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The Royal College of Psychiatrists Improving the lives of people with mental illness

15 Minute Interview - Professor Louis Appleby

Professor Louis ApplebyKuljit Bhogal, 2015


In this month's 15-minute interview I speak to Professor Louis Appleby, who is Professor of Psychiatry at the University of Manchester. He has had a varied career that has included being the National Director for Mental Health (2000-2010), and leads the National Suicide Prevention Strategy for England.


Can I start by asking you how you ended up working as National Director for Mental Health?

It was really a fluke of timing that changed my career. When I got the call from the then government about the position of National Director I honestly thought it was a hoax. The phone call came out of the blue and I said yes without asking what I was supposed to do.

You oversaw a great many changes in your time as National Director, what are you most proud of?

I tend not think about things that way as many things are an evolution and everything involves more than one person. Investment almost doubled, there were 50% more consultant psychiatrists, 700 new specialised community teams, and the suicide rate fell to its lowest rate for 150 years. When the rest of the NHS was going smoke free, inpatient mental health units were going to be excluded. We successfully argued that they should not be. This was quite an important thing as it got rid of something that was unacceptable about inpatient wards the “smoking den” culture and it also emphasised that the lives of mental health patients were just as important as the lives of everyone else.

How do you feel about the changes in mental health services that have taken place over the last 5 years?

It is important to say that 10 years ago, it was a very different economic environment. When I was working as National Director it was a time of expansion. The fear now is that mental health has not just got its share of cuts, but has seen more cuts than most.

Instead of cutting specialist services when money is tight we should be developing them. We should be using this as an opportunity to innovate.

What is the current state of academic psychiatry?

There is still very good research going on, but we are a long way off getting the share of research resources that we deserve. This hasn’t happened by accident it was deliberate. The lack of appropriate funding may make it a less attractive career.

The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness has been a powerful initiative. What have been the highlights for you and why do you think it has been so effective?

When I think back to when we first started, people would say that suicide is the ‘unavoidable mortality’ that was associated with mental illness, or relate it to the sociological risk factors that we as psychiatrists can’t do much about it. I don’t think I hear people say that any more.

There is something very different about the way that frontline clinicians view their preventative potential. I feel very positive about that and the contribution that the Inquiry has made.

We are also working collaboratively with patients with a shared aim of safety. We found that trusts that had acted on more of our recommendations had lower rates of suicide.

Of course we rely on clinicians to send us confidential and frank information and if they didn’t do that we wouldn’t be able to provide recommendations that we do.

The most recent report was published in July this year. Are there any key points to highlight for psychiatrists?

Two significant themes in the last report are the use of crisis resolution and home treatment teams and the use of out of area beds. Both of these are issues for psychiatrists and the people who commission services.

I’m in favour of crisis resolution teams and it was my job to bring in crisis resolution, but I am worried about how it is being used as a kind of default when the service is under pressure, when there is no bed, or when the bed is needed by somebody else. Crisis resolution becomes the stopgap and that’s not a clinical need, it’s an economic need.

We have also reported a risk of suicides following a discharge from an out of area bed. Most clinicians would agree that out of area beds as a practice can be inhumane it is also likely to be unsafe.

If you could be granted three wishes, what would they be?

From a professional point of view my wish is that the national suicide rate comes down again to the rate of 2006-2007 when it was the lowest suicide rate that had ever been recorded in England since records began in 1861.

I have had many a time waiting for the train at Stockport Station and was once rung by 10 Downing Street and asked if I could tell them the main thing that we do for the mental health of the country. I said we should put much more into the mental health of children, infants and young family because that’s where the best long-term pay off will be. It did lead to some work, but hasn’t had the wholesale impact I had in mind. I would like us to get back to that, but it requires a major realignment of how we view children’s emotional health.

My third wish is that I’ve got time to write another book. Twenty years ago I wrote a travel book, which did moderately well at the time. It would be great to get back to this.

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