I received a letter..The brain is poorly understood and the way psychiatrists

pretend to understand it is ridiculous. Where is the science?Psychiatry is too woolly. I also dislike how difficult it is to be wrong in psychiatry because it’s all based on people’s opinions. In psychiatry there can be justifications for pretty much any diagnosis and no one ever gets better.

I also dislike the creation of conditions to excuse unpleasant behaviour. Some people are just plain unpleasant but are labelled as having all sorts of disorders therefore removing the pressure on them to change. Their bad behaviour just becomes “medicalised” but of course these isn’t anything “medical” about psychiatry

How can it be taken seriously when we don’t even get taught? We just roam around the hospital taking histories and the consultant or his registrar meet us once a week. I suppose the only thing I like about psychiatry at medical school is the way it’s quite chilled out. There isn’t much work to do and no one really keeps an eye on us

And then I received another letter

Mental illnesses are very common

In any one year 1 in 4 British adults

experience at least one mental disorder

Between 8% and 12% of the population

experience depression in any year

10% of 5-16 year olds have a mental disorder

5.4% of men and 3.4% of women have a

personality disorder

Among people under 65, nearly half of all ill health is mental illness

1.2m people in England have a learning

disability

There will be over a million people with dementia by 2021

and it’s serious Lifelong incidence of 25% of population 1% (600,000) with schizophrenia 15% lifetime risk of depression 10% mortality from

Schizophrenia Depression Eating disorders Alcohol dependency

Symptoms in US primary care

Kroenke and Mangelsdorff, 1989

0102030405060708090

100

Chest p

ain

Fatig

ue

Dizzi

ness

Headac

he

Back

pain

Dyspno

ea

Abdo pai

n

Numbnes

s

n pr

esen

tati

ons

Unexplained

Organic

Prevalence of unexplained symptoms in consecutive new attendees to medical clinics at King’s College Hospital

Clinic Prevalence (95% CI) Chest Cardiology Gastroenterology Rheumatology Neurology Dental Gynaecology

59% (46-72) 56% (46-67) 60% (45-73) 58% (47-69) 55% (45-65) 49% (37-61) 57% (50-68)

Total

56% (52-60)

Nimnuan and Wessely, 2000

80% of CMD seen in primary care

About 50% of new referrals to physicians don’t have conventional biomedical disorders

20-40% of A & E admissions involve drugs/alcohol

The commonest diagnosis in rapid access chest pain clinics is panic

Patients with any long term condition have three times the rate of depression

Mental health problems now largest cause of sickness absence

And lets not mention confusional states, dementia,

Etc etc

So how did I reply to the young men

Simon’s 3 challenges

Simon’s 3 challenges

1. Primary and secondary care

2. Health and social care

3. Physical and mental health

A tale of two hospitals

                                                                          

                                                                          

The gap…

The Mind Body Divide......

So the future doctor needs..

Effective team working

Long term care

Whole patient care/patient centred care/holistic care/people not pathology etc etc ….

Comorbidity

Consent, capacity, deprivation of liberty

Managing uncertainty, managing risk

Reduce complaints and litigation

• provide the opportunity to develop leadership, team working and supervisory skills in order to deliver care in the setting of a contemporary multidisciplinary team and to begin to make independent clinical decisions with appropriate support

2016 FP curriculum

So what is the new requirement

Promise of a remodelled and modernised PRHO not delivered on

Rands /Lowe -Psychiatry 2% -FY1 5.1 %- FY2 posts approx 400/12000 FY posts

Rotation through same specialty restricted in 2 year FP

22.5% of FY1 and 22.5% FY 2 with 4 month psych placements by 2015

Community placement for all FY doctors by 2017

BTFP breakthrough

My first priority Appointed FY Lead (Dr Ann Boyle) and FTE admin support Setting up National Foundation Psychiatry Leads network Setting clear standards for Psych FY placements Learning materials - 10 on line core packages First Trainees and First Trainers events held Foundation Doctors College Associate (08/15) Foundation Autumn School in each division by 12/15 Webpage Contribution to FP curriculum revision Developing strategy with HEE to support high quality placements

nationally Guide for supervisors Cultural –Faculty of educators Educational research - appointing Fellow to look at impact of FY on

skills, and what makes a high quality placement

Role of RCPsych

24

Annual cost of physical healthcare per patient (Colorado Access claims)

Source: Welch et al., 2009.

THANK YOU

HEE prioritise increase in core and higher training

HEE prioritise increase in General Adult HEE prioritise increase in CAMHS Generic

competencies in FY untested in specialities outside of GAP

HEE prioritise increasing physical medicine skills of psychiatrists

Post Francis /Post Winterbourne landscape transferable FY skills

CfWI overview

Number of FTs appointed to Core Psychiatry Training