Letter from the Chair of RCPsych in Scotland - March 2021

Scotland news
04 March 2021

The Lion the Witch and the Wardrobe’ begins

Annual leave at present requires a certain degree of imagination.  Those embarking on inventive trips to the spare room reminded me of the adventures of the evacuated Pevensie children, looking for distraction in war time England. Like us they spent too much time in the house, were separated from friends and family and had limited choices of outdoor activity.  Their adventure begins in a wardrobe to Narnia, a land where it is always winter and never Christmas and so the C.S. Lewis’s ‘The Lion the Witch and the Wardrobe’ begins. They, like us, observe the first signs of Spring and we hope for better times.

Covid vaccines have been both a source of hope and anguish. Professor Sir John Bell speaking on BBC Radio 4’s The World at One on the 11 September was a high point for me.  In answer to @Sarah_Montague ‘s question about life returning to normal this Spring he replied ‘yes, yes, yes ‘ and she silently raises her arms in the air in celebration.  My lowest point was hearing front line workers on the ‘red zones’ at Hogmanay receiving texts cancelling their second Pfizer vaccination, whilst I observed the rise in new variant cases.

Corona-coaster

‘Corona-coaster’ was the neologism I came across recently to describe this experience of living through this time of Pandemic with its hopeful highs, gut-wrenching periods of demand interspersed with tedious expectation - like a malign fairground ride.  This extraordinary step of going against the manufacturers recommendations was only justified as an emergency measure given the dreadful rise in Covid cases.  The piece of evidence that I found most helpful was from  the British Society of Immunology and the Scottish Academy endorsed the CMO’s decision.

This being said the communication coming late on Hogmanay failed to appreciate how the message would be received and to fully explain it. There was also a failure to appreciate that second dose vaccination clinics could not simply be transformed into first dose clinics.  Far more encouraging was witnessing staff in vaccination clinics navigating the booking confusion with professionalism and pragmatism – determined that not one dose of vaccine was wasted.  Best of all was meeting a retired consultant psychiatry colleague volunteering at a vaccination centre. 

Group 6

Along with our President, Adrian James, I lobbied for the inclusion of those with intellectual disability and mental illness in Group 6 of the JCVI roll out.  Those with ‘Severe mental illness i.e. individuals with schizophrenia or bipolar disorder, or any mental illness that causes severe functional impairment’ along with severe, moderate and mild learning disabilities should be receiving vaccination invites over the next 4-6 weeks.  Definitions and inclusion criteria for those with intellectual disability have been challenged.  Group 6 is the largest priority group and it will take weeks for the invitations to be sent but if you believe an eligible patient has been missed the following form can be used.

Workforce Specialist Service Announcement 

I am delighted to at long last have confirmation, in the form of an announcement from the Health Secretary last Friday, of a specialist mental health support service for health and social care staff. The Workforce Specialist Service is the culmination of years of lobbying by the RCPsych in Scotland, General Medical Council and other stakeholders. I share a few words from our Scottish Lead for Clinician Mental Health, Jude Halford:

This is an extremely welcome development to ensure health and social care staff can access the mental health care and treatment they need. Improvement in staff mental health is essential. There is an unmet need amongst health and social care professionals who face barriers to attending existing services, which include stigma, fears for their careers, concerns that they will be treated by colleagues, and worries about confidentiality. Sadly, we know that not only do staff experience mental health problems, there is also a higher rate of suicide in doctors, dentists and nurses than the general population.

Scotland's health and social care staff have needed a service like this for many years, and the pandemic has caused extra demands, stress, and pressure for staff making the requirement for mental health care even greater. The need for a specialist service predated the pandemic, was compounded by it, and will persist beyond it. It is very positive to see the Workforce Specialist Service being developed to address these needs.     

Publication of review of Forensic Healthcare in Scotland 

Last Friday saw the publication of Derek Barron’s review of Forensic mental healthcare and a Webinar about the report is to be held on 11th March which I encourage members across all specialties to join. I was pleased that the urgency of reform was acknowledged in the report but fear that the creation of a new ‘Forensic Board’ for all Scotland’s forensic services will take years of difficult transition from the existing arrangements, during which there will be no delivery of the existing well-crafted plans across Scotland – some approaching ten years old – to address gaps and discrimination in the forensic estate.  It would be very unfortunate for us to spend the next three years discussing Barron whilst no developments occur and inequalities worsen.  The plans need to be clearer about timescales and the funding of the proposed Board.

RCPsychiS and SMHP Manifestos

Throughout the first part of the year we engaged with all the main political parties on our manifesto for the May Scottish parliamentary elections.  We also used key messages from the manifesto to argue for the £120 million mental health investment announced in the 2021 budget on the 16th February.  I have had it confirmed that this will be open for the full range of mental health services including gaps in inpatient provision.  We also joined with the wider Scotland’s Mental Health Partnership to launch a joint manifesto

What good looks like

We continue to work closely with the mental health division at Scottish Government and I am delighted they have accepted our ‘What Good Looks like’ campaign proposal.  Government will now lead on this important piece of work which will clarify both the standard and scope of mental health services.  The Feeley report into adult social care spoke explicitly about standards and commissioning in their vision of a National Care Service.

Mental health legislative reform was the theme of the winter meeting.  Given that virtual meetings are still something of a novelty, I was delighted at the Conference feedback and delegate participation on the day.  The College continues to support the Scott review and also the emergency mental health legislation oversight group, whose minutes are now available.  There is very helpful analysis and guidance from the Mental Welfare Commission regarding the continuing appropriate use of remote technology and mental health assessments. 

Fourth Sequel

In the fourth sequel in the Narnia Chronicles we are introduced to a topsy-turvy underground domain where Prince Rillian is captive in a silver chair at night on the pretence he is mentally disordered and dangerous, when that is in reality his only period of lucidity.  The very suggestion that the sky or sun exist is ridiculed. No-one knows when and how this pandemic will end but the seasons will still unfold and there will be an end.  I was greatly encouraged to see this message from a member about their choice regarding the Government bonus many members will have recently received.

"Whatever our individual circumstances, we as doctors are not unfamiliar with giving our time, talents and resources on both an individual and professional basis. In the last year we have all had to give of ourselves in new and unexpected ways.   I find myself wondering about the new opportunities there may be to give as we reach the other side of the pandemic.  I wonder how the pandemic will contribute to the cohort of people I will meet in my consulting room and how I might contribute to this being prevented.  I especially find myself thinking about children and young people who are missing normal social interaction with their peer group in school and out of school clubs, activities and hobbies which plays such an important part in developing independence, self confidence, sense of identity and ability to manage interpersonal relationships.   I also find myself thinking how hard it must be as a parent not to be able to feed a child through loss of income and the need to ask for help from foodbanks.   As I look to the future, I find myself challenged to think how my time, talents and resources could be used in new ways.  Perhaps I am not alone." – Dr Amy Macaskill

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