Mary Docherty

2018/2019 Recent Returners

Mary Docherty, B.A. (Hons), M.A., M.B.B.S. (Hons), MRCP, MRCPsych

 Mary was an Expert Clinical Advisor to NHS England’s Adult Mental Health Program and had completed her specialist training in psychiatry when she started her fellowship. She had previously held positions in the National Institute of Health and Clinical Excellence (NICE), NHS England and, London’s Healthy London Partnership focusing on programs that address inefficiencies and inequalities at service interfaces. Past outputs include tools and methodology for disinvestment in ineffective practices, standards and implementation of multi-agency crisis care pathways and, national guidance and the delivery program to reduce premature mortality in individuals with serious mental illness. She also established the first national specialist service for assessment and treatment of cognitive and negative symptoms in schizophrenia. Her previous research publications span the translational spectrum and have informed national policy including the new mental health investment standard. In her earlier career she attained a First-Class Honors degree and Masters with Distinction in Politics, Philosophy and Economics, graduated with Honors (Gold medalist) from medical school, completed her psychiatry training on the Maudsley Training program and NIHR research fellowships at the Institute of Neuroscience, Newcastle and then the Institute of Psychiatry, Psychology and Neuroscience, London. She is an alumnus of the Chief Medical Officer’s Clinical Advisor’s Scheme and a member of both the Royal College of Physicians and Psychiatrists.

During her fellowship, Mary studied at New York State Psychiatric Institute at Columbia University, where her study topic was “Implementing integrated primary care, mental health and social care for individuals with complex needs. The impact of co-morbid mental and physical health conditions on poor health outcomes and high costs are well known. Social determinants of health substantially impact health behaviors and influence whether an individual is able to access and benefit from health care.  There is strong evidence that care models that integrate behavioral health and primary care improve outcomes but implementation of these care models remains challenging. Current UK policy commits to delivering new community models of integrated mental health and primary care. Mary wanted to learn how to overcome barriers to integration and her research investigated exemplar programs delivering this work, focusing on the different approaches being used by policy makers, payers and providers.

Mary found that lack of appropriate payment models, shortages of appropriately trained staff and cultural differences across clinical specialties hinder care delivery and sustainability. She was able to profile a series of practical and priority strategies that had supported different tiers of stakeholders to advance this work. Investment in core infrastructure including technology, workforce, data and quality metrics, governance structures and supports for the third sector to develop these capabilities were key. Changes to accountability mechanisms including value-based payment models and creation of new accountable entities offered helpful levers but additional efforts were needed at all levels of the system to advance and sustain integrated practice. Integration of social need interventions into mental health and primary care pathways was relatively less developed. Addressing the deficit of quality measures for care processes and outcomes in social interventions, building data sharing arrangements to track impact at a system level and conducting robust evaluation of different delivery models emerged as important next steps. Many of the strategies identified in her work can inform current UK policy and practice in this field.

Since her return Mary is directly applying her research and working as a Consultant Liaison Psychiatrist in an innovative service spanning three major London hospitals, integrating mental health provision into care for individuals living with long term cardiac and respiratory conditions. Additionally, she is co-leading the National Confidential Enquiry into Patient Outcomes and Death’s (NCEPOD) study into the physical health care of patients in inpatient units. Alongside her clinical and research activities she is completing her Master’s study at the Tavistock and Portman in organizational consultancy.