hospital with knife wounds. Some of these strategies are now being adopted by cities in England.
“Notably the ‘preventative’ approach taken by Glasgow – once the city with the highest murder rate in western Europe – has now been adopted by London.
“This is where my research into kitchen knives comes to the fore. This is a public health measure and public health measures are always about society deciding on a self-imposed restriction for the public good.”
Dr Crichton attended a roundtable discussion hosted by Nick Hancock, Secretary of State for Health and Social Care.