I am Professor of Social Psychiatry at Bangor University, North Wales and Honorary Consultant in liaison psychiatry in Wrexham.
From 1988 to 2009, I was a full time NHS Consultant Psychiatrist in community mental health teams. I worked in Toxteth and Liverpool City Centre for 16 years. In 2004, I moved to work in Mold, North East Wales for five years.
At an age when sensible people look forward to retirement, I was appointed to my first substantive academic post. In 2012, Professor Catherine Robinson and I established the Centre for Mental Health and Society, which we co-direct within the School of Social Sciences at Bangor University.
My professional interests, research, publications and appointments can be perused here.
In the course of a long career, I have done a lot of different things. Nonetheless, there have been some enduring themes:
I have a strong interest in good clinical skills, and much of my work has been about understanding and promoting them.
I am not unequivocally enthusiastic about medication, whether psychotropic or otherwise. I am not against it either. It is sometimes necessary to assist in recovery from physical or mental illness, but it is rarely, in itself, sufficient. I am more interested in social and psychological interventions which are equally or more important. This is not to deny that people can sometimes overcome ill health without any professional intervention at all, including mental illness. Medication, along with psychological and social intervention, has to be respected because it can have adverse effects, some of which are predictable, and some of which can be unexpected.
I am involved in work on rational prescribing, currently looking at the overuse of opioid medication. My colleagues and I have labelled this Dysfunctional Therapeutic Use of Opioids to indicate that the problem is not necessarily located in the patient but in interactions between patient, prescriber, the health system and wider social factors.
I am concerned about a loss of policy focus on those people who are most seriously affected by mental illness. I have had long-term involvement in rehabilitation psychiatry. I have had roles in establishing mental health services for people who are homeless, or who are caught in the criminal justice system, or who have substance misuse problems.
Early in my career I realised that the greatest burden of mental ill health falls on people who have the least financial and personal resources. I believe that establishing good quality user-friendly psychiatric services for those who have least is an essential part of the general struggle against social injustice and inequality. I am angered that privilege and the misuse of power are on the rise, and by the demonization of people on benefits, of migrants and of minorities.
A few years ago, Dr Duncan Double called me ‘an old-fashioned radical’. I was quite pleased. There is a part of me that is strongly drawn to be an iconoclast. This is one factor that has led me to become involved in controversy over the integration of spirituality and religion into clinical practice. I am against it. I am not antagonistic to, or uninterested in, other people’s beliefs, but I believe that proper boundaries between professionals and service users protect both parties. I am concerned that this is being eroded by a failure to understand that religion and power cannot be separated.
I have little patience with post-modernism or with the inventors of mental health cults (biological, psychological or other). I admire the mischievous spirit and elegance of the Sokal hoax. I am located within the mainstream of my profession, but I am not uncritical of it, nor, I hope, of myself.