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The Norfolk Lane refuses to be impressed by the weather, by my clinical workload, or by the slow theft of Cody’s strength. It keeps its bends, its stiles, its quiet insistence. Cody, too, keeps going. I envy his certainties because I, so often, feel far less certain about so many things.
What has rankled is the recent chorus on the topic of “medical leadership” in mental health care. I don’t think it is wrong but can’t help reflecting on its convenient rediscovery.
I can’t help reflecting on how responses to the centrality of the doctor’s role in mental healthcare was so very often allowed to be diluted and how this might have been because challenging the system could be tiring and appeasing it was often rewarded.
There is something oddly theatrical about the change of tone now: the breathless pitch, the talk about innovation and transformation, the willingness to listen. It is almost as if mental health care were a start-up, waiting for a rebrand.
The script is familiar and mentions kindness, drive, compassionate leadership … all of them fine qualities. They are offered though as if they are a strategy, rather than the bare minimum for working with human distress.
It is a leadership lexicon that can sound profound while saying almost nothing. Meanwhile, the real work remains stubbornly unglamorous: patients, families, clinicians trying to do honest medicine in systems that lurch and strain.
This is where I want to be plain. Psychiatry is not an apologetic add-on to medicine. It is, unapologetically, a branch of medicine rooted in the biopsychosocial tradition and anchored in diagnosis, formulation, evidence, risk, treatment, and outcomes. Our patients do better when we practise it that way.
Psychiatry is not a managerial construct or a collection of well-intentioned words. It is clinical work with medical discipline and humane purpose and that precisely is what medical leadership in mental health should mean.
Medical leadership is the willingness to name these truths, to protect them, to practise them, even when it is unfashionable.
Medical leadership is not a badge you pin on when it becomes convenient, useful or safe.
That reminds me of something else.
If I had to choose, I would take every time, followership with integrity over leadership without principle.
In healthcare, the gentle tug of followers who refuse to abandon what is true will always be more meaningful than the bluster of leaders who rediscover truth only when convenient.