“Anti-depressants not a scrap of good for situational or reactive depression”

Forensic testing of blood can now determine if anti- depressants were the cause of violent behaviour, including murder or suicide, new research has found.

Genetic variations in metabolism affect how different people react to anti-depressants, and now medical examiners say they can identify those variations, and use the evidence to “potentially absolve people charged with homicide”, and explain why they acted like they did….

Here is the full version of last week’s Irish Examiner piece. Note additional and important quotes from Dr. Lucrie at the end.

Jennifer Hough

Forensic testing of blood can now determine if anti-depressants were the cause of violent behaviour, some of which results in murder or suicide, new research has found.

Genetic variations in metabolism affect how different people react to anti-depressants, and now medical examiners say they can identify those variations, and use the evidence to  “potentially absolve people charged with homicide,” and explain why they acted like they did.

The research, published recently in the Journal of Forensic and Legal Medicine, was carried out by a medical specialist, a forensic psychiatrist and a pharmacogeneticist. It looks specifically at three cases where people with no previous diagnosis, who were prescribed antidepressants for stress-related issues, ended up killing others, with two attempting suicide.

“An out-of-character unmotivated homicide or suicide by a person taking medication might be chemically induced and involuntary. The capacity to use frontal lobe functions and control behaviour can be impaired by brain toxicity,” the paper states.

 “None improved on medication, and no prescriber recognized complaints as adverse drug reactions or was aware of impending danger.”

 The researchers took accounts of restlessness, akathisia (a state of severe restlessness associated with thoughts of death and violence), confusion, delirium, euphoria, extreme anxiety, obsessive preoccupation with aggression, and incomplete recall of events.

“Weird impulses to kill were acted on without warning. On recovery, all recognized their actions to be out of character, and their beliefs and behaviours horrified them,” the paper notes. The research concludes that the “medicalization of common human distress” has resulted in a very large number of people getting medication that may do more harm than good by causing “suicides and homicides and the mental states that lead up to them.”

Irish mental health campaigner Leonie Fennell, whose son Shane was prescribed anti-depressants and soon afterwards killed himself and another person, said she has been aware of this evolving science for some years, and has had Shane’s blood tested in Australia.

The researcher who tested Shane’s blood, Dr Yolande Lucire, is one of the papers’ authors.

She cited his case in another research project she carried out in 2011. Dr Lucire noted that Shane was initially prescribed a double dose of the common SSRI anti-depressant, citalopram. Five days later he overdosed on the tablets, taking 23 pills, and two days later he told his doctor, who then restarted him on a lower dose of the anti-depressant.  “He immediately became violently akathisic, unable to stay in one place, moving constantly between the houses of friends, unable to sit and have a conversation. According to his mother, communicating with him was like “talking to a brick wall.” His friends reported that, immediately after taking citalopram, he became agitated, emotional, irrational and aggressive. His brother saw him throw a mobile phone, destroying it, with trivial, if any provocation,” Lucire writes in the 2011 research.

 Post-mortem toxicology of blood revealed levels of citalopram of about 30 times the therapeutic level.

Dr. Lucire, a forensic psychiatrist who specialises in adverse drug reactions to psychiatric drugs, said in her experience patients do not need the drugs they are being prescribed.

“Doctors have to learn that anti-depressants not a scrap of good for situational or reactive depression and should stop prescribing them,” she said. “They have to understand the drugs have side effects. All doctors should be retrained in the drugs they prescribe. They should give out consumer information for every drug that they prescribe and they should get informed consent,” she said.

 Dr. Lucire says prescribing anti-depressants without knowing about patients’ genetic make-up – and the possibility of having an abnormal gene that cannot metabolize these drugs properly – is like giving blood transfusions without checking blood groups. 

ENDS

“Classism and racism” colours how we treat Travellers

Article featured in Irish Examiner today from UCC Traveller conference, additional reporting here cites barrister David Joyce, IHREC member.

Jennifer Hough

Traveller families in Cork city are forced to shower at a local swimming pool, share one portaloo and have no piped water or electricity – because the city council refuses to recognize the site they live on.

Breda O’Donoghue, chair of grassroots organization the Traveller Visibility Group, said this particular extended family has children in local schools, good relationships with the settled community, and has been living on the site for 15 years. But, she said, the city council will not install electricity because where they live is deemed an “unofficial” site.

It was just one of many similar stories told to a Traveller housing conference at UCC on Tuesday, organized by Cork and Kerry Traveller Project’s Regional Accommodation Network.

Chair of the conference Bridget Quilligan, the project coordinator of Kerry Travellers, said Traveller families are living in cars, in unsafe accommodation, and regularly presenting to services as suicidal as a direct consequence of their living conditions.

Quilligan said the Carrickmines tragedy, which saw ten Travellers – including five children – die in a fire last October, has “marked us all, it could have been any one of us.”

The aftermath of the horrific fire has seen Travellers mobilize around the housing issue with new vigour and on Tuesday, the conference launched a manifesto to fight for adequate accommodation.

“Projects all across the country have decided our approach has to change,” Quilligan said. “We cannot continue working with local authorities the way we were before, because despite out best efforts, we are not getting results,” she said.

 “We have been shouting for 25 years but all these committees…structures are not working. We are meeting people in complete chaos and stress. When you have no safety and security, everything else is affected. People wonder why our woman are turning to prescription drugs– family life is decimated by insecure accommodation.”

Quilligan said the State is pushing a “policy of assimilation,” pushing Travellers into private rented houses, from which they are evicted, mostly because neighbours don’t want them.

 “It is exhausting for people, the impact on mental health is terrifying. Travellers living in private accommodation cannot let their parents visit, children can’t go outside door, for fear of being bullied or recognized as Travellers.”

David Joyce, barrister and a member of the Irish Human Rights and Equality Commission, said this kind of behaviour in Irish society needs to be called what it is – classism and racism. “People can object to things on legal grounds, but not just because someone is a Traveller, that is racism.”

Joyce said in the last 100 years the law has worked to negate the freedoms that once existed for Travellers.

“Travellers began to be classified in law as nuisances, there was no talk about improving or providing services, or solutions, but just denying their way of life. The law has been used to denigrate and wipe out the community.”

Joyce said he believes the lack of action on behalf of local authorities culminated in the Carrickmines tragedy.

 “Local authorities are not being held to account for bad planning and bad design. There were clear elements of negligence on part of Local Authority in respect of Carrickmines,” he said.

Joyce said there is also an issue that Travellers looking for planning permission to self-fund their own sites are being hit with legislative barriers.

“I know of instances where individuals have gone for planning for themselves, but come up against local connections, or are told caravans are not suitable for long term living, but the same authority is providing caravan accommodation for Travellers elsewhere.”

ENDS

As NGOs document human rights abuses at Europe’s borders…

Here’s my latest piece on migration/refugee issues.

http://www.irishexaminer.com/viewpoints/analysis/europe-scales-up-plans-to-control-migration-379242.html

Europe scales up plans to control migration

As drownings in the Mediterranean continue and winter grips the perilous routes refugees are beating towards Europe, EU leaders remain divided over how to deal with the largest movement of people since the Second World War.

Under ambitious European Council proposals, a super-agency would ramp up the security and patrols of EU borders. Picture: AP

At the heart of the political debate are quotas, border controls, and controversial plans, announced by the European Commission in December, for a new European border and coastguard agency.

Amid a climate of fear following the Paris attacks, the commission presented an ambitious proposal, aimed at “securing the EU’s borders… while safeguarding the principle of free movement of persons”.

INCREASED POWERS

Under the plan, Frontex, the current border guard agency, would be rolled into a bigger agency: A European Border and Coast Guard, with funding worth €322m by 2020, compared to the €238m due this year.

Although much of the commentary around the revamping of Frontex has stated the organisation’s current weakness, it already has access to ocean patrol vessels, dog teams, helicopters, thermovision vehicles, night-vision goggles, heartbeat detectors, and about 1,000 border guards.

The new agency, however, would be able to buy its own equipment, have a “rapid reserve pool of at least 1,500 experts that can be deployed in under three days”, and operate drones in the Med. Under the plan, officers could be deployed in an emergency without the approval of governments, giving it a much stronger mandate than the Frontex border teams.

The proposal, backed by France and Germany, has sparked heated political debate but member states in December agreed to “rapidly examine” the proposals aiming to reach agreement by mid-2016.

HUMAN RIGHTS CONCERNS

The enduring memories from Europe’s refugee influx over the past few years will undoubtedly be the heart-wrenching stories of lives lost in the Mediterranean.

Until the 1990s, there were relatively few drownings of migrants at sea, and it’s well documented that the only reason people resort to dangerous illegal crossings is because of Europe’s strict visa policies and carrier sanctions for airlines or ferries who take anyone without the correct papers. Over the past number of years, Amnesty International, Human Rights Watch, and scores of smaller NGOs, have been documenting human rights abuses at Europe’s borders.

Theses include pushbacks at border crossings in Greece, Bulgaria, and Spain, where border authorities have denied people access to asylum procedures in direct breach of international law. Pushbacks are often accompanied by violence and put people’s lives in danger, Amnesty says. To date, no authority has been held accountable for such practices.

A report by Médecins Sans Frontières highlights the objectives of Frontex’s joint sea operations: To strengthen border controls, rather than to save lives at sea or offer safe, legal passage to people.

Late last year, Human Rights Watch documented attacks by masked men on boats with asylum seekers and migrants in the Aegean Sea. Bill Frelick, director of Human Rights Watch’s refugee program, said until there is meaningful accountability, the attacks will continue.

“The stretch of water that migrant boats have been crossing in large numbers is relatively narrow and widely known. Frontex is conducting a joint operation in those waters, as are Greek and Turkish coast guard patrols,” he said, suggesting that the agency knows about the attacks and does nothing.

A Frontex spokesperson said any allegation of ill- treatment or other violation of fundamental rights is reported to authorities in the respective member state and Frontex requests an probe is carried out.

“It is important to note the investigation on the alleged incidents is in all cases conducted by the host MS authorities, not by Frontex. Frontex monitors the developments on those investigations in all cases.”

PUSHING OUT THE BORDERS

While the world’s eyes are focused on the frontlines of the refugee influx into European territories, behind the scenes, the EU has been active on other fronts.

Since 2011, Frontex has powers to sign agreements with “third countries,” (countries outside the EU) as a way to “counter illegal/ irregular migration and related crossborder crime”, as well as to “strengthen security at relevant borders”.

This effectively pushes the EU’s borders outside of Europe. Frontex has deals with at least 17 countries such as Nigeria, Turkey, Morocco, Senegal, Tunisia, Armenia, Azerbaijan, Belarus, Georgia, Moldova, and Ukraine.

It has also been involved in Libya, training border guards, coast guards and border police officers. The idea behind this strategy is to make the border controls of third countries more effective, decreasing the chances of refugees and migrants getting to the EU.

NGO’s Statewatch, a non-profit that monitors civil liberties in the EU, and Frontexit (a campaign funded by the European Programme for Integration and Migration to highlight Frontex’s activities) claim it is difficult to get data about what goes on under these deals.

Frontexit says many people who entered Libya irregularly are forcibly removed. It claims border training from the EU increases the risk that migrants and refugees are detained in Libya and subsequently deported. For example, 25,000 people were deported from Libya between May 2012 and May 2013.

Since September 2015, Amnesty has documented cases of refugees being forcibly returned to Syria and Iraq after being intercepted by Turkish authorities while trying to reach the EU. Others have been arbitrarily detained without access to lawyers, the NGO contends.

Peter Sutherland, UN special envoy on migration, believes asylum assessment should take place in third countries, arguing it’s better people are vetted for eligibility before “risking everything and getting into rickety boats” to reach Europe, perhaps only to be deported. But, he stresses, this work should be carried out by the office of the UN High Commissioner for Refugees.

Nina Perkowski, a doctoral researcher on EU border controls at the University of Edinburgh, says this “outsourcing” of migration control has been ongoing since 2001. “Co-operation in migration ‘management’ is often a pre-condition for all sorts of agreements with the EU, including trade deals and development aid,” she says. “The EU envisions a ‘humane’ EU side of the border. The violence that is necessary to prevent people from moving would then also be ‘outsourced’ to third countries, and be outside of the jurisdiction of the EU.”

Perkowski has written a number of academic papers on Frontex. She believes strengthening the agency simply continues the path the EU has chosen over the last 10 years, which has led to unfathomable numbers of deaths at EU borders.

We’re still failing the vulnerable – Children in direct provision

Editorial from Irish Examiner on recent Direct Provision story.

WHEN those appalling, shaming reports about how vulnerable children were so mistreated in care homes were published, we took comfort in the suggestion that most people were unaware of what went on in these wretched institutions.

We may not have entirely believed that convenient fiction but it was the best we could do, it was a straw of decency we clutched at in a very dark moment.

However, we cannot use that excuse about the suspended lives of asylum seekers or the children born into the 15-year-old system of direct provision. We are all aware of the inhuman indignities underpinning a system that is one of enduring the black marks against our society.

That the Department of Justice does not know how many children have been born in direct provision just adds to the concerns around the process. The latest figures from the Reception and Integration Agency shows there are at least 1,225 children living in direct provision centres. No one can say how long they will be so confined or denied the opportunities all children need to become decent, worthwhile citizens. At a moment when the refugee crisis is bringing new challenges to Europe, this is a particularly worrying admission. Imagine if our system had to cope with numbers proportionate to those reaching Germany — a million this year alone — or Sweden, almost 200,000 this year. Unbelievably we are failing another generation of vulnerable children.

Ireland availed of less than half of EU funds for migrants/refugees during worst recession years #refugeecrisis

Less than half of €15m funds for refugees drawn down

Less than half of the €15m in EU funds available to Ireland between 2007 and 2012 to support groups working with migrants, asylum seekers, and refugees was drawn down.

In the period, Ireland was allocated over €8m under the European Refugee Fund (ERF) and approximately €7m under the European Integration Fund (EIF).

A spokesperson for the Department of Justice said in the period 2008 to 2012, 48% of the funding allocation under the ERF was drawn down, and that between 2007 and 2012, Ireland drew down 46% of the funding allocation under the EIF.

The department said “not enough suitable projects” came forward with necessary match-funding, which has to be sourced by projects.

Edel McGinley, director of Migrant Rights Centre Ireland said:

“I am actually quite shocked to learn that this money wasn’t drawn down. Resources were scarce during the deep austerity years and everyone was struggling for money. Entire communities could have benefited from this money.”

The ERF is intended for NGOs and other bodies to implement integration initiatives with a focus on areas such as education, health, community development, promoting access to services and provision of training for service providers.

The EIF is to support initiatives for newly-arrived and legally resident Non-EU Nationals (excluding asylum seekers and refugees) of different cultural, religious, linguistic and ethnic backgrounds, to facilitate their integration into Irish society.

The office for the promotion of migrant integration, in the Department of Justice, is the responsible authority for the funds.

Read rest of story here:

http://www.irishexaminer.com/ireland/less-than-half-of-15m-fund-for-refugees-drawn-down-358771.html

Beyond Psychiatry, where the mental health debate needs to be

Here’s my latest contribution to mental health awareness, which ran in the Irish Examiner this week, with some additional information, marked sidebar.

Sidebar:

In 1999, the UK’s Critical Psychiatry Network was set up because, according to its founders, the profession had become infiltrated and too aligned with the pharmaceutical industry.

Those involved in the network have, over the years produced countless books and academic papers chronicling what they believe has gone wrong within their own profession.

In 2012, the British Journal of Psychiatry carried a pivotal paper from the network entitled Psychiatry, Beyond the Current Paradigm.

Dr. Pat Bracken, an Irish psychiatrist then based in the UK, was one of 29 mental health professionals who put their name to it.

It challenges what the authors call the “technological paradigm” of psychiatry, the “medicalisation of everyday life, which, in turn, is associated with expanding markets for psychotropic agents.”

“Psychiatry is not neurology; it is not a medicine of the brain,” they wrote. “Although mental health problems undoubtedly have a biological dimension, in their very nature they reach beyond the brain to involve social, cultural and psychological dimensions.”

It concludes that “good psychiatry” involves active engagement with the complex nature of mental health problems, a healthy scepticism for biological reductionism, tolerance for the tangled nature of relationships and meanings and the ability to negotiate these issues in a way that empowers service users and their carers.

“Retreating to an even more biomedical identity will not only sell our patients short, but risks leading the profession down a single narrow alley, when what is needed is openness to alternative route.”

 DSM-5 concerns

Perhaps the most overt embodiment of the medical model of psychiatry is the American Psychiatric Association’s, Diagnostic and Statistical Manual of Mental Disorders (DSM), generally accepted as a trustworthy scientific manual to diagnose mental health problems as “disorders.”

The latest incarnation of the manual, the DSM-5, has caused extensive concern, even in the mainstream community. Dr Allen Frances, chair of the DSM-IV Task Force, has called it “flawed,” and “reckless” because of how it grossly inflates human emotions into illnesses. For example, the DSM-5 will allow clinicians to label a child with temper tantrums as having disruptive mood dysregulation disorder, and overeating can now be called binge eating disorder, to name a few.

“Drug companies take marketing advantage of the loose DSM definitions by promoting the misleading idea that everyday life problems are actually undiagnosed psychiatric illness caused by a chemical imbalance and requiring a solution in pill form,” Dr. Frances has warned.

Printed article begins here:

A persistent social crisis which is not all in our heads

SOME call themselves anti-psychiatry, some are part of the critical psychiatry movement, or promote the theory of “post psychiatry”. Others just know there has to be a better way.

http://www.irishexaminer.com/viewpoints/analysis/a-persistent-social-crisis-which-is-not-all-in-our-heads-354857.html

Over the past 20 years, the voices of concerned mental health professionals, service users and academics have gained momentum in a bid to break down the medical model of psychiatry, and the damage they believe it is inflicting on people in distress.

Issues around overprescribing of medications, control and coercion, and the focus on labelling people’s emotions are the kind of debates critics of mainstream psychiatry demand be heard and tackled.

Some want psychiatry dismantled, others believe it can be a part of the way forward, but only if it embraces new ways of thinking, and places people and their individual experiences before longstanding medical views of distress.

The latest in a growing canon of books, blogs, research papers, lectures, and conferences railing against the mainstream is The Depression Delusion, Volume One, the Myth of the Chemical Brain Imbalance, a book by Limerick-based doctor and psychotherapist Terry Lynch. Set for release in September, it chronicles how the notion that a chemical imbalance in the brain is responsible for depression was started by pharmaceutical companies to market their pills, but was adopted widely by the psychiatric community.

Lynch, who has sat on several government-appointed mental health advisory groups, writes that psychiatry is unique in medicine in that none of its diagnoses have any scientifically established biology or pathology.

“Claims that depression and other psychiatric illnesses are biological are crucial to psychiatry’s identity and its unmerited position at the top of the mental health tree… after all, if biology isn’t central to the experiences that have become known as mental illness, what special expertise do psychiatrists really possess?” Lynch asks while the majority of medical practitioners are sincere people trying to do their best, a consequence of the medical model is that generations of people on medication have not been treated for the psychological and emotional components of their distress, reducing the potential for recovery.

Drug treatment

Lynch equates the scale of the problem to any of Ireland’s recent major social crises, such as institutional child sex abuse or the Magdalene Laundries.

“For 50 years, doctors have been telling people that antidepressants work by correcting brain chemicals that are out of balance. I know from many phonecalls and contacts I receive from people to this day, that this practice still goes on regularly in the privacy of the consultation room,” he says.

Lynch, a practicing psychotherapist, stresses he is not anti-medication, but believes it’s imperative that people be fully informed.

“It’s very clear that medications change how people feel, sometimes people feel better, sometimes they feel worse… There is a place for medication and it does help a lot of people, but I think doctors have a duty to tell people: we really don’t know how these work. Numbing is one of their more common effects.”

It’s a point SSRI expert David Healy has written about. “Their [SSRI anti-depressants] primary effect is to emotionally numb. Patients on them walk a tightrope as to whether this emotional effect is going to be beneficial or disastrous.”

Dr John Hillery, director of communications of the College of Psychiatrists of Ireland, says Lynch’s charges are “at odds” with what the college believes.

“I don’t believe the chemical imbalance theory is still widely believed in Ireland,” he says. “It’s not something that I would have told patients, I would have told people about the theories… and that there is a lot of evidence to show they [medications] help people. But they are not going to help everyone and should be part of a treatment package that includes talking therapies and other forms of support.”

Hillery says the college does not have an “official position” on the chemical imbalance theory.

“It is one of the theories behind depression, we talk about it when training people, and teaching the theories behind how medications work, but we do not teach people ‘this is what you tell patients’.”

Hillery, a practicing psychiatrist, said the most important thing for doctors, is to point out medications’ side effects, and that if they do not work, they should be stopped.

“Science that has produced theories [on medications]… beyond that we know they are very helpful for some people, but they should not be given without careful reflection. A lot of recommendations for treating depression now don’t put medications as first-line treatments, but one of the big problems in the public sector is getting access to other therapies for people.”

Lack of alternatives

Compounding matters in Ireland, and indeed globally, is the economic crisis has pushed so many people into despair; people who likely need social and psychological — not chemical — solutions.

An Irish Examiner investigation earlier this year found that almost 2.3m prescriptions were written for anxiety and depression drugs in 2012, enough to cover more than half the population. These figures only take the top five most frequently prescribed anti-depressants and anti-anxiety drugs under the General Medical Services (GMS) into consideration.

There has been an acknowledgement by the Government that alternatives to medication for people presenting to their GPs — who are the first port of call for more than 90% of mental health problems — are needed.

In 2013, the Counselling in Primary Care (CIPC) service was set up to offer free counseling sessions to medical card holders, but the need is far greater than what’s currently being offered.

Lara Kelly, spokesperson for Mental Health Reform, says the scheme was allocated a development budget of €3.8m, just one half of 1% of the mental health budget in 2014.

“The service is available to medical card holders only and has a limitation of eight counselling sessions for each individual accessing the service,” Kelly says. “We want to see it extended to meet the counselling needs of low to middle-income people with mild to moderate mental health difficulties and an increase in the number of sessions from eight to 20.”

Beyond Psychiatry

Those within the critical psychiatry movement, however, say a fundamental reimagining of how human distress is handled is needed — not just tweaks around a broken system.

Harry Gijbels, a lecturer of post-graduate psychiatric nursing at UCC, and Lydia Sapouna, a social work lecturer at UCC, in 2010 founded the Critical Voices Network of Ireland (CVNI), a grassroots movement that aims to redress the balance between patients and practitioners, and give a voice to people who have been silenced.

They believe although Irish psychiatry promotes an image of change, it’s still very embedded in the traditional model of thinking.

“People’s struggles, distress and despair are still very much framed in biomedical terms without looking at a broader picture of people’s lives,” says Sapouna.

Gijbels says psychiatry has engaged with the service user movement and talks about change, but contends that what’s happening is just “lip service”.

“Psychiatrists talk the talk a lot because they feel they have to, but with very little substantial change. We have seen no change in the services. It’s still the very traditional way of thinking.”

He pointed to the new €15m mental health unit at Cork University Hospital (CUH) as an example. “This is very much the old way of thinking — you are ill so you need to be in hospital.”

Recovery

A Vision For Change (AVFC), the national blueprint for modernising the mental health services, calls for the implementation of the recovery concept. The idea emerged in mental health in the 1980s and grew from the publication of personal stories and research studies that showed people diagnosed with severe mental health problems could recover and lead meaningful lives.

The recovery ethos requires new knowledge, skills and approach and is seen as a challenge to professionals working within traditional services, according to Mental Health Reform.

“We talk about recovery as a paradigmatic shift, but what’s happening is just tinkering at the edges, without major changes,” Gijbels continues. “There is a national project, Advancing Recovery in Ireland, and a number of mental health services are trying to implement change, but again there is no real big change. Recovery is not about models or systems… it’s supposed to be about giving people hope, opportunities, control, but that’s not happening and psychiatry remains firmly in charge.”

Lynch devotes a chapter of his book to telling the stories of nine people he has treated and who have recovered from their mental health problems.

All, he says, were told they had a chemical brain imbalance that needed long-term treatment with medication. In each of the cases, the person either never took the medications in the first place, or came off them during the course of his work with them.

Lynch says he’s not suggesting everyone who comes to him makes such a recovery, but uses the examples to point out what’s possible when the right emotional and psychological supports are in place.

“I’m not saying it’s easy, it’s very difficult because there are very few supports for it, but surely if recovery can happen, that’s what we should be aiming for.”

Hillery of the College of Psychiatrists says the college is pushing the “bio/psycho/social model” and the recovery concept, and teaches trainee psychiatrists to look beyond the medical model. “I would hope people are being told they can recover, and can eventually get off medications… some can get off them, but others will need to remain on them.

“One of biggest frustrations we have is a lack of access to other therapies for people who can’t pay.”

Systemic change

In an article published in 2012 in the Irish Journal of Psychological Medicine, Dr Pat Bracken, consultant psychiatrist and clinical director of mental health services in West Cork, wrote that one of the most important questions facing psychiatry is its relationship to the emerging international service user movement — groups like the Hearing Voices Network, Mad Pride, and Mindfreedom International.

“As it becomes more organised and influential this movement is starting to play a major role in shaping the sort of questions that are being asked about mental health services and their priorities,” he wrote.

“Yet there is limited reflection in our profession about how we, as doctors, might engage positively with it. It seems that while we are comfortable working with individuals and organisations who accept the medical framing of mental problems, we are less willing to contemplate working with critical service users.”

Sapouna says: “Naming something as recovery is not change… the college [ICP] can say, ‘we have a group, we are talking’, but the power imbalances need to change and they are far from changing,” she says.

“One indicator of real change would be to see peer-led services. We constantly get calls and emails from people, and the families of people, who are experiencing difficulties, they are despairing for other services, asking us what other ways there are… we need to develop other structures outside mainstream services,” she says.

“For example, people in crisis need a safe place where they can be supported and nurtured, an acute unit is not necessarily the best place for someone in crisis.”

Sapouna points to a unique service in rural Cork, Slí Eile, a housing and support facility, with a farm, for people looking to get away from the revolving doors of the psychiatric system.

“We need crisis homes, more places like Slí Eile… places where people who are in a bad place can find a sense of hope and meaning.

Gijbels says it’s about giving people choices.

“Society need to find ways of understanding how life affects people, we talk about impact of the recession, but at the same time, I don’t think distress has been framed in a different way… effectively you need to seek advice from your GP, at the moment there’s no one else to go to,” reinforcing the notion that people have a medical, rather than a social, problem.

“Drugs will take the pressure off but they won’t fix what’s wrong,” Gijbels says.

“I can understand why GPs prescribe them, they only have 10 minutes with people and want to alleviate their suffering. Some people will get a counsellor, but it’s still a very individual approach… the idea that people’s problems are within them rather than social problems, faults in structures, systems and the lives that we lead.”

Ultimately, says Sapouna, it’s about a more democratic process that allows people to lead the way.

For any of this to happen, political will is needed.

As pointed out by Mental Health Reform in its report in June, A Vision for Change, Nine Years On, in 2012, the current government took a decision not to appoint an Independent Monitoring Group (IMG) to oversee implementation of the strategy. The cost of having an IMG — there were six, from 2006 to 2011 — is negligible as experts appointed, such as Terry Lynch and John Hillery, do not get paid.

Hillery says the move was “disappointing” as the final IMG recommended the Mental Health Commission take over monitoring, and it became a statutory requirement.

Lynch says he’d like to see an independent public inquiry into what’s gone wrong in the past, and how to fix it. “It may need to be international… it should be officially funded and involve a range of people and groups, including mental health service users, with special emphasis on the input of people who have fully recovered from diagnoses such as bipolar disorder, schizophrenia and depression. Psychiatry should have an input but should not be controlling it. It’s widely recognised that we are going through a major mental health crisis, this is a huge societal issue that needs to be tackled properly.”

Romping around #Newfoundland from @irishexaminer

Newfoundland feels like Ireland 20 years ago, when people left their doors unlocked, hitchhiked without fear and took time to stop and chat. Jennifer Hough feels right at home in the Canadian province.

Read full article here:http://www.irishexaminer.com/lifestyle/travel/bigread/theres-one-place-like-home-in-newfoundland-canada-353170.html