I am Professor of Social Psychiatry at Bangor University, North Wales and Honorary Consultant in liaison psychiatry in Wrexham. From 1988 to 2004, I was a full time NHS Consultant Psychiatrist in a community mental health team in Central Liverpool. In 2004, I moved to work in North East Wales. In 2009, I was appointed to my first substantive academic post. In 2012, Professor Catherine Robinson and I established the Centre for Mental Health and Society at Bangor University. It is now co-directed by Professor Peter Huxley and myself.
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. Early in my career, I realised that the greatest burden of mental ill health falls on people who have least. I believe that fighting for good mental health services is an essential part of the general struggle for equality and fairness. I am angered by privilege, by the misuse of power, and by attempts to misconstrue self-interest as philanthropy. The global pandemic has clearly demonstrated the effects of health inequity. If there was ever a time for action against social injustice in the interests of national and global health, it is now.
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. I am not against it either. It is sometimes necessary to assist in recovery from physical or mental illness, but it is rarely sufficient on its own. I am interested in social and psychological interventions, which are equally or more important. Medication 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 concerning the problems associated with long-term high-dose opioid medication for chronic pain. My colleagues and I have developed a model whereby the problems are understood to lie in interactions between the patient, the prescriber, the health system and wider social values. The pharmaceutic industry has not behaved well over these drugs, but this is by no means the only factor that has led us to current difficulties.
I am concerned about a loss of policy focus on those people who are most seriously affected by mental illness. I have had a long-term interest 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. Dr Duncan Double once 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 mental health cults (biological, psychological or other). I am located within the mainstream of my profession, but I am not uncritical of it, nor, I hope, of myself.
I was genuinely shocked to receive the Royal College of Psychiatrists Lifetime Achievement Award in 2017. Obviously, I was incredibly pleased, but it shook me. I was truly humbled.