Fair play for psychiatrists


Madam, - I write in defence of my work and the work of my colleagues, which has received considerable negative coverage recently. This has included blame for the delay in the implementation of the 2001 Mental Health Act, the state of mental health services as outlined in the report of the Inspector of Mental Health Services, and more recently, the fundamental bona fides and value of the role of the psychiatrist in mental health.

Mental ill-health blights the lives of those who experience it, their families and communities. It deprives people the opportunity of a full contribution to society as well as their own fulfilment.

Denying the reality of an illness component to this, and the role of health professionals in its alleviation, debases that suffering, isolates it from a potentially powerful source of alleviation and further stigmatises sufferers as undeserving or beyond medical treatment or assistance.

Furthermore, it contributes to the erosion of support for mental health services by the public, sowing destructive misinformation, doubt, defeatism and despair.

Psychiatrists have been given key positions and powers in the delivery of mental health services, based on our capacity to explain and alleviate some of the illness component of this suffering. Faults and all, there is a reasonable track record of doing more harm than good, especially as treatment options advance. The system does impinge on certain rights, but only on the basis that wider rights are better served by so doing.

Some victimisation remains; it must be heard, and elicit a meaningful response with proper protections. It is illusory, however, to imagine that psychiatrists have a predominant influence in how services are designed or delivered, or how services can damage people. We share that responsibility and its failures with other disciplines. We also share it with those who contribute to the wider systemic failures pointed out in the inspector's report, and with a societal and political system that tolerates and ignores repeated citations of these failures year after year.

The majority of satisfied users of the mental health services are seldom heard. We live in hopeful times and can expect wonderful advances in treatment in the years ahead. Working in psychiatry can be extremely rewarding, challenging, and permit great insights and opportunities to address the most profound mysteries of human behaviour, suffering and recovery. It is also sometimes unwelcome, thankless, counter-productive, and even wounding. We as a profession, like others, share that task and accept these responsibilities in the belief and hope that the good we can do outweighs or limits any damage.

Most psychiatrists are frustrated at the lack of political momentum. We are also deeply worried that the history of neglected services will continue to repeat itself. It is a major battle to overcome many professionals' experience of powerlessness in the face of systemic and sometimes intended stagnation and neglect.

Psychiatrists can do more, but we also need sufficient support, some understanding, and greater balance in commentary to continue to uphold and sustain our commitment toward the common goal - better mental health services. - Yours, etc,

Dr JUSTIN BROPHY, Consultant Psychiatrist, HSE, Newcastle Hospital, Co Wicklow.