Faculty of General Adult Psychiatry

Chair: Dr Bala Oruganti

General adult psychiatry encompasses a range of specialities involved with the provision of psychiatric care to adults.

Updates

Figures released today (18 Sep) from Public Health Wales' Harm Reduction Database Wales: Drug related mortality, Annual Report 2018-19 show that drug-related deaths in Wales are at their highest levels on record.

The number of people dying from drug poisoning has increased by 78% in just 10 years, while there has also been a rise in deaths of younger people from substances such as cocaine and MDMA.

Drug misuse deaths, a subset of drug poisoning deaths, increased by 12% from 185 deaths in 2017 to 208 in 2018, with Wales having the second highest rates of drug misuse deaths in England and Wales regions.

Deaths were more than four times more likely to occur in the most deprived areas of Wales compared to the least deprived.

The report noted a rise in deaths involving cocaine, amphetamine and MDMA tended to involve younger people in their 20s.

A third of all drug deaths reviewed saw "no known contact" between those that died and any local health, social care or criminal justice service in the 12 months beforehand.

The health agency's report makes a number of recommendations to tackle the increase, including protecting drug users from prosecution when seeking medical attention, and reclassifying heroin substitute Take-Home Naloxone as an over-the-counter medication.

Josie Smith, Head of Substance Misuse at Public Health Wales, said the increasing availability of drugs was causing the rise in drug deaths, and warned the trend was set to continue.

She added: "Given the scale of problem drug use in Wales, it is likely that every member of the population will know someone affected by, or experiencing difficulties with drugs be they illegal or prescribed, but may be unaware.

"Evidence is clear that seeking support early on can prevent escalation of problem use and dependency, however, fear of stigmatisation and social exclusion may be barriers to this. Consideration needs to be given to how this can be overcome in Wales to prevent future tragic deaths."

Professor Keith Lloyd, chair of the Royal College of Psychiatrists in Wales said:

“With the number of people dying from drug poisoning increasing by 78 per cent in just 10 years, we are now at crisis point and this should serve as a wake-up call to the government.

“Years of austerity, shortages in professional skilled staff and underinvestment in addiction services mean people living with multiple needs cannot be helped properly.

“The top priority should be to get more people into effective treatment and ensure health services can keep up with demand.

“We should be targeting young people and local communities, especially with hard to reach groups such as the homeless population.

“We need action on this issue before the problem spirals out of control and destroys more lives.”

Figures released today (27 June) by the Office of National Statistics shows death by suicide has increased and is more prevalent in males.

In 2017 there was 13.2 deaths per 100,000 – significantly higher than the rest of the UK which stood at 10.1 deaths per 100,000.

And Wales is comparable to the trend in Scotland – 13.9 deaths per 100,000 when it comes to suicide.

The suicide rate for males has seen an increase from 2008 to 2010, 16.1 deaths per 100,000 men to the latest period of 20.6 deaths per 100,000 men in 2015-2017.

For females, the rate of suicide has remained relatively stable since the mid-1990s with 5.1 deaths per 100,000 females in 2015 to 2017.

The statistics also show males aged 25 to 44 years have had the highest age-specific suicide rate since the early 1990s.

Professor Keith Lloyd, chair of the Royal College of Psychiatrists Wales, said: “Suicide among men has been rising in Wales since 2008. The causes are many and linked to deprivation and exclusion as well as to mental health problems and substance misuse.

“If we are going to change this, we need to combat stigma against help seeking for mental health issues and ensure that the social and health care services needed to support people are properly funded and easily accessible to all”

The Royal College of Psychiatrists Wales welcomes the Position Statement on Antidepressants and Depression (PS04/19) issued by the Royal College of Psychiatrists and offers the following, additional Welsh specific recommendations:

  • Welsh Government should invest further in alternatives to antidepressants for people with depression
  • Welsh Government should offer updated, evidence-based, prescribing advice on antidepressant, withdrawal and tapering at the earliest opportunity to help people come off antidepressants with as few issues as possible.
  • Welsh Government should commission further research into the rates and behaviours of antidepressant prescribing to Children and Young People.

Professor Keith Lloyd, chair of the Royal College of Psychiatrists Wales, said:

"These treatments used in the right way can be life-saving, particularly in combination with talking therapies.

"It is clear, there is underinvestment in evidence-based psychological therapies and we’re also calling on more support for prescribing advice, withdrawal and tapering at the earliest opportunity.

"Going forward, we will share this report with the Welsh government and recommend they commission further research into the rates and behaviours of antidepressants, particularly in relation to children and young people.”

Responses and Publications

Published Report (December 2018) (PDF)

The extent of the problem of suicide in Wales was consistently raised in evidence to the Health, Social Care and Sport Committee’s inquiry on loneliness and isolation earlier this year.

Between 300 and 350 people[Opens in a new browser window] in Wales die from suicide each year; it is a major cause of death amongst people aged 15-44.  About three quarters of people who commit suicide are men, in Wales and across the UK. The most recent statistics on suicide (published 7 September 2017) show an improvement in Wales of the age-standardised suicide rate for males and females from 13.0 in 2015 to 11.8 per 100,000 people in 2016.  The Welsh Government’s suicide and self-harm prevention strategy Talk to me 2 - Suicide and self-harm prevention strategy for Wales 2015-2020 was launched in July 2015.  It followed Talk to Me. The National Action Plan to Reduce Suicide and Self Harm in Wales 2009-2014. Talk to me 2 identifies suicide as a ‘major public health challenge’. 

Mental health services have an important role to play in suicide prevention.  The Welsh Government’s priorities for mental health services in Wales are set out in the Together for Mental Health strategy and the Together for Mental Health Delivery Plan 2016-19 and mental health service provision is underpinned by the Mental Health (Wales) Measure 2010 which has a preventative ethos.

The Health, Social Care and Sport Committee’s inquiry will focus on suicide prevention for people aged 15 and over in Wales.

Published Report (December 2018) (PDF)

An Assembly Member Bill, introduced by Paul Davies AM. Paul Davies AM was successful in a legislative ballot on 28 March 2017, and given leave to proceed with his Bill (PDF, 93KB) by the Assembly on 14 June 2017.

The Business Committee has remitted the Bill to the Health, Social Care and Sport Committee.

The overall purpose of the Bill is to ensure the needs of children and adults with Autism Spectrum Disorder in Wales are met, and to protect and promote their rights.  The Bill delivers this purpose by seeking to:

  • Introduce a strategy for meeting the needs of children and adults in Wales with ASD conditions which will:
    • Promote best practice in diagnosing ASD, and assessing and planning for meeting care needs;
    • Ensure a clear and consistent pathway to diagnosis of ASD in local areas;
    • Ensure that local authorities and NHS bodies take necessary action so that children and adults with ASD receive the timely diagnosis and support they need across a range of services;
    • Strengthen support for families and carers and ensure their wishes, and those of people with ASD, are taken into account;
    • Promote research, innovation and improvement in ASD Services;
    • Establish practices to enable the collection of reliable and relevant data on the numbers and needs of children and adults with ASD, so that the Welsh Ministers, and local and NHS bodies can plan accordingly;
    • Ensure key staff working with people with ASD are provided with appropriate ASD training; and
    • Regularly review the strategy and guidance to ensure progress.
  • Require the Welsh Ministers to issue guidance to the relevant bodies on implementing the strategy.
  • Require the Welsh Ministers to collect suitable data to facilitate the implementation of the Bill.
  • Require the Welsh Ministers to undertake a campaign to raise awareness and understanding of ASD.

Further detail about the Bill can be found in its accompanying Explanatory Memorandum (PDF, 1MB).

Published Report (February 2018) (PDF)

A Welsh Government Bill, introduced by Rebecca Evans, Minister for Social Services and Public Health. Following a change in ministerial portfolios in November 2017, the First Minister authorised Vaughan Gething, Cabinet Secretary for Health and Social Services, as the new Member in Charge of the Bill, from 9 November 2017. The Business Committee has remitted the Bill to the Health, Social Care and Sport Committee.

The Bill provides for a minimum price for the sale and supply of alcohol in Wales by certain persons and makes it an offence for alcohol to be sold or supplied below that price.

The Bill includes provision for:

  • the formula for calculating the applicable minimum price for alcohol by multiplying the percentage strength of the alcohol, its volume and the minimum unit price (MUP);
  • powers for Welsh Ministers to make subordinate legislation to specify the MUP;
  • the establishment of a local authority-led enforcement regime with powers to bring prosecutions;
  • powers of entry for authorised officers of a local authority, an offence of obstructing an authorised officer and the power to issue fixed penalty notices (FPNs).

The Bill proposes the MUP would be specified in regulations. However, for the purpose of assessing impacts and the associated costs and benefits, the Explanatory Memorandum uses a 50p MUP as an example.

Further detail about the Bill can be found in its accompanying Explanatory Memorandum (PDF 2MB).

Published Report (December 2017) (PDF)

There is evidence that loneliness and isolation can have a significant impact on physical and mental health; preventing loneliness and isolation may therefore help to reduce demand for health and social services. Many older people live alone, experience poor health and are unable to participate in social activities without help and support, especially in rural areas. This leaves them vulnerable to loneliness and isolation. Loneliness and isolation are not the same thing – each can be experienced without the other. There is a need for evidence on good practice in addressing loneliness and isolation, identifying what does and doesn’t work and how best to use existing and additional resources most effectively. The Wellbeing of Future Generations (Wales) Act 2015 places certain requirements on public bodies which includes setting wellbeing objectives.

The Welsh Government has published national indicators of wellbeing as required by section 10(1) of the Act. There are 46 indicators, one of which (30) is the “percentage of people who are lonely”. Other indicators are concerned with related issues such as mental well-being. The Minister for Social Services and Public Health has stated (30/9/16) that she recognises loneliness and isolation as important public health issues on which the Welsh Government is committed to developing a cross-government strategy.

Get in contact to receive further information regarding a career in psychiatry