Opinion

Greater need to train psychiatrists to meet demands

Kate Lovett says the government needs to train additional psychiatrists to meet the nation’s growing mental health needs.

 

Kate Lovett says the government needs to train additional psychiatrists to meet the nation’s growing mental health needs.

On 4 October 2016, health secretary Jeremy Hunt announced 1,500 extra medical training places every year, in a bid to end the NHS’s reliance on overseas doctors.

Kate Lovett

I and the rest of the Royal College of Psychiatrists echo the views of many, in welcoming this planned expansion.

Golden oppurtunities

This could, if delivered in the right way, provide us with a golden opportunity to address one of the biggest issues in our profession, and in the ongoing mission to achieve real parity of esteem – the chronic shortage of mental health professionals, including psychiatrists.

The latest Adult Psychiatric Morbidity Survey underlined, once again, the enormity of the mental health challenges we face. And yet, despite the best efforts of the profession, we don’t have enough junior doctors coming through to fill the gaps in psychiatry, which will continue to limit what is achievable.

Inconsistent numbers of trainees

Medical schools produce inconsistent numbers of psychiatry trainees, ranging anywhere from 0.5% to 5.4% of their students (The UK Foundation Programme Office 2016). In 2016 only 82% of core psychiatry training vacancies were filled. Although there had been a welcome increase of 10% in numbers recruited from the previous year, there is clearly a long way to go.

Sadly, psychiatry is not the only healthcare profession to be affected be recruitment challenges, as figures from a recent report by the RCN show – nearly half the nursing workforce is within 10 years of being eligible for early retirement, and replacing the bursary with loans is making the profession less attractive to new recruits (Royal College of Nursing 2016).

Those experiencing mental health issues deserve their fair share of the brightest and best in the medical and mental health nursing professions.

Worsening issues

For years, psychiatric training places have been under-filled, and the recruitment and retention problems within nursing are worsening. The last Royal College of Psychiatrists’ census in 2015 identified approximately 218 consultant vacancies in England (Royal College of Psychiatrists 2016). This number is likely to grow if our training places remain undersubscribed.

Similarly, figures show a 25% reduction in the number of nurses joining the register (RCN 2016), meaning employers will continue to struggle to fill key posts if there aren’t enough nurses with the right skills to move into the more senior roles being left by those choosing to retire at age 55.

We who are already in the profession know how rewarding and exciting it can be, but it is hard for medical students and aspiring mental health nursing students to know what might be in store for them if they choose mental health as a career route.

What is needed

To serve the future of psychiatry, we need to increase the numbers coming through, but also broaden access to medicine. In medicine we don’t recruit enough students from diverse backgrounds, meaning our profession is far off being able to reflect the populations we care for.

In 2011, 80% of medical school applicants came from just 20% of schools and 57% of those accepted into medical school came from the top three socio-economic classes (Independent Reviewer on Social Mobility and Child Poverty 2012).

I worry that drawing on such a narrow pool limits our ability to recruit those with personal experience of the sort of social disadvantage and adversity that many of our patients have faced, and continue to face in their lives.

Mr Hunt's expansion plans sound like a huge step in the right direction, but if they are to have the impact we need in psychiatry, specifically, they must be linked with widening participation and a fair showing for the profession at entry-level.

We need reformed selection processes, increased exposure to psychiatry at undergraduate stage, better resourced services to give consultants time to provide high quality teaching and to act as effective and attractive role models, and a UK-wide expansion of the foundation programme, with high quality placements.

We need sufficient mental health nurses who play a vital role in creating a positive learning culture for the wider multidisciplinary team of which our trainees will be a part.

And finally, we must all recognise that throughout our work towards this goal, we will continue to rely on the dedication and expertise of our colleagues from around the globe who have helped us maintain safe services over decades of chronic underinvestment.

If we are to achieve the vision in Mr Hunt’s welcome promise, we will need their help now more than ever.


References

Independent Reviewer on Social Mobility and Child Poverty (2012) Fair access to professional careers. The Cabinet Office, London.

RCN (2016) The UK Nursing Labour Market Review. RCN, London.

Royal College of Psychiatrists (2016) Census 2016. Royal College of Psychiatrists, London.

UK Foundation Programme Office (2016) F2 Career destination report. UK Foundation Programme Office, Birmingham.


 

Kate Lovett is dean of the Royal College of Psychiatrists

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