Shame and Stigma; why doctors won’t seek help for their mental health

Ever since I can remember, I have been fascinated by people. At school I was quite good at science and since I also liked people and, well, mainly because I was 15 and thought the idea of working at a computer in an office sounded particularly dull and a spectacular waste of my life; I decided to become a doctor.

People fascinated me you see, because inside we are all the same. We are all human beings. We all have a heart and a brain and lungs and a liver and kidneys and blood and skin and muscle and bones and mostly the same number and arrangement of each. But being a person is not the same thing as being a human. Being a person requires some strange abstract concepts like consciousness or a soul or a conscience and having these means you do strange things like develop connections with other people and ponder the meaning of your existence or, you know, spend all day binge watching Netflix.

When I became a doctor I realised that I wasn’t so interested in the precise mechanisms and intricacies of anatomy and physiology as I was in the idea of understanding the person; their beliefs and attitudes and behaviours. Instead of focusing on the HbA1c and the level of sugar in the blood of a diabetic patient, I wanted to know what their beliefs were about their illness, how they viewed themselves and what was happening in their life that could be affecting their diabetic control.

You see, from a young age, I always knew I wanted to become not just a doctor, but a psychiatrist. A job where I could combine my scientific knowledge with psychology and sociology and ethics and law. A job where there aren’t flow charts and right answers but lots of unknowns and abstract concepts. In my opinion psychiatry is brilliantly challenging yet so important. In today’s society it feels like more and more mental health resources are needed, whether that’s because we are generally becoming unhappier or because we are finally seeking the help we always needed. My job is not to make everybody happy but to help everybody to make the most out of the precious time they have on this infuriatingly beautiful yet sometimes heartbreakingly cruel little planet we call home.

The thing is, that many other people don’t share my enthusiasm for psychiatry. In fact, within medicine it has a reputation for being a “soft specialty”. It’s been said that I’m “not a real doctor”. I’ve been asked if I practice psychiatry by choice, as if I might have accidentally stumbled into the wrong room one day and got stuck there or it was a punishment for not paying enough attention at medical school. There is an implication that it’s a specialty for bad doctors.

Now, I’m not that surprised when I hear this type of thing from the public because I think there’s a degree of misunderstanding and ignorance when it comes to mental health which I am hoping is changing. But I receive this type of courtesy stigma from my colleagues in other specialties. It is my belief that this is partly a product of the entrenched culture of medicine. It’s not something we talk about or that everybody experiences to the same degree but I think most of us are affected, be it subconsciously or consciously by antiquated, competitive, hierarchical values. Revered doctors are those that work above and beyond the hours they are paid for, that come in even when they are sick, that prioritise work over their families, over sleep and their own health. Doctors that are kind and compassionate but that don’t allow themselves to be affected by their experiences. Doctors that would go from one cardiac arrest to the next without letting their judgement cloud or their actions falter.

But doctors are people, not robots.

This way of thinking is not safe for them nor for their patients.

The Office of National Statistics showed that between 2011 and 2015, 430 doctors died by suicide. A survey by Medscape in 2018 which collected results from nearly 1,000 UK doctors, found that 22% of doctors from all specialties feel burned out, 4% feel depressed and 10% feel both burned out and depressed. Of these, only 1 in 10 said that they had got help or planned to get help. We have problems with recruitment and retention of doctors in almost all specialties. Many are moving abroad or pursuing other careers.

How can we expect to help others if we do not help ourselves? There’s a saying that “you cannot pour from an empty jug” and we need to do more to keep our own jugs full.

This is partly why I joined The Doctors’ Association UK. Doctors need their voices to be heard both within our workplaces and more widely, in politics and in the media. We need to work on creating a safer place to work with better resources and abilities to do our jobs but we also need to work on the culture within the healthcare system. We need to encourage our colleagues to treat each other with respect, kindness and compassion rather than to bully and belittle. Asking for help should not be seen as a sign of weakness and mental health should not be seen as inferior to physical health.

Saving doctors’ lives ultimately saves patients’ lives.

 

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World Mental Health Day – How YOU can help

So today is World Mental Health Day and my social media feeds are full of positive posts about mental illness aimed at raising awareness and reducing stigma. This is great by the way; just a few years ago people didn’t talk about their mental wellbeing at all let alone mental illness. As a consequence, we have seen a reduction in the stigma particularly around anxiety and depression and whilst we still have a way to go, especially with psychotic disorders, personality disorders and addictions, it feels as though we have made progress lately. Added to this, mental illness is making its way into political agendas with the government announcing increased funding into mental health services.

Or so it seems…

In 2010, a study by the World Economic Forum found that mental illness was the number one economic burden and that by 2030 the economic burden would reach $6 trillion. To put that into perspective, the entire global health spending in 2009 was $5.1 trillion!

The World Health Organisation also found that people with mental illness suffer the greatest disability with greatest number of years of their lives lost due to disability. It is also estimated that 1 in 6 people in the past week experienced a common mental health problem.

So at the very least it makes sense to invest in mental health services for financial reasons alone.

And the government IS investing in mental health services, right?

Sort of.

In 2016 Theresa May pledged to invest an extra billion pounds into mental health by 2021 and the government claims that it is investing more than ever before. Well, that is probably true but the problem with these kinds of statements is that whilst the raw figure is higher, the real terms investment is not necessarily higher, because it doesn’t consider inflation. A press release by the Royal College of Psychiatrists in 2018 showed that in England, the total amount of income that mental health trusts received in 2016-17 was £11.829 billion, £105 million lower than in 2011-12 at today’s prices.

The second problem is that whilst the money is going towards mental health, it is not actually getting to the front line services themselves. Mental health trusts provide most of the the mental health services including most psychiatric hospitals and outpatient services, with 90% of psychiatrists employed by a mental health trust. However, mental health trusts only received 6% of the increase in spending on mental health in 2016/2017. In England, 62% of mental health trusts (34 out of 55) at the end of 2016-17 reported lower income than the amount for 2011-12

Plus there is a great deal of discrepancy between areas. The reason for this is that the funding goes to the CCG (clinical commissioning group) who then decide how to distribute the funding they receive. Mental health funding is also distributed through GPs, local councils, private providers and the voluntary sector.

Another problem we have is that where the money goes exactly is not clear because the figures are not publicly available.

So, mental health awareness is a big deal nowadays and investment into mental health services has a lot of public support, which in turn means that politicians want to be seen to be taking it seriously and doing something about it. They announce increased funding for mental health services which is actually much less than it seems once inflation and increased demand is considered. Then, out of this not-so-fantastic increase in funding, only a small proportion is making it to the mental health trusts where it is really needed and where the public really see it making a difference.

Not ideal right?

But what can we do about this?

Well, this is where YOU can help.

Write to your CCG and your local MP. Tell them about your experiences with mental health services. Tell them about being sent to hospitals miles away from home because there were no available beds closer. Tell them about the year long waiting list for psychological therapy or the lack of follow up by community mental health team. Tell them that these things are a direct consequence of lack of funding, understaffing and budget cuts and tell them that they need to invest more.

We NEED your help.

You can find your CCG contact details here:

https://www.nhs.uk/service-search/clinical%20commissioning%20group/locationsearch/1

And details for your MP here:

https://www.parliament.uk/get-involved/contact-your-mp/

Doctors, obesity and fat-shaming

Ever since I started medical school, I have been told that being fat is unhealthy. That fat people are at increased risk of disease and death and because of this, it is my job to educate people about this risk and help them to lose weight. It makes sense right? Being fat is unhealthy and I want to help people, so telling them to lose weight is the ethical thing to do.

Around the same time that I qualified as a doctor, I discovered the body positive movement and I thought “Wow, Yes! This is great!” I wanted people to feel empowered and confident, not ashamed of their bodies. But, then this cognitive dissonance came. If I believe that people should love and accept themselves for who they are, does that mean I shouldn’t tell people to lose weight? Is it still fat shaming if it is coming from a medical professional? Can you help people to lose weight without shaming them? I’ve seen accounts from people who have left their doctor’s appointment feeling humiliated, ashamed and angry after being told by their doctor to lose weight. I hardly think that is an effective way to motivate people into lifestyle changes.

Added to this is the feeling of guilt I get whenever I have to discuss weight with my patients. This is because often psychiatrists are the ones who have made our patients fat. Particularly some of the newer antipsychotics (I’m looking at you – Olanzapine) make people gain a vast amount of weight in a short amount of time. Then we turn around and dump that guilt and responsibility onto our patients, lecturing them about exercise and healthy eating, pretending as though we did just give them the “make me fat” pill.

Well, I’m about to investigate these issues.

It is well documented that obesity is associated with higher risks of all kinds of diseases. A systematic review and meta-analysis of the research available in 2009 found that obesity was significantly associated with type 2 diabetes, all cancers except oesophageal and prostate cancer, all cardiovascular diseases, asthma, gallbladder disease, osteoarthritis and chronic back pain.

However, the reason why obesity is associated with these things is not yet determined; i.e. we do not understand the finer biological mechanisms that link obesity to these diseases.

Added to this, we know that despite millions of people  actively dieting, with more fad diets, diet books and nutrition experts than ever before; dieting does not work. People do not tend to achieve sustained weight loss through diet and exercise alone.

In fact, we have had a better solution to weight loss for many years. It is called weight loss surgery and it is way more effective than dieting. But, it’s rarely available on the NHS.

This is absurd right? All of this talk about obesity being the cause of all these diseases. The modern day enemy of medicine. If the medical community REALLY thought that obesity was a major cause of disease and death, why would it not do everything it can to prevent it and the complications of it by offering weight loss surgery to everyone who is obese?

The reason? Systemic fatphobia. 

Obesity is seen as a problem of will power, as a defect in the character of the person who is overweight and not as a disease. Society’s deeply engrained prejudice against fat people is preventing them from getting the care they supposedly so desperately need.

Well, actually, I’m not even convinced that obesity is the harmful epidemic that it is made out to be.

Firstly, what do we even mean when we say obesity? Well, the standard recognised definition is a Body Mass Index (BMI) >30kg/m². The BMI is your weight when compared to your height. In general, people who are shorter would be expected to weigh less and people who are taller expected to weigh more. But there are some real problems with using BMI as a measure of obesity.  The BMI was never created for individual use; in fact it was only supposed to be appropriate for use in population studies not to track individuals. An example for why this is the case can be found in people who are extremely muscular who will often have a high BMI despite having a low body fat percentage. On top of that, many studies have shown that it is not enough to look at weight and height as well but where the fat is distributed. More detrimental effect on health is thought to occur when fat deposits on organs rather than superficially under the skin. In that case, someone with a large abdominal circumference or “beer belly” is thought to be more unhealthy than someone with equally distributed fatty tissue. This is not something reflected in a BMI measurement.

Ok, so to start off, we are using BMI as a proxy for obesity which is problematic in itself. Added to that, we are also using obesity as a proxy for poor cardiometabolic health.

Here’s the interesting thing. There are healthy fat people and unhealthy fat people. There are also healthy lean people and unhealthy lean people. A study by Guo and Garvey (2016) looked into obesity and metabolic status separately to see which one really carries the higher risk of disease. Their results are very very interesting and I would recommend reading the full paper as there were many more findings than those that I will discuss here.

This study split people according to BMI into lean, overweight and obese using the standard measures for these. It also split people into healthy, unhealthy and suboptimal metabolic health. To do this, they looked at 3 risk factors known to cause diabetes and cardiovascular disease which were high blood pressure, high blood sugar and high cholesterol. People who had all 3 factors were labelled “unhealthy”, those who had none “healthy” and those who had one or two “suboptimal health”.

They then followed these people up over 20 years and saw how their weight and disease status changed.

Starting with obesity, they found that people who were obese stayed obese. They did not lose weight and become lean. Whilst 18% of young lean people became obese, older lean people did not tend to become obese.

In terms of cardiometabolic risk factors, what they found was that being unhealthy was associated with a high risk of cardiovascular disease and diabetes regardless of weight. They also found that people’s metabolic health remained stable. If you started as metabolically healthy, you would remain healthy and vice versa. Even more significant was this finding; Metabolically healthy people with obesity are not at increased risk of cardiovascular disease and only at slightly increased risk for diabetes compared to healthy lean people but not at increased risk compared to unhealthy lean people.

So, what does this really mean?

If your risk of cardiovascular disease and diabetes is dependent on your metabolic health rather than your weight, you cannot tell someone’s health status by looking at them.  

This means, you cannot continue to fat shame people using “health” as your scapegoat.

Unless you are someone’s doctor, you do not have access to the information you need to decide if someone is healthy or not. And even if you do; metabolic health is a more significant risk factor than weight.

So in the mean time, what do I do at work? I am obliged to document and monitor weight and to promote “healthy lifestyle” and weight loss. I have to fill in countless forms and document conversations about this because otherwise my trust won’t receive the money it needs to pay for the psychiatric treatments I deliver. I can’t just boycott anything to do with obesity in my job. I’ve always felt that it was hypocritical to advise people about their weight anyway. I mean, I am a lean person but I am far from healthy all the time. I am also human and I didn’t get into this job to put myself on a pedestal or lecture others about their life choices.

Well I don’t have all the answers I’m afraid and I’m hoping the system will change. In fact, I will actively use my voice to speak out against it.

Until then, what I can do is to listen to my patients; understand what their relationship with food is like, how they view themselves and their health. I can explain the facts as we know them; explain the current guidelines, the evidence behind them and any new evidence we have. What I can do is support my patients and listen to them. By fat-shaming, we ensure that people feel guilty and ashamed and what’s worse, we damage the therapeutic relationship we have with them. What is most important is that, regardless of your weight, you are a living being, worthy of compassion, worthy of respect and worthy of dignity.

 

9 tips for surviving your first year of Core Psychiatry

This is the first year that I have worked in my chosen specialty. Psychiatry is the only thing I have ever seen myself doing and I was nervous before I started. What if I hated it? What would I do then? What if my dream job didn’t live up to my expectations?

Luckily, a year in and my passion for psychiatry has only grown.

However it certainly hasn’t always been smooth sailing.

Under the current climate of the NHS, lack of funding, demoralisation, understaffing, it has felt like more than an uphill struggle at times.

So here are my top tips for surviving working as a psychiatry trainee in the NHS whilst preserving your own wellbeing.

1. You always have time.
It is easy to feel pressured at times to make decisions that you are not sure of or to see patients immediately. You always have time to stop and read the notes so you are prepared and you always have time to discuss with a senior before making a decision. You also always have time for lunch. Do not let yourself be shamed into thinking you don’t!

2. Not sure? Just ask
Just because you are a doctor does not mean you know everything! Nurses are fantastic resources, particularly at the beginning of a job. A trick my friend taught me was to say “I’m new here, what does the doctor normally do in this situation?” Different sites do work really differently so it’s good to know what the norm is. You can also ask your registrar or consultant at any time. Generally psychiatrists are lovely people and will be keen to turn any questions into learning opportunities for all.

3. Spend time with your patients
It’s so easy to get caught up in trying to get your assessments done quickly as you have a ton of other things to do but take your time. Try to get to know your patients and understand why they do things, what is important for them and what they really want and need. Not only will the patient appreciate it but you will gain so much from that insight in terms of ongoing care and how to approach decisions and difficult situations with them. Overall, my fondest memories over the past year were of times when I felt like I really got to know someone and had a human and compassionate connection with them.

4. Don’t be afraid to speak out
The NHS is a harsh environment to work in and there will be times when you see things that you don’t agree with or think could be done better. Never be afraid to voice your concerns and speak up. We need to learn and grow and we need to create a culture that welcomes criticisms and learning not one that blames or shuts down debate. Trainees are in a unique position as we travel a lot and have lots of great ideas. Don’t feel that your opinions are any less important than anyone else’s. Lead by example and speak out.

5. Be persistent
I found this year that I had lots of ideas and lots of things I wanted to do but it was difficult to get other people to listen to them. Whether it’s a learning opportunity like observing a tribunal or going to a clinic or a quality improvement project, keep asking!
It’s very easy to feel that you are not being listened to or that others dont have time to hear you out. The system and culture does not welcome change so it’s not always going to be easy to get people on board with your ideas or concerns. But the louder you shout, the harder it is to be ignored.

6. Learn when to say no
At times this year, I felt pulled in all directions. You have your base team work load, the oncalls, your portfolio requirements, exams and it can really build up. Tell your clinical or educational supervisor when you feel overwhelmed and they can help re-evaluate your work schedule.

7. Know your rights
Ok so we are now working under a new contract which was enforced on us despite our opposition. Use it to your advantage when you can. Rotas should be sent to you 6 weeks in advance, check your rota complies with the new contract, make sure you get all the annual leave, study leave and lieu days you are entitled to. If you work excess hours or miss training opportunities then exception report it!

8. Preserve your work life balance!
You cannot pour from an empty jug. If you are overworked, tired and stressed, how are you supposed to help your patients? Switch off from work completely on your days off, don’t put in too much of your free time into portfolio and exams. Make sure you still schedule time for you, your friends and family and the things you enjoy.

9. Enjoy it! Each day of your life only happens once. Try to appreciate every day and enjoy yourself!

So those are my top tips, let me know if you are starting core psychiatry training or if you have any tips of your own!

Psychiatry; how much do we really know?

So I have a feeling that a lot of my posts are going to have a common theme and that is this; we do not know a lot of things.

In my experience, it is very common for patients and people in general to think that doctors must know everything and that when we recommend something, that is because we know it works.

Well, I wouldn’t blame you for thinking that because we do often give off that impression.

The truth is that we know very little. In fact, the more we seem to know, the more we realise we knew even less than we thought we did.

Sounds alarming right?

Let me explain…

The human brain is probably one of the most complex things on this planet and we haven’t really scratched the surface in understanding it.

Now, I’m not saying we don’t have a clue what we are talking about, I’m just saying we are far from full understanding of the complexities of what we are treating and how. And if we don’t know exactly what is going on in the brain to cause our symptoms then it follows that we also wouldn’t understand exactly how to treat it.

It’s quite possible that years from now, we will look back and think “what the hell were we thinking?”

Because, although we don’t know a lot, we are learning more and more everyday.

At the Royal College of Psychiatrists International Congress last month, I went to a talk by Professor Thomas Barnes, an expert in schizophrenia and antipsychotics, about the newest updates in guidelines for treatment of schizophrenia.

Well, guess what his take home message was? “It’s all uncertain!”

Interpreting evidence and research is hard. The evidence has to be accurate and reliable. We have to believe that the study is well designed and takes into account other variables that could influence the results. We also have to look at the group of people studied and see whether those people are similar to the people we treat. For example, a study of antidepressant efficacy in elderly people in remote villages in Ecuador is probably unlikely to be relevant to a 16 year old in London.

Then, when we’ve looked at the study, we’ve decided it was well designed, it’s relevant to our population and takes into account other variables, we have another problem.

We now have to take population based data and apply it to an individual person. If a medication cures 60% of people but also causes bad side effects, is it worth it? How can you tell that your patient will be one of the 60% it cures? What if your patient is part of the 40% it doesn’t cure and gives them side effects? What would be the consequences if you didn’t treat your patient? Are there any other medications available?

The truth is we have no way of knowing whether the medication is going to help you individually or not but we do know that if we treat 10 people, 6 will get better. We just don’t know which 6 it will be.

To help us with this we have calculated “number needed to treat”. This is the average number of patients needed to be treated for one person to get a positive outcome but again this doesn’t tell us exactly who will be helped.

In addition, people do not behave in real life in the same way they do in trials. You may have a certain type of person who signs up to the trials or they may be more diligent because they are being observed. Trials also tend to be quite short term as they are expensive and difficult to organise over long periods of time so we often don’t have any evidence for long term treatment.

An example of this was given in Professor Barnes’s talk. The available studies we have on antipsychotic usage are less than 10 years long and most are much shorter follow up than that. We can say quite confidently through meta-analysis of 65 trials that antipsychotic medication reduces relapse risk in patients with schizophrenia for up to 2 years but that very little is known about the long term effects of antipsychotics (Leucht et al 2012). 

Professor Barnes also highlighted that in real world data, it looks like antipsychotic depot (intramuscular injection) medication is effective however, randomised controlled trials suggest they are not.

As you can imagine, this is all a bit confusing and really no one knows what the best treatment is for each patient.

We create guidelines and treat our patients based on the best available evidence but I think it is important that our patients and their families understand that too.

We don’t have all the answers yet, but we are doing the best we can with the information we have.

So next time you are discussing a medication with your doctor, ask them what the evidence is for its efficacy, what is the number needed to treat, how common are the side effects and what the alternatives are.

Then you and your doctor can come to a decision together about what is the best treatment for you at that time and you can feel empowered to be involved in the decision.

 

Happy Birthday NHS!

Happy Birthday to the NHS!

The NHS is 70 years old and I am immensely proud of that. In fact, I think it is the one thing that everyone in the UK should be proud of. A world class healthcare system that is free at the point of need. It’s wonderful isn’t it?

My life is devoted to the NHS, I eat, sleep and breathe in that hospital smell that the rest of you loathe. And I love it.

Yet on the 70th birthday on the NHS I feel angry.

I feel angry because whilst I was born and raised with the NHS, I worry that my children may not be. I fear that the National Health Service as we know it is critically ill and I’m terrified that its days are numbered.

And what really grinds my gears is when I see politicians on TV wearing #NHS70 badges, tweeting about how proud they are of the NHS while simultaneously dismantling it. I abhor their arrogance. The way they can sit their shamelessly despite the fact that they are running the NHS to the ground. We are 10,000 doctors short, 40,000 nurses and around 15,000 beds fewer since 2010. Theresa May has not ruled out the NHS being part of the UK-USA trade deals and our government is proud of itself. The NHS survives despite the government not because of it and it survives due to the good will of its staff.

I have spent 6912 hours so far working in the NHS and have volunteered many more. In those 6912 hours I have felt just about every emotion there is. I have been elated, overjoyed, shocked, devastated, frustrated, angry, hurt, ashamed, guilty, hopeful and relieved. I have had soaring highs and crushing lows. I have laughed until my stomach ached and I couldn’t breathe through the giggles and I have sobbed and wailed through swollen tired eyes.

I have assisted in the births of tiny perfect humans and held them while their mothers were being cared for. I have played silly games with children, done crosswords with the elderly, made cups of tea, mopped floors, wiped mouths. I have held the hand of a patient in the middle of the night while they told me their deepest fears. I have sat with a family well past my home time to discuss end of life plans for their dad. I have explained options after the ultrasound showed the sac was empty or the biopsy was positive or the scan showed a mass.

I have listened to a thousand stories, all unique and novel and none of them forgotten.

I have run to a cardiac arrest petrified and full of adrenaline waiting for my training to kick in so that I can forget the emotion and do the job. I have pushed aside the tears as, exhausted and unsuccessful, I have returned to my job list which is now longer than I care to know. I have gone to see the next patient minutes after only to be shouted at because they have been waiting several hours and they are scared.

I have been pushed and scratched, hit and kicked and called a fucking bitch. I have physically prevented patients from harming themselves and negotiated with a man wielding a chair as a weapon.

I have felt like the biggest failure in the world and I have lain awake at night wondering what I could have done better.

But never have I ever regretted choosing medicine.

The NHS is not a smooth clean machine. It is clunky, disorganised and inefficient. It is flawed. But it is resilient. The staff are dedicated, passionate and loyal. The nurses, doctors, physios, occupational therapists, pharmacists, cleaners, porters and secretaries, each have a unique role and responsibility, each vital in its own way.

No, the NHS is nowhere near perfect, but it is incredible.

When I think of my patients, I feel frustrated that I can’t always offer them all the services I want to because we don’t have the money. I feel angry that I have let them down because there is nothing more I can do. But I wonder where these patients would be without the NHS. Most cannot afford private healthcare insurance. They could not pay for treatment. Many of them are homeless, many more unemployed because they are too sick to work and they lack the kinds of practical skills needed to fill in application forms for housing and benefits. We help them with that by the way, it’s not “our job” but we do. The government tells us not to, tells us to do more with less, cuts our funding but expects the same care, the same results. So we push harder, try to pour from our empty jug, to squeeze the last few drops.

And when I look to the future, I am petrified that we will lose it all. The plan to privatise is already in place and a large part of our services are private already just people aren’t aware of it.

(Supporting the #wearyourNHS campaign by Dr Lauren Gavaghan – get your Tshirt designed by Vivienne Westwood at wearyournhs.teemill.co.uk)

Well, I don’t want to feel ashamed when I look back in 30 years time. No, I want to be celebrating 100 years of the NHS not mourning its death. And for that reason I am and will continue to fight the privatisation of the NHS.

Our NHS is not yours to sell.

As Aneurin Bevan said in 1948 “The NHS will last as long as there are folk left with the faith to fight for it’

So please, don’t let them take it away.

(Check out the Great NHS Heist for more info on privatisation in the NHS)

Attending the Royal College of Psychiatrists International Congress

Last week I trundled up to Birmingham on the train from my current hometown of Luton to attend the Royal College of Psychiatrists International Congress (RCPsychIC). It’s a four day international conference that around 2000 psychiatrists and other healthcare professionals/people with an interest in psychiatry attend annually.

It ran Sunday to Thursday but I only attended Monday and Tuesday (I get limited study leave!) as I had an audit poster accepted for presentation on the Tuesday.

That sounds way more impressive than it is by the way.

(You put your poster on display in a hall and stand by it during the breaks from the conference for people to walk past and ask you questions about it.)

The set up usually involves a few key note speakers for each day with smaller talks in between where you have the choice to attend one of 5 different sessions. There is usually a wide variety of topics including people explaining their latest academic research, clinical research, quality improvement, latest guidelines, political and ethical issues.

There are also great networking opportunities and chances to meet with other trainees.

I had a great couple of days and will be blogging further about some particular talks I attended but here are a few highlights.

The first breakout session I attended was on the PREVENT strategy. This kicked things off with a very controversial topic it seemed and the room got pretty heated! PREVENT is part of the government’s counter-terrorism strategy. It is a safeguarding programme that works with all areas of the community including healthcare, schools, police, charities etc.

This session was interactive and we had to discuss a fictional case and whether they should be referred to PREVENT or not. There was a panel who did a roleplay of an multi-disciplinary team discussion. At first people were very reluctant to refer to PREVENT as it seemed they didn’t have much experience of it and felt more comfortable referring via the traditional safeguarding route.

There was a lot of debate in this session with many believing that psychiatrists should not be involved in counter terrorism strategies but instead should be treating the mental illness. They felt that often the concerns were secondary to symptoms of mental illness and that it was not right to break confidentiality and damage the doctor-patient relationship. Others felt that we had a duty to protect the public and that we should raise concerns appropriately in the same way we would if it was domestic violence or child safeguarding concerns.

Overall, by the end, just over 50% of people would have referred the patient to PREVENT and it definitely sparked discussion.

Next I went to a session on asylum seeker/refugee mental health. There were some great speakers who were clearly very passionate about their work. First, I learned that the UK is the only country in Europe with indefinite detention centres. I was really saddened to hear this. Dr Katy Briffa spoke first saying that we cannot treat mental illness until the patients have their basic needs met such as shelter, food and safety. She talked about “anticipatory anxiety” and the fact that, although we think people are likely to be suffering from PTSD, often they have experienced complex chronic trauma which is still ongoing as they are worried about being deported. Dr Piyal Sen talked more about the complexities of treating asylum seekers and refugees and the need to take a “helicopter view” of them. Dr Majid then gave advice about the psychiatrist role as an expert witness in immigration cases. Her advice was to be as detailed as possible as this is really appreciated by judges.

Later I saw the keynote speaker Dr Robin Murray talk about the genetic and neurochemical overlap between schizophrenia and bipolar affective disorder which perhaps should mean we see them as part of the same spectrum of illness rather than two dichotomous disorders.

I kicked off the next day with a talk by Dr Altha Stewart on trauma in children. One of the take home messages for me was that we must include children in their treatment plan and break away from a paternalistic  approach.

I next went to a session for trainees about getting your work published. Maybe it’s because I haven’t published anything myself but I didn’t know that there were so many predatory publishers trying to trick you into paying money to publish your papers in sham journals!

The journal titles on the left are the sham ones and the right are the legit ones -very similar right?! (Speaker: Dr Steve Kisely)

I found that their tips to getting published appeared to suggest there is inherent disadvantage for people who do not speak English as a first language and another audience member identified that the high costs is also a disadvantage for people from developing countries who want to get published. This is a real concern for me, as it seems there is institutional racism at play in academia which I really think we need to be addressing.

I then attended another key note session on schizophrenia, this time an update from the latest clinical guidelines which I will be discussing in another blog post.

By this point over the two days I was beginning to notice that I had been to a lot more talks from men than I had women which was disappointing. However, it’s almost as though they heard my thoughts as the next two keynote speakers were from women. Firstly Professor Phillips explaining her work on reward pathways in the brain and how they could relate to the disease process of bipolar affective disorder. Then Professor Emily Holmes presented her fascinatingly simple yet remarkable work on using tetris to prevent intrusive images following trauma. They found that distracting someone using a game of tetris following a trauma meant they had much less incidences of intrusive images, one of the key symptoms of Post Traumatic Stress Disorder. This was really interesting as although it only targeted one symptom, I think it has the potential to help us develop possible preventative therapies for PTSD or at the very least, allow us greater understanding of it.

So, finally after 2 days of jam-packed scientific excitement, (and just before my brain exploded) I attended a session on the impact of Brexit on the UK’s mental health workforce. It was a really interesting session and Dr Subodh Dave’s talk on the barriers faced by Black and Minority ethnicity doctors was particularly thought provoking. This session really made me feel more positive about what the Royal College of Psychiatrists is doing to encourage more people to choose psychiatry as a career and to improve retention. We have a long way to go and the truth is that we don’t really know what effect Brexit will have, all we know if we need more doctors, more nurses and more funding urgently in mental health.

Overall I think that regardless of the topic, it is all about the way they are presented. People who were clearly passionate gave the best talks! These sessions are not to explain every detail of your research study including how you analysed the data as to be honest that is pretty dull! It should be about giving people a taster of it so that they can go away and read the intricate details themselves if they need to. Always remember your audience and don’t just be there because it looks good on your CV!

It was a pretty heavy two days with a real variety of topics covered but that really is why I love psychiatry.

So I hope you’ve enjoyed my first blog post, if you’ve made it this far. I promise they will be shorter in future. If you want to know more or have suggestions for topics you want me to blog about, leave a comment or message me on instagram/twitter. Also let me know your experiences of the RCPsychIC if you attended too!