A broader platform to discuss mental health service concerns

OVER the past number of years there has been an increasing articulation of concerns about the current state of mental health services in this country.

Such concerns include the inhumane physical conditions in hospital units, over-reliance on and excessive use of medication, lack of meaningful community-based alternatives to hospitalisation, involuntary treatment, abuse of professional power, lack of information and choice in relation to “treatment” options.

New approaches have emerged to address these concerns. These approaches recognise that the bio-medical strategy in mental health care today will at best provide temporary symptomatic relief (which may be valid as a first step), but may compound, exacerbate and even cause further deep distress. Current responses to distress fail to capture the complexity of human experiences by ignoring the underlying grief, heartbreak and trauma in people’s lives. These new approaches also recognise that the whole person needs to be centrally engaged in their own recovery.

Key actors in the development of this new thinking are diverse, but represent people who describe themselves in such terms as service users, survivors, patients, members of the mad community, carers, family members, practitioners, professionals, academics and the lay public, all of whom are dissatisfied with current forms of care and its underpinning bio-medical philosophy. Significant attempts have been made to bring about changes at different levels by individuals and groups. For example, at the level of legislation there is the campaign to delete section 59b of the Mental Health Act which allows for the involuntary administration of ECT on the basis of the signature of two consultant psychiatrist. At the level of service delivery there are some innovative examples of practice such as the Slí Eile housing project in Charleville providing a therapeutic community type environment for people with mental health difficulties. At the broader level of service ethos and philosophy there are examples such as the West Cork Mental Health Services, demonstrating an active commitment to community-based, recovery-oriented practice. However, such campaigns, initiatives and new approaches remain quite isolated and fragmented events, and have not yet achieved to significantly influence the bigger scheme of mental health practice at a national level.

In an attempt to provide a broader platform to discuss and debate concerns and share new initiatives and approaches, a two-day critical perspective conference was organised by the Schools of Nursing and Midwifery and Applied Social Studies, University College Cork, in November 2009. Informed by positive feedback, another two-day conference was organised in November 2010. At this conference, attended by 300 people each day, the setting up of a network of critical voices in mental health was debated.

The Critical Voices Network Ireland (CVNI) emerged out of these deliberations as a coalition of service users, carers, professionals, academics, national campaigning and advocacy groups, all looking for a mental health system not based on the traditional bio-medical model. This network provides a democratic space with no hierarchical structures, open to everybody who wishes to join its discussions. An e-list and a Facebook page have been established to share, debate and discuss issues of concern and different ways of working. It was agreed at the launch for the network to meet quarterly. Since then, meetings have taken place in Tullamore and Dublin, finding common ground and identifying priorities on relevant issues.

The network, in association with other organisations, organised the lecture tour of acclaimed American medical journalist Robert Whitaker, taking in seven engagements with wide media coverage. The network also provides ongoing support for the existing Delete59b campaign, which can now draw on a much wider and larger network of support. Health Action International Europe, in association with the CVNI are organising an open seminar on September 24 in University College Cork to promote greater public awareness and debate about the Irish and European drug regulation systems and situations where conflicts of interest can arise

The third critical perspectives conference, organised again by the Schools of Nursing and Midwifery and Applied Social Studies, University College Cork, but this time in association with the CVNI, will be held on November 16 and 17 in UCC. The focus of this year’s conference is on the over-reliance of medication as the main response to human distress. The conference will discuss and debate the use of medication as the dominant response to distress in mental health care, medication withdrawal concerns, strategies and solutions, and creative and enabling non-medicated ways of working.

The role of universities in networks such as the CVNI is an important one, as a key role of universities is to foster and nurture critical thinking. It is through the CVNI that an environment has been created where different and sometimes conflicting voices and agendas can be heard and respected. In that sense, UCC has begun to play an important and positive role in supporting, enabling and empowering people who have so often been silenced and marginalised.

- Dr Harry Gijbels, senior lecturer, School of Nursing and Midwifery, UCC, and Ms Lydia Sapouna, College Lecturer, School of Applied Social Studies, UCC

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