A positive start: learning from others
26 January, 2024
In her first blog post of 2024, Lade talks about the Annual National Conference of the Indian Psychiatric Society that she attended this month, prescribing Clozapine and much more.
It’s already been a busy start to 2024, and this has set the tone for the year – it will be the year of progress.
Many of you will have seen The Times published an article about the antipsychotic, Clozapine, on Monday 8 January. The article ‘Britain’s most dangerous prescription drug — linked to 400 deaths a year’ included some very powerful but worrying patient experiences of the medication.
There are a number of reasons why the assertions about Clozapine in the article are a cause for concern, not least that the evidence shows that the medication is associated with lower mortality than other treatments used for schizophrenia. Needless to say I wrote to the Editor of The Times about this issue.
As Clozapine remains the only licensed drug for treatment resistant schizophrenia, we will be developing guidance for members and associates about how best to prescribe this medication to patients.
Much to learn from communities around the world
I have just returned from the 75th Annual National Conference of Indian Psychiatric Society held in Kerala, India. What a trip! It was filled with the great and the good. I was very pleased to meet the Indian poet and writer Jerry Pinto and listen to Dr Rajiv Tandon, Department of Psychiatry lead at Western Michigan University. We also had a very good interactive meeting with over 30 members from the Indian diaspora community from the UK. It was wonderful to see so many of our UK members in India. What a wealth of talent.
We had a brilliant discussion about innovative ways to retain our workforce. There was an example of how the use of technology and hybrid working has allowed some psychiatrists to return to India for short periods. They are still able to provide their service remotely, to the patients they know, with the help of a care co-ordinator who attends with the patient in person.
During the conference I attended a great talk on shaping UK mental health services from the British Indian Psychiatric Association (BIPA). Other highlights included our Dean, Professor Subodh Dave, speaking about stress, burnout and mental illness; with our Presidential Lead for Retention and Wellbeing, Dr Ananta Dave and Dr Anis Ahmed. Our Presidential Lead for Global Mental Health Strategy, Professor Mohammed Al-Uzri led a session on trainee wellbeing with Psychiatrist of the Year, Dr Fabida Aria, Dr Manoj Kumar from Kerala and Dr Chathurie Suraweera from Sri Lanka.
It was also surprising, but great, to see a number of UK mental health trusts recruiting, such as Northamptonshire, Somerset, Navigo, and Tees, Esk and Wear.
While in Kerala I was treated to a visit to MHAT, founded by College member, and Chair of the South Asian Division, Dr Manoj Kumar. I was incredibly impressed. MHAT provides high quality, comprehensive mental healthcare to the poorest sections of the population with severe mental disorders. It is entirely based in the community and very few of their patients are ever detained in hospital. The service is provided in collaboration with other like-minded local partners, which allows the services to be free to the end user.
This service provided an excellent example of collective responsibility. It offers outstanding support to the most underserved groups in society, despite having limited resources. They have kept to these core principles for the last 15-years, and so it can be done.
My takeaway from the trip was that we have a huge amount to learn in the UK about collective responsibility and collective decision making, and how this can be a protective measure to support people to stay well in the community and reduce detentions. From what I learned, it seems that hardly any of the patients in South India are sectioned and that’s because peoples’ families are involved. When I say families, it doesn’t necessarily mean your blood relatives, it could be your proxy family too.
Although we know that families can be a source of trauma, they are also the people who know patients the best and can provide invaluable support, help and care.
In countries and cultures where we see strong family connections – it could be in India or even Spain – there is an expectation that families will surround patients, make them feel comfortable and be present at hospital or throughout a person's care pathway.
In the UK, families are too often discouraged from being involved in the care of their loved one. The way we have structured our services means we don’t expect to include families in care. We should be utilising families better to help bridge the gap between individual autonomy, agency and coercion. Social inclusion and integration helps recovery, so we need to learn not to simply tolerate but embrace families from the beginning of a care episode, not just when a person is being discharged. Families can support engagement with services and take-up of treatment. Maybe it's time for us to be more like our colleagues in the global south and adopt some of the concepts of collective decision-making?
I really had a fantastic trip.
Our Strategic Priorities 2024-2026
Moving on from one positive start to another. I am very pleased to inform you that after many weeks of discussion, collaboration and development, the College’s three-year Strategic Plan 2024-2026 Advocating, educating and collaborating to achieve excellence in psychiatry has now been published.
This is the first time the College strategy has been developed in such a collaborative way. The membership, represented by the Officers, Devolved Nation Vice Presidents, Division Chairs, Faculty Chairs, and SAS Chair, together with patients and carers, Presidential Leads, and staff, all had input into this strategy.
The overarching aim is to improve the working lives of psychiatrists and secure the best outcomes for people with mental illness and their families.
It is a high-level document that outlines six strategic priorities underpinned by two core objectives. It will be accompanied by an action plan for implementation. Progress against the plan will be reviewed quarterly by the College’s Senior Management Team and the Board of Trustees will be updated on progress every quarter.
Challenging, but exciting times are ahead. I want to thank all those that had input thus far and hope you will all support the implementation of our plan over the next three years.
Preventing mental illness: Our manifesto for the next UK general election
An election year provides us with the perfect opportunity to help the main political parties understand the positive difference the next government can make to mental healthcare.
As with previous elections, one of the main tools we use to engage politicians is the College’s own election manifesto, Preventing mental illness, which is published on the College website. It is directed at the political parties and allows us to seek commitments on specific issues from them, if they are elected.
The manifesto focuses on prevention and aligns with our Strategic Plan. It highlights five key areas of focus and calls upon all political parties to prioritise mental illness in their own manifestos.
There are regulations that monitor our campaigning activity in the lead-up to and during an election which means we will be restricted from calling on our membership to get involved with our lobbying work. We will however be developing plans for engagement once our new Government is in place, when we will need all hands on deck.
Influencing health ministers
Within days of publishing our College general election manifesto I was very pleased to have been invited to attend a health reception with Leader of the Opposition, Sir Keir Starmer and Shadow Health Minister Wes Streeting along with other key members of the Labour Party. Also joining me were College Dean, Professor Subodh Dave and Associate Registrar for Policy, Dr Mayura Deshpande.
During the event the Labour Party announced commitments on children’s mental health and suicide. Wes Streeting was particularly keen to hear the College’s view of their commitments and took a copy of our manifesto for review. We have followed up with a request to meet their Shadow Minister for Women's Health and Mental Health, Abena Oppong-Asare.
Separately I met with the Secretary of State for Health and Social Care, Victoria Atkins MP. She was very keen to discuss her concerns around mental health and urgent and emergency care.
We’re also in communication about women’s mental health as the Secretary of State recently announced some of the Government’s top priorities are being tackled under the Women’s Health Strategy in 2024. These include menstrual problems, menopause, maternity care and birth trauma support, women’s health research and support for domestic and sexual abuse victims. We will be ensuring that our Presidential Leads for Women and Mental Health, Dr Cath Durkin and Dr Philippa Greenfield are in touch.
2024 New Year Honours List
I was extremely proud to see five College members have been recognised in the King’s 2024 New Year Honours List, marking the extraordinary contributions and service of people across the UK.
I would like to share my many congratulations to RCPsych Fellows, Professor Tim Kendall who received a CBE and Professor Ulrike Schmidt who received and OBE. Also, to our College Members, Professor Bienvenido Arturo Langa Ferreira who received an OBE, Dr Edward Day who received an MBE and Dr Muhammad Saleem Khan Tareen who also received an MBE.
Their achievements demonstrate the importance of striving for the best possible care for those with mental illness. Very well deserved and well done.
You too can be recognised for your achievements – apply now
And finally… I wanted to remind you of the EPA's Constance Pascal–Helen Boyle Prize for Outstanding Achievement by a Woman in Working to Improve Mental Health Care in Europe, of €10,000. Nominations must be submitted online by 31 January 2024. Don’t miss out on this great opportunity.
As you’ll have seen we’ve started this year with a very big bang. I hope this positive start will continue. I look forward to keeping you updated but also hearing your views too, please keep sending me and the Officers your questions.
In the meantime, look after yourselves. I wish you all the best for your work and home life.
Question Time with the Officers
Each month, our President Dr Lade Smith CBE is joined by one or more of the College’s Officers to respond to questions and feedback from members and affiliates.
This is your opportunity to put forward suggestions about to how to improve things in mental healthcare, ask about some of the initiatives being undertaken and decisions being made, and learn more about the College and what it does.