women and mental health special interest group newsletter v7.pdf · psychiatrists who strive for...
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Chair’s Report
Thank you for all your support during a very busy
few months since I took on the role of Chair of
WIPSIG (as it was then) and welcome to our first
newsletter under our new name. Henceforth our
SIG will be known as the Women and Mental
Health SIG, more accurately reflecting our core
aim of promoting the mental health of women as
well as our commitment to supporting
psychiatrists who strive for work life balance- not
just women!
For those of you who don‟t know me, I‟ll begin
with a little bit of background about myself. I am
a dually qualified forensic and general adult
psychiatrist with a special interest in women‟s
mental health, personality disorder and offending.
My clinical role involves being the consultant
forensic psychiatrist on a medium secure
admissions unit in the Women‟s Service at St
Andrew‟s Healthcare in Northampton. I trained
in the East Midlands where my clinical career has
covered a range of settings, including high,
medium and low security as well as community
forensic psychiatry, general community mental
health teams and prison in-reach services as well
as medicolegal work within the area of mental
health and particularly women‟s mental health.
My research interests are in the area of women‟s
mental health, particularly treatment of
personality disorder. I combine my clinical work
with the role of Strategic Lead for Services for
Women and Associate Medical Director -
Training and Education for the Charity.
We have welcomed new members onto the
executive committee: Dr Maria Atkins (Flexible
training/ working), Dr Jackie Short (re-joining
from New Zealand), Dr Nisha Shah and Dr Anya
Topiwala (PTC representative). Dr Michelle
Gilmore has decided
to continue as an
executive committee
member following the
end of her term as
PTC representative.
A special thank you
to Dr Fiona Mason,
outgoing Chair, for so
ably undertaking this
role.
Highlights of the last few months have included
two successful conferences hosted by our SIG.
A Lifetime of Caring (held jointly for the first
time with the Northwest Division of the Royal
College) saw the culmination of our Mental
Health Impact of Caring workstream. The
quality of presentations and discussion
generated was excellent. Presentations are
available on our website. Our annual essay prize
was awarded at the conference to an excellent
submission from Dr Ruth Reed about her
research on the mental health of asylum
seekers. Dr Reed writes about her research in
this edition of the newsletter.
The Women in Leadership: Meeting the
Challenges Conference took place in London in
March 2012. A very enthusiastic group gathered
to participate in some inspirational
presentations, one of the highlights being the
Olivier Mythodrama session. We are
considering a follow-up event based on
feedback received after the conference.
Our new workstream for the next two years
will focus on the mental health of women in
disadvantaged groups. We are seeking
Women and Mental Health
Special Interest Group Summer 2012 Newsletter
Inside this issue:
Chair‟s Report 1
Editor‟s Report 2
Kia Ora! 3
Dance Around
Brick Walls 4
The mental health
impact of caring 7
Life As a Junior
Doctor 8
The spring
conference from a
trainee‟s
perspective
9
Research Prize
2012 9
Less than Full
Time Training:
Less is More?
10
My ABC of
Management &
Leadership
12
Judith Edwards -
Biography 17
Rise of the
computer and
e-portfolio?
18
What is the
Women and
Mental Health SIG?
20
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Since our last newsletter we have welcomed our new Chair,
Dr Katina Anagnostakis, Consultant Forensic Psychiatrist at
St Andrews Hospital, Northampton who has taken over
from Dr Fiona Mason. We thank Fiona for her strong
leadership, focus and hard work, and support Katina in her
new role taking our Special
Interest Group forward.
The Women and Mental Health
SIG and Newsletter will continue
to encompass both women's
mental health needs and services,
as well as career issues relevant to
psychiatrists.
Historically our SIG‟s membership
has been predominantly women
psychiatrists, however we have
recently welcomed our first male psychiatrist members with
an interest in Women‟s Mental Health and hope the change
of name will encourage both male and female psychiatrists to
join our SIG in the future.
Within this Newsletter edition there is a major focus on
careers from the challenges of a junior doctor,
correspondence about the difficulties progressing through
training and having children, career development and
leadership and management. Our successful Spring 2012
Conference, " Women, psychiatry and leadership : rising to
the challenges" is summarized by Dr Gira Patel, who did a
fantastic job organizing the event and securing high quality
inspirational women speakers. One
comment that particularly struck a
chord for me was Dr Geraldine
Strathdee talking about how early
challenges in her formative years had
shaped her personally and shaped
her drive and determination.
Forging a career with personal and
family commitments requires focus
and drive balanced with
organisational skills with flexibility
and an ability to shift between roles,
backed by a solid support network. Dr Nisha Shah in her
article about her portfolio career demonstrates these
attributes ably and is also an interesting read.
Our annual essay prize is this year reflecting one of our
workstream topics: “The mental health of women in
disadvantaged groups” which I would encourage medical
undergraduates, trainees and new consultants to enter.
We always welcome feedback and correspondence to the
Newsletter, as well as articles for submission, so please get in
touch.
Dr Rebecca Horne, Consultant Psychiatrist and
Newsletter Co-Editor
Editor’s Report
“We hope the
change of our name
will encourage both
male and female
psychiatrists to join
our SIG.”
Page 2
motivated colleagues to join a working group in order to
follow through with a programme of projects around this
theme. This is a great opportunity to get involved with an
initiative aimed at improving the mental health of women and
gain some valuable experience with College work and
project management. The output of this workstream along
with other projects will inform a larger project aimed at
developing a curriculum in women‟s mental health for
psychiatric trainees.
Finally, the Women and Mental Health SIG Exec would like
to hear from you! As one of the larger SIGs there is an onus
us to contribute to the work of the College. Engaging our
membership of almost 3000 will be central to the work of the
SIG as we go forward. Therefore I‟d like to encourage you to
get in touch with us if you would like to become involved in
our workstreams for the year ahead, with any issues you
would like the SIG to take forward or explore whether
relevant to women‟s mental health or the working lives of
psychiatrists, and Newsletter submissions or correspondence.
Dr Katina Anagnostakis, Consultant Forensic Psychiatrist
and Chair of Women and Mental Health Special Interest
Group
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throughout New Zealand by funding family violence
intervention coordinator positions in all district health boards
(DHBs), auditing DHB performance, supporting related
research and evaluation, and offering technical advice and
training support to health services committed to the
programme. As a member of the Mental Health VIP group for
CCDHB, we are looking forward to launching our specially
tailored training for mental health professionals in May 2012.
This will also help to alert health professionals to their legal
responsibilities to all vulnerable adults as well as to children,
set out in recent legislation. The Crimes Amendment Act
(No.3) 2011, which came into force on 19 March 2012, makes
it an offence to fail to take steps to protect a vulnerable adult
(or child) from injury – with a maximum penalty of 10 years
imprisonment. A sobering thought!
Another exciting initiative to report is the establishment of
the Australasian Committee of Forensic Women‟s Services
(ACFWS), which comprises of a group of psychiatrists who
work with women in secure settings across Australasia. We
are delighted to report that the membership includes
colleagues who have moved from the UK namely Dr John
Jacques in New Zealand and Drs Daniel Riordan and Sophie
Davison in Australia. The ACFWS is also keen to establish
links with Women and
Mental Health SIG and to
contribute to raising the
profile of women‟s mental
health at an international
level. Three of us, Dr Nina
Zimmerman from Victoria,
Dr Megan Ferris from
South Australia and myself, attended the RMA Conference in
Dunblane, Scotland 5-6th March 2012 “New Directions in
evidence-based and gender-informed practice”, which included
training in the Female Additional Manual (FAM) for use with
the HCR 20, when assessing risk of violence in women. We
are looking at trialling this in our respective services. It was
also important to trial the local fare and Nick Nairn‟s
Restaurant, The Kailyard at the Dunblane Hydro comes highly
recommended!
Dr Jackie Short,
Consultant Forensic Psychiatrist & Senior Clinical
Lecturer (University of Otago)
As we prepare for winter on this side of the globe, it‟s a
good time to reflect on the progress made for women in
secure mental health services in New Zealand. The national
Women in Secure Care Committee (WISC), established by
the New Zealand Forensic Psychiatry Advisory Group, in the
wake of the report of the Working Party into the Standards
of Care for Women in Secure Mental Health Services in
New Zealand, released in 2009, has
just completed its first year of work.
The Terms of Reference are:
To implement the recommendations of
the National Working Party for Stan-
dards of Care for Women in Secure
Mental Health Services in New
Zealand (2009), in line with Regional
Plans. The identified, agreed standards
of care will be implemented across all
Regional Forensic Mental Health Services and their maintenance
subject to audit and regular review. They will be suitable for
international benchmarking.
To advise, advocate and act as a resource on all matters relating
to the mental health of women in secure care to NZFPAG; the
Ministry of Health, Ministry of Justice, and other government
departments for example, the Ministry of Women‟s Affairs; NGO
providers and other relevant agencies.
To develop a nationally-agreed programme for gender training in
women‟s mental health, informed by international practise, to be
delivered at Regional level.
There are now local WISCs established in each of the five
Regional Forensic Services, whose remit is to work at the
local level within the individual Regions, to deliver on the
nationally agreed standards. The first national audit of the
care standards is about to be undertaken, with the aim of
identifying needs and guiding the direction of developments.
We are also committed to having a gender-informed
forensic mental health workforce across New Zealand and
proposals as to how to best to achieve this are currently
being considered.
The Ministry of Health‟s Violence Intervention Programme
(VIP) supports health sector family violence programmes
Kia Ora!
Page 3
Summer 2012
“We want to raise
the profile of
women‟s mental
health at an
international level.”
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Dance Around Brick Walls
Page 4
‘Dance around brick walls’ was the inspirational take-
home message from the Women and Mental Health SIG
2012 Spring Conference entitled „Women, psychiatry and
leadership: rising to the challenges‟ and held in London on
7th March. The quote from one of the speakers, Emma
Stanton, beautifully captured
the acknowledgement that
women still face barriers to
taking up leadership roles but
that these can be overcome by
optimism and energy, both of
which were flowing in
abundance at this memorable
event.
I had originally been inspired to
organise a women and leadership themed conference
following some of the recommendations made in the Deech
Report (2009) such as encouraging women into leadership
roles and improving access to mentoring and career advice
for women. Although about two years in the making, this
event finally took place at a time when we have a female
President of the College and a female Dean, and
coincidentally, the day before International Women‟s Day,
so it could not have been a timelier opportunity to bring
together women in psychiatry who are interested in
leadership development. The event was an excuse to
celebrate the achievements of ordinary working women
who have demonstrated extraordinary leadership and paved
the way for future women leaders as well as being an
opportunity to inspire women in psychiatry to step up to
current leadership challenges. The fact that the event was
deliberately aimed at and exclusively attended by female
delegates meant that topics such as tackling glass ceilings,
gender pay gaps and juggling motherhood with compromises
in career progression were openly raised and comfortably
discussed, something that might not have been possible with
a mixed audience or a more general leadership themed
event.
The line-up of speakers was impressive and varied. Opening
the event was the dynamic Dr Geraldine Strathdee. She is a
consultant psychiatrist who manages to combine working in
an intensive community treatment service in South-East
London with being the Associate Medical Director for
Mental Health at NHS London and being the mother of
four…and an enviable life-long requirement for only five
hours sleep a night. Geraldine set the scene for the
conference by describing leadership challenges in psychiatry in
the context of national economic and socio-political drivers
for changes in the health and social care systems. She
reminded us that some of these changes are simply not an
option; the system will not be fit for purpose if left as it is. She
also reminded us that not all change is bad – for example,
look at the number of women now entering medical school
compared to the era when she entered as the only female
intake. She movingly described the key leadership role mental
health professionals have in preventing the disintegration of
families and communities caused by poverty, crime, drugs and
mental illness through all of us committing to use our scarce
resources better, to encourage our teams to train in systemic
and recovery approaches and to relentlessly and
demonstrably support and advocate for individual patients to
achieve their full potential in life, whatever their
circumstances.
If Geraldine lifted us with her dynamic enthusiasm and
personal insights, then the next speaker Dr Penny Newman
took us further still. Penny is a GP in Sussex and also
possesses an ability to not only do the day job spectacularly
well but juggle other impressive leadership roles including
being an Associate Medical Director, Consultant in Public
Health and member of NHS East of England Commissioning
Development Team. She is also
mother to three children.
Penny‟s talk entitled „How I got
there- what top women doctors
say‟ included insights from the
report she was commissioned
to write in 2011, „Releasing
potential: women doctors and
clinical leadership‟. This report
suggested several practical
solutions to improve the female
talent pipeline and address
gender gaps in clinical leadership
including improvements in childcare and family support, ini-
tiatives to retain career paths in leadership (even if women
“Women still face
barriers to taking up
leadership roles but
these can be overcome
by optimism and
energy.”
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Page 5
Summer 2012
make temporary exits from their career or work flexibly),
networking opportunities, role models, sponsorship and
earlier leadership development including mentoring and
coaching. It was actually Penny who pointed out that
International Women‟s Day
followed the day after our event
and on this note, she described
her involvement in the inspiring
work of the Half the Sky
movement in poor developing
countries, which turns oppression
into opportunity for women
worldwide. She described the
example of micro-finance projects where oppressed women
in poor communities are economically and educationally
empowered as leaders by being given a small loan to start a
business within their community. Research has shown that if
a man is given a $100 loan, he tends to spend the majority
on himself and invest only a small percentage in the
community whereas women tend to invest the majority into
their children and wider community, resulting in sustained
and shared benefits for entire communities. We did not
really need a coffee break such was the stimulation and
energy from the two morning speakers but discussions over
coffee clearly showed we had all been inspired to learn more
about Half the Sky and to watch inspirational leadership talks
by some of the world‟s most fascinating thinkers and doers
on the popular TED.com website.
There has been increasing use of mentoring and coaching for
leadership development in recent years as our next speaker,
Dr Rebecca Viney told us. She is a GP and Coaching and
Mentoring Lead for the successful London Deanery
Coaching and Mentoring Service which has helped over 1200
mentees and trained 460 mentors. Rebecca explained the
value of mentoring and coaching for women in particular on
topics such as finding work-life balance, managing
relationships, prioritising commitments and making career
choices. She got us to describe the behaviours of someone
who was a positive influence on our own development and
growth. Interestingly, there was strong consensus that
behaviours such as active listening, being interested in
others, being approachable and empowering others to find
solutions to problems were the most influential. Rebecca
suggested these simple behaviours are the very leadership
behaviours that can turn good women into great women.
Dr Emma Stanton, a former Commonwealth Fund Harkness
Fellow in Health Care Policy and Practice and former
Clinical Advisor to previous Chief Medical Officer Professor
Sir Liam Donaldson, is an incredibly talented psychiatrist and
sailor. Having achieved so much in high level clinical
leadership roles after being a member of a winning yacht
sailing team in a round-the-world race and then achieving an
MBA, she is unbelievably, still a young trainee and currently
combines clinical work with her role as chief executive of
Beacon UK. Emma eloquently provided insights from a
trainee‟s perspective and talked about the habits of emerging
women leaders such as maintaining one‟s clinical credibility
whilst taking on formal leadership roles. She said barriers
will always be present whether that barrier is an individual
not agreeing with you or an organisation not wanting to
undergo change but the key to success was to have a clear
vision, be brave, be optimistic and spot the opportunities to
overcome barriers - learn to dance around the brick walls,
not feel beaten by them. With this enthusiastic and
entrepreneurial spirit in mind, we were fascinated by the
success story of Dr Sally Ernst, a lady who had survived
meningitis, lives with bipolar disorder and who has built a
multi-million dollar global web solutions business from
scratch having spotted a gap in the market at a time when
the Internet was in its infancy. Sally described the value of
resilience and learning from failure. She described how her
leadership approach had needed to adapt quickly over time
as her business portfolio became increasingly large and
successful whilst facing increasing competition in the
booming IT industry and battling health problems. Her
“Learn to dance
around the brick
walls and not feel
beaten by them.”
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evident energy, relentless attention to detail, and sheer
determination to succeed have been why she has succeeded
but she admitted, success has at times been at some cost to
her health. Her parting message was to truly believe in what
you are doing because your passion will rub off onto those
around you.
In the final afternoon sessions, we were treated to hearing
about new approaches in
leadership practice and training.
Firstly Becky Malby, Director of
the Centre for Innovation in
Health Management re-iterated
the words of earlier speakers that
in the current context of meeting
targets, bearing financial pressures,
reconfiguring services and no-one
wanting to be the next Mid-Staffs,
it was clear that new and
innovative solutions were needed,
which requires new and innovative
leadership approaches. An example
of this is co-production, a process that involves ordinary
people in the design and, crucially, in the delivery of the
services they enjoy. Co-production lends itself particularly
well to changes in public services as it naturally results in
social value for users of those services, promotes more
effective use of local resources and can lead to more
constructive engagement and involvement of individuals and
communities. For those who feel brave and want to try
something new for problems you are stuck with, there is an
increasing evidence base for co-production, with good
examples of successful application of co-production
particularly in health services include Time Banks and The
Good Gym amongst others. Becky also emphasised the value
of networks to support leaders attempting to address big or
compelling issues and advised that networks can be in many
forms including clinical networks, social websites,
communities of practice for learning and development right
through to large-scale social movements. Following Becky,
we had a captivating final session from the actress and
singer, Phyllida Hancock of Olivier Mythodrama who
introduced us to a particular style of leadership development
and training based on theatrical performance of William
Shakespeare‟s plays and analysis of leadership lessons
contained within them. Sounds strange? I think for most
delegates, it was certainly different to any other leadership
training they had had before, but all agreed that it is so
interesting to explore Shakespeare‟s work in this way and the
theatre style is unbelievably powerful. Phyllida took us
through the leadership lessons in Henry Vth emphasising his
reluctant entry into the role of king and difficulties adjusting
to his new responsibilities, followed by lack of belief in him by
followers who eventually became traitors. The final act right
of the unexpected victory at battle was the result of Henry‟s
inspirational vision and enduring belief in his people. Phyllida
beautifully summed up the key leadership lesson as vision- the
art of seeing what life could be like while dealing with life as it
is.
This leadership themed conference, the first of its kind
organised by Women and Mental Health SIG was an
undoubted success thanks to the high calibre of our
wonderful speakers and the enthusiasm of delegates who so
willingly shared their experiences and networked on the day.
Evaluation feedback strongly indicated there was an interest
for further leadership events from Women and Mental Health
SIG in the future. As a result, Women and Mental Health SIG
is continuing its Women and Management work stream for
another year and we look forward to organising further
events in the near future.
Dr Gira Patel,
Women and Mental Health SIG Women in Management
work stream lead
Page 6
“Phyllida beautifully
summed up the key
leadership lesson as
vision- the art of
seeing what life could
be like while dealing
with life as it is.”
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Page 7
The mental health impact of caring on refugee women: where to
start?
The mental health of refugees is all too often considered in
terms of the health of individuals, and fails to take account of
the interlinks between individual, family and community
health.
I examined the degree to which Western mental health
services‟ models of the „carer‟ and „cared-for‟ are helpful in
understanding the complex situations of refugee women and
their roles within families and communities where many
members may be suffering from post-migration psychological
difficulties.
These difficulties can range from distress and subthreshold
symptoms which have minimal functional impact, through to
complex psychiatric disorders. I conducted a systematic
review of literature exploring the impact of caring on refugee
women‟s mental health and found the number of relevant
studies to be very small and purely focused upon parent-child
effects, rather than considering a broader range of caring
roles.
I also considered future research directions which could help
health services to gain a deeper understanding of the
complexity of women‟s caring roles.
Possible directions included longitudinal work, the evaluation
interventions targeting one or more family members, and
qualitative studies to explore refugee women‟s own
perceptions of their caring roles.
Dr Ruth V Reed, Specialty Registrar ST4 in Child and
Adolescent Psychiatry, Oxford Deanery
The mental health impact of caring
Our Autumn Conference, A Lifetime of Caring took place in
Manchester on 9th November. This first time collaboration
for our SIG with a College Division (North West) was very
succesful. The conference examined the mental health issues
around caring and the cared for from a lifespan perspective,
attracting a varied audience and resulting in some very lively
discussion and debate!
Dr Angelika Wieck, Lead for the North West
Perinatal Mental Health Service, started off the
morning session with a focus on Perinatal
Assessments of Parenting in Women with Severe
Mental Illness.
The morning breakout sessions, kept the focus
on young carers and the parent child dynamic:
Louise Wardale (Barnados) facilitated a session
on Helping children and young people come to
terms with parent‟s mental health problems and
Dr Louise Theodosiou and Jane Davies facilitated a session
on Parents caring for children with mental illness and
children caring for mentally ill parents. In a parallel session,
Dr Art O‟Malley presented a fascinating session on Bilateral
Affective reprocessing.
Dr Kathryn Abel, Director, Centre for Women‟s Mental
Health, University of Manchester presented her team‟s
research on Optimising parenting outcomes for mothers
with schizophrenia, inviting us all to examine our clinical
practice with women of childbearing age.
The afternoon session opened with Dr Irene Cormac,
Honorary Forensic Psychiatrist, who presented an extremely
thought provoking and insightful session highlighting the
mental health issues for Women as Carers. The session also
explored the complex interpersonal dynamics at play within
carer – cared for relationships.
Further parallel sessions followed, covering amongst others:
Implementing a “Think child, think parent, think family”
approach: Findings from 6 UK sites facilitated by Hannah
Roscoe, SCIE and Women in secure services – assessing risk
to children; facilitated by Dr Victoria Norrington-
Moore and Dr Olivia Guly.
Dr Daniel Anderson, Consultant Old Age Psychiatrist,
concluded the event with a session focussed on a
psychodynamic insight into Carer Stress in Dementia.
The film Iris was used as a device to aid understanding
and discussion.
The results of our annual essay competition were
announced during the conference and the very well
deserved prize was awarded to Dr Ruth Reed, whose
submission impressed our judging panel with it‟s originality,
clarity and coherence. Congratulations! A summary of Dr
Reed‟s essay is included within this newsletter.
Event feedback suggested that the program enabled
participants to develop their insight and understanding of this
complex issue from a number of new perspectives.
Our thanks go to colleagues in the North West Division for
co-hosting the event with us and to Dr Beth Haider (exec
member) for all her hard work on the planning committee.
Dr Katina Anagnostakis, Consultant Forensic Psychiatrist
and Chair of Women and Mental Health Special Interest
Group
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Dear Dr Horne and Dr Gilmore,
On reading Dr Gira Patel's article "The Psychogeriatrician's Week" in the WIPSIG Winter 2010 newsletter, it made me think
about the multiple emotions experienced in a 'typical' day in a psychiatry post, especially when working in multidisciplinary
teams. It made me think about my training so far in psychiatry as a CT1 and I wanted to share some work I had previously
done - it was an entry I submitted for a Junior Doctor's Prize and the theme was 'A day in the life of a junior doctor'. Just
thinking about the topic in my day-to-day job in psychiatry for older adults made me realise the long list of feelings/emotions I
would regularly experience on a daily basis. The best way I could think of describing my feelings and emotions was to present
them in a word-picture rather than an essay.
I feel it is relevant to being a female trainee as sometimes I feel more easily affected emotionally by my clients and even
colleagues.
I am currently a CT1 trainee in KSS Deanery and I am working for Surrey and Borders NHS Foundation Trust. My current/
second psychiatry post is adult psychiatry following a 6 month placement in psychiatry for older adults.
Kind regards
Dr Ekaterina Doukova
A Day in the Life of a Junior Doctor
Active Advantageous Agreeable All right Amazing Angry Awesome Beneficial Big
Bleep-free Bloody Boring Busy Calm Challenging Chaotic Cheerful Clever Cold
Cool Crazy Complicated Confusing Decent Delightful Demanding Demonstrative
Depressing Devastating Different Difficult Disappointing Disconnected
Distressing Disturbing Doable Drastic Ecstatic Educational Emotional Emotive Enjoyable
Enormous Eventful Excellent Exciting Exhausting Exhilarating Expensive Expressive Fair
Filling Fine Frantic Friendly Frightening Frustrating Fulfilling Funny Gloomy
Good Great Gripping Gruelling Hands-on Happy Hard Heartbreaking Heavy Hectic Helpful
Heroic Huge Immense Imposing Impressive Incredible Indefinite Informative
Joyful Just Kind Knowledgeable Lonely Long Loud Lovely Magical Majestic
Manageable Manic Meaningful Momentous Monotonous Moody Moving
Nauseating Nervous Nice Noble Noisy Obedient Observant On-the-go Opportunistic Piercing
Powerful Practical Proficient Purposeful Pushy Quiet Rebellious Regular Rewarding Rich
Risky Safe Satisfying Scary Scrappy Sensitive Skilful Sleepy Slow
Social Splendid Stimulating Strange Stressful Taxing Tearful Testing Thrilling
Tiring Touching Tricky Trusting Turbulent Unique Useful Useless Vigorous Violent
Wacky Weird Wild Worthwhile Wow Youthful
Life as a Junior Doctor
Page 8
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Women and Mental Health SIG Research prize 2012
Have you ever imagined how an all-women conference
would be?
I hadn‟t. Not until I found myself in that situation. Through
my role of representative on the Psychiatric Trainees‟
Committee of the Royal College I was asked to attend on
behalf of a colleague.
The spring conference of the Women in Psychiatry Special
Interest group had as topic “Women, Psychiatry and
Leadership: Rising to the Challenges”.
As a junior doctor who recently started higher training, I
feel I am at the stage of my career when I find myself,
consciously and unconsciously, looking for role models. The
opportunity to listen to inspiring people is invaluable, and I
strongly recommend every trainee to look out for them.
During this conference I heard about the careers of those
with extensive experience, such as Dr Strathdee and Dr
Newman, but also those who are at the beginning of their
career like Dr Stanton (a psychiatric trainee).
PTC Report
The spring conference from a trainee’s perspective
Page 9
Summer 2012
non-career grade staff doctors or within three years of
appointment as a consultant psychiatrist.
Notice of the Prize will be given annually in the Women and
Mental Health SIG newsletter, with a deadline for submission
to the Chair each year. Candidates should prepare a
summary of their project (max length 2000 words including a
structured abstract).
Entries will be short listed to a maximum of four by two
members of the Women and Mental Health SIG Executive
and one independent assessor from the College.
The prize winner will present their paper at the Women and
Mental Health SIG meeting and will be judged by three
Executive members.
The subject matter should be in the form of either research,
a review or an essay on the subject.
CLOSING DATE: 7th December 2012
Submissions should be made to the Academic Lead
(Professor Howard) of the Women in Psychiatry Special
Interest Group in both electronic and paper versions c/o Sue
Duncan at the Royal College of Psychiatrists
The mental health of women in disadvantaged
groups
Women and Mental Health SIG has established an annual
prize for the best project conducted by medical
undergraduates, psychiatry trainees and new consultants
(male or female).
The work can be based on literature review, research, or
audit but needs to comply with the regulations below.
PRIZE: £250
Frequency: Annually
Eligibility: Medical undergraduates, psychiatry
trainees, new consultants within 3
years of first consultant post
Topic: The mental health of women in
disadvantaged groups
Where presented: Women and Mental Health SIG
Autumn conference
Regulations
Applications may be from medical undergraduates, trainees
in Psychiatry in a recognised unit in the UK or Ireland,
The role of mentoring and coaching was highlighted by
different speakers.
There were some take home messages for me: the
importance of “having another job”, another role besides the
clinical one, such as one in leadership for instance; the
importance of “who you are”; and, in the face of adversity,
“to dance around brick walls”.
I have to admit this event exceed my expectations at many
levels and I was left full of inspiration to rise to the challenge
and consider a leadership path in my career.
Dr Marisa Dias,
PTC Representative
“I find myself consciously and
unconsciously looking for role
models.”
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Over the last six years there has been a massive overhaul in
the arrangements for training less than full time (LTFT,
formerly known as flexible training) in the UK. As a former
flexible trainee myself in London from 1995-2000, and now
the Wales psychiatry specialty advisor on LTFT training, I
have reflected often upon the differences between my
personal experience and that of
LTFT trainees today. There is no
point though in indulging in
nostalgia about the good old
days(!) and I will restrict myself
here to describing the current
arrangements and hopefully
stimulate thought about how we
can work within the current
system to best help those wishing
to train LTFT. I hope this article
will be useful in informing trainee members of Women and
Mental Health SIG about the current arrangements for
LTFT training and encourage them to explore this option if
it would improve their work life balance. LTFT training with
good planning and support is a good option still for persons
struggling to meet the demands upon them.
Current arrangements
The new arrangements which were agreed by the BMA, the
Departments of Health, Conference of Postgraduate
Medical Deans (COPMeD) and NHS Employers took effect
from 1 June 2005. The main thrust of the changes were
intended to integrate LTFT training into mainstream fulltime
training and to phase out the concept of „supernumerary‟
status for LTFT trainees.
Slot Shares
Two trainees can slot share an existing approved post. As
training slots are now quite rigid in their allocated level of
training it is necessary for 2 trainees at the same level to
share a slot. Top up funding may be available from the
deanery so that both trainees can work 60%.
Reduced hours in a FT (full time) post
A LTFT trainee occupying a FT slot with the shortfall in
service being filled by locums, is a less attractive option for
all. However with the current recruitment crisis in Wales
we have felt very grateful to have the LTFT trainees in
these positions.
Less than Full Time
Training: Less is More?
Page 10
Other aspects
There is no longer any formal restriction on the minimum or
maximum % WTE (whole time equivalent) which a LTFT
trainee can work. In practice however practicalities can
enforce a 50% working arrangement if top up funding is not
available, and there is ongoing debate about the actual
feasibility of working less than 50% (I am not sure if this has
ever actually been successfully achieved).
All work should be pro rata, including out of hours work, as
well as study leave time and budget. It follows that WPBAs
should be completed in a pro rata time frame and this needs
to be understood at ARCPs.
The vast majority of applications for LTFT training are from
women with caring responsibilities for children although all
doctors in training can apply for LTFT training for many
reasons, and all applications should be treated positively. The
applications are still categorised to favour those with
dependents or with medical need. Deaneries around the
country should have full information on their websites about
the procedure for applying to train LTFT; the Wales deanery
site is very informative and much of the information
contained there should apply nationally.
The future
Marguerite Paffard [[email protected]] has
recently taken over as Director for LTFT Training at the
Royal College of Psychiatrists and is in the process of
compiling a list of all LTFT specialty advisors around the UK.
I am told that there is a survey about to be undertaken of all
LTFT trainees to gather information on their experiences
which hopefully will inform best practice. I would however
“We can lead the
way in good
practice concerning
supporting trainees
to work LTFT.”
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Page 11
Summer 2012
have considered training LTFT to find out the factors which
have dissuaded them from that course of action.
Very important, in my opinion is the formation of LTFT
networks locally for support and information sharing.
I also wonder in areas of high demand whether it would be
possible to create permanent LTFT rotations within
schemes. This might enable certain trainers and services to
adapt and become more familiar with LTFT working.
Thought could then also be given to whether the locations
of those posts could be more centralised to lessen the
travelling problems.
The new arrangements for LTFT training have meant that
many individuals at many different levels within the NHS
have now had to start facing issues which were unknown to
them previously. I hope that there have not been too many
casualties of this. The introduction of the changes at roughly
the same time as working pattern changes for doctors in
training has, in my experience been rather a bumpy ride, but
LTFT working amongst junior doctors is more in the
mainstream now and arrangements should be much clearer.
With the increasing numbers of
women entering medicine it is
expected that the demand for
LTFT will massively increase in
years to come. Already psychiatry
is among the specialties where
LTFT seems most popular. As a
branch of the profession most in
tune with the impact on of a
stressful working life upon mental
health I think we can lead the way
in good practice concerning supporting trainees to work
LTFT if they so wish.
Dr Maria Atkins, Consultant Psychiatrist
LTFT advisor for Psychiatry in Wales since 2004
“The majority of
applications are
from women with
caring
responsibilities.”
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Over the past two years, I have been developing an interest
in medical management and clinical leadership. This was
never intentional. Ever since my first baby steps as a newly-
qualified House Officer eleven years ago, „management‟ and
„leadership‟ were foreign terms, and not something that
concerned me amidst other pressing issues, like ordering
investigations and getting
Membership. And even once in
higher training, I, like many of my
peers, still considered
„management‟ and „leadership‟ as
foreign. Some kind of Holy Grail
you needed to find in your final
year of training to succeed at
consultant interviews. As such, I
continued merrily rotating
through my higher training,
focusing on clinical skills, teaching
and research activities. But, at
appraisals, my consultants would
always point to the blank
„Management and Leadership‟ section on my CV. Clearly
this „management and leadership‟ stuff was more important
than I first thought- why else would all my consultants have
flagged it up and so often?
One of my consultants suggested I get a general feel for
management in the Trust by „shadowing‟ people like the
Chief Executive and attending „management team meetings‟.
How these ideas filled me with horror! Nonetheless, I went
along as it was something to put on the CV. Initially it did
seem as though everyone was speaking a foreign language in
those meetings and I did not want to look foolish but
nobody actually ever made me feel unwelcome or foolish.
In fact, it was the very opposite. They said it was great to
have a Doctor sitting in the meeting and that it should
happen more often; maybe I could explain some of the
medical stuff that came up in discussions? It was surprising
to me how many decisions that affect what we do clinically
were being made by colleagues without the involvement of
clinicians. I was amazed to learn more about this new realm
behind the familiar clinical world I had inhabited for the past
decade. Finally, I had discovered the people who inhabited
that stretch of mysterious office suites on the first floor!
My ABC of Management
& Leadership
Page 12
In subsequent posts, I regularly attended local clinical
governance and service development meetings. I began to
understand how Trusts and services are run and in some
cases, how they really should be run. I realised there are all
sorts of pressures our managers face in order to meet a
myriad of statutory and financial requirements to run the
business of the Trust whilst satisfying the Commissioners
and Regulators and ensuring the Trust does what it says on
the tin- sound patient care. I wondered how Chief
Executives sleep at night- talk about having your neck on the
line! As my new-found interest in health service management
developed, I attended a couple of well-known expensive
medical management courses which I was informed at the
time were valuable additions to the CV. These courses
certainly were interesting,
a great opportunity to
meet other registrars and
hear about the challenges
within their specialties and
workplaces. The courses
also educated me about
the bigger management
picture beyond the walls of
my Trust; the national and
political contexts of health.
Whilst useful and very
inspiring, I came back from
the courses not really
knowing how to apply this
wider knowledge back in
the workplace. I deliberately requested rotating to training
posts with consultants who were Clinical Leads, as I wanted
to learn how national policy gets translated into what we do
in our clinical day jobs and how do they „do‟ management yet
remain hands-on clinicians. I wanted to know more about
how Taxpayers‟ money is actually spent in our Trust, our
department, our team and who decides how it gets allocated.
I also wanted to know how to successfully make local small
changes that could improve everyday care. Finally, I realised
that to learn about management and leadership, you actually
have to do it, not just observe others or listen to lectures.
That was the main reason I applied for a Darzi Fellowship- an
opportunity to work with managers on real-life, real-context
management projects in my Trust.
“To learn about
management and
leadership you
actually have to do
it not just observe
others or listen to
lectures.”
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Summer 2012
There isn‟t room here to describe
what I actually did during the year-
long Darzi Fellowship but having
done it, I would strongly encourage
trainees to consider applying for
one. Darzi Fellowships are still only
available in London but there are
now several excellent management
Fellowship schemes in the country
and not just for higher trainees,
nor even just for doctors.
Examples include the National
Leadership Council‟s Clinical Fellowship Scheme and
Fellowships run by the North Western Deanery. If you can‟t
or don‟t want to take time out of training, or even if you are
not that interested in management, I would recommend you
do more than just attend a management course or shadow
Executives. I believe having hands-on experience of medical
management and clinical leadership at the grass root level
will prepare you so well for a life-long career in medicine,
whichever specialty you are and whichever grade you are.
It‟s not just a ticket to enter consultant grade. In any case,
many consultant job adverts nowadays mention
„demonstrable health management activity‟ as an essential
requirement in the Person Specification. It‟s no longer
enough to say you went on the Kings Fund Management
course or to think that an impressive list of publications will
suffice- even for an Academic post. I will talk a bit more
about simple ideas for getting practical management
experience below. I am in no way proclaiming myself an
expert in this, but I feel as though I have now had a more
thorough medical education and that makes me a better
professional. I still wonder why no-one ever taught me this
earlier. We should be learning this from medical school
onwards, surely? That‟s another discussion but in the mean
time, here‟s my ABC of management and leadership. I would
love to hear about your own lessons, ideas….and horror
stories!
A is for Assumptions
I admit I made sweeping generalised assumptions about managers
before getting to know some of them. That they were all ignorant
of clinical matters and only interested in targets. These have
thankfully been challenged and cast aside, simply through getting to
know more managers and learning about what they do. This
includes many who originally started out in clinical roles in the
NHS. Most managers, like most clinicians, are deeply interested in
and committed to doing more of what‟s best for patients and doing
less of what‟s not helpful.
B is for Behaviours
I have seen great leadership qualities in colleagues from all
backgrounds and grades, such as enthusiasm, humility, integrity,
confidence, resilience, warmth and fairness. These set the path for
leadership behaviours of self-reflection, coordinating the behaviour
of others to achieve common goals, tolerating different viewpoints
and listening actively, asking questions of others to help them find
solutions rather than just telling people what to do, although
sometimes, as I saw, telling people what‟s expected of them is
exactly what‟s needed. Leaders are adaptable- they take charge
when they need to and lead inconspicuously when they need to.
C is for Communication
Poor communication is so often the cause of conflict, complaints,
untoward incidents and burnout, amongst other serious problems. I
learnt that leaders are the role models for how communication
operates within teams and that body language and tone can be
more powerful than the actual words within a message.
D is for Dark Side
„Going to the dark side‟ is probably the commonest negative view
of doctors who take an active interest in management or take on
clinical management roles. Images of Darth Vader and Jedi knights
aside, all I can say is I went to the „dark side‟ and I think I came back
enlightened and even more committed to good patient care than
ever.
E is for Efficiency
There is no escaping the fact that we are in the midst of
unprecedented financial crisis and uncertainty. We cannot afford to
waste precious resources. Clinicians can learn a lot from managers
about efficiency and productivity- doing more for less, not more of
the same. I strongly recommend looking at various activities within
your teams such as how referrals get processed and how clinics are
run. There are often too many „wasteful‟ steps in these activities
that add no value to patients and simply eat into valuable clinical
time. Many steps can usually be cut out with significant impact on
improving efficiency. There is abundant literature on „Lean‟
principles in healthcare and process mapping if you want to know
more.
F is for Feedback
I learnt to be able to view constructive feed back as a gift to aid
“Good leaders know
how to give
feedback and to
use it to make
positive change.”
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learning and personal development. Good leaders know how to
give feedback and to use it to make positive change. They are also
not averse to seeking or receiving it.
G is for Gawande, Atul
Atul Gawande is a respected American surgeon and professor
who eloquently wrote about the complexity of health care and
inevitable fallibility of doctors. His books „Better‟, „Complications‟
and „The Checklist Manifesto‟ are master classes in reflective
practice, humility and team-work. He
also argues for the simplification and
standardisation of processes in health
care to reduce error and improve
safety.
H is for High Quality Care
for All
Lord Darzi‟s report was released
when the NHS turned 60 and
presents a vision for the NHS over
the next decade. Whilst some of the
ideas have since fallen out of vogue
or were hard to swallow from the
start, for example, the polyclinics,
Darzi‟s core message of clinical
engagement for quality in health care, in other words, clinicians
and managers working together for safe and effective services
with positive patient experiences remains relevant.
I is for Information vs. Data
Working with managers makes you realise that for all the data
being collected within our Trusts, clinicians can remain
uninformed and unable to make use of this data to aid every day
clinical care decisions. On a larger scale, it is sometimes difficult
to benchmark one Trust‟s data with that of another so you do
not know whether your standards are similar to the best Trusts
or not. The term „data-rich, information-poor‟ has been used to
describe the NHS but my experience is that gradually, very
gradually, this is changing.
J is for Jargon
I learnt that managers use jargon. As a „starter for ten‟, I did a lot
of „drilling down‟, „brainstorming‟ and „thinking outside the box‟
usually „before close of play‟ when working with managers. But,
clinicians use jargon too. Simple mutually-understood language is
always best for effective working relationships.
Page 14
“Find out about
your leadership
strengths,
preferences and
attributes so you
know how you
prefer to operate .”
K is for Knowledge
I learnt that it is something to know lots of facts about the NHS,
but leadership is only possible when you can collate and organise
the relevant information and use it for the right purpose.
L is for Leadership style
I learnt that there isn‟t „one leadership style fits all‟ nor a right or
wrong way to lead. I strongly recommend finding out about your
leadership strengths, preferences and attributes so you know how
you prefer to operate and how others you work with may perceive
and relate to you. Personally, I believe it‟s better to play to your
strengths rather than spending too much effort trying to correct
„weaknesses‟. Far easier to draw in help from others who have
strengths where you don‟t. Leadership profile assessments are often
offered on management and leadership development courses and
some Trusts also invest in offering staff one of the commonly used
leadership style tests, such as the MBTI (Myers-Briggs Type
Inventory). Doing the MBTI I learnt that I have a leadership style
that is emotion-based and also helped me understand why I argue
with my other half about restaurant choices and what to do at the
weekend- he is the mirror opposite MBTI profile to me!
M is for Meetings, meetings, meetings….
Spend enough time with managers and your ward rounds get
replaced with a new unit of work time known as „a meeting‟.
Meetings get called for all sorts of reasons. Learn how to run
effective meetings. Essentially, meetings require preparation before
hand and should have an organising or tidy-up function. The work
should get done outside the meeting. Being observed chairing
meetings is a simple way of developing and practising meetings skills.
Another „M‟ is for Mentoring. In my opinion, finding yourself a good
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Page 15
Summer 2012
R is for Reflective practice
I learnt that engagement in reflective practice as a way of
continuously learning is a defining characteristic of a professional.
Simple ways to develop reflective practice skills include journaling,
giving and receiving constructive feedback and to practice being
objective about your experiences- for example, „what would so-
and-so say about the way I behaved in that meeting?‟
S is for Silo thinking and Systems
I heard time and time again, usually as a reason for increased
clinical engagement with managers, that the NHS can never solve
its problems whilst we remain in silo mentality- that is, „them and
us‟ thinking between clinicians and managers. The other use of the
term, „silo thinking‟ I came across was in describing how
departments function separately, often out of tradition and history,
when what patients need (and want) is integration of services and a
seamless flow across the system. I learnt that systems can be
complex, none more so than the NHS. I learnt that you can know
about the parts of the system, the structures and the hierarchies
but the life of the organisation is in the connections, relationships
and communication between the parts. An excellent book on
systems is „Working Whole Systems‟ by Julian Pratt.
T is for Targets, targets, targets….
I used to think targets were simply
managers meddling with clinical
matters and an excuse to blame
people for not achieving. I still don‟t
entirely agree with targets, as I think
they can in some cases cause people
to focus on the wrong thing in the
name of good care, with resulting
terrible care. But, what I learnt is that
like it or not, targets are written into
contractual arrangements for Trusts-
and there is no choice. Either achieve
the target or the Trust doesn‟t get
paid. What I think could be improved
is the incorporation of targets into
actual care processes instead of adding additional paperwork and
bureaucracy for staff. This is easier said than done.
U is for Understanding
If there is one thing I now have more of since working more
closely with management colleagues, it is an understanding. Better
mentoring for leadership development and has an extensive
service available to support clinicians of all grades and specialties.
N is for Networking
Networking is important in leadership development and
essentially involves forming mutually beneficial relationships with
others who may share a common interest or purpose. Through
networking, I have been put in touch with people who can help
me with a work project and even consider a book proposal
together. I think conferences can be a great way to develop
networking skills.
You basically just have to become confident at approaching other
delegates, putting out your hand and saying, „Hi, my name is….‟
rather than standing on your own pretending to check your
voicemails.
O is for Openness
This is something I struggled with and still do. On the one hand,
there is a need to be open about clinical issues and data-sharing,
for example making performance figures public to show
accountability and to benchmark practice to drive up standards.
On the other hand, we are in an increasingly competitive market-
driven environment. Being open about failures, poor performance
and mistakes could result in loss of business and result in demise
of a Trust. Is it always possible to be open?
P is for Politics and Power flows
These can be played out oh so subtly! At a cellular level in
meetings for example, I saw subtle shifts in power flows resulting
in explosive outbursts or unspoken tension. I learnt that the most
powerful people in Trusts do not necessarily have to be those at
the top, in some cases medical secretaries and even porters were
more „powerful‟ in Trusts than some consultants. Regarding
politics, well, everything we do in health is driven by policy. As a
result, the NHS is never static and therefore change, for better or
worse, is always on the political agenda.
Q is for Quality
I learnt that the purpose of clinical leadership is ultimately to
improve the quality of health care. Quality cannot be achieved or
maintained without clinical leadership. I think Lord Darzi was
right when he defined quality as safe, effective care with a good
patient experience. Professor Sir Bruce Keogh offered another
pithy definition: quality is the right people delivering the right care
to the right person, in the right place and at the right time.
“Quality is the right
people delivering
the right care to the
right person, in the
right place and at
the right time.”
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understanding of myself, of others I work with, of the systems I
work within, of the complexity of health care, of the challenges of
making ethical resource allocation decisions and so on. Whilst I
cannot change everything, just understanding these things better, I
believe, makes me a better clinician.
V is for Vision
One of the words most often quoted in conjunction with great
leadership is vision- literally, to see where you are going. In a
constantly changing, morphing and evolving NHS, it helps to have
strategic leaders who can help teams evaluate their purpose, aims
and objectives and remain aligned to the task at hand by setting a
clear vision.
W is for Work-related stress
There were times during my management Fellowship when I felt
physically unwell from the pressure to meet a deadline or staying
up at night to complete a report for a
Board meeting. This is clearly not
healthy leadership behaviour. Leader-
ship requires an ability to modify the
main sources of stress- which usually
include demands of workload and
work pattern, having little control in
the way you do your work, poor
support, conflict, poor understanding
of roles and poor management and
communication of change within the
organisation. Leaders recognise their own signs of stress so it can
be managed before it detrimentally impacts on others. I have
learnt that you literally need to be „fit‟ to lead.
Xand Yis eXperiential learning in Your work place
I did say I would give some tips on simple ways to obtain
management and leadership experience that may be cheaper than
going on a 5-day theory course and which will get you Brownie
points on the CV! This is it. For me, the best way to learn
management, is to do it „live‟ with a manager. This could be a small
piece of specific time-limited improvement work done as a
workplace-based project in your service. This could be anything
from managing a rota, getting involved in recruitment, developing a
cost-improvement programme or redesigning a bit of a service.
Most Trusts will offer some kind of in-house project management
training that you could access if it was a larger project. During my
Darzi Fellowship, I along with nine other Darzi Fellows in
Psychiatry wrote a business case to the Deanery for money to set
Page 16
“The best way to
learn management
is to do it „live‟ with
a manager.”
up a pan-London scheme for higher trainees to do workplace based
management projects and receive support in Action Learning Sets.
We managed to get over 30 trainees from all 10 mental health
Trusts in London involved in specific management projects within
their Trusts. Some of the projects included redesigning a Section 12
MHA rota and centralising a depot clinic service, resulting in
demonstrable financial savings for the Trusts. Having something like
this on your CV, that demonstrates an ability to deliver actual
improvement and/or savings, is worth far more than a management
course certificate. Also, get into the habit of writing up completed
good quality audit work as quality improvement articles. Fiona Moss
published some tips on how to do this in a structured way in the
journal, Quality & Safety in Health Care in 1999.
Z is for creative buZZ
Finally, and you can see I am clearly struggling now to complete my
alphabet, but the other quality I noticed of great leaders was an
ability to generate creativity among people. This allied with vision
are the key ingredients to successful change for improvement.
Dr Gira Patel
Women and Mental Health SIG, Women in
Management work stream lead
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Page 17
Summer 2012
sector. Via the VAWC subgroup Louise and myself I were
invited to a book launch by the Black Sisters of Southall, a
voluntary group which has always provided support and
advocacy for women from ethnic minorities, many of whom
are victims of domestic violence. Louise spoke at that event
and the Medical Director of my current Trust, which is in
Southall, was on the panel.
Apart from that I am still kept busy with my role as
Treasurer and am pleased to report that the SIG is in good
financial health.
Feedback from a male!
I had a brief conversation with Dr Paul Gilluley, who is a
consultant Forensic psychiatrist and who has more recently
started to work with women in medium security. Paul noted
the following:
1. He had never considered joining Women and Mental
Health SIG as he perceived it to be mostly about the careers
of women psychiatrists
2. He likened the potential to confuse our role with that of
the SIG for Gay and Lesbian and Bisexual – is the group for
the Doctors and their careers or is it focussed on a specific
area of clinical interest.
3. He considers that working
solely with women is very different
from working with men and requires
a different skill set.
He would be interested in joining or
being involved in a group focussed
on Women‟s Mental Health, but
considers that the issues of female
psychiatrists should remain.
I am of the view that as a SIG we
need to be as inclusive as possible
i.e. we need to attract men and women who work with
women and/or are interested in women‟s issues, plus we
need to retain that important function of being a resource
for female psychiatrists.
Dr Judith Edwards, Treasurer of Women and Mental
Health Special Interest Group
I have taken a rather meandering route in my career, and as
a result have travelled through different clinical terrains. I
initially, as so many do, trained in primary care, but then
moved to psychiatry where because of personal
commitments I worked both part time and full time in a
range of settings and grades, including that of Clinical
Assistant. My first substantive Consultant post was in
General Adult Psychiatry in the NHS, where I really was a
true generalist, having responsibilities in a CMHT, a PICU,
another inpatient ward and a Women‟s Prison. As a result of
my forensic experience I then moved to working with
women in secure settings, both in the independent sector,
and the NHS working in high, medium and low secure
services .After 7 years solely working with women I recently
negotiated another change and returned to high security to
work with men. Despite this I still have a passion about
working with women and am pleased to continue my
involvement with Women and Mental Health SIG.
The past few months have felt very productive. I have
continued in my role as the Women and Mental Health SIG
representative on the Department of Health, VAWC,
Violence Against Women and Children‟s sub group on
workforce education and training „which aimed to improve the
health outcomes of women and children who had been affected
by gender violence, by enhancing the skills and competencies of
NHS funded staff to address the needs of the victims‟.
The group is time limited and will meet for what may be its
final meeting in September, but to date has achieved a lot,
through networking and raising the profile of this important
issue. The Obstetricians and Gynaecologists are now
delivering a Diploma in the Forensic and Clinical Aspects of
Sexual Assault whilst the RCOG are working on a training
package for a Diploma on Leadership on Sexual Violence,
and the A and E Consultants are ensuring that domestic
violence is covered in their postgraduate training. Meanwhile
Louise Turner and I have linked up with key people in
medical education to emphasise the need for violence against
women / domestic violence to be included in all
undergraduate and post graduate trainings, which was agreed
to. It was surprising that an issue so important was initially
omitted from a proposed curriculum, but the organisers
were pleased that this omission had been brought to their
attention.
As well as networking with NHS colleague‟s important links
have also started to be made with parts of the voluntary
“We need to attract
men and women
who work with
women and are
interested in
women‟s issues..”
Judith Edwards - Biography
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Page 18
medical and non-medical colleagues in the task of managing
multiple interfaces in order to look after women during the
perinatal period.
Working in a female-dominated speciality such as this, I have
spent some time considering gender differences in personal
attributes. Whilst self-belief and assertiveness are possessed
by both men and women, they seem to be explicitly
demonstrated with differing levels of conviction amongst
female psychiatrists. Whether an ability to hold several things
in mind simultaneously is gender related cannot be proven
but the popular media suggest this is so. For me, house-jobs
followed by motherhood provided an excellent training in
multitasking.
My multiple psychiatric roles allow me to maintain general
skills. I never imagined myself as a specialist, was tempted to
defect to general practice at one point, and am convinced
that in the current political and economic climate these
general skills and competencies continue to be useful, if only
to provide me with the facility to acquire more work to
meet personal and organisational demands.
With the introduction of Service Line Management in our
Mental Health Trust, there has been considerable
reorganisation of consultant job plans, and my part-time
perinatal job has left me with the capacity to pick up extra
sessions when required by the trust, if only on a temporary
basis.
Many of us have portfolio careers, as mothering or caring is
in itself a skill set. For me, the care of my 3 children has been
the single biggest influence on my clinical and educational
practice, (after my medical training of course!). Another
contributor has undoubtedly been the care of my mother-in-
law who sadly died from dementia this year. All of us draw
on personal experience in the application of psychiatric skill.
I wanted to achieve a substantive consultant job in order to
support other women who are on their way through, and I
know that I only achieved this with immense support from
trainers and colleagues, many of whom are women.
Grasping opportunities has been key. For example, I took a
short part-time job for only 6 months after a problematic
Rise of the computer
and e-portfolio?
The portfolio career and its appeal to women
in psychiatry?
Since becoming a new member of the executive committee
I have attended two excellent conferences, "A Lifetime of
Caring" and "Women Psychiatry and Leadership". The days
have stimulated me to reflect on the ability of many women
to generalise their skills from multiple domains and apply
them to their working life.
I have a portfolio job, with educational, in-patient and ECT
sessions in addition to my main job which is the
development and leadership of a small perinatal mental
health service in North London. In addition to the NHS
work I see a few patients for psychosexual difficulties in the
private sector, in order to complete a Diploma in
Psychosexual Therapy.
I have arrived at this point in my career after a long and
varied training. My decision to choose psychiatry may well
have been a consequence of the chance to do an
intercalated philosophy degree, after which I felt reluctant
to return to medicine at all. Psychiatry has been a way to
apply philosophy to everyday life.
Following on from a medical rotation, which I needed to
complete in order to prove myself a "proper doctor" I
moved into psychiatry, ultimately
choosing adult patients despite
my initial intention to be a child
psychiatrist which had caused me
to undertake a paediatric job.
Career development is not always
predictable and opportunistic
events sometimes conspire;
having initiated a perinatal clinic as an SpR special interest
session with no intention at the time of following a specific
career path in that field, I found myself in the position of
contributing to the development of a new perinatal service,
which led several years later to my current appointment as
Consultant Perinatal Psychiatrist.
Perinatal psychiatry necessitates an interface between adult
and child psychiatry and I spend much time engaging both
“Psychiatry has
been a way to apply
philosophy to
everyday life.”
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Page 19
Summer 2012
return to full-time work. My decision to apply for the
perinatal post was a difficult one as I was in a CMHT at the
time doing work I felt I had always been training for.
It has sometimes been necessary to manage personal
challenges and take difficult decisions such as shortening
maternity leave to take advantage of a fantastic training
opportunity.
Support from family, friends and colleagues has been key. My
mother must deserve a mention at this point, not only for
her unstinting confidence in me but also for solving several
childcare crises along the way.
And I have a personal religious belief that has undoubtedly
helped.
I feel proud of my achievements
thus far, though not for any
academic, managerial or
high-profile success. My
satisfaction comes from the day to
day execution of a job that I love
while fulfilling several other roles. I
feel highly privileged indeed. I
hope my future includes the
development of an educational
portfolio and with this and my
own experience; I aim to
empower other women to balance
career and domestic life.
Dr Nisha Shah, Consultant Psychiatrist
“It has sometimes
been necessary to
manage personal
challenges to take
advantage of a
fantastic training
opportunity .”
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17 Belgrave
Square
London
SW1X 8PG
Phone: 020 7235
2351
Fax: 020 7245
1231
www.rcpsych.ac.uk
Royal College of
Psychiatrists
Membership of the Women and Mental Health Special Interest Group, established
1995, is open to all Members, Inceptors and Affiliates.
The aims of the group are to:
• Focus on the mental health of women and services for women
patients, and
• Supporting the careers of psychiatrists who strive for a healthy work
life balance
For information on how to join the group, please contact:
The Registration Department
The Royal College of Psychiatrists
17 Belgrave Square
London SW1X 8PG
or call 0207 235 2351 (ext 280 or 102)
Submitting Articles
Contributions, including articles and letters from readers, are actively encouraged
and welcomed.
All submissions should be in MS Word format and sent by email. Please remember
to include your full name, preferred title, place of work and email contact details.
A digital passport-style photo of yourself can also be submitted for inclusion with
your article. The editor reserves the right to edit contributions, which should be
limited to 700 words unless otherwise agreed. Letters should not exceed 200
words.
Opinions expressed in the Newsletter are those of the authors and not of the
College unless otherwise stated.
Dr Rebecca Horne
What is Women and Mental Health SIG?
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