Observations BMJ Confidential

Geraldine Strathdee: Cooking on gas

BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.h7017 (Published 20 January 2016) Cite this as: BMJ 2016;352:h7017


Geraldine Strathdee is a consultant psychiatrist at Oxleas NHS Foundation Trust and national clinical director for mental health at NHS England. She’s refreshingly frank: “There’s an enormous amount spent on mental health—the only problem is, it’s spent on dealing with the adverse consequences of not having given access early to effective interventions or having a proper prevention programme,” she told a King’s Fund conference in 2015. She believes that people can be coached into becoming literate about their own mental health and that early intervention will improve self management and avoid lifelong bad outcomes for many.

What was your earliest ambition?

To be a multilingual diplomat, negotiating peace and collaboration: the ambition of a child growing up in a community with civil unrest and exclusions [Northern Ireland]. I’ve achieved my ambition, if not quite in the way I’d envisaged.

Who has been your biggest inspiration?

My patients and my first mentor. I went to medical school planning to be a GP, but I met people with psychoses. I was humbled by their courage, creativity, strength, and humour despite the double whammy of a challenging illness and stigma. I’d found my lifelong vocation. My first mentor, the Belfast psychiatrist Alex Lyons, was already closing big institutions and establishing therapeutic day centres, primary care clinics, and peer support groups in the 1960s. His ability to put his values into practice was inspiring.

What was the worst mistake in your career?

Several times I’ve taken on big roles without negotiating the resources I need. I love big challenges, so I accept jobs without asking for the resources to deliver as well as I’d like.

What was your best career move?

Discovering that I’m best suited to a portfolio career, which includes frontline clinical practice and a range of policy, academic, clinical management, teaching, and regulatory roles. My last portfolio had four roles: medical director for mental health for London; consultant psychiatrist, Oxleas Assertive Outreach Team; an academic role with UCLPartners; and national professional adviser to the Healthcare Commission. My colleagues describe it as “cooking on gas.”

Bevan or Lansley? Who has been the best and worst health secretary in your lifetime?

There has been a quantum change: on a mental health index, they get better and better. I’m stunned and excited by the pan-party and pan-government department commitment to mental health literacy, prevention, and access to high standards of care.

Who is the person you would most like to thank, and why?

The army of frontline community leaders rallying to support mental health. One totally unpredicted phenomenon has been the impact of our Crisis Care Concordat policy: a cohesive movement of hundreds of thousands of frontline leaders from all crisis care agencies across the 211 local areas in England, committing to local action plans to provide 24/7 care, stop police custody assessments, and aim for zero suicides.

To whom would you most like to apologise?

My family and friends, for tolerating my absenteeism and presenteeism in the 16 hour national clinical director role. In terms of life/work balance, I’ve been trying to improve for my entire career.

If you were given £1m what would you spend it on?

Communication to end stigma.

Where are or were you happiest?

Clinically, I’ve been happiest working with a great assertive outreach team in Oxleas, with a service based on patients’ needs and delivering award winning standards of care. We helped achieve “independence and recovery” for people who had been in institutions for a long time, and we developed a new intervention (as yet undiscovered by NICE) we call “RH”: relentless harassment of any agency or service, from housing to psychological therapy to employment, until they gave in and provided it to the patients.

What single unheralded change has made the most difference in your field in your lifetime?

Two huge ones: social media and primary care mental health. My first reaction to Twitter was, “140 characters? I’m Irish!” But it’s been brilliant to connect to like minded champions internationally, to get new data and intelligence.

With primary care mental health we’re seeing a comeback and a focus on community population health. I did the first national survey in the 1980s and found that almost 25% of psychiatrists were spending one day a week in GP surgeries—the “silent growth of a new era.” We then lost this vital collaborative work through the development of community care without proper resourcing. But the silent revolution is here again: commissioning groups developing wellbeing and prevention “hubs,” integrated physical and mental health therapy groups, and enhanced psychosis care.

What book should every doctor read?

An anthology of poems by Georgina Wakefield [see www.georginawakefield.co.uk/7-poems/]. One poem, Proud, is a mother’s story of her son who develops a life changing illness, and it conveys the personal pain, the 10 year struggle to get the right treatment, and the family’s unfailing courage and care.

What poem, song, or passage of prose would you like mourners to hear at your funeral?

I’d choose music. Dvořák’s “Stabat Mater,” which is one of the most emotive pieces of music ever: he wrote it while seeking to recover from the deaths of his three children. And then something cheerful like “Mambo No 5,” to remind people that I was fun to be with.

What is your guiltiest pleasure?

Chocolate and coffee, together, often.

If you could be invisible for a day what would you do?

I’d steal the million pounds I need to end stigma.

What television programmes do you like?

Good medicine is investigative, and I like detective programmes, from Paradise to Inspector Morse.

What is your most treasured possession?

I don’t really get attached to things. I love people, so I value my family, my friends, and my many gifted trainees who are now impressive leaders in healthcare, academia, and social movements. I cherish the memories of the many patients who put their faith in me.

What, if anything, are you doing to reduce your carbon footprint?

I’m promoting the sustainability strategy of the Royal College of Psychiatrists, with its high impact plans such as prevention and medicines optimisation.

What personal ambition do you still have?

I have lots. As my life expectancy is now 92 I only need five hours’ sleep, and my dyslexic brain loves variety, so that gives me decades to achieve them. So, apart from the two new languages, 20 recipes, 120 places to travel to, and four books to write, I’d love to do more on building resilient communities, making productive employment a reality for young people, developing models of integrated healthcare, and seeing through the commitment to parity of access to high standards of care in mental ill health.

Summarise your personality in three words

Passionate, committed, loyal.

Where does alcohol fit into your life?

Occasionally, as part of a range of other things. I love the taste, but I could happily lose the effect.

What is your pet hate?

Bullies, bigots, and healthcare professionals who just can’t “get” that the mind and body are integral. A failure to see the whole person is at the heart of poor outcomes.

What would be on the menu for your last supper?

Grilled Moroccan chermoula sea bream, wild rice, and samphire, served with a glass of Virginian Blue Mountain Viognier, followed by a white Magnum.

Do you have any regrets about becoming a doctor?

Not for a second. I wake up every day raring to get stuck into the next set of programmes to improve mental healthcare.

If you weren’t in your present role what would you be doing?

I’d set up an organisation to promote new forms of intelligence and leadership that understand the needs of whole communities and maximise improvement.


Cite this as: BMJ 2016;352:h7017

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