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Mental health services in crisis over staff shortages

Cambridge Neuroscientist speaks to the Guardian to highlight how overcrowded and understaffed psychiatric wards are leaving patients fearful for their safety and unable to make proper recoveries.

Professor Peter Jones, Head of the Department of Psychiatry, and pictured right, at Cambridge University, admitted the lack of psychiatry applications was a "terrible state of affairs". He said the formation of specialist mental health trusts had made psychiatry "seem more remote from mainstream medicine". He also said stigma "is a huge problem for people with mental health disorders and trickles into professional lives."

Peter spoke to the Guardian in response to the damning assessment of Britain's mental health service by its lead professional body, Royal College of Psychiatrists.

A survey by the royal college found that 544 consultants' posts in the UK – 14% of the total – are either unfilled or filled by a locum. In addition, 209 consultants intend to retire or resign soon, a situation exacerbated by the government's cap on immigration from outside the EU.

"This is a huge, a massive problem," said Professor Dinesh Bhugra, the outgoing president of the Royal College of Psychiatrists "We will be left with a dangerous vacuum of help for people with mental health disorders or will be forced to get special dispensation from the government to recruit heavily from countries who can ill afford to lose their mental health professionals."

These warnings are supported by a study to be published next week in which the royal college describes how about half of patients – mostly women – report feeling unsafe in many of worst-performing hospital trusts. The report also says:

• Average bed occupancy rates in English inpatient units are much higher than the 85% standard, with some wards running at 120% occupancy.

• Access to psychological therapies falls far short of acceptable standards recommended by the National Institute for Health and Clinical Excellence and other health bodies.

• Daily one-to-one contact with nursing staff is less than that accepted as being conducive to recovery.

• Outreach links into the community are insufficient in two-thirds of the wards inspected by the royal college's centre for quality improvement.

Speaking to the Guardian via e.mail, Peter explained:

"It's a terrible state of affairs when we have problems recruiting to the most fascinating medical speciality, involving one of the best universities in the world, and focusing on the most awe inspiring organ in the body - the brain. Developments in modern neuroscience will revolutionise psychiatry and the understanding and treatment of mental health disorders within the professional careers of doctors who begin clinical psychiatry now.  

A few years ago we would have had one or two hundred applications from recent medical graduates for the early, post-graduate training grades in psychiatry. Changes in the rules regarding overseas graduates are starving the NHS of doctors in the training grades for several specialities that relied on these doctors for much of the workforce, one of which is psychiatry. There should be enough local graduates but too few apply to train in psychiatry. We put a great deal of thought and energy into trying to attract the brightest and the best medical students, from Cambridge and elsewhere, into our speciality. I think we do get the cream but we need to enthuse more potential applicants.  

So why don't enough good applicants apply? We'd do better in Cambridge if we could be more autonomous in what we offer to trainees, particularly in blending enough clinical training with the exciting research and academic opportunities we can offer; we need to be able to tailor training to the needs, talents and interests of young doctors. Recent changes in post-graduate medical training have resulted in a system that is too constrained, rigid and clunky; it wasn't meant to do this but there's too much process and reliance on a one-size-fits all approach.  

In their early years medical students flock to options on neuroscience and the biological basis of mental health disorders and we do a good job with teaching them clinical psychiatry later in their course; but they don't then decide to pursue it as a career.  

I think the formation of specialist mental health trusts has made psychiatry seem more remote from mainstream medicine, a paradox at a time when we're understanding the serious physical consequences of mental health disorders such as schizophrenia; a young adult with an illness such as this is as likely to die prematurely, largely from cardiovascular disease, as is someone who develops a common cancer. Conversely, we're realising that for conditions such as obesity and its consequences the biology is in the brain, not the body. As doctors we need to put the brain back in its body and deal with the whole person.  Current health service structures subvert this, as does an all too common supine attitude from psychiatrists who forget that it is only they who are equipped to champion this approach.

Stigma is a huge problem for people with mental health disorders and it trickles into professional lives, too. Attending a 25 year reunion of my medical school chums one told me that that I was too bright to have gone into psychiatry - a backhanded compliment but also a comment on the attitudes young doctors have to deal with if they're considering psychiatry. I now work in a service for young adults with a first episode of potentially devastating psychotic illnesses www.cameo.nhs.uk ; the majority of the youngsters we see get their lives back and recover. Psychiatry needs to get the message out to the public and to professional colleagues that we have some of the most effective interventions in medicine. That's not to say that treatment developments aren't desperately required. Neither can we deny that understanding the way the brain interacts with its environment in the genesis of mental health and its disorders is fundamentally complex and difficult. But we've got to get the message across that it's also exciting".

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Posted on 21/06/2011