By Dinesh Sinha, Andrew Williams, Myooran Canagaratnam, Elizabeth VanHorn
The Trust centenary has come at a point in our national life, when the crisis of the pandemic has exposed challenges to the foundations of social cohesion and delivery of healthcare. This is a situation remarkably similar to the period following the first world war with its enormous social and health consequences, when the Trust was first established.
It was an extraordinary time, as care was needed for those suffering from the effects of the war and by the 1920’s the Tavi had been established as a centre of psychotherapeutic interventions for children and adults. There is a roll call of medical luminaries from the beginning, starting with Dr Hugh Crichton-Miller, who led the plans for launching the Tavistock Square Clinic to provide psychotherapeutic treatments for patients in the community, in a de-medicalised environment. By 1930, it was evident that many of Dr Crichton-Miller’s innovative ideas and vision for the Tavi were widely accepted, as evident in the acknowledgement of preventative psychiatry and economic benefits of population mental health (https://tavistockandportman.nhs.uk/about-us/who-we-are/history/).
There was a prominence of physical interventions in the psychiatry of the early NHS, usually delivered in large asylums, even though there was also a pre-existing psychological movement led by psychoanalysis. Over the later years, much was made of the battles between the biological versus psychological origins of illness and some organisations felt the pull to make a choice between one or the other, as a belief system. Meanwhile, the Trust and its clinicians remained firm and prominent advocates of the importance of psychological and psychotherapeutic understanding and various leading practitioners made significant impact on government policy.
There were many Doctors amongst them, including John Rawlings Rees, Wilfred Bion and John Bowlby, who helped shape various services and establish the Trust, as a centre of excellence over the intervening decades. Progress has also been achieved in other parts of the NHS and in recent years the role of the Consultant Psychiatrist acknowledges a biopsychosocial stance, taking into consideration the entire combination of biological, psychological and social factors in order to arrive at a diagnostic formulation and treatment plan.
In this article, we aim to explore the role of medical consultants through the history of the Trust and aims for the future. We consider the history and ongoing contributions using examples and perspectives from the three divisions within the Trust:
- Adult and Forensic Services
- Children Young Adults and Families
- Gender Services
The various sections reflect on the contributions made by the medical discipline, which from the beginning have been marked by doctors who did not just follow, but had something specific to add to knowledge and practice, enriching the work of the Trust. Our attempt in the individual sections is to use various examples to link the past with ongoing attempts to contribute to the development of the Trust’s vision for the future.
The particular skills gained through lengthy training and experience of our Medical Consultant workforce is evident, both from examining the past, the continuing delivery of our services and also in the collective ambitions for the future. However, it is important to note that the ethos of the Trust has been from the beginning its de-medicalised approach and importance of multidisciplinary work, which seeks to be truly contributed by a multiplicity of professionals. Hence, all the achievements of the medical consultants in the Trust are best viewed through the prism of collegiate working and this equally links with the bridge towards the future.
This exploration starts with psychotherapeutic techniques and approaches in AFS, the oldest part of the Trust, continuing the narrative with the trailblazing child and adolescent mental health initiatives and moving onto the continuing story of innovative work within our gender services.
Adult and Forensic Services
From the 1940s onwards, the development of pharmacological treatments (in the form of antipsychotic, antidepressant, anxiolytic and mood stabilising medications) meant that there was an increasing emphasis upon biological approaches to understanding psychiatric conditions. This was later further enhanced by the development of a more comprehensive understanding of the underlying neurological basis for these conditions through the use of techniques, such as functional MRI and PET scanning.
Alongside the entirety of this movement, the Tavistock Clinic held an important role in developing our psychological understanding of these conditions. Wilfred Bion (a Tavistock alumnus) for example, following on from the work of Melanie Klein, went on to develop important theories about the processes involved in psychotic illnesses. Nowadays, most adult psychiatrists embrace and maintain a dialogue between the ‘traditional’ biological psychiatric world and the psychological world.
Working Psychotherapeutically with Complex Mental Health Conditions
Patients seen within adult services at the Tavistock and Portman Clinics are often not able to pay for private treatment, and therefore turn to the NHS for help. For this reason, we are privileged in being able to offer treatment to an often more socially deprived and complex group of patients who would not have otherwise received psychotherapy. As psychotherapy is by definition a treatment that involves the development of hypotheses and formulations regarding a patient’s way of functioning psychologically, our work not only helps patients to improve, but also serves as a means of developing our understanding of the mind in complex mental health conditions. This has led to the publication of a wide range of literature derived primarily from work at the Tavistock by clinicians.
Psychodynamic Psychotherapy at the Adult Complex Needs Department
It is a common misconception outside the Trust that services for adults within the Tavistock and Portman only provide psychotherapy in its traditional form. Whilst this still forms the bedrock of Adult and Forensic Services, the development of psychodynamic and organisational work has meant that there has been a significant proliferation in the breadth of activity across the Directorate over the years.
With the gradual movement towards care in the community since the 1980s has come the need to manage increasingly complex mental health conditions within outpatient settings. This has certainly been evident in terms of the adult patient population at the Tavistock, with our services required to treat or offer consultation to those who treat increasingly risky and complex patients.
This is when the combined use of traditional psychiatric and psychotherapeutic approaches is essential. Some patients who present significant risks to themselves or others require the ‘holding’ support of a local community mental health team in order that psychotherapy can be conducted safely. Medication, risk assessment and active community input may all be essential to enable a patient to negotiate their therapeutic journey. This is one reason why it is helpful to have senior psychiatric expertise within the Trust’s departments.
Trauma, Personality Disorder and Couples Services
There are notably services for patients suffering with the after effects of severe trauma, couples presenting in difficulty and patients with complex personality or other difficulties. All have developed over the years, accruing expertise through learning about patients from psychoanalytic, psychological, sociological and other perspectives, which of course requires collaborative working between staff from multidisciplinary backgrounds.
Other Service Innovations
In terms of service development, one of the major developments nationally has been the provision of specialist services for patients suffering with personality disorders. This has led to the emergence of outpatient services delivering targeted interventions, such as dialectical behaviour therapy (DBT) or mentalisation based treatment (MBT), particularly for patients suffering with borderline personality disorder or other complex conditions. Consultant Psychiatrists, along with colleagues from other disciplines, have made a significant contribution to the development of these services, due to their experience in combining pharmacological and psychological approaches, and also the need to conduct robust risk assessments and liaise with inpatient and other colleagues to ensure patient safety.
Primary Care Services
It has long been recognised that some patients who frequently present to primary care (general practice) settings, such as those with psychosomatic conditions, or personality difficulties that lead to complicated relationships to health services, present complex dilemmas for the clinicians working with them. Indeed, this connects back to the views of the founders of the Tavistock (Crichton-Miller and JR Rees), both GPs who had recognised, partly through their work with shell-shocked survivors of the first World War, that neurotic disorders were often associated with early traumatic experiences. These patients often benefit from additional input from a psychological perspective. The Adult (Complex Needs) Department has a long history of providing consultation and reflective spaces for staff working in primary care for these reasons, in the form of Balint Groups for GPs and other interventions. This strand of the Adult Department’s work was later developed into a structured service, initially for the borough of City and Hackney, and more recently for the borough of Camden. This was developed by staff from several disciplines coming from backgrounds, such as social work, psychiatry, psychotherapy, and clinical and counselling psychology.
The management of psychosomatic conditions requires a nuanced understanding of the interface between physical and psychological factors. It demands particular expertise through the use of a varied model, by which primary care staff can be supported in how they think about and work with such patients. Coupled with an assessment and brief treatment model delivered by specialist clinicians, such as clinical psychologists, psychiatrists and psychotherapists, the understanding of and work with such patients has been greatly enhanced within primary care settings.
The Portman Clinic
The Portman clinic has provided treatment for patients presenting with delinquency, compulsive sexual or violent behaviours dating back to the early 1930s. Initially known as the ‘Psychopathic Clinic’, it has now developed into a service that functions very much in keeping with the modern NHS, offering intermediate and long-term interventions alongside a robust research program. The specialist knowledge and expertise developed at the Portman clinic has meant that it is able to provide consultations to other relevant settings, such as prisons and secure mental health units. Much like within the Adult Complex Needs department, a psychodynamic understanding of the clients found in these services can greatly enhance the way in which patients are risk assessed and managed, enabling staff to develop a deeper understanding of their work.
Within the sphere of the criminal justice system, there is an inherent tension between the main function of the Court system (trial and sentencing) and the forensic mental health system (diagnosis, risk assessment and treatment). Sometimes these opposing cultures can come into conflict, with forensic psychiatrists being seen as too sympathetic to a patient’s difficulties, or the criminal justice system being seen as unsympathetic and harsh in its response to offending (although this is often a misconception on both sides). Existing somewhat at the interface of these two domains is the probation service, where offender managers are tasked with the complex role of both enforcing compliance with rules in order to avoid recall to prison, and engaging the offender in a programme of rehabilitation, aimed to address their psychological, social and occupational needs. This can prove to be immensely taxing for the professionals involved in fulfilling this role, ending up in feeling that they are failing, by either being too punitive or too lenient, or feeling negligent in their work if something untoward happens.
Psychodynamic and organisational approaches can be helpful in these situations. Questions such as ‘What does it mean for an individual to be tasked with preventing a person from reoffending, when ultimately this cannot be prevented from happening?’ and ‘why is it so difficult for me in particular to exert my authority with a client who I am fond of?’, when given time and thought, can enable professionals to negotiate the emotional demands of their work.
Other forms of treatment have been incorporated into the work of the Portman, most notably mentalisation based treatment (MBT) for men with antisocial personality disorder (ASPD). The development of this strand of the clinic’s work has been led by the current Director, Dr Jessica Yakeley, and led to the establishment of a national randomised controlled trial testing its efficacy for men with ASPD within the probation service.
Training within the Adult and Forensic Services Directorate
Both the Adult Complex Needs department and the Portman Clinic have traditionally provided a rich range of courses and trainings, which have been further developed in collaboration with the Department of Education and Training (DET) over the years. These include introductory courses for persons who have an interest in psychoanalysis and psychodynamic theory and practice up to intensive clinical trainings that lead to professional qualifications that enable graduates to practice independently as psychoanalytic psychotherapists.
Similarly, the Portman Clinic offers a two-year training in Forensic Psychotherapy, which equips its graduates not only to provide psychotherapeutic treatment to patients presenting with compulsive sexual or violent behaviours, but also crucially with a rich understanding of the ways in which these patients affect the clinicians working within the institutions that contain them.
Within both the Portman Clinic and the Adult Complex Needs department, many of the patients seen within the service are treated by clinicians undertaking these trainings, under close supervision by senior clinical staff. Thus, clinical trainings and service provision are closely entwined, and contribute to the richness of the department within a culture of enquiry and development.
Child and Adolescent Psychiatry at the Tavistock
Child and Adolescent Psychiatry began to emerge as a distinct medical speciality in the 1920s. Therefore, if not quite present at the birth of the Tavistock, the discipline certainly shared the institution’s tentative first steps. Over the course of the ensuing 100 years, Child and Adolescent Psychiatrists have been active in all aspects of the work and development of the Tavistock clinic, and have also made substantial wider contributions in the field of child mental health as a whole. It is of course difficult to write about the history of the discipline in isolation, given that its work, at its best, is fundamentally collaborative and interdisciplinary in nature.
Most notable was John Bowlby, internationally recognised for his ground-breaking research leading to the development of attachment theory, which combined insights from psychoanalysis, ethology, and cognitive science and systems theory. Bowlby was appointed Director of the renamed ‘Department for Children and Parents’ in 1946 at the Tavistock, where his influence was substantial. In particular, he brought an increasing recognition of the relevance of the child’s environment to clinical work, emphasising the involvement of mothers and fathers in treatment, as well as paying attention to the child’s school experience. Bowlby was also instrumental in the development of training, inviting Esther Bick to set up child psychotherapy training within the NHS. Few come close to matching the magnitude of Bowlby’s impact on the field. His philosophy of multidisciplinary working, and integrating diverse theoretical perspectives, whilst remaining firmly rooted in research and evidence, remains a model for Child and Adolescent Psychiatrists at the Tavistock to this day.
As trained medical doctors, Child and Adolescent Psychiatrists’ particular clinical contribution within the multidisciplinary team derives partly from an understanding and experience of the relationship between mind and body, and the role of diagnosis and medication in treating mental health issues, and the management of clinical complexity and crisis. At the same time, the Tavistock has traditionally attracted and cultivated doctors with an interest in understanding broader approaches to mental health which extend beyond the biomedical model.
A respect for, and understanding of, the value of other child mental health disciplines is a prerequisite to working at the clinic. It is this interdisciplinary entente that has enabled Child and Adolescent Psychiatrists to play a major role in both the delivery and the development of clinical services, alongside colleagues. This has included community child and adolescent mental services in Camden, particularly those targeting the most disadvantaged and hard to reach young people, such as the Camden Adolescent Intensive Support Service and the Returning Families Service. Child Psychiatrists have also played leading roles in developing innovative specialist services such as the Gender Identity Service, and The Family Drug and Alcohol Court Service.
Child Psychiatry Training
Over the years, the Tavistock training programme for Child Psychiatrists has provided unrivalled opportunities for doctors to undertake additional trainings in psychodynamic psychotherapy and systemic family therapy. Tavistock trainees have also learned about the value that psychodynamic and systemic perspectives can bring when applied to the work of consultation to other mental health, social care and educational professionals and to working within organisations in general. Over the past decade, medical students from UCL completing Special Study Components in Adolescent Mental Health have also been able to gain a flavour of the richness of the Tavistock approach to mental health and illness – and as a result, several have been inspired to pursue psychiatry as a career.
An important area of clinical work for Child Psychiatrists is to provide care for young people and families presenting in mental health crisis. Generations of Tavistock Child and Adolescent Psychiatry trainees and Consultants have provided emergency cover for acute general hospitals in North London where young people have presented following suicidal self-harm or with acute mental illness. At these times of crisis, young people are often at their most desperate, and sometimes may appear to have given up all hope. At other times the crisis manifests in extremely disturbed and disruptive behaviour in the young person. This can be difficult to contain, both at home and in the hospital. The anxiety and concern of those around the young person is therefore intense. The child psychiatrist registrar can find themselves called in the middle of the night to intervene in a situation that at first seems impossible to manage, particularly in the context of scarce NHS resources, (including adolescent inpatient beds).
In close liaison with paediatricians, Tavistock Child psychiatrists have worked with these young people and their families assessing risk, formulating safe management plans, as well as helping to manage the anxiety of the family and professionals supporting them. The immediate containment this provides, allows the network to be able to think about what support the young person needs in the longer term. The first task, of course, is for the psychiatrist to manage their own anxiety. In many ways, the intensity of the experiences all medical professionals have as junior doctors in hospitals equips them for clinical leadership in this most challenging and important task – one which literally involves life and death. The hours spent on call providing emergency psychiatry cover further develops this capacity, which is vital in the work of the Consultant Psychiatrist.
Child Psychiatry Research
Child Psychiatrists at the Tavistock have played a key role in relation to research, building on the interdisciplinary tradition evident from the founding of the clinic and most clearly associated with the work of Bowlby. In 1990, Professor Israel Kolvin was appointed to the newly established Bowlby Chair in Child and Family Mental Health at the Tavistock Clinic and the Royal Free and University College London Medical School. Dr Judith Trowell and the late Dr Hartwin Sadowski conducted a trial of interventions in childhood depression and another study into the consequences of sexual abuse. Professor Kolvin’s successor Professor Alan Stein worked at the Tavistock Clinic and UCL from 1995 until 2001 when he moved to Oxford University. His work focussed on the impact of maternal mental illness, including eating disorders and anxiety, on early child development. Dr Rob Senior was involved in this work with Professor Stein and has subsequently been a joint investigator on two large randomised controlled trials, the IMPACT study and the SHIFT study.
The IMPACT study evaluated the effectiveness of three different psychological treatments in adolescent depression – Cognitive-behavioural therapy, Short-term psychoanalytic psychotherapy and a Brief Psychosocial intervention. The study found that whilst these psychological interventions each entailed very different clinical approaches, they were all associated with a similar degree of clinical improvement, cost-effectiveness and subsequent maintenance of lowered depressive symptoms. The study provides support for increasing patient choice for adolescents with depression in terms of the therapies offered. The SHIFT study is an ongoing trial comparing family therapy with treatment as usual in adolescents who have self-harmed.
Both these important studies were led by child psychiatrists from other Universities with Tavistock clinicians developing, delivering and supervising clinical work. To this day, Tavistock child psychiatrists remain actively involved in research, devising and testing psychosocial interventions to improve outcomes for children. Dr Senior and Dr Eilis Kennedy are currently leading on large scale externally funded programmes focused on conduct and oppositional problems in small children and on Gender Identity.
The Future of Child Psychiatry
Child and Adolescent Psychiatry in the 21st century is a rich, diverse and advancing field. As such, its practice requires collaboration both within and between disciplines. Through links with other training programmes, and academic institutions, Tavistock child psychiatry trainees have kept abreast of the latest findings in genetics, neurobiology and psychopharmacology. More often than not however, it is the timeless and most human qualities of empathy, compassion, and an attempt to understand, that are most important in work with families – qualities that might seem quite ‘ordinary’, but are often compromised at times of extraordinary stress and anxiety. Child Psychiatrists bring their particular accumulated professional knowledge and experience to the task of understanding, but must listen to families who bring their own personal experience and knowledge.
Such qualities underpin the core values shared by Tavistock child psychiatrists across the ages, including those who have progressed to take up a variety of roles delivering mental health care, training other professionals and developing services in other organisations across the globe. Their appreciation of what has been internalised during their time working at Belsize Lane, is illustrated by the strength of the bonds within the network of Tavistock Child Psychiatry alumni. Many return yearly to their professional ‘secure base’ for intellectual, social and emotional sustenance – essential for what is a demanding vocation.
These core values are perhaps best encapsulated in the words of Sebastian Kraemer, a former Training Programme Director: ‘to strive to be therapeutic in contacts with young people and families’. They are shared values that will continue to remain central to both Child Psychiatry and the Tavistock Centre as they stride forward together into the next centenary.
Gender Services at the Tavistock
Gender medicine has had more than its fair share of controversy over the years and all gender services are subject to the influences of wider cultural and political influences. More recently this has perhaps most acutely experienced by colleagues working in ‘GIDS’ the Gender Identity Development Service for children and young people, also located within our Trust. There is liaison between the two services and joint meetings between clinicians from the adult service, young people and their GIDS key workers, in order to help them to move as smoothly as possible between GIDS and GIC (Gender Identity Clinic), the adult service. Both of our gender services seek to find out what interventions will be most helpful for people, and to ensure to the best of our ability that any decisions to commence medical or surgical interventions will be beneficial. We want our patients to be healthy and happier. We seek neither to push people down the road of transition where they are unsure or where we have concerns that medical interventions are premature, nor do we seek to deny them treatment where it is appropriate.
The Adult Gender service began in 1966, and was initially based in Charing Cross Hospital, at that time based in the heart of Central London, and despite several moves since then, has retained its name. It was for many years the only gender identity service for adults in the country and it remains the largest national service, with approximately 130,000 patients being seen, in its life time. In considering the various roles of the Consultant Psychiatrist within our service, it is almost impossible to do this without reference to all of the other members of the multidisciplinary team. Clinicians rely heavily on each other in relation to clinical consultation and delivery of care, but also more broadly in the sharing of information, the learning from and supporting of each other, and our mutual collaboration to ensure our continued professional development.
Role of Medical Consultants at the GIC
The role of medical practitioners within adult gender services is unique. Perhaps a better way of thinking about this is to consider medical professionals as ‘Gender Medicine Consultants’, Gender Medicine being a highly specialised area, albeit one that has not yet been ecognised formally as a specific ‘discipline’. Our job is to help people who identify with gender difficulties. Some are unsure about what path they wish to take and need help in understanding their feelings and sense of gender. Other struggle to make the changes they wish for because of stigma, lack of acceptance from others or their own inner confusion or lack of confidence. Many wish to start medical treatments such as hormone therapy or to embark on surgical treatments. Our approach in helping people is to listen and talk with our patients, to try and determine what is the best route for them to take in terms of both their move towards living as they wish (the social transition), and the appropriateness of medical interventions, such as hormone therapy, and surgical treatments.
This involves assessment of many factors; psychological, physical and social. As a national service this means that we need to liaise closely with more local services, such as GPs. The process of helping patients to move forward involves developing an understanding of how to best manage co-existing mental and physical health problems and to consider how any medical prescribing or surgery may impact on this. Hormone therapy, when recommended, is arranged through shared care with GPs or local endocrinology specialists. We also provide a specialist psychology counselling service, or link in with more local services which may be more convenient for our patients. Similarly, our speech and language therapy service is there for those with dysphoria or distress in relation to voice and communication issues.
Our team is composed of medical doctors including psychiatrists, but also colleagues from general practice, and other branches of medicine including a Consultant Endocrinologist (or hormone specialist), sexual health, and oncology (or cancer services). Non-medical colleagues include clinical and counselling psychologists, speech and language therapists, a hair removal therapist and clinical nurse specialists with particular training in endocrinology. Many clinicians have experience of clinical research. The clinical team is supported, of course, by our administrative and managerial colleagues who are essential components contributing to the functioning of the service. We also liaise closely with our surgical colleagues with expertise in gender surgeries.
Ongoing Developments and the Future
Since the Adult Gender Service was taken over by the Tavistock and Portman Trust there have been great improvements in the quality and efficiency of the care we deliver. No team is without flaws and all clinical services need to be prepared to seek ways of improving their care quality. This is a dynamic and ongoing process and my experience has been of working in a service prepared to listen to patient feedback, review the evidence base and learn from its mistakes as well its successes. There is an ongoing programme of audit, quality improvement projects and research, which is overseen by our clinical improvement group.
There has recently been an important change in the way that our patient’s gender difficulties have been classified by the European classification of health difficulties (ICD 11), and it is thankfully no longer classified as a mental disorder but as a problem relating to sexual health. Of course in the past homosexuality and other variations from the ‘heterosexual norm’ were also classified as mental disorder and thankfully this was rectified some years ago but in fact only as recently as May 1990. Just like everyone else in society, individuals identifying as transgender or nonbinary may have mental health problems and these difficulties are only magnified by the pressures put upon them by others perpetuating negative attitudes, and leading our patients to feel excluded and misunderstood.
There are high hopes for the future of our gender services, which are shared by colleagues and our patients. We aim to further develop our services both in regard to direct patient care but also research. We hope to be able to expand both and that these changes will be sufficiently financially resourced. At the moment patients remain frustrated by long waiting times within our service for both psychological assessments, endocrine review, psychological input and speech and language therapy. There are then further delays in accessing surgeries.
One view is that family therapy is an obvious area to develop within the adult service. With more scope and capacity to deliver patient centred care, we will be in a position to help our patients achieve better emotional and physical health, to alleviate much of their gender dysphoria, and contribute to their ability to get on with living their lives in a productive manner and with a sense of ease around their gender identity and a sense of freedom from discrimination.
Various contributors to this chapter have used examples from their services to bring together the centrality of medical colleagues in shaping the vision and delivery of services from the beginning of the Trust. This phenomenon is demonstrated from the beginning, in the seven founding clinicians of the Tavistock Clinic, who were doctors and subsequent clinical leaders, who have contributed to our achievements.
Their roles have been significant in adding to the impact of our services and standing in the wider field of health and social care, in the UK and worldwide. In AFS, the full breadth of innovative service offerings, in various settings, including primary care and for diverse patients, such as the Portman, help create genuine understanding of need. In CYAF, the skill set of our medical consultants adds to the work of the team in the management of complexity, by bringing a specific appreciation of the relationship between mind and body. Their training contributes in various ways, such as by a holistic appreciation of the role of diagnosis and medication in treatment. In our gender services, our medical colleagues provide an extensive repertoire of skills for supporting the journey of our service users through a number of significant decisions and in this way, helping them move forwards with their lives in the ways wished for by each individual.
A unique offer of many parts
A very important aspect of the trusts contribution to the development of high quality practice has been the unique synergy of clinicians using their skills and experience to deliver training, which has then become highly recognised for its quality and standards. This is evident in each of our divisions with many key figures, including medical staff, leading on the development of innovative practices and services.
The expectations and pressures on consultant medical staff in the Trust have changed significantly since the Tavistock started its work. At first glance, our clinical services appear far too specialist and dissimilar, both in the content of their interventions and the populations served for any common values. However, on deeper examination, there are common themes of providing services for chronically disadvantaged populations that are traditionally held at the peripheries of the health and social care system. This is true of adults, such as those patients who seek the support of the Portman, children with varied difficulties who need support from our CAMHS services and also the disenfranchised populations of our patients attending the gender identity clinics.
Similarly, all our divisions have a story of knitting together significant services, from modest means. Most have gone onto become providers of training and education in their fields and finally led on producing leading research to embed knowledge. This trajectory is evident in the sections above on AFS and CYAF, as the Tavistock and Portman established clinical innovation in these fields and set standards for training of a number of professionals. Research projects from these areas have and continue to define good practice and use of resources. Similarly, our gender services are leading in delivering innovative services in the midst of often contentious areas of practice. The Trust is currently engaged in some of the most significant research in this area of medicine, through the LOGIC project.
Our medical consultants also continue to support the range of trainings that are on offer through the Department of Education and Training. These include courses with national and international reach, such as psychoanalytical trainings, trainings for CAMHS practitioners, reflective practice etc. The current efforts include building on our knowledge and expertise from our gender services to create bespoke training for gender practitioners. Also, we now have a well-timed offer through the digital academy to deliver a range of courses and trainings.
None of this has been or will continue be possible by a single individual, or indeed by any single group, such as medical consultants. It was and is only by working in partnership with colleagues from other backgrounds and disciplines in a collegiate way that we accomplish gains, which is uniquely emblematic of the multi-disciplinary culture in the Trust. This is one of the main reasons that Trust remains a force in health services, taking forward well evidenced applications of practice changes to benefit service users.
Looking towards the future
The future is hard to predict, as in the past seven months so much of what we thought and recognised has already changed. The pandemic has once again exposed a picture of disproportionate impact on populations, where health inequalities are chronic and inadequately addressed. It has also proved beyond doubt that the Trust and all of us are connected to the wider health and social care system, which comes with a significant burden of responsibility.
We will need to continue to respond to upcoming challenges, which will include demands from the healthcare system, stretched resources and changing needs of our patients and their carers. Our task for the future remains to build on ongoing efforts to advance knowledge and practice within our range of specialities. Our contribution, as medical consultants will be to ensure that a holistic view of the patient, as whole people with minds and bodies within a biopsychosocial frame prevails. Ultimately, the approach of the Trusts’ Medical staff in working with colleagues to champion disenfranchised populations will ensure that the Trust’s retains its uniqueness and remains available for future generations.