Response

The thought-provoking commentary by Richard Morriss^{Reference Morriss1} on a recent editorial in the BJPsych ^{Reference Critchley, Tracy, Malhi, Alexander, Baldwin and Cavanagh2} highlights funding initiatives by major UK mental health research funding bodies and argues that this illustrates the wider recognition of, and political will to address, challenges faced by academic psychiatry.

The editorial,^{Reference Critchley, Tracy, Malhi, Alexander, Baldwin and Cavanagh2} penned by members of the Academic Faculty of the Royal College of Psychiatrists (including myself), sought to refresh the understanding of academic psychiatry, wherein educational and research activity is pursued alongside clinical work. The editorial discusses how academic psychiatry is essential to the training of medics and allied professions and underpins evidence-based practice, particularly in relation to mental illness and the health implications of psychiatric disorders, psychological conditions and vulnerabilities. In this context, the culture and environment across higher educational and healthcare sectors are vital to delivering the proven clinical benefits of aligning healthcare provision with research. The article also states the importance of fostering a more diverse academic psychiatry workforce to challenge perceptions of exclusivity.^{Reference Stewart3} Indeed, as also recognised by Morriss, there is a need to attract medical students into psychiatry and staff into research, which may benefit from even earlier communication with schools and teachers to enhance understanding of psychiatry and its value, which can otherwise be overshadowed by broader notions of mental health.

Morriss appreciates that a key motivation for our editorial is the ongoing depletion of the UK academic psychiatrist workforce, despite increasing numbers of medical students, for whom the delivery of teaching about mental illness and psychiatric conditions is now often delegated to non-medics. Across old and new medical schools, a critical mass of academic psychiatrists is required to train and mentor a future psychiatry research workforce and guide their bids for research funding. Between 2003 and 2023, the number of academic psychiatry posts in UK medical schools dropped by 84,⁴ almost all (80) from mid-career level (senior lecturer, reader, associate professor) positions, and lost at a rate of more than four per year. A highly conservative ‘back of the envelope’ calculation (for salary costs only) shows the ‘massive’^{Reference Morriss1} disinvestment in academic psychiatry to be at least £40 million historically and £8 million per year prospectively. Admittedly, although academic psychiatry is disproportionally affected, the number of UK clinical academics has generally declined across medical disciplines. Consequently, a consortium of major health research funders, including the Medical Research Council, Wellcome Trust, British Heart Foundation, Cancer Research UK and National Institute for Health and Care Research (NIHR), are collectively ‘looking at injecting money into the system’ of around £10 million per year.^{Reference Bisson5} For UK academic psychiatry alone, all this investment sustained over at least 5 years would be required to recover faculty numbers to 2012 levels.

For decades, research spending on physical health conditions has eclipsed patchy mental health research funding.^{Reference Woelbert, Kirtley, Balmer and Dix6} Helpfully, Morriss highlights a range of recent investments in the broad UK mental health funding landscape, including the 2022 launch of the 10-year £42.7 million Mental Health Mission⁷ and the Mental Health Research Group initiative.⁸ These are important schemes involving the NIHR, designed to support collaborative and applied mental health research through investment in infrastructure and the multidisciplinary workforce, with a focus on areas of clinical need. Such initiatives will hopefully improve longer-term career opportunities within academic psychiatry, but this impact needs demonstrating. Psychiatrists should of course, in line with the suggestions from Morriss,^{Reference Morriss1} capitalise on these initiatives (and those offered through the UK Research Councils and charities such as the Wellcome Trust) to sustain academic psychiatry’s essential contributions to clinical knowledge, medical education and evidence-based practice and care. Nevertheless, coordinated efforts are needed to disseminate awareness of, and foster interest in, such opportunities, promote this information across the UK nations and ensure that the academic aspirations of psychiatrists-in-training are met with equitable access to pursue research. It is also important to monitor whether this changing UK research funding landscape has more than a tangential impact on the recovery and maintenance of the academic psychiatry workforce.