Latest news with #SuzanneCrowe
Irish Examiner
01-08-2025
- Health
- Irish Examiner
Health workers see inclusion as central to caring for patients
Training to raise awareness of diversity and inclusion among medical workers is boosting the quality of services being delivered to patients, says Dr Suzanne Crowe, president of the Medical Council. Dr Crowe, who works in paediatric intensive care, says that an inclusive medical workforce leads to greater understanding of patients' needs, culturally competent care, and ultimately, better health outcomes for patients. Speaking during Cork Pride 2025, which runs from July 26 to August 3, Dr Crowe says that she welcomes Pride events, which allow us to pause and reflect on the importance of accepting people for who they are. In this Q&A interview, Dr Crowe outlines some of the areas in which Irish health service providers have been very positive in ensuring diversity and inclusion in how patients are cared for, while also highlighting a number of areas where further improvements would be beneficial, notably further supports to help doctors with a disability to carry out their work effectively. Does the Irish medical profession see itself as actively diverse and inclusive? I think the medical profession does see itself as diverse, and increasingly inclusive. Medicine as a profession welcomes people from all walks of life, and there is increasing diversity in terms of gender and sexuality, so I would see it as being inclusive in this sense. In my opinion, we've made a lot of progress over the last couple of decades in certain areas, particularly in diversity of ethnic backgrounds, as well as from a gender balance point of view. The profession is increasingly seeing equal numbers of men and women working in medicine, in fact, we're seeing a shift towards it being more female-dominated in some specialisms. Our most recent (2024) Medical Workforce Intelligence data shows that the gender split among GPs in Ireland had slightly more females (52.4%) than males (47.6%). The majority of female GPs are between the ages 30 and 59, and older age brackets from there and above are dominated by males. This suggests that as older male GPs retire, the proportion of females in general practice will continue to grow. As well as this, in 2024 our clinically active medical workforce consisted of 13.8% of doctors who qualified in the EU/UK, and 27.8% who qualified outside of Ireland, the EU and the UK — meaning that 41.6% of our medical workforce qualified outside of Ireland. Without these doctors, our health system would collapse immediately. An area that could be improved upon is for doctors with a disability. Further supports should be put in place for doctors with a disability to carry out their work effectively. Overall, the profession does regard itself as diverse and inclusive. In what ways does the sector's openness help with attracting and retaining talent? The healthcare sector is very active in attracting talent, both in Ireland and abroad. Doctors are united as protectors of health — of the individual, and the community; and Ireland is now seen as an open, democratic, and progressive society to live in. That's why a career in medicine in Ireland can be rewarding for those who have experienced trauma or marginalisation for their beliefs, and are seeking to contribute to an inclusive, modern society. While openness brings many benefits to medicine, it's worth noting areas that still need attention, such as long working hours, working environment, and conditions. We may be attracting talent, but need to ensure we're retaining our workforce in Ireland by providing a sustainable environment to work in. Do you believe there is a link between having a diverse workforce and safer patient outcomes? I believe there is. As doctors, we should ensure that we advocate for trust, partnership and informed consent in our relationships with patients. The Medical Council carried out research in 2023, which showed that 80% of people feel it is important to be treated as a partner in their healthcare by their doctor. What this essentially means is that patients want their doctor to be approachable — someone they can bring personal concerns to. This same survey showed that people in Ireland believe that the elderly (57%), members of the travelling community (34%), refugees (33%) and immigrants (32%) are among the minority groups most at risk of receiving substandard care. Members of minority groups have unique healthcare needs and may find it easier to speak to a doctor who comes from a similar background. If the patient can relate to their doctor, they'll feel understood, in a safe space, and like their care will be approached in a non-judgemental way. This helps patients feel safe in communicating with their doctor, which helps the doctor to personalise their treatment plan and direct it to specific issues. It can help the patient to follow their plan when there's a good relationship. All these elements combined help to enhance patient care and improve patient safety. Does training help promote a more actively diverse and inclusive approach to recruitment? Training our future workforce at an early stage to have an open, empathetic approach to people of different backgrounds helps ensure that Diversity, Equity & Inclusion (DE&I) awareness is already part of their understanding when they start work. Discrimination and lack of understanding can impede the path to compassionate healthcare. Bringing DE&I awareness to students throughout the lifecycle of the doctor from school into undergraduate and postgraduate education; will help doctors to address potential biases. Not only do they then have the awareness, correct language, and training about DE&I, but they'll eventually look to recruit that diversity into their own teams, because they know it'll increase inclusion, produce better working environments, and ultimately enhance patient care when treating patients of different backgrounds. Celebrating Pride also provides chances to educate and to learn, promote awareness and increase understanding of issues faced by the LGBTQI+ community. We saw a great turnout of doctors and healthcare workers from the HSE and LGBT Ireland for the Dublin Pride Parade a couple of weeks ago, and I have no doubt the representation will be strong for Cork Pride as well. LGBT Ireland's LGBT+ Champions programme is available to doctors and healthcare professionals to help understand the identities and advocate for their LGBTQI+ patients. These are provided by LGBT Ireland, the HSE, post graduate training bodies, universities, advocacy groups and charities.
Irish Examiner
17-06-2025
- Health
- Irish Examiner
Dr Suzanne Crowe: FemTech can fight medical misogyny — but not if it's going to be used to monitor us
A couple of months ago I was contacted through LinkedIn seeking support for a start-up company keen to target women seeking health services using a digital platform. Specifically, mental health services. As a mother of two young women, my interest was piqued by the term the company used in the description of their innovative product: FemTech. FemTech is the term for the pairing of technology with women's health and wellbeing. It was coined in 2016 by Ida Tin, a Danish entrepreneur who co-founded a menstrual tracking app called Clue. In almost a decade, there has been an explosion of devices, services and software applications aimed at longstanding deficits in women's healthcare. Novel technology solutions include contraceptive prescription and delivery, fertility-tracking and advice, health support for new mothers and their newborn babies, at-home testing for sexually transmitted infections, smart lactation pads, osteoporosis predictors, and psychology assessments. As one friend put it to me, "men get trading platforms for shares and fitness trackers, women get sold stuff to 'fix' their bodies". FemTech is now a massive industry, with Flo, the period-tracking app valued at almost a billion dollars. Dr Suzanne Crowe: 'It's hard not to see the rapid growth of FemTech as a comment on women's healthcare as it is currently provided.' Picture: Moya Nolan Both my daughters have used menstrual apps since they were young teenagers, enjoying the accessibility and responsiveness. It's a world away from the coy TV ads I grew up with, depicting strange blue fluid being poured onto pads. Historically, medical research focused almost uniquely on white men, and women's health concerns were often overlooked or dismissed. Dr Hazel Wallace's book The Female Factor captures the extent of medical misogyny and women's exclusion from diagnosis and treatment. Restriction extended to the development of medications, where women were excluded from testing for many years, leading to dose ranges based only on men's bodies. Coupled with a pervasive shame attached to sexual health, mental health and women's bodies, traditional medical practice has unwittingly created a significant gap which healthcare 'disruptors' are eager to capitalize on. This is largely a positive thing. But if technology solutions become the dominant offering, they may contribute to leaving ever-increasing service gaps unaddressed. Technology bypasses some issues but not all, fostering more empowered, but increasingly frustrated, women who continue to require intervention from an overwhelmed local hospital. It is a tool, not a replacement for a functioning health service. Technology won't do much to change attitudes among healthcare professionals to women's health needs either – that needs to come from deep listening, respect, kindness and education. The potential benefits are clear: technology empowers women to input their personal information, identify symptom patterns, and possible health issues, and use that data to receive personalised healthcare. Using software, they can consider a diagnosis, learn what their choices are, and make informed decisions. Digital platforms carry no judgment, with women from different ethnic origins and/or the LGBT+ community finding understanding there. Of course, empathic patient-focused care, delivered in partnership is fundamental to healthcare. So, it's hard not to see the rapid growth of FemTech as a comment on women's healthcare as it is currently provided. As FemTech moves to fill a perceived gap, it would be easier to leave traditional views undisturbed rather than reflecting on how our people-based service can improve. Just as vinyl records gave way to CDs, and CDs ceded to music streaming, traditional health services must apply humility, excise stigma and barriers, and improve their offerings or be left behind. Data tracking Not only do we risk losing our imperfect humanity in a technology-dominated health service, but we also risk the negative consequences of commercialising health data. Putting a price on data and its interpretation may make this assistive technology too expensive for the marginalised groups it was aspiring to reach. More worryingly, a research group in Cambridge University's Minderoo Centre for Technology and Democracy have raised significant concerns about the use of data collected by fertility tracking apps. Data collected on apps is designated 'special category' rather than treated as medical data from a regulation perspective. It potentially could provide a valuable advertising tool for companies – or worse. The report's authors caution that information from cycle tracking apps in the wrong hands could result in risks to job prospects, workplace monitoring, health insurance discrimination, and in some countries, limit access to termination of pregnancy. In an ideal world, new digital solutions would become publicly owned, allowing integration into real-life health services, leading to better outcomes for society. However, tech entrepreneurs are not going to wait for Valhalla. As women's healthcare needs are finally validated, it is vital that new technologies are evaluated for potential benefits, and or potential harms. Any likely harms, for example compromise of privacy, require informed consent and regulation, especially when it comes to the retention and use of highly personal data. FemTech is here to stay. We must ensure the hand guiding its use is an ethical one. Dr Suzanne Crowe, consultant in paediatric intensive care, President of the Medical Council Read More A period of life we need to talk about — the stigma that still surrounds menstruation
Irish Examiner
12-06-2025
- 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
09-06-2025
- 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
