Malcolm Garland, a psychiatrist at St Ita’s Hospital Portrane, and a senior lecturer in psychiatry at the Royal College of Surgeons, used the metaphor of a dying tree to describe psychiatry and community mental health teams.
“The tree is not savable, it cannot be made healthy, it must go,” said Dr Garland, one of six keynote speakers at a two-day conference organised by the School of Applied Social Studies, the School of Nursing and Midwifery and the Critical Voices Network of Ireland.
Dr Garland said services are “withering” under the weight of procedures and protocols and that the HSE delivers a medical model service, treating diagnoses, not people. He said community mental health teams lack unity and purpose, and though they are made up of highly trained professionals, they are not what people in distress need.
Dr Garland’s vision involves training a new breed of mental health care worker to offer support through highly-specialised care groups, funded through local authorities on the basis of demand and usage. They would be completely independent of the medical system.
“These groups would have no geographical boundaries, and you would not need a referral. They would be supported by an ecosystem dependent on the service user. There would be no hospitals, no forced treatments.”
The groups would also be made up of service users.
Dr Garland suggests teaching children self-care from a young age in school.
“If everyone learns these things, when they see someone in distress they will know, they don’t need pills or a diagnosis, they need love and compassion.”
The psychiatrist stressed he is not proposing a dumbing down of services.
“Human distress can be very dark and complex. We need to have places for those people too, with people trained in open dialogue.”
Open dialogue is a system of care for those experiencing a mental health crisis. It involves bringing the family together and engaging in dialogue with the person in distress. It evolved in Finland in the 1980s, which now has the best-documented outcomes for psychosis in the western world.
Dr Garland said there is absolutely “no political will” for his vision. His own team in Dublin, he said, are seen are mavericks and exist on the “edge of toleration” by HSE management.
“We give people space to talk and use minimal medications,” he said.
The theme of this year’s conference is a critical look at the value of talk therapies. Dutch “expert by experience” Wilma Boevink says she was diagnosed as a paranoid schizophrenic at 20, locked in an institution and given medications to suppress her psychosis and voices. By listening to her voices, she has only recently discovered the root of her problems — child abuse.
In the Netherlands trained “experts by experience” are running recovery groups and the government is starting to fund it.