RANZCP Elected Director Election 2020

Supporting Statement

Dear Colleagues,

I am standing for election to one of the College Board Director positions. I hope that you might support my nomination. I am very pleased to have been nominated by two senior College Fellows; Dr Shirley Prager and Prof Lorraine Dennerstein.

I believe I have the qualifications, skills and experience to make a substantial contribution to the College as a Board Director at this time of significant challenges to our profession.

Our College confronts changes that question the future of our profession.

There is a crisis in the psychiatric staffing of public mental health services in Australia. Mental health services in regional, rural, outer suburban and even capital city teaching hospitals no longer can attract or retain salaried specialists.

Poor working conditions, excessive bureaucracy and paperwork, heavy workloads, a lack of inpatient beds, and inappropriate facilities to manage patients with chronic, severe, and often drug aggravated psychosis are the main reasons for this situation.

These services rely on locum psychiatrists to constantly fill positions. Many of these locums are on short-term placements, sometimes no longer than a week at a time. This destroys the continuity of care. It damages the supervision of registrars and junior medical staff and the teaching of medical students.

The loss of salaried public psychiatrists blights professional development in the field of psychiatry in Australia and dries up the source that provides academic psychiatrists.

This sad state of conditions within public sector psychiatry in Australia now threatens the viability of the future of the profession – medical students are losing interest in the speciality and it is becoming harder to recruit trainee psychiatrists in some states. Trainees and young psychiatrists are becoming profoundly disillusioned. This must change.

Psychiatric training does not reflect the nature of the type of practice that most psychiatrists will work in. Trainees are not getting to experience a wide variety of clinical problems because the majority of training takes place in environments where treatment is frequently involuntary and short-term. This leads to a constriction of clinical diversity. While the care of patients with chronic psychosis is a very important part of psychiatry, this must be complemented with training covering other conditions and other treatment modalities, including a refocus on psychotherapy.

Expanding the range of training experiences is crucial for making psychiatry an attractive speciality that is a magnet for the most talented of younger doctors. A substantial proportion of training settings should be in the office-based practices of psychiatrists.

Our patients who suffer from the most chronic and disabling psychotic conditions have been dispossessed of humane treatment settings. They now fill acute inpatient wards or, worse, live in unsupported hostels or on the street. These patients need secure, stable clinically supervised accommodation with embedded rehabilitation, recovery and social services. Our College must fight for the establishment of these facilities to enable these patients to live in dignity and hope.

Continuing professional development (CPD) is facing challenges that will impact the working lives of all psychiatrists. The Medical Board of Australia is stipulating coercive changes that will require doctors to spend substantial time completing bureaucratic tasks that have no relevance to the professional development needs of individual psychiatrists.

The Medical Board provides little evidence to support its proposals to limit the choice of CPD activities and to force doctors to its mandated model. The Board’s proposals are unreasonable and will not lead to improved physician knowledge and skills, or better patient outcomes.

Our College does not seem to acknowledge the compliance costs (time and money) of ever-increasing CPD demands on private practitioners in comparison to salaried psychiatrists who can meet these requirements within their employment contracts and regular salaries. The College needs to work harder to engage with its members so the CPD program can be a flexible and relevant activity for all members of the College, including those in private practice.

The College needs to question the Medical Board about the evidence base for its proposed changes. Our College should defend our successful current CPD program that emphasises the individual professional needs of psychiatrists, provides a wide variety of CPD activities, and encourages peer review groups and support, rather than just meekly appeasing the Medical Board by sacrificing the psychiatrist-focused CPD needs of our College members.

The College Board needs a diversity of opinion and experience. Board members with experience in private practice are needed as the majority of Australian members of the College are in private practice. Board Directors need to be independent voices representing psychiatrists and their patients, not the policies of their employers.

These challenges are not insurmountable. But they will require bold and fresh ideas.

I believe I have the experience and energy to work with the College Board to meet these challenges.

I have a broad experience in different workplace settings including senior academic positions, directing federal and state public health services, and working in private practice (see CV). I am currently in independent private practice.

As well as providing direct patient care, I have implemented primary, secondary and tertiary prevention strategies in psychiatry, and contributed to public policy development and decision-making.

Throughout my career, I have been deeply involved in teaching, training, research and scholarship. I have demonstrated excellence in the field of veterans’ mental health and memory/cognitive disorders.

My personal style is characterised by cooperation with and encouragement of others, carefulness, thoroughness, and persistence.

I have worked in senior leadership positions with other medical associations and organisations (the Pacific Rim College of Psychiatrists, the Australian Medical Association Queensland Branch, the National Association of Practising Psychiatrists, the Australian and New Zealand Mental Health Association, and the Gold Coast Medical Association). I have relevant management experience working on the boards of these organisations that will translate well into what is needed by the College Board.

I have worked with the College over many years in the state branches and as chair of the Bi-National Continuing Professional Development Committee.

Please join with me in making our College Board more responsive to our members and more effective in the field of mental health. Please take time to vote in this election. I would very much appreciate your support.