Time to Walk the Walk

1 November 2019

This month's guest blog is written by RCPsych in Scotland Chair, Professor John Crichton.

While attention has been focused on all things Brexit, a quiet revolution in the way mental health care is delivered was announced in the Scottish Government’s Programme for Government. Community Wellbeing Services offer the possibility of early self referral and an immediate assessment of need. No more lengthy waits for a specialist who tells you don’t have the right type or severity of illness. There needs to be a common expectation of what Community Wellbeing Services will provide and consistent availability across Scotland. No more short term funding. No more postcode lottery. The workers need the right training and skills and most importantly the right support from psychiatrists and other senior clinicians.

There then needs the right range of treatments given when and where they are needed involving the right professional. We are fortunate in Scotland to have the Wellbeing Centre at Dumfries house as a catalyst for development elsewhere. Working closely with local GPs it shows what can achieved by social prescribing for adults, enhancing the lives of those with dementia or giving hope to those in despair. But there will always be the need for psychiatrists, especially for those with serious mental illnesses. There will always be the need for a range of supported living places and inpatient facilities. We must be alert to a narrative that the right social interventions will make the need for specialist mental health services redundant and that psychiatrists are an expensive and unnecessary accoutrement. If the new Wellbeing model is to succeed, psychiatrists must be at the heart of oversight arrangements and pathways of escalating management interventions.

It is all too fashionable for psychiatry to be dismissed along with the medical model, as was the case in the latest consultation exercise on mental health legislation for those with Intellectual Disability and Autism. The College’s response (PDF) is a robust defense of the role of psychiatrists. We should also challenge the way the ‘medical model’ is dismissed out of hand. In contemporary Scotland the medical model is multidisciplinary, reflective, takes into account carer and lived experience, evidence based, embraces realistic medicine and embraces human rights principles - in mental health encapsulated in legislative principles. I look forward to Scottish Government Ministers speaking positively about psychiatry and how recruitment must be a priority for workforce planning within government, working collaboratively with the College and NES. I would like to thank everyone who is supporting the Choose Psychiatry Campaign in Scotland and in particular highlight Jo Brown’s recent blog which is well worth a read and share.

I would like to congratulate one of our members, Arun Chopra, on his recent appointment to Executive Director (Medical) of the Mental Welfare Commission. Arun brings with him a wealth of experience from working in a number of different jurisdictions, and a forward-thinking approach which I’m confident will be of great service to the Commission. I’d also like to thank Moira Connelly for so ably managing the interim post, and wish her all the best for the future.

Children and young adults will lead the way in the development of Community Wellbeing Services. Too often there have been innovative projects which evidence new ways of doing things better but have not had funding sustained. Innovations such as the national roll out of veterans services have simply raised expectations which are then dashed. In this announcement Government has signaled it will do things differently. Gone is the empty rhetoric of ‘sharing good practice’, instead the Royal College of Psychiatrists and partners have been listened to. Building on a successful pilot project in Highland new treatment for those who frequently present to emergency services in distress will be delivered across the country. Just as the College campaign for Perinatal mental health services has brought about improvements, so too has the government responded positively to the College’s call for better services for those with personality disorder. New processes will ensure that investment to identify the best way of doing things is not wasted but becomes part of an accepted framework of what a good mental health services looks like.

The promise of integrated health and social care was to realise the potential for local solutions, early interventions and care at home. The risk was the fragmentation of mental health services and the creation of a bewildering mosaic of short term projects which create inequity of access and leave vulnerable those with the greatest need. We already have the interim report into failing mental health services in NHS Tayside to illustrate what can go wrong. Part of the solution is a nationally accepted evidenced based framework for what mental health services must consist of – an outline pattern onto which local detail and knowledge can be applied. Essential is engagement with those with lived and professional experience, local groups who can hold managers to account, scrutinize planning, and monitor performance, reporting not only to local bodies but to the emerging national safety and quality structures.

As I met civil servants recently there was an atmosphere of excitement. Government has been listening – the announcement has been made - now time to walk the walk.

As ever there is much to do and I am grateful to everyone in the Queen Street team who work flexibly to manage our schedule of events whilst responding to consultations and taking action to shape the unfolding agenda. We did have a short pause at Dunblane in September to reflect on 25 years of the College Office in Scotland and to make a presentation to Karen Addie after all of her years of service. Thank you again to the team and Pauline for constructing an exceptional programme which included an exploration of gender identity and psychiatry in a respectful, thought provoking way which was also enriched by lived experience. Shortly the programme will be published for the Winter Meeting. I am delighted our President Wendy Burn will once again host a President’s lecture as part of the meeting. This year we will welcome our Chief Medical Officer Dr Catherine Calderwood to give the address as part of conference which will address the changing approaches to cannabis and management of novel psychoactive substances.

We have been very lucky to have been supported by the wider College and I am very pleased to let you know that the latest stage of revising the devolution arrangements was unanimously agreed by the Trustees of the College in October. Minuted and agreed at Trustees was this helpful note of interpretation:

The Devolved Councils of Northern Ireland, Scotland and Wales respectively are the decision-making body of the College for matters of devolved policy in relation to Acts of devolved Parliament or Assembly, activities of the devolved administrations, devolved health services, devolved health and social care integrated arrangements, devolved medical education arrangements, devolved regulatory arrangements and any other devolved matter relevant the duties and objectives of Devolved Council as set out in Byelaws and regulations.

Any action or activity of Devolved council which may affect the wider College should be brought to the attention of the Honorary Officers or senior staff members. In a similar way the wider College should bring matters to the attention of devolved Honorary Officers and devolved staff members if a decision affects the business of Devolved council. All parties will strive to work collaboratively and constructively – in particular in situations where a topic could be considered potentially controversial - respecting the different roles and duties of office bearers and always bearing in mind the values of the College and its code of conduct.

Devolved Councils must maintain their ability to respond quickly and flexibly to events within their jurisdictions.

Updates of activities will be provided to UK Council by the relevant Devolved Council.

The Membership of Devolved Council, its terms of reference, any sub-committees and minutes of Devolved Council meetings, will be laid before the Board of Trustees and the UK Council.

You should all have received notification of the Presidential elections. Wendy Burn has been an outstanding President. Wendy commenced her term of office at the International Congress in Edinburgh and we will be welcoming our new President again in Edinburgh this July at International Congress. Please read the candidates statements, have a look at the hustings on line and participate in the election. I have spoken to all the candidates and each one appreciates and supports the College in Scotland. We must return that respect and promise by voting.

It was great to welcome past chairs and colleagues from the College from across the UK to our celebrations at Dunblane. In the midst of it all many of us had a moment to think about absent colleagues and appreciate all the contributions made by so many over the years. As many of you know our past chair Dame Denise Coia has stepped down from public service as – as she puts it so disarmingly – life has thrown her a bit of a curve ball. Dame Denise wrote me this message which is my honour to share:

‘I thoroughly enjoyed my working life and in particular my long involvement with the College. I have been so lucky to work with such wonderful colleagues and friends and have had lots of fun over the years with you all. Unfortunately I am not well enough to attend the 25th Anniversary Gala of the College in September but will be thinking of you all and know you will have an amazing time celebrating what the College in Scotland has achieved.’

College Honorary Officers with speakers from the trainee presentations session at the RCPsych in Scotland Autumn Meeting (left to right: Kate Lovett, Steven Voy, Fiona Duncan, Rosemary Gordon, Louis Yssennagger, Jennifer Wyllie, Jennifer Bryden, John Crichton and Adrian James)

RCPsych in Scotland Honorary Officers Past and Present (left to right: Alastair Cook, Tom Brown, Linda Watt, John Crichton, Linda Findlay, Peter Rice and John Taylor)

RCPsych in Scotland 25th Anniversary Ceilidh 2019