Issue 6 Winter 2018 RCPsych INSIGHT COLLEGE NEWS IN BRIEF Contents 04 Choose Psychiatry media success POLITICAL CONSENSUS ON MENTAL HEALTH The Choose Psychiatry recruitment campaign President’s The College’s role in ran again in October and, as with all ongoing supporting the All-Party campaigns, getting high-profile media attention Parliamentary Group second time around seemed a hard task. Our update strategy paid off; RCPsych’s press team worked closely with polling company ComRes to devise a Professor Wendy Burn 11 hard-hitting poll that would give an unprecedented PSYCHIATRY AND SITCOMS insight into how long people are waiting for specialist mental health treatment and what the Welcome to this winter issue of We speak to consultant impact of that wait was on their lives. Insight, I hope you enjoy reading it as psychiatrist and television screenwriter Grace Ofori-Attah Imagery from the Choose Psychiatry campaign much as I have. As always, we were spoilt for choice in selecting which of psychiatrists too and that psychiatry offers a varied the great things that our members are and exciting career. We filmed in Aldershot with one doing should be highlighted. of our very own serving psychiatrists who was only I’m now almost halfway through my too happy to tell us how rewarding her career is. term of office. There is no doubt that being President has changed me. I For more on the Long-Term Plan, please turn to pages 5−7 had no real interest in politics before taking up the role, but now I find it 12 Data sourced from RCPsych as shown on Channel 5 news New website a fascinating and totally absorbing PLAYING WITH THE The results were stark: Northern Ireland’s report into subject. I am lucky enough to visit the ROOTS OF STIGMA Palace of Westminster on a regular Innovative campaigning 1 in 4 people (24%) with a diagnosed mental More than 25,000 people visited the College’s • health condition reported waiting more than new website when it launched on Monday 19 prisoners’ mental health basis, and at each visit I feel awed, to reduce mental health honoured and privileged to be setting stigma in south India three months to see an NHS mental health November. The website plays a huge role in specialist. foot into a building where so much of the way the organisation presents itself and A report released by RCPsych in Northern Ireland than in other parts of the UK. The our history has played out. Some (6%) say they waited more than a year communicates with the outside world, but the Ireland says prisoners are being failed by report by the Forensic Faculty in Northern 14 • to see an NHS mental health specialist – one old design had become dated and performed the health services and that mentally ill Ireland detailed the issues that need to On a more prosaic level, I have man interviewed following the poll said he poorly on smart phones and tablets. So, a project patients are being kept in solitary confinement be addressed and potential solutions to honed my ability to get onto even the CLIMATE CHANGE waited 13 years to get the help he needed. involving 80 members of staff and a user group of contrary to professional advice. The report’s support progress. It gained some high- most crowded train or tube and can 120 psychiatrists, patients and other stakeholders authors said this practice was proven to be profile press attention with one of its usually manage to grab a seat. Why it’s a mental health matter Where respondents’ mental health got worse, led to the creation of a new brighter, bolder, detrimental to mental health. Rates of mental authors, Dr Adrian East, being interviewed The thing that hasn’t changed is • these waits led to relationship problems mobile-friendly site. The overhaul involved re- illness are said to be higher in Northern on BBC Sounds, local TV and for a blog. missing my cats. The occasional including divorce (36%), financial troubles (32%) writing 1,500 pages of content and creating new meeting with Larry, the cat at Number 17 and work problems including job loss (34%). sections and navigation systems to make content FOOTBALL AND GAMBLING easier to find and use. 10, doesn’t really make up for leaving The College achieved 572 mentions in the media, them behind in Yorkshire. Sport’s role in gaining reaching around 5.5 million people. Dr Jon Goldin Visit www.rcpsych.ac.uk to see the site for Recently, much of my time has been treatment equality was filmed for Good Morning Britain in a piece yourself, and follow the feedback banner at the top taken up with work to influence the that coincided with the first-ever Global Ministerial of the homepage to let us know what you think. Long-Term Plan for the NHS. I am Mental Health Summit in London. Dr Kate Lovett appeared on BBC Two’s Victoria Derbyshire show, hoping that by the time you read this, BBC Radio Solent and ITV’s lunchtime news. Our the plan will be public. At a recent President, Professor Wendy Burn, was interviewed visit to Bristol Psychsoc, I was lent for talkRADIO’s breakfast show and local radio in a magic wand by a friendly child Bradford. psychiatrist and allowed one wish. I The success of the 2017 campaign led to the used it to ask for a good settlement 18 military part-funding our video, which now includes for mental health, so I’m hopeful that THE INFLAMMATION a military psychiatrist storyline. They’re keen to get we will do well. the message across that the armed forces need REVOLUTION HMP Maghaberry. Picture by Jonathan Porter, Press Eye Does the body’s immune system hold the key to new antidepressant treatment? Editors: Rebecca Couper, Gemma Mulreany and Kim Catcheside Clinical Editors: Dr Tony Rao and Dr Santosh Mudholkar Design: Lee Braithwaite Want to contribute or offer feedback? Contributors/writers: Colin Richardson, Rachel Pugh, Sophie Goodchild, Claire Read and Jo Carlowe Cover illustration: Martin Rowson Send in your suggestions to [email protected] Photographers: Grainge Photography, Jeremy Sutton-Hibbert, Adam Bronkhurst, Inside illustrations: Kipper Williams 2 Phil Mynott and Jonathan Porter #RCPsychInsight 3 YOUR NEWS FEEDBACK FEATURE

were achievable and properly evidenced.” Throughout the summer, Holly and her team worked with the College offi cers and College Registrar Dr Adrian James and Helen Whately MP faculties to produce a compelling vision for mental health services in 2029 with a detailed description of how that could be achieved. Our submission calls for a FEEDBACK Getting political consensus commitment to the biggest expansion in access to mental health services across Europe, with a much-needed focus on # tackling inequalities. The College wants the “RCPsych Insight is the best on mental health NHS to become the safest, most effective, thing the College has done for its and transparent health system in the world members. It captures a whole range The College’s role supporting the All-Party Parliamentary with mental health trusts leading the way. of members’ contributions. It’s the President Wendy Burn adds: “We never public face of what psychiatry is all Group (APPG) on Mental Health has resulted in a hard-hitting report. The hope is that this will bring about much-needed know what is around the corner, but about.” regardless of whether this plan stays a plan Dr Rajesh Mohan, Chair of change for patients. Holly Paulsen, Deputy Head of Policy and Campaigns at RCPsych and Professor Wendy Burn or becomes something more concrete, it’s the Rehabilitation and Social the biggest investment opportunity we’ve Psychiatry Faculty had in a long time. We want better services and a commitment to building a mental “I really like the magazine. It makes ndless queues outside of experienced their fi rst case of psychosis health workforce that can deliver what our you imagine things more creatively.” Parliament are usually an getting treatment within two weeks. But patients need.” Dr Amar Gupta indication that something it cannot be right that people with severe By September, the College had put important is about to happen. mental illness are being told there are no together a 100-page response with key “It’s a quick and easy read that gives The October launch of the APPG services available for them and therefore asks including: you updates on what the College Eon Mental Health’s report On the Road to to lie and downplay the severity of their Shaping the plan @is up to in a way that is humorous, Parity was no exception. The room was symptoms to get help.” 70,348 more mental health staff on the • engaging and accessible.” packed and Twitter was already buzzing. Ministers are known for being elusive ground by 2028/29, including 4,218 It marked the culmination of months of hard when uncomfortable truths are being NHS England announced a Long-Term Plan for the NHS and psychiatrists Dr Helen Killaspy asked for our ideas. Naturally, we were happy to oblige. work from the College, mental health charity announced. Yet Health Secretary Matt • An additional £3.7bn for mental health "Whilst I do enjoy reading the Rethink Mental Illness − who provide the Hancock was at the report launch along services between 2019/20 and 2023/24 magazine, I do have reservations APPG secretariat − and several committed with 13 other MPs and peers. When the and a further £3.3bn between about the cover. I feel the cartoon politicians. report was debated in Parliament later 2024/25 and 2028/29, all above infl ation effect denigrates the specialty, in fact The report was the result of an inquiry in October, the College was praised self-denigration which is serious." investigating the progress of the for its support, and the Government’s • Spending by CCGs and NHSE on Government’s mental health strategy, the representative called the report ‘timely’ mental health to increase from 10.8% Rosemary Macdonald, in response in 2017/18 to around 13.1% in 2028/29 to Issue 5 (Autumn 2018) Five Year Forward View for Mental Health, as it came just as the Long-Term Plan for hen the Prime “We want better services published in February 2016. the NHS was being put together. Minister announced of the total estimated NHS England The inquiry received over 70 contributions “The College is not going to be organising there would be more and a commitment to budget money available to building a mental health from across the sector, including patients, a march down Whitehall, but we can still • On top of this, capital funding is required housing associations and professionals. be quite infl uential,” stresses Dr James. spend on health we workforce that can in next year’s Spending Review from It gave MPs the chance to get out of The APPG provides an opportunity for wereW pleased, obviously. But when you HM Treasury to address a growing deliver what our patients Editor response: Parliament and visit a mental health trust the College to form relationships with have a vision as ambitious as parity for Thank you for your comments. While maintenance backlog and build new and talk to patients and carers about politicians from all political parties while mental health, the end of one battle is need” there was no intention to be self- estates. The government should also their own experience of the system. The giving them an expert steer. just the beginning of another. So, the denigrating, we’ve taken on board what commit to increasing the overall DHSC politicians also had an opportunity to quiz “The report rates as a major infl uencing Policy and Campaigns team at RCPsych you've said and will be more mindful budget by at least 3% each year to www stakeholders in person, including the opportunity and having approval from immediately set itself the task of ensuring of the content and themes of the cover safeguard public mental health and College’s Registrar, Dr Adrian James, and those close to Government, including that mental health services were allocated illustrations we use in future. workforce development. NHS England’s national Mental Health Simon Stevens, is the ultimate stamp of a big enough share of the extra £20 billion Director Claire Murdoch. She said she approval,” says Dr James. to begin to close the treatment gap for fi rst mental health organisation or Royal Asking for money is something the Please send your feedback to hoped the APPG recommendations would The College is determined to hold the patients. Being asked by Simon Stevens College to get a full submission to him. President says she’s getting better at: or tweet [email protected] infl uence the NHS’s Long-Term Plan. Government to account over Five Year himself to contribute to a wish list for the Holly Paulsen, RCPsych’s Deputy Head “When you’ve been at the back of the us with hashtag #RCPsychInsight The APPG chair, Helen Whately MP, said: Forward View promises. “The document mental health chapter of his Long-Term of Policy and Campaigns, says: “This funding queue for years, it’s easy just to be “We know change is possible because we provides an evidence base to lobby for Plan was an opportunity we couldn’t afford wasn’t just a list of demands. We saw grateful for anything. But for mental health, have achieved so much since 2016, with change,” says Dr James. “We can quote to miss. Not only did the College’s Policy this as an opportunity to actively engage a ‘fair share’ needs to be a bigger share 89% of people receiving treatment in IAPT from the fi ndings which independently give and Campaigns team rise to the occasion with NHSE and DHSC to build trust and to enable us to close the gap – and that’s within six weeks and 74% of people who credence to what we’re saying,” he added. but, according to NHSE, we were the persuade decision makers that our ideas what we will be fi ghting for.”

#RCPsychInsight #RCPsychInsight 4 5 NEWS FEATURE Responding to theLong-Term Plan We asked the chairs of each College faculty what should be included in the NHS Long-Term Plan if Academic Psychiatry mental health care is to be fi ghting fi t by 2028. Anne Lingford-Hughes “We’d like a 50% increase in clinical senior lecturer posts to deliver innovation and improved care for our patients. We’d also like to see high-quality psychiatric training guaranteed with the presence of academic psychiatrists Forensic Psychiatry General Adult Psychiatry at every medical school.” Pamela Taylor Lenny Cornwall “The Long-Term Plan commitment “Core general adult services have Addiction Psychiatry Child and Adolescent Eating Disorders to reducing health inequalities been neglected recently, with services Julia Sinclair Psychiatry Dasha Nicholls must include better services for hit in community, crisis and in-patient Bernadka Dubicka teams. We need NHSE to recognise “If we want to really help those with prisoners. We need to retain “Eating disorders carry a high this as a major concern and take alcohol and other substance use resources for specialist in-patient “It’s our hope that the majority who mortality rate and they need to action to prioritise core services as the disorders, and improve outcomes for hospitals and build community need help can get it when they be recognised as serious mental vital foundations of the whole mental patients across the NHS, addiction forensic psychiatric services, need it (not, as currently, just the illnesses. We’d like NHS England health service.” services and the training of addiction minority); the most vulnerable and Public Health England to coworking with probation services psychiatrists need to be re-established. children have all needs addressed; recognise the value of eating to reduce numbers of prisoners The burden of addiction on patients, services are offered up to the age disorder psychiatrists being fully with mental disorder and improve their families and services is huge and of 25; and all children have the best engaged in public health and in care when imprisonment is Liaison Psychiatry growing, and to address it we need to start in life with integrated early educational settings to prevent unavoidable.” Jim Bolton be included in the NHS Plan.” years services. Lastly, we hope to eating disorders developing.” have a well-supported workforce to “Liaison Psychiatry bridges the provide the best care.” artifi cial divide the NHS has created between mind and body. We want the NHS to endorse liaison psychiatry for patients of all ages at all times in all hospitals, and to extend it to patients with long-term physical illnesses.” Intellectual Disability Psychiatry Ken Courtenay “We are very pleased intellectual disability (ID) is a clinical priority in the Rehabilitation and Social Medical Psychotherapy NHS Long-Term Plan, giving people Psychiatry Old Age Psychiatry Steve Pearce with ID the focus they deserve. We Rajesh Mohan Perinatal Psychiatry Amanda Thompsell hope the Plan will deliver on improving “The Improving Access to Gertrude Seneviratne the mental and physical healthcare of “We’d like to address the “The next 10 years must see Psychological Therapies programme people with ID so that disability is no needs of people with long-term “The investment in Perinatal a far greater focus on older has successfully expanded services longer a barrier to high quality care.” conditions, such as psychosis, Services has been valued people’s mental health. We for mild to moderate anxiety and through funding for locally with the expansion of mother need better prevention and depression; it is now time to extend and baby units but that Neuropsychiatry based community and in-patient early diagnosis of mental illness readily accessible psychotherapy Eileen Joyce rehabilitation services. Early commitment must continue. It among older people; more to people with more severe mental provision will enhance recovery is also crucial that countrywide widespread post-diagnostic disorders. This must include “Neuropsychiatrists help patients and reduce the need for out- services support perinatal and support for patients with personality disorders and medically when brain damage or dysfunction of-area care. Whole system parental mental health, and the dementia and their carers; and unexplained symptoms and is contributing to their mental illness. approaches are required, with emotional and psychological crisis care that is accessible to somatoform disorders, as well as Unfortunately, services are few NHS, social care and housing development of babies and older adults and can meet their psychoses and more severe mood and far between. We believe every working in partnership.” young children.” complex needs.” disorders.” neuroscience centre should have dedicated neuropsychiatry services.”

#RCPsychInsight #RCPsychInsight 6 7 RCPSYCH AWARDS 2018 RCPsych Awards

The College welcomed over 300 of the Royal College of Psychiatrists, guests on 7 November 2018 to who congratulated all the shortlisted mark the annual RCPsych Awards. candidates. The lifetime achievement Broadcaster Victoria Derbyshire, award was presented to Dame Fiona fresh from the set of her BBC TV Caldicott, the College’s fi rst female show, presented the afternoon’s president. awards and was acknowledged for her own role in championing mental More details of our awards can be found health awareness. Proceedings on our website: kicked off with an introduction from www.rcpsych.ac.uk/about-us/rcpsych- Professor Wendy Burn, President awards-2018

The 2018 winners are: • Medical Student of the Year: Konrad Wagstyl Foundation Doctor (FY1 – FY2) of the Year: Dr Beth McCausland Dame Fiona Caldicott with Professor John Wing Lifetime achievement award winner Fiona Caldicott with broadcaster Victoria Derbyshire • at the 1996 AGM • Core Psychiatric Trainee of the Year (CT1 – CT3): Dr Ahmed Hankir • Higher Psychiatric Trainee of the Year (ST4 – ST6 and SpR): Dr Charlotte Blewett • Service User/Patient Contributor of the Year: Katy Chachou • Carer Contributor of the Year: Michelle Long A lifetime of paving the way • Psychiatric Communicator of the Year: Hellblade Developer Team, Cambridgeshire and Peterborough NHS Trust • Psychiatric Trainer of the Year: Dr Christopher O’Loughlin, Cambridge and RCPsych’s fi rst female President, Dame Fiona Caldicott, receives the College’s Peterborough NHS Foundation Trust Lifetime Achievement Award. • S N Jajoo Memorial Academic Researcher of the Year: Dr Andrea Cipriani, Dr Charlotte Blewett, Higher Psychiatric Trainee of the Year University of Oxford, Oxford Health NHS Foundation Trust • Specialty Doctor/Associate Specialist of the Year: Dr Thandar Win, Tees, Esk and Wear Valleys NHS Foundation Trust hen Fiona Caldicott “It was a marker that training part time, something Fiona • Psychiatrist of the Year: Dr Heather Hanna, Southern Health and Social Care hears of efforts to feels was important. “It was a marker Trust, Northern Ireland reduce hospital you could have a family that you could have a family life that admissions for those life that was stable was stable and rewarding but also • Psychiatric Team of the Year (children and adolescents): Psychological Medicine with physical illness, and rewarding but also achieve a lot in the profession.” Team, Great Ormond Street Hospital for Children NHS Foundation Trust Wshe can’t help but feel pride on the And that’s all before one considers • Psychiatric Team of the Year (working-age adults) joint winners: King’s Health achieve a lot in the part of her specialty. After all, she says her eponymous reviews on patient Partners Pathway Homeless Team, South London and Maudsley NHS psychiatry led the way on care closer to profession” data security in the age of digitisation. Foundation Trust, & Peer Supported Open Dialogue Service, Kent and Medway home decades ago. Or her decade as chair of Oxford Dr Ahmed Hankir, Core Psychiatric Trainee of the Year NHS and Social Care Partnership Trust “It’s interesting to see some of those University Hospital's NHS Foundation Psychiatric Team of the Year (older-age adults): Surrey Heath Community ideas about mental health coming into Trust, where she has helped ensure • Mental Health Team, Surrey & Borders Partnership NHS Foundation Trust physical health,” says Dame Fiona, the “the psychological treatment service recipient of this year’s Royal College days in the 1960s as one of only 10 is absolutely integrated with physical • Psychiatric Team of the Year (non-age specifi c):Integrated Psychological of Psychiatrists' Lifetime Achievement women in a year of 100 students – care”. Medicine, Oxford University Hospitals NHS Foundation Trust Award. “Mental health really was the or the spell in the 1990s when she It all means she has “various points • Psychiatric Team of the Year (quality improvement): Teesside Locality Mental forerunner.” became the RCPsych’s fi rst female of pride” when she looks at her Health Service for Older People, Tees, Esk and Wear Valleys NHS Well, as the saying goes, it takes one dean and then its fi rst female president. career. The award from the College Foundation Trust to know one. To review Dame Fiona’s Her presidency also marked another is, she says, the icing on top. “It’s just career is to fi nd multiple instances of fi rst: a Royal College being headed by wonderful. I’m really appreciative of • Psychiatric Team of the Year (outstanding commitment to sustainable service trailblazing. Take her medical school someone who had completed specialty something which is very special.” development): Transforming Mental Health, Hywel Dda University Health Board Dr Heather Hanna, who won Psychiatrist of the Year for her work with CAMHS Intellectual disabilities in NI

#RCPsychInsight #RCPsychInsight 8 9 NEWS NEWS FEATURE FEATURE

because, the way psychiatry is, the junior is with the patient all the time. It’s you and the nursing staff trying to manage the ward.” She wrote a script for a TV series based on her idea and submitted it to Channel 4’s 4Screenwriting scheme, and … boom! In short order, Grace was accepted onto the scheme, had her scripts read by industry movers and shakers and was hired as one of the scriptwriters for In the Long Run, Idris Elba’s semi-autobiographical sitcom for Sky TV. The show went into production in autumn 2017, was broadcast this spring, and Grace is now working on Dr Rosalind Ramsay, Specialist Advisor for the PSS the second series. And a fi lm script may be on the cards. Interestingly, it isn’t her mental health member back at a convenient time – on expertise that Grace draws on for In the an evening or weekend, if needed. Long Run, but her parents’ experiences of Peer support for Having their identity protected is a major moving to Britain from Ghana in the early concern for those getting in touch. To 1980s. The show is about a family from ensure this is achieved, Rosetta arranges Sierra Leone raising their British-born son for each member to be called by an on a council estate in east London in 1985. advisor who has a different specialty, practitioners Dr Grace Ofori-Attah Grace’s parents loved it, especially the bits wherever possible, and is based in they recognised from stories they had told another part of the UK. Most importantly, their daughter. A free and confi dential helpline for members is making a real the advisor is never told the member’s What’s remarkable is that Grace forged di erence to callers when they need support or advice. name. her writing career while training to be and The intention is not for the PSS to replace Psychiatry and sitcoms working as a psychiatrist. She wrote in her any other service supporting doctors. Nor free time, in the car, while on call. She took is it a counselling or treatment helpline – six months off when she fi rst got her break any caller in need of such specialist care honing a stranger for help One moment, Grace Ofori-Attah was a consultant psychiatrist; the into TV, but she’s now back working one PSS calls by issue (2017) is signposted to the appropriate body, may sound a daunting next, a television screenwriter for Idris Elba. How did that happen? day a week as a consultant for Islington’s such as the BMA Counselling Service, prospect. But the task is WorkplaceWorkplace stress stress addiction service. DocHealth or the Practitioner Health made easier when you know TrainingTraining advice advice She hopes that one day her show about Programme. you will be put in touch with StalkingStalking junior psychiatrists will be produced. Part “This isn’t a treatment service or legal aP psychiatrist who understands your MentalMental health health sychiatry and storytelling my sister’s friends had made about of the problem is that another series set on advice line,” says Dr Ramsay. “It’s dilemma, and that your call will be treated InvestigationInvestigation have always walked hand depression and I thought, I wonder if I a psychiatric ward – Psychos, broadcast about peer support to help an individual in total confi dence. HealthHealth in hand, so it’s not entirely could write something like this.” on Channel 4 in 1999 – caused a huge feel more safe and secure. The doctor This is the mission of the Psychiatrists’ EmploymentEmployment issues issues surprising that consultant A swift bit of internet training in script- furore. It was condemned for its portrayal of advisors use a coaching approach and Support Service (PSS) – to provide DiffiDifficult cult colleague colleague psychiatrist Dr Grace Ofori- writing from Professor G.O. Ogle and psychiatrists and their patients by, among what’s satisfying for the caller is they end members with an anonymous and non- CareerCareer advice advice PAttah has found herself writing scripts she was off. “I didn’t really know what many others, RCPsych. “I’ve been to a up with a realistic plan for their next steps.” judgemental space to air their concerns, BullyingBullying for a sitcom. But, as she says herself, it’s I was doing, but I had an idea about lot of meetings,” says Grace, “and that is 0% 5% 10% 15% 20% 25% Judging by the positive feedback to date, catering for the wide range of issues they 0% 5% 10% 15% 20% 25% all happened so quickly. She can’t quite being a junior doctor in psychiatry and quoted in every single meeting. People are the PSS is proving to be of signifi cant might face at home and at work. believe it and still seems slightly dazed by junior doctors’ interactions with patients, wary of going there again.” benefi t to members. Findings from an Toxic job environments, the emotional the way her life has changed. RCPsych survey of callers over the last cost of their roles and having to manage Launched in 2007, the UK-wide helpline “I’d always had this feeling that I wanted two years show that 91% of respondents confl icting demands are all placing had dealt with almost 1,000 enquiries by to write stories and it never left me. I felt understood and 100% would doctors under unprecedented stress. November 2016, ranging from coping with come from a fairly traditional west African recommend the service to a colleague. This is why the PSS is absolutely vital, burnout or investigations to managing background. My parents said, ‘You’re Ultimately, the value of the service according to Dr Rosalind Ramsay, workplace stress and diffi cult working going to university, you’re going to do a is refl ected in the fact that members Specialist Advisor for the PSS. relationships. vocational subject,’ and the idea of going feel they are being listened to by a “Psychiatrists are only human – they Members contact the PSS via the to study an arts subject, which I’d quite like professional who is not there to judge experience personal and work-related dedicated phoneline or email address. After to have done, was just not a thing. ‘You them. As one caller to the helpline wrote: diffi culties like anyone else,” she says. listening to the situation, the PSS Manager, can write in your spare time,’ they said.” “He (the consultant) made me feel “It can sometimes be an isolating Rosetta Wotton, provides some initial So she did just that: she started to write validated.” experience if you’re struggling to cope. advice and may, with the caller’s consent, a book, but it didn’t really go anywhere. Psychiatrists need a safe space away make a brief record of the conversation “Then, about four years ago, I decided to from work to talk through issues they’re on a secure server. She then shares the Contact the PSS in confi dence: switch to script-writing,” Grace says. facing. We strive to reassure callers that anonymised information with a doctor 020 7245 0412 “I’d never seen a script, but I went to they aren’t alone.” advisor and arranges for them to call the [email protected] a screening of a short fi lm that one of The sitcom In the Long Run with Idris Elba and Bill Bailey – ©Sky UK Limited for Sky One

#RCPsychInsight #RCPsychInsight 10 11 NEWS OPINION FEATURE PIECE

illagers in India’s Andhra Pradesh region are used Field sta conducting a door-to-door campaign on raising mental health awareness in 2015, to welcoming drama Andhra Pradesh, India companies to stage performances, but it’s fair Vto say this play was a little out of the ordinary. Rather than telling a tale of folklore or myth, it spoke of a subject Playing with the often considered taboo in this rural area and, indeed, in the country more widely An ex-o ender's story – mental ill health. The performance had been organised roots of stigma by a team at The George Institute “There are lots of factors that go into for Global Health, India. They were creating and sustaining an enabling exploring the value of giving community When Dr Pallab Maulik and colleagues launched a campaign Talking works environment – a sense of belonging, health staff electronic versions of to reduce mental health stigma in south India, they turned to a establishing boundaries, supportive screening questionnaires for depression drama company for help. Why the CCQI’s quality assurance service of workplace communication, etc. However, you and anxiety, along with an intervention can put in place all the policies and guide. The aim was to understand if culture is making a big di erence to mental health. procedures that you like but really it these tools would help increase the comes down to human relations. If number of people seeking treatment for you believe that someone is really common mental disorders from primary concerned about your wellbeing, healthcare workers. ometimes, the smallest things “EE has had a positive you’re more likely to develop on This sort of electronic platform had already had a script centred on domestic mean the most. Sarah Paget is impact on culture and a personal level. It is a two-way already been successfully used for violence and seeking help, they suspected the College Centre for Quality process, so it is equally important physical health complaints. “But,” says they may have a powerful means of Improvement (CCQI) Programme staff morale” for both parties to take responsibility Pallab Maulik – a psychiatrist as well addressing some of these worries. Manager for Enabling for the wellbeing of the other. On a as the Institute’s Deputy Director and After making a few tweaks “to align the SEnvironments and she cites the example human level, even though I’m an Director for Research – “there was script to the messages we wanted to of a probation hostel she worked with. Staff ex-offender and you might not be, awareness that its use in mental health give,” the staging began. The troupe said they had almost no interaction with the and, ultimately, promotes good mental the fact that I ask, ‘Are you ok?’ and would need to be coupled with a robust performed live in eight of the 42 villages residents, who would only be seen when health. show interest and concern about anti-stigma campaign.” involved in the study, with the play shown they signed themselves out in the morning EE has a membership of 200 you as a fellow human being is Current estimates are that 75−85% of on video in the rest. and in again before the evening curfew. organisations, including hospital wards, important. people with mental illness in low- and It was but one plank of the team’s anti- Sarah encouraged staff to take a ‘small prisons, schools, day centres, supported “The staff need to buy into the idea middle-income countries do not receive stigma campaign – others included changes, big impact approach’. And so, living projects and universities. Any of an enabling environment being effective treatment, in part due to printed material and a video of someone among other changes, staff started to say organisation that meets all its criteria as much for them as it is for those stigma. with a mental illness talking about “Good morning” to the residents as they will be given an EE Award, valid for in custody. Equally, if the ladies Asked about the problematic beliefs that his experience – but subsequent signed out. Within a month, exchanges three years. The award is a quality see that the staff are genuinely needed combatting in Andhra Pradesh, evaluation showed it to be one of the had blossomed into proper conversations. mark that recognises ‘an outstanding trying to support them, they will be Dr Maulik reveals some specifi c to most successful. “It was found to be a “I rang to see how they were doing,” Sarah level of best practice in creating and prepared to work with them. For India. “One of the areas people brought very powerful tool and a very powerful says, “and they said: ‘You’ll never believe it. sustaining a positive and effective social those in custody, being part of an up was that if you have an unmarried medium,” reports Dr Maulik. People are talking to each other now and environment’. establishment with a supportive, daughter, and you also have someone He is convinced the lessons from the having cups of tea. Everything’s not perfect, The biggest participating organisation enabling environment means they in the family with a mental illness, then it project are broadly applicable, reporting but we now have an environment where is Her Majesty’s Prisons and Probation carry a positive mindset with them becomes very diffi cult to fi nd a match for Dr Pallab Maulik that recent conversations with a Time to people can engage with us’.” Service (HMPPS) but it is the Offender after custody.” that person in the community.” Change team working in East London The Enabling Environments (EE) project Personality Disorder Pathway But the three most commonly cited worried about what other people in the have borne this out. So, while it may was inaugurated in 2009 by the CCQI Programme that has put EE at the core With thanks to Lesley and The concerns will sound familiar to UK- community may think of them. And the be 5,000 miles from the home of the as part of RCPsych’s accreditation of their work. They tailor services for Prisoners’ Education Trust. based psychiatrists. “People feared that third concern was that it may affect College to the village homes of Andhra programme. Its purpose is to encourage those with a severe personality disorder if they were diagnosed with a mental them getting a job.” Pradesh, when it comes to combatting organisations to foster positive relationships and who pose a high risk of harm to Full details of the Enabling illness, their children might be taken When Dr Maulik and colleagues stigma it seems the psychiatrists’ world among staff and patients in a way that others or are likely to reoffend in a Environments project can be found at: away from them. Second, they were discovered that a local drama company is a small one. supports personal growth and wellbeing harmful way. www.enablingenvironments.com

#RCPsychInsight #RCPsychInsight 12 13 NEWS FEATURE A passion for improving inpatient services

In The British Journal of Psychiatry Dr Page. “It’s obvious that all of these (June 2012), Dr Page and colleagues factors will have a huge impact on reported that patients with mental people’s mental health.” illness had an increased risk of death Despite this, Dr Page, who sits on of around 5% for every 1ºc increase RCPsych’s Sustainability Committee, in temperature – compared with 2% says colleagues are often ‘sceptical’ for the general population. Similarly, and question what climate change has a systematic review, published in the to do with psychiatry. Public Health journal (August 2018), “I have always found public health found a positive association between doctors are more interested in this increasing temperatures and suicide. than psychiatrists,” she says. This The situation is only set to get worse. contrasts with what she describes as The Intergovernmental Panel on a “huge public appetite for change,” Climate Change (IPCC) warns global prompted by campaigns such as Blue warming is on a trajectory to exceed Planet II’s focus on plastic waste. 1.5ºc, and rising temperatures are just It’s time, she thinks, for RCPsych the tip of the (melting) iceberg. As the members to capitalise on this. world heats up, so does the risk of “We became doctors because we drought, fl ood and poverty. believe health should be maximised In the UK, we’ve already had a taste of and suffering reduced where possible. what fl ooding means for mental health. Our patients are particularly at risk from In England 2013, a tidal surge saw the health impacts of climate change rivers burst their banks and breach and we work for an organisation (the sea defences, after which fl ood victims NHS) that has enormous potential to reported depression, anxiety and reduce the UK’s carbon emissions. Dr Lisa Page, Consultant Liaison Psychiatrist PTSD (National Study For Flooding Being part of the health community, and Health). we have a strong and trusted voice “There are signifi cant global with the lay public, institutions and implications as a result of increased government which should be used.” natural disasters, greater civil unrest, Dr Page’s plea could not be more Why climate change is a forced migration and the impact on timely; November marked 10 years communities of the destruction of since the inception of the Climate mental health matter habitats and food ecosystems,” says Change Act. How are her patients dressed? Are Evidence shows that rising temperatures can a ect mental health and it’s the reason they clad in thick layers or sweltering in heavy jumpers? campaigners want more to be done to tackle climate change. “What is going in their fl at? Is the heating still on? Are they aware or able to follow basic advice around rehydration, and staying out of the midday sun?” This makes Dr Page sound a bit like “ worry about patients with major “Public health doctors Dr Page, of Sussex Partnership NHS an anxious parent, but her concerns mental illness not being aware or Foundation Trust, is one of a growing are well founded. able to comply with advice about are much more number of psychiatrists concerned “Unexpectedly hot weather is associated how to keep cool in hot weather. interested in this about the impact of global warming. with an increase in suicide, self-harm This summer we had several than psychiatrists… She passionately believes that and other adverse health outcomes in Ipatients on long-acting injectables climate change matters enormously, psychiatric patients,” she says. admitted to the emergency department but our patients are not least because it affects her A growing body of evidence supports with heat stroke or severe sunburn, as particularly at risk” patients’ wellbeing. her claims. Studies link heatwaves they had been relapsing and ‘wandering’ As a liaison psychiatrist working with with excess hospital admissions around the city for long periods of time the emergency department, a spike for psychiatric presentations, and in inappropriate clothing.” in temperatures has her on high alert. increased hospitalisation for self-harm.

#RCPsychInsight #RCPsychInsight 14 15 OPINION NEWS PIECE FEATURE

We need to begin with the youngsters at football academies, by providing clear education for aspiring young stars about this silent addiction. Psychologists working across the training establishments, using standardised psychological tests (including tests for risk taking and impulsivity), can identify the most vulnerable. Players should be equipped with practical strategies such as meditation and mindfulness to use as diversionary measures to resist temptation. They also need education to help them manage their fi nances and free time. The truth is that acceptance onto training squads pushes youngsters with little life Norman Lamb MP and Dr Suyog Dhakras Pamela Walters with former football captain Tony Adams experience into a ‘work hard, play hard’ lifestyle that many can’t cope with. They also become targeted because of their of the Child and Adolescent Faculty. Last premature wealth by predatory marketing year, just over half the CAP specialist from gambling companies. Revitalising child and training programmes were fi lled. Why we need national action: Part of the responsibility lies with the The number of child and adolescent football industry itself, with 95% of breaks psychiatrists at all grades has been in football matches featuring at least one falling steadily for years, with some areas Football and gambling gambling advertisement. Add to that a high- adolescent psychiatry struggling to recruit any. tension life in which fi tness is paramount Now, hopefully the tide is beginning to Pamela Walters − Addictions Advisor to the RCPsych Sports and all is focused on 90 minutes before the turn. At a recent College event, Norman fans on match day. The prevailing culture Can an innovative run-through pilot help end the recruitment Lamb MP, mental health campaigner and and Exercise special interest group − on sport’s role in gaining sends many young athletes straight onto crisis in child and adolescent psychiatry? former Liberal Democrat spokesperson treatment equality. their smart phones afterwards, where on health, paid tribute to the efforts of the fortunes are lost on the team bus home at College's Child and Adolescent Faculty. the mere click of an icon. “I’m so grateful to all of you; we Positive steps have been taken since desperately need bright and capable 2013, including the establishment by the young people to choose psychiatry. Professional Footballers’ Association (PFA) “ hen we launched We know that 50% of mental health ootballers have become of a 24-hour helpline, and a network of 26 a scheme to allow “I would say to anyone conditions manifest by the age of 14, national idols, epitomising youth, counsellors nationally. Former England mental health interested in helping and 75% by the age of 18. Children and fi tness and glamour, but the football captain Tony Adams also runs trainees to specialise shape children and young people’s mental health care needs very qualities that propel them Sporting Chance − a charity to provide a in child and young people’s lives – the workforce to help provide urgent help.” to the top of the Premier League specialist addiction and recovery facility for adolescentW psychiatry from day one of The pilot is set to run for three years and, Fcan contribute to their vulnerability to athletes. However, we need a change in their ST1 training right through to ST6, it choose child psychiatry” if it fulfi ls its current promise, it is hoped developing a serious gambling addiction. culture towards gambling. was a shot in the dark,” says Dr Suyog that Health Education England (HEE) will Online gambling among the UK’s Parity of care is not given to people with Dhakras, consultant child and adolescent roll the scheme out across England. footballing elite is now a greater problem a gambling addiction compared with psychiatrist at Southampton, and chair Dr Dubicka believes the scheme will help than alcohol addiction and it destroys alcohol or substance misuse. That needs of the Child and Adolescent Psychiatry to attract the next generation of child lives. I believe we need a national to change. It sends out a message that (CAP) Specialty Advisory Committee. trainees on the pilot and is currently in psychiatrists. screening programme to identify those gambling is not a serious problem. “But it’s had an incredibly positive start her ST1 year at the Woodlands Hospital “This is an exciting time for our most at risk at the point when they and has fi red up the imaginations of in Ipswich. profession,” adds Dr Dubicka. “With enter footballing academies, rather than medical students who are fl ocking to join “I knew I wanted to be a child and all the recent focus on CAMHS, we waiting for a gambling habit to spiral, with Michael Bennett, Head of Player the new CAP run-through programme.” adolescent psychiatrist right from the start have a real opportunity to shape the catastrophic costs to them and to those Welfare for the PFA, said: The scheme was launched as a pilot in of medical school,” she says. “It’s exciting agenda, including the research agenda. around them. August in the North West, Yorkshire and to be able to get straight on with it.” There are a lot of stimulating research I was fi rst alerted to the severity of “We provide services to more London regions. Next year she’ll spend half the year on opportunities for trainees across gambling addiction when I dealt with a than 600 individuals this year… Dr Dhakras recalls: “We were a pediatric placement and the other half many fi elds, from neuroscience and patient in prison, reduced to the lowest of Pamela Walters, addiction advisor to the RCPsych including those considering their overwhelmed at the enthusiasm from in CAP. “I’m really excited about this the developing brain to psychosocial the low having embezzled funds to feed relationship with gambling. With medical students with 90 applications for whole-person approach,” she says, “it will research, including improving his need to gamble. Even then, he could is a good place to start tackling this regards to screening tools, we the original seven places. We were able be really good to hear from pediatricians interventions and better understanding not get access to help for his addiction. inequality, because this problem is more do monitor developments in this to respond to the demand by increasing about dealing with families and working risk and resilience. I would say to I feel a huge responsibility to raise the than three times more common among area; however, we are focused on the number of places to 11, but it’s still through really complex diagnoses.” anyone interested in helping shape profi le of this problem. players (6.1%) than in the UK population a universal approach and creating highly competitive.” All this could not have come soon children and young people’s lives – People with a gambling addiction are (1.9%) and more than 7.5 times more quality, confi dential treatment Dr Anna Eaton is one of the pioneer enough for Dr Bernadka Dubicka, chair choose child psychiatry.” simply not getting a look-in and football frequent in males than females. pathways.”

#RCPsychInsight #RCPsychInsight 16 17 NEWS FEATURE

is not only strongly associated with for genetic and infl ammatory biomarkers that psychiatry has worked. Everybody depression but can cause it. Bullmore in their blood that are likely to make them with depression tends to get offered the cites a 2014 study of 15,000 children in more responsive to treatment. “We’re same few treatment options. We don’t Bristol and the south-west of England using MRI imaging in the trial to try to help have any particularly precise way of using that found that children at the age of nine, us understand a little bit more about how biomarkers or blood tests, or have any who had mild infl ammation but were not the drug works,” Bullmore explains. “If other kind of predictive tool to determine depressed, were signifi cantly more likely it does work as an anti-depressant, the which of the patients we see are most to be depressed 10 years later. imaging data may help us explain how likely to respond to which treatment.” There is still much work to be done that happens.” Bullmore’s revolution is not confi ned to pin down the precise mechanism Even if the trial is successful, it is unlikely to depression. As more becomes by which bodily infl ammation causes that new anti-depressants would be widely known about how bodily infl ammation depression, but the outlines are clear. The available for some years to come. And any affects mental functioning, there may infl ammatory process is usually triggered new treatments that do emerge won’t work be benefi ts for the treatment of other by infection or injury. The response is for everyone. “It’s important to emphasise mental disorders: Alzheimer’s disease rapid and overwhelming. Proteins known that this is unlikely to produce a panacea,” and schizophrenia, for example, both as cytokines fl ood into the bloodstream, Bullmore says. Cavanagh agrees: ”I don’t of which seem to have an infl ammatory putting the entire system on a war footing. think infl ammation can explain all of the component. White blood cells pile into the affected biology of depression,” he says, “because Bullmore looks to a future where area, destroying foreign bodies, such as depression is deeply heterogeneous. But depressed people are offered “a more Professor Ed Bullmore bacteria or viruses, before they can spread if I were to speculate, then those people integrated, holistic assessment of their any further. The immune system hits hard who have shown resistance to currently mental and physical health, as if each of and, in so doing, causes what Ed Bullmore available treatments might benefi t along them was being treated individually as one calls ‘collateral damage’ to surrounding with those who have depression in the patient, not two”. He sees doctors working healthy tissues. In most cases, the damage context of infl ammatory disease.” across the disciplines of medicine and is repaired once the crisis is over. But if The use of blood tests to detect cytokines psychiatry. And he hopes that as we start “ e are on the cusp of a infl ammation is chronic, serious damage and other infl ammatory biomarkers is a to see that mental illness is not just in the revolution,” declares may result. major departure from current psychiatric mind, the stigma attached to it will fade. Ed Bullmore, Professor It used to be thought that the brain was practice. “That’s a very routine way of “I might be wrong,” Bullmore says of his of psychiatry at unaffected by infl ammation in the rest of the working in most areas of medicine,” anticipated revolution. “But I think it has The infl ammation body. But it is now known that cytokines in Bullmore says, “but it’s not at all the way already begun.” Cambridge University, Wat the close of his book, The Infl amed the blood can trigger infl ammation in the Mind. If he is right, it is a revolution that brain. And when that happens, nerve cells will change the ways in which we think could be damaged and neural networks about, diagnose and treat depression and, revolution disrupted, thereby causing mental disorder. potentially, other mental disorders, such But why should infl ammation be present as Alzheimer’s disease. And the changes in people without obvious infection or an will be revolutionary, Professor Bullmore Does the body’s immune system hold the key to infl ammatory disease such as RA? “That’s contends, because we have been looking the development of new and more e ective the crucial question,” says Jonathan at depression in the wrong way and in the antidepressants? Is a blood test for depression on the Cavanagh, Professor of psychiatry at wrong place. Glasgow University. And his response very The central theme of The Infl amed Mind, cards? Professors Ed Bullmore from Cambridge and much chimes with Ed Bullmore’s thinking: which was published in April, is the need Jonathan Cavanagh in Glasgow think so. early-life stress. “There are some data that to move on “from the old polarised view of suggest that a harsh or adverse early life depression as being all in the mind, brain, can set a person on a trajectory to a more or body, to see depression instead as a infl amed internal environment,” Cavanagh response of the whole organism or human says, “which, if you like, primes you for self to the challenges of survival in a hostile concerns: “Depressed? Well, you would infl amed responsiveness and leads to world”. “Everybody with be, wouldn’t you?” In other words, Mrs higher levels of infl ammatory cells in the What set him on the long road to this depression tends to get P’s depression was entirely caused by peripheral system than might be present in conclusion was an encounter with Mrs P, offered the same few the way she thought about her RA, not in a healthy person.” a woman with longstanding rheumatoid any way by the disease itself. Professors Bullmore and Cavanagh are arthritis (RA) whom he met in 1989 while treatment options” At about this time, several papers were about to collaborate on a phase II trial, still in medical training. He quickly saw published that posited an association funded by the Wellcome Trust, to test that Mrs P not only had RA but was also between infl ammation and depression. In an anti-infl ammatory drug on a group of depressed. He mentioned this to his the past fi ve years or so, study after study people with depression. Trial participants senior physician, who airily dismissed his has provided evidence that infl ammation will be selected by fi rst being screened Professor Jonathan Cavanagh

#RCPsychInsight #RCPsychInsight 18 19 BRIGHT IDEAS

f 1,500 admissions for bipolar disorder over a three-year period, two thirds were readmissions and approximately 150 people Owere admitted more than once a year. These stats represent not just a fi nancial burden to the trust, but an awful lot of human suffering. That’s according to a preliminary audit of South London and Maudsley NHS Foundation (SLaM). Inspired by a specialist bipolar disorder service in Denmark, SLaM offers people with recurrent admissions for bipolar episodes a focused care programme. The aim is to build on their recovery and Dr Karine Macritchie to reduce the risk of relapse. In 2015, it launched the OPTIMA Core Programme − an innovative schedule of effective medication and self-management. “Manic episodes often bring an aftermath New programme cuts of distressing memories, relationship diffi culties, fi nancial losses and problems with work. There is also a signifi cant risk of readmissions for patients a manic recurrence or the emergence of depression. The person recovering from a bipolar episode faces an uphill struggle, with bipolar disorder rebuilding their life when they feel most depleted,” says Dr Karine Macritchie, Consultant Psychiatrist in Affective An audit of the OPTIMA programme shows promise for Disorders, at SLaM. e ective treatment for those frequently admitted with bipolar. “People with bipolar disorder were poorly served by government-led initiatives in the Could it be rolled out further? past,” explains Dr Macritchie. “The failure to address bipolar disorder in the National Service Framework (Department of Health, 1999) had far-reaching implications for resources, services and patient “There was a focus on Dr Macritchie. “But early results show it’s management. There was a focus a vital time to progress treatment and to on service development for schizophrenia service development prevent recovery loss, episode recurrence and depression, but bipolar disorder for schizophrenia and and re-admission. People who have missed out.” depression, but bipolar experienced several bipolar episodes SLaM’s OPTIMA programme in quick succession can be given more provides regular psychiatric review, disorder missed out” frequent support at a time when they need nursing, occupational therapy, and it the most.” psychoeducation. Participants can talk OPTIMA currently runs in three London about their experiences, identify episode boroughs, but Dr Macritchie hopes triggers, discuss medication, and develop the approach will roll out more widely. individually tailored self-management She urges the College to raise public strategies. The work can include stress service for bipolar during my time of crisis awareness of the nature of bipolar reduction techniques, the establishment of has been a godsend.” disorder, its severe impact on people’s a work−life balance and support in dealing An early audit shows that average monthly lives, and the high risk of suicide. with the impact of bipolar disorder on admission rates following participation fell However, her message is a hopeful one. important relationships. by 80%. Much can be done to help people with The view from patients has been positive; “The period immediately following bipolar disorder regain control in their lives. one said: “I was struggling to exist but now hospital admission for bipolar depression OPTIMA shows what can be achieved I’m a functioning adult once more.” Another or mania is often a vulnerable one for when a fl exible, responsive service is said: ‘‘Being able to access a dedicated people struggling with this illness,” says supplied in a timely and targeted way.

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