The psychiatrists’ support service
BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c3951 (Published 29 July 2010) Cite this as: BMJ 2010;341:c3951
- Chris Simpson, committee member and doctor adviser,
- Vishal Agrawal, committee member and doctor adviser,
- Diana Chan, manager,
- Peter Snowden, associate registrar
- Chris.Simpson{at}nyypct.nhs.uk
Abstract
Chris Simpson and colleagues look at a support service from the Royal College of Psychiatrists and ask if it could be a template for other colleges
Doctors face increasing challenges during their career pathways, which can come in the form of difficulties, both professional and personal, as well as because of inadequate knowledge about systems and processes. The demand on doctors to ensure delivery of high quality care has increased, which inevitably leads to greater pressure. There are professional bodies that can help doctors in various ways, ranging from the British Medical Association, which advises doctors on contractual difficulties, to defence organisations, which support doctors in medicolegal issues. A number of other organisations can help doctors, such as the Royal Medical Benevolent Fund, which helps doctors in financial difficulties.
However, is there a role in providing support from one’s own profession? The Royal College of Psychiatrists decided that there was and that it needed to provide its members with a dedicated service that could support them in difficult times. Indeed, information from the General Medical Council, the National Clinical Assessment Service, and more recently the Practitioner Health Programme, all indicate the need for extra support for psychiatrists. The Royal College of Psychiatrists decided to respond to the needs of its members.
Informal mechanisms have always been in place for doctors to seek advice, support, reassurance, and guidance from their peers but no formal systems. Quite often doctors will seek help from colleagues on trivial matters, but when it comes to serious issues that they perceive might affect their career, they are more reluctant. One reason for this is concerns about the confidential nature of any discussion with a colleague. A need to have a formal support mechanism was therefore recognised, where colleagues could be reassured of confidentiality and get high quality advice and support from peers working in the same area of medicine.
How the service works
The psychiatrists’ support service (PSS) follows a clear pathway.⇓ The doctor contacting the PSS is not given the full details of the network member who is talking to them. If the doctor wishes to contact the network member they have to go through the PSS manager. In addition, there is clear focus on providing advice, signposting, and, where necessary, brief, focused support for the doctor. Although it is not a counselling or a mentoring service, mentoring and counselling skills may be used. Often doctors are advised to seek other forms of medical or psychological help, and although these are not provided by the PSS, doctors can be signposted to this type of service if necessary.
Setting up the service
The Royal College of Psychiatrists initially set up a scoping group to look into the feasibility of developing a service to support psychiatrists in difficulty. It was this group that recommended setting up the PSS, which was formally launched by the college during its annual general meeting in June 2007. Because of the growing nature of the work entailed, the college appointed an associate registrar to lead the service along with a PSS manager.
To ensure that sensitive information was dealt with appropriately and confidentially, the college allocated dedicated office space with necessary equipment and facilities for the service to function. It was important to reassure members contacting the service that their information would be dealt with in a confidential and sensitive manner.
These systems were put in place roughly eight months before the official launch of the service. The limitations of this service were specified from the outset so as not to raise unrealistic expectations. The role was never to provide a counselling or treatment service, advocacy, or legal advice, and there was no attempt to duplicate work of other organisations. The service was made available at no extra charge to all members and associates of the college.
Following the successful launch of the service, a group of experienced psychiatrists (advisers covering the range of issues likely to be raised by doctors in difficulty) were appointed to a core group. This group supported the management of the service and were the initial cohort of advisers. These were psychiatrists who had worked as medical directors, for the National Clinical Assessment Service, and who had experience with the General Medical Council or special knowledge of inquiries such as workplace relationship issues, stalking, and so on. Because of the increasing number of calls, a further seven advisers were recruited to cover the geographical spread and to add to the pool of specialist experience. From the beginning, trainees and specialty doctors have been kept in mind, and there has always been trainee adviser representation on the committee. The PSS continues to link in with other college committees, and the service has also developed strong links with external organisations such as the General Medical Council, the National Clinical Assessment Service, and the British Medical Association.
Evaluation of the service
During initial service design meetings in December 2006 the topic of evaluation was discussed and debated. It was agreed that it would be essential to gain feedback from the doctors using the service to gauge whether it was meeting the needs of doctors using it and what it was doing well and to learn about the development needs for the service.
The PSS devised a feedback questionnaire which is sent once the contact with the service has closed. Feedback is anonymous, and there are currently plans to offer feedback online. The form is separated into three discrete areas of communication, confidentiality, and effectiveness, and there is a separate area available for any general comments.
In total 54 forms have been received.⇓⇓⇓ Although the responses are largely positive (box 1), a small group of doctors were not happy with the service. It has not been possible to determine whether there are specific issues that are not being tackled, but the PSS continues to analyse the feedback to improve the service.
Box 1: Comments on feedback questionnaire
“Thank you very much indeed for the help. I was feeling rather isolated with the problem I am faced with and it was most reassuring and helpful to find the royal college had a service to offer.”
“Everybody who dealt with me did so professionally, sensitively, intelligently, and in a timely manner. It really helped me get my head around my problem—now I am hopefully on my way to resolving it.”
“I felt that consideration had been given to key issues and that the right person for the job had been chosen.”
“My evaluation of the service as I experienced it is that I was in a situation, which was very distressing and that had been going on for a number of months. After pursuing various avenues in order to access appropriate care and yet failing to do so, I felt disheartened and drained of energy and motivation. In the end I contacted your service and was amazed at the acknowledgement I received, the acknowledgement of my feelings was so important in helping me to accepting that I had not been wrong in wanting support. The speed of action on the part of the person who handled my situation was unbelievable—I received constant feedback via telephone contact 2-3 times in the same day. I can honestly say that at the end of the first working day that I contacted your service my heart lifted, I felt positive that the problem would be solved by this person/service and I would not simply be referred to another agency.”
Future of the service
The PSS has been a great success for the Royal College of Psychiatrists, as determined by both the evaluation and also the take-up of the service. As well as continuing to provide the support service by telephone, a number of information guides have been developed to give advice on specific areas (box 2). It is hoped that these will guide doctors who require help, giving them an alternative to contacting the PSS. A resource booklet has also been developed to bring together information on external organisations that a doctor could turn to for help and support.
Box 2: Information guides developed by the psychiatrists’ support service
Guides are available on the college website (www.rcpsych.ac.uk) on:
Being excluded from work
Coping with complaints
Whistle-blowing and passing on concerns
Coaching and mentoring
Probity
Bullying and harassment
Reviews, investigations, and inquiries
Transition from trainee to consultant
Planning a portfolio career
Dealing with exams
Stalking
A career in medical managementhttp://www.rcpsych.ac.uk/member/psychiatristssupportservice/informationguides.aspx
The Royal College of Psychiatrists has been trying to increase awareness of the service. The college website has information readily available. The PSS manager has given talks to divisional meetings across the country, and stalls, with the leaflets, have been set up at many college meetings.
There remains an issue about how far the college can develop this service in times of financial constraint and also whether it is appropriate to provide the service only to psychiatrists. The PSS has developed its services to support psychiatrists and it is provided by members of the Royal College of Psychiatrists—that is, for psychiatrists by psychiatrists. This is part of its success, as doctors contacting the service know they will be contacted by a fellow member of their profession. However, other specialties face similar problems. Generic services are available for doctors, but sometimes doctors feel that they want someone who has similar experiences to them to help with their problems. In addition, the Royal College of Psychiatrists’ members who provide their time and energy free of charge do so to help their fellow psychiatrists. Therefore, it is not seen as appropriate for the PSS to extend its role outside psychiatry. There are two areas which may help other specialties:
The information guides may be of benefit to all specialties and indeed some of them could be changed and developed slightly for different specialties if other colleges wished
The experience that the PSS has had over the past few years is invaluable in developing such a service and it could help other colleges develop services for their own members if required.
The PSS continues to be a great success. However, it is constantly changing in an effort to develop, although its unique selling point is that it is for psychiatrists by psychiatrists. It could be seen as a useful model for other specialties to develop similar services.
Footnotes
Competing interests: None declared.
Further information on the PSS can be obtained from the associate registrar, Psychiatrists’ Support Service, Royal College of Psychiatrists, 17 Belgrave Square, London SW1X 8PG.