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questionable. To borrow from Burns adequate conclusions being formed. What which limits the external validity of the 2000), how do they know that any of is needed is a well-defined model with research. these features are necessary or make a tightly defined components followed by columns difference? The so-called `model' has not extensive testing of model fidelity. What BURNS,T. 2000) Psychiatric home treatment. BMJ, been adequately defined. At present, the the authors are reporting on here is the 321,177. terminology of crisis intervention, or characteristics of those who were home treatment as it is otherwise known, selected for their particular hybrid version Andrew Sandor, Lecturer in Social and is inadequate and confusing and prevents of home treatment and day hospital, Community Psychiatry

the college Thirtieth Annual Meeting July 2001

The Thirtieth Annual Meeting of the been elected as Chairman of the West Politics College, held jointly with the World Midlands Division, and Dr H. Thorley as Psychiatric Association WPA), was held at Secretary of that Division. This had been the year of the National the Queen Elizabeth II Conference Centre, London, from 9^13July 2001. Service Frameworks in England for Adults New Chairmen/Secretaries of Working Age, Older People and, thanks of Faculties and Sections to effective and shrewd College lobbying, Business Meeting Dr S. Bailey had been elected as Chairman for Children. It had also been the year of the Faculty of Child and Adolescent when we had begun to face up to the The Business Meeting of the Royal College Psychiatry. Dr T. Zigmond had been issues of devolution and the new roles of of Psychiatrists was held on Wednesday, elected as Chairman of the Faculty of the Welsh, Scottish and Irish Divisions as 11 July and was Chaired by the President General and Community Psychiatry. well as the future responsibilities of John Cox. It was attended by 109 Dr G. Lloyd had been elected as Chairman College officers within these new political members of the College. of the Section of Liaison Psychiatry. contexts. As Professor Cox wrote in The Minutes of the previous meeting Dr S. Davenport had been elected as `Corridors of Power?' 2001), much of his held in Edinburgh on 5 July 2000 were Chairman of the Section of Social and time was rightly devoted to the public approved and signed. Rehabilitation Psychiatry, and Dr F. Winton education of governments and to The formal Report of the Treasurer and as Secretary of that Section. lobbying on behalf of psychiatrists and a summarised version of the Annual other mental health professionals ^ and Accounts for 2000 were received and fundamentally on behalf of our patients approved. The re-appointment of the President's Report and carers. Never before in his experience auditors was approved. The new fees and had mental health services achieved such subscription rates from 1 January 2002 Introduction a priority within the public policy and were approved. financial commitment of governments, The Registrar reported the followingnew The President reported that it had been and within a specific context of restoring appointments and results from elections. a challenge to know how to focus his and rescuing the NHS. President's Report at the Annual General He believed these `corridors of power' Honorary Officers Meeting AGM) of the College, particu- had indeed been traversed by himself The new Honorary Librarian was Dr D. Tait. larly in a year that had included the and other officers to good effect; such thirtieth anniversary of the College; the diplomacy and advocacy was undoubtedly celebration of a new millennium; `2001: an art that, like a musical performance, Members of Council A Mind Odyssey - Journey into New required rehearsal, good timing, risk Dr R. Ramsay, a Member, had been Therapeutic Space'; and a year in which taking and a healthy recognition that it elected to the membership of College the pace of change within the medical was, at the end of the day, only the art Council. Dr R. Jenkins and Professor profession and in the renegotiation of the of the possible. R. Murray, Fellows, had been elected to boundaries with governments and the It was, however, a totally new and the membership of College Council. public had been breathtaking. All was welcome situation for Government to changing and all had changed. Yet the appoint a National Director of Mental Members of the Court of Electors College, which had had to look inwards Health who was a psychiatrist, but could Dr D. Bhugra, Dr S. Kraemer, Professor and outwards had, the President believed, have been a nurse or psychologist. This H. Lacey, Dr C. E. Rowe and Dr P. R. renewed its core commitment to its core individual needed the College to fulfil Snowden had been elected to the Court tasks ^ standard setting, training and the public goals of implementing the of Electors. education, research and public education. Government's policies in England, and Professor Cox's report would therefore must therefore work with an elected New Chairmen/Secretaries sample those activities that he wished to President of a Medical Royal College. of Divisions communicate at this point to College Informal contacts with Senior Civil Dr C. Halpin had been elected as members, and which should be placed Servants and indeed with Ministers had Chairman of the Irish Division. Dr D. Coia within the full account of College activities been numerous, and would continue, had been elected as Chairman of the contained in its `new look'Annual Review, Professor Cox hoped, with the new-look Scottish Division. Dr D. McGovern had now published in December. Government.

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Formallinks were also crucially important. year that had particularly preoccupied him and Professor Cox believed we had now The College had now established a twice as he endeavoured to fulfil the full-time left behind our more isolated offshore columns yearly Committee with the Department of responsibilities of his office. He reported islands image, as we engaged, perhaps Health, the Home Office and the Prison this as being a job that was mostly enjoy- at some cost, with colleagues and other Health Service Chaired alternately by the able, was appropriately hard work and yet mental health professionals working President and Professor Louis Appleby ^ thoroughly backed up by a most able team across the world in developed and devel- and most Faculties had observers from of officers whose skills and styles comple- oping countries. During the year the the Department of Health on their Execu- mented each other, as well as by over 100 President had attended, for example, tive Committees. Professor Cox was College staff led by Vanessa Cameron) meetings of the Pakistan, Brazilian, Turkish himself a Member of the Mental Health who remained deeply committed to and American Psychiatric Associations, Taskforce and the Workforce Action Team. providing management and administrative several of these being Joint Meetings with Democracy may be cumbersome but support ^ without which there would be the WPA. The President was glad to once opinion became clarified, then no time to think, write or travel. announce that Professor Hamid Ghodse, Government plans for new mental health a Vice-President of the College, had been legislation, for example, could be delayed, appointed as the new Director of the modified and conceivably `binned'. Adult psychiatry Board for International Affairs. Vindication indeed for the College's In the past year the agenda set by the The second report was by a Working strategy endorsed by Council, led by College and by the Government had been Party that the President Chaired on the Registrar Dr Mike Shooter, and sus- close to Professor Cox's own work as an training and service delivery issues for tained by the opinions from members as adult psychiatrist with a special interest in Black and ethnic minorities Royal College expressed through Divisions and Faculties. transcultural and perinatal psychiatry. As of Psychiatrists, 2001c). This Working The College had therefore now estab- the first Chairman of the then Section of Party made 10 striking recommendations, lished good formal and informal links with General Psychiatry, he was pleased that all of which had been endorsed by the Department of Health in London, this Section had now become an Adult Council. They were far reaching and the which had characterised for some time Psychiatry Faculty. Council Reports on commitment of the College was persis- this political interface in Scotland. What community psychiatry Chaired by Profes- tent. They related to training in cultural was certainly lacking at the present time sors Burns Royal College of Psychiatrists, competence, rooting out individual dis- was a similar advisory structure for the 2001a) and Thornicroft, together with the crimination and racism, and inviting an Government in the Republic of Ireland. Faculty's Report Roles and Responsibilities external body to review our procedures The President concurred with the view of a Consultant in Adult Psychiatry Royal and structures to determine the extent to that these years were providing a `last College of Psychiatrists, 2001b) had at which institutional discrimination was pres- chance' for the values of the NHS. The re- long last begun to re-establish this once ent. The new Ethnic Issues Committee would election of a government that, having en- pristine speciality and this development be Chaired by a Sub-Dean, Dr Parimala couraged the`bashing'ofdoctors, was now was for the good for all other specialities Moodley and was currently advertising in signingupto anew concordat and recog- ^ boundary disputes included! the Psychiatric Bulletin for committee mem- nisingperhaps that, unlessrecruitment and bers. This could be seen as a key example retention of doctors ingeneraland psychia- of the College setting its own agenda. trists in particular improved, delivering the Learning disability The President reported that other NHS mental health policies and being re- notable reports during the year had elected) became less likely outcomes. Consultants in learning disability and their included an authoritative report on The College was therefore urging the Faculty Executive had described in their research with human subjects from UK Government and the NHS to maintain survey that they appeared to have a working party Chaired by Professor Sir mental health as a core priority and had discovered the secret of how to maintain Michael Rutter Royal College of Psychia- welcomed the additional resources. So morale even when there were staff and trists Working Party, 2001), and that of far, most new monies had gone to the resource shortages. Other Faculties may Dr Margaret Oates 2000), on Provision of Government's preoccupation with safety have something to learn in this regard. Perinatal Mental Health Services. Council and public risk, and sadly into changing The President was hopeful that the new was reviewing the roles of the Research our secure hospitals into institutions more Consultant's Charter would capture some Committee, and the Joint Report by the like category B prisons ^ razor wire on of the core components of what being a College, College of Physicians and British the walls of Broadmoor included. Other consultant psychiatrist really was, how to Medical Association BMA) Mental Illness: monies had not been ring-fenced and so delegate and to recreate team work that Stigmatisation and Discrimination within never arrived at a local target. could enhance motivation, interest and the Medical Profession Royal College of The College had offered to help the altruism. Psychiatrists et al, 2001) was likely to Government to track these lost monies, ignite the Changing Minds Campaign. and to develop systems to ring-fence monies so that they impacted locally. Working parties In the Autumn, the College would Members of the College working in publish a consultation paper reviewing the local implementation teams, and those During the year, two major working Faculties, Sections and Special Interest Divisions that were intrusive in their links parties established by Council had Group structures that had developed to regional offices could undoubtedly reported with far-reaching recommenda- some organisational anomalies which, exert considerable influence in this regard. tions. The first, on the international when resolved, could unlock yet more Similar structures would need to be in responsibilities of the College, Chaired by creativity within these structures. There place for primary care trusts and the new Professor Cox's predecessor Dr Kendell, was also a constitutional review being strategic health authorities. made powerful recommendations, undertaken by College officers. including establishing a revived Interna- Addiction psychiatry and the need for tional Committee, urging the College to an addiction psychiatrists'paper landed on General issues become better Europeans, to strengthen Ministers' desks, and the debate unlocked the overseas groups, and also to recog- a review of the number and range of Against this political backdrop, the nise the College's historic and wider Specialist Certificates and how to train a President in the remaining sections of his international responsibilities. The College sufficient number of consultants in that Report focused on those aspects of the was indeed an international organisation speciality.

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The College Research Unit, thanks to Colleges. The College would remain as an The College was also arguing stridently Professor Sir David Goldberg and Dr Tim examining and a standard setting body for an increase in SHO posts by at least Kendall, had maintained its place as a and, with a delegated authority from the 25% and, as a member of the SHO columns highly respected research unit promoting Specialist Training Authority and the new Modernisation Board, Professor Cox recog- multi-professional research and yet being Medical Education Standards Board, a nised that this review could be good news able also to influence more directly the certification body. for the mental health training of all doctors. College agenda. So far, the President had reported on Never before had the President seen selected aspects of College activities, many physicians and surgeons being almost of whichwerethefruits ofearlierproductive proactive in their inclusion of mental Court of Electors Presidential reviews and officers'away-days health and mental disorder in their basic curricula. The workforce capping on SHO The Court of Electors ^ the senior that had characterised the past decade. numbers in other specialities facilitated Education Committee of the College ^ These activities, whenconsideredalongside recruitment of young psychiatrists and of Chaired by Professor Cox, had been amembershipthatnowexceeded10 000, general practitioners. equally hardworking and bold in its inno- the largest number of MRCPsych Part II vations. It had agreed to proceed with a candidates ever 429) and a financial Diploma in General Psychiatry based on situation steered by Dr Fiona Subotsky the Part I MRCPsych examination; agreed that had allowed risks to be taken for Medical regulation example the refurbished high-tech Warren a new MRCPsych curriculum and changes The President wished to conclude his to the examination based fairly and Suite, the Mind Odyssey, and this joint Report by reviewing some of the squarely on sound educational principles. meeting with the WPA) would all suggest persisting and specific challenges that we that the College was very much alive ^ Within the context of the high-speed also faced at the present time within the and kicking ^ and forward-looking. senior house officer SHO) Modernisation field of medical regulation. Undoubtedly Task Force, the College's examination there were opportunities as well as fortunately continued to assess the threats. Yet, if we remained true to our learning taking place at the end of SHO Recruitment and retention core purposes of standard setting, training. The Dean, Chief Examiner and education and training, public education their teams had worked well within the Yet there was, of course, a down side. The and research then, he believed, because new Committee structures set up some President noted that we continued to of the good standing of the College and years ago, and Professor Cox acknow- face major problems of recruitment and the strength derived from almost all ledged fully the extent and importance retention that, in a climate of opinion only psychiatrists being members of the of that work with its implicit standard- slowly changing from a blame to a College, that the present was also a rich setting and innovation. The Dean, learning culture, continued to sap the opportunity. having established peer review as a morale of mental health professionals to Any threats to the power and influence core component of continuing profes- the extent that his overall optimism over a of Colleges was also an opportunity. sional development CPD) had now 5- to 10-year period had to be tempered One could construe the new Medical stood down as Director of CPD, and because of this specific issue. Indeed, Education Standards Board, the workforce was replaced by Dr Joe Bouch. The Professor Cox had never before heard, in confederations, the National Clinical President felt that the Dean deserved the 15 years since he first worked in Assessment Authority, powers of our thanks for steering this particular Belgrave Square, the issue of recruitment Commission for Health Improvement and ship ^ in addition to directing other and retention achieving such a priority National Institute for Clinical Excellence educational matters. and prominence in College committees. NICE) as threats. They were only threats A Revalidation and Performance He had Chaired a Department of Health if we ceased to maintain our core tasks, Committee was established during the committee on this subject, which made or brought ourselves regularly into disre- year under the Chairmanship of the strident recommendations contained pute. The College would remain a body Senior Vice-President, Dr Sheila Mann. within the Workforce Action Team Report independent of governments, yet able to Vice-Presidents were now no longer ^ now with Ministers. College officers collaborate and constructively debate unclear as to their responsibilities ^ both had themselves reviewed recruitment and when it was for the good of our patients. now Chaired key committees! Dr Mann retention options, supported by Dr Sally In the President's judgement, the more brought to bear her authority both as a Pidd. These had ranged from roadshows external bodies, the more lay involvement, member of the General Medical Council for medical students and combating the more Department of Health officials GMC) and former Chief Examiner, and stigma in medical schools to tracing the who wished to scrutinise our work, the Professor Cox acknowledged fully her so-called `lost SHOs'. Sixteen per cent of better. We had nothing to hide and every- support to himself and, as important, her flexible trainees who got onto the thing to be proud about; the front door coordination of the crucial standard Specialist Register did not immediately of the College must remain wide open. setting, audit, revalidation and appraisal take up consultant posts ^ another exit There was, however, a risk that the mechanisms. She, together with the poll had therefore to be undertaken. Academy of Medical Royal Colleges would Dean and others, produced the much- The Joint Workforce Committee with become weakened, and that the lack of respected publication Good Psychiatric the Department of Health was a good concordat with Government and the Practice Royal College of Psychiatrists, example of collaboration at its best, the public would mean that if other older 2000). That the College had now been end result being more influential work- Colleges sunk, then we would sink with asked by the GMC to do yet more work force projections to the Workforce them. Politicians were sensitive to votes on unacceptable practice, to produce Numbers Board; 12% of consultant posts and voters - and the media - and in 4 guidelines for revalidation and to consider in England and Wales remained unfilled, years' time would be even more so. being involved with the revalidation yet 120 more consultants were now However, the structures presently in process for unusual groups of doctors in post. The 95 new national training place - including new governance of the e.g. those taking career breaks, non- numbers NTNs) in general adult GMC, annual appraisal underpinning clinicians, doctors working in non- psychiatry and a further 85 NTNs in old revalidation, the Academy led by a full- managed institutions and Presidents of age psychiatry were much to be time Chairman more influential than ever, Royal Colleges), was a measure of the welcomed ^ and the budgets would CollegeCPDhighuptheagenda,aGovern- new concordat between the GMC and the now be held by Postgraduate Deans. ment that was prepared to listen and work

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with the College and our increased cred- than was at present the norm. CPD, the ö, ROYAL COLLEGE OF PHYSICIANS OF LONDON & ibility with the public and patients - intellectual excitement of discovering new BRITISH MEDICAL ASSOCIATION 2001) Mental should all enable the storms that would things, including why things went wrong, Illness: Stigmatisation and Discrimination within the columns Medical Profession. Council Report CR91. London: blow following the Bristol Inquiry not to having responsibility with power and the Royal College of Psychiatrists, Royal College of become a destructive hurricane. ability to own and influence a budget Physicians of London & BMA. could restore the self-confidence of well- trained consultant psychiatrists. ROYAL COLLEGE OF PSYCHIATRISTS WORKING PARTY Users and carers groups As he entered his third and final year as 2001) Guidelines for Researchers and for Research Ethics Committees on Psychiatric Research Involving President, Professor Cox concluded by During the year, the President had Human Participants. Council Report CR82. London: thanking members for their support and Chaired a Black/White User Committee. Gaskell. thanking Keele University and Combined Initially they had met in a somewhat Healthcare NHS Trust for `seconding' him clandestine manner in the basement of to the post. the College; however, 2 weeks ago, the He also expressed his thanks to his work of this group had achieved such Treasurer's report wife, Karin, and to his three daughters, prominence that we were on the search who had seen them through some The Treasurer presented a brief report, as for more leaders of Black User Groups unexpected severe health problems, members had already received a copy of and this Working Group would, in future, which had placed them on the receiving her formal Report, together with a sum- be accountable to the new Ethnic Issues end of the NHS, and their resultant mary of the accounts. Both had already Committee. This development was poten- recognition of the benefits of skilled been approved by the Executive and Fin- tially of the utmost importance as tertiary, secondary and primary care ance Committee, Council and the auditors. patients from Black and ethnic minorities services. The learning curve was steep; The Treasurer reported that the were disadvantaged by a perceived gulf the suffering real and yet the care and College's largest source of income came between their needs and the mental cure miraculous. from members' subscriptions, so it was a health services that were available. The Professor Cox suspected that by the cause of satisfaction that the membership Patients and Carers Committee, now a end of the AGM on Friday, and certainly had increased to over 10 000. However, in Special Committee of Council, would by Saturday, the College staff would 2000 there was a less good climate for therefore become increasingly influential; need and deserve a holiday, and that investment and for fundraising and, as a why should they not contribute to the the College as well as the WPA would result, the surplus was less than for the Court of Electors and to the Education by then have changed a little for the previous year. None the less, many and Examination Committees of the benefit of our patients and for the good worthwhile activities and developments College? of all. had been supported, in line with the Certainly, the boundaries between the The Winged Cross, the Egyptian Ankh, College's charitable objectives. Next Government and the medical professional as a symbol of Hope on the College crest year, more equitable tiered subscription were being redefined. Colleges who had was surely an imaginative act of heraldry. rates would be introduced for overseas jealously guarded their independence now When 30 years ago the Royal Medico- members and for those with reduced had to accept much greater accountability Psychological Association became the incomes for reasons such as taking to Parliament and the public. The Presi- Royal College of Psychiatrists, wisely the maternity leave or working part-time. dent noted that, as psychiatrists, we motto Let Wisdom Guide was chosen, The Treasurer stated that she aimed knew that seeming opposites were the wisdom being defined as an ``ability to to make the College's income and energy for creative endeavour, and that think and act utilising knowledge, experi- expenditure as transparent as possible, threats were spurs to action for wider ence and understanding, common-sense which she hoped would be helpful to links with other professionals, govern- and insight''. members. ments and user groups. Such wisdom was therefore both a Finally, in response to a question Professor Cox said that we had known, science and an art: it was a mind odyssey. concerning the surplus made by the or should have known, from Maxwell Professor Cox hoped his report had Examinations Department, the Treasurer Jones et al all about user involvement, shown that wisdom in its fullest sense confirmed that this was a very well run multi-professional training and compre- nurtured by his predecessors was still Department, which set budgets with hensive care planning ^ but we had not present in the here and now, and would, appropriate prudence, but which could had the resources and the back-up to he was sure, follow us into the next not be certain in advance of numbers of deliver what we knew to be better College year ^ and beyond. applicants. However, if as last year) a management. The roles of consultant modest surplus was made, the College psychiatrists, including those with References was discussing with the trainees how psychotherapy training, within multi- this could be used to benefit both the disciplinary teams needed to be clarified. COX, J. 2001) Corridors of power? College News, 12, examination system in general and the Medical psychotherapists were central to 1^2. trainees themselves. the culture of our profession. OATES, M. 2000) Perinatal Maternal Mental Health Services. Council Report CR88. London: Royal College of Psychiatrists. Resolution Conclusion ROYAL COLLEGE OF PSYCHIATRISTS 2000) Good The following resolution was proposed by Psychiatric Practice. Council Report CR83. London: The President said that his Report Professor Robin Jacoby and seconded by Royal College of Psychiatrists. reflected his own opinions and his hopeful Dr James Birley: ``Bearing in mind the belief that those who worked in the ö2001a) Community Care. Council Report CR86. available evidence that political dissidents mental health field in 5 years' time ^ and London: Royal College of Psychiatrists. in The People's Republic of China PRC) perhaps sooner ^ would see substantial ö2001b) Roles and Responsibilities of a Consultant are being systematically detained in improvements in recruitment and reten- in Adult Psychiatry. Council Report CR94. London: psychiatric hospitals, we propose that the tion and in working conditions, including Royal College of Psychiatrists in press). Royal College of Psychiatrists takes the the appalling state of the acute in-patient ö2001c) Report of the Ethnic Issues Project Group. following action: 1) to join with the WPA wards. We might then gradually see a Council Report CR92. London: Royal College of to arrange a fact-finding visit to the PRC; return to much greater job satisfaction Psychiatrists in press). and 2) if this visit and other evidence

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