Going in the right direction

Mind MovesMy early years as a trainee clinical psychologist involved, for the main part, administering IQ tests to schoolchildren who had been referred by the school medical officer.

These children were of concern because they were perceived to be underachieving, anxious or disruptive in some way.

I saw them for a once-off session and annually "processed" about 400-500 referrals at the rate of three a day.

Many of these children were from chaotic families, with parents who were stretched to their limit and very often depressed; many carried significant stress and tension in their bodies, which often was expressed in vague "pains" or bed-wetting.

Their difficulties at school were more often the outward expression of their complex inner lives.

Treatment options of any kind for these children and their families, at that time, were severely limited. Training in child and family therapy hadn't yet arrived in this country, child psychiatry personnel were spread very thin, and clinical training for psychologists hadn't evolved beyond preparing us to administer and interpret a variety of assessment tools.

Sometimes, when the session was over, I felt that all I had to offer these children and their accompanying parents was the reassurance, that given all that was going on in their lives, everyone was doing a pretty good job.

Since my trainee years the scope of clinical psychology services in Ireland has changed radically.

This was brought home to me forcefully at a conference hosted by the School of Psychology UCD last week titled Innovations in Clinical Psychology.

Clinicians from every corner of the health service - primary care, community care, child and adult mental health, services for the intellectually disabled - gathered to hear about the most recent developments in the field and to consider the direction that clinical psychology was taking in Ireland.

The opening message from Prof Alan Carr, who convened this conference, was clear and forceful: the profession is alive and well. The training and professional development for psychologists in Ireland is now world-class.

While assessment remains important in trying to understand and make sense of complex problems, psychologists have also developed therapies to help people overcome emotional barriers in their lives.

They are trained in scientific research so that they can investigate what works for people and the challenges they face, and increasing emphasis is being given in their training to clinical supervision, service management and organisational development skills.

The one-day conference was a veritable feast of inspiration, featuring three "courses" from eminent pioneers in the area of child mental health, intellectual disability and psychosis, and an "after-dinner" speaker, Martin Rogan, HSE national care group manager for mental health.

Martin presented a brilliantly crafted and most entertaining presentation that challenged psychologists to beware of "silo thinking" and to take an active role in reforming the broader mental health service, in line with our national mental health policy, A Vision for Change.

A danger for any profession is that when it achieves professional recognition and economic viability - when it finally comes in from the cold - it can become mesmerised by its own expertise and lose touch with the multiple influences that have a bearing on the human problems they are trying to solve.

The first speaker, Prof Paul Stallard, spoke of the danger of the profession limiting itself by focusing exclusively on working clinically.

He stressed the need to increase the capacity of people working within the community who are skilled in basic prevention and early intervention.

Psychologists have a much better chance of stopping children falling through the net if we step out of our traditional silo role and take up our role as educators and capacity builders.

Prof Eric Emerson, speaking on innovations in the field of intellectual disability, reminded us that the power of any clinical intervention, no matter how evidence-based it happens to be, pales in significance to the impact of social adversity and inequality on mental health.

For psychologists to have a meaningful impact, they need to both advocate and agitate in the broader community and political landscape.

The day was inspiring and also challenging. It ended with the launch by Health Minister Mary Harney, of three volumes (each one circa 1,000 pages) that distill the finest psychological approaches available for helping children and adolescents, people with intellectual disability, and adults, respectively.

Published by Alan Carr and his colleagues, this unique collection represents a remarkable achievement and a milestone in the world of literature.

The profession of psychology has well and truly arrived; the challenge to the profession now is to make an impact on the real world of the people it seeks to serve.

Tony Bates is founding director of Headstrong - the National Centre for Youth Mental Health (www.headstrong.ie).  Contact tbates@irish-times.ie