All Party Parliamentary Group for Mental Health

Notes of meeting: 12 October 2004

Workforce Issues and the Revised Draft Mental Health Bill

Lynne Jones opened the meeting saying that the Government had published a revised Draft Mental Health Bill and that the Group would hold a series of meetings to discuss issues arising from it. Rosie Winterton MP, Minister of State with responsibility for mental health, had been invited to address the next meeting on the subject of the Bill.

Dr Mike Shooter, President of the Royal College of Psychiatrists:

Dr Shooter began by explaining that there are workforce shortages across mental health including psychiatrists, psychologists, CPNs and social workers. He noted that the stigma which is attached to mental illness also affects the workforce and people are often put off entering psychiatry because of prejudice within medicine. Undergraduate medical training is very knowledge and exam-based and skills which are useful in psychiatry, such as communication skills, are undervalued and underdeveloped. People are also put off psychiatry at post-graduate level by other doctors telling them that they would be better off in a more prestigious specialty. Retention is also a problem in mental health due to a variety of problems.

The College is working with the Department of Health and other bodies to address the recruitment and retention problems as well as training issues. There is also a NIMHE strategy to develop new ways of working for senior psychiatric personnel. They are also interested in how best to use training to increase the contact between doctors and service users. The College is also working with chief executives of trusts to implement the new strategies.

Dr Shooter reported that tackling many of these problems would take a long time and that it would be 5 years before improvement could occur. He noted that the current vacancy rate for consultants was 12% and at one stage recently had been 30% in Wales. Many vacancies are filled by locums and while some are very well qualified, others are not.

On the Revised Draft Mental Health Bill, Dr Shooter noted that the proposals were likely to lead to a huge increase in workload due to the extension of the use of compulsion. The Bill, as it stands, would also be detrimental to the relationship between psychiatrists and service users as more people would fear compulsion and be scared to give their psychiatrist the full details of their illness. Dr Shooter noted that the Royal College of Psychiatrists felt that the new Bill was unethical and would be unsafe. He also felt that any new resources should be channelled straight into services rather than being used to implement an unpopular Bill. For example it would be a wrong if new services such as Early Intervention Teams, which had been welcomed, then suffered from under-funding.

Q&A

Lynne Jones began by asking whether the Government had listened to any of these concerns before publishing the revised Bill. Dr Shooter responded saying that the reform of the Mental Health Act had been a long process and the College, along with other stakeholders had communicated with Government throughout. Everyone agreed that the legislation needed reform to reflect modern practice and some good developments have been proposed by the Government, such as clearer thinking about safeguards and the rights of patients and carers. In response to opposition the Government also dropped the proposal to introduce compulsory treatment in prisons and has made changes to the proposals for compulsory treatment in the community. However, the College and Mental Health Alliance still felt that there were serious flaws in the Draft Bill, particularly the broad definition coupled with the criteria for compulsion and the absence of exclusions.

Joan Penrose asked Dr Shooter whether users and carers could do more to express their concerns about the legislation. Dr Shooter responded that one of the positive outcomes of the process has been to unite the mental health world through the Mental Health Alliance and that there was now a good opportunity through the pre-legislative scrutiny committee to advise on what changes should be made.

Liz Blackman asked what work the College has done to tackle shortages through targeting universities. Dr Shooter said that the College had found it hard to implement positive schemes in universities and that Post Graduate Medical Education Training Board  had also had a shaky start. He noted that there is a problem with the formula used for the number of training places available in universities. However he noted that the College was determined to attract more people who want to become psychiatrists to stay in the training.

Lynne Jones followed this question up by asking how the College can make psychiatric training more attractive. Dr Shooter said that the training needs to be made more competency-based and more driven by the criteria that users and carers demand. Skills such as communication, teamwork, crisis resolution and leadership should be given a higher priority.

Prof. Bosanquet noted that the increased compulsion under the new Bill would have a particularly negative impact on BME groups who are already over-represented in compulsory treatment. Dr Shooter reported that the use of compulsion had increased over the last 10 years due to a change in the climate to a blame culture where psychiatrists feel that they must section people rather than risk anything going wrong. He agreed that BME issues needed a higher profile in the discussion on the legislation as young black males from inner cities were 6 times more likely to be sectioned than the average. Dr Shooter noted that the legislation also contradicts other Government policy in health, which focuses on choice and empowerment.

Lynne Jones asked what alternatives there are to compulsion and mentioned a case in her community where a man did not receive help from mental health services until he had reached a crisis point. Dr Shooter said that cases such as these should be addressed long before they reach crisis through better monitoring of users in the community.

Earl Listowel asked whether staff working in children’s homes needed more support from mental health services. Dr Shooter agreed that, though this support had been provided when he was training as a Child and Adolescent Psychiatrist, this rarely happened now due to stretched resources. He noted that Child and Adolescent Psychiatrists can often spot potential problems in children at an early age but unfortunately many of these children do not have the opportunity to have their problems addressed at this early stage and most child psychiatry is fire-fighting rather than prevention. Earl Listowel followed this up by asking whether other disciplines should have more responsibilities to take the pressure off psychiatrists. Dr Shooter said that most multi-disciplinary child teams include psychologists and nurses and that it was appropriate for other members of the team to take on new roles following training.

Adrian Delamore asked whether part of the problem in mental health concerned bad practice, inappropriate use of legislation and over-reliance on treatment using drugs. Dr Shooter agreed that in psychiatry as well as other branches of medicine there can sometimes be an over-reliance on medication at the expense of preventative work and treating people in a holistic way.

Philip Dixon-Phillips reiterated that many users and carers consider the Draft Bill to be draconian and that he was alarmed that opposition was being ignored. He also said that locums do not provide continuity of care. Dr Shooter noted that it is unacceptable for locums to go through the motions and not provide proper care and consultation. He noted that the College has produced checklists for psychiatrists, patients and carers to help inform them to make consultations more productive.

Miranda Teffer stressed the importance of the voluntary sector in providing services and how they are often ignored, also that treatments such as cognitive behavioural therapy are often under-resourced. Dr Shooter agreed that the voluntary sector should be more involved and that they have been particularly important in supporting carers. He noted that the College is currently running a carers campaign with the Princess Royal Trust for Carers and hope to get users and carers more involved in training. Dr Shooter agreed that CBT was very helpful to many people (including use in prisons) and should be more widely available.

Celia Richardson asked whether the College had been “reassured” by the inclusion of ‘clinical appropriateness’ in the Draft Bill as members of the Mental Health Alliance were unclear what the term meant. Dr Shooter said that he didn’t know anyone who had been reassured by this.

Baroness Murphy said that, as a former psychiatrist and chair of a health authority, she was very worried about the workforce implications of the Bill and also how personality disorder would be dealt with. Dr Shooter responded saying that personality disorder is part of the remit of psychiatry but that treatability depends on having appropriate facilities available and that this is often a problem. In terms of "dangerous personality disorder", the Home Office has managed to deal with the elements they are concerned about through criminal justice legislation and so the focus of the Mental Health Bill should be on health.

The Chair thanked Dr Shooter and reminded members to look out for details of the next meeting when the Minister would address the Group.

Present	Apologies
Lynne Jones MP	Rt Hon Virginia Bottomley MP
Liz Blackman MP	Rudi Vis MP
Doug Naysmith MP	Lord Carlile
Earl Listowel	Peter Bottomley MP
Tim Loughton MP	Syd Rapson MP
Baroness Murphy	Dame Marion Roe MP
James Holden (Virginia Bottomley MP)	Lord Alderdice
Dominic Curran (Sarah Teather MP)
Rachel Barker (Stephen Hesford MP)
Laure Thomas (Evan Harris MP)
Ashley Kosiak (Plaid Cymru)
Agnes Wheatcroft - RCPsych
Miranda Teffer (PPI)
Philip Dixon-Phillips – Hearing Voices Movement/UKFSMHA
Tom Hamilton (Maca)
T. Troullidon (BMS)
R. Marsh (BMS)
Helen Lord (Lilly)
Eric Penrose (Individual)
David Stone (Mind)
Celia Richardon (MHF)
Caroline Hawkings –Turning Point
Sherée Parfoot (CAPITAL)
Prof. Nick Bosanquet (Imperial College)
Martin Aaron (JAMI)
Joan Penrose (Individual)
Dr Roger Freeman (RCPsych)
Dr Mike Shooter (RCPsych)
Lee Lanciotti (Innovex)
Ken Coates (Janssen-Cilag)
Adrian Delamore

 

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