Friday 20 September 2019

'Psychiatrists have a negative reputation'

Prince William, Duke of Cambridge and Prince Harry look upon flowers, photos and other souvenirs left as a tribute to Princess Diana near The Sunken Garden at Kensington Palace on August 30, 2017 in London, England
Prince William, Duke of Cambridge and Prince Harry look upon flowers, photos and other souvenirs left as a tribute to Princess Diana near The Sunken Garden at Kensington Palace on August 30, 2017 in London, England

There has been a huge drive both in the UK and in Ireland to destigmatise mental illness and to encourage people to seek help when they are experiencing emotional problems. The British royals have led the initiative in Britain and both the young royals - Prince William and Prince Harry - have spoken very openly about the devastation of losing their mother.

In Ireland, sporting organisations like the GAA as well as professional bodies such as the College of Psychiatrists of Ireland, Shine and Aware have been to the forefront.

Offering advice is simple, but delivering on that is more complex. So, while those who have mental health problems may be enthusiastic for help, accessing it may be challenging, to say the least.

There are huge barriers to obtaining treatment, including the most fundamental one of choosing the psychiatrist that is right for you. The delivery of psychiatric services is based on address and any change of address requires a change of psychiatrist, a practice that in my opinion is anti-therapeutic. If there is only one psychiatrist covering the geographic area in which you live, the attitude is "tough, mate". A further difficulty is that those most in need of help are often the most reluctant to request it or to accept it when offered.

Psychiatrists have a negative reputation with connotations that conform to the worst stereotypes. Overmedicating, detaining people compulsorily, and not practising evidence-based medicine are among the many criticisms we face. Then there is the image of old institutions lurking in the collective consciousness of the public, although this thankfully has been eroded with the relocation of psychiatric treatment centres to general hospitals.

For people seeking information on how to find a psychiatrist, what to expect from the consultations and what the legal position is regarding those who may be at high risk of injuring themselves or others, information is now available. With the enticing title of Mental Health in Ireland: The Complete Guide for Patients, Families, Health Care Professionals & Everyone Who Wants To Be Well by Professor Brendan Kelly, the public will have accurate information at their fingertips. Hitherto the main source was the internet, but that is of variable quality and accuracy.

This book is written by a former colleague of mine now based in Tallaght Hospital as Professor of Psychiatry in Trinity College. He is a mainstream practising psychiatrist, with a keen interest in the history of psychiatry in Ireland, warts and all, and its advances in the 21st century.

Not only does it highlight how the services work and how their impenetrability can be overcome, but it provides clear information on a number of common conditions such as depressive illness, bipolar disorder, schizophrenia, eating disorder and so on. For each it poses four questions that include: what are the causes; how common is it; what are the signs and symptoms; and what is the treatment? These are answered in clear and accessible, jargon-free language.

It also explains the workings of the Mental Health Act and the Assisted Decision Making (Capacity) Act. By way of contrast, there is a most interesting chapter on happiness and well-being. Other important issues such as stigma, and structural violence, human rights and dignity are explored.

Professor Kelly is well-placed to write on human rights as he is the author of a definitive book on human rights and mental illness published last year, titled Mental Illness, Human Rights and the Law.

In his new book, Professor Kelly has enlivened the chapters dedicated to specific psychiatric disorder by the use of case vignettes to illustrate aspects of mental illness and the impact it has on the person and on families. The section on carers is particularly welcome as their role is often not given enough credit in facilitating recovery.

But the focus is not just on adults - mental health issues in children and adolescents are also discussed, as are the dementias that are found in older people. And the reader in each chapter is directed to other useful resources.

This book is the first of its kind for an Irish audience and it deserves to be a best-seller. Authoritative, clear, practical and evidence-based, a discerning public should receive it warmly.

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