Minutes of the Meeting of the Special Committee on Professional Practice & Ethics Held

Minutes of the meeting of the Special Committee on Professional Practice & Ethics held at 11.00am on Thursday 11 October 2012 at the Royal College of Psychiatrists.

1. Present

Prof Susan Benbow (In the Chair), Ms Claire Churchill (Minutes), Ms Jo Cresswell (guest joined the meeting at 1.30pm), Dr Chris Freeman, Uhla Htay, Dr Julian Hughes, Dr Mike Kingham, Dr Gordana Milavic, Dr Pranveer Singh and Dr John Watts.

2. Apologies for absence

Apologies were received from Dr Denise Cope, Dr Susan Welsh, Dr Gwen Adshead, Dr Karl Scheeres, Dr Alan Mclead, Dr Ananta Dave and Dr Ashok Roy.

3. Approval of minutes from 11th July 2012

The minutes from the last meeting were approved, apart from one amendment: the Psychiatric Liaison Accreditation Network was approved at the last meeting by Dr Julian Hughes and this needed to be added in.

4. Matters Arising

4.1 Development of the work plan

The updated work plan for the SCPPE was circulated to the group. It was asked that the task of producing a paper on the ethics of commissioning should be amended to state that Dr Ananta Dave and Dr Ashok Roy were the lead authors.

4.2 Contact with service users forum

Dr Susan Benbow had recently had an email exchange with Thomas Kennedy about the forthcoming Service Users Recovery Forum meeting, which will be held on the 4 December. SB would attend to discuss how Service users and carers could input into issues surrounding confidentiality, ethics and professional practice and the wider work of the SCPPE. It was commented that there would be new members of SURF from the end of December.

Action: For SB to give an update on this at the next SCPPE meeting in January.

Special Committee for Professional Practice & Ethics Minutes Thurs 11th Oct 2012 Page 1 of 7 Registered office: 17 Belgrave Square, London, SW1X 8PG, UK Tel: +44 (0)20 7235 2351 Fax: +44 (0)20 7245 1231 www.rcpsych.ac.uk Charity registration number: 228636 NO HEALTH WITHOUT MENTAL HEALTH 5. Standing items

5.1 Ethics Update

5.1.1 Imaging and incidental findings

It was discussed whether the statement on this could be placed on the website and following on from that a paragraph about the work could be placed in the e-newsletter.

The report on this was startling, with a high rate of incidental findings in lifestyle scanning.

It was thought it needed to be examined how the original report on this had been disseminated.

Action:  For members to have 2 weeks to comment on this statement.  For the statement to then be posted on the website and for a paragraph to be placed in the e-newsletter.

5.1.2 Use of interpreters in psychotherapy

This was a recent query, which was asking what the role of interpreters was in general psychiatry. A response had been given. The Committee was asked whether this should be posted on our webpages and this was agreed.

Action:  For Dr Chris Freeman to add references and recirculate to the Committee.  For the document to be posted on the website.

5.1.3 Code of ethics

Chris Freeman tabled a paper on a proposed Code of Ethics (CoE) for the College and proposed that the Committee should base a CoE on the Royal Australian and New Zealand Code, which consists of 11 principles.

It was agreed that each Committee member should take one principle and write a paragraph of around two to three hundred words about it.

Dr Julian Hughes would produce an additional section on the ethical context, which would go before the principles. An additional point is that perhaps it should include a system for patients to give feedback/ complain.

The aim is that by the end of the year the Code of Ethics will be drafted and this could be sent to the Policy Committee in early 2013.

Action: For CC to divide up each section of the ethical code and then for a paragraph to be written of around 200-300 words by the respective member.

5.1.4 Workshops at the International Congress 2013

Workshop proposals have been submitted for two half days at the International Congress. One session would be on boundary violations. Dr Gwen Adshead had also sent in some further submissions. Special Committee for Professional Practice & Ethics Minutes Thurs 11th Oct 2012 Page 2 of 7 Registered office: 17 Belgrave Square, London, SW1X 8PG, UK Tel: +44 (0)20 7235 2351 Fax: +44 (0)20 7245 1231 www.rcpsych.ac.uk Charity registration number: 228636 NO HEALTH WITHOUT MENTAL HEALTH Dr Chris Freeman had written to Dr Helen Miller about the Kerr Haslem report and what work had been completed by the College since then in regards to training. Unfortunately no response had been given. It was suggested that the correspondence should be resent with Prof Sue Bailey and the CETC being copied in.

Action:  For CC to find out a timeline of when people will be notified about whether their proposals has been accepted for the International Congress.  For CF to resend the correspondence and copy in Prof Sue Bailey and the CETC.

5.1.5 Disclosure of murder during therapy

CF had received a query which focused on the disclosure of murder during therapy. The issue was how this should be dealt with; did the psychiatrist have a duty to disclose, it was thought the psychiatrist did not have a duty to do so. It was suggested that an anonymised discussion with the police could be helpful, but it wasn’t clear whether confidentiality was guaranteed with this.

It was commented that Dr Jessica Yately and Dr Lars Davidson were completing some work on health confidentiality and Dr Mike Kingham would contact them to see what their view was. The comments could then be passed onto Dr Chris Freeman. An interim response had been sent.

Action: For MK to contact Dr Jessica Yately and Dr Lars Davidson.

5.1.6 Ethical dilemmas

Two ethical dilemmas were presented by Uhla Htay, and discussed by the Committee, with viewpoints given as to possible means of action. These scenarios suggested that clinicians were abdicating responsibility in respect of decisions and expecting patients and/ or carers to make inappropriate decisions about their care.

Action: For the issue of responsibility for clinical decision-making to be included in the ethical code.

5.2 Confidentiality update

The e-group for confidentiality was now fully functioning, with all members having tasks to carry out on CR160. Dr John Watts had completed a section on children and young people. The deadline for a draft version to be completed is January 2013. Dr Mike Kingham and Dr Gwen Adshead would take away the draft when all sections had been completed.

One of the new factors to be taken into account of the draft was confidentiality and commissioning. This was something that was also being followed up by Dr Josanne Holloway from the Forensic faculty and Dr Mike Kingham would follow this up after the meeting. It was likely that a whole new chapter needed to be added on commissioning.

Action: For an update on CR160 to be given at the next meeting in January.

Special Committee for Professional Practice & Ethics Minutes Thurs 11th Oct 2012 Page 3 of 7 Registered office: 17 Belgrave Square, London, SW1X 8PG, UK Tel: +44 (0)20 7235 2351 Fax: +44 (0)20 7245 1231 www.rcpsych.ac.uk Charity registration number: 228636 NO HEALTH WITHOUT MENTAL HEALTH 5.2.3 Open disclosure

Since the last meeting, Dr Mike Kingham had emailed Prof Sue Bailey about open disclosure.

5.3 Professional practice update

5.3.1 Update on CR146: Vulnerable patients, safe doctors: good practice in our clinical relationships

The draft version of this report was circulated for information purposes.

Dr Gwen Adshead had contributed a fair amount of work on this and it was suggested that her name should be added to the document.

GM had been in touch with Dr Peter Jarrett and he was happy for his name to remain in the document as an author.

CC was asked to check whether Ashok Roy’s name needed to be included as an author.

It was thought an executive summary should be added, and the introduction could include the key recommendations.

Website links providing useful advice would be added to the reference list.

Dr Mike Kingham would add a section on maintaining privacy and would send this back to GM.

Action:  For all the various changes to be sent back to GM  CC to check authorship  For the draft report to be circulated to the Service Users Forum in December  For CC to finish the references for the document  For the final document to be approved in January

5.3.2 Psychiatrists in difficulties

The work on this dated back to an initial meeting held in February, between various involved organisations. Since then SMB had met with Diana Chan of the Psychiatrists Support Service and had talked over the phone with a College Member who had gone through the NCAS process. The Member’s experience suggested that the National Clinical Assessment Service was not sensitive to the needs of psychiatrists and/or did not have the relevant expertise available. There was also a concern that those psychiatrists who came from outside of the UK, did not gain the support they needed on commencing practice in the NHS, and that the context doctors were working in was not taken into account during the process.

One identified issue is a need to develop mentoring for psychiatrists and the College could have a greater role in providing support to psychiatrists. Awareness of the Psychiatrists Support Service could also perhaps be increased.

It was proposed that the first hour of a meeting in 2013 should be devoted to a discussion about professional practice issues and international medical graduates with Dr Subodh Special Committee for Professional Practice & Ethics Minutes Thurs 11th Oct 2012 Page 4 of 7 Registered office: 17 Belgrave Square, London, SW1X 8PG, UK Tel: +44 (0)20 7235 2351 Fax: +44 (0)20 7245 1231 www.rcpsych.ac.uk Charity registration number: 228636 NO HEALTH WITHOUT MENTAL HEALTH Dave, with a focus on what the College could be doing to help prevent difficulties or to support those having difficulties. Diana Chan the Psychiatrist Support Services and Remediation Manager will also be invited.

Action:  For a session on psychiatrists in difficulties to be held at a future meeting.  CC to check with Dr Dave which meeting he can attend.  CC to invite Diana Chan once a date is fixed with Dr Dave.

6. Current issues

6.1 End of life issues

A discussion document was provided on end of life issues. This has been written due to the rising profile of euthanasia and end of life issues.

It was suggested that the document could be an editorial in Advances in Psychiatric Practice as it was more about the facts of the matter, rather than an opinion piece for psychiatrists.

It was agreed that Dr Susan Welsh should be asked for her view on how to take this piece of work forward.

Action:  It was agreed that comments would be fed back to SW.  For Julian Hughes to liaise with SW regarding the article.

6.2 Doctors and social media

Drs Mike Kingham and Karl Scheeres were producing a document about doctors and social media. A final version would be circulated to the Committee shortly.

6.3 Conflicts of Interest

A paper was tabled on conflicts of interest; it had been suggested that it might be possible to combine it with the paper on the ethics of commissioning. It was agreed that it would be preferable for these to be separate documents.

Action: For members to send any comments on the conflicts of interest paper to SB.

In regards to the Ethics of Commissioning Paper, it was thought that the comments on conflicts of interest should be removed. An introduction was needed for the paper and the context of the paper should be more focused on the issues that psychiatrists should consider. The paper might in effect offer a commentary on ethical issues arising for psychiatrists during the process of commissioning.

Action: For SB to liaise with AD and AR and for SB/AD/AR to contact Dr Neil Deuchar, the Specialist Advisor for commissioning at the College to ask if he would collaborate in developing the paper.

Special Committee for Professional Practice & Ethics Minutes Thurs 11th Oct 2012 Page 5 of 7 Registered office: 17 Belgrave Square, London, SW1X 8PG, UK Tel: +44 (0)20 7235 2351 Fax: +44 (0)20 7245 1231 www.rcpsych.ac.uk Charity registration number: 228636 NO HEALTH WITHOUT MENTAL HEALTH 6.4 CR147 Court report work

It had been agreed at the last meeting, that the CR147 Court report work would be revised and a process would be drawn up as to how this should be produced.

Action: For CC to check with GA and SS about how this was progressing.

6.5 The psychiatrist

Dr Ananta Dave was currently liaising with The Psychiatrist about having sections on ethical issues in the journal, starting with psychiatry and social media It was suggested that an articles could be written on the revision of CR160.

Action: For an update on this to be given at the next meeting in Jan.

7. CCQI accreditation

The Chair welcomed Joanne Cresswell, Senior Programme Manager for AIMS projects.

7.1 Therapeutic Communities Accreditation Panel

Dr Chris Freeman had viewed the documents. He was concerned that the types of places visited and the process for accreditation was not clear. It was agreed that the documents could not be approved at the meeting and that it would be appropriate for a discussion to be held with Sarah Paget.

Action: Following discussions held after the meeting, the documents were approved on behalf of the Committee.

7.2 Psychiatric Liaison Accreditation network

Dr Chris Freeman approved the document on behalf of the Committee.

7.3 Quality network for Inpatient CAMHS

Dr Gordana Milavic approved the document on behalf of the Committee.

7.4 AIMS

7.4.1 Learning disabilities

Dr Ashok Roy approved the document on behalf of the Committee. It was noted that following the meeting, there would be no further accreditation documents for AIMS LD as accreditation would take place through a different network.

7.4.2 PICU

Dr Mike Kingham approved the document on behalf of the Committee.

Special Committee for Professional Practice & Ethics Minutes Thurs 11th Oct 2012 Page 6 of 7 Registered office: 17 Belgrave Square, London, SW1X 8PG, UK Tel: +44 (0)20 7235 2351 Fax: +44 (0)20 7245 1231 www.rcpsych.ac.uk Charity registration number: 228636 NO HEALTH WITHOUT MENTAL HEALTH 7.4.3 Working age adults

Dr Mike Kingham approved the document on behalf of the Committee. It was noted however, that in the locality of the two wards, there was limited access to psychological therapies.

7.4.4 Rehab units

Dr Julian Hughes approved the document on behalf of the Committee.

7.4.5 Older people

Dr Julian Hughes approved the document on behalf of the Committee.

7.5 MSNAP

Dr Susan Benbow approved the document on behalf of the Committee.

7.6 ECTAS

Dr Susan Benbow approved the document on behalf of the Committee.

8. AOB

It was noted that Uhla Htay would leave the Committee at the end of 2012, as his time of office on the Carers Forum was finishing. Uhla would pass on his notes about the Committee to Deborah Hart, so that a new member could receive an induction. Uhla was thanked for his time and help on the Committee.

9. Date and time of next meeting

The Special Committee for Professional Practice and Ethics would next meet at 11.00am- 2.00pm on Thursday 17 January at the Royal College of Psychiatrists, 17 Belgrave Square, London, SW1X 8PG.

Special Committee for Professional Practice & Ethics Minutes Thurs 11th Oct 2012 Page 7 of 7 Registered office: 17 Belgrave Square, London, SW1X 8PG, UK Tel: +44 (0)20 7235 2351 Fax: +44 (0)20 7245 1231 www.rcpsych.ac.uk Charity registration number: 228636 NO HEALTH WITHOUT MENTAL HEALTH