Resources, not new laws, needed in mental health


ANALYSIS:Mental health workers are critical of levels of awareness and the resources available

THERE IS, understandably, much sympathy among mental health professionals for Una Butler’s call for legal changes to protect children against threats caused by mental illness in the family.

However, psychiatrists and social workers active in the area are generally sceptical about the benefits of enshrining in law a requirement for mandatory risk assessment for children in such situations.

A greater barrier to effective intervention to prevent parents with mental health issues harming children is a lack of resources and a lack of awareness of existing guidelines, they say.

Orla Barry, director of Mental Health Reform, says a consistent message emerging from consultations is the need for support for families where a member has a mental health issue.

She says there are huge variations in the way services interact with such families across the country.

In some areas, families are hugely engaged in the treatment process while in others confidentiality is the greatest priority.

Barry is sceptical about the value of over-emphasising risk assessments when resources in many areas are lacking.

A promised €35 million investment in mental health teams has yet to happen, with many of the professionals not due to start until December at the earliest.

Frank Browne of the Irish Association of Social Workers says it is quite common for his colleagues’ clients to have thoughts about harming their children.

But he makes the distinction between fleeting thoughts and more elaborate plans, and points out that under Children First guidelines professionals are required to inform services where such cases arise.

“Where there’s a risk to a child, there is no confidentiality,” he says. While family members should be invited to care meetings, Browne maintains that it doesn’t make sense to put this requirement on a mandatory footing.

Siobhán Barry, a psychiatrist with Cluain Mhuire in Blackrock, Dublin, points out that the Children First guidelines state that “giving information to others for the protection of a child is not a breach of confidentiality”.

The guidelines also state that, in cases where a psychiatric examination of a person has implications for children, this information must be shared among health personnel.

In addition, Medical Council guidelines require doctors to report concerns they might have for the protection of children.

“What Una Butler said clearly came from the heart and from her own experience, but much of what she called for is already there in guideline form,” says Barry.

“The welfare of children trumps everything else in these situations.”

The problem is less one of a lack of mandatory regulations than of a lack of awareness of, and training in, existing guidelines, she says.

Anne Jeffers, a director of the College of Psychiatry of Ireland, says that, while it is important to learn from all cases, it is also important to stress that the vast majority of people with a mental illness do not pose a risk to themselves or others.

“We need properly resourced mental health services with multidisciplinary teams in all services nationwide, which will ensure best practice and, importantly, that service users and their families receive the best possible care, attention and support – [which] they deserve.”