| Editorial May 2006 "One must stop in time, while one still has the sense to stop in time(Dag Wiren) Talks often begin with a picture to grab attention! This, my last - and indulgently  retrospective - editorial offers a depressing image, photographed this week, with resonances which will become clear below. It epitomises, perhaps, difficulties for the profession in the ever changing medical world: for prospective consultants trapped without jobs because of a "vacancy freeze" (The Guardian) - (a disaster with a knock-on effect for junior doctors); think too about " Every doctors' surgery is to be awarded Michelin-style stars to show patients are getting value for money " (The Times ) Illustration: Greenwich District Hospital (May 2006) Upon entering my 80th year recently, I felt it was time to not renew my near-50 years approval as a S.12 accredited psychiatrist (not so long ago the compulsory retirement age was much younger, but needs serve to bend rules.…). I had indicated also that I would wish not to continue editing a medical journal once I was no longer pursuing clinical work, and that for the Society to move forward it needs to recruit a younger, pro-active editor with an interest in modern communication methods - such as phone/video conferencing to involve actively more of the Society's members who live far from London. No material for publication having been received this month, this may be a good opportunity to summarise some aspects of a long life in psychiatry, especially those relevant to the Society's core interest in doctors with professional difficulties, a continuing problem in an era of the NHS dominated by reorganisations and Management. Trained in psychotherapy at the Tavistock Clinic in the '50s, I was “headhunted” there to inaugurate a Child Psychiatry Clinic for Warwick . My first consultant appointment (combining child and adult psychiatry) coincided with the coming into effect of the 1959 Mental Health Act and first duties at Central Hospital, Warwick included “ regrading to informal status ” the vast majority of my allocated in-patients, all of whom had been held under compulsory certificate until then. Some four years later I moved back to London for family educational reasons; Warwickshire could not offer suitable non-residential schooling for my handicapped daughter, nor were there equivalent opportunities in that county for my musically gifted son, who went on to become the finest boy singer of his generation . [I was disappointed that the Hobbies section of Links and Downloads didn't take off.] Based in Kent and S.E. London, I developed my interests in assessment and psychiatric treatment of brain damaged children, and of offenders in hospital, in youth and adolescent institutions and in the community, and involved myself as an expert witness in litigation; retiring from maximum part-time NHS employment at 58 (on my accountant's advice!) just when the hospital service was entering the brave new world of Trusts – and of diminishing trust in consultants and psychiatrists? Few institutions in which I had served as consultant remain. They have been closed down, changed in usage or demolished; the original Borstal at Rochester , two schools for maladjusted and offender children and adolescents.... Of my hospitals in Warwick , Kent and South-East London , several are long gone. With their hospitals mostly no more, the elderly active members of the SCP have become relics of a bygone age.... - - - - - - - Viewed retrospectively, a key event leading towards my involvement with SCP flowed from a legal decision in respect of one of my own offender patients at Darenth Park Hospital - long before my medico-legal career began to flourish. From that date (probably in the '60s?) all Restriction Orders thenceforward would be “without limit of time”, unless there were compelling exceptional circumstances, and whatever the level of seriousness of the offences. That established a precedent and a norm which in effect put an end to the more usual operation of short-term Restriction Orders in ordinary psychiatric hospitals. Until then, restriction orders were frequently made for a limited period (such as one year) to endeavor to ensure a modicum of uninterrupted treatment; detained patients not so subject often availed themselves of the “28 days” rule, whereby absconders who were not recovered within four weeks (the police didn't try too hard to find them...) were assumed to be fit to run their own lives in the community. Amongst our patients, “going over the wall” was prestigious, even after the hospital gates were no longer shut and manned! The Home Office became more closely involved in RMOs' recommendations for relaxation of conditions and discharge; I found that involving their representatives in a ward round was a successful way to hasten release on conditional license, which might otherwise entail prolonged correspondence and delays. Nothing was better than face-to-face contact with the deciders when there were differences of opinion in correspondence; a principle to which I have never ceased to adhere. Early in the 1960s I became a medical member of the Mental Health Review Tribunal - most of my consultant colleagues were reluctant to become involved with medico-legal work and the hazards of cross-examination. I lectured and published widely about the MHRT and its problems, and initiated the first MHT Member' News Letter which grew into a DoH-funded Journal. The growth of Tribunals, and the scarcity of willing medical members, made the MHT become nearly a full-time job, with automatic retirement at 70 a thing of the past. - - - - - - - The involvement of Judges and QCs chairing tribunals (mandatory for reviews of restricted patients) grew until the death of the MHRT's Regional Chairman, a solicitor who had been a good friend and colleague of his MHRT Members. I met my professional nemesis in the shape of his replacement, a retired Crown Court Judge who appointed himself to sit on hearings of all types, including those for reviews of 28 day assessment detentions. That new Chairman's difficulties in his unaccustomed role as an equal amongst a tribunal of three, presiding over S.2 hearings that could not be prepared in the manner which he'd taken for granted in Court, and mine as one of his members, caused friction which eventually led to my suspension and then to contact with the Society of Clinical Psychiatrists and its Suspensions Study Group. Thereafter, a long continuing frustrating correspondence with the jointly responsible Departments of Health and the Lord Chancellor's.... Material published on SCPNET by myself and by my predecessor as Editor is ripe for development by a student of law &/or ethics looking for a research topic - those Departments' organization and interrelationships very much a case of divide and confuse and rule, which came to light pursuing in depth investigation, and which echoes the problems of large institutions exemplified by the recent illegal immigrants scandals in the Home Office, Prison Service and the Department of Work and Pensions! The rest is, as they say, history; history some of which - including a brief history of the Society of Clinical Psychiatrists - is available to read on the pages of SCPNET, the editorship of which I took over on request to help out in deplorable circumstances during 2004, which is another story… - - - - - - - The problems hinted at in the March & April editorials have remained unresolved, with a hardened - and regularly contested - misplaced belief that I had somehow been blocking access to SCPNET from material needing to be published. To conclude this my final editorial for SCPNET, I express my thanks for many letters and emails of appreciation and support received from SCP members and visitors to the site, and my hope that its health will be regained under my successor and that it will become essential (and often controversial) reading for psychiatrists. If my incumbency is to have one legacy, I hope it will be my demonstration of the value of hyperlinks , of which there are half a dozen above, a facility which leaves paper journalism light years behind the potentiality of the www . PGW [This farewell has been written without checking facts and dates; so there may have been be a few errors of chronology and interpretation which a fallible near-80 memory may partly excuse, and upon which comment and correction will be appreciated?] P.S. June 2006: Dr Moudi Elameer, who created the website, has kindly agreed to take over webmastering SCPNET until the next Annual General Meeting. He looks forward to posting material received for publication. And, above all, we are in the midst of an accelerating revolution in web based communication and telecommunications, with the national paper's taking on the growth of blogging to give ordinary people a voice. All this, if taken on board, could make SCP (which was prominent in campaigning for the foundation of the Royal College of Psychiatrists) become far more more influential and effective again than it has been in recent years.
|