ISSUE 10

EATING DISORDERS SECTION

ROYAL COLLEGE OF PSYCHIATRISTS

Inside this issue

1) Foreword from the editors 2) Foreword from the chair 3) AED news4) Assessing Capacity in Eating disorders 5) EDSECT annual conference –two trainees’ perspectives

6) Poster winner

7) Other News and forthcoming events8) List of Executive Members of EDSECT

December 2012

Time has passed quickly again since our last newsletter and this time round we will be focussing again on the Annual conference held in November 2012. Congratulations and many thanks again to Frances Connan for another amazing conference where we were able to listen to many renowned speakers and also to catch up with friends and colleagues.

It was great to hear a lot of positive feedback about the conference and especially from Jane Morris who told us about two very inspired and enthralled students from Aberdeen who are thinking about psychiatry electives!

We thank AED president Dasha Nichols who has agreed to provide news from AED as a standing item in our newsletter.

Jacinta Tan, senior research fellow and an empirical medical ethicist has written for us a great article on assessing decision-making capacity in patients with eating disorders. Can we remind you again that we would welcome any issues that members would like to be included in the newsletter.

The bursary winners of a place at this year’s annual academic meeting, were Peter Sellars, E Barrett, J Theivendran, K Jawahar and Jessica Wright. Peter and Gemma have both written articles for this newsletter which are well worth a read. Dr Golnar Aref-Adib’s poster presentation won this year and makes interesting comments in the present climate of a wish for early discharges by various commissioning bodies.

Dr Irene Yi Dr Rebecca Cashmore

Editor Co-Editor

Irene.Yi@sabp.nhs.ukRebecca.cashmore@leicspart.nhs.uk

1. Foreword from the Editors

Dear Colleagues,

We are pleased to be bringing you another issue of the Section’s newsletter, with wide ranging contributions on many subjects that should be interesting and enlightening.

Trainees continue to be actively involved in the Section, with high quality and competitive submissions for the Section Poster Prize. This prize was established to encourage interest in Eating Disorders psychiatry and research in the specialism, and we are fortunate to attract high calibre submissions, as well as an increasing number of Bursaries to attend the Section Annual Meeting.

Our Annual Conference was held on 2 November 2012, at the Cavendish Conference Centre, London. Thanks are especially due to Frances Connan for her indefatigable enthusiasm. The conference was acclaimed by attendees, and covering a wide-range of clinically relevant topics, in relation to medical and treatment issues.

Our Executive Committee has welcomed a number of new members and bade farewell to some old friends. We maintain our primary focus on ensuring quality of treatments around the UK, engaging proactively with new processes of commissioning and carving out our special expertise as a subspecialty of psychiatry.

The issue of ensuring high quality services remains a key concern, and our UK-wide quality assurance network of eating disorders services is germinating nicely.

Finally, we look forward to 2013 with all its promises and pitfalls. As the Health and Social Care Act puts competition between services at its heart, we are committed to putting quality and collaboration at the centre of our own philosophy.

With kind regards

John

Dr John MorganChair EDSECT

2- Foreword from the Chair

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In the last EDSECT newsletter I told you a bit about the AED, who we are, and debunked a few myths. If you missed it, here is the link to the last newsletter (see section 7). [link to http://www.rcpsych.ac.uk/members/sections/eatingdisorders.aspx ]

This time I thought I’d tell you a bit about some things the AED have been up to recently that might be of interest to EDSECT.

Firstly, the AED has recently published the long awaited Residential and Inpatient standards https://www.aedweb.org/AED_Inpatient_Standards.htm . The purpose of the guidelines is to promote high quality residential and inpatient treatment for eating disorders. Specifically they are intended to (a) safeguard patients and families who seek eating disorder residential and inpatient treatment; (b) review and improve the quality of care offered by residential and inpatient treatment programs; and (c) provide a quality of care benchmark for third party payers in the development of comprehensive models of care and its reimbursement, where applicable. Like the QED standards, the recommendations are intended for use in clinical governance, quality assurance and/or the development of key performance indicators. In the USA they will also be used as a guide for credentialing of treatment programs.

The AED does not see its role as ‘accrediting’ organisations or individuals, but rather using our expertise to collate and distil information to produce best practice guidance based on evidence, where available. The initial steps for this venture preceded QED, and indeed may have influenced it, since both Janet Treasure and Tony Jaffa were part of the process. The complexities and political sensitivities of US health care has made progress towards standards that are likely to have a acceptability in the US, never mind applicable globally, a slow and challenging task.

Nonetheless, we are delighted that the basic elements of good care for people with eating disorders have been laid out succinctly and specifically in a way that will be of use to those seeking treatment as well as those delivering it. We are now in discussions about developing standards for individual eating disorders practitioners.

3. Update from the Academy for Eating Disorders

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There is only a limited amount that can be achieved in a year as President, so my aim is simply to handover, in May, to our incoming President, the great Pam Keel, an organisation strong and healthy enough for the next stage of its development, as the AED comes into its 21st year. The main thrust of my work with the AED this year has been to overhaul our strategic plan i.e. its vision, mission, goals and objectives. Unlike EDSECT, we rely on donors to support the extensive scholarship programme for clinicians and researchers, whilst also meeting the needs of members in many different countries and health care settings. It’s quite a big task! Thankfully I have had the support of Karine Berthou, CEO and Founder of the SUCCEED foundation www.succeedfoundation.org, and business woman supreme, and of the AED advisory board, which includes the fabulous Susan Ringwood, CEO of b-eat www.b-eat.co.uk .

Finally, we are in the throes of making plans for next year’s International Conference on Eating Disorders (ICED) in Montreal. If you haven’t been, Montreal really is the best amalgam of North American and European culture. The conference promises to be great too. Our own Nadia Micali, together with Bryn Austin from Harvard, has been jointly responsible for putting the conference programme together and overseeing the scientific committee. Caroline Meyer has also been part of the programme planning team, all accountable to Glenn Waller as Director for Annual Meetings. So quite a strong UK presence! The theme for the 2013 ICED is “Crossing Disciplinary Boundaries in Eating Disorders.” There will be sessions on BED and Obesity, Biology and Medical Complications, Body Image and Prevention, Children and Adolescents, Comorbidity, Course and Consequences of Eating Disorders, Diagnosis, Classification and Measurement, Epidemiology, Gender, Ethnicity, and Culture, Personality and Cognition, Risk Factors and Eating Disorders in Underserved Populations, Risk Factors for Eating Disorders and Treatment of Eating Disorders. There will also be special interest sessions, a session dedicated to research-practice integration, and welcome, closing and award ceremonies. If you haven’t been to an AED conference, I would be delighted if you would join me there. Until next time, wishing you all a very Merry Christmas and Happy New Year.

Dasha NichollsPresident, AEDGreat Ormond Street Eating Disorders Team

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Jacinta O A Tan, Senior Research Fellow

Address: The College of Health and Human Sciences, Swansea University, SA2 8PP, United Kingdom

Correspondence to: j.o.a.tan@swansea.ac.uk

In two recent legal cases in Wales and England, judges have reached different conclusions as to whether compulsory treatment was in the best interests of patients suffering from severe and life threatening eating disorders.(1, 2)i Both judges, however, found that these patients lacked capacity to make decisions about their treatment. In the case of Re E, Justice Jackson found that although E could understand the information and communicate a decision, the anorexia nervosa made her unable to use and weigh the information and she therefore lacked capacity. These rulings make it clear that capacity in eating disorders can be a problematic issue.

As mental disorders, eating disorders falls under both the scope of both mental health and mental capacity legislation in England, Scotland and Wales. On the one hand the Mental Health Act 2007 could be used to deliver treatment of a mental disorder (but not of other unrelated medical conditions) without a patient’s consent if there is a significant risk posed to the individual (or others), without reference to capacity.(3) The Mental Health Act Commission has clarified that re-feeding constitutes treatment of an eating disorder under the meaning of the Mental Health Act.(4) On the other hand, the Mental Capacity Act 2005 and Adults with Incapacity (Scotland) Act 2000 allow decision-making by others regarding treatment and other aspects of life in the best interests of a person, if that person lacks capacity.(5, 6) Where there is no mental capacity legislation, for example in Northern Ireland, case law suggests patients who lack capacity should similarly be treated in their best interests.

With the availability of mental health legislation, why would we need to assess capacity? There are (at least) three scenarios where this might be useful:

4. Assessing decision-making capacity in eating disorders

1. Where the disorder is considered by clinicians to be untreatable and they need to decide whether to accept patient refusal of treatment, nutrition or life-sustaining measures;

2. Where the disorder may be treatable but there is doubt in the clinical team about whether formal compulsory treatment is appropriate, so knowing capacity status can guide the team as to how much weight they should give to patient decisions which may not be in their own best interests;

3. Contentious cases, for instance prolonged use of mental health legislation, where the assessment of capacity may help inform clinical and tribunal decisions.

The definition of incapacity varies between different legal jurisdictions (see box for current definitions applying to the United Kingdom). Grisso and Appelbaum in the USA developed the MacCAT-T instrument of competence which conceptualises capacity as: Understanding, Retention, Appreciation, and Reasoning (comparative and consequential).(7) Importantly, the mental capacity laws applying in England, Wales and Scotland require that incapacity arises from disturbances of mind, which includes mental disorder. Studies have shown that there are high rates of incapacity amongst inpatients in acute general medical and psychiatric wards.(8, 9) Worse, however, physicians often fail to detect patients’ incapacity.(8)

In some cases of mental disorder, it would be evident that a person lacks capacity, for example if a patient is extremely thought disordered from schizophrenia or severely cognitively impaired from dementia. In eating disorders, however, sufferers typically have the ability to understand and retain information, and indeed many possess an impressive knowledge of their illness and its risks. There are, however, other ways in which eating disorders may affect the ways in which, or the reasons for which, people with eating disorders might make decisions about whether or not to accept treatment. Any assessment of capacity therefore needs to be both thorough and nuanced to pick up more subtle but significant difficulties in decision-making. The application of the Mental Capacity Act in the two law cases suggests that the main difficulties are generally categorised under the broad criterion ‘ability to use and weigh information’. This criterion, however, is poorly defined and gives little guidance to the clinician. A suggested format for assessment which should help clinicians to perform a full assessment of factors which may affect capacity is given below.

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Format for the assessment of capacity in eating disorders1. Assess ability to understand and retain information

Checking understanding and retention is fairly straightforward – disclosure can be followed by a request for the patient to repeat the information back in his or her own words. The MacCAT-T competence instrument provides a structured and systematic framework for doing this. (7)

2. Assess ability to use informationThis can be assessed in the course of the discussion and by asking the patient for his/her reasons for the decision - it should become evident whether the patient is able to use the information provided.

3. Assess appreciation of information and facts of the decisionAppreciation, not seen in UK legislation but found in Grisso and Appelbaum’s definition of competence, is the ability to apply the information to oneself.(7) This can be a problem in eating disorders, for example, a patient may say, “I understand that’s the definition of an eating disorder, I understand I have those features, and I understand eating disorders need treatment; but I do NOT have an eating disorder and therefore I do not need treatment”. This clearly would affect capacity to make decisions about treatment for an eating disorder.

4. Assess presence of compulsionLook for compulsions (or obsessions) that may prevent the patient from acting on the basis of his/her understanding or even desires. The Code of Practice of the Mental Capacity Act gives an example that patients with anorexia nervosa may be unable to ‘use and weigh’ treatment information as part of the decision-making process: “For example, a person with the eating disorder anorexia nervosa may understand information about the consequences of not eating. But their compulsion not to eat might be too strong for them to ignore.”(10)

5. Assess for changes in values due to the eating disorderIt is part of the core criteria of anorexia nervosa that a person should either have a fear of fatness, or an overvaluing or pursuit of thinness.(11) This dread of fatness and overvaluing of thinness, found in many eating disorders, means that being thin or losing weight becomes disproportionately highly valued by sufferers, in some cases this is even valued above life itself. This disproportionate value can drive some patients to decide, even after they have weighed up the

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options, not to have treatment because they would rather die than gain weight.(12)

6. Assess for changes in identity due to the disorderOne of the characteristics of eating disorders is that they can be egosyntonic disorders, that is, experienced as part of the self and also consistent with one’s own values.(13) Further, many people with eating disorders become ill as adolescents, and may as adults have little or no sense of who they would be without the disorder. This intertwining of the disorder with the sense of self can make it difficult to decide to have treatment in order to recover from it; for example, patients may be either unable to envisage a self without eating disorders.(12)

7. Assess for depressive features, loss of hope and affective elementsEating disorders have clear effects on emotion and mood; there is a high rate of comorbidity of depression.(14) It is important to assess for depressive features and particularly for suicidality, more covert wishes for death (for example, wanting to die thin) and inability to envisage or hope for recovery, all of which would affect how options are weighed. Charland and colleagues further argue that beyond comorbid depressive disorder, anorexia nervosa itself may have clear affective components, fitting Ribot’s conception of a ‘passion’ in its very nature.(15) These components include having a fixed focus and motivational force and attachment; these may have an impact on decision-making.

ConclusionThere are several ways in which eating disorders can affect decision-making. This does not mean, however, that all patients who have eating disorders lack capacity. It also does not mean that all patients who have eating disorders should be compelled to have treatment, though it should be borne in mind that patients themselves favour compulsory treatment to save life.(16, 17) Capacity must always be assessed at the time for the decision at hand. The assessment of capacity requires a careful and systematic approach, but as the MacCAT-T instrument acknowledges, even with formal instruments, in the end the judgement of the presence or absence of capacity is a clinical, global judgement.(7)

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Definition of incapacity in England and Wales: The inability –

(a) to understand the information relevant to the decision,(b) to retain that information, (c) to use or weigh that information as part of the process of making the

decision, or (d) to communicate his decision (whether by talking, using sign language or

any other means)” (5)

Definition of incapacity in Scotland:A person who is not capable of –

(a) acting; or (b) making decisions; or (c) communicating decisions; or (d) understanding decisions; or (e) retaining the memory of decisions.(6)

Definition of incapacity in Northern Ireland:Common-law test applies. This test of capacity is as follows:

(a) Does the patient comprehend and retain treatment information?(b) Does the patient believe that information?(c) Does the patient weigh that information, balancing risks and needs, to

arrive at a choice? (18)

Jacinta Tan Senior Research Fellow at Swansea University Honorary Consultant Psychiatrist Eating Disorders Team at the Abertawe Bro Morgannwg University Health Board, Wales.

References:1. A Local Authority v E [2012] EWHC 1639 (COP).2. Gordon C. Force-feeding 'not in best interests' for 3 stone anorexic woman. The Independent [serial on the Internet]. 2012: Available from: http://www.independent.co.uk/life-style/health-and-families/health-news/forcefeeding-not-in-best-interests-for-3-stone-anorexic-woman-8079158.html.

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3. The Mental Health Act 2007. Available from: http://www.legislation.gov.uk/ukpga/2007/12/pdfs/ukpga_20070012_en.pdf.4. Mental Health Act Commission. Guidance Note 3: Guidance on the treatment of anorexia nervosa under the Mental Health Act 1983. London: HMSO; 1997.5. The Mental Capacity Act 2005: Available from: http://www.dca.gov.uk/menincap/legis.htm.6. Adults with Incapacity (Scotland) Act 2000: Available from: http://www.legislation.gov.uk/asp/2000/4/pdfs/asp_20000004_en.pdf.7. Grisso T, Appelbaum P-S. MacArthur Competence Assessment Tool for Treatment (MacCAT-T): Sarasota FL US: Professional Resource Press/Professional Resource Exchange Inc. vi 35 pp.; 1998.8. Raymont V, Bingley W, Buchanan A, David AS, Hayward P, Wessely S, et al. Prevalence of mental incapacity in medical inpatients and associated risk factors: cross-sectional study. Lancet2004;364:1421-27.9. Owen G, Richardson G, David AS, Szmukler G, Hayward P, Hotopf M. Mental capacity to make decisions on treatment in people admitted to psychiatric hospitals: cross sectional study. British Medical Journal2008;337(Jun30):4.10. Department of Constitutional Affairs. Chapter 4: How does the Act define a person’s capacity to make a decision and how should capacity be assessed? Mental Capacity Act 2005 Code of Practice: TSO; 2007. p. 40-63.11. World Health Organisation. F50.0: Anorexia nervosa. ICD-10 Classification of Mental and Behavioural Disorders. Geneva: World Health Organisation; 1994.12. Tan JOA, Hope T, Stewart A, Fitzpatrick R. Competence to make treatment decisions in anorexia nervosa: thinking processes and values. Philosophy, Psychology and Psychiatry2006;13(4):267-82.13. Serpell L, Treasure J, Teasdale J, Sullivan V. Anorexia nervosa: friend or foe? Int J Eat Disord1999 Mar;25(2):177-86.14. Braun DL, Sunday SR, Halmi KA. Psychiatric comorbidity in patients with eating disorders. Psychol Med1994 Nov;24(4):859-67.15. Charland LC, Hope T, Stewart A, Tan J. Anorexia Nervosa as a Passion. Philosophy Psychiatry & PsychologyIn press.16. Tan JO, Stewart A, Fitzpatrick R, Hope T. Attitudes of patients with anorexia nervosa to compulsory treatment and coercion. Int J Law Psychiatry2010 Jan-Feb;33(1):13-9.17. Watson TL, Bowers WA, Andersen AE. Involuntary treatment of eating disorders. Am J Psychiatry2000 Nov;157(11):1806-10.18. Re C. (Adult: Refusal of Treatment), In re [1994] 1 W.L.R. 290; [1994] 1 All E.R. 819.

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At the time of writing, the legal ruling is not yet available in the public domain and the only information available is from newspaper reports.

The EDSECT National Conference – Perspective from a Medical Student

None of the Royal Colleges seem to have put as much genuine effort into trying to encourage and enable students to pursue their career pathways as the Royal College of Psychiatrists. I first became aware of the conference via the student associate newsletter. As a local co-ordinator for the Student Run Self Help (SRSH) group for young people with eating disorders, I was immediately drawn to the possibility of such a valuable opportunity to further my learning on the subject and for local networking. I was very grateful for the prompt response from the Royal College and for the bursary that made the possibility of attending a reality.

The conference itself was a truly pleasurable learning experience. The cross professional involvement, included pure scientists and the Rheumatology team, as well as Psychiatrists. This painted a multidimensional image of the service and the professionals closely working together to look after the patients in their care. As an ex-neuroscientist I may be slightly biased in mentioning the presentation by Professor Kringelbach on pleasure centres involved in food intake and the implications of reward pathways on eating disorders. I found this to be of particular interest personally as the neurological pathways described are shared by many other conditions. Whilst this research may still be in its infancy, it may help to direct more targeted management for these conditions in the future.

The general atmosphere of the conference was very friendly and I was struck by how approachable the other delegates were. When it came to patient management I learnt as much by talking to the attending consultants as I did from the insightful post presentation discussions. I thoroughly enjoyed the manner in which each consultant, including the speakers shared their personal experiences for patient management. I believe this very revealing of the heterogeneity of the subject and each individual patient experience. I also believe this is perhaps the most important point which I will take away with me from the conference.

5. EDSECT Annual Conference – A Trainee perspective

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I would like to thank the Royal College of Psychiatrists for this enriching experience.

Peter Sellars

The EDSECT National Conference – Perspective from a Psychiatry CT1 trainee

I was fortunate to be awarded a bursary to attend the Eating Disorder Annual Section meeting, held at the Cavendish Conference Centre on 2nd November 2012.

As a CT1 in psychiatry, with my only prior experience in the field being a few weeks in an inpatient unit during my elective, I was a little unnerved that the content would be heavily focused on the minutiae of eating disorders and would, therefore, go over my head. 

To my delight, I found the whole experience thoroughly enjoyable. The lecture hall was packed, the food was good and the conference centre staff were very helpful.

The programme was varied and interesting, with medically orientated lectures on bone health and fertility to psychology based ideas such as CBT as used in irritable bowel syndrome. It was evident how these could link in with management of patients with eating disorders, and spawned much discussion around the topics after the lectures.

Two highlights were the presentation on the pleasure of food intake by Professor Kringelbach, and the results of a study on Multi Family Therapy by Professor Eisler, the proposal of which  had been presented at a previous Eating Disorder Annual section meeting.

The conference has positively contributed to my peaked interest in eating disorders, and I feel inspired to pursue it further. As there are few training posts in the specialty, the conference provides an invaluable opportunity for trainees to

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meet those established in the field and start the cogs turning for developing a clinical or research interest in eating disorders. 

Jemma Theivendran

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Early Discharge at the Expense of Readmission:

A Six-year Review of Admissions in an Eating Disorder Unit

Dr Golnar Aref-Adib CT3 Psychiatry BMedSci MBBS MRCPsych

Victoria Stone 4th Year Medical Student BSc (Hons)

Sarah Lawrence 5th Year Medical Student BSc (Hons)

Dr Panagiotis Kyrtatos FY2 Doctor BMedSci MBBS PhD

Emma Friddin Assistant Psychologist BSc

Dr Eric Johnson-Sabine Consultant Psychiatrist

MBBS, MRCGP, ,FRCPsych

Background

Whilst working as core psychiatry trainee on Phoenix Eating Disorder Unit the first three patients I admitted had a BMI ranging from 9 to 10. I was alarmed and surprised at the severity of the cases and the team commented that anecdotally year upon year admission and discharge BMI was dropping. There was a general feeling that this could be associated with stricter commissioning and leading to

higher readmission rate. The new constraints in commissioning became evident as I observed how funding had to be sought prior to each admission with estimated date of discharge specified on entry.

Under the supervision of the consultant I worked with a team of medical students and a psychology trainee to determine whether there was a trend for discharge from hospital to occur at a lower BMI over the course of the last 6 years and whether this was leading to a higher readmission rate.

5. EDSECT – Poster Winner

About the Phoenix Wing

The Phoenix Wing, St Ann’s Hospital is a tertiary referral centre. It is commissioned to serve a population of 5 ½ million in North Central, North East London & home counties. There are approximately 1000 referrals per year. .

The unit provides comprehensive treatment for all types of eating disorders that includes inpatient treatment (Phoenix Wing,15 beds), a residential stepped down facility (Acacia House 5 beds) and a day service (Russell Unit, 8 places).

Aim

To determine whether new constraints in commissioning were associated with:

Lower admission BMI Lower discharge BMI Increase rate of readmission Shorter admissions

Method

The analysis comprised of a retrospective case note review of all inpatient admissions from 2006 to 2011 to The Phoenix Wing Eating Disorder Unit. Data regarding primary diagnosis, admission and discharge BMI, length of stay, mode of discharge, MHA section status, and transfer to Acacia House were obtained from the hospital database (RiO) and checked against the discharge summaries completed by ward doctors. The data were all anonymised and each patient was assigned a number, to cross reference in the event of readmission.The data was entered in Excel and analysed using GraphPad Prism.

Results:

There have been 278 admissions since January 2006, with 240 of these having a primary diagnosis of anorexia nervosa, 17 with severe bulimia nervosa and 21 with atypical eating disorders. Mean age at admission was 30 years (median 27.5), with 95% of admissions being female. The average number of patients on MHA section each year was 7 (range 4-9).

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The average length of stay was 132 days and there was no significant variation over the period from 2006 to 2011.

Admission and Discharge BMI over the last 6 years

For patients with anorexia, for the cohort as a whole, mean BMI upon discharge decreased steadily between 2006 and 2011 (p=0.05). Mean BMI on admission decreased but was not significant (p=0.32).

Repeat admissions-Admission and Discharge BMI.

Mean admission and discharge BMI for individual patients also decreased with subsequent readmissions (admission BMI p=0.03, exit BMI p=0.01).

% Readmissions within 12 months over the last 6 years.

From 2006 to 2011 there was a rise in both the absolute and relative number of readmissions of these patients.

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% Increase in BMI for those who attended Acacia step down.

The percentage change in BMI was higher for those with an extended admission that included the Acacia, step down facility (p=0.03).

Conclusion

These data confirm that patients are being discharged at lower BMIs with a poorer psychiatric outcome and higher readmission rate.

Admission and discharge at lower BMI is likely to be associated with more psychiatric morbidity in the community and reduced likelihood of making a social recovery. As length of stay was unchanged, there was no cost saving and the increased rates of readmission suggest that over time there will actually be a cost increase.

Commissioners are encouraged to review reasons behind early discharge and to support admission at a higher BMI. This is an important public health message, which could lead to potential savings in the long term.

A culture of stricter commissioning is associated with:

Lower admission BMI Lower discharge BMI Increase rate of readmission Shorter admissions

Work on mapping of ED Service across the country is still continuing with much work from Jessica Morgan and Agnes Ayton.

6- Other News

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Paul Robinson’s training programme for the MARSIPAN is also taking place

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Member Year of joining Position

Dr Agnes Ayton 2012 (C) Co-opted Member

Dr John Morgan 2011 (E) Chair

Dr Jane Shapleske 2007 (E) Financial Officer

Dr Carol Wilson 2012 (A) Psychiatric Training Committee Rep

Dr Rebecca Cashmore 2011 (E) Elected Member

Dr Frances Connan 2007 (E) Elected Member

Dr Philip Crockett 2011 (E) Elected Member

Dr Christopher Freeman 2011 (E) Elected Member

Dr Philippa Hugo 2011 (E) Vice Chair

Ms Veronica Kamerling 2011 (C) Co-opted Member

Dr Nikola Kern 2011 (E) Academic Secretary

Dr Adrienne Key 2007 (E) Elected Member

Dr Jessica Morgan 2011 (E) Elected Member

Dr Elizabeth Morris 2011 (E) Elected Member

Dr Sandeep Ranote 2011 (C) Co-opted Member

Dr Lorna Richards 2007 (E) Elected Member

Ms Susan Ringwood 2008 (C) Co-opted Member

Dr Paul Robinson 2007 (E) Elected Member

Dr Christine Vize 2011 (E) Elected Member

Dr Irene Yi 2011 (C) Co-opted Member  

8. EXECUTIVE MEMBERS OF EDSECT

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