Mick Wallace (Wexford, Independent) | Oireachtas source

The interim report is ambitious in its scope but, I would say, cautious in its goals. The proposed staff and service provision increases are a no-brainer and, basically, no mental health care to speak of is provided by the HSE. There are three excuses for mental health provision in Ireland: locked up on drugs, drugged in the community and trapped on waiting lists. The report mentions these problems in passing but one gets the sense that the only thing that will change if the report is implemented is that the waiting lists for being seen might decrease.

The report acknowledges the lack of talking therapies available in Ireland and that there is an over-reliance on pharmaceutical interventions, but there is no mention of the problems surrounding these issues or the type of actions that will better this state of affairs. There is no mention of a lack of expertise and help provided by medical practitioners in weaning people off medication and dealing with after-effects. There is no mention of the negative effects or even the usefulness of antidepressants and other powerful drugs that are almost exclusively used alone for long periods with no auxiliary counselling services provided. There is no discussion of the types of talking therapy that need to be expanded, or discussion or evaluation of the types of therapy the HSE promotes at the moment. There is no mention of the fact GPs are allowed to prescribe drugs while the majority of them have zero training in helping people in distress. There is not a word of input from those who have survived the mental health services or who are going through them right now. There is an old saying that has been adopted by those who have survived mental health services, "nothing about us without us", the idea being that no policy should be decided by any representative without the full and direct participation of members of the group or groups affected by that policy.

Last week I spoke here about the dominance of the medicalised model of mental health care in the HSE and how GPs and psychiatrists were prescribing powerful antidepressants like they were fertiliser, all without so much as a question about what may be going on in the lives of those in emotional or psychological distress. There is a huge misconception about how these drugs work and around the idea that they work at all. They are nothing more or less than very powerful painkillers. Much like the dominant philosophy one finds in the HSE, they sometimes work on people to remove them from their pain and remove them from difficult and uncomfortable experiences in the short term. When the situation is a crisis, this kind of intervention can have a numbing effect which may help. However, a growing body of evidence is demonstrating that, as a long-term solution, it is not a good approach. Much better outcomes are achieved by helping people through their pain, by being there for the patient and by helping them to build the tools they need to confront their pain and trauma. This approach should be pursued by the HSE but, instead, we have set up a situation where patients are diagnosed with illnesses based on checklists and their pain is outsourced to the pharmaceutical business, while their underlying problems are buried where they cannot possibly deal with them.

What makes the situation even worse is that there are terrible side effects from taking these drugs that can last years. Aside from the fact that the class of drugs called SSRIs are known to increase suicidal ideation, as the clinical trials of the drug show again and again, sexual dysfunction is also a major problem with these drugs, with many people reporting, even after coming off the drugs, that they feel they will never enjoy sex again, which leads to further distress. There is a lot of misinformation, which leads to people continuing to take these drugs and downplaying the side effects.

The best at promoting these products are those in the psychiatric profession. Only two months ago the president of the Royal College of Psychiatrists and the chair of its psychopharmacology committee claimed in England's The Timesnewspaper that, for the vast majority of patients, "any unpleasant symptoms experienced on discontinuing antidepressants have resolved within two weeks of stopping treatment". This is not true. A formal complaint disputing this claim has been signed by 30 people, including ten psychiatrists, and the president of the Royal College of Psychiatrists has not been able to come up with any scientific research to back up the claim.

It is clear that there are disagreements within the psychiatric discipline about what forms of care have the best results for patients. It is frightening that powerful members of that group will put the lives of thousands of people at risk in order to protect the reputation of the pharmaceutical industry. Coming off antidepressants is extremely dangerous and should be done with the assistance of a professional. The idea of a two-week hangover is a dangerous one. Fortunately, there are other ways to address mental health issues but based on our office's experience with the CHO 5 top brass, and their lack of respect for the people with whom they work, it is hard to be optimistic about progress and reform in this area.

Two years ago, I spoke in the House about Open Dialogue, a mental health care approach that has been used in Norway for 30 years with amazing results. It has been successful in curing so-called schizophrenia and other mental health-related diagnoses. The Open Dialogue approach is about person-centred care, where the medical professional is present with people's distress and open to it. Most important, it ensures the person having the crisis is empowered and has the final word about how their care proceeds. The mental health professional goes on a journey with them and is open to going where they are and letting them decide what happens next. The whole system needs to be organised to facilitate this, especially in terms of continuity of care. The same professionals who are involved in the meetings when the crisis first arises are involved through the whole process of care. What we have now is very different because people go from team to team. If relationships are fundamental to care, why have we created a system that is like a conveyor belt? In Open Dialogue, the same professionals must engage with the social network of the person in crisis because the crisis is not just happening to the patient and trained staff must work with them mindfully. It is a whole-system change that puts the patient at the centre of care and empowers them and their social network to move forward together.

In the UK, the NHS is conducting a randomised control trial of Open Dialogue interventions in seven centres throughout the country. They are trying to see if they can replicate the success they have had in Norway and they have trained up to 400 people in Open Dialogue practice in their training centre in London to take part in the trial. We should pay heed to the results as they could be very interesting. To really change the system one needs a system-wide approach and not just a set of interventions and techniques. It is obvious that the system is going in one direction, that is, the medicalised one with the dominance of the notion of brain disorders, diagnosis and medication. This report may be calling for a few different techniques but, unless we change the direction of the stream, very little will change.

I would not lay this at the Minister of State's door. We have a lot of problems in this area. I think he is very interested in the whole subject but he has an incredible challenge on his hands to persuade the HSE to take a different approach. This goes for every section of the HSE. The organisation is a monster that is very difficult for any Minister to get to grips with in a short period of time. I wish him the best of luck with it.

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