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

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29/08/2018 09:31:43

RCPsychiS August 2018 Blog

This month’s guest blog is a follow-up piece to an article brought to us by Dr Ahmed Saeed Yahya, a Higher Trainee in Psychiatry working in a NHS Trust in East London. 

 

Dear Colleagues,


Many thanks for allowing us to publish on your guest blog. We enclose our final article in a series of three which explore staff burnout and wellbeing in psychiatric services. In this blog we amalgamate previous research and conclude our work in this area. We discuss the importance of a ‘happy workforce’ and how changes can be implemented across the board to accentuate this. We hope you have enjoyed our series of articles in your college division and welcome any feedback.


Dr Ahmed Saeed Yahya
Specialist Registrar in General Psychiatry (North East London)

Addressing Staff Morale and Wellbeing in Psychiatric Services

 

Dr Ahmed Saeed Yahya (Speciality Trainee in Psychiatry), Dr Nisha Shah (Consultant Perinatal Psychiatrist), Dr Claudius-Adeniyi Olusegun (Acting Consultant Perinatal Psychiatrist), and Dr Jude Chukwuma (Consultant Psychiatrist).

 

About the authors

 

Dr Ahmed Saeed Yahya is a Specialist Registrar in Psychiatry who is currently based at East London NHS Foundation Trust. Dr Nisha Shah is a Consultant Perinatal Psychiatrist with the North East London NHS Foundation Trust. Dr Olusegun is an Acting Consultant Perinatal Psychiatrist also with North East London Foundation Trust. Dr Jude Chukwuma is a Consultant Psychiatrist with the Cygnet Hospital Group.

 

Introduction

Declining staff morale is an ongoing concern amongst senior managers and clinicians who are striving to make improvements to patient care. There is a causal link between staff engagement and the level of care provided to patients. Forty seven percent of NHS Finance directors at the King’s Fund ranked staff morale as one of their top three concerns.1With mounting pressures the NHS remains reliant on the dedication of staff to provide a continued world class standard of healthcare. 

 

Challenges in psychiatric services include recruiting appropriate numbers of high quality staff and retention. Shortages in the workforce can in turn affect the mental wellbeing of existing employees in a feedback type loop. They may feel pressured to meet the high levels of expectation and make up for shortages created by unfilled posts.

 

We have researched and written about leadership/management in previous articles. We completed quality improvement projects on staff burnout and bullying within the workplace. Our research investigating workplace stress and time management in administrative staff continued to nurture our interest. 

 

In this short review article we aim to pool together our research and explore the significance of staff wellbeing. We make reference to the Boorman Review2 and the findings from the King’s Fund survey.1We discuss strategies to boost morale particularly amongst colleagues with lower banding grades but who nonetheless form the lynchpin within respective psychiatric services.

 

Discussion

 

Dr Boorman in his 2009 review urged for a ‘sea change in the way in which staff health and wellbeing was perceived.’2One of the highlights was the emphasis on placing the health of staff within the ‘heart of the NHS mission’. The review found clear links between workplace wellbeing and patient satisfaction/trust performance. It suggested that more than £555 million pounds could be saved annually if measures were placed to address this.2  

 

Dr Boorman called for a ‘rebranding’ of the occupational health service and a drive towards staff health and wellbeing. A key recommendation included early intervention for staff with mental health or musculoskeletal health problems. Additionally, senior management were to be held accountable for staff health and wellbeing. Finally the NHS organisation should adopt a prevention focused health and wellbeing strategy for employees.2

 

Strategies have since been put in place to implement the recommendations from this report. A positive feature is that staff wellbeing remains a primary focus in the agenda of senior management. This can be evidenced from the findings of the King’s Fund survey.1 It is apparent that there has been a change in the culture of the NHS. There are opportunities for NHS employees to access a gym membership at reduced rates. The change in staff canteens/shops is also visible with the greater availability of healthier meal choices.

 

Our findings

 

In July 2017 we aimed to evaluate the use of the Oldenburg Burnout inventory in establishing the signs of burnout in staff working in a London based inpatient PICU. The findings demonstrated signs of emerging burnout in staff on the unit.  We concluded that the use of a burnout inventory may be considered in individual psychiatric services. It would assist as a screening measure for staff wellbeing.3

 

Towards the end of 2017 we investigated the workload demands on administrative staff in a London specialist perinatal service. The demands and pressures they experienced were noticeable. We found from this that three out of the four secretaries reported heightened work stress levels. We noted a possible link between time management and work stress levels but the sample size was very small to reach any definitive conclusion.4

 

We discovered that the health care environment has one of the highest incidences of workplace bullying. The Francis report examined the causes and failings within an NHS trust. Workplace bullying was a likely contributory factor in the failings of this trust.5 Bullying at work is known to impact staff morale/wellbeing and in turn precipitating increased feelings of burnout. We accentuated the benefits of ‘good leadership’ and in particular distributed leadership. It was imperative that there should be continued progress in introducing policies and strategies that deterred bullying at all levels and across the board.There already had been some service change to account for staff wellbeing. A monthly staff support group supervised by a senior psychotherapist was introduced. 

 

Conclusion

 

In this brief article we have discussed staff wellbeing and the influence of this in delivering effective, quality care to patients. We have brought together our research and written about causal factors which can lead to an ‘unhappy’ workforce. We are drawn to the importance of good leadership and the positive manifestations of this. It is imperative that the progress in circulating the relevance of this is continued, given the key role of positive leadership, in addressing workplace bullying and subsequent burnout in staff.

 

Good time management can moderate work stress levels and subsequent job strain. This is an area that can be targeted and improved. Monitoring of staff skills within this domain by conducting individual anonymised questionnaires would guide further management. The consideration of delivering a lecture to all new employees in strategies and positive outcomes may be an additional step. These are simple measures which could be effective in improving wellbeing at relatively low cost.

 

The utilisation of a screening measure for staff burnout within services may quantify the problem and the proportion of staff on the threshold of emerging burnout. It would likely exemplify the importance of continued efforts to address staff wellbeing. Employees remain one of the, if not the most important assets within any NHS organisation.

 

References

 

  1.  www.kingsfund.org.uk:  ‘Are we supporting or sacrificing NHS staff’ year 2015.
  2. The Boorman Report on the Health and Well-Being of NHS Staff: Practical advice for implementing its recommendations May 2010. Professor Ivan Robertson and Professor Cary Cooper.
  3. Yahya AS, Phillips M, Naguib M, Chukwuma J. Assessing the utility of the Oldenburg Burnout Inventory for staff working in a Psychiatric Intensive Care Unit… A Pilot Study, rcpsych.ac.uk 2017:1-7.
  4. Yahya AS, Shah N, Chukwuma J. Investigating Workplace stress and Time management in Administrative staff who work in Psychiatric Specialist Services, rcpsych.ac.uk 2018: 14-18.
  5. The Mid Staffordshire NHS Foundation Trust Public Inquiry Chaired by Robert Francis QC, http://www.health.org.uk/.
  6.  Yahya AS, Shah N, Chukwuma J. Targeting Workplace Bullying: Emphasis on Good Leadership with Across the Board Approach, RCPsychiS June 2018 Blog.
26/07/2018 14:43:27

RCPsychiS July 2018 Blog

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.

J Crichton Small Image

On my work noticeboard is a letter from the Health Board Chief Executive.  It warns all staff of financial constraints ahead and the imperative to work efficiently.  It could have been written last week but dates from my first NHS employment as a psychiatry nursing auxiliary in 1985. It seems fitting to reflect on this the 70th anniversary of the NHS that some challenges have always been there.  A fascinating insight into the creation of the NHS was conveyed in Archive on 4 UK Confidential: the Birth of the NHS (BBC R4, 30th June).  There was an argument between localism in health administration and regional structures. Most hospitals were run by local authorities prior to 1948 and wouldn’t it be wise to maintain that local connection.  Ultimately that approach was rejected because of the degree of variability in services and standards that were already apparent in local authority run hospitals.  Many of the arguments for the retention of local authority control have parallels in the arguments which have resulted in our current health and social care partnerships.  There remains the same tension between organisations prioritising local needs against providing an assured scope and quality of services.  Part of the solution might be mental health service commissioning guidelines, but the voice of practitioners is also key. 

Psychiatrists have a vital role in assuring the success of these arrangements and protecting against a mental health ‘post-code lottery’.  As we face an inquiry into mental health services in Tayside, I am reminded that struggling services often appear to have disempowered clinicians from raising concerns and have disengaged them from planning.  Partly, this is because old mechanisms of influence which are uni-professional and do not include lived experience appear anachronistic.  It is surely time to reinvent local structures to ensure the scope and quality of local mental health services, and monitor the implementation of new initiatives arising from the mental health and suicide prevention strategies.

Another way we can exert influence is in responding to the numerous consultations which are sent to the College.  We particularly look to our faculty representatives and to the larger faculty and committees for help.  If there is a specific consultation you would like to contribute to through the College please let us know.  We have all been invited to give our views in a Government survey of staff regarding investigations following the death of a patient following, for example, suicide.  This is an opportunity for us to comment both in regard to internal incident reviews and external reviews – for example, by the Mental Welfare Commission.  I would encourage everyone to participate and highlight the survey to multidisciplinary colleagues.

Recently, Vice Chair of the Royal College of Psychiatrists in Scotland (RCPsychiS), Linda Findlay, spoke at the Scottish Parliament’s Cross-Party Group (CPG) on Mental Health about primary care mental health.  In that context you see MSPs from all parties working together.  I am looking forward to working with our new Cabinet Secretary for Health and Sport, Jeane Freeman, and the new Minister for Mental Health and recent Chair of the CPG on Mental Health, Clare Haughey.  Clare brings a wealth of experience as a mental health nurse and has been a faithful supporter of promoting mental health issues in the Scottish Parliament.  I have written to acknowledge both the contributions of Shona Robison, who championed the parity between physical and mental health, and Maureen Watt who was always approachable and engaging.

An early challenge to the new Ministers will be the provision of CAMHS services as highlighted in the recent report on rejected referrals to CAMHS.  Elaine Lockhart, Chair of the Child and Adolescent Faculty continues to influence the Government response and will be addressing issues of recruitment, retention and workforce expansion.  I have been working closely with Government and will be following up my letter regarding retention to Health Boards with feedback from Dr Tom Brown, new chair of our Working Retired Psychiatrists Group.  We will continue to seek funding for recruitment activities and I look forward to giving an update to you soon about this.

It was great to see so many Scottish Psychiatrists making their way to Birmingham for the RCPsych UK’s International Congress and supporting the vote at the Annual General Meeting to create Devolved Councils in Scotland, Wales and Northern Ireland.  The creation of Devolved Councils will be the most important structural change to the College in Scotland for a generation.   We owe an enormous debt of gratitude to RCPsych UK’s Chief Executive, Paul Rees.  Paul identified that the old constitutional arrangements were inequitable and failed to meet the realities of devolution.  Paul used his experience of introducing Devolved Councils at the Royal College of General Practitioners to push through this change.  This step affirms the College in Scotland in its devolved role – engaging with NHS Scotland, NHS Education for Scotland, Scottish Government, Scottish Parliament and the Scottish media.  There are further steps to be taken before the Devolved Councils can be formally put in place, but we look forward to these next steps. 

To mark the creation of RCPsychiS Devolved Council we have been donated a gavel created by craftsman Matthew Toleman with wood from a 70-year-old ash tree taken from the Royal Edinburgh rebuild.  A natural split in the wood during drying is secured by a set of butterflies –in the spirit of Kintsugi. It is on permanent display at the office in Queen Street.  All members are welcome to drop in and use the facilities of the member’s room.   I wish everyone a great summer and safe travelling for those going on holiday.

27/06/2018 11:16:44

RCPsychiS June 2018 Blog

This month’s guest blog is an article brought to us by Dr Ahmed Saeed Yahya, a Higher Trainee in Psychiatry working in a NHS Trust in East London. 

 

Dear Colleague

I wrote this article with two colleagues who work as Consultant Psychiatrists.  Many thanks for including this in your guest blog.

 

This is a follow up to the report on staff burnout which was included in last year’s monthly Scottish newsletter. Bullying can lead to increased feelings of burnout in employees. We highlight the importance of recognising bullying behaviours, and how good leadership can make a positive impact. We hope you enjoy this blog article and find this of benefit to your practise.

 

Dr Ahmed Saeed Yahya (Speciality Trainee in Psychiatry)

 

Targeting Workplace Bullying: Emphasis on Good Leadership with Across the Board Approach.

 

Dr Ahmed Saeed Yahya (Speciality Trainee in Psychiatry), Dr Nisha Shah (Consultant Perinatal Psychiatrist) and Dr Jude Chukwuma (Consultant Psychiatrist)

 

About the authors

Dr Ahmed Saeed Yahya is a Specialist Registrar in Psychiatry who is currently based at East London NHS Foundation Trust. Dr Nisha Shah is a Consultant Perinatal Psychiatrist with the North East London NHS Foundation Trust. Dr Jude Chukwuma is a Consultant Psychiatrist with the Cygnet Hospital Group. 

 

Introduction:

Workplace bullying remains a topical area within the healthcare environment. The healthcare sector has one of the highest incidences.1There is concern that the culture of bullying is underreported within the NHS and other healthcare settings. It remains prevalent and pervasive across the specialities.

 

In this short article we highlight the importance of recognising bullying behaviours, and how good leadership can make a positive impact. We make reference to the Francis inquiry report which examined the causes and failings of an NHS Trust. Workplace bullying was a likely contributory factor, with staff failing to raise concerns because of potential retribution and other consequences of whistleblowing.

 

Our interest in this area has grown since our publication on ‘Employee Burnout’ in the Royal College of Psychiatrists Scottish Newsletter.2 Bullying can lead to increased feelings of burnout in employees. Burnout describes a state of physical and emotional exhaustion that occurs following prolonged exposure to emotionally exacting work situations/environments.3

 

Discussion:

To recognise bullying behaviours it is important to have an understanding of bullying and be aware of the different manifestations.  Bullying is defined as a situation in which an individual perceives that he/she is the target of negative actions and/or attitudes, perpetuated persistently over time by one or more others. Isolated or one-off instances of negative behaviour are not usually classified as bullying.4 Examples of bullying can include mistreatment, disrespectful attitudes or inappropriate behaviours. Incivility, rudeness and/or other disrespectful behaviour/s consistently perpetrated with an ambiguous intent to cause harm to the other can also be forms of bullying. Bullying can be either covert or overt in form.4

 

Authoritarian ineffective styles of leadership have been linked to lower levels of job satisfaction, and can be associated with bullying. The Mid Staffordshire report raised concerns that there was a culture of fear and compliance amongst staff within the NHS. In that report, Robert Francis recommended that such a culture be abandoned, and that efforts should instead focus on fostering an environment of ‘openness, honesty and transparency.’6 We could not agree more. However, it would have been helpful to make some specific recommendation/s expressly targeting work place bullying in the report.

 

Einarsen et al have divided ‘bullying’ into three categories which include; work related, person related and physical intimidation.5 Work related bullying behaviours can include allocating excessive and unmanageable workloads to an individual, disregarding an individual’s professional opinion or undermining an individual’s competence. An example is by consistently assigning work to the individual which is below or above the individual’s competency. The intention being to ridicule and/or humiliate the individual.5

 

Person related bullying can include persistently and repeatedly ignoring or excluding a person (the victim) from conversations/meetings, hinting or signalling in suggestion that a person (the victim) gives up employment, and/or integrating the victim into workplace gossip or rumours. Others may include physically intimidating behaviours manifesting in threats of violence, invasion of personal space or acts of actual physical abuse.5

 

The place of leadership:

Good leadership plays a significant role in alleviating bullying in the work environment. The Royal College of Psychiatrists places huge emphasis on good medical/clinical leadership, and it is imperative that this approach is applied across the board.

 

We write in support of good leadership and good distributed leadership, whereby senior clinical leaders and managers model the behaviour expected of staff within their organisations. This approach would form the backbone for the implementation of strategies to facilitate/filter a positive cultural change across organisations.

 

Conclusion:

Ideally, good leadership should permeate all aspect and levels of health services, from senior management to frontline. Efforts should be channelled towards adequately resourcing and monitoring individual jobs and job demands to prevent bullying.5 Emphasis should be placed on staff empowerment through distributed leadership to prevent bullying as well as protect employees from bullying behaviours.4 Staff should feel confident to whistleblow without fear of retribution.

 

Organisation leaders play a key role in addressing workplace bullying. They should lead by example, particularly in the area of work place conduct. They should not only ‘talk the talk but walk the talk’ and ensure an across the board approach. There should be the right balance between hands-on and hands-off approaches to leadership, including emphasis on task orientated leadership when appropriate.4Training and refresher training to create awareness about systemic factors in the aetiology of bullying and the beneficial effects of good leadership should be encouraged.

 

We must acknowledge that there seems to be an increasing drive to improve awareness and tackle workplace bullying. A strategy implemented by the NHS has been to change the current culture of apprehension and fear to one of ‘openness, honesty and transparency.’

 

The national staff survey and national training survey remain helpful tools in identifying bullying. There should be continued focus on promoting a collaborative culture through education and team communication programmes. Progress should continue in introducing policies and strategies that deter bullying at all levels and across the board.

 

References:

1) Allen BC, Holland P, Reynolds R. The effect of bullying on burnout in nurses: the moderating role of psychological detachment. Journal of Advanced Nursing 2015; 71: 381-390.

2) Yahya AS, Phillips M, Naguib M, Chukwuma J. Assessing the utility of the Oldenburg Burnout Inventory for staff working in a Psychiatric Intensive Care Unit… A Pilot Study, rcpsych.ac.uk 2017:1-7.

3) Maslach C, Schaufeli W, Leiter M. Job burnout. Annual Review of Psychology 2001; 52: 397-422.

4) Olsen E, Bjaalid G, Mikkelsen A. Work climate and the mediating role of workplace bullying related to job performance, job satisfaction, and work ability: A study among hospital nurses. Journal of Advanced Nursing 2017; 73: 2709-2719.

5) Rodwell J, Demir D, Steane P. Psychological and organizational impact of bullying over and above negative affectivity: A survey of two nursing contexts. International Journal of Nursing Practice 2013; 19: 241-248.

6) The Mid Staffordshire NHS Foundation Trust Public Inquiry Chaired by Robert Francis QC, www.health.org.uk.

09/04/2018 10:16:36

RCPsychiS April 2018 Blog

 

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 JCrichtonImagemental 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

29/06/2017 10:43:45

RCPsychiS June 2017

Our blog this month is written by our outgoing Chair, Dr Alastair Cook.

 

Dr Alastair Cook - October 16

Dear Friends and Colleagues,

As I write the International Congress is in full swing in Edinburgh once again. This year at least it is taking place before the schools break up for the summer holidays. Scottish Psychiatrists are prominent as both speakers and delegates and so far the event appears to be going very well and 2400 psychiatrists from around the world will leave Edinburgh with a very positive impression.

The last time Congress came to Edinburgh was 2013. At that time I took over as Chair of the Royal College of Psychiatrists in Scotland from Peter Rice. On this occasion I am handing that privilege to John Crichton, who will lead the College in Scotland over the next four years as Chair in Scotland and Vice President (Scotland) of the UK College.

 

A handover seems like a good time for reflection. Being Chair for the last four years has been one of the most enjoyable experiences of my career to date. Working with the other Officers, Faculty Chairs, Regional Advisers and Executive Committee Members has been fun and I hope also productive.

 

We started out by agreeing a work programme that included a continued focus on recruitment and retention, trainee engagement and ongoing support for consultants through mentorship and training. Our progress on recruitment has been limited but mirrors experiences in other parts of the country and other specialties.

 

We initiated a working group to look at perinatal and infant mental health resulting in the Healthy Start Healthy Scotland campaign and have followed that up with a working group on personality disorders that will report this year.

 

There is now recognition in the central College that the offices in the devolved nations can no longer be regarded as regional divisions and that a new constitutional arrangement is necessary. A paper proposing the creation of devolved councils of College for Scotland, Wales and Northern Ireland will come to Council in July and is expected to be implemented in 2018. Greater autonomy for the College in Scotland will need to be matched by improvements in resources and there is commitment to build on this within the College, helpfully supported by the new Chief Executive, Paul Rees and our new President, Wendy Burn.

 

I have particularly enjoyed working with our third sector colleagues to build the Scottish Mental Health Partnership. The Partnership has had some influence in the early stages of the new mental health strategy but needs to build a greater role in the monitoring and ongoing development of new commitments and describing a new framework for mental health services in our integrated world.

 

Being Chair can be a challenge, especially when trying to fit the College role into an already busy job. All College roles add to our workload but in my experience the rewards far outweigh the costs. This is only possible because the College in Scotland is supported by an amazing group of staff in our Queen Street Office.  My own personal highlight of the four years will be the 20th anniversary dinner we held during the autumn meeting in 2014. The 20 year celebration marked not only 20 years of a College office in Scotland but 20 years of Karen Addie as manager of our office. Karen has been supported by many staff over the years but Angela Currie, Susan Richardson, Rebecca Middlemiss, Laura Hudson and latterly Elena Slodecki have all been crucial supports during my time in office. The team do so much to make the job of the Chair and other officers possible. I can’t thank Karen and the team enough for their support over the last four years.

 

Would I do it again? I would recommend a College role to anybody who is willing and interested in contributing. The rewards are great and the work well supported by the team. I’m looking forward to continuing to contribute from the sidelines as John and Linda Findlay, our new Vice Chair take over and hope they have as much fun over the next four years as I have over the last four.

Dr Alastair Cook, Outgoing Chair of the RCPsych in Scotland

 

09/03/2017 10:18:41

RCPsychiS March 2017 Blog

 

This month we are delighted to welcome guest blogger Dr Stephen Potts, Chair of the Liaison Faculty in Scotland. Dr Potts is a liaison psychiatrist who has also worked part time for many years to pursue a parallel career as a writer, initially as an author of adventure fiction for children, and latterly as a screenwriter specialising in historically set adaptations. He has written eight feature films and one TV drama. He is now acting as an independent writer/producer to make a feature film based on the book Anatomy of Malice by Professor Dimsdale. We were lucky enough to have Dr Potts speak at the recent RCPsychiS Winter Meeting in January this year.  The theme for the meeting was "Fear and Psyche" and  Dr Potts presented on "Antomy of Malice: A psychologist and psychiatrist compete to understand the minds of Nazi war criminals on trial at Nuremberg".  In this months blog Dr Potts provides us with an overview of this fascinating project.

 

For more than 20 years I have worked part time in psychiatry to pursue a parallel career as a writer, latterly of screenplays. These worlds did not intersect until I went to a medical meeting in Nuremberg, then sweltering in a July heatwave.

I knew of Nuremberg’s notorious pre-war history as a centre of Nazism, the setting for huge rallies, and I wandered round the Zeppelin fields where they were held, which still felt sinister and forbidding.

I also knew about the post-war Nuremberg trials, where leading Nazis were prosecuted for war crimes by the victorious allies. But I did not know about the part played by mental health specialists in the first and best known of these trials, in which the surviving political and military leaders of Nazi Germany were held to account.

A very eminent American psychiatrist, Professor Joel Dimsdale, of the University of California in San Diego, has been researching this subject for some years, and he presented his findings at a keynote address which opened the conference — and which was held in the very building where the Nuremberg trials took place 70 years earlier.

He recounted the story of Dr Douglas Kelley, a US Army psychiatrist assigned to the trial, and Dr Gustave Gilbert, who translated for him and acted as the prison psychologist. Together and separately they assess all the leading Nazi defendants, with repeated interviews over an extended period.

They were assigned several roles: to prevent the defendants committing suicide; to advise on any use of the insanity defence; and to guide the tribunal (ie the prosecution) in the conduct of the proceedings. They had unique access to the men responsible for the war and some of the worst atrocities committed in it. They saw an opportunity, indeed a duty, to understand, and then explain to the world, the workings of that they called “the Nazi mind.”

They began by co-operating, and planned a jointly authored book, but tensions soon emerged, and they fell out spectacularly. Kelley left the trial early, with Gilbert alleging he had taken some of his records. Each then published their own books, delayed by arguments about intellectual property and threatened  lawsuits. The work they did together did not feature prominently in either publication.

As to their roles: one of the defendants (Robert Ley) killed himself before Gilbert took up his role but after Kelley had warned of the risks in his particular case. Another, the most senior, Hermann Göring, took cyanide the night before he was scheduled to be hanged. In just one case, that of Rudolf Hess, a special hearing was held to determine his fitness to plead, in view of very obvious memory problems. Before the Tribunal came to a decision, Hess, who had been warned by Gilbert he might be found unfit, shocked the world by announcing he had been feigning amnesia. He was judged fit, along with all the other defendants. Gilbert’s recommendation that Göring be separated from the other defendants successfully undermined his attempt to rally them  — and a defeated Germany  — behind him as he mocked and browbeat the lead prosecutor.

The conflict between Kelley and Gilbert may have been intensified by the pressure-cooker atmosphere of Nuremberg, where the trial was closely followed by the world media.  There were many elements to it: but in some ways the most interesting is the apparent contradiction between their professional disciplines and their understanding of the ideology of Nazism.

Gilbert, the psychologist, placed the Nazi leaders in a separate category, distinguished from the rest of the population by extreme abnormalities of personality. Kelley, the psychiatrist, took a different view, arguing that they displayed personality characteristics which could be found throughout the public, and especially among those in positions of power and responsibility.  Kelley’s message was unpalatable at the time, but it might find greater acceptance these days.

I was fascinated to hear this, and it immediately struck me as a story crying out to be dramatised. After trying to make myself memorable to him at the conference dinner by donning a kilt in 100 degree heat, I asked Professor Dimsdale if I could review in advance the manuscript of the book he was about to publish. He kindly agreed, and when it came, I read it in a single sitting. (I recommend it highly.)

Having then optioned the screen rights to the book, I began writing the screenplay. Before it was complete I pitched the project at the American Film Market in LA, where I hooked up with a producer. I finished the script at the turn of the year, and the producer likes it enough to want to make the film!  All we need now is $15 million…

 

Dr Stephen Potts, Chair of the RCPsych in Scotland Liaison Faculty

 

15/12/2016 10:59:19

RCPsychiS December 2016 Blog

The mince pies are starting to appear at meetings and turkey is on the menu for team lunches and ward night outs. The Christmas hysteria seems to start a little earlier each year and all the old favourite festive songs start to dominate the airwaves.Dr Alastair Cook - October 16

It’s a time for reflecting back on the previous year and hopefully looking forward to fresh starts, new commitments and new plans.

It is hard to be positive about the year that has just passed. Big events such as Brexit, the US election, political uncertainty in the rest of Europe and the awful situations in Syria, Yemen and Iraq make the world feel a very uneasy and uncertain place.

Closer to home the junior doctor’s dispute in England, ongoing recruitment and retention problems and the emerging crisis in General Practice reflect a sense of unhappiness in our profession as a whole. We have lived with “austerity” for 9 years now and the impact is really beginning to bite. Efficiency savings have trimmed any fat that could be found and we are all facing the reality of real cuts to front line services, even in the supposedly “protected” NHS.

Austerity has had bigger effects on our new colleagues in the integrated world. The pressures on social services are making headlines as I write and there is a real sense of inevitability about rising demand for social care as our population lives longer with more long term conditions. People with greater complexity of need are spending shorter periods in hospital and our society demands that discharge is supported by higher levels of input by both paid staff and the huge army of unpaid carers that we need to support to continue doing what they do.

For our patients the real stresses of an unsympathetic benefits system, cuts to social services and third sector supports and difficulties in Primary Care make it more difficult to see where the light at the end of the tunnel can come from.

So where can we find glimmers of hope for 2017?

We will have a new mental health strategy for Scotland in early 2017. There will be a focus on prevention, early intervention, an improved range of options available to manage mental health difficulties in primary care settings and hopefully a commitment to begin to address the scandal of premature mortality amongst those with severe and enduring mental illnesses. The politicians “get” the need for more parity between mental and physical health and we have to hope that the review of targets by Sir Harry Burns will result in a shift away from the obsession with access to unscheduled care and more emphasis on good holistic outcomes.

For all the potential risks in Health and Social Care Integration there are real potential benefits if we can use this as an opportunity get closer to our GP colleagues as well as those in Social Work and other services. The potential to shift the balance of care from acute to community will only be realised if those of us with experience of delivering this successfully in mental health and learning disability services can influence the wider health and social care system and help them learn from our mistakes and our successes.

As for the big picture..... we can only hope that common sense prevails over some of the rhetoric and that 2017 brings a new sense of hope and optimism in the word.

To quote a festive favourite: “A very Merry Christmas, and a Happy New Year, Let’s hope it’s a good one, without any fear”

Alastair

Dr Alastair Cook, Chair of the Royal College of Psychiatrists in Scotland

27/10/2016 12:06:36

RCPsychiS November 2016 Blog

Our Blog for this month is written by Ella Robertson. Ella is one of the Service User members of the Child and Adolescent Faculty of the College in Scotland. As part of our programme of engagement with Scottish Political Party Conferences we organised a joint Fringe meeting at the SNP Conference in the SECC in Glasgow on the 14th October with our friends and neighbours, the Royal College of Paediatrics and Child Health. Despite our Fringe meeting being in the furthest venue from the main auditorium (truly on the “Fringe”) we had a reasonable number of delegates attending. We were very grateful to Maree Todd MSP for the Highlands and Islands who Chaired the meeting and, of course, to our excellent panel of speakers. I will let Ella tell you about her involvement.
Karen Addie, Manager, RCPsych in Scotland.

 

SNP Party Conference Speakers at Fringe

This month I was lucky enough to be invited along to the Scottish Nationalist Party’s Conference to discuss why prevention is better than a cure for young people’s mental health. I joined Dr Anne McFadyen Consultant Child and Adolescent Psychiatrist and Dr Shiuli Russell, Consultant Paediatrician to make up the panel.

 

Each of us did a small individual talk; I focussed mine on education and what can be done in schools to improve young people’s mental health which is, as we all know, a growing and very current issue. I advocated an approach of transparency and honesty around mental health based on a three prong approach:

 

1.   Providing young people with the facts about Mental Health 

2.   A school culture of openness around Mental Health

3.   Links between schools and Mental Health services to improve knowledge of what help is available

 

The hope is that by following these three themes an environment can be created in schools where nobody is afraid to discuss their own mental health, or caringly enquire as to how someone else is mentally. In addition, awareness of the facts around mental illness, as well as exposure to the treatments and staff who are in place to support anyone experiencing issues, will hopefully provide a large knowledge base; reducing confusion, and with that fear.

 

My hope is that through developing these areas we can create a world where there is no stigma or fear around mental health and young people are empowered to ask for the help they need, and know where to get it.

Ella Robertson, Service User Member, Child and Adolescent Faculty, Royal College of Psychiatrists in Scotland

 

22/09/2016 13:11:44

RCPsychiS October 2016 Blog

 

Personality Disorder - Raising awareness, raising expectations and raising hope

I am beginning to realise just what the College in Scotland means to me, as I look forward to a range of events and projects in various stages of planning with some excitement. I have served on committees in the college at different times as a trainee and a consultant, and recently as chair of the Medical Psychotherapy Faculty in Scotland. I have helped organise many interesting psychotherapy conferences, secure in the knowledge that the organisational and planning skills of the college staff are behind me to keep things on track. I could easily lapse into thinking that this kind of internal professional focus is the main purpose of belonging to the college and trundling along to meetings. I am aware, however, that I have been increasingly impressed over recent years by the ambition of the executive committee to engage in a more public and political way with subjects to do with mental health in Scotland. I am not sure my own performance during media training singled me out as destined for the limelight – but the aim of putting ourselves into a more vocal position on subjects that perhaps do not get the attention they should on behalf of our patients seems to me to be absolutely right.

 

 

A lot has been made recently about the issue of parity of esteem for mental health (“No Health without Mental Health”). My own area of interest throughout my career has been working with people with a diagnosis of personality disorder, who could be said to be one of the least well provided for groups of patients within mental health. This puts them at the bottom of the list twice over; the least deserving patients in the least deserving end of healthcare! It can often feel that way as a clinician too, when trying to advocate for better care and treatment services, but feeling at the bottom of everyone’s priority list. It has felt at times over the past 10 years in my clinical job like a losing battle to engage managers and colleagues to take a sustained interest in this group of patients, even though our knowledge and understanding about these conditions has continued to grow, alongside some therapeutic optimism and pockets of expertise in some of these therapies.

 

There have been some rays of light in the gloom in Scotland, like the Scottish PD Network, which has brought together clinicians, service users and carers to share experiences and expertise in a lively conference format, and the progress in some health boards with developing and implementing better care pathways for people with personality disorder. Now, it feels as though a bit of momentum is gathering, as the college in Scotland has chosen personality disorder as a theme to pursue following the last strategy day. Rather suddenly at the end of last year, I found myself agreeing to chair a Short-life Working Group on personality disorders for the college. I had fears that this might involve me sitting in a room with Karen, waiting for anyone who might turn up. I have been extremely pleasantly surprised by the level of enthusiasm so far, with many people from across the college faculties coming forwards with interest and ideas, wanting to identify themselves with this work, and bringing a wide range of experience and knowledge. We have met several times since the start of the year, with representatives from service users, nursing, social work, police, psychology, AHPs all contributing.

 

We have started on a number of strands of work, including a survey of the current status of specialist and general services for people with PD in Scotland (this is being led by 2 higher trainees, and is based on a similar survey in England by kind permission of its authors), and a survey of training models for staff. I have a bit of a passion for engaging people’s interest and enthusiasm through training about personality disorder, and will be interested to gather views about what are thought to be the core components that are important. My guess is that improving understanding of the development of personality difficulties, and consequently improving staff’s capacity for empathy might be key.

 

We have been offered the next forum of the Scottish PD Network on Wed 19th October to present some of the progress so far, and to gather in a wider stakeholder group’s opinions. The day will be a combination of talks and opportunities to feed in to the process, and I would encourage anyone with an interest to come along. https://www.eiseverywhere.com/ehome/184866

 

We plan to work on a document next year for the college, to describe the current status of care for people with personality disorder in Scotland, and a good practice guide. My hope is that this piece of work raises the profile of this group of patients and encourages discussion and engagement within the profession, as well as in the public domain.

I am in awe of the campaign “Healthy Start; Healthy Scotland”, and hope that we can in some way emulate the success of this. We would all support the work that should be targeted on preventing mental health problems by early intervention, but we must not neglect those for whom difficulties persist into adolescence and adulthood.

 

Andy Williams, Consultant Medical Psychotherapist, Chair of Medical Psychotherapy Faculty in Scotland

 

20/07/2016 11:42:49

RCPsychiS July Blog

International Congress: a Pathfinder Fellow's perspective

 

The Royal College of Psychiatrists held its long-established International Congress in the ExCeL International Convention Centre in London in at the end of June. Spanning over 4 days, with hundreds of lectures from countless distinguished speakers giving talks based on this year’s theme of ‘Brain, Body and Mind’ and around 3000 international delegates in attendance, the sheer scale and scope of the Congress was hugely impressive and very exciting to be a part of.

 

Day 1 of the Congress kicked off with a key note lecture from President of the College, Professor Sir Simon Wessely who discussed some of the challenges psychiatry as a specialty faced. This was followed by a lecture from the highly eminent winner of the Nobel Prize for Medicine Professor Sir John O’Keefe who discussed the function of the hippocampus as a cognitive map. As a final year medical student who is extremely interested in psychiatry, I am still shocked to find that psychiatrists and their patients are often stigmatised by other doctors and students within the medical profession. I thus chose to attend a parallel session exploring recruitment of medical students into psychiatry and the innovative strategies which have been developed in order to maximise recruitment into this fascinating and constantly evolving speciality. Finally, the day closed with an extremely memorable discussion on Scientology and psychiatry.

 

The remaining 3 days of the Congress continued to be as interesting and diverse as the first. Particular highlights for me included lectures on concussion and CTE, an area of neuropsychiatry which is becoming increasingly controversial and gaining greater recognition in the public domain as a result of its recent portrayal in the film Concussion. Other highlights included discussions on functional disorders in neurology and a conversation with the comedian Jo Brand to name but a few. 

 

The International Congress was a hugely stimulating and fascinating experience and is something I thoroughly enjoyed. The sheer variety and breadth of the Congress and the findings discussed at various research presentations emphasised that there has never been a more exciting time to be a psychiatrist and confirms psychiatry’s place at the forefront of medicine.

 

Clare Langan

Royal College of Psychiatrists Pathfinder Fellow & Student Associate  

 

 

 

 

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With this new feature we are bringing you a guest blogger every month. The aim of the blog is to inform people about the work the College undertakes in Scotland and to highlight the different activities our members are involved in. We invite members in Scotland to write a blog, perhaps on a project they are working on, a recruitment initiative, engagement with the third sector, teaching, training or just day to day working in mental health services in Scotland. The Chair will have the final say on which ones we publish. There will be an invite for readers to comment.

If you have something that you feel might be of interest to members and would like to write a future guest blog then please contact  Angela Currie at the RCPsych in Scotland.