by Ed Boyne
In August of this year Mr. Tim O´Malley, T.D., Minister of State at the Department of Health & Children with special responsibility for mental health announced the establishment of an ‘Expert Group’ on Mental Health Policy. The Group will “prepare a new national policy framework for the mental health services” for the next 10-15 years.
According to its stated terms of reference it is envisaged that the Expert Group will examine, inter alia: “models of care, the respective roles of medication and psychotherapy, measures to reduce stigma, and psychiatric services for specialised groups such as the homeless, prisoners and children/adolescents”. The Group is expected to complete its work within 18 months.
Apart from myself, the appointed members of the Expert Group include among others:
Professor Joyce O´Connor, President, National College of Ireland (Chair).
Dr. Dermot Walsh, Psychiatrist, Inspector of Mental Hospitals.
Dr. John Owens, Psychiatrist, Chairman, Mental Health Commission.
Ms. Bairbre Nic Aongusa, Principal, Mental Health Division, DoHC.
Dr. Justin Brophy, Consultant Psychiatrist, Wicklow Mental Health Service.
Dr. Colette Halpin, Consultant Child & Adolescent Psychiatrist, MHB.
Dr. Mary Kelly, Consultant Psychiatrist (Intellectual Disability), Brothers of Charity, Limerick.
Dr. Terry Lynch, GP and author, Limerick.
Dr. Tony Bates, Principal Psychologist, St. James´s Hospital, Dublin.
I believe that, by any measure, this is an exciting opportunity for those in the field of psychotherapy in Ireland. This is the first time to my knowledge that the terms of reference of any such major and far-reaching review has so clearly and unequivocally included psychotherapy within its remit. Those of us who campaigned for the review and to include psychotherapy in its terms of reference wanted to ensure that the full range of real and credible therapeutic approaches were considered and included at the highest policy levels.
Psychotherapy as a field of activity has grown considerably in recent years– for the most part in the private sector. The number involved, including clients and professionals, is now significant. It is also taking place on a national level. However the growth in the field has not been matched by appropriate recognition at Governmental and official levels.
In particular there is little or no recognition at official level that psychotherapy is a separate and distinct profession independent of other professions such as social work, psychology and medicine with its own unique training standards etc. For example, in my experience, senior government officials are very prone to state that the biggest difficulty they see with the provision of psychotherapy services is ‘the scarcity of qualified personnel’. At this level there is as yet no real recognition or awareness of the ICP register of accredited practitioners or of the wide range of backgrounds among accredited ICP members.
Government policy to date in relation to psychotherapy has been piece-meal and ad-hoc. There is no coherent vision or pattern to it. This is partly due to the fact that official mental health policy has always been driven by the psychiatrists and the medical model.
The domination of official policy and practice by the psychiatrists has remained largely unchallenged in Ireland. This is in marked contrast to other countries. Certainly the emerging Irish psychotherapy profession has done little to either directly challenge the psychiatrists at a policy level or persuade them to adopt a wider vision in their work with people. The implicit position is that psychotherapy is a self-regulating profession which largely operates in the private sector with its own standards and rules and that this situation can be expected to continue indefinitely.
The opposite is much more likely to be the case. The current situation where psychotherapy occupies a ‘cinderella’ position in relation to state policy while being self regulating will hardly be allowed continue for much longer. Our society is becoming increasingly regulated and to a degree that would have been unthinkable even three to five years ago. It is inevitable that some form of regulation and possibly legislation will be enacted in the area of psychotherapy before too long.
Before that happens what is needed is a national consensus on where psychotherapy fits in to our health and caring services both public and private, who should be allowed train for the profession and how it relates as a profession to other relevant professions. If this consensus is not achieved the danger of one-sided and ill-conceived legislation becomes greater. Psychotherapy practitioners need to leave aside familiar quarrels with other modalities etc and face outwards towards these challenges.
All interested parties have been asked to make submissions to the Expert Group. The Group’s final report will form the basis of a national consensus on policy in this area for the next 10 to 15 years. Advertisements have been placed in the national press inviting submissions and I hope that psychotherapy practitioners and professional groups will avail of the opportunity. Subject to the agreement of the editors of “Inside Out” I would hope to return to this topic in these pages with an update before too long.
Edward Boyne MA, MPhil, is Director of the Tivoli Institute and a founding member of IAHIP. He is also a human rights campaigner, Chair of the Irish Penal Reform Trust and Secretary of Amnesty International (Irl). firstname.lastname@example.org