From the Secretary's Desk

Review of Education and Training

This key project being undertaken as part of the College Strategic Plan is now well under way. The Issues Paper in the December issue of Australasian Psychiatry (pp. 296–302) ‘Throwing out the bath water: preparing psychiatrists for the 21st century’ elicited feedback from a range of Fellows and Trainees.

The Project Team met in late February to examine responses to the Issues Paper and provide feedback on an initial draft of an Options Paper prepared by Professor Bob Adler and Ms Sheena Mathieson. Formal consultation with College groups will occur over the next few months with the intent of preparing a preferred option by mid-year 1999. I urge all Fellows and Trainees to participate in this project which is critical to the future of our profession in both countries. OPEN IN VIEWER

FIONA JUDD

Trainee Representation

The Working Party established to examine General Council's decision to address the issue of training representation on College bodies met for the first time in Sydney in late February.

The Working Party is chaired by the President Elect, Dr Jonathan Phillips, and membership includes the Honorary Secretary, the Honorary Treasurer, Chair of the Fellowships Board and trainee representatives Dr Andrew Darby (from New Zealand) and Dr Debra Wood (from Victoria). Terms of reference for the Working Party require it to consult boards and committees on the appropriateness, practicality, number and cost of trainee representation and to consult the Association of Psychiatrists in Training on the issues of process of nomination and election within the APT for representatives to College bodies.

An annual allocation in the College budget is being considered to the APT to directly assist their ability to network and meet nationally and binationally.

At the initial meeting of the Working Party discussion focused on establishing which College bodies would be regarded as priority areas for trainee participation, how this can work most advantageously and the means to ensure that trainee representatives are able to effectively represent the views and interests of trainees binationally.

Drs Debra Wood and Andrew Darby have been invited to attend as observers at the General Council meeting in April.

NZ Mental Health Commission Blueprint

The Mental Commission of New Zealand has issued a revised Blueprint (December 1998) for the total range and volume of mental health services required to meet New Zealand's National Mental Health Strategy. It is estimated by a complementary document (The Funding Needed for Mental Health Services in NZ) that present service resources and funding are at about 60% of levels needed for the Government's service access targets, indicating that a total increase of $NZ355m would be required on current expenditure to meet the Blueprint targets - amounting to a total annual expenditure of $NZ845m.

The Blueprint emphasises a recovery approach with consumer and carer needs as the starting point for describing service requirements, essential service components and resource guidelines. This includes the needs of Maori and Pacific Peoples, mobility through general health, mental health and other services sectors, a variety of service provider models and the significant role of families and carers in supporting care programs. Mental illness is acknowledged as now being the number one health concern for Maori. The Blueprint also calls for the development and articulation of resource guidelines and a service funding model and sets a well integrated mental health service for New Zealand as its objective. Copies of both documents are available from The Mental Health Commission PO Box 12 479 Wellington NZ; fax +64(0)4 474 8901.

Australian National Mental Health Strategy

The Mental Health Promotion and Prevention National Action Plan (January 1999) has now been released and circulated. The Plan outlines a five year strategic framework and a plan for action to meet the prevention and promotion priorities and outcomes outlined in the Second National Mental Health Plan (NMHP) for 1998-2003.

The Action Plan provides a framework to lessen morbidity through diminishing risk and enhancing protective influences that contribute to the disorder process. It also contains strategies for promoting mental health. The primary objectives of the Action Plan are to:

The Action Plan is concerned with mental health promotion and the prevention of mental health problems and mental disorders. The prevention strategies are restricted to universal, selective and indicator interventions and case identification. The Action Plan does not encompass treatment and maintenance interventions which it defines as the responsibility of mental health treatment services. Early intervention will be considered in a separate report and is not addressed in this plan. Youth suicide prevention and depression strategies are the subject of the National Youth Suicide Prevention Strategy and the Depression Action Plan respectively, and so are also not included in this plan.

The Action Plan is a working document that will be updated regularly over the five year period of the NMHP as the outcomes of research and other projects become available. This is one of several documents proposed by the Promotion and Prevention Working Party to meet the priorities and outcomes outlined in the NMHP. Feedback on the action plan has been invited from individuals and organisations. The College has formed an ad hoc group to provide feedback which is due by 31 August 1999. Input from any interested Fellows is invited and should be sent to the College Secretariat, attention Mr David Norman (fax: +61(0)3 9642 5652 or email <David.Norman@ranzcp.org>.

Commonwealth Mental Health Adviser

Professor Scott Henderson FRANZCP has been appointed as part-time Mental Health Adviser to the Mental Health Branch of the Commonwealth Department of Health and Aged Care in Canberra.

This follows the departure of Director of Mental Health, College Fellow Dr Harvey Whiteford, to take up a one-year appointment as mental health consultant with the World Bank/WHO in Washington from January this year. Professor Henderson has a world-wide reputation for his work as director of the psychiatric epidemiology research centre at the Australian National University. He was also principally involved in the first national survey of mental health and well-being undertaken in Australia and reported last year. In Dr Whiteford's absence the Mental Health Branch is being headed by Mr Dermot Casey as A/g Asst Secretary.

Clinical Practice Guidelines

Work is now well under way on the College Strategic Plan Project involving the development of Clinical Practice Guidelines (GPG). At the close of tenders, applications were received for the development of guidelines in five of the six advertised areas: schizophrenia; major depression; anorexia nervosa; panic disorder and agoraphobia; and deliberate self harm.

The Steering and Implementation Committee met at the end of February to evaluate tender applications. Four tenders were proposed for acceptance subject to some modification, and work is expected to commence shortly for completion by the early part of next year. In the fifth area the Committee is requesting further details from all applicants prior to any decision being made about proceeding. The final area - bipolar disorder - is expected to be re-advertised later in the year.

‘Area of Need’ Assessments

For some years now the RANZCP, along with all other Clinical Colleges in Australia, has been assisting Medical Boards in the assessment of the training and standards of overseas trained medical practitioners who are being recruited for positions that are identified as ‘area of need’ positions, i.e. positions that health authorities have been unable to fill by other means using Australian medical graduates and where there is demonstrable need for such specialist services.

Typically these are rural/remote area positions or appointments in disadvantaged outer metropolitan areas. This mechanism has come in for some scrutiny and challenge by overseas trained specialists in recent months, along with other avenues for recognition of overseas trained doctors. The College has had discussions with medical registration bodies about changes to the present arrangements. These are also being discussed by the Colleges in the forum of the Committee of Presidents of Medical Colleges and will be reviewed by the General Council at its meeting in April. It seems likely that there will be changes to this system to align these assessments more closely with the College Fellowship program requirements and standards. Any changes will be reported and advertised to those affected.

Telepsychiatry

The Funding and Financing Options Working Group of the National Telehealth Committee (representing all Australian States and Territories) has proposed that Telepsychiatry services be included in the Medicare Benefits Schedule (MBS).

The College has been reviewing a confidential submission prepared by the Working Group preparatory to its consideration by the Medicare Benefits Consultative Committee for psychiatry (MBCC). The process for approval of new MBS items is conducted by the MBCC which involves the College, the Australian Medical Association and the Government. General Council is expected to consider the submission and a proposed College position paper on telepsychiatry at its April meeting in Perth. Psychiatry has been identified by the Working Group as the initial area for the development of telemedicine funding in the private sector, so the process will involve questions on key generic requirements for the clinical application of telemedicine as well as those specific to psychiatry. These considerations necessarily concentrate on telepsychiatry in the provision of clinical services, although its current applications in Australia and New Zealand already include consultation, supervision, training and CME.

Medicare Relative Value Study

Over the past several months there have been a number of meetings of College representatives in connection with three consultancies being carried out as part of Stage 2 of the Relative Value Study (RVS) of the Medicare Benefits Schedule.