COVID-19: Message from the President

Dear Colleague,

These are worrying times for our patients, our families and ourselves.

I believe that by our continued collaboration with each other and the wider health system, we will get through this crisis. With continued confidence in the high quality of our training, experience and professionalism we can continue to care for our very vulnerable group of patients, our teams and ourselves.

By using the values we have as a College, the path for the College is to adapt to the crisis of COVID-19 to sustain our mission and objectives as much as possible. We will continue with the high quality of our training and ensure that our BSTs and HSTs progress to become fully trained confident specialists and we will hold and advocate for parity of esteem for those suffering with mental illness and disorders.

I have outlined some areas below on how the College is responding and adapting during this crisis. The College website will also provide updates.

Training

The aim is to ensure we continue with progression through training to graduation. Core to this will be at key decision points which will ensure that BSTs move into HST and that HSTs complete their training.

Obviously, all of training is contingent on how the crisis evolves.

I advise Trainees and Trainers where possible to continue to do what you can. You should however keep the Postgraduate Training Department informed at all times of what is not possible. Similarly, the College will do what it can, adapt and revise when it needs to, especially on those key decision points.

The Dean of Education, Dr Aoibhinn Lynch, will send an update on arrangements in due course. These arrangements are under constant review and are likely to change, so please expect further updates.

Professional Competence Scheme

Meeting CPD requirements is a challenge in these extraordinary circumstances and any updated guidance and flexibility from the Medical Council will be brought to your attention.

In addition to my last communication, restrictions on the number of credits you can log from online CPD in 2019/20 have been lifted as have restrictions on the total number of Internal / External CPD credits you can log from participation in CPsychI faculty meetings, committees and working groups.

Please check our website if you will struggle to meet the deadline because of COVID-19.

College Activities

As you already know the Spring Conference is cancelled, as are the Hot Topics series of events. Faculty and committee meetings however, can still operate through the College’s video conferencing and teleconferencing facilities if the Chair deems this is necessary. Again, look out for updates on the College’s website, as these may be cancelled in response to the current situation.

College Staff

I want to pay tribute to the College Staff who are striving to continue with the business of the College in very different and changing circumstances and ask for your continued patience of every department, as we cannot expect the same high level of response we usually get. Most of the team are working from home and responding to emails with some available by phone also. Again, the website has information on how best to correspond with the team.

Useful Information for Rapidly Changing Service Delivery

The current crisis as you know is stretching the resources of the health service and ourselves. Due to social distancing and other practices now required services are changing and adapting delivery of those services where necessary and possible. Psychiatry is no different. The College Professional Ethics for Psychiatrists can help when deciding on what is best practice for difficult choices.

The College is also developing a position paper on the use of ‘telepsychiatry’. This is still in draft form but it does provide a process on how to adapt our practice utilising tele-methods. See draft ‘Telepsychiatry and its use’ here which may be of help. The Irish Medical Council outlines its appropriate use specifically in paragraph Section 43.0, page 32 of the 2019 “Guide to professional conduct and ethics”.

The MPS has also provided an on-line session on remote consulting and a ‘medico legal aspects of tele-medicine’ document.

Parity of Esteem for Psychiatric Illness

There is rightly a considerable focus on the medical management of COVID-19, but we must not neglect the mental health consequences of this crisis. The WHO has issued guidance on Mental Health and Psychosocial Considerations during COVID-19 outbreak.

The College will continue to advocate for parity of esteem for those suffering from mental illness. The life expectancy for those with Severe Mental Illness before COVID-19 was considerably lower than that of the general population. Let us not reduce this further. Psychiatric Patients should have the same access to testing, containment and treatment as other Patients in the Health System.

Emergency Council Meeting of the College

I am calling an emergency Council meeting by teleconference for next Tuesday to discuss training and the psychiatric response to this crisis.

Stay safe and look after your own health as much as you can in this time of daily shifting demands and expectations. The WHO guidance is relevant to us all.

With wisdom and compassion, we will get through this together.

Yours sincerely,

Dr William Flannery

President

Dear colleague,

On behalf of the College, I want to express sympathy to the families of those who have passed away from Covid-19, especially those from residential mental health institutions. I also want to acknowledge the hard work and dedication of the staff who cared for them.

It is a false dawn when mention is made of the acute hospitals avoiding a surge while Covid-19 is taking a heavy toll among psychiatric patients. It is imperative, collectively and individually, that we continue to advocate strongly for parity of esteem for psychiatric illness. As I said in my last address, psychiatric patients should have the same access to testing, containment and treatment as other patients in the health system.

The responsibility of the College is to ensure there are fully trained and competent specialists who the Medical Council can place on the specialist register, to work in the Mental Health Services. The responsibility for delivery of these services is with the HSE and the responsibility for regulation is with the Mental Health Commission. The College continues to collaborate with the HSE and the Mental Health Commission to support them in their responsibilities.

I believe all who are involved in the Mental Health Services want what the College wants – the best possible outcomes for individuals who experience mental illness. This must mean parity of esteem for psychiatric illness. The challenge, as always, is how this is operationalised. We have issued press statements and correspondence to Minister Harris addressing this.

There are two main challenges ahead for the College in collaborating to achieve parity of esteem. The first is what we are doing during the Covid-19 crisis and the second is how to ensure that lessons are learnt from this crisis. Outlined below is what the College has been doing, and will continue to do, to meet the first challenge. The second challenge is evolving daily and requires us to use the College structures now and in the future (Faculties, Council, Communications & Policy etc) to collate and examine the learnings which can shape and define what parity of esteem means for us.

HSE Mental Health Operations and Faculty Input 

Collaboration with the Mental Health Operations Team is facilitated by monthly meetings between the Management Team of the College and the National Clinical Advisory Group Lead for Mental Health.  We welcome Dr Amir Niazi who has just taken up this post and look forward to mutually beneficial collaboration with him.

I have asked the Chairs of each Faculty to collate experiences and examples that can be used to guide these meetings with Mental Health Operations. It is important for the Faculty meetings to continue in some form to allow this to happen and I ask that members bring their experience and examples to their Faculty through the Chair or by ‘attending’ meetings remotely when they occur.

Mental Health Commission

The first principle of the College Professional Ethics for Psychiatrists is that “Psychiatrists shall treat every Patient with respect.” We have to be mindful of a patient’s human rights, the quality of care they receive, and that their best interests are considered a priority if they lack capacity.

The Mental Health Commission has been informed of our concerns about how the changes to the Mental Health Act and the Mental Health Commission regulations have the potential to undermine these values and may lead to unintended consequences of an adverse nature. I have provided them with specific examples of how Tribunals now operate and the regulations for Approved Centres as part of the ongoing communication with them.

‘Be on call for Ireland’ Initiative

This initiative was set up with the aim of employing healthcare staff who are not currently working for the HSE and quickly deploying them into the health service to work for the duration of the crisis. The duration is for a three month period but may be extended. The College’s role with this initiative is to give an expert recommendation for doctors with any level of psychiatric training as to what grade and setting they might work in.

College Video Series for Families of Young People with Mental Illness

Restrictive measures are difficult for everyone and an additional stress for those who suffer from or care for those with Mental Illness. The College, through the Communication, External Affairs & Policy Department, has been developing a video series titled Supporting Families of Young People with Mental Illness During Covid-19. I want to thank those who are leading out on this, Dr Kieran Moore, Prof Fiona McNicholas and Prof Louise Gallagher for their videos on ADHD, Eating Disorders and Autism respectively. While we have released them to media and relevant organisations to reach the families, I encourage you to share them with your teams and families who you believe will benefit from them. More videos are in the pipeline and being added to the website as they are completed.

COVID-19: Information and Updates on College Website

This evolving section on the College website, which is very useful for members and trainees, contains Covid-19 specific updates on Postgraduate Training, CPD, Healthcare Professionals’ welfare and College press statements during this crisis. Tips on self-care, links to useful resources as recommended by College members as well as the above video series are also published in this section.

If you wish to add anything to this section, please contact the Communication, External Affairs & Policy Department directly or through your Faculty and Faculty Chair.

College Activities and Business

All departments of the College are still operating, are available for members by email and phone, and are continuing with activities and functions that can be completed but in a different way when necessary to comply with Covid-19 restrictions. Some activities and functions cannot be carried out due to the restrictions but updates and possibilities are discussed daily by all concerned.

Post-COVID and Budgetary Parity of Esteem

I have no doubt there will be a reckoning when this crisis passes. For the past 12 years, Mental Health has received 6% or less of the overall Health Budget, when it should be 12%. We now see the consequences. What will this reckoning bring for Mental Health Services?

By coming together and using the processes in place in the College, be they Faculty meetings, Hot Topics or Training, we can define that reckoning and what it means for parity of esteem for psychiatric illness.

Finally, I want to acknowledge the hard work of all healthcare staff, who make up a quarter of all Covid-19 cases. Psychiatric services are very much still in operation across the country and are reporting to be very busy. There is much to be proud of despite these very difficult times.

With the wisdom to have hope for the future.

Yours sincerely,

Dr William Flannery

President

Dear Colleague,

This is the time of year where we acknowledge the relationships we have with those around us. Where we thank those who have given meaning to who we are and what we do. Reflecting on this for the College, the people involved and the connections made, there are many to thank.

Foremost, I want to thank the Management Team of the College, Dr Lorcan Martin, Vice President and Director of Professional Competence, Dr Mike Scully, Treasurer, Dr Maeve Doyle, Director of Communication and Public Education, Dr Aoibhinn Lynch, Dean of Education, Ms Miriam Silke, Chief Executive, and the College Staff, who have been solid despite the whirlwind of changes around them. Where would the College be without Ms Lorna O’Callaghan, Manager Professional Competence, Ms Andrea Ryder, Manager Communication, External Affairs & Policy and Ms Kellie Myers, Operations Manager Postgraduate Training.

Next, I want to thank the Council, who discharged their duties admirably during the year as Trustees of the College. I want to welcome the new full specialist members of the College, who are our future. I want to thank all Members of the College for their support and belief that our College is the true voice of Psychiatry.

Dr Justin Brophy, former Chair, Forum of Irish Postgraduate Medical Training Bodies

I want to thank Dr Justin Brophy, a former President of the College, for his work as Chair of the Forum of Irish Postgraduate Medical Training Bodies and of course for never forgetting the College. His last task with the Forum is to complete a National Medical Training Strategy, the objectives being a vision for postgraduate training, improvement of healthcare and a world class medical training. Aoibhinn, Miriam and I sit on the working group ensuring there is parity of esteem for psychiatry.

Prof Frank Murray, former Director NDTP and agreed psychiatrist workforce planning figures.

I want to thank Prof Frank Murray, who in November stepped down as Director of National Doctors Training and Planning unit of the HSE. He may be an eminent Gastroenterologist, but he has that core skill of a psychiatrist, empathy, which was evident in how he guided planning for the number of Consultant Psychiatrists needed by 2030. He has signed off on the document with the agreement of the College, but it remains a draft resting with the Chief Clinical Officer for final approval.

An idea of the figures in that document are as follows: there are just under 600 specialists in psychiatry, with about 450 Consultant posts in the HSE, with about 100 of these either vacant or filled by non-specialists. By 2030, we will need around 800 specialists. As we now have an indication of how many are needed, we can plan towards determining how many specialists we need to train. At present the College is allowed to recruit circa 60 Trainees a year. Often allowance is given to recruit a few more and the College has more suitable applicants than training places. We will need more, but how, given the shortfall in funding for training the College gets and the challenges in being a Consultant Trainer alongside a frenetic clinical workload?

Dr Amir Niazi, HSE National Clinical and Group Lead Mental Health and revised Mental Health Act.

I want to thank Dr Amir Niazi, National Clinical and Group Lead Mental Health. He has another core skill of a psychiatrist, that of collaborative working, shown in abundance in the challenging post he has. Most recently he has liaised with the College about the draft changes to the Mental Health Act. Of note, it is unclear yet if this is to be a new or amended Act. The Department of Health has asked the HSE and, on the request of the Mental Health Commission, the College to examine the Child section, which we are doing. The Department asked the HSE to examine the rest of the Act, mainly the adult section, but not formally the College, as it is was felt that sufficient psychiatric opinion was obtained from the board and structures of the Mental Health Commission. My impression is that the suggested changes will need further review by team with clinical and legal expertise.

External Stakeholder Relations and Collaboration

The College has good collaborative links with the Operations and Inspectorate of the Mental Health Commission, helpful meetings with Tulsa, a beneficial working relationship with Mental Health Reform and a growing relationship with the Mental Health Unit of the Department of Health. I want to thank the Minister for Mental Health, Mary Butler, TD, for opening our recent online Winter Conference, for stating that Sharing the Vision does not replace, but builds on A Vision for Change and knowing the difference between mental health difficulties and mental illness.

It is essential to hear each others voices for true collaboration. I believe our voice is increasingly being heard, if not yet understood. One example is how the results of our survey to members on COVID-19 Impact on Secondary Mental Healthcare Services in Ireland was referenced by Government as being used to influence their decision-making, quite possibly the largest influence of any of our initiatives in this area so far this year. It is for this reason the College wants to repeat this survey, so that we can continue to put forward our voice. Sometimes our voice is heard, but not yet fully clear. When I presented recently to the Oireachtas Sub-Committee on Mental Health, there was an innocent mistake made confusing us with Psychology. It is Psychology who want extend the upper age limit of CAMHS to 25, not Psychiatrists.

The College through the year has reminded the Medical Council about Patient Safety. There was good work done on this with progress in the processes for Specialist Registration and working towards an ethical framework for shared care. The Council has been very supportive in interpreting the regulations for professional competence and training to the virtual world. The College has prompted the Medical Council to examine Patient Safety by applying for specialist recognition for Forensic Psychiatry. I would have expected the Medical Council to be advocating the College to apply for this given how safety here is central, but in fact the converse is true, with our application being rejected pending appeal!

National Mental Health Policy and Implementation

Sharing the Vision rumbles on. Instead of a National Implementation and Monitoring Group mentioned in the document, there is a National Steering Group. I want to thank Dr Siobhan MacHale, who is the College Representative to this group, and to Dr Maeve Doyle who is on the Specialist Panel, for allowing their names to go forward. I struggle to pull together the links between what Sharing the Vision states and what in fact is planned for Mental Health Services; an increase in bed capacity, more WTEs in Mental Health, opening of the National Forensic Mental Health Service Hospital and resourcing of CAMHS. Also mentioned of course are ‘crisis cafes’. I have mentioned before how we need to have our own vision or pathway for psychiatric services. My intention early next year is to establish a Policy and Strategy Committee to this, as well to support Siobhán and Maeve.

Digital Transformation

Information technology has worked well for the College in the last few months, with greater attendance and participation at Faculty and Council meetings, enabling College Staff to work from home and, most importantly, permitted training to continue. There were relatively few glitches. Hot Topics online is very popular and the College Winter conference was such a success that we will aim to have a two-day virtual conference next year. Special credit goes to the completion of the College examinations online. Typically, 10% of candidates do not finish on-line examinations as a result of IT difficulties. However we got everyone over the line with every candidate able to finish and be eligible for a result. Of course, IT does not replace what we did before, but can and does complement it.

Rewarding relationship

One relationship within the College I have found increasingly rewarding is between Psychiatrists, Patients and their Family Members, which is our REFOCUS Committee. I want to thank Ms Jeannine Webster, mother of James, who has Schizoaffective Disorder, who spoke for the College alongside me at the Oireachtas Sub-Committee on Mental Health last week (17th December) and who put to them that having a fulfilled life should not be an aspiration, but a reality. I have asked the Chairs of each Faculty to discuss with you how we can bring this lived experience fully into our College Structure, including, I hope, having the Non-Psychiatrist (Joint) Chair of REFOCUS sit on Council alongside the Psychiatrist (Joint) Chair of REFOCUS. The voice of Patient-Doctor is a powerful one and one that cannot be ignored.

Other developments

I am proud of our College mission, to promote excellence in the practice of psychiatry. We have accomplished a lot since our beginning in 2009 and we will do more. One next step is the College office building; the roof has been repaired, work has just started on the mews and will move onto the main building when this is done. By 2022, I will able to welcome you into our Members’ Library and in person not virtually.

This is the darkest time of the year, but the light is coming.

Finally, I want to wish you and yours a Merry Christmas and a Happy New Year.

Dr William Flannery

President