RCPsych eNewsletter February 2018

Wendy hails the great news that CCGs must meet the Mental Health Investment Standard.

Read the full update.

Hundreds of medical students attended a college event this month to hear Stephen Fry tell them: “Choose psychiatry”.

Stephen, who supported the college’s #ChoosePsychiatry campaign last autumn, told students in London, “Physical health is important but nowhere near as exciting as the science of cognition and consciousness.”

And he urged the students at Barts and The London Medical School: “The brightest and the best minds must join the fight against mental illness.”

Stephen – hailed by our President Professor Wendy Burn as a national treasure – was speaking at an event called Psychiatry: Brain, Mind and Body in the 21st century, which also included excellent talks on neuroscience.

Professor Ania Korszun set the scene with a talk which advocated psychiatry’s role at the centre of medicine and medical care.

Dr Gareth Cuttle spoke about the exciting future which beckons for tomorrow’s psychiatrists, thanks to advances in neuroscience and our improved understanding of the relationship between mental health and the brain.

Then Dr Derek Tracy gave a lively talk about the evolution of the human mind, which had students learning and laughing in equal measure.

After Stephen Fry’s brilliant speech, he joined a panel discussion.

The event followed a successful National Student Psychiatry Conference in January in Brighton.

Last Monday (12 Feb), Jeremy Hunt hosted a webchat with a panel of experts to answer questions on the Children and Young People’s Mental Health Green Paper.

The discussion was chaired by the Royal College of Psychiatrists’ Director of Strategic Communications, Kim Catcheside.

Dr Jon Goldin, Co-chair of the Royal College of Psychiatrists Westminster Parliamentary Liaison Committee and Consultant Child and Adolescent Psychiatrist, Great Ormond St Hospital, joined the Secretary of State for Health and Social Care as one of the panellists. 

fully subtitled recording of the discussion is available on the Department of Health and Social Care’s YouTube Channel.

The College will submit a response to the Green Paper. If you want to have your say, please respond to the consultation by 2 March.

Last week we published our response to the Independent Review of the Mental Health Act 1983 call for evidence.

Our submission primarily focussed on the areas set out by the Review as priorities for reform as well as other areas that are important to members, these are:

  • Community Treatment Orders (CTOs)

  • Nearest Relative

  • Advance Care Planning

  • Safeguards: Advocacy

  • Safeguards: Tribunals and Statutory Second Opinions

  • Reforms to Part III

  • Child and Adolescent Psychiatry

  • Intellectual Disability

We also made clear that legislative reform can only play a small part in improving patient care and that we must tackle other problems, such as: inadequate service provision, accessibility, societal injustices and ingrained inequalities.

We’ve done our best to reflect the opinion of members and the entire morning session of Council in January was dedicated to agreeing on the College’s line on potential reforms.

As well as this, the members’ survey that was undertaken last year has been essential in framing the work and making sure the submission was in line with opinions of psychiatrists. Read the final results of the survey. Thanks to all who took part.

This is only the first stage of the Review and there will be a lot more work to be done on this.

All members who want to share their opinions on the Review and the College’s response to it should contact mentalhealthactreview@rcpsych.ac.uk.

In this podcast, Diane Goslar, a recovering alcoholic, talks with brutal honesty about the stigma she faced among family, friends and work colleagues as she battled alcohol addiction.

While describing the difficulties, she also provides advice which could help addicts, or people around them, to manage their way through a profoundly challenging period in their lives.

This podcast is the first in a series which will explore different aspects of managing addictions.

What is the RCPsych Parliamentary Scholars Scheme?

Since 2012, Baroness Hollins, ex-President of the Royal College of Psychiatrists and a Professor of Learning Disabilities Psychiatry, has taken on a Learning Disabilities trainee for a special interest session to work with her as a parliamentary researcher in the House of Lords.

This is the first year the scheme has been opened to trainees in all psychiatric sub-specialities.

Dr Susan Howson is one of the five speciality trainees who spend one day a week treading the floors of Westminster. Each of them is attached to a different peer from across the political spectrum; Conservative, Labour and Cross-Bench.

About Susan

Susan is an ST6 in child and adolescent psychiatry working in Devon Partnership NHS Trust.

She is attached to Lord McColl for a year. Lord McColl is a British surgeon, professor, politician and Conservative member of the House of Lords. McColl was made a life peer for his work for disabled people in the Queen's Birthday Honours in 1989.

Here are the highlights of what she’s done and learnt so far…

Joining the scheme

Being tucked away in rural Devon I can sometimes feel a little cut off, so I have always jumped at interesting opportunities to see the wider social and political context in which psychiatry operates.

When the College advertised Parliamentary Scholarships which would be supported to enable trainees to participate from outside London I was very keen, and was delighted to be accepted onto the scheme.

I was given Lord McColl of Dulwich, a general surgeon and Conservative politician, to work with.

Although I was nervous initially, all thoughts of professional or political stereotypes were very quickly banished (a different sort of #banthebash!) when I met him.

Getting to know Lord McColl and learning about his long career in medicine and public life has been really interesting. It was particularly memorable hearing about his experiences as a House Officer, working with people who had taken overdoses, when suicide attempts were illegal.

I am so glad we no longer have to contend with the police to assess someone’s mental health after the supposed ‘crime’ of attempting suicide.

Parliamentary involvement

So far, I’ve had a really varied, engaging experience, including watching or getting involved with debates, question times, select committee oral evidence and ministerial meetings.

It’s great to have the chance to brief on issues related to mental health in questions or debates, including a detailed discussion of the recent children and young people’s mental health green paper.

I’m due to view Prime Minister’s Question Time in person soon, and looking forward to seeing how it compares in reality to what we see on television.

It was really rewarding to work with Lord McColl on submitting written questions to the Government on a subject I care about greatly, the well-being of looked after and vulnerable children.

Another peer involved in the scheme raised the subject in the House and I was happy to be in a position to give Lord McColl a detailed briefing.

He's also currently steering a private member’s bill through Parliament, which has been a great opportunity to learn how legislation is formed.

Other experiences

Not everything I have been involved with has been directly to do with the processes of Government.

I have been able to give some support to a campaign raising awareness about issues associated with human trafficking and modern slavery, a cause which has long been very close to Lord McColl’s heart. It’s interesting to see how he approaches the issues he works with and the responses he gets.

I would strongly encourage trainees from across the UK to consider applying for this scheme. Participating from a distance has required planning and organisation (and kind support from my school and TPD) but it is certainly manageable.

I think my experience has been a little different to London trainees, but it has been a great opportunity to see and learn things that I can also take back and share with my colleagues.

Thank you particularly to Olivia Clark from the College for help in making this possible.

More from the Parliamentary scholars

Each Parliamentary scholar is writing a blog for the eNewsletter.

If you enjoyed hearing about Susan's experiences, you can catch up with the others in forthcoming eNewsletters.

Quality Improvement: a case study

Last month the college’s Quality Improvement lead Amar Shah brought you the third in a series of QI case studies, which we hope will inspire ideas for quality improvement in your areas of work.

It focused on work done by the Adult Learning Disability Unit in Durham.

This month we’re looking at a project which took place at Merseycare NHS Foundation Trust, focusing on preventing suicide.

The aim of the project

In 2015 Mersey Care NHS Foundation Trust (MCT) announced its ambitious commitment to ‘Zero Suicide’ and the aspirational goal of no suicides of service users in our care.  Four areas were initially identified for quality improvement approaches;

  • Service user and Partner engagement
  • Safe and effective care and treatment
  • Competent workforce
  • Research and Evaluation

Content theory

Under the ‘safe and effective care’ heading it was agreed to test the potential impact of the introduction of individual safety plans.

The ‘Safety Plan’ is a psychologically informed, risk management and reduction tool co-designed by Consultant Psychologist, frontline staff and service users. It is evidence based and built to national guidance standards.

Recovery orientated, it’s a key component of NCI safer services requirements. It supports skill enhancement, problem solving, generates hope and includes opportunities to learn from and prevent future crisis.

Execution

The Model for Improvement was used consistently to learn and refine the plan and a number of  PDSA cycles were completed prior to implementation.

Another PDSA was carried out with the aim of assessing the feasibility, acceptability and safety of implementing the safety plan into business as usual practice across four sites. 

A thorough service evaluation was carried out exploring potential impact on locus of control (MHLOC) for service users, impact on emotional coping (DERS), impact on working alliance and any adverse effects to ensure safety. 

Focus groups pre and post implementation were conducted and a thematic analysis completed to capture themes and maximise learning.

Feasibility

  1. The Safety Plan (SP) was successfully implemented in three out of the four sites.
  2. Operational management support was imperative for implementation
  3. Service User (SU) engagement was influenced by the attitudes of staff
  4. Staff initially candid about participation due to fear of administrative burden but once engaged became keen advocates

Acceptability

  1. SP is appropriate for all service users but timing of when to engage is important
  2. SUs found the safety plan emotionally challenging but very welcomed
  3. Benefits included validation of feelings, improved self insight, hopefulness, self reliance and affirmation of support networks
  4. Staff were doing something valuable
  5. Engaged staff noted improved job satisfaction and working alliances

Safety

  1. SP considered to provide an intensive, collaborative and personalised intervention over existing clinical practices
  2. SP provided a defensible, formal structure to their clinical practice which they valued
  3. Staff felt adequately prepared following training and several suggestions for improvements
  4. No adverse effects were reported by service users.

Data

Broader implementation, monitoring and evaluation systems illustrate the following.

Conclusion

The SP is an evidenced based tool that enhances service user skills, staff engagement, confidence and satisfaction. Data included 0% readmission rate across a 90 day timeframe for service users supported by a safety plan compared to 4% readmission rate for those without. Also a reduction in the number of complaints relating to poor staff engagement noted post implementation. Broader implementation was indicated.

Contact  details, Project Lead

Dr Claire Iveson
Consultant Clinical Psychologist (Clinical Lead Safety planning)
Claire.iveson@merseycare.nhs.uk
Tel: 0151 473 2907

View full article with graphs (PDF).

The ‘iceberg model’ has fatal self-harm (suicide) as the highly visible tip overlaying the more frequent non-fatal self-harm seen by clinical services, which lies atop of an even larger basenever contacting services. Although accepted in principle, few data have shown the relative sizes of these three groups, hampering potential preventative and educative programmes. A new paper in Lancet Psychiatry explored this in young people using national mortality and hospital monitoring self-harm data, and a schools’ survey. The data are harrowing: 171 adolescents (aged 12–17) died by suicide in England between 2011 and 2013; for each of these deaths there were about 370 hospital presentations with self-harm, and 3900 adolescents self-harming but unseen in the community. Ratios of non-fatal/fatal self-harm varied between genders – the former far higher in females, with males accounting for 70% of suicides. Hanging or asphyxiation were the most common cause of death, self-poisoning the most common hospital presentation and self-cutting the most common form of self-harm in the community. These figures are difficult to ignore, suicide is the leading cause of adolescent death in the UK. Every year an estimated 200,000 young people self-harm in England and are not seen; this suggests that out-reach of our services must be developed and the authors propose schools-based programmes as a key target.

#MeToo is leading us through a necessary cultural shift. The other day Formula 1 announced it will no longer have “grid girls” from next season; well that only took thirty years from Play Your Cards Right’s “Dolly dealers” – our children will look back with the same bewilderment we feel when we see old footage of people smoking on planes. A challenging but moving editorial in the New England Journal of Medicine argues that unacceptable behaviour is an issue beyond politicians and film directors to occur also in healthcare. A second paper reviewed in Kaleidoscope takes a related difficult topic: despite accounting for the majority of undergraduate science and healthcare degrees at University, women remain grossly under-represented at the most senior professional levels. The authors went to multiple university lectures and found that when women:men student ratios were equal, women were two and a half times less likely to ask a question than men; it got even worse if a man asked the first question. It argues that women are literally less visible, and something needs to change. Difficult but important conversations for us all. We’ve recently recorded a highly stimulating podcast at the College with some leading women in medicine and neuroscience, and will be publishing that with the Mental Health Foundation next month; watch out too for a forthcoming editorial in the BJPsych on the topic.

Quiz

  1. Despite pharmacodynamic logic and early animal model success, the first randomised controlled trial of cannabidiol in psychosis failed to show any benefit over placebo.

    Answer: False; the data look promising.

  2. Analysis of behaviour following calls for gun control changes and public health warnings after the ‘Sandy Hook’ school shootings showed it was followed by an increase in gun sales.

    Answer: True, sadly.

  3. Data on unwanted sexual approaches towards female doctors from male colleagues show these to occur at a similar rate to those in society more generally.

    Answer: True, sadly.

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