A Vision for Change, 2020 edition

The Black Oil

Just publish VfC already. And this better not be an excuse to cut corners.

https://www.rte.ie/news/ireland/2020/0601/1143764-mental-health-services-ireland/

Mental health services in Ireland could be provided remotely to a large number of people under a new ten-year policy plan.

It is understood that the unpublished draft policy suggests this could include psychiatry services, cognitive behaviour therapy and counselling.

The updated Vision for Change plan states that this could allow for much greater access to both mild and acute mental health services.

The plan, which is likely to be discussed as part of the government formation talks this week, also aims to place more emphasis on care in the community.

It would require funding of an extra €10 million annually beginning next year and an Implementation Office would be established to oversee it.

It says better supports around employment, housing and education are key to getting positive outcomes for people with mental ill-health.

A review of the last policy plan identified the recruitment of specialist staff as being among the biggest challenges facing the service.

It also found that there was poor alignment between services and access was limited.

Yeah, no surprises there.

The Black Oil

'Sharing the Vision - a Mental Health Policy for Everyone' is due to be published this Friday.

https://twitter.com/SimonHarrisTD/status/1268804532236103680

Freedive Ireland

It's still just a vision imho, Peer support workers and one or two other roles like IPS in some teams has happened but not in most teams. The psychiatrist still rules with the odd punch up/disagreement with nursing staff. The MDT exists and it's various voices can be heard but totally at the discretion of the psychiatrist. We still do non-consent ECT ffs.

The Black Oil

Launch delayed until next week, June 17th.

Gremlinertia

I am not very hopeful for this.. Being in the system, nothing short of an overhaul is needed, even down to the mental health act. However i'm looking forward to reading it to see what positives can be taken from it..

The Black Oil

Gremlinertia wrote: »

I am not very hopeful for this.. Being in the system, nothing short of an overhaul is needed, even down to the mental health act. However i'm looking forward to reading it to see what positives can be taken from it..

Similar really. I am concerned it'll be just more of the same and it's meaningless without costs and a funding commitment. Tricky given the recession, granted. However, if we were not in a pandemic I'm not sure I'd be optimistic anyway. Really seems like those in power don't get it and I wish they would think of families, children and just add more clinicians, reduce waiting lists and fix the systemic problems.

The apparent lack of consultation of health and social care professionals is hugely concerning.

There's talk the Minister for Children might be axed, so already sets a pretty low bar.

This is Ireland.

Gremlinertia

If the document gives a load of "undertakings" then we know where staff and service users stand.

pheasant tail

Mental health services provided remotely, I don’t know. I’ve had a few therapy sessions on zoom since all this began. While I feel it’s better than nothing, still so far from the experience of what happens in the room when face to face. Any practicing psychologists or psychotherapists on here care to share their experience of what they thought of their online sessions in the last couple of months?

The Black Oil

Gremlinertia wrote: »

If the document gives a load of "undertakings" then we know where staff and service users stand.

https://threadreaderapp.com/thread/1271187045315215362.html

This thread from Mark Smyth gives a good indication of his concerns. That's on the @ireland account, not his personal one, so his pic will be gone once the account moves to its next host. I'd agree with what he has posted.

pheasant tail wrote: »

Mental health services provided remotely, I don’t know. I’ve had a few therapy sessions on zoom since all this began. While I feel it’s better than nothing, still so far from the experience of what happens in the room when face to face. Any practicing psychologists or psychotherapists on here care to share their experience of what they thought of their online sessions in the last couple of months?

I wouldn't be keen to see them as the default long term, particularly if they're seen first and foremost as a money saving exercise. People need human connection. Plus there can Zoom fatigue, for both parties and you can't necessarily see over video if someone's deteriorating.

Freedive Ireland

From my experience most remote work during the pandemic was just keeping in contact and more of a check in than actual work. A few people online have expressed concerns with remote theraputic work that you probably can't leave the physical space where you may have disclosed something distressing. So there wasn't a definition of leaving something behind, it was still in your built environment whether that space was a safe place or not. Lot's more issues too but it was a case of something better than nothing.

The Black Oil

Mark's not too hopeful.

https://twitter.com/psychpolis/status/1272649045589331970

The Black Oil

Launch is at 11am tomorrow morning.

The Black Oil

Available here. https://www.gov.ie/en/publication/2e46f-sharing-the-vision-a-mental-health-policy-for-everyone/

The Black Oil

I really wish the decision makers would just 'get' it, but they really don't.

https://twitter.com/ireland/status/1273204036053938177
https://twitter.com/ireland/status/1273210977060884480
https://twitter.com/psychpopgirl/status/1273212493867950082

Freedive Ireland

Scanned through it rather than an indepth read but first impressions are a "Sharing a Vision for slight modification" may have been a better name.

The Black Oil

I really just have no time for this. Poor form from Daly.

https://twitter.com/jimdalyclon/status/1273374636424691713

The Black Oil

Says it all, really. https://twitter.com/psychpolis/status/1278811974168698886

Freedive Ireland

To be fair psychiatry wasn't best pleased either.

"A new national strategy for psychiatry is needed to address gaps in the recently ‘refreshed’ 10-year mental health strategy, the President of the College of Psychiatrists of Ireland has said.

In an interview with the Irish Examiner, Dr William Flannery said psychiatrists were “dismayed and disillusioned” by the recently launched ‘Share the Vision’ strategy which, focused more on wellbeing than on psychiatry."

Freedive Ireland

Maybe the DSM VI could include DDD, dismayed disillusioned disorder.

The Black Oil

Freedive Ireland wrote: »

To be fair psychiatry wasn't best pleased either.

"A new national strategy for psychiatry is needed to address gaps in the recently ‘refreshed’ 10-year mental health strategy, the President of the College of Psychiatrists of Ireland has said.

In an interview with the Irish Examiner, Dr William Flannery said psychiatrists were “dismayed and disillusioned” by the recently launched ‘Share the Vision’ strategy which, focused more on wellbeing than on psychiatry."

Haven't seen a statement from the College, though I only briefly looked at their Twitter. Never been a great fan of the term 'wellbeing' myself.

https://www.irishexaminer.com/breakingnews/views/columnists/gerard-howlin-mental-health-must-be-central-to-stephen-donnellys-new-system-1008461.html

Piece from the Gerard Howlin.

On Tuesday the CSO said that unemployment is over 22.5%. A study by the National Suicide Research Foundation found that by 2012, Ireland’s male suicide rate was 57% higher than it would have been if the pre-recession trend had continued. Referrals to child and adolescent mental health services rose by up to 25% following that recession. After it, the HSE said in 2018 that it needed €177m to provide the full staffing set out in the national mental health policy, A Vision for Change.

That was the national plan for mental health since 2006. It was good but never fully delivered. A new national mental health plan, Sharing the Vision, was published two weeks ago. It’s great. It has a posie of platitudes in the programme for government. It is also unfunded, and until money is provided on budget day, it is meaningless.

It is expected that a new minister of state for mental health will be appointed on Wednesday. Working as I do with Mental Health Reform — a coalition of organisations working in the sector — I can say that the new minister’s predecessors, Jim Daly, Helen McEntee, and Kathleen Lynch, were capable people. But there was a fundamental problem. Come the divvy-out, it was about making do with what was left. The last senior health minister who systematically prioritised mental health was Brian Cowen. A lot depends on the new minister of state, presuming there is one. But the fundamental call, on whether imperative priorities are realigned, will be with Donnelly.

The Black Oil

Freedive Ireland wrote: »

Maybe the DSM VI could include DDD, dismayed disillusioned disorder.

More of the same/plus ça change disorder.

Freedive Ireland

https://www.irishexaminer.com/breakingnews/ireland/new-vision-for-mental-health-more-about-wellbeing-college-of-psychiatrists-1006887.html

cyllyn28

The Black Oil wrote: »

Really seems like those in power don't get it and I wish they would think of families, children and just add more clinicians, reduce waiting lists and fix the systemic problems.

I have a lightly paranoid theory, that conservatives deliberately maintain systemic dysfunction as a means to achieve institutional conservatism as the end in itself.



There's a back to frontness in some health protocols that have personally effected me, and the healthcare costs would have been much lower if they had been ordered the right way round, my most serious health problems were diagnosed more by accident than through a logical screening process.



There are strange gaps in understandings. Autoimmune specialists typically underestimate the importance of autoimmune related psychiatric disorder and psychiatrists underestimate the importance of autoimmune disorder. There is a body of literature and ongoing research that straddles both. What's in the research is autoimmune disorder is a major contributor to everything from dementia through to autism.



Before Covid, there was an autoimmune related psychiatric crisis, after Covid this will be worse, because the harm involved in a Covid infection is amplified by an autoimmune disorder. But, those people who had preexisting autoimmune disorder, were likely to have been experiencing or developing psychiatric disorder as a result of their autoimmune disorder before the Covid infection. Do Irish or British clinicians know this, or know it to the extent they should. I know there are senior people who have pushed their pet theories into the health protocols, where they're isn't much evidence for their theory to be true, but where there is substantial evidence for re-ordering protocols.



Pet theory medicine is very dangerous and expensive.

The Black Oil

Thought this was the Times, but it's the Sunday Business Post.

https://twitter.com/catrionaotoole/status/1282313235623022594

cyllyn28

The Black Oil wrote: »

Thought this was the Times, but it's the Sunday Business Post.

https://twitter.com/catrionaotoole/status/1282313235623022594

This highlights a number of misunderstandings, probably originating in training where simplification, or more oversimplifications are held to be fundamental facts. A statement like chemical imbalances in the brain, is as meaningless as saying heart attacks are caused by chemical imbalances in the blood.



To unpick the misunderstandings. Psychosocial trauma. Brain scans of psychosocially traumatised people, can show things like brain damage. And people who've received physical trauma to the brain, will present with psychosocial trauma. Similar injuries achieved through different means. And something strange that appears to have been a mantra in medicine, that the brain cannot recover from damage. Like the liver it can, but like any organ in the body it defends on how substantial the damage has been. ECT, barbarism with modern technology, simply induces brain damage. Its' benefits are random. Something like encephalitis lethargica, the brain damage is initially asymptomatic, but the repair leads to the final problem, the damage can not be repaired, but a sleeping pill is an effective treatment to supplement the brain into normal function.



The brain is an organ, the liver is an organ. Any GP should be able to tell you, autoimmune disorders traumatise every organ in the body, but there's always a strange disconnect when it comes to integrating the brain into this schema. The actual research is saying, the brain does not escape the general trauma. And that autoimmune disorder is a major contributing factor to psychiatric conditions.



I'll give an example. Dianne Abbot, the English MP, campaigning in the 2017 UK election. I knew a little bit about her health previously. She is normally bright and intelligent, but she began having intermittent episodes of cognitive impairment, and after one particularly bad episode while on radio, she retired from her position in the campaign. What was happening to her. Dianne has diabetes. Diabetics need to keep their blood sugar at low levels, or they will experience autoimmune disorder. The sugar itself was not attacking her brain, but her autoimmune system was.



Are the public experiencing autoimmune related psychiatric problems on a large scale. The evidence, when you look at it from the right angle, says the are.



Post-partum and autism. The evidence strongly suggests these are the result of gestational autoimmune disorder related encephalitis. Which is a real mouthful of terms, but makes the underlying problem much clearer. Obstetricians, are fully aware of the critical problems of gestational autoimmune disorder, but may be unaware of the encephalitis dimension.



Back to the misunderstandings. Google Rosacea and psychiatric problems. You'll see a psychosocial attribution, that these people feel suicidal depressed because they feel ugly, but Rosacea is an autoimmune disorder. And again something like acne. It is long known, their is a suicide risk associated with acne creams. And this risk, is fundamentally autoimmune related encephalitis.



I know there are big wigs in the service insisting on Ireland's psychiatric problems are being driven by alcohol related encephalitis. But, it may be back to front in terms of what is driving what.












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dar100

Nice to see a focus on service users voice and feedback.practice based evidence needs to be incorporated into all psychosocial services. The research to practice model and the medical model have really disempowered clients, not to mention the many poor treatment outcomes from rather dodgey RCT and the whole EST/EBP paradigm.

We need more focus and the social model of rehabilitation. Leaving people on medication long term with not so much as a remblence of a care plan is disgusting.

There has been excellent outcomes by using lots of methods other than the often toxic psychiatry model. While it of course has a place, it's dominance has been at the expense of very real human rights, and social justice issues

cyllyn28

dar100 wrote: »

Nice to see a focus on service users voice and feedback.

There people working in the services, who know their voice doesn't matter. Can the people practicing ECT give a sound scientific reason for its' use, or are they simply powerful conservative people, who can get away with something that has widespread disapproval.

practice based evidence needs to be incorporated into all psychosocial services. The research to practice model and the medical model have really disempowered clients, not to mention the many poor treatment outcomes from rather dodgey RCT and the whole EST/EBP paradigm.

There are a number of problems. It is established, that statistical medicine gives the best outcomes. However, many practitioners are opposed to the statistical approach believing they should have autonomy. There's a mish mash of autonomy, and protocols, and there is research, but practices often improving more by accident than anything else. Doctors are often taking medical advice from pharmaceutical company sales rep, who neither have morals nor medical training, whereas there's enough anecdote, research and even experiences to indicate, that the underlying cause of some psychiatric conditions is not best treated with psychiatric drugs. People with hypothyroid will often get treated for years with psychiatric drugs, before their condition is stumbled upon. The statistical evidence is many people with hypothyroid are not getting treated.

We need more focus and the social model of rehabilitation. Leaving people on medication long term with not so much as a remblence of a care plan is disgusting.

To make the funds available for that kind of thing, all the other protocols should be maximised for economic efficiency, which is absolutely identical to maximised health outcomes.

There has been excellent outcomes by using lots of methods other than the often toxic psychiatry model. While it of course has a place, it's dominance has been at the expense of very real human rights, and social justice issues

Ignaz Semmelwies, one of the major figures in modern statistical medicine. His medical colleagues had him committed to a lunatic asylum, where he was beaten to death by the staff. And all he was asking his colleagues to do, was wash their hands. Sometimes, it is the lunatics running the asylum.