A Birds Eye View
Reflections from the President of the Royal College of Psychiatrists on the latest series of PsychStar blogs
I was glad to be invited to write this blog to conclude this fantastic series of work from our PsychStar participants. I’ve read the blogs with interest, and have found the topics thought-provoking and forward-thinking.
I’ve worked as a psychiatrist for many years, and I specialise in Forensic psychiatry.
I became the President of the Royal College of Psychiatrists in July of this year. The College is the professional and educational body for psychiatrists in the United Kingdom. We work to secure the best outcomes for people with mental illness, learning difficulties and developmental disorders by promoting excellent mental health services, training outstanding psychiatrists, promoting quality and research, setting standards and being the voice of psychiatry.
I want to highlight how important it is to develop support and encourage the leaders of the future, and I think the PsychStar initiative should be commended for doing just that. The students that have been involved to date are incredibly talented, and I hope we can continue to support many more students in the future through this programme. My thanks also go to all of our colleagues who manage the blog and make it possible, and in particular to Professor Carmine Pariante.
When I have psychiatry trainees who work with me, I generally ask them to imagine what people in fifty years will think about our current practices. I ask them to think ahead and try and use this perspective to understand what we should be doing more of and what we should be doing less of, as we have sometimes not been so good at reflecting on our practice.
This series of blogs was indeed reflective, and covered diverse and wide-ranging topics. As I read them, I also reflected on my own four priorities (parity for mental health, equality and diversity, sustainability, and workforce wellbeing) as the president of the College, and thought about how we can move forward in developing our practice and driving changes which will result in better care for people with mental illness. I also reflected on our need, no matter what the topic or specific illness we’re working with, to involve people with lived experience of mental illness every step of the way, and to continue to make strides in achieving genuine collaboration with people with lived experience to help make services better.
I much enjoyed reading the blog about neurology and psychiatry working together, and it was fascinating to reflect on the history of neuropsychiatry and to think about the importance of understanding of both neurology and psychiatry for practitioners of either specialty. It made me think about integration, parity, and the need for those with physical and mental health expertise to work closely together.
There is also the need for integrated specialist care for both physical and mental illness, especially for those with severe mental illness (SMI), who sadly have a 15–20 years shorter life expectancy than the general population, partially due to higher rates of comorbidities such as cardiovascular disease or chronic respiratory illness. If mental and physical health were valued equally, the person-centred care needed would be easier to achieve, and people with SMI would have a more integrated package of support, something the College I lead is currently pressing for.
I have also been working recently on equality issues in mental health, both concerning people with mental illness, and the mental health workforce. 2020 has been an important year for equality issues, with the pandemic and action on racial inequality highlighting the need for change. Equality, diversity and inclusion is one of my four presidential priorities, and the College is working hard to develop a strategy on this, this year. We are looking at inequalities broadly, how they can impact on mental health, and how they can affect people’s access to, experience of, and outcomes from mental health care across the UK.
I was interested to read the two blogs in the series that had a perspective on gender, and outlined how gender stereotypes can impact mental health. One refers both to disparities in how women are cared for when they have mental illness, and how women have experienced challenges in efforts to achieve equality within the healthcare workforce. The other looks at high rates of male suicide, and explores possible contributing factors, including toxic masculinity. It also highlights why we must continue to work hard to tackle stigma around mental health because, although we’ve come a long way, there is still much further to go. We know that big disparities also still exist for those with intellectual disability and autism, and so I was glad to see that intellectual disability was also highlighted through another of the blogs, which explored the history of care for people with intellectual disability, and highlighted the important role of specialist community services, as well as specialist psychiatrists and the need for medical professionals across the board to have understanding and knowledge of intellectual disability.
I enjoyed reading the two articles that focused on children and young people’s mental health, one focusing on how we can improve child and adolescent mental health services (CAMHS) — both in regard to the variable service provision across the country and also with regard to what will undoubtedly be the huge impact of the Covid-19 pandemic on young people’s mental health. The second article spoke to the need to bridge the generation gap between young people and their elders, especially in turbulent times, and focus on the need to encourage fostering a compassionate approach, which is incredibly important in these difficult circumstances. It made me think about one issue I know many of us, and particularly young people of today are worried about, and that’s the climate. Sustainability is another of my four presidential priorities, and we’ve been doing a lot of work at the College to look at sustainability and mental health, including trying to understand how best we can support those who are worried — and particularly young people — about the climate, both now and in the future.
The problem of climate change highlights the need for us to think globally, and reminds us just how interconnected our small planet really is. I was glad to see that the series included a piece looking at mental health care across the globe. It was a stark reminder of the fact that mental illness is a leading cause of disability globally, and that yet, many who would benefit from treatment have no access to the right support. The College has recently developed an international strategy to enable us to work better with our colleagues in other countries, and to work to try to tackle some of these issues as an international community.
We also need to think about innovative new ways of treating patients, and I was intrigued to read the thought-provoking article on using psychedelics to treat drug-resistant depression. This has been a topic that has been on the agenda recently through colleagues who are working hard to research the potential benefits of these new treatments, and I follow the progress with interest. An example of our recent work on pharmacology and depression was our patient-facing leaflet on stopping antidepressants.
The Covid-19 pandemic has also fast-tracked our use of digital and tech to help support patients, and so the article about advancing telepsychiatry comes at a time when this is especially important. It is generally acknowledged that these services are really the future of our healthcare system, and so considering how we can harness their impact and ensure services stay accessible to everyone is very important.
Of course, we as a profession also have our role to play in public health, both specifically and broadly. I agreed with the points set out in the blog that explored the role of a psychiatrist in prevention, and highlighted the need for parity when it comes to prevention as well as care. Reflecting on how we may be able to mobilise better tools to help us identify those who could be at risk of mental illness and act to prevent illness from developing was very thought-provoking and is something we should continue to explore and prioritise.
These blogs delve into some fascinating and specific areas, which of course link to the wider picture. We must also view these issues in light of the broader landscape for psychiatry in the UK and beyond. We have done so much work in recent years to drive mental health up the agenda, and increase the public and political will to help make change happen. Although huge steps forward have been made in the UK — for example with substantial moves to further integrate physical and mental healthcare — we still have a long way to go before parity of esteem, and ultimately care, is achieved. That is why parity of esteem — treating mental health with the same value and importance as physical health — is another of my top four priorities.
Finally, I’d like to highlight the importance of our workforce, my final presidential priority, the silver thread running through all these blogs, and the core of psychiatry and mental healthcare as a whole.
Without dedicated and committed mental health workers to care for and support our fellow human beings, we have no health service. We need to advocate for better training and opportunities to enable new generations of psychiatrists and other mental health professionals to develop in their professional practice and continue to move our healthcare system forward, just like those who have written the considered and intelligent pieces featured on this website. And we need to make sure we support them to realise their potential so they can best care for their patients, and ultimately to be happy and fulfilled themselves. The College will continue to work to support whatever progress is needed to make this happen.
NOTE FROM THE EDITORS: We would like to take a moment to say a massive ‘thank you’ to Dr Adrian James for taking the time to share his thoughts on the successful Psych Star series, and highlighting the continual need to improve existing systems to get psychiatry to the best place it can be to support every patient effectively — we’re all incredibly proud of the hard work these fantastic students and future leaders in mental health, and looking forward to seeing what they do next. Well done and thank you, Dr James and the brilliant Psych Stars.