THE BLOG

Irish Psychiatry and Consent

06/08/2014 12:49 BST | Updated 05/10/2014 10:59 BST

My comelling motivation to do an investigation into Psychiatry in Ireland was stimulated by an event had in the function room of a plush Dublin hotel. A political party held a meeting on Electro-Convulsive Therapy (ECT), commonly called by many as 'Shock Treatment'. The turn-out was modest. Thirty people, if even. The speakers were supposed professionals in suits, with sexy power-point presentations and lasers, informing us of the success of their treatments. They seduced with facts, figures, pie charts, the usual sort of enticements were presented us. I felt slightly suspicious with there being no difference of opinion, no opposite views, and like most people unfamiliar with the treatment, it seemed somewhat frightening and backward. What I had imagined to be rare and last case scenario we were told were actually much more pedestrian and regular treatments. I was being convinced. Until one lady stood up, she was weeping. "My best friend's daughter had this treatment. She was never right afterwards. I'm telling you now, she was just never right at all. She killed herself." Another lady stood up. "I know a woman whose son had this treatment, and he took his own life. Then his father did, too." The atmosphere was sheerly horrendous. What was my attending a casual public informational meeting became a battering experience. Things like that remain with you.

It decided me, as a journalist, that I must follow this up. I consulted the outstanding and dexterous human rights journalist, Anne Daly. Anne has made many documentary films, and been awarded Television Journalist of the Year, twice. Her latest film is a necessary and powerful story, regarding women whom have had barbaric medical procedures called 'Symphysiotomy's'. It is called 'Mothers against the odds'. Anne gave, as always, generous and good direction. She suggested I research Doctor Ivor Browne. As Chief Psychiatrist for the Eastern Health Board, Ivor tried to reform Ireland's mental health system despite tremendous disapproval from those who condemned his unorthodox methods. He wrote, "We have a hundred ways in this country of undermining a person who wants to act, whether by ridicule or by showing how it is impractical". His overall work was mainly, in ways, to take people away from psychiatric institutions and bring them back into community care. The things that he describes seeing a good bit back in the early days perturb one greatly. Corridoors filled with people of all sorts of intellectual disabilities (a widely disputed term, and rightly so) and various mental problems, stresses and anxieties, being neglected and all thrown in together with no regard for their individual conditions. We have come far from that I hope, how far is what I wanted to know. I wanted at this point to begin contacting those with the authority of experience to tell their stories.

I chanced, soon after, on an article about a group called "MindFreedom", that held a peaceful protest down in County Cork regarding ECT. "MindFreedom Ireland is a voluntarily run organization that explores and promotes alternatives to the mainstream psychiatric model (sometimes called the 'medical model') of 'mental health' care", it says on their website. Mary and Jim Maddock were the people whom I initially contacted, as Mary is the main person whom co-ordinates the group, and is one of its founders. She is softly spoken, articulate, and determined. Many people spoke to me about how much she helped them to get on with their lives following very bad experiences within Psychiatry. I spoke over the phone with Mary firstly, and she told me of an event they were having down in Cork later that month, so I traveled down to meet Mary, her husband Jim, and some others, and hopefully to get some interviews with an additional hope of making a radio documentary. Mary is a music teacher, and was also a Nun for seven years. "On leaving the convent in 1972", she writes in her book 'Soul Survivor', "within two years I had met and married my husband Jim. Within a further two years, I found myself in Sarsfield Court Psychiatric Hospital, two days after the birth of my daughter. Heavily medicated and subjected to many sessions of ECT." Mary impressed me with her warmth as well as her drive. The get together down in Cork composed of people from all sorts of backrounds with firsthand experience dealing with Psychiatry, and the sense of community was both endearing and sincere. Mary gave a very moving speech and encourages people to seek empowerment within themselves. Look to your family, your friends, your community, and not for a quick fix from a psychiatrist.

"I believe", Mary told me at her house in Cork, "the biggest issue around this is human rights. The human right to decide what you want to do for yourself. " Regarding Electroshock in Ireland, Mary told me that the capacity to consent is not there because there are two words planted around it, 'unable' and 'unwilling'. "In the Mental Health Act 2001 as it stands", Mary explained to me, " two psychiatrists need to tell me, a survivor of electro-shock, that I can have it again if they think I need it again. Now I don't think I need it again, my family don't think I need it again, my friends don't think I need it again, but that is how it stands." There is no clause in The Irish Mental Health Act 2001 that can prevent someone receiving Psychiatric treatment despite not giving their consent. This is clearly a human rights abuse. Section 58A (5) (c) of The Mental Health Act 1983 (England and Wales) states:

"ECT should not be administered to a person who lacks capacity if to do so would conflict with an advance decision or a decision made by a donee or deputy or by the Court of Protection."

Why do we not have a similar clause that is respected? Last year, according to a report sent to me from the Irish Mental Health Commission there were 18,173 admissions to Irish Psychiatric Units. 1,574 were involuntary admissions. 30% were related to depressive disorders. 20.5% were related to Schizophrenia, Schizotypal and Delusional disorders. By allowing ECT to be administered to an involuntary patient who is "unable or unwilling" to give consent, our law does not respect the right of a competent patient to refuse treatment. They may use seclusion for a maximum of up to eight hours, at first. Sometimes mechanical restraints. In a letter to The Irish Times in June 2008, Ivor Browne described ECT as "highly damaging and therapeutically ineffective", and also that, "Over many years, studies of ECT have shown no long-term benefit, only a temporary relief of symptoms due to confusion and brain damage".

I did another interview, with a tremendously impressive lady, Bernie, whom had a family member that had spent time in a psychiatric institution. She spoke of the fear surrounding Psychiatry, and said "the ones with all the power are the ones with the keys and the prescription pads, and they're medicalising each and every one of us". She mentioned the lack of accountability surrounding psychiatry. "I'm involved in Trialogue and we'd one young mum whose son was 14 years of age, he had mild Asbergers, and was prescribed Prozac after a ten minute consult with a psychiatrist and 46 days later that child was dead. Died by suicide." It put me in mind of a disturbing and brilliantly made documentary by Louis Theroux, about strong pharmacuetical drugs being issued to children for their "mental health in the United States. She stressed that you should do your own research, the need for more talking therapies, and a more dignified approach to dealing with the stresses and anxieties of life.

I spoke to Richard, whom attended a psychiatric institution when he was at third level college for three weeks. "My experience back then, basically, is that I was laced with Meloral, not in a tablet form, but a syrum form. I remember being told 'well, we'll give you this injection and you will be better much quicker'. The previous thing I seen was someone do a shuffle and stare blankly down a corridor, another person was talking or preaching or whatever". When I asked him about the effectiveness of those pharmaceutical drugs, he responded: "The Meloral I was on was banned, I'm not sure if it was totally banned because of involuntary movements and it was in a syrup form which left me totally immobilized and nobody told me, or talked about what was going on in my life. I felt I was being coerced into taking them". Richard was given Gamerol, and "basically sky rocketed through the roof with Euphoria for about two weeks and then I was taken straight off that and then put on Lithium." The stress for clarity surrounding these drugs must be given. This does not seem to be the case.

When I asked Mary if there is any accountability should there be a mis-diagnosis, she replied, "The chances of you winning a case would be so slim that you would be mad to do it because you'd lose everything and people in Psychiatry have lost so much already". I also spoke with Laura Delano, from Medford, Massachusetts, in The United States, a self-described activist, community organizer, writer, and ex-mental patient. She told me that patients are being told a story of promise and hope and so informed consent cannot happen when a person is being told a false story, and that was the story she was told for 13 years. When I asked her about the issue of accountability, she said "It is a real dilemma currently. No one is being held accountable because they are doing exactly what they are supposed to be doing. The standard care in psychiatry today is to put people on these powerful drugs and so if a doctor does not do that then they can be held accountable for practicing so called poor medicine".

Ireland and Psychiatry has a very peculiar relationship. The Human Right to informed consent is clearly being neglected. The capacity to consent is also something that needs more clarification. The effectiveness of the treatments need to be scrutinized more, and there seems to be a lack of accountability surrounding treatments by some whom have had ill diagnosed their patients. I will close with a quote from Ivor Browne's 1976 essay, 'Mental Health and Illness': "We are mentally healthy to the degree to which we manage ourselves - to the degree to which we take responsibility for our own actions in what we are and what we do. Naturally, there seems to be a deep thrust in us to grow and develop, to take hold of ourselves, to take responsibility for the management of our lives as we mature ; a freedom without responsibility. Immaturity and maturity."