Dr Joan Rutherford

Dr Rutherford is an honorary consultant psychiatrist at South London and Maudsley NHS Foundation Trust and Chief Medical Member of the Mental Health Tribunal Service. She is one of 25 women to be highlighted as part of a special project that celebrates the stories of 25 amazing women psychiatrists.

Dr Rutherford's story

I’m so very pleased to have been nominated as one of the 25 women.

My current role is Chief Medical Member for the Mental Health Tribunal Service in England, a national post, based here at the Royal Courts of Justice in London; the only medical doctor with an office here.

Appointed in 2010, my role is to 'take a lead with all things medical’ within the Tribunal. I’m the equivalent of a Medical Director for the 440 Medical Members (MMs), who are all consultant psychiatrists, and I also sit as a MM on tribunals three days per week, seeing the wide variety of services nationally. I’ve worked with the Royal College of Psychiatrists and my previous Trust, South West London and St George’s, to produce guidance and training – now available on Trainees Online (TrOn) – for trainees before they actually present evidence at tribunals, trying to reduce that awful experience of being a total novice.

In this legal world, it has been helpful for me to focus on recruitment to drive change. I became the first Suitable Person approved by the GMC in 2012, so that MMs who wish to retain a Licence to Practise can do so. My Deputy Dr Gabrielle Milner and I have established a similar medical appraisal system as in NHS Trusts.

On the subject of recruitment, since 2015, more MMs who are still working within the NHS and independent sector have been appointed, which has reduced the average age at appointment by seven years and, as more attention to diversity has been given, more female and BAME Medical Members have joined.

A Mental Health Tribunal and Royal College collaborative study is currently underway which is exploring patients’ and clinicians’ experience of hearings. The collaboration has included the College race equality leads and the South London and Maudsley NHS Trust. The results are expected to generate ideas for the future training for both Tribunal Members and clinicians and to improve the patient experience.

In moving on to think about the value of mentorship for this blog, I begin by reflecting that the women who have much inspired me throughout my career are Dr Adrianne Reveley, Dr Marisa Silverman, Dr Geraldine Strathdee and Professor Wendy Burn. I admire their – respectively – academic skill, work with patients and carers, innovative thinking, and support for trainees.

Reflections on mentoring

1. Mentoring in preparation for a role

My experience of being supervised and mentored during my training was positive, especially so in my final year as a specialist trainee, when I worked in rehabilitation psychiatry. My consultant prepared me to become a consultant. He encouraged me to take on projects as his deputy, accompany him to management meetings which he attended as a Clinical Director, and to chair ward reviews and CPA meetings. In our weekly supervision, I was encouraged to reflect on what it felt like when the ‘buck stops here’ acting up as a consultant. This was also around the time when a final group of long-stay patients were being moved into an NHS-funded and staffed long stay community rehabilitation setting.

His advice to me on attending the planning meetings as his deputy was, ‘Remember the lightbulbs!’. What he’d meant was to listen and be patient when other people at these planning meetings wanted to discuss details that I didn’t think relevant to me as a psychiatrist, and to accept that others needed time to voice concerns important to them. Being indifferent or showing impatience about what seemed to be irrelevant details would not help team-building. I’ve never forgotten this advice; it remains very useful.

2. Approachability

As a medical student, and in my first year of work as a doctor, it took me some time to regard my seniors as people who could be approached for advice. My regret about this is that I was probably coming across less involved or interested than was really the case. So as a trainee, then a consultant, when we had medical students on placement, I tried to make a point of demonstrating humanity and also concern at their experience of speaking with people with distressing mental illnesses during their weekly session with me. It was satisfying to see their confidence grow – they often used sessions to discuss difficulties in communication that they’d either witnessed or knew they would face – such as breaking bad news or managing aggressive behaviour from patients.

3. Enabling the mentee to believe in themselves

My nominator for the 25 Women project, Dr Sara Beleil, is someone whom I have the greatest respect for. She at first underestimated her considerable intellect, clinical skills, resilience and above all her multi-tasking abilities when applying for a post with my NHS Inpatient and Community Mental Health Team. Instead of settling for this role, she and I worked together so she took and passed membership, and then she has moved on up to be a consultant and Postgraduate Tutor, and she is now a Fellow of the Royal College of Psychiatrists. For us both, this was such a positive experience of coaching and mentoring – I was a Postgraduate Tutor at the time. We’ve both participated as mentors in the Startwell initiative – such a support for newly appointed consultants.

In 2010, when I applied and moved into my current role as Chief Medical Member with the Mental Health Tribunal, I left the NHS but have continued to provide support for consultants as part of my honorary consultant contract. An interesting feedback comment has been that it’s useful for people to have a mentor outside their immediate workplace to discuss issues with, rather than someone also caught up in the day-to-day politics.

4. Mentoring as continued development

In my current role, I’ve worked with the Ministry of Justice in developing the mentoring system for newly appointed Medical Members. Medical Members of the tribunal are all experienced consultant psychiatrists but as Medical Members they are moving into a whole new role. They are sitting on the opposite side of a table – or screen, because tribunal hearings are currently virtual – with a judge and Specialist Lay Member, making legal decisions using the statutory criteria and applying case law. It’s a fascinating role but very different from being a consultant giving evidence. We say it takes 1-2 years for even these very clinically experienced consultants to become totally familiar with the role. So, after a two-day induction, each newly appointed consultant has a mentor – an experienced Medical Member who is funded to support them for a year.

Mentors can do their job in different ways. For instance, have regular meetings with all six of their mentees so there’s peer support as well – easier to do now we are more used to virtual meetings, and respond to emails or phone queries about tribunal hearings. It means that a newly appointed Medical Member can contact their mentor and ask questions readily.

5. My message

To trainees of all grades and newly appointed consultants – take up opportunities for being mentored and pass good tips you learn down the line. For more experienced colleagues, you’re never too experienced to benefit. We appoint psychiatrists as Medical Members from three years after consultant appointment to those who have retired from clinical work up to a maximum age of 65. Feedback from new Medical Members is that whatever their own age or previous experience, they benefit from their mentoring.