Fresh take on mental healthcare

Tue, Aug 21, 2012, 01:00

Dr Pat Bracken, consultant psychiatrist and clinical director of Mental Health Services in west Cork, strives to use a wider, more individual, approach to tackling mental health problems, writes SYLVIA THOMPSON

SOME HEALTH professionals are heroes because they make clinical breakthroughs in their speciality. Others are heroes because they are particularly caring individuals who consistently reach out to their patients with understanding, kindness and respect. And, then there are the ones who push the boundaries of their profession to embrace change.

Dr Pat Bracken, consultant psychiatrist and clinical director of the Mental Health Services in west Cork, fits into the third category. That’s not to say that he isn’t a kind, thoughtful individual who is making breakthroughs in his profession but his guiding principle is to give people with mental health problems “the kind of help that suits them best individually rather than that based on a diagnosis”.

Psychiatry has been widely criticised in recent years for its overemphasis on diagnosis and drug-based treatment. International patient movements critical of the care they received in psychiatric hospitals, are now seeking wider approaches to dealing with mental health problems. Bracken is cogently aware of these changes and critical of the medical model of psychiatry which has promoted an overuse of medication in the treatment of mental illness.

“It’s very clear to me that what service users want from the mental health service is dignity, respect and time. They want to be listened to, to feel empowered and in control. They want to be able to access different kinds of help that suits them individually rather than medication based on their diagnosis,” he says. “Our job is to work with whose voice – for too long – has not been heard.”

Conscious that he can sometimes be dubbed anti-psychiatry, he is at pains to point out that he works hard to stay “inside the camp of psychiatrists”. “I’m not anti-medication or anti-psychiatry. But I do believe that the onus is on professionals to reflect critically on our disciplines and practices. The history of psychiatry is not a pretty picture – when you consider the large asylums and the disempowerment that went with that. I do prescribe anti-psychotic medication to my patients if they want them but I’m keen to develop alternative ways of engaging with people.”

Such alternative ways of engaging with mental health problems include music and art projects, community gardening projects and peer-to-peer support groups.

Just after we met, Bracken was returning to west Cork to listen to what service users had written following a creative writing course. And, Cumasú – the Wellness Bus – is a resource library which will soon travel through the area offering a multitude of materials on looking after your mental health.

Bracken sees the 2006 mental health policy document, A Vision for Change, as a guiding force behind his work. “We take A Vision for Change very seriously and work with a recovery orientation,” he explains. The National Service Users Executive [a group of people who have used psychiatric services] judged the West Cork Mental Health Services to be the “most improved service” in Ireland in 2010.

Bracken’s interest in a wider approach to mental healthcare came early in his career. Following his graduation from Medical School at University College Cork in 1982, he became deeply disillusioned by his experience of institutional psychiatry while working in hospitals in Cork city. In 1987, he left Ireland to work with the Medical Foundation for the Care of Victims of Torture in Uganda.

“I became aware that these rural communities in Africa had their own strengths in the face of suffering and the introduction of western psychiatry could possibly do more harm than good. I learned that distress can manifest in different ways and that healing takes place along many diverse paths. One can do damage by trying to impose a singular way of understanding and responding to mental health problems.”

After three years in Uganda, Bracken moved to live in England with his wife – Dr Joan Giller, a gynaecologist, social anthropologist and more recently counsellor – who he first met in Uganda. They have four children.

As consultant psychiatrist, he set up an innovative home treatment service in Bradford in west Yorkshire. While there, he also began to actively engage with the emerging service-user movement, a group of people who spoke out about their experiences of mental health problems and various treatments they received.

In a recent opinion piece in The Irish Times, Bracken wrote about the importance of people being involved in defining the nature of their own problems and being centrally involved in decisions about treatment. “The powers invested in psychiatry are a legacy of the asylum era and can no longer be justified on scientific or moral grounds,” he wrote.

Bracken has maintained an active interest in academic work during all this time, having a BA and MA in philosophy while doing his post-graduate studies in psychiatry. And, from 2006- 2008, he held the half-time post as professor of philosophy, diversity and mental health in the University of Central Lancashire in Preston. He is also the author of Trauma, Culture, Meaning and Philosophy (Whurr Publishers, London 2002) and wrote, with Dr Phil Thomas, Postpsychiatry: Mental Health in a Postmodern World (Oxford University Press, 2005). He returned to his current post full-time in 2008. He acts with the Schull Drama Group in his spare time.

Speaking about what’s most important now for people suffering from mental health problems, he says: “We often fail to recognise the full importance of social context in which people struggle.

“In Africa, I witnessed how people could recover from the most traumatic experiences with a strong sense of community support. To recover from illness, people need to have a sense of hope, purpose and meaning in their lives and ultimately, this comes more from the culture, economy and relationships they have.”

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