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Correspondence |
Rectory Farm, East Chaldon Road, Winfrith Newburgh, Nr Dorchester DT2 8DJ
Sir: I am afraid that Dr Lowe (2000) has misunderstood my position on the selection of inquiry panel members. I am not particularly concerned with the appropriateness of individual psychiatrists sitting on inquiry panels, although there is an issue of ensuring that they have experience of the type of service that is the subject of the inquiry. Frequently, for example, homicide cases cross boundaries between general psychiatry, community psychiatry and forensic psychiatry.
Furthermore, Dr Lowe is in error when he suggests my approval of the idea that inquiry members should be selected from those who take part in extensive expert witness work. On the contrary, my view is that if there are to be inquiries, the membership should come from as broad a base as possible. And, while I do not fully share Professor Maden's view (1999) about medical members who are not currently practising, somebody on inquiry panels should have some idea of current practice, service problems and their causation.
My assumption has been that Dr Lowe and his colleagues in the inquiry members' community have been appointed to act as a psychiatric fig-leaf for the antimedical majority, shot through with institutional consultantism, among whom the barrister keen on making a professional reputation and the bureaucratic pedant are familiar characters. It is the selection of the non-medical members, and the chairman in particular, that is the issue.
The high level of dissatisfaction and perceived sense of injustice indicate that psychiatrists sitting on inquiry panels have been wholly ineffective in ensuring the proper examination of the bigger picture and identifying the responsibility of senior management and politicians for difficulties that arise in clinical services, rather than simply pinning everything on the front-line clinician. One of the more surprising admissions of Judge Fallon (1999) was that, although he and his inquiry members had among them one of the most eminent forensic psychiatrists in the country, they were clearly not going to be influenced by his views on the delivery of forensic psychiatric services.
I have yet to hear any of us peripheral jobbing psychiatrists (those most at risk) express a view about homicide inquiries which does not hold them and those involved in some contempt. These inquiries are manifestly unjust. They are quasi-judicial. They are prone to over-examine a restricted, unbalanced part of an enormously complex situation. They are not open and there are no rights of cross-examination. They often have severe effects on the reputations, morale and lives of those who are caught up in them. Psychiatrists should not be lending such inquiries credibility by involving themselves in them.
I have no particular knowledge of the problems at Ashworth or any of the individual psychiatrists involved, although any professional colleague caught up in these enormously stressful situations has my sympathy and support. My concern is that senior College officers and members of the committees referred to by Professor Cox (2000) either did not consider the factors mentioned by Dr Payne (1999) or did consider them and dismissed them. What steps did the College take to discuss this matter with all of the psychiatrists criticised by the Fallon Inquiry before issuing a document which could further prejudice their position? I suspect none.
The principle I am trying to establish is that the College should not act in this way and that, while it is going to be necessary for the College from time to time to produce documents or act in some way which might prejudice the position of individual members or fellows, under no circumstances should this be done without a thorough and full examination of the situation, including discussing it with all of those fellows and members involved in the controversy. All I am asking is that the College's officers act in a fair and impartial way, particularly as inquiry and other official reports are clearly frequently seen by those involved as neither fair nor impartial.
References
COX, J. L. (2000) College comments on the Fallon
Inquiry (letter). Psychiatric Bulletin,
24, 197.
FALLON, P. (1999) A response from the Chairman.
Psychiatric Bulletin,
23,
458-460.
LOWE, M. R. (2000) Selection of inquiry members
(letter). Psychiatric Bulletin,
24, 116.
MADEN, A. (1999) The Ashworth Inquiry: the lessons for
psychiatry. Psychiatric Bulletin,
23,
455-457.
PAYNE, A. (1999) Comments of the Royal College of
Psychiatrists on the Ashworth Special Hospital (letter).
Psychiatric Bulletin,
23, 504.
President, Royal College of Psychiatrists, 17 Belgrave Square, London SW1X 8PG
I am grateful to Dr Veasey (2000, this issue) for raising this matter. The College has to balance its obligations to members with its main purpose of raising standards in psychiatry. Sometimes this is a difficult balancing act.
Members will be aware that Council has recently agreed to establish an External Clinical Advisory Service. This will offer expert external advice to NHS trusts on any psychiatric service which is not functioning effectively. Further details of the service, which will be of assistance to College members as well as protecting patients, will appear on the College's website. Dr Peter Snowden has been appointed Director of this service.
You will be glad to know that the College has made a robust response to the recent Tilt Report and copies of this response will also be available on the College's website in the near future.
References
VEASEY, D. A. (2000) Further comments on inquiry
panels (letter). Psychiatric Bulletin,
24, 393.
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