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Spotlight on suicide at College of Psychiatrists meeting

The issue of suicide will be accorded particular focus at the upcoming Spring Conference of the College of Psychiatrists of Ireland, which takes place in Athlone on 12-13 April.

A presentation on ‘Suicide in Doctors — What we Should Know’ by Dr Justin Brophy, Clinical Advisor to the National Office for Suicide Prevention (NOSP), opens the morning session on 12 April, followed by an examination of contemporary suicide prevention strategies by Professor of Mental Health Sciences at Ulster University, Prof Siobhan O’Neill.

Also speaking will be Consultant Liaison Psychiatrist Dr Siobhán MacHale on the role of psychiatrists in respect of suicidal behaviour; and Prof Ella Arensman, Director of Research at the National Suicide Research Foundation and an expert on the epidemiology of suicide.

Later in the day, two presentations will further examine this important public health issue: ‘Not Waving but Drowning: Suicide Crisis Intervention in an Ocean of Risk’ by Clinical Director of Donegal Mental Health Services Dr Cliff Haley; and ‘Assessment of Risk of Suicide’ by former Inspector of Mental Health Services Dr Patrick Devitt and Consultant Psychiatrist Dr Declan Murray.

Speaking to the Medical Independent (MI), College President Dr John Hillery said suicide is a “constant” concern for psychiatrists. Nevertheless, in wider society, psychiatrists’ management of patients with suicidal thoughts is not always well-understood, he suggested.

“People may feel suicidal but they don’t always want to share that, because they would think people would get alarmed, they’d send them to hospital and they’d be admitted, when really they would rather carry on trying to deal with this in the community with the support of people. And yet, if there is a suicide, the professionals who have been dealing with that person often come in for very close scrutiny and even criticism,” outlined Dr Hillery.

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Dr John Hillery, President, College of Psychiatrists of Ireland

“So the role of the psychiatrist is to enable people, not to disable people. In enabling people, we have to take risks and the trouble is, if the risk goes wrong, what is the outcome for the psychiatrist as well as for the patient, obviously? But if we don’t take risks and allow people to plan their own recovery and to try to deal with their own issues with our support, rather than the old days when everyone ended up incarcerated, we are not being good doctors either.”

Suicide is of concern within the body of psychiatrists in respect of their patients, but there is growing recognition of the risk to doctors themselves. Sadly, a number of suicides of doctors have occurred in Ireland over recent years. Dr Hillery feels this will be an important focus at the meeting. “What is it about our health service, and the wonderful privilege it is of being a doctor, that it can result in such a negative outcome?” he commented.

“I remember when I was President of the Medical Council, we ran a full day [conference] on doctors’ health and [the late, renowned psychiatrist] Anthony Clare was there. At the end of it, we had a large group discussion; Anthony Clare said we really needed to realise that being a doctor was a huge privilege — very exciting, interesting work, but also very stressful… between the hours and the commitment, and we need to be teaching doctors about resilience from an early stage in their career.”

Economics

On a different tact, health economics from a mental health service perspective will be the focus of a presentation by Dr Caragh Behan, Consultant Psychiatrist and PhD in Health Economics.

Dr Behan’s workshop will outline how utility values are generated and why equity issues are so important in mental illness.  In the UK, the National Institute for Health and Care Excellence (NICE) requires that interventions provided by the health service prove their ‘utility’. In order to receive funding, the cost of the intervention has to be under a certain amount per quality-adjusted life year (QALY). In Ireland, to date, this has only applied to medication reimbursement and some screening, but as Dr Behan will outline, it is expected to become increasingly prevalent in time.

This workshop will also be an opportunity for delegates to further discuss under-funding of mental health services, a matter that has perturbed the College for many years. “The mental health budget remains way behind equivalent countries, as well as behind A Vision for Change, which is over 10 years old. The College say it should be between 12-to-13 per cent [of the overall health budget], but it’s about 6.5 per cent,” commented Dr Hillery.

Other afternoon sessions on 12 April include a presentation on body image and eating disorders in men. This will be delivered by Consultant Child and Adolescent Psychiatrist Prof Fiona McNicholas and Consultant Psychiatrist Dr Caroline Maher, who chaired the College’s Clinical Advisory Group on the development of the model of care, and Dr Niamh McNamara, psychologist, UK.

Consultant Psychiatrist Dr Lorcan Martin will chair a debate titled ‘Our Daily Lives are Incompatible with Maintaining Professional Competence’, which Dr Hillery predicted will elicit “robust discussion”, particularly as many psychiatrists are working above a whole-time equivalent post.

“A lot of people are covering much more than they should be and are working without [the required numbers of] junior doctors or allied health professionals, and getting criticised as they are not giving people access to the other things which they’d love to do; when do you find the time for personal reflection on your practice, which is very important, and keeping up your competence?”

Retention

According to Dr Hillery, recruitment and retention in psychiatry remain of deep concern.

He emphasised that there has been positive feedback to the Medical Council from medical graduates who enter specialist training in psychiatry.

However, there are also perceptions that mitigate against medical students and junior doctors opting for a career as a psychiatrist in the first instance, outlined Dr Hillery.

“There is a perception, first of all, about psychiatry, that you are dealing with people with chronic illness and they never get better and it is very depressing. We obviously work to overcome that, because there is a well-known phenomenon called the ‘hidden curriculum’ where in medical schools, general practice and psychiatry are portrayed to medical students as places for people who aren’t able to do other things in medicine, or places where you are really not dealing with scientific stuff — it is just not true, but it is a battle.”

Many doctors who enter psychiatry training often fear that they will not have the time and resources to practise appropriately as a consultant, added Dr Hillery. Moreover, trainees want to be working in teams with fully-trained specialists, “not locums who are just passing through. We have a problem in this country with having locums who aren’t on the Specialist Register — that’s a difficult one too. Once again, that discourages people from staying to train here.”

The College has at times experienced difficulties filling all training posts in recent years. However, this year it requested a 10 per cent rise in numbers into basic specialist training (to 66), but was only accorded a 5 per cent increase (63). “We are a bit concerned because we know we can fill the training posts,” said Dr Hillery.

“This year, we actually have enough people for more training posts applying for our scheme and of a quality that we’d be happy to accept, if we could. This is a ‘good news story’ but unfortunately, they [HSE] are giving us less than we wanted, but more than we had before.”

Dr Hillery pointed out that non-training posts involve doctors in the General Division of the Medical Register who don’t have the same level of supervision. He also alluded to the barrier to entering training experienced by some non-EU doctors, whose internships are not deemed equivalent by the Medical Council. He said the College has advocated for an amendment to the Medical Practitioners Act 2007 in this regard.

Meanwhile, among the highlights of the Spring Conference’s final day will be a presentation on early parent-infant interaction and attachment, and why infant mental health matters. Child and Adolescent Psychiatrist Dr Aoife Twohig will discuss a range of findings, including those from a study on the effects on maternal sensitivity and infant social-emotional development of an early attachment-focused intervention using video interaction guidance for parents of very preterm infants born at less than 32 weeks’ gestational age, in the neonatal ICU.

The presentations on 13 April will conclude with an examination of mental capacity in legislation and practice implications for professionalism, ethics and care (Prof Brendan Kelly); mandatory reporting/legal requirements in relation to children (Dr Brendan Doody); and professionalism in medicine (Dr Anthony Breslin).

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