My final month as President

Reflecting on my tenure

When I first found out that I would become President in 2020, I remember saying how humbled and delighted I felt and this feeling has only grown over my tenure. It only feels right then that I start off my final blog post as President, by stating how proud and grateful I am to have had the opportunity to be the President of the College.

The experiences I have had have been amongst the most challenging and yet rewarding in my professional and personal life so far, from being a psychiatrist, someone with lived experience, and then Registrar of the College and all of you that I have worked alongside were at the heart of this.

The big headlines and national policies are often what capture the spotlight, from having a significant portion of my tenure being known as the ‘Pandemic Presidency’, to numerous reforms, reviews, bills and acts. In the future, my legacy as the President of the Royal College of Psychiatrists may be defined by these, but I want you all to know that it has been the amazing people that I’ve worked with, and the stories and spirit that you have shared with me that have been the driving force behind so many of our shared successes.

As I prepare to demit office on Tuesday 11 July, I urge you to take this blog post as a heartfelt thank you, and also as a reminder that if you feel that the value of your effort and commitment sometimes goes under the radar, remember and take pride in the fact that you are doing essential and sometimes life-saving work to secure the best outcomes for people with mental illness, intellectual disabilities and developmental disorders.

Together, we have achieved incredible things and given a voice to those who really need it.

_{Dr Adrian James pictured wearing the Presidential chain, taken shortly after becoming President in 2020.}

Industrial action

Junior doctors in England have announced industrial action which will take place from 7am on 13 July until 7am on 18 July. BMA Consultant members have also announced industrial action from 7am on 20 July until 7am on 22 July.

The NHS consultant workforce, including the psychiatry workforce, has been under immense pressure for years. Consultant psychiatrists, in common with other consultants, have worked tirelessly before, during and since the pandemic, to keep NHS services running with inadequate resources.

As the professional medical body responsible for supporting psychiatrists at all stages of their careers, it is not our role to advise members on whether they should take part in industrial action. This is a personal decision for each consultant.

While this will be a difficult decision for some, I know colleagues who decide to take industrial action will do so after careful consideration and after balancing the various risks to patient care and service provision.

The College will continue to seek to influence Government to push for a fully funded multi-year workforce strategy to grow the psychiatric workforce.

In order to deliver the best possible care to our patients, we need a workforce that is motivated, supported, and happy in their jobs.

Pride 2023

As we reach the end of June we also reach the end of Pride 2023. Earlier this month, I reflected on the importance of supporting the LGBTQ+ community, which has been central to our efforts as a college to promote equality, diversity and inclusion, one of my four presidential priorities.

I also want to draw attention to a new essay prize from our Rainbow SIG, named in memory of Professor Michael King, who sadly passed away in 2021. He co-founded the College’s Gay and Lesbian Mental Health Special Interest Group (now the Rainbow SIG) in 2001 and was a very valued member of the SIG following its inception.

The title of the 2023 essay prize will be 'LGBTQ+ Mental Health – The Role of the Psychiatrist in Reducing Stigma' and the deadline is December 31.

Over 5,000 out of area placements for adults with acute mental health needs

First and foremost, we need comprehensive community services to avoid admission wherever possible. We also need beds available locally when patients need admission. This is severely lacking in many areas.

This unacceptable practice - sending patients hundreds of kilometres away from their homes and families – has been happening for decades. It risks patients’ mental health to such a degree that they often remain in hospital for longer.

Government must keep its promise to put a stop to this practice. Patients should be offered effective alternatives to hospital admission so they can receive help earlier, from the right specialist, for their specific needs, instead of being sent out of area for treatment.

When patients require hospitalisation, it is vital that there are properly staffed inpatient wards, which depend on a robust mental health workforce. This is impossible without the long-awaited NHS Workforce Plan, which, at the time of writing, is due to be published imminently. It was good to be able to discuss the mental health workforce with the Prime Minister in Downing Street on 27 June 2023.

If these placements continue it is ultimately patients who will pay the price.

Responses to BBC Panorama

At the beginning of this month, concerns were raised in BBC Panorama's ADHD programme. With our Neurodevelopmental Special Interest Group (SIG), we closely monitored the reaction and recognised the valuable contribution this documentary has made to highlighting the existing challenges in this field.

It is essential to observe that the issues presented in the documentary do not encompass most services dealing with adult ADHD, many of whom provide a high standard assessment and care under significant pressures. However, this documentary raises very real concerns we acknowledge, and we take this as a very serious reminder of the need for continuous learning, improvement, and standardisation of practices across all areas of adult ADHD diagnosis and management.

We also see this documentary as a critical opportunity to advocate for more resources to be allocated to NHS mental health services, especially those dealing with neurodevelopmental disorders. Inadequate funding and long waiting lists are not only detrimental to patient care but also put undue strain on our dedicated professionals who are doing their best to provide effective services.

This month we also responded to the BBC Panorama programme on antidepressants. Depression is a serious and potentially life-threatening condition that is treatable, usually involving a combination of self-help, psychological therapies and medications.

We reiterate that ultimately, the use of antidepressants, should always be a shared decision between a patient and their doctor based on clinical need and the preferences of the patient.

We would advise all those thinking of stopping their antidepressants to talk to their doctor first, as these medications should not be stopped abruptly.

2023 Birthday Honours

His Majesty King Charles III announced his inaugural Birthday Honours list this month which recognises psychiatrists and others for their contribution to mental health. I was delighted to see two members of the Royal College of Psychiatrists have been recognised for their significant contributions:

RCPsych Member and Honorary Fellow, Professor Louise Michele Howard, Professor Emerita of Women's Mental Health, King's College London, received an Order of the British Empire award for her services to Women's Mental Health.

RCPsych Member, Professor Raja Anindya Sekhar Mukherjee, Consultant Psychiatrist, Surrey and Borders Partnership NHS Foundation Trust, received a Member of the Order of the British Empire award for his services to People with Fetal Alcohol Spectrum Disorders

My congratulations to our members who have received these prestigious awards. They are richly deserved and mark considerable contributions to the advancement of mental health across the UK.

Sounding the alarm over plans to detain refugee children

Alongside leading medical organisations, as well as Together with Refugees, the College is warning of the serious harm that may come to children if current provisions in the Illegal Migration Bill become law.

This Bill’s potential to permit detaining children for indefinite periods is wholly unacceptable, especially when they are already some of the most vulnerable members of society.

We call on Government to immediately remove any provisions from the Bill that would allow this to happen and instead focus on the support and safeguards that should be established to meet children’s needs.

RCPsych International Congress 2023

This year’s RCPsych International Congress will be my last as President. I am looking forward to seeing many of you at RCPsych’s International Congress in Liverpool in July, where I will give my last valedictory lecture before officially stepping down on Tuesday 11 July.