Health literacy, governance and systems leadership contribute to the implementation of the One Health approach: a virtuous circle

One Health is an important approach to addressing health threats and promoting health through interdisciplinary health, policy, legislation and leadership research to achieve better human and animal health and better outcomes for the planet. The Covid-19 pandemic has triggered an urgent awareness of the need to develop innovative integrative solutions to address root causes of such threats to health, which requires collaboration across disciplines and amongst different sectors and communities. We explore how achieving the Quadripartite Organizations' One Health Joint Plan of Action can be supported by the concepts of 'One Health literacy' and 'One Health governance' and promote both academic and policy dialogue. We show how One Health literacy and One Health governance influence and reinforce each other, while an interdisciplinary systems leadership approach acts as a catalyst and mechanism for understanding and enacting change. Based on our understanding of how these elements influence the implementation of the One Health approach, we describe a model for considering how external triggering events such as the Covid-19 pandemic may prompt a virtuous circle whereby exposure to and exploration of One Health issues may lead to improved One Health literacy and to better governance. We close with recommendations to international organisations, national governments and to leaders in policy, research and practice to enhance their influence on society, the planetary environment, health and well-being.

The Royal College of Psychiatrists' Leadership and Management Fellow Scheme

The Royal College of Psychiatrists' Leadership and Management Fellow Scheme aims to develop and support a new cohort of leaders within psychiatry. This article provides an introduction to the scheme, which is accessible to all higher trainees with the support of their host organisation. We explore its development, structure and how it is evolving to provide a strong platform for achieving the College's ambition to benefit patient care by embedding a culture of medical leadership within mental health services.

Psychiatric leadership development in postgraduate medical education and training

The value of strong, compassionate medical leadership in the delivery of high-quality care to patients within mental health services is clear. Leadership development, however, is far less well explored. This article is for psychiatric trainees, trainers and mental health organisations. It provides an introduction to the importance of leadership development within postgraduate medical training, the theory that should underpin its delivery, and the opportunities for both informal and formal leadership development within psychiatric training.

In-programme leadership development for psychiatric higher trainees: The Royal College of Psychiatrists’ Leadership and Management Fellow Scheme

Introduction

The Royal College of Psychiatrists’ (RCPsych) Leadership and Management Fellow Scheme was established to develop and support a new cohort of medical leaders within psychiatry. Sponsored and mentored by a trainee's local education provider, the scheme combines a high-impact national leadership and management training programme, with a novel in-programme apprenticeship model, where Fellows gain local leadership experience.

Method

An internal review team conducted a mixed-methods evaluation of feedback from Fellows and Mentors on the scheme’s structure, delivery, provision of individual leadership development and the impact fellows had on their teams and the organisations within which they were embedded.

Results

With a response rate of 67% (n=20) from Fellows and 30% (n=7) from Mentors, a clear benefit from the scheme was observed, alongside opportunities for improvement. Strengths of the scheme included the bespoke in-programme design, mentoring from a senior medical leader, networking opportunities, and experiential learning through local leadership experience, which additionally promoted medical engagement within organisations. Opportunities for improvement included strengthening existing offers, particularly mentoring relationships and enhancing the network established between fellows.

Conclusions

A bespoke, uniprofessional and in-programme leadership and management fellow scheme can play an important role in the development of future medical leaders within psychiatry.

Debating personal health budgets

Personal health budgets (PHBs) were piloted in the National Health Service (NHS) in England between 2009 and 2012 and were found to have greater positive effects on quality of life and psychological well-being for those with mental health problems than commissioned service, as well as reducing their use of unplanned care. The government intends to extend PHBs in England for long-term conditions, including mental health, from April 2015. Given the importance of engaging clinicians in the next phase of PHB development, we provide an overview of the approach, synthesise the evidence from the national pilot and debate some of the opportunities and challenges. Balancing individual choice and recovery with concerns for risk, equity and the sustainability of existing community services is the central tension underpinning this innovation in mental health service delivery.

Lofexidine and desipramine: Interaction results in breakthrough opioid withdrawal symptoms

A patient was receiving treatment for concurrent opioid and stimulant dependency. When desipramine was added to his lofexidine regimen for treatment of stimulant withdrawal, there was an exacerbation of opioid withdrawal symptoms. With the increasing use of lofexidine for opioid withdrawal, clinicians need to be aware of the potential for interactions with tricyclic antidepressants in the treatment of concomitant stimulant users. (Int J Psych Clin Pract 2002; 6: 179-181 ).