Has our understanding of Psychiatry really changed over the last 50 years?

Has our understanding of Psychiatry really changed over the last 50 years? Growing up the son of a psychiatrist and now one myself, I’m not convinced.

We have been very lucky over the past three years to have had Professor Sir Simon Wessely as the President of our Royal College of Psychiatrists. Simon has done so much to give mental health not just a fair deal but a better one. But he is handing over the reins this week at the International Congress in Edinburgh. Among his many achievements in the role, he has certainly succeeded in putting mental health very much on the political map, but we still face an uphill struggle in changing public perceptions of mental illness.

As the newly appointed Associate Registrar for Public Engagement at the Royal College of Psychiatrists, my role over the next five years will be to engage the public in more than just information about mental health problems. I say this because we are often easily satisfied by the notion that a newspaper story or information leaflet is the answer to changing hearts and minds.

Engaging people in any meaningful discussion about mental health problems and mental illness means knowing when to speak, what to say, how to say it and to know something about those people or groups that we are trying to engage. Another psychiatrist recently told me that she was giving a talk about what she did to primary school children. She told them that she was a “Feelings doctor”. Brilliant!  I had my own take on how psychiatrists could best be described. Surgeons have operating skills. We have communication skills, so, what about Psychiatry being called “Communications Science Medicine”. Whether it is gaining rapport, assessing for a diagnosis or forming a therapeutic partnership to develop a care plan-we all need to be finely tuned into how our patients and service users are feeling, thinking and behaving. In a way, Psychiatry is probably best described as the “Art of Science”.

Public engagement is mostly of thought of as engagement through newspaper and magazine headlines, television, radio, the World Wide Web and through social media. This is where we can get stuck. It should be so much more. It could easily be the classroom, the workplace briefing, the pub bar mat, the hairdressing salon poster, the supermarket aisle and the library bookmark. The list is endless.

The other thing that stops us from having an open discussion about mental health is that we are often reactive against and ready to criticise the portrayal of mental illness as reinforcing stigma. There’s nothing wrong with that. It is very much the right thing to do. But it sometimes stops us from being proactive in putting messages out there that actually start a discussion about mental health.

The Duke and Duchess of Cambridge and Prince Harry have successfully launched the Heads Together campaign. Yes, it was about tackling stigma but also about seeking help. It was about starting a national conversation.

If we want to engage the public in what we do as psychiatrists, we also need to change the way that are viewed by other medical specialities. There is still a great deal of bad-mouthing of psychiatry and it is up to us the change this.

Public engagement needs to improve for psychiatry to stand any chance of surviving as a specialty. We need to attract the best and make sure that we strive to be the best that we can be as a specialty.

There’s just one problem at the moment. The public also need to know that. 

Dr Tony Rao, Consultant Psychiatrist.

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