Medical management and clinical leadership

Am I alone in finding a distinct irony in the publication of the first two articles in the June issue (Psychiatric Bulletin, June 2006, 30, 201–203 and 204–206) - namely ‘Medical managers in psychiatry - vital to the future’ and ‘Kerr/Haslam Inquiry into sexual abuse of patients by psychiatrists’? I note in the latter paper comments by Dr Kennedy regarding ‘consultants being “all powerful”’ and that ‘the report challenges the absence of a clear moral and contractual obligation for all mental health professionals to report all such information, and the lack of an NHS system to maintain an accessible memory bank of all such data. Will the professions fear this as a “ big brother” scenario or welcome it as an essential protection of their patients and their credibility?’ These comments are made immediately after an article by Griffiths & Readhead which champions the cause of ‘medical managers’ and which sets out clearly their views of how ‘vital’ this role is to ‘psychiatry’.

In my opinion these two articles highlight the inherent danger of the move by the Royal College of Psychiatrists to appoint a vice-president to promote ‘ medical management’ with the clear aim that we continue a ‘ medical model’ of ‘medical management’ where psychiatrists in these roles are seen as having great influence at strategic board and other levels and indeed over other professional colleagues.

I would respectfully suggest that this move by the College reinforces the stereotype of consultants and of medical managers being ‘all powerful’, as highlighted by the Kerr/Haslam Inquiry. The reality is that if we as a profession are serious about leading services into the future and providing strategic direction, we should only be given this role if we are able to demonstrate the ability to provide clinical leadership to all clinicians working within mental health services. We expect psychiatrists to work and indeed provide leadership to multidisciplinary and often multi-agency mental health teams in a variety of settings, yet at College and other levels we continue to promote a model of ‘medical management’ rather than a model of clinical leadership.

My opinion is that if we are serious as a College in wishing to provide leadership in both the development and provision of services in the twenty-first century then we need to embrace models of clinical leadership in which consultants engage with other professionals and accept that being a consultant gives one no divine right to act in an all powerful, inappropriate way. It is unacceptable for consultants’ behaviour to be challenged only by other consultants who are ‘medical managers’. If these models of clinical leadership are not adopted I fear the ‘failures’ identified by the Kerr/Haslam Inquiry will only be repeated in the future. This surely is the challenge for psychiatrists interested in management roles in 2006, and the College should be promoting a model in which psychiatrists are selected for management roles on merit rather than simply because they are a doctor.