Why the mental health sector should pay heed to the wisdom of Twain

One of the great pleasures of my job is to meet incredibly intelligent, enthusiastic young doctors who are just starting out on the path to become psychiatrists. With more people willing to talk about mental health, many young people are being inspired to look for a career helping others with their mental health.

It is vital that we harness the enthusiasm of these young people and do everything we can to help them along the path to their chosen career in the broad range of opportunities in our field.

Yesterday the government published their plan for how we are going to have the staff needed to deliver the promise of the Five Year Forward View for Mental Health. The acknowledgment of the extent of the problem and the urgent need to recruit and retain staff has to be welcomed.

It has been 18 months since the forward view was published. It set out to revolutionise the treatment of mental illness in England by 2021 but provided no clear indication of how to secure the right staff in the right numbers to deliver the right support.

A workforce plan could not have come soon enough. Talking to trainees across the mental health professions it strikes me that if we really wanted to revolutionise mental health services by the end of this decade, a strategy to create the workforce to match was needed back in 2008. After all it takes 13 years to train a psychiatrist.

For such plans to have impact requires tough and honest reflections on why staff chose to leave in the first place, accompanied by innovative action to encourage them to return

I know how exciting and inspiring it is to work in psychiatry, and I see the impact on a daily basis working as a general psychiatrist the positive difference it makes to people’s lives when delivered by well-resourced and skilled multidisciplinary teams. It is important that others see it as an attractive career choice.

Otherwise newly created posts will go unfilled. RCPsych is working with Health Education England and others to promote the positives of working with us, going right back to medical students and highlighting the importance of granting more of the new medical school places to universities that put mental health at the heart of the curriculum.

Given this lengthy training time, proposals within the plan to address gaps in the shorter term are important, including encouraging those who have left the sector to return to work. But for such plans to have impact requires tough and honest reflections on why staff chose to leave in the first place, accompanied by innovative action to encourage them to return and to ensure those working in the sector are keen to stay.

Growing demand

This week’s workforce plan focuses squarely on delivering the ambitions of the Five Year Forward View for Mental Health. The Royal College of Psychiatrists is determined to work, in partnership with other Royal Colleges, the third sector, central bodies and local NHS to ensure its success. But while doing so we all must bear in mind that the forward view does not give due attention to all mental health services, which is in turn reflected in the new workforce plan.

As such, the plan includes no strategy for increasing numbers of old age psychiatrists, despite demand rapidly growing (an unsurprising state of affairs given that there are 10 million older people in England, and rising) and a 10 per cent drop in consultants since 2014. Nor does it cover the workforce to support people with intellectual disabilities or with addiction problems despite the assessment and management of mental health problems in each of these groups requiring bespoke skills.

As with all “wicked problems” the sooner that clinicians, patients and local health and care leaders are fully involved in the planning, the better.

To address these crucial gaps and to be on the front foot as demand for mental health services rise, rather than chasing our tails to keep up, looking for quick fixes, running on almost empty, further grinding down over worked staff, we need workforce planning that thinks in terms of decades, not just the next few years.

Thankfully the need for a long-term comprehensive mental health workforce strategy has been accepted by HEE and a clear commitment given within the plan to ensure this happens.

As Ian Cumming, the chief executive of HEE, states: “No one organisation holds all of the levers necessary to produce the required workforce”, it’s a complicated business which requires input and co-operation from across the health and care sector.

Radical plans

Work to build on this week’s short term solutions and to develop a sustainable mental health workforce frankly needed to start a long time ago. Details now need to be clearly set out on how this work will be done, what will be covered and who will be involved in scoping, developing and implementing the work. The workforce plan has defined the challenges but not the solutions. As with all “wicked problems” the sooner that clinicians, patients and local health and care leaders are fully involved in the planning, the better.

The Royal College of Psychiatrists has argued often this year: any patient would expect to see a consultant if you had cancer or a heart problem, so it should not be any different for severe mental illness.

But if we do not make radical plans now to secure future numbers of psychiatrists, given our 13-year training pathway, we will never be able to meet patients’ needs.

There is much to be sceptical about and plans announced by politicians are seldom going to have an easy ride. Life on the frontline in mental health services isn’t easy right now. But in the words of Mark Twain “the secret to getting ahead is getting started”. The alternative is not an option.

Dr Kate Lovett is dean of the Royal College of Psychiatrists