It looks as though the current British government is smitten with health czars. It announced a czar for cancer, a czar for heart disease, and a czar for drugs. Now comes a psychiatry czar as well.

The psychiatrist tapped for the post is Professor Louis Appleby of the University of Manchester. His official title will be National Director of Mental Health for the National Health Service in England. And his major mandate, British Health Minister John Hutton explained when announcing the appointment on April 14, will be to drive "through the national program for improving mental health services."

Not all British psychiatrists are especially interested in, or well-informed about, this latest development. But those who are seem to be enthusiastic about it. For instance, as John Gunn, M.D., a professor of forensic psychiatry at the Maudsley Institute of Psychiatry in London, told Psychiatric News, "I think our profession as a whole is very pleased with this appointment. . . pleased with the idea."

John Cox, M.D., president of the Royal College of Psychiatrists in London, said in an interview that the new health czars "are a slightly new departure. Nobody knows quite what influence they will have. But one assumes that it will be quite considerable. . . . Obviously he [Appleby] will have the ear of ministers, and I hope he will keep his ear open to opinion of psychiatrists up and down the country. These are very exciting times for mental health services in Britain."

Ebullience also seems to prevail regarding the man dubbed the psychiatry czar. "Professor Appleby is well known to the college," Cox said. "He is a well-recognized academic in Manchester. . . . I think the advice he will give to ministers is likely to be good advice."

In Gunn’s opinion, "He is a really bright, up-and-coming academic with a strong interest in public issues and media. . . .He is quite a popular man."

Observed Michael Launer, M.D., a psychiatrist and clinical director of the Lamont Clinic in Burnley, Lancashire, England, "There has been a lot of criticism of the government because [officials] surround themselves with people who have no hands-on experience with mental illness, people who have been long retired, or academics who do not actually treat patients. Professor Appleby actually does treat patients. He’s also quite young—he’s not an old fogey with gray hair or anything. So I think it shows they are appointing one of the brightest academics in psychiatry to advise them. That is a good sign, really."

It’s not just because Appleby is a young, bright, popular, hands-on academic, however, that he has garnered the psychiatry czar title. He has also earned it. For instance, he was recently in charge of a national inquiry into homicides and suicides among the mentally ill in Britain. It was a joint venture between the British Department of Health and the Royal College of Psychiatrists. Psychiatrists were asked to report to Appleby’s team in Manchester whenever they lost a patient to suicide or homicide, and in return, they were promised that their reports would remain confidential. These reports then led to useful data on how such disasters occur, and on the basis of the data, Appleby and his team made recommendations to psychiatrists on how they might thwart such tragedies in the future.

Also, Appleby has been closely involved in the development of the National Service Framework for Mental Health (NSF) in Britain. This framework, which was published by the British Department of Health last year in its thrust to modernize and reform mental health services in Britain, sets certain national standards for them. The phase-in of the framework began in April, and its implementation is being bankrolled from now through 2002 to the tune of £700 million (roughly $1.04 billion) beyond the government’s £3 billion (roughly $4.5 billion) for mental health services. In fact, one of Appleby’s major goals as psychiatry czar will be to implement the NSF, he told Psychiatric News.

Indeed, his overall thrust in his new position, Appleby explained, will be "to produce a modern, high-quality service. A quality service would respect patients/service users, incorporating their views in its developments. It would recognize the role and skills of families acting as caregivers, including them as partners in care whenever possible. It would make the best and most effective treatments available. It would shape the service according to need, so that people who needed urgent care would be given prompt access, and people with a broad range of social and health needs would receive a broad range of supports and treatments. It would highlight safety, particularly of patients themselves. And it would produce a skilled and motivated workforce. This is what we have to develop."

No, it won’t be easy. The biggest challenge, Appleby observed, "is to ensure that these changes happen quickly, because hard-pressed services and busy clinicians sometimes find it hard to adopt new ways of working, and of course I have to convince patients/service users and families that they will see a difference. . . ."

But will they? "I think it is possible," opined Launer, although he has been critical of Britain’s socialized medicine system in the past. "It depends on the civil service [and] how shackled he is. I know him personally to talk to—he is a very affable guy; there are no airs and graces about him. I think that if he is allowed to have his head, if you like, he’ll do a good job."

"The drug czar has been around for some time, which is of course psychiatrically related," Gunn pointed out. "An ex-constable—ex-policeman—has been doing that. He has made some sensible comments, collected some data, but really, as you might expect, no [major] changes on the ground. I think that is probably the situation that we’ll see with the psychiatry czar. We are not expecting dramatic changes because they’ve appointed one chap as their adviser. But it illustrates commitment to psychiatry, and in that sense, it has to be good news."