RCPsych eNewsletter April 2018

Wendy reflects on working conditions, world-leading mental health legislation and work to combat racism in mental health care.

Read the full blog.

Write an original article on a psychiatric topic aimed at the general public and you could win £1,000.

That’s the prize on offer for the winning entry in this year’s Morris Markowe prize.

Your article should be around 1,000 words long, and be suitable for publication in a newspaper, lay journal or online.

Previous winners have covered a wide range of topics from Prince Harry’s revelations about his own mental health to the names we give to different drugs.

The deadline for entry is 1 May 2018.

For more information see The Morris Markowe Public Education Prize.

The proportion of children with an eating disorder starting urgent treatment within one week remains far higher in London than the rest of the country, according to data analysed by the Royal College of Psychiatrists.

New figures from NHS England show that while the country is on track overall to meet the national waiting time standard, there is still a postcode lottery for children accessing treatment for eating disorders.

In London, 84 per cent of urgent cases in England began treatment for an eating disorder within one week, but in the Midlands and East of England the proportion was much lower at 72 per cent.  

The pattern was the same with routine cases, where in London 88 per cent of cases began treatment within four weeks but in the North of England, just 78 per cent were seen within the one-month target. 

By 2020/21, NHS England have said that 95 per cent of children under the age of 19 with an eating disorder should access NICE-approved treatment within a week in urgent cases and within four weeks for routine cases. 

Across the country, the proportion of urgent cases being seen within one week is:

 

Q1-Q2 2016/17

Q3-Q4 2016/17

Q1-Q2 2017/18

ENGLAND

61.5%

67.9%

72.1%

NORTH OF ENGLAND

52.2%

65.1%

67.7%

MIDLANDS AND EAST OF ENGLAND

66.9%

67.9%

72.2%

LONDON

74.6%

89.3%

84.4%

SOUTH OF ENGLAND

58.4%

60.8%

72.4%

 

Across the country, the proportion of routine cases being seen within four weeks is: 

Q1-Q2 2016/17

Q3-Q4 2016/17

Q1-Q2 2017/18

ENGLAND

66.3%

78.9%

80.6%

NORTH OF ENGLAND

63.4%

76.2%

78.1%

MIDLANDS AND EAST OF ENGLAND

66.2%

80.9%

80.6%

LONDON

62.2%

78.4%

88.3%

SOUTH OF ENGLAND

70.8%

79.2%

79.2%

 

London racing ahead in treating eating disorders quickly

 

The College is taking the successful President’s lecture series on tour during 2018/19, to give psychiatrists across the UK the chance to take part.

Up to now the lectures have taken place in London but this year, we’re holding events in Belfast, Cardiff and Manchester, followed by a lecture in Edinburgh in January 2019.

Dame Sue Bailey, former President of the College, gave the first of the series last month when she spoke to a packed room with a talk titled ‘Back to the future – on the road less travelled’.

You can catch up with Professor Bailey’s lecture on the RCPsych website.

We promote all President’s lectures in advance on our website, social media channels and through our monthly eNewsletter to college members.

We also provide live updates of each lecture on Twitter, and publish recorded versions of the lectures on the website, for people who cannot be there in person.

Older people worried about their mental health can seek advice with new tailored resources published by RCPsych last month.

MindEd for Older People is a new online educational resource that explains a range of mental illnesses commonly experienced by older people, and offers practical advice for dealing with them.

A team of older people and professionals are the authors behind the new MindEd resources which cover a range of common problems such as insomnia, depression, medications to be aware of, anxiety and alcohol-related problems.

The resources are a vital crutch at a time when the number of Old Age psychiatrists is falling.

Families caring for the older generation need simple, clear, free, accessible advice written by experts that they can use online, on phones and tablets, without stigma or ‘referral’.

While there are many online educational mental health resources, the College is saying there must be more support to recognise mental health conditions specifically in older people to prevent wrongly attributing symptoms of mental illness to ‘old age’.

Keith Chambers, Programme Manager for MindEd for Families said: “Working with older people to produce these resources was vitally important to us to ensure they were accessible.

“There is a growing need for information like this and we hope that older people struggling with their mental health, or families worried about a loved one, will be able to get the support they need from MindEd.”

Visit the new MindEd for older people website.

What is the 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.

Paul Lomax 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.

Paul is a ST6 dual trainee in General Adult and Old Age Psychiatry in South West London and St George’s Mental Health NHS Trust. He is attached to Baroness Hollins for a year.  

Here are his thoughts on his time so far…

Joining the scheme

I don’t have a background in policy or health politics but I felt there was no harm in applying. The chance to spend time in parliament seemed an exciting way to use my special interest session.

I read through some of the big policy issues the College has identified and went to the interview a little nervous. In the end it went fine and was more of a discussion than I had expected.

I would really encourage people to consider applying in the future. You don’t need to have a background in health politics.

I have never sat on any central committees or met with politicians before. What you really need more than anything is a genuine interest in health policy and politics.

Recent experiences

In the past couple of months, we have had a variety of experiences. The scholars as a group have met with Duncan Selbie, Chief Executive of Public Health England, and Sarah Wollaston, Chair of the Health Select Committee and ex-GP.

These meetings were informal and we were able to ask about both their personal careers as well as some of the key current health policies.

We are now working on a proposal to the Health Select Committee to look into addiction services and working with College on a follow up to the Health Committee’s suicide prevention report last year that called on Colleges to raise awareness of the Consensus Statement on information sharing.

I have also helped Baroness Hollins with submissions to the Mental Health Act review as well as having compiled briefings and material for speeches in the House itself.

Some of these have been productive but I am still getting used to some of the idiosyncrasies of parliamentary scheduling where emergency questions are asked in the evening and debates postponed at the last minute.

If I wasn’t aware already I have quickly realised that there is quite a big issue at the forefront of everybody’s mind currently; Brexit.

Final thoughts

If you have an interest in politics, both health and wider politics, I would encourage you to look out for future programmes.

It has taught me a lot about how health policy is formulated and can be influenced, but at a more basic level it is simply a really interesting experience.

I never pictured my medical training would involve walking around the lobbies and corridors of Westminster but I think I could get used to it!

The College’s Centre for Advanced Learning & Conferences (CALC) holds over 70 educational events a year, providing CPD for over 10,000 delegates.

We’re seeking trainers to help with the development and delivery of a series of new training courses and are especially keen to hear from anyone with expertise in management, service development, supervision, WPBA, appraisals and coaching.

We are also looking for help to deliver our new Mental Health Awareness training package that’s being developed as well as support with ongoing training around diversity in practice and preparing for exams.

There are opportunities for Trainees as well as Consultants, so if you’re interested in working with CALC to help develop and run the College’s training programme please contact David Williams

The rising tide of obesity and diabetes, the complexity of cases we are seeing in the liaison and primary care setting, and increasing acknowledgement that there are interactions between mind and body in diabetes means it's time for a diabetes and psychiatry working group!

The Liaison Faculty Executive is formally supporting setting up a working group in Diabetes Liaison Psychiatry (DLP). The aims of this group are to:

  1. Build a critical mass of liaison psychiatry experts in diabetes
  2. Synthesize the evidence base for different models of integrated care for diabetes
  3. Generate consensus on key performance indicators of liaison psychiatry in diabetes
  4. Network with Diabetes UK/ABCD/RCPs (London & Edinburgh), NHSE, NHSScotland
  5. Developing proforma for business cases for commissioning liaison mental health models into diabetes pathways
  6. Develop training and educational programmes for diabetes professionals
  7. Identify and promote key areas and gaps in diabetes and mental health research
  8. Foster interest and mentor medical students and trainee doctors

We plan to hold our inaugural meeting at the Liaison Faculty conference on Thursday 17 May 2018 from 12.30 to 1pm.

This is during the lunch break. There will be time to get your lunch and bring it to the meeting. As you can see from the conference programme, Dr Partha Kar, NHSE Associate Director for Diabetes will be presenting early in the morning and taking questions and answers during his talk.

Please email Stephanie.Whitehead@rcpsych.ac.uk if you are interested and please forward to colleagues who are or want to work in this field.

Do contact Professor Khalida Ismail or Dr Luke Solomon if you want to have an informal chat.
Otherwise in the meantime, we look forward to seeing you in Liverpool with your 'diabetes hats'.

Professor Khalida Ismail

Professor of Psychiatry and Medicine

Institute of Psychiatry, Psychology and Neuroscience

King's College London

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Dr Luke Solomons

Consultant in Psychological Medicine/ Psychooncology

Oxford University Hospitals NHS Foundation Trust

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It sometimes seems that no matter how much we lecture and talk at them, our patients just won’t appreciate our expertise on how we know best about their taking medication. Okay, perhaps we’ve moved from that particular patriarchal model, but discussions on, and problems surrounding, adherence are a core issue, especially for those with psychoses, where paranoia, insight, and understandable concern about side effects abound. Into the fray comes a remarkable new antipsychotic: Abilify MyCite.

The core compound, as one can tell from the name, is aripiprazole, but here’s where it differs: the tablet also contains an ‘event marker’ liberated and activated by gastric fluid that transmits a signal to a cutaneous path; this in turn sends data to a mobile phone app for further collection and analysis of adherence patterns. An impressive technological achievement, and one I that I know all patients will heartedly endorse and gladly welc…oh yeah, wait – Houston we have a problem.

We have the technology: will it help, or might this just feed very nicely into narratives of psychiatrists as pill-pushing societal controllers? Is it conceivable that new advice about tablets transmitting signals from one’s abdomen could concern people? Kaleidoscope broadens the debate, reviewing an editorial on the matter.

Data on self-harm and suicide are always amongst the most challenging but important stats in mental health; the drive to reduce them rightfully enormous, but how? April’s Kaleidoscope looks at an impressive randomised controlled trial evaluating manualised family therapy (compared with treatment as usual) in over 800 young people (11-17) who had self-harmed at least twice.

The intervention had been showing promise in earlier less rigorous work, and of course tackling this issue in this cohort is essential. For every adolescent death from suicide, there are 370 hospital presentations with self-harm, and 3,900 self-harming but unseen in the community: the issue is enormous.

Disappointingly, and against prediction, the active intervention showed no benefit in terms of re-attendance at hospital with self-harm in the subsequent 18 months. It’s not clear why this was the case, though the authors note how self-harm is a final common pathway for many problems in a diverse group of people. The search continues; it has to.

Quiz

  1. New data show that fast-acting GABA modulators are showing promise as antidepressants.

    Answer: True. The main focus and excitement has been around ketamine/ketamine-like glutamatergic compounds, but there are now parallel data on GABA ones.

  2. “Abilify My-cite” is a novel antipsychotic that transmits gastric-data, via a cutaneous patch, to a mobile phone app to monitor medication adherence.

    Answer: True.

  3. The first large RCT of family therapy in adolescent self-harm has confirmed earlier nascent data that it reduces subsequent hospital attendances.

    Answer: False, sadly.

 

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