Latest news with #SuzanneCrowe
Irish Examiner
3 days ago
- Health
- Irish Examiner
Psychiatry cannot be allowed to dominate debate on Mental Health Act
Recent public debate around long-awaited reform of the Mental Health Act, 2001 has predominantly consisted of doctors and commentators creating moral panic over legal changes they claim will erode doctors 'right' to force treat people. Let's be clear: the Mental Health Act, 2001 will continue to allow people to be involuntarily confined and force treated. Let's also have some clarity that under the current system, mental health outcomes are very far from satisfactory. Indeed, despite the now accepted deconstruction of 'mental illness' as simply a diagnostic construct, this system is now largely upheld because of legislative frameworks. It begs the question, should those within the system and seeking to uphold it be allowed to constantly dominate the discourse around reform? Let's get to the heart of the real issue here — psychiatry and its wish to retain its legal powers. Psychiatrists use a legal defence of medical necessity for forced treatment but this is increasingly untenable. As Dr Pat Bracken, the highly respected independent consultant psychiatrist, has written: If psychiatry is going to take away people's liberty and use invasive methods of treatment, then it needs to be 'confident that we can predict outcomes, and happy that we understand how our treatments work and for whom.' His conclusion – and the now widely accepted scientific reality, is that psychiatry cannot reach this efficacy standard. The treatment on offer for people who are severely unwell and distressed is not, as some may erroneously believe, intensive therapy that seeks to get to the root cause of the issue. Rather it is drugs and sometimes electricity. There may be psychological interventions but these are few and far between. Of course there are situations where people need acute care and medication to stabilise them, but traumatising environments that use powerful psychotropic drugs should not be the only answer when someone is in distress. People in this system are guinea pigs, labelled treatment resistant if drugs don't work, lacking insight and branded non-compliant if they don't agree with doctors and do what they are told. Debate in Ireland is regressing as is our move towards a rights-based system. Just this week it has been reported that the Cabinet has signed off on an amendment brought to Cabinet that someone who is involuntarily admitted to an acute psychiatric unit can be detained for up to 42 days, an increase on the 21 days previously proposed under the bill. This is a flagrant move in the wrong direction with no debate and no rationale given. In this paper recently Dr Suzanne Crowe argued that people experiencing psychosis do not know they are ill and have no insight into their psychiatric condition. This contention assumes that viewing people through a psychiatric lens is the legitimate view, ergo if a person does not subscribe to this view 'psychiatric illness', then this means they have no insight and therefore must have their liberty taken away to be sufficiently chemically restrained. People who are struggling, who are different, who are living in a chaotic family or community, who have extraordinary experiences, who are in deep emotional distress may not have 'insight' into the limitations of psychiatric diagnosis but the way to help them and those around them is not to lock them up as second-class citizens, take away their liberty and assault their personhood. Insight is so very important, but it is a two-way concept. In order for these 'psychotic people' to receive the help and human engagement they may need for healing, it is important that those tasked with providing care also develop insight. Insight into the multiple perspectives, experiences and circumstances that cause people to warrant support; insight into the need to provide choices that might be more conducive to people wanting to engage, and insight into the damage the 'medical model' paradigm of care causes. This is about a fundamental right to health. Moving towards a rights-based legal system, as outlined in the UN Convention on the Rights of Persons with Disabilities, to which Ireland is a signatory, means treating people as rights holders, not as mere subjects of legal or state control. Consent Unquestionably, evidence-based care should be at the core of cancer or heart, or any other type of health treatment. Therefore, it cannot be the purview of just one highly contested profession (psychiatry) to impose what is increasingly seen as a dogmatic ideology onto people who are already in a vulnerable state. This is not to say psychiatry should not be part of a suite of measures available to people, but mental health care should be based around consent and choice — a right to choice should be enshrined in legislation, and requisite funding must be put into things like family work, peer support, peer-run grassroots organisations, community development, non-medical crisis houses and open dialogue. Choices should not be viewed through the sole lens of a psychiatric classification system that prescribes meaning to people's struggles, distress, environmental outcomes and extraordinary experiences. These choices have long been mandated as part of the post-psychiatry paradigm for mental health service provision, and the new paradigm is awash with international examples of best practice. In other words, there are examples of how we can do things better. Certainly, things cannot get much worse for people in distress. In 2013, the UN Special Rapporteur on Torture explicitly stated that forced psychiatric treatment may amount to torture or ill-treatment, especially when not evidence-based. Doctors may be offended that their well-intentioned treatment is causing harm, but advocates cannot dampen the quest for change and justice to appease psychiatrists. Because the harsh truth is that while some coercive practices might not always meet the legal threshold for torture, they do often qualify as inhuman or degrading treatment. Surely if there is even a question that 'care' could be considered as something akin to torture, this requires radical debate and reform. Jennifer Hough is a human rights and social justice advocate Dr Líam Mac Gabhann is Associate Professor in Mental Health Practice at Dublin City University Read More Watchdog to create code of practice for using surveillance in mental health services
Irish Examiner
6 days ago
- Health
- Irish Examiner
Watchdog to create code of practice for using surveillance in mental health services
A code of practice is to be drawn up for the use of CCTV, GPS trackers and other surveillance technologies in Ireland's mental health services. A public consultation process is currently underway by the Mental Health Commission, to seek the views of people who use mental health services about how the use of surveillance equipment impacts on them. The views of family members, carers and friends are also being sought, as well as those of people working in the sector. The Director of Regulation at the Mental Health Commission, Gary Kiernan, says surveillance technologies have advanced considerably in recent years, and their use has become 'a complex area' in mental health services. He said: 'The Mental Health Commission wants to develop a code of practice that takes account of these technological advancements while encouraging and promoting good practices and high standards in relation to their use. "This consultation is particularly concerned with how Ireland's mental health services should protect the rights of people who use mental health services, especially their rights to privacy and dignity. I would encourage all interested parties to engage and ensure their voices are heard.' According to the commission, such technology is used to observe or monitor service users to 'inform their care and treatment'. While CCTV is currently the most commonly used form of surveillance, other technologies being used include bodyworn cameras, infrared cameras, sensors, alarms, and GPS trackers. The use of such equipment falls under regulation 25 of the Mental Health Act 2001 (Approved Centres) Regulations 2006. The Mental Health Commission says the purpose of the consultation is to identify key areas that the new code of practice should address. It said: 'The Code of Practice will apply initially to inpatient mental health services. Its scope may be widened in the future to include community mental health services and community residences once the MHC's regulatory remit expands to include these services.' The survey can be accessed online here. PDF versions of the survey may also be requested from standards@ and returned via email or by post. Focus groups and interviews with interested stakeholders will also take place, with interested parties invited to email standards@ The public consultation will close at 5pm on July 16. Read More Suzanne Crowe: People with severe mental illness will be failed by proposed new law
Irish Examiner
19-05-2025
- Health
- Irish Examiner
Suzanne Crowe: People with severe mental illness will be failed by proposed new law
My mother reminded me recently of a warm summer's evening when I was a child, when the neighbour's son Mark jumped over our garden wall and ran straight through our house, with two gardaí chasing him. Mark was in his early 20s and had schizophrenia. Every year or so he became acutely mentally ill. That night he howled and tore at his hair as the guards restrained him. He didn't go easy, and we were frightened of the man we knew as a gentle character. He needed involuntary admission to hospital and treatment. A few months later, he was back in our housing estate, peaceably mowing lawns for a few quid. Life was difficult for Mark's parents when he was sick, the worry etched deep on their faces. The Mental Health Bill 2024 is beginning Oireachtas committee stage, for debate and amendments. It offers lots of innovation, with a clear clinical and legal framework for mental healthcare, including the management of children in approved centres. Inexplicably, however, it drops the ball for seriously sick people like Mark. Significant mental illness is a world away from the ebb and flow of mood and distress experienced by most of the population. Services for the mental health of most people do not require such tight regulation or legislation, as the person feeling unwell mostly understands their poor health and is actively asking for help. They can advocate for their human rights, including their right to be treated when they are sick. People with psychosis don't know they are ill A relatively small number of people, like Mark, suffer from terrifying delusions, hallucinations where they see things that are not real, and voices telling them horrible things. Or have episodes of mania where they run through the streets in the dead of night, handing away their possessions and scribbling furious letters to hundreds of people known and unknown. The ripple effects on a person affected, their family, their community, and emergency services are terrible. A subtle but critically important difference between a distressed man with crippling depression and a man with delusions of torturing demons often amounts to one key detail: Insight. Irish Medical Council president and consultant paediatric intensivist and anaesthesiologist Suzanne Crowe. Picture: Moya Nolan Psychosis robs the sick person of any insight into their illness. They cannot ask for treatment because although they are suffering beyond all pain that we can comprehend, they do not know that they are sick. And that their demons are treatable. In medicine, there are only a small number of people who are unable to ask for treatment, including those experiencing psychosis. Knowing how they would wish to be treated is helpful, which is why Mark's parents could support his involuntary treatment, as they knew he was happiest when he was well. The Mental Health Bill, if enacted in its current form, will mean that Mark can still be detained without his consent — but in his active psychotic state he cannot be treated if he says that he does not want treatment. A young man who believes he is being monitored by special agents or evil scientists intent on draining his blood, is unlikely to accept treatment from the doctors who have assessed him. The psychiatrist who wants to treat Mark will have to make an application to a circuit court judge for permission to treat Mark against his will — but not for the detention itself. Unlike those suffering from most mental illnesses or physical ailments, people with psychosis are unaware they are sick, let alone how ill they are. Stock picture Mental Health Bill creates a bizarre anomaly Bizarrely, a situation is created by this proposed new legislation where the doctors are detaining, and the judges are treating. Going to court for permission to treat will add to the legal complexity for patients, families, and staff, and increase legal costs. If the judge allows the treatment to go ahead, the care plan must then be agreed with the minister for health — an Orwellian development that sees medical care directed by politicians. Even if the health minister were a doctor — as has happened — it is still an unprecedented degree of control over the medical care of any person. Why are the mentally sick and vulnerable being singled out for this political influence? Psychosis robs patients of their autonomy It appears that the care of severely sick people is being bound up in these legislative chains because of a positive intention to better protect their human rights, particularly the right to choose to decline medical treatment. Autonomy over our lives is a core human right. One of the key things to understand about people experiencing psychosis is that their capacity to comprehend their illness is robbed by the illness itself. Picture: iStock When the capacity to comprehend your illness is robbed by the illness itself, autonomy is eroded by the illness as choices, risks, and benefits may not be understood either. Early treatment assists the sick person to regain their autonomy, in addition to protecting their right to dignity, respect, access to healthcare, and the avoidance of cruel or degrading treatment. Leaving a person psychotic and untreated is degrading and avoidable and I don't believe any of us would want that for ourselves or our loved ones. Current act respects patients' rights There is no doubt that in the past there were plenty of situations where autonomy and other human rights have not been respected in the context of psychiatric illness. However, the current Mental Health Act 2001 — with mental health tribunals and the oversight of the Mental Health Commission — has been effective in ensuring that patients who are admitted and treated without their consent, have their care reviewed by an independent psychiatrist within days of their admission, and have access to an appeals process. Other countries, such as the US, which have adopted laws which prohibit involuntary treatment, have seen seriously mentally ill people drift on to the streets, unable to engage with social services or benefits. A shopping trolley filled with cardboard boxes and belongings, or a prison cell, become their only home. It is timely treatment that restores people like Mark to better health, sending him home rather than risking arrest and imprisonment. Acute mental illness intervention and care undoubtably requires a complete overhaul, with significant investment in community mental health teams, crisis intervention services, and holistic assessment separate from A&E — it doesn't need this bill as it is currently drafted. Mental health remains a chronically underfunded part of healthcare, receiving 5.6% of our health budget in 2024 despite a Sláintecare commitment to increase it to 10%. To compound this ambivalent funding approach to such vulnerable people with a piece of legislation which holds the prospect of limiting care further is illogical and cruel. Listen to parents who beg for intervention Too often in intensive care, I have admitted young people who have tried to take their own lives. Often their admission, and sometimes their death, is accompanied by harrowing parental accounts of how they begged for their sick loved one to be involuntarily treated for their mental illness. The loss of human potential is heartbreaking. To admit and not promptly treat denies the person their right to return to health. This incomprehensible flaw in the proposed bill needs urgent amendment. Suzanne Crowe is a consultant in paediatric intensive care and president of the Medical Council
Irish Examiner
30-04-2025
- Health
- Irish Examiner
Letters to the Editor: Suzanne Crowe spoke up for Ireland's voiceless
In response to the article about 'talking back' or 'speaking up' by Suzanne Crowe (Patients are failed by medical culture of ignoring those who speak up — Irish Examiner, April 23): I agree with her. There's a culture in Ireland where speaking up is frowned upon. That's why we have such an awful past, and even present, with horrific abuse scandals and more — the Grace case being the one at the forefront of my mind. As a parent of a disabled teenager who has been under the care of 14 medical teams for his life so far, I have seen how people working in medicine are afraid to speak up, and parents are the same. We are often afraid of the consequences of relaying our concerns to a nursing manager or a doctor, we are afraid that our child's care will be compromised. It is not an irrational fear, as it has happened to me and my son. My son is extremely medically complex and requires 24-hour care. He has severe/profound intellectual disability, Down syndrome, and an ultra-rare disease. He is non-verbal and a full-time wheelchair user. He is tube fed into his jejunum. He is on a tonne of medication, many of which are pain meds to keep him as free from pain as possible. Having a disability definitely means that he is very often the subject of passive discrimination. This is very obvious in a hospital setting. There are so many little ways that he is discriminated against. He is not alone, I believe that everyone with a disability is discriminated against in some way or another. Parents of children like my son often find ourselves having to 'speak up', also known as advocating. Our children are often forgotten about as they have no voice of their own, so parents like me have no choice but to be their voice. We are sometimes made to feel as if we are being awkward or troublesome. But, in fact, most of us who care 24/7 for our kids at home are experts in their care, and good doctors and nurses know and appreciate that. We appreciate that understanding and empathy more than they know. It's about having compassion. These are important traits to have for anyone working in healthcare. But also — as Suzanne outlines — is bravery. We need medics to speak up and make a stand if something isn't safe. Not after the damage is done, but before. Whistleblowers shouldn't even exist because people should be listened to. The new national children's hospital is a good example where many doctors 'spoke up' but were ignored, as it is not in the correct location and it's not open yet, and the most important co-location of all, a maternity hospital, is absent. So ill newborns are still going to be at risk of disability or death. Having to be transported from a maternity hospital to a children's hospital is so risky for many newborns. Many doctors and other workers in healthcare spoke up and were ignored. Then it became obvious that if they did speak up, their jobs could be at risk. Parents 'spoke up' too, but were also ignored. What would we know? I think Suzanne's daughter will go far, she did nothing wrong in school. 'Talking back', 'speaking up' or 'advocating' is something that our children are doing better than we did. I was afraid to 'speak up' in school, as to risk the wrath of the nuns was not worth it. My daughter is 21 and in college doing journalism and she is well able to stand up for what she believes in and to form her own opinions. I'm very proud of her. My son will never speak, so I will have to continue 'speaking up' on his behalf. I appreciate those doctors, nurses, and allied healthcare professionals who advocate for him alongside me. Aisling McNiffe, Ardclough, Co Kildare Public hearings shine a spotlight I read with admiration and some relief the article on whistleblowers by Medical Council president, Suzanne Crowe. I would like to ask her to take appropriate steps to ensure Medical Council inquiries revert to public hearings. Public hearings were introduced as a direct result of the Caesarean hysterectomy scandal in Our Lady of Lourdes Hospital Drogheda, which came to light in 1998. I had the honour of working with the women and families concerned for several years, and understand how vital the change was for them and how hard they worked for it. Public hearings for professional misconduct were suspended during covid, for obvious reasons. Online hearings are now held where neither doctor nor complainant attend in person. This is unsatisfactory for injured patients and families. It reinforces the unhealthy secrecy surrounding bad doctoring and, in so doing, indirectly encourages it. Public hearings help to normalise the raising of concerns and accountability in a way that is necessary to encourage whistleblowing. They need to return. Sheila O'Connor, via email What's your view on this issue? You can tell us here Finger off the pulse As a taxpayer contributing over 40% of my income to the State, I am compelled to ask: At what point does this Government acknowledge its systemic failures and commit to meaningful reform? While Ireland's public services and infrastructure crumble, and families grapple with exorbitant mortgages, the self-congratulatory rhetoric of our leaders feels increasingly detached from reality. Decades of mismanagement have left us with a healthcare system in perpetual crisis and a housing market that prices generations out of home ownership. Infrastructure projects like the National Children's Hospital (€1.4bn or more over budget) and the delayed MetroLink exemplify fiscal recklessness. Yet the Government's solution, selling off public assets and privatising essential services, prioritises short-term cash injections over long-term public good. Natural resources, from offshore wind to minerals, are increasingly outsourced to private interests, eroding public ownership and energy security. Similarly, the privatisation of critical services has left households paying more for utilities and waste collection, while corporations profit and avoid taxes. Public-private partnerships, touted as efficient, often saddle taxpayers with hidden long-term costs and reduced accountability. This short-termism has consequences. Households today require two incomes to afford what a single wage could secure in the 1970s, sacrificing family time and quality of life in the process. Meanwhile, our elderly population, many of whom built this State, face neglect, with inadequate homecare supports and nursing home scandals exposing systemic failures in their welfare. Our children, too, bear the brunt: Under-resourced mental health services and endless waiting lists for Camhs betray a generation in crisis. Taxpayers deserve answers. Why must we pay world-class taxes for subpar services? Why are public assets and resources sold off for fleeting gains? When will those responsible for repeated failures be held to account? Ireland's social contract is fraying. It's time our leaders govern for citizens, not private interests. Michael Reynolds, Kilgarvan, Co Kerry Banking on war Humanity has never witnessed such atrocities before perpetrated on children; over 50% of the Gazan population is under 14 years of age. Every day and night we see images of powerful missiles dropped on tents on purpose, with the deliberate intention of burning and shredding people alive. The Israeli government is intent on eradicating the Palestinian population. No food, water, or medical supplies have entered Gaza since March 2. I find it disgusting that the Central Bank of Ireland (CBI) continues to allow Israel to market its sovereign war bonds in Ireland, and acts as the gateway for their sale throughout the EU. It is absolute nonsense that our Government cannot direct the CBI to stop this. This could be stopped in the morning under existing legislation if they had the will and stopped pandering to the US and the EU who have too much skin in the game, selling arms to Israel. As an aside, the CBI's code of ethics states the bank is an apolitical institution and staff should protect its apolitical position at all times. The code states that staff must not engage in any activity which could call into question this apolitical status or risk the bank being drawn into any political or public controversy. Facilitating the sale of war bonds would surely be classed as political, and their absence of cop-on and continuing sale of bonds has and continues to draw the CBI into political and public controversy. Sheila O'Riordan, Charleville, Co Cork What's your view on this issue? You can tell us here Séamas O'Reilly's support for trans rights Thank you for publishing Séamas O'Reilly's wonderful piece on the moral panic fomented around trans rights in Britain. He cuts cleanly through the disingenuous rhetoric used to disguise the intentions of the transphobic few who deliberately whipped up and led a mob to protest the very right to exist of a tiny and vulnerable minority. I echo his call to resist this 'very British bigotry'. It is time for us all to stand in defence of our transgender brothers, sisters, and children. Love wins. Bernie Linnane, Dromahair, Co Leitrim
