Time to say goodbye

It was interesting to read this month’s guest blog for the Royal College of Psychiatrists by the Chair of RCPsych Scotland, Professor John Crichton. The College has recently celebrated 25 years of its office in Scotland: coincidentally I have worked as an NHS psychiatrist in Scotland over the same period. This gives me the encouragement to briefly reflect on Scotland’s approach to mental health over the last quarter of a century. Those who follow this blog will be aware that I have decided to retire at the age of 52.

I was sorry to learn that Dame Denise Coia is unwell and has stepped down from public office. In any correspondence I ever had with her, I always received a thoughtful, respectful and constructive reply and was impressed with her moral leadership. I send her all my very best wishes.

To return to Professor Crichton’s blog, he states that “it is all too fashionable for psychiatry to be dismissed along with the medical model”. Over my career I have encountered this defensive response a number of times, most notably in a lead editorial in the British Journal of Psychiatry from over a decade ago entitled ‘Wake-up call for British Psychiatry’. Then, as now, there was wide-ranging discussion about the medical model in psychiatry, often arguing that on its own the medical model is insufficient to address the mental health of any population. I was particularly struck by Professor Crichton’s description of the medical model in “Contemporary Scotland” as “multidisciplinary, reflective, takes into account carer and lived experience, evidence based, embraces realistic medicine and embraces human rights principles”. This is a confident summary of current practice which has been, and no doubt will continue to be, challenged by wider Scottish society.

Professor Crichton mentions the Choose Psychiatry campaign. As I am about to retire from psychiatry I would like to offer some suggestions which could contribute to the campaign. As is the case for all medical and scientific practice, ethics needs to be at the heart of all that we do. One aspect of this, which I have campaigned for over many years, is the need for Sunshine legislation to address any potential biases introduced by commercial interests. I do not think that the current recruitment challenges will be fixed by the “rebranding” of psychiatry, particularly if the focus continues to be defensiveness around the medical model. Psychiatry, like all branches of medicine, needs to acknowledge uncertainty and recognise that we are humans before we are patients. Learning comes in a range of forms and we must be open to learn from all experience.

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