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The advocate: Pushing for best standards in psychiatry

In only two years’ time, the College of Psychiatrists of Ireland will celebrate its 10th anniversary. The College was formed in 2009 when it broke away from the Royal College of Psychiatrists in the UK to form an independent institution. Consultant Psychiatrist Dr John Hillery, who recently became President of the College, pointed out to the Medical Independent (MI) that though it is still young, the College has achieved its initial targets.

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Dr John Hillery, college President

“It is in a strong position, in that it has achieved a lot of the initial goals, which were to consolidate training and to have an active professional competence system in place — that has all happened,” said Dr Hillery. “It was set up with a lot of responsibilities and has managed to meet them all in a short course of time.”

The role is the latest prestigious position occupied by Dr Hillery, who has previously served as President of the Medical Council. He has replaced outgoing College President Dr Ruth Loane and will hold the position until 2020.

Consultant vacancies

For Dr Hillery, the College has two main functions: To oversee the training of psychiatrists in Ireland and to provide the latest evidence-based information on psychiatric practice.

An issue the College is currently concerned about is the large number of consultant vacancies for psychiatry in the health service.

“We have a manpower document in which we have recommended that by 2020, there should be 800 consultant psychiatrists in the country, which not only is well beyond what we have at the moment, but it is also beyond what had been previously recommended,” he stated.

“We are doing that on the basis of the needs we see. What I see coming across my desk in the College of Psychiatrists is services closing or being reduced due to people being on sick leave or due to people taking maternity leave or parental leave. All of these are things that people are entitled to and are important and if they don’t take them, they are not going to be able to provide a good service. But the trouble is, we don’t have sufficient consultants in the system to ensure the provision of a modern mental health service.”

Dr Hillery referred to the new document on consultant recruitment produced by the group chaired by Prof Frank Keane, which identified how the current processes of filling posts is inefficient and cumbersome. This document has made a number of recommendations to rectify the problem.

“Unfortunately, those are things outside the College’s control but we keep advocating and saying what we think will help and it does come back to having the numbers of trainees and the numbers going out the other end. And it is interactive. To attract trainees, you need a good quality of work, a good quality of education, so you need the numbers at a higher level as well. That is improving but there are still deficits around the country and we are very conscious that there are certain areas of the country where it seems to be harder to find consultants to work in.”

Dr Hillery said it is vital that trainees feel supported and appreciated in the work they do. “Many times you have trainees who feel they are not supported or appreciated,” he said.

“I know of many cases where trainees do not always get paid when they should, or may end up on-call when they don’t expect to be. These are systems issues. What the College can do, first of all, is to ensure that the training experience is a good one as far as possible and secondly, advocate and interact with the employers to ensure they support that.”

A new mental health policy is on the agenda, with the time period of the previous strategy, A Vision for Change, having come to an end. Dr Hillery said it is still a good document, despite having been published over 10 years ago.

The College will be central to the development of any new policy. The implementation of A Vision for Change was hampered at the outset by a lack of financial support, meaning the community mental health team model outlined in the document never fully came to pass. One problem, according to Dr Hillery, has been the difficulty in obtaining accurate information as to the precise levels of staffing in teams across the country and also of how financial supports have been utilised.

“What we have consistently asked for in our budget submissions since I have been involved in the College is that clarity, oversight and transparency be brought to the whole process,” Dr Hillery said.

“I was involved with the last Vision for Change monitoring group, but it had no powers to compel people to give information and it was difficult getting information. We know politicians have found it difficult getting information. That last monitoring group had suggested that a group be given statutory power and that the Mental Health Commission be given oversight over A Vision for Change, but that hasn’t happened either. The College has consistently supported that since then, but it hasn’t happened.”

Medical Council

One area of potential additional responsibility for the College relates to professional competence. The Medical Council has expressed the view that, in the near future, training bodies could have an expanded role in the supervision and remediation of doctors on professional competence schemes. The precise nature of this role has still to be negotiated. Dr Hillery said any change in the role of the training bodies would have financial and resource implications. Also, he said he would not necessarily agree with such a role change.

“I wouldn’t like to see that change in role because you have to have one group  supporting doctors and interacting with them in a way that is formative, not punitive, and if the colleges aren’t doing that, who is going to do that?” outlined Dr Hillery.

“If the colleges are seen by their members as bodies who are watching them all the time and likely to pull them up, report them and discipline them, what does that do to the relationship as regards education and training?

“It is a balancing act between different parts of the system and I wouldn’t like to see that change. But we need to wait and see what the Medical Council wants to roll-out over the next few years. If the role is to expand, it will require resources and the money will have to come from somewhere. And it is in the public interest, so you would feel it is something the health service would be involved in, as well as individual members of the College.”

Dr Hillery said the College is satisfied with the high number of its members who have registered on professional competence courses.

“But at the same time, we do know there are a lot of people in consultant posts who aren’t specialists, who are just post-membership because the posts either haven’t been set up in such a way or something has happened in that they are not attractive to fully-trained specialists, and that is an issue. We are going to the Medical Council, we have been to the Department of Health and we have been to the HSE as well. And it is a concern for them too.”

One of Dr Hillery’s ambitions is that he would like the College to publish more position papers on issues related to the profession. This process allows the College to develop consensus positions on important issues affecting psychiatry.

It requires members to dedicate time voluntarily to develop the documents — a difficult task, considering their already busy professional lives in an overstretched mental health service.

“We do have documents on benzodiazepines and other areas of practice. The important thing is to free people up to do those things. The psychiatrists that we have in practice are training juniors, doing their own CPD and also involved in other things with the College, such as their faculties, and being involved in advocacy at a local level and we are also looking at them to accredit training schemes. So we are calling on the same pool. That all takes people’s time; it is back to the need for people having the cover and being released to do it.”

Dr Hillery said he was elected unopposed to the position of President. He said when he steps down, he would like to see a number of potential candidates vying for the role.

“The main challenge is to remind people of the importance of the College as regards giving support to people in their individual practices in delivering high-quality treatments by having standards that people can turn to. It is about people seeing the College as a resource and then being involved in the further development of the resource. It is a work in progress.”

Dr Hillery said it is an honour to serve as President of the College and that he is looking forward to working with stakeholders in the role.

“We will continue to advocate for high standards and resources so that members of the College can do their work and trainees can be trained in environments that support training to the best standards.”

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