President's Report

The President's life is a varied one. On one day recently, I had morning coffee with our Patron at St James’ Palace, visited Pentonville Prison in the afternoon and chaired an on-line evening discussion of the biochemistry of transmitters!

During the latter, I found myself saying that when I first came into psychiatry, a quarter of a century ago, schizophrenia was a diagnosis of hopelessness - of resistance to treatment and inevitable decline. Now all that has changed. Thanks to the sort of holistic package of help recommended in the NICE guidelines, the watchword is ‘recovery’. And this could be an analogy for the College, too. Where once there was demoralisation, now there is a spirit of creativity typified by the events of this past year - with RECOVERY as their acronym.

Reassessment of the Roles and values of consultant psychiatry is the remit of a College scoping group that feeds into the National Steering Group we co-chair with the National Institute for Mental Health in England and the Department of Health. That group is drawing together creative examples from all over the UK of how consultants can be freed to get back to what they enjoy doing best - taking on the most complex cases and consulting to the rest. Educational revision is a corollary of this. We have carte blanche, under the auspices of the new Postgraduate Medical Education Training Board (PMETB), to redesign our psychiatric training from undergraduate through to continuing professional development levels, to produce the sort of consultants that modern services require.

Despite being one of the newest Colleges, our Constitution needs overhauling with an eye to the devolution of powers, tasks and responsibilities out from 17 Belgrave Square to the geographical divisions and subspecialty faculties. In such a way, the College may begin to have a more immediate meaning to grass roots membership. Overseas, this is being mirrored by the establishment of international divisions through our Board of International Affairs. The meeting has already heard of our dealings with the World Psychiatric Association over the political abuse of psychiatry in China and the aftermath of conflict in the Middle East.

There are huge Vexations, of course. Like the rest of the NHS, we continue to struggle with the endless changes thrust at us, often with little evidence base to them. A survey we have commissioned from the CRU has shown just how little of all that promised new money has trickled down to the service level. And the College has continued to campaign vociferously for new mental health legislation that is fair, practical and effective, along the Scottish model. But the learned helplessness that threatened to engulf us in the face of these problems has changed to a firm, and sometimes angry, determination to take back control over our own profession.

The College continues its Ethical examination of all its structures and processes. One scoping group has tightened the guidelines on our relationship with industrial sponsors in general, and the pharmaceutical industry in particular; another is looking at what responsibilities the College might have for disciplining Members whose practice is beyond the pale. The External Review Team from the University of Central Lancashire has reported on its search for evidence of institutional racism. An implementation plan has been drawn up by the Chief Executive and promises to be a template for all other colleges to follow.

Relationships have become crucial in all these issues. No longer should the College feel isolated in its fight to improve the lot of patients and those who care for them. Our full membership of the Mental Health Alliance has been crucial in the battles over the Mental Health Bill; inter-college cooperation through the Academy did much to rescue our role in training from a PMETB that once threatened to shunt the colleges to the edge of their educational lives. We are looking at ways of developing closer ties with chief executives with whom we share the responsibility for establishing good services. Our relationship with the media has been improved by a greater willingness to face up to the controversial nature of much of what we do, and to talk about it openly in public.

So - RECOVERY: Roles; Education; Constitution; Overseas; Vexations; Ethics; Relationships; and You, the membership of the Royal College of Psychiatrists. None of my optimism should obscure the very real suffering of some members, struggling with the stress of trying to run poorly-resourced services or being bullied in their day-to-day trainee or consultant lives. A fifth scoping group is looking at ways of opening a confidential support and advice service to such members. But the prevailing mood has changed. Psychiatrists should not feel ambivalent about what they do. Whatever politicians and the media might say, our clinics are overflowing with patients and their carers who want and respect our help.

It hasn't always been a smooth ride over the last year, but we never promised that it would be. If you wanted ‘Royal College Sleepy Hollow’ then you should have elected a different set of officers!