If you were to become one of the one-in-four Irish adults who experiences mental health problems, and if you were then to end up with the stigmatising label of "psychiatric in-patient", you might be surprised at your treatment. While popular psychology endorses a holistic mind-body approach, this attitude has yet to penetrate the psychiatric profession.
The prevailing ethos in psychiatric hospitals is to label patients with diagnoses such as "schizophrenia" and "clinical depression" and then to put them on medication. The "medical model", as it is known, sees mental illnesses as essentially biochemical problems requiring medical interventions, such as drugs and electroconvulsive therapy (ECT).
But this approach is being challenged by a new group of consumers, who are taking the mysterious world of the psychiatric hospital out of the closet and putting it onto the public agenda. In October, a group of Irish users of the psychiatric services will be launching a consumer advocacy group, Minds Matter, through which they hope to persuade the psychiatric services to become more "holistic" in their treatment of mental illnesses.
"We are not opposed to the use of drugs, but we believe that drugs are not the only answer," says Kieran McCormac, chairman of the group.
"The psychiatric service is a medication-delivering device," agrees Dr Michael Corry, consultant psychiatrist at the Institute of Psychosocial Medicine in Dun Laoghaire. "It's a massive collusion between the Department of Health, the medical profession and the drug companies," he says.
Psychiatrists have the right to keep people involuntarily in hospitals, to put them into seclusion rooms and to inject them forcibly with drugs. The Inspector of Mental Hospitals, Dr Dermot Walsh, has criticised the tendency among psychiatrists to prescribe strong doses of multiple medications, pointing to "an increasing number of sudden deaths in psychiatric hospitals, some of which were attributed to drug-related effects".
The powerlessness of patients in some hospital situations is striking: "In hospital, I have seen tablets forced down people's throats," says Kieran. He has also seen patients placed in seclusion rooms for what he observed to be minor offences resulting from interpersonal problems between patients and staff.
On the other hand, psychiatrists can provide a secure anchor during recovery, but either don't have the time or the inclination to go into helping people in practical ways, with relationships, diet, relaxation, recreation, healing and so on. "Not all psychiatrists are bad; some are excellent," Kieran hastens to add. However, he and the other members of Minds Matter are critical of the prevailing ethos in psychiatric hospitals.
"Many psychiatrists are a little bit arrogant. In general, communication is very poor between the person and their psychiatrist. In our own experiences of hospitalisation, we were disempowered by people who diagnosed and treated us without talking to us," says Kieran.
"I wasn't asked anything about relationships, diet, lifestyle or work. You have to have the drugs, but once you settle the person down, you have to tackle the cause of their psychological problems."
A psychiatrist who agrees "100 per cent" with Minds Matter's call for a holistic approach is Dr John Owens of St Davnet's Hospital in Monaghan and spokesman for the Royal College of Psychiatrists. He says too often patients receive "blanket diagnoses" instead of individual care, and "the illness becomes more important than the person.
We won't change this stigmatising attitude without revolutionising the whole system of psychiatric care," he asserts. At St Davnet's, psychiatrists are pioneering new approaches to schizophrenia where each individual is treated within their own home by an "assertive outreach" programme.
The development of Minds Matter has been facilitated by Deirdre de Burca, psychologist with Rehab. She agrees that the dominant medical model is "too narrow and reductionist". A rounded approach to assisting the mentally ill would recognise all the different aspects of human functioning which play roles in creating mental health problems, including biological, social, environmental and spiritual factors, she believes.
The founders of Minds Matter see themselves as campaigning on behalf of people who are unable to speak for themselves. They hope to do this by "peer advocacy", through which people are assisted by trained advocates who are - in Kieran's words - "people with direct experience of being on the receiving end of the psychiatric services and who have survived it".
The advocates, by virtue of personal experience, would understand what the patients were going through and would help them to articulate their needs and desires around their care.
"When you are experiencing a psychotic episode, you are in a state of extreme confusion, you are feeling afraid, possibly manic, and you don't have a great deal of will power to question what is going on. You are very vulnerable and feel that everyone is out to get you. It's hard to articulate what your needs are. And you are encouraged to give up control of your own decision-making power," says Declan Flynn, another Minds Matter founder.
Peer advocacy is already underway in Derry by the Irish Advocacy Network (IAN) and Foyle Advocates. One of their founders, Martha McLelland, a survivor of manic depression, describes peer advocacy as "a tool for recovery". People have the seeds of recovery within them, but need hope which can be provided by a relationship with a person who has the unique credibility of having survived severe mental illness, she says.
Advocates do not go into hospitals to agitate and challenge the system. They merely support and clarify. According to Foyle Advocates' annual report, only two per cent of cases they were involved in involved complaints against psychiatric hospital staff.
In the majority - 37 per cent - the advocate provided nothing more than a listening ear. In 18 per cent, information was required by psychiatric patients who had not been offered full information by their doctors. In 13 per cent of cases, interpersonal communication was the problem and the advocate helped to clear up misunderstandings between patients and staff about language or behaviour.
Martha stresses the usefulness of advocates in a situation where there is a huge power imbalance in the relationship between doctor and patient. If the patient - who is held against his or her will - refuses to co-operate or questions decisions, he or she may be branded "paranoid" or "anxious", thereby delaying eventual release from hospital.
By providing advocacy, Minds Matter hopes to redress the imbalance between health professionals and people being treated in hospital for psychological and emotional distress. Robert Frayne, one of the founding members, says that, basically, "it comes down to two things: acceptance and love".
"Yes," says Kieran, "love is the answer."
Ian may be contacted at 04871263461. Minds Matter Clarence House, Clarence Street, Dun Laoghaire) will be launched on October 12th at Buswell's Hotel, Dublin at 4 p.m.
kathryn.holmquist@weblink.ie