RCPsych in Scotland news

Letter from Chair to all members of the RCPsych in Scotland

6 November 2020

Scottish Election Results

I have the greatest pleasure in announcing the RCPsych in Scotland Officers from Summer 2021 until 2025.   Linda Findlay will be moving from Vice Chair to Chair of RCPsych in Scotland and Vice-President of the RCPsych.  Jane Morris from acting Finance Officer to Vice Chair and Pradeep Pasupuleti from Chair of the RCPsych in Scotland Forensic Faculty to Finance Officer. Seamus McNulty continues as Scotland’s Education and Training Committee lead and Ihsan Kader as Chair of Choose Psychiatry Scotland.  They will be supported by Devolved Council including new and returning faces, Jude Halford, Lovely Rajan, Andrew Robertson and Andy Williams.

A number of posts in Scotland and more widely in the College will be subject to an election. Whoever you may choose to support I would encourage every member to participate.  It is very straightforward to electronically vote.  The main problem is the College having up-to-date emails and important messages not being lost in a blizzard of messages or disappearing in spam folders.  For most of us nhs.net accounts will stop forwarding messages to the migrated Scottish NHS email shortly. Check on the website that your details are correct.  

Scottish Manifesto

Before my own term of office ends next June, I hope to have finished some loose ends from our establishment as a Devolved Council.  We also will use the forthcoming Scottish parliamentary elections of May 2021 as an opportunity to emphasise the importance of funding mental health services and highlight some more specific issues we have been campaigning for - such as expanding the number of foundation year doctors working in psychiatry and the creation of statutory aftercare duties on local authorities  to improve patient flow.  We will be issuing a manifesto to all political parties in Scotland from the College (before the political parties have settled on theirs) and a series of meetings with the political parties has already begun with the hope that our suggestions will be widely considered and adopted.  The manifesto’s theme is on access and working to ensure there is no wrong door to accessing the right care for mental ill health at the point of need. 

To enable all members to participate in the manifesto process, in addition to those groups already consulted with, we have developed a survey of members on some of the key issue highlighted in the document. By adding you voice to these responses, you can ensure the priorities we outline carry authority. A powerful statement begins, ‘Our members tell us . . .’ but we have to evidence on what basis we make such a claim.  

Our aim is that the RCPsych in Scotland manifesto can then be a resource for every member in engaging prospective parliamentary candidates. We are in the process of examining how best to enable this ahead of launch at the end of this month, and will contact the membership ahead of time with further details.  

Looking ahead

One appealing aspect about elections is that they focus on the future and what we can do better.  At the beginning of the Pandemic I was often cautioning others that Covid would go on for longer than they thought – now I find myself reminding others that this extraordinary period of time will come to an end. The International Congress 2021 will be a digital event which aims to stand out from the various digital offerings available in terms of its production and content.  Edinburgh is identified for the Congress in 2022 which will be a great opportunity to showcase Scottish Psychiatry.

So my passing over of the Chain of Office in June 2021 is likely to be a muted affair.  There are few opportunities to wear it and such things are a little out of fashion, but it serves of a reminder that for generations we have come together as a professional community. At such a time of pandemic, that collegiate belonging and mutual support has never been never more important. 

Professor John Crichton


Letter from Chair to all members of the RCPsych in Scotland

24 September 2020

When will this end?  This question posed by the citizens of Punxsutawney every February 2nd to a Groundhog regards the length of winter.  The tradition has older roots than one might suppose with parallels to St Brigid’s day and the Celtic festival of Imbolc.  It was the starting premise of the 1993 film Groundhog Day starring Bill Murray. His 70th birthday on Monday provided an excuse for the PM programme on BBC Radio 4 to draw parallels with the film and our current situation.  

Bill Murray’s character, a burnt-out weatherman, is called on again to report on the Groundhog celebration which he despises. Caught by a winter storm (he failed to predict) he stays on in the loathsome town only to relive the same day’s events again and again.  There is no escape and it is uncertain how long this repetitive cycle of experience lasts.  He goes from despair to resignation before adapting to his circumstance, discovering new skills and kindness to others and thus is able to move on.  The film is somewhat dated and the gender stereotypes and lack of diversity jar, but the central theme of the film – that we must change to circumstance and not the other way around – has been used widely as a positive life lesson. 

How long?

The challenge we now face is different from March.  We have a better idea what to expect, there has been investment in new IT and remote working kit. Even the technophobes have come to grips with Zoom, Teams and a myriad of other new communication platforms.  The First Minister this week spoke of the rise in cases being slower than in March and that may be a good sign. On the other hand we have an exhausted workforce and there has been a substantial increase in demand on mental health services. Many are already experiencing the loss of employment, separation from loved ones in care homes and grief.  Overshadowing all of this is the uncertainty of ‘how long’?  

Of the Prime Minister’s and First Minister’s addresses this week I preferred the positive messaging.  We can be confident that there will be a day when we are looking back on the pandemic and not living through it.  That positive messaging was summed up for me in a Tweet on Wednesday from psychiatrist Professor Louis Appleby:

“[We] need to return to [the] positives from March: cohesion, support, looking out for others, esp children & young ppl, those with mental ill-health, ppl who are anxious, lonely or bereaved, or facing economic distress”    

Another celebrity birthday this week was that of Bruce Springsteen who was 71 on Wednesday – although given his stamina for live performance I suspect his ‘Covid age’ is substantially less than mine. Springsteen addresses a similar topic to Groundhog Day in Tunnel of Love where a couple experiencing the rides around the fun fair is used as a metaphor for how relationships adapt and survive existential threat. In response to the rough ride, ‘you’ve got to learn to live with what you can’t rise above’. We cannot escape this second wave of Covid, but we can employ the skills we have learnt to get through it and again look to forgiveness, kindness and community as our greatest allies.  

Professor John Crichton


Developments in Foundation Posts in Psychiatry in Scotland

1 September 2020

It is now recognised that exposure to Psychiatry during Foundation years is one of the greatest predictors of foundation doctors subsequently planning a career in Psychiatry.

A number of new initiatives in seeking to enhance experience in Psychiatry for foundation doctors are now being formulated.

1. Increase in Foundation Doctor numbers

In 2019 the Scottish government announced an increase in the number of Foundation posts available to new medical graduates, recognising the increase intake to Scottish Medical Schools over recent years. The Scottish Government stipulated that these new posts should be prioritised for “community facing “ specialties such as General Practice and Psychiatry.

Unfortunately, due to the recruitment difficulties into General Practice over recent years, these new posts have preferentially been allocated to GP with only modest increases in the number of new Psychiatry placements coming on stream in 2021 and 2022. It is hoped however, in light of more recent recruitment difficulties into Core psychiatry, that the balance between GP and Psychiatry will be re-visited in the near future.

2. Psychiatry Foundation Fellowships.

For three years now, the Royal College of Psychiatrists in England has offered a number of specially badged Foundation Doctor Posts termed as Psychiatry Foundation Fellowships. Successful applicants to these posts were guaranteed a Psychiatry placement, generally during their FY1 year, plus guaranteed attendance at their local Core Psychiatry Balint Group, a Psychiatric Mentor who would offer regular supervision for the duration of the successful applicants’ foundation training and attendance at the Royal College of Psychiatrists Annual International Congress.

This initiative was funded by Health Education England (HEE) and for the first time in 2020 was rolled out to each of the devolved administrations. Scotland, Wales and Northern Ireland were each allocated three such posts. Although the recruitment process for foundation Fellowships did not neatly dovetail with actual Foundation recruitment, these posts were advertised and interviewed for in March 2020.

Three successful candidates were appointed and have started in their new roles in August 2020. The successful candidates were Dr Zain Hussein, Dr Kimberley Duffy and Dr Esme Beer. Both Drs Hussein and Duffy have commenced employment with NHS Tayside and Dr Beer has started working in NHS Greater Glasgow and Clyde. There is some ongoing debate as to how this model fits in NHS in Scotland however and other more innovative developments are now due to be piloted.

3. Foundation Priority Programmes

Whilst there was very real competition for the Foundation Fellowships, the long term impact on recruitment into Psychiatry remains an unknown as it was obvious that all the candidates interviewed had set their hearts on a career in Psychiatry early on in Medical School. Thus, together with the Foundation School in Scotland, the Mental Health Specialty Training Board is seeking to develop what is called a Priority Programme for Psychiatry.

Priority Programmes in Foundation already exist in other specialties, most notably Remote and Rural Medicine, but until now, no consideration had been given to developing similar programmes in Psychiatry. From August 2020, the Foundation School and the Mental Health STB are going to pilot a Psychiatry Priority Programme in the North region of NHS Education for Scotland. The north region was chosen because historical recruitment issues in this geographical location, especially in the Inverness locality.

In essence, Priority Programmes are advertised and recruited to earlier than the main Foundation recruitment process and are generally seen as popular because of this and because Foundation trainees have advance knowledge of their geographical location and their placements for the subsequent two years of training. In order to enhance the potential popularity of this programme, the successful candidates will be given similar benefits to the Foundation Fellowships.

This will include a Psychiatric mentor for two years, attendance at their local Core Psychiatry Balint group and funding for attendance at one or more Royal College of Psychiatrist in Scotland meetings such as the annual Winter and Summer meetings or at any of the meetings run by the constituent faculties within Scotland.

Once this programme has been evaluated, we will be looking to roll out further Psychiatry Priority programmes throughout Scotland with southwest Scotland being proposed as the next geographical location.

Dr Seamus McNulty, ETC Representative and Chair of the STB

Letter from Chair to all members of the RCPsych in Scotland

12 June 2020

The killing of George Floyd and the protests which followed have seen friends and colleagues share their experiences of racism. Not remote experiences that can be thought of as coming from a different time and place, but experiences that call us to action here and now. One colleague told me of his guilt for advising a trainee not to raise concerns about experiencing racism in a professional setting.

Another spoke of routine harassment that almost becomes part of life and is largely invisible to those of us not from a BAME background. We have shared within the Devolved Council our ideas, thoughts, and experiences. I am grateful for the diversity we have in that group and in the College in Scotland, but more must be done.

It is insufficient for us to be simply non-racist. We must be anti-racist and oppose it wherever possible.

In Paul Rees, we have an exceptional Chief Executive at the RCPsych and a champion for diversity and anti-racism. I encourage you read his blog. Paul told me that following that shocking news footage of George Floyd struggling to breathe, he paused to consider what we as a College can do to tackle the inequalities and injustices facing BAME communities. As you will read, he himself has experienced racism throughout his life, including mistreatment from the police.

The College was the first UK Royal Medical College to put out a statement, but Paul became aware of the hurt and anger expressed by BAME RCPsych staff and staff from every background. In response, the College staff had a reflective event and Paul composed his thoughts. It moved senior colleagues in the College to tears and Paul was asked to share his reflection to the wider RCPsych community.

It was almost as if the initial shock needed to pass before friends and colleagues felt able to articulate their anger and share their experiences of discrimination. It should also not be accepted that Scotland is in any way exceptional in this regard, as this piece by Prof Helen Minnis illustrates.

The various protest movements that have been given prominence in the aftermath of George Floyd’s murder has parallels in the Covid-19 response.

I was wrong to consider the virus as a ‘great leveller’. As quickly became apparent, the BAME community were more likely to be severely affected by the virus. Anti-racism calls us to understand the reasons behind this in the light of historic discrimination. That includes variation between BAME and White British colleagues in our own College activities, from exam pass rates to representation on committees and contributions to events. It includes differentiation in who receives psychiatric treatment. It includes differentiation in pay and seniority in key public health bodies. None of these issues are simple, all are complex.

Psychiatry relies on people feeling able to trust that what they say will be treated with the respect and confidentiality it deserves. I cannot imagine how much more difficult it would be to open up to a clinician who I perceived did not share my values or had an awareness and understanding of the cultural factors linked to my mental wellbeing.

Leading work for the College on all these issues are the new Presidential leads announced today. I have also spoken to Dr Arun Chopra, Medical Director at the Mental Welfare Commission about a proposal he is developing a proposal to capture the experiences of colleagues in Scotland, which I have promised to take to the Board of Trustees. Arun has worked this week with Pradeep Pasupuleti and Selena Gleadow Ware to bring together the thoughts and ideas of the Devolved Council and as a result I am announcing today the creation of a RCPsychiS BAME champion to ensure the BAME voice is heard in our decision making. As a Devolved Council we will also consider the creation of other champions to ensure that the diverse voices of the College membership are always heard.

We will also add our voice to efforts by the Scottish Government to investigate through an expert group the disproportionate impact of COVID-19 on BAME communities. We will also consider how research currently being developed into the direct impact of COVID-19 on in-patient mental health patients will account for ethnicity.

The diversity of the College is its greatest strength. We all have a part to play and if anyone feels excluded because of race, sexuality diversity, gender, belief, or racial background, we all have a problem. The resources we are developing for the Choose Psychiatry Scotland campaign will reflect that diversity as will our ongoing educational events. In Scotland we have elections later this year and a sign of our health will be a range of candidates who represent our diversity.

To help guide us on the experience of members, please complete the fourth COVID-19 member survey. There has been a fall-off in responses, but there are important questions on issue such as emergency mental health legislation.

Only this week, there were calls for the contingency mental health measures included in COVID-19 legislation to be repealed as they have not yet been necessary. A letter from the College was cited by the Scottish Government in parliament in favour of retaining these measures, as there remains a real risk of a second wave and overwhelming workforce pressures as a result. Our arguments are strengthened in making this case if there is good response to the survey and you will see a specific question on that topic.

It should not have taken the death of George Floyd, nor the countless injustices faced by BAME communities, to bring about change. It would be wrong, though, not to consider what we can do to correct wrongs which our colleagues and patients still face.

Professor John Crichton

Letter from Chair to all members of the RCPsych in Scotland

29 May 2020

‘Furore’ was the term used by Scottish Conservative leader Jackson Carlaw in relation to events in Westminster this week (BBC News 26 May 2020). It comes from the Latin and originates in those ancient daemons of the underworld, the ‘furies’, three vengeful deities who would relentlessly pursue miscreants to the point of utter despair (BJP Vol. 208 Issue 3). Rather like the most evil character from Harry Potter their names were not to be spoken aloud. I suspect it will be some time before the tourists arrive back in Greyfriars church to visit the grave of the original Tom Riddle.

The phases of the route map published by Scottish Government is worth studying. It is both hopeful and sobering, marking a divergence between Holyrood and Westminster Governments regarding the important question of what next. In Phase 1 a visit to a friend or relative in the open or the opening of garden centres become a possibility. The Government has been keen to stress nothing is guaranteed.

We now know what ‘lockdown’ means and if easing goes too quickly or winter brings a second wave we should be ready to return to more restrictive measures. Third sector organisations, churches and businesses are beginning to match the phases of the route map to how they might operate and that is a useful exercise for our own mental health services as well. We each need to develop an idea of what psychiatry in Scotland will look like in the four phases of easing and reflect on what might work better in a return to lockdown. The sobering aspect of the route map is the final phase, characterised by ongoing social distancing, and which has no end date.

A recurring theme at the Scottish Academy of Royal College’s weekly meeting has been concern about social distancing in healthcare settings. In the ‘red zone’ the clear risk of infection arises from the patient population. In a mental health setting free from COVID, the risk of infection is between each other and from us to our patients. It is important as medics we lead by example with clutter free offices, frequent handwashing and maintaining 2 m distance between colleagues. In primary care fabric covered chairs are being replaced by ones that can be wiped. The use of screens and dividers will need to be considered along with spacing in open plan offices. The capacity of meeting rooms will reduce by up to 80% to allow for safe social distancing. There has been recent guidance from the Society of Occupational Medicine about returning safely to the workplace for those who have been risk-assessed in lockdown to work from home.

This was one of the areas highlighted by the Academy this week in response to a request by the Scottish Government who invited the Academy to set out issues, concerns and suggestions as the NHS responds to the next stages of COVID. One key public message is the NHS is open for business but we cannot return to business as usual. Overnight many outpatient consultations and much of primary care have become remote – that will continue in phase four. There is nothing good about the suffering caused by COVID but it is appropriate to reflect on those things we have learnt from the crisis which can be positively taken forward. Nevertheless I know there is a considerable concern about the pressure on mental health inpatients and community referrals. There is concern that the Government messaging about population mental wellbeing confuses peoples understanding of major mental illness and obscures the need to have adequate resources for the population of patients who require mental health service support. I am convinced that the senior civil servants at Government ‘get it’, they are aware and understand these concerns but in our meetings with them the College will nevertheless continue to highlight these issues.

In addition to Tom Riddle, the graveyard at Greyfriars also houses the mausoleum of George Mackenzie of Rosehaugh who despite a ruthless execution of the laws against Covenanters and witches, introduced the earliest documented insanity defense in Scots law for those identified as ‘furens’. Often translated as ‘mad’ the term has the same origin as ‘furore’ and might be better translated as ‘bedeviled’. Cicero gives us a clue about how the term was used in ancient times likening a sufferer to those in mythology who came to false beliefs about the identity of others. In contrast Cicero used the term ‘insania’ to describe a less serious condition of ‘wrong thinking’ and poor moral choice. We have at least moved on from such terminology (RCPE, 24 February 2020).

Professor John Crichton

Letter from Chair to all members of the RCPsych in Scotland

15 May 2020

Caledonian Antisyzygy was the phrase used by BBC Scotland Political Editor Brian Taylor on Monday’s Good Morning Scotland to describe the mixed message being given in the most recent Prime Ministerial broadcast. It describes the idea of dueling polarities within one entity and in this context the competing desire to get back to familiar patterns of life whilst wishing to remain safe and isolated. The term was coined by Gregory Smith (1865 – 1932) in a literary debate about contemporary Scottish Literature and elaborated by Hugh MacDiarmid. The suggestion is that the creative genius of Scotland emerges from dual polarities in the Scottish Psyche – Lowland v Highland; British v Scottish; Protestant v Catholic; and more recently Brexit v remain and ‘are you aye or are you nae’.

Similar to the term ‘schizophrenia’ the term is a modern confection of ancient Greek. Syzygy in Greek refers to a conjunction or a yoking together. Jung used the term to refer to the union of opposites. It reminds me of Melanie Klein and the emergence of the depressive position from the paranoid-schizoid position and the perils of splitting within our clinical teams. I was comforted to hear that a colleague was asked about how to handle team splitting in an interview this week – a topic always worth preparing for.

The very fact that an interview took place reflects a shift in our response to the coronavirus. The immediate emergency is passing – although the risk of a second peak will remain for some time – and we are devising ways to return to those tasks and activities which were suspended in March. Every aspect of our professional lives has changed and this is so for everyone else. The themes of the College’s discourse with Government is shifting from PPE and testing to key worker wellbeing and the challenge of a healthcare system where the norm overnight is medicine delivered remotely. These are the emerging themes captured in our most recent COVID survey. Another emerging theme and a priority of the UK College is the effect of COVID on BAME colleagues – I am delighted Ihsan Kader is our Scottish representative on this important piece of work.

This week saw the Scottish Government announcing the National Wellbeing Hub for those working in Health and Social Care. The College working closely with the Academy of Royal Colleges in Scotland have had very positive discussions with Scottish Government about the Scottish Practitioner Health Service proposal and how it can be made most suitable for the context we now find ourselves in.

This month will see various meetings of the College restart – all of course online - our Medical managers group, Choose Psychiatry Scotland and Devolved Council. Our new campaign to describe the characteristics of a good mental health service – ‘What Good Looks Like’ - will have to change to ‘What Good Looks Like Now’. This month the College will make its submission to the Scott review of mental health legislation. The task in all these endeavors is to take the good ideas we had and adapt them both to what we have learnt in this first phase of COVID and make them fit for a new future.

Our recovery will have different stages. The first will be dominated by the ongoing need for social distancing. Telepsychiatry will be with us as our primary means of community work for many months. Webinars will be our primary source of CPD and education. Our inpatient facilities and staff facilities will have to maintain social distancing adaptions for a similar period. In the longer term we can expect the mental health consequences of grief and economic hardship.

In many areas of life there will be something of a crossroads. Do we turn to cheap oil to kick start the economy or do we use the opportunity to embrace the green agenda? Do we return to old patterns of the workplace or will we maintain a degree of homeworking. Do we return to convenient manufactured imports from across the world or see a domestic manufacturing capability as an essential strategic capability.

Hugh MacDiarmid celebrated the coming together of language in particular the dialects of lowland scots into ‘Synthetic Scots’ - Lallans. We now have a task of synthesising our professional expertise and knowledge with what we have recently learnt and are learning. Not simply about the biology of a virus or the epidemiology of pandemic but how as a community we have responded and changed – our collective resilience and adaptability but above all kindness – the new theme for Mental Health Week in Scotland 2020.

Professor John Crichton

Letter from Chair to all members of the RCPsych in Scotland

1 May 2020

Gardening is good metaphor for the rewards of patience. With all this time at home the garden has never looked so good and the recent good weather was beguiling. So that’s my excuse for putting out the runner bean seedlings too early which were nipped by a late frost this week. I should have waited another couple of weeks.

How long will it be doctor? That question must be asked in a myriad of different contexts everyday. We become skilled in responding, mixing the truths of estimates and uncertainty with a hopeful encouraging delivery. How long until the treatment works? When will I get home? When will I see my loved ones? How long will this go on? We know that medicine cannot be rushed. Each illness and treatment has its own timing which can only be modified to an extent. I was warned after a diagnosis of thyroid disease it would take a while to reach a balance– it took a year. I usually try to switch the focus of such enquiries onto an achievable shorter-term goal; an activity or freedom which goes someway down the road of the desired longer-term objective. I usually regret rushing things although there is an ever-present pressure to do so.

As we appear to be finding equilibrium after this first wave of COVID there has been much talk of recovery plans at the moment - how are we to exit the lockdown. There is something of a mixed message as this week also saw new official letters to those who are shielding, giving the strong impression of restrictions continuing. The shielded will perhaps be the last to enjoy the freedom of going where they like and seeing who they choose. We all want it to be over as soon as possible, but just like the anxious patient early in their recovery we must kindly acknowledge that there is a long journey ahead. Recovery in mental health often involves the living of amazing lives but with ongoing challenges. I wonder how the term ‘new normal’ is heard by those whose ‘old normal was not normal at all.

So it is with COVID – we are moving from the immediate to the longer term. One colleague told me this week that for the first period of lock down he had no space to think about anything other than the immediate demands of the crisis. Only recently has he had the capacity to think about all of the other important things which were so abruptly suspended. The resumption of all those endeavors has been the theme of the latest round of meetings. This week we have had guidance from NES for Educational Supervisors preparing for ARCPs. On Monday, I also met with Adrian Dolby at NES about providing the part 2 initial AMP training on line – he is hopeful a remote access course will be available as soon as possible.

On Monday Evening I heard from Dave Caesar about his role as national lead for health and social care staff wellbeing. Dave has a massive portfolio which includes logistical support for us all, online wellbeing resources and more. He reports to Gillian Russell, Director for Safer Communities and the Minister for Mental Health Clare Haughey. The first priority is to get a Hub of information established and a phone line of support. Much of the post will be about marshaling what is already out there and what Boards have already put in place.

I am anxious that this staff wellbeing work is transformative for the longer term and builds on the work recently completed by Dr Dame Denise Coia and the GMC. David Garbutt, Chair of NES, worked closely with Dame Denise and I continue to be in regular contact with him about Practitioner Health Programme proposal. I was also moved to read some further obituaries of Dame Denise this week – each one told me a little but more about her extraordinary life. Email Angela Currie for the book of condolence – may I suggest that some of the comments made on social media would make excellent contributions if you could cut and paste them and send them to Angela in an email. I hope the book will be a comfort to Archie and the family, especially when all the normal ways of marking a loved one’s passing are disrupted.

A new resource for you to try is the first of a series of free RCPsych in Scotland webinars on topics relevant to our current situation. The first was recorded last week on the topic of emergency mental health legislation and I am very grateful for the contributions of Drs Roger Smyth and Arun Chopra. It is important to stress those provisions have not been started and as things are currently stand may never be. However, we must be prepared for another wave of infections with greater pressure on services because of staff absence. Roger also speaks about the current COVID restrictions and how reasonable excuses for being out of the house might apply to patients. This is the first of a series and the RCPsych in Scotland team would be grateful for feedback, suggestions for future topics and speakers. You don’t need fancy technology to contribute or to watch. This is a good time to set up a WhatsApp group of your CPD Peer Group to consider mutually approving such online activities as we find new ways of learning and keeping up to date.

Even if we have no we have no commencement of the Emergency Mental Health Act, we are not working as we used to. The consequences of social distancing have changed how Tribunals operate, Mental Health Act assessments are carried out and the management of restricted patients. The Mental Welfare Commission has gathered together its advice for working at this time but I have raised with Government the possibility of developing a COVID Code of Practice giving formal relaxation of certain measures and the introduction of others.

Last week I gave feedback on the first Scottish COVID survey and indicated this would be a rolling programme of short SurveyMonkeys to track the existing themes of testing and PPE and emerging themes such as wellbeing. The whole College has decided to follow Scotland’s lead and today the second survey is launched for completion over the weekend. To maintain its usefulness in our regular contact with Government a good response rate is essential. Please encourage other College members to take part via your WhatsApp and other groups

I knew I was taking a risk with the runner beans. As a contingency I planted a seed along with every seedling. I am very glad I did now but I hope the mice don’t get them.

Professor John Crichton

National MyPsych COVID-19 App

As some of you may be aware, the My Psych app was developed by colleagues in NHS GG&C as a resource to assist medical students and junior doctors during their psychiatry placements. It initially launched in December offering 3 toolkits on student placement, medicine companion and MH research.

Whilst this was originally initiated as a medical resource within NHSGGC MH services, in view of the current circumstances and requests from colleagues elsewhere the developers decided to create a National COVID-19 Toolkit. This includes clinical information resources as well as training materials. The National toolkit is now available to download. Please install the MyPsych App from the Google Play or Apple app stores; you will be prompted to download your choice of toolkits. Select the Scotland COVID-19 toolkit. With information and guidance changing on a daily basis, it is important that you update your app when prompted - you will see a red exclamation mark to alert you to this at any sections with new content. In addition you will receive pop up notifications for any urgent updates; iOS users should install the new version of MyPsych from the app store to enable these. Please contact mypsych@ggc.scot.nhs.uk with any feedback. Please note that the MyPsych Team does not generate any material but simply gathers resources and links that have been approved by the appropriate bodies and management teams.

Letter from Chair to all members of the RCPsych in Scotland

24 April 2020

Gold, silver and bronze commands have sprung into being for many of us as Health Boards mobilize and civil contingency plans are activated. It has a military feel but originates from the police: gold for strategic decisions, silver for tactical and bronze for operational. Government command is sometimes fancifully referred to as platinum. I remember planning exercises where such terminology was used – it felt like a school field trip where the teachers were at pains to point out we were there for serious work but could not quite dampen down the spirits of the class enjoying a day away from normal routine.

It’s all more serious now. These times bring references to wartime resilience and Churchillian quotes as we tap into a collective national memory of how we respond to national emergency and make do. In all of this what place does a Royal College have? To continue the metallurgical theme we perhaps have a refining role as critical friend to Government, placing proposals and announcements under the fire to remove as many impurities as possible and improve their decisions.

To do that task we need information fed back from members across the country. Last week we had our first members COVID survey. We were able to feed back to Government on Friday evening about your experience of PPE availability, the availability of testing and functioning of mental health legislation. Thank you to our new policy lead Aidan Reid who has hit the ground running and pulled together the analytics and report. In Scotland we have decided to repeat that survey every two weeks so that we can track progress and quickly identify the extent of emerging topics. Government takes our results seriously and I thank all 180 Scottish members who took part with very short notice. Going forward I would like to improve on that response rate – put simply the more members respond the more clout we have in bringing forward your views (fittingly I learn that ‘clout’ originally meant a metal patch or repair).

As the reality sinks in about how long social distancing will need to continue the new Scottish mental wellbeing campaign was launched on Tuesday. “Clear Your Head” sends clear and simple messages about the benefits of routines, keeping in touch and a balance to the time spent watching news and social media. RCPsych in Scotland were proud to be a partner and give expertise. It has united support from every Scottish mental health professional organization and third sector partner. They may be simple messages but the messages are good advice for everyone – for our communities, our colleagues and those with mental illness or intellectual disability. As time goes on there will be more focused advice for specific groups and the wellbeing of health and social care staff.

One aspect of wellbeing is that assurance better times will come. This will be over. Arun Chopra and I are looking forward to a ‘café crawl’ of the caffeinated watering holes of Edinburgh. Arun is also responsible for my lighthearted moment of the week as he texted me to get the ravioli on – a message meant for his ‘coworker’. I am looking forward to out first meeting as a College again. I miss the students and trainees. I know many will be disappointed about the cancellation of the International Congress but I am delighted to announce two dates for your diary. The International Congress will be returning to Edinburgh on 20-24 June 2022 and 17-20 June 2024 and in perhaps my greatest achievement as Chair the timing has been brought forward – International Congress will longer clash with Scottish School holidays. Fair warning to everyone organising ARCPs in future years to avoid those weeks.

George McOwat was an injured serviceman who my Grandfather commissioned to copperplate certain quotes from Winston Churchill, including a BBC broadcast from June 1940: ‘There are vast numbers, not only in this island but of every land, who will render faithful service . . . whose names will never be known, whose deeds will never be recorded.” This struggle against Coronavirus is no war of ‘gold commanders’ but the efforts of a rich alloy of key workers, from those in red zones to those in care homes, health workers on telephones to postal staff, supermarket workers and refuse collectors. It is a communal effort of ‘bronze workers’. The greatest honour our country can award is not made of precious metal but is the Victoria Cross, fashioned from bronze.

Professor John Crichton

Dr Dame Denise Coia - RCPsych in Scotland Obituary

17 April 2020

The College in Scotland was deeply saddened to hear that former Chair, Dr Denise Coia DBE, passed away on 9 April 2020.

Paying tribute on social media, RCPsych in Scotland’s current Chair, Professor John Crichton commented “her extraordinary contribution to psychiatry, as well as the wider medical profession, can only be described as unmatched”. The immense list of all of her achievements and her impact on the profession is difficult to condense, but her accomplishments were ultimately recognised when included in the Queen’s Birthday Honours in 2016 for services to mental health and healthcare quality improvement.

Initially a Consultant Psychiatrist working for Greater Glasgow and Clyde Health Board, Dame Coia always had an interest in improving the delivery of mental health services, and set up several community teams and services in South Glasgow. From 1998, in addition to her clinical post, she worked for the Director of Planning and Implementation for Greater Glasgow Health Board within a joint social work/NHS mental health commissioning team. Its remit was to develop a ‘modernising mental health strategy’, focusing on shifting the balance of care from hospital to community settings. She designed specialist intensive community services providing an alternative to inpatient care; and keen to provide better support for young people with mental illness, she introduced early intervention services, leading the development in the treatment of people who present to acute hospitals with physical problems but who also have underlying mental health problems by delivering a new liaison psychiatry service and a self-harm nursing liaison team.

Dame Coia was also an active member within her Royal College, taking up the Officer’s role of RCPsych in Scotland Meetings Secretary in 1997, before becoming Vice Chair, then Chair from 2001-2005. During that term, she was instrumental in collating the views of psychiatrists regarding the proposals for the Mental Health (Care and Treatment)(Scotland) Act 2003.

Thereafter, acting as Principal Medical Officer for Mental Health for the Scottish Government from 2006-2011, Dame Coia was involved with working across a number of policy and performance directorates to support the development and delivery of national policy. During this tenure, in 2010, she was appointed Chair of the new national health body Healthcare Improvement Scotland (HIS), whilst also adopting the role of Board member for the Care Inspectorate, its sister organisation.

Since 2017, she had been convener of Children in Scotland, the national agency for organisations working with children and their families. Latterly, she was asked to chair the Children & Young People’s Mental Health Task Force before stepping down in 2019 because of ill health. The taskforce was jointly commissioned by the Scottish Government & COSLA in June 2018 to identify the best way forward for children and young people’s mental health services in Scotland.

During her career, she has also held the roles of Senior Honorary Lecturer, Glasgow University Department of Psychological Medicines (1987-2011); Vice Chair of the Academy of Royal Colleges of Scotland (2002-2006); GMC Assessor, Supervisor and Advisor to Fitness to Practice Committees; and Chair, GMC Quality Scrutiny Board (London). In addition, from 1987 – 2012 she was involved in a voluntary capacity as a member of Support in Mind Scotland.

Scotland’s First Minister, Nicola Sturgeon, wrote on social media that Coia’s “contribution to medicine, psychiatry and public service in Scotland was immense”. She was indeed a leader in the field of mental health, instrumental in the design and delivery of transformational mental health services; initially in the Glasgow area, and then nationally through her appointments in both government and senior public bodies. Consequently, the influence of her work has spread internationally.

She will be a great, great loss to the profession.

Colleagues remember her kindness and sense of fun, her sense of humour, approachability and consistent generosity with encouragement. Dr Pramod Jauhar, a colleague and friend of Dame Coia’s for many years, told the College “It was an honour and privilege to have enjoyed Dame Denise Coia’s friendship over the years. She was able to effect changes and improve the status and importance of mental health without acrimony, reflecting her calm, pleasant and affable manner. Despite her commitments, she remained a clinician who would be aptly described as a doctor’s doctor.”

Our thoughts and sincere condolences are with her family and friends at this difficult time.

If you have any personal comments or tributes you wish to make, please send contributions to Angela.currie@rcpsych.ac.uk. The College in Scotland will be gathering a book of condolences.

Letter from Chair to all members of the RCPsych in Scotland

16 April 2020

Schindler’s List is a film I purchased but could not bring myself to watch. Statistics can become numbing. We find it hard to take it in. Steven Spielberg used a red dress in an otherwise black and white narrative to illustrate one heart breaking story amongst a sea of awfulness to make it personal and real. I was reminded of this hearing Dorothy Duffy’s poem, ‘My sister is not a statistic’ as she rails against those bare numbers and puts a face and personality on one person’s life as she remembers her sister Rose ‘Billy’ Mitchell (nee Duffy).

It is important we remember the individuals we know who have died whether by Coronavirus or not. As a community of psychiatrists in Scotland we have lost one of our most inspirational colleagues. The tributes to Dr Dame Denise Coia have been extraordinary. For those of us lucky enough to have known her we will all have our favourite memories. As Chair I met with Dame Denise regularly and she was unfailingly enthusiastic and encouraging. She would quip that people only used her title “Dame’ when they had a really difficult task for her to perform. Reading through her obituary in the Times (also in the Herald) it is staggering to reflect on the scope of her work and influence. I have written to Archie and the family and we will collect tributes to her which will be put together in a volume for the family.

The College in Scotland have produced an obituary and are gathering a book of condolences. If members would like to contribute could they please email angela.currie@rcpsych.ac.uk.

This week saw the First Minister’s daily briefing on Tuesday having a mental health theme. The resources available on nhs.inform were highlighted and the key message was ‘Help is There’. There are additional funds for NHS 24 with expansion of their Breathing Space programme and a national roll out of Distress Brief Interventions – especially focused on those struggling with aspects of the crisis. John Mitchell at the briefing quoted Viktor Frankl, ‘when we are no longer able to change a situation, we are challenged to change ourselves’. Inspiration from an Austrian Psychiatrist and Holocaust survivor to the Scottish people in 2020.

Books will be written about the psychological effects of coronavirus on key workers, grieving families and the wider population. There is a need for mental health research as the crisis unfolds as called for by Professor Rory O’Conner from Glasgow in this week’s Lancet. We will have specific challenges in the recovery phase of those whose assessments or treatments have been delayed. Simply reflecting on my immediate family, colleagues and patient group I would observe an encouraging degree of resilience. There were not the expected civilian psychological injuries following bombing in World War II – perhaps something to do with everyone being effected. That gives cause for some optimism, as does many of the things that emerged following peace – the welfare state, the NHS, transition from empire to commonwealth and the Universal Declaration of Human Rights.

There is a second theme in Schindler’s List in which colour is used. It is a Sabbath candle, whose surroundings lose their colour at the beginning of the film and which retains colour to the end.

Letter from Chair to all members of the RCPsych in Scotland

9 April 2020

The natural world is not in lockdown. Signs of spring are everywhere. Golden daffodils still dance in the breeze, whilst the 250th anniversary of the birth of William Wordsworth on Tuesday went with little notice. The natural cycle of renewal and rebirth are reflected in the symbols of Easter. The Rainbow is the symbol of this time capturing both ancient themes of hope and modern concepts of mutual respect and support for each other. One of my highlights as Chair was when we adopted Rainbow lanyards at our 25th Anniversary meeting last September.

Wordsworth also spoke of the ‘bliss of solitude’ – well I suspect many of us have had quite enough of that already – but in my conversations with patients this week I have been interested in how time is being spent and indeed some unexpected poets have emerged. In contrast I know many of us have never been busier, working long days, already managing new complex clinical situations and supporting wider family and friends. I suspect for most members the last three weeks has passed very quickly.

In the blizzard of changing advice and guidance the RCPsych in Scotland Hub is designed to bring together links to the most up-to-date guidance. If you spot something that has been superseded or left out before the team does get in touch. The College is offering a variety of free educational resources. All College meetings and events have now been cancelled until the end of August, including International Congress. New ways of learning and coming together are emerging. I have yet to join a live Webinar and many Faculty groups and workplaces have new WhatsApp groups to keep in touch. I am putting in place arrangements for Devolved Council to meet using Microsoft ‘Teams’ after a very successful UK Council last Friday using this method.

Scottish Government Mental Health Directorate has 6 work streams to respond to the crisis: Mental Health law; health and social care worker wellbeing; population wellbeing; restricted patient support; liaison with mental health COVID leads in every Health Board; and support for special populations who are shielding. I attend a Ministerial stakeholder’s group on a Monday and a Government Forensic Group on a Tuesday. The Scottish Academy of Royal Colleges meet on a Monday evening and have regular meetings with the Cabinet Secretary and the interim CMO.

RCPsych in Scotland decided to continue our support for the Mental Health Film Festival this year. The event will be very different but will provide an opportunity for broadcasting material over the Internet which will be of interest to patients and mental health workers alike and will be a useful resource.

Another anniversary this week reminded me of an exercise I use in teaching. I pose the question, is psychiatry more concerned with restricting liberty or setting people free? There is no correct answer, it is a device to reflect on what it means to lose freedom including that lack of liberty caused by illness. We all know now what it means to be limited in where we go, who we see and what we do. Monday saw the 700th anniversary of the Declaration of Arbroath, and I read its lines about ‘freedom’ in a completely new way.

Professor John Crichton

Letter from Chair to all members of the RCPsych in Scotland

3 April 2020

Have you noticed a change in our language? New words or phrases which are either new or have new meaning: see you on the other side; when this is over; the new normal; are you well? We are all discovering new patterns to our days and new ways to support patients and colleagues who are all getting used to their new normal too. Coronavirus is a great leveler, and the shared experiences have been a way to connect in my conversations with patients. They need to know they are not alone or forgotten - everyone of us can share in that. We also work with teams who have had to rapidly adapt. Our multidisciplinary teams need clinical leadership and emotional support – each one of us too are supported by multidisciplinary colleagues and every day I am humbled by the selfless actions of others. Forgiveness too is important – and when I say that I am first and foremost thinking of myself - everyone is working in unexpected roles and not everyone is suited to the new tasks allocated to them.

The RCPsych in Scotland webpage is where we are updating the latest PPE guidance, emergency legislative changes, where returning clinicians can find out how to reregister, changes to ARCPs, training and recruitment. If you spot any guidance which has been superceded or links which have crashed, please contact the Queen Street Team at scotland@rcpsych.ac.uk and it will be put right.

The emergency mental health act has not started. It will only commence when there is evidence normal working has become unsustainable. At the Monday meeting with the Minister for Mental Health the evidence is reviewed with submissions from the Mental Health Tribunal for Scotland, Mental Welfare Commission and the RCPsych in Scotland. If you are having difficulties with the normal working of the Act let the MWC know and report it to your medical manager. I have asked the Medical Managers group to collectively report difficulties in their area to the RCPsych in Scotland team.

I am delighted to welcome back John Mitchell who has come out of retirement to take up his role as Principal Medical Officer Mental Health until our new PMO, (and former Chair of the RCPsych in Scotland) Alastair Cook, can be released from NHS Lanarkshire to take up post. Scottish Government have asked that we pass on their gratitude for the work and collaboration across Mental Health Services. They are seeing great examples of people putting patient care first, using common sense and going the extra mile.

Over the last few months there has been a reorganization of staffing in the devolved nations. I am delighted that Elen Cook has been appointed Head of International, Devolved Nations and Divisions and Laura Hudson has been confirmed as the RCPsych in Scotland Manager. The policy work in Scotland has been reorganised with a new post created. As a result, Andrew Fraser, who has been a valued part of the RCPsych in Scotland team has left us. I have thanked Andrew for all his service to the College over the last 18 months and passed on the gratitude of the membership for all his hard work and contributions. We all wish Andrew well.

In these strange times it has sometimes been the funny moments interwoven with the somber which have helped get through the long day. We are all rapidly mastering new technologies. For me this week it has been Microsoft ‘Teams’ – unfortunately not all team members realised it was a video call – but perhaps all such meetings should be in pajamas.

Professor John Crichton

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.

Findings included:

  • 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.

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