Sunday 20 April 2014

Leading from the Couch - Psychiatry and Leadership

In just under a week, I will be attending the World Medical Association (WMA) Caring Physicians of the World Leadership Program at the INSEAD business school in Singapore. I will be one of a number of delegates from around the world representing our respective local medical associations. I am attending as a psychiatrist and will be learning and engaging as much as I can to become a better leader in this most challenging and important area of medicine.
Although a terrific honour, this is also confronting, and has led me to ponder what it is to be a psychiatrist and a leader? And even more importantly, can we still call ourselves leaders in debates around mental health or mental illness?

In a world that is post de-institutionalisation, over time more and more non-government organisations, consumer lobby groups and front line services such as Lifeline do an amazing job at helping people in crisis, enhancing the awareness of mental illness and attempt to reduce stigma. Government funding is directed at large organisations so that they can fund projects and inform the metal health debate. Office bearer positions within these organisations are not reserved for psychiatrists but a range of mental health clinicians. In fact WE are largely being labelled 'mental health clinicians' when we are Psychiatrists with medical degrees and post graduate training. And although funding and awareness is all important, I should not be at the expense of evidenced based care that psychiatrists are trained to deliver.

Today on Twitter, SANE posted a comment from their CEO, Jack Heath. In a recent comment in the Age he stated that more than 2500 people died by suicide in this country in 2012. He described this as deeply concerning, not least because it is the highest number of suicide deaths in the past 10 years. He called for collaboration between clinicians, NGO’s and Government. He believes mental health clinicians need more skills in recognising and managing suicidal tendencies. But what about psychiatrists, who are trained in this and can do this work being engaged in this debate. Actually, why aren’t we leading it?  

I am concerned about the ‘dumbing down’ of a profession I am very proud of. When I have a patient in crisis and need to call crisis services, I rarely get to speak to a medical colleague. Imagine a cardiologist sending in a patient to an emergency department with chest pain only to be told he cannot speak to the admitting officer, another doctor. And psychiatrists are largely losing traction as leaders in hospital multidisciplinary teams. Policy is often informed and determined by others.

Two ways I see that psychiatrists will continue to experience challenges as becoming leaders in the mental health debate:

1.    The Monash University Medical School now offers a course titled 'Medicine of the Mind' rather than psychiatry. I can only imagine the outcry if they offered orthopaedics as ‘Medicine of the Bones’. Not only is this a watering down of our skills and abilities, it may discourage medical students becoming future psychiatrists. Medical students need to be educated that psychiatry covers more than just the mind.

2.    On 16 April 2014, Dr Murray Patton, current President of the Royal College of Australia and New Zealand Psychiatrists (RANZCP) spoke on ABC Radio National about addressing community misunderstanding about psychiatry. He reported results from a survey of 1500 members of the public in Australia and New Zealand, which will be released shortly. Perhaps the most staggering finding was that more than half of Australians (56%) are unaware that psychiatrists have undertaken medical training as a doctor, and 15% of the community incorrectly thinks a psychologist has medical training. This would be unthinkable in other specialities in medicine, and one ponders how this has happened? If patients don’t know what we do, they may not feel comfortable being referred to us. Hence the barrier to effective evidenced based treatment widens.

So, I will be heading to off to Singapore, as a medical doctor, passionate about psychiatry and willing to work out how I can become involved as a leader in this very important debate. The incidence of mental illness is a global concern, a local issue, and we need a strong empowered medical workforce for generations to come.