April 2018 - Dr John Crichton, RCPsych in Scotland Chair

This month's guest blog is written by RCPsych in Scotland Chair, Dr John Crichton. Dr Crichton will be updating you on the College in Scotland's activities quarterly via the guest blog.

I have a confession: I like reading mental health law – any mental health law. It is not necessarily a shared passion and usually evokes a pitying glazed look the faces of my colleagues. But I was in my element hearing about the fusion of incapacity and mental health legislation last week in Northern Ireland. How would the issues of fluctuating capacity and forensic disposal, which so vexed the Millan committee and generated the compromise of 'significantly impaired decision making', be addressed? What about children? The UN Convention on the Rights of People with Disabilities? Advance statements? Resources? Training?...sound familiar? In a perfect world we would wait to see how implementation of the Act in Northern Ireland goes. In a perfect world we would have learnt more from their experience of integrated health and social care before its implementation in Scotland. But with no current Northern Irish Government we will have to wait to see how this trailblazing piece of legislation works in practice.

In Scotland we had our tweak of the 2003 Act in 2015 and the College is working up its response to a more thorough redrafting of Scots incapacity legislation currently being consulted upon. The 2000 incapacity and 2003 mental health acts were radical in their day but less so now - my prediction is that within the next 5 years we will set in motion a fundamental review, fusing Scots mental health and incapacity legislation. In the meantime, Professor Sir Simon Wessely has been asked to review English mental health law in an implausibly short period of time. Well, if anyone can pull it off Simon can but at best his review can only be a tweaking of English law and we may well find elements of current Scots law being adopted.

One of the unexpected pleasures of being Chair is meeting and working with our professional and third sector organisations in the mental health partnership. When we focus on the needs of our patient population, challenge stigma and misinformation and champion positive messages about mental health there is a real spirit of collaboration, which transcends any differences of approach. Together we can articulate persuasive messages to Government. As a partnership we recently met with our Mental Health Minister, Maureen Watt. One theme of discussions is how to get Health and Social Care Partnerships to work effectively in mental health and how to get the practitioner's voice heard. Integrated Joint Boards must have real engagement with practitioner groups – just as engagement with the third sector is recognised as essential. IJB governance and accountability structures also need to be clearer – a topic of conversation I have had with both the Mental Welfare Commission and Health Improvement Scotland.

Quality Improvement can be a powerful mechanism for getting across the perspective of practitioners. I was pleased that this was a theme at our Glasgow meeting in January.  Underpinning our QI endeavors and the monitoring of IJBs is the intelligent use of published data. I had been struck by the usefulness of the dashboard of mental health data available in England. It came as a pleasant surprise that much of the same data is available publicly in Scotland – it's just hard to find. We are now producing a quarterly digest of key information, available from the Queen Street team, to help guide discussions and move from anecdote to evidence in the issues we raise. We have also had a series of very helpful meetings with Information Services Division about what mental health data is available in Scotland and how it is presented. I am hopeful they will produce a new look Scottish Mental Health dashboard of information later this year.

One of the striking observations from that data is the percentage of colleagues with MHO status currently over the age of 50. As well as encouraging young doctors to Choose Psychiatry there needs to be a retention strategy developed. It will be vital to creating the right working environment for both those taking early NHS retirement to continue in part-time work and those facing a much longer working career. I have written to all Health Board and Integrated Joint Board Chief Executives and HR Directors regarding the creation of a retention strategy and look forward to the support of our working retired group to identify the right professional environment for those in their late 50s and 60s. We cannot expect those who are now contemplating a retirement at 68 to work in the same way as generations before. Getting retention strategies right is as important as getting recruitment strategies right.

There is considerable enthusiasm for recruitment. The problem (and it's a good problem to have) has been how to fund all the great ideas coming forward from members in Scotland. This year I have already spoken at a number of medical student events – over 200 Scottish medical students - all interested in a career in psychiatry. As a College we must improve what we provide for them as student associates and I hope there will be opportunities as the College IT platform is upgraded. That upgrade should also at last bring about reliable video conferencing for College committee meetings later this year, when I also expect we will become a devolved Council of the College.

Over the next quarter we will be making some preparations for becoming a devolved council – it gives an opportunity to refresh and review College structures and roles in Scotland. I am also looking forward to further discussions on the work led by Andy Williams regarding Personality Disorder. If we can come to a sensitive and accurate consensus regarding how we can better meet the needs of this patient population, and if we can gather support and endorsement from our partnership colleagues, then there is a good prospect of this being adopted into the work of the Mental Health Strategy, bringing about the sort of transformation we see in perinatal care.

With a patient focus and joining with partners, the College in Scotland can be the catalyst for positive change. After recent excitement about the commencement of Minimum Unit Pricing, I was asked for the materials produced in Scotland by former Chair, Peter Rice, to inform the debate. I hope we will all work with the mental health strategy to bring improvements in many areas: early intervention, mitigating the effects of Adverse Childhood experiences, harnessing modern technology, closing the mental illness mortality gap, achieving parity. Much of this will rest on the implementation and commissioning of research and the dissemination of best practice – the College will continue to play a vital role.

I wish everyone a refreshing seasonal break and perhaps some kinder weather for the Spring.

Dr John Crichton

Chair, Royal College of Psychiatrists in Scotland