Women and Mental Health Special Interest Group Newsletter v7.pdf · psychiatrists who strive for...

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

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.”

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

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!

Summer 2012

“We want to raise

the profile of

women‟s mental

health at an

international level.”

Dance Around Brick Walls

‘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.”

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.”

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

“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.”

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

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

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

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

([email protected]).

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.”

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?

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.”

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.”

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

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.”

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.”

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.

“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

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.”

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

“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

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

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.”

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 .”

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

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