Paddy McGowan spent over 10 years in treatment for mental health difficulties. Now, a unique 'expert by experience' role as a research officer in DCU will enable him to help others in the same situation, writes Hélène Hofman
When Paddy McGowan first saw Dublin City University's (DCU) advertisement for a research officer to develop new practices in mental health provision, he didn't think he was qualified to apply. Having suffered serious mental health problems through his teens, McGowan had never completed his formal education and, after being diagnosed at the age of 18, spent most of the next 10 years as a patient of mental health institutions north and south of the Border.
However, the post was unique in that it sought an "expert by experience", someone who had first hand experience of using mental health services in Ireland rather than academic qualifications. It's the first time that a position like this has been offered in Europe, and last month McGowan was officially appointed as research, teaching and practice development officer to DCU's school of nursing.
"The only university I've ever been to is the psychiatric hospitals," says McGowan. "They taught me to become ill, they taught me to become the label that was given to me and to become a mental patient. I don't have an academic qualification. The qualification I bring is that I have direct experience of using mental health services and can use that to educate others."
Over the next three years McGowan will work with both students and lecturers to develop new ways of providing mental health services across Ireland. He will also act as an informal adviser on mental health issues to the Health Service Executive (HSE) which supported the creation of the post under the recommendations of the HSE's report on mental health policy, A Vision for Change.
"As part of A Vision for Change we have a number of goals and fulfilling those without someone like Paddy on board would be impossible," according to Prof Chris Stevenson, chairwoman in mental health nursing at DCU.
"We couldn't progress in our aims without using someone who has solid user experience of the services and who would act as a credible ambassador to us, someone who could ask the right questions having been there himself," she says.
One of the main aims of A Vision for Change is to incorporate service users into the decision-making process and help develop new ways of dealing with mental health problems.
"After my first assessment I was told I had an illness, a serious illness and that when I would work - if I could work - I would be on medication for the rest of my days anyway and that that was the height of what I was going to be - a patient for the rest of my life," says McGowan.
"Some people believe that once you have a mental health problem, you never recover. I would argue that that's the wrong attitude. I have clearly recovered from mine.
"I don't use services or medication. I work actively and have done for the last 20 odd years. Giving that message to people takes away your hope and diminishes you as a person," he says.
In the end it was a specialist counsellor in Britain who helped McGowan understand the origins of his illness and he managed to come off all medication.
Soon after, McGowan began campaigning for mental health service users to be consulted on service provisions. He also lobbied for the introduction of advocates to mediate between patients and medical staff. Advocates are former service users who can speak on behalf of the patient when requested.
"In the 10 years I spent in hospital I never had anyone speaking for me. In a sense I was isolated and often I wasn't able to speak for myself. I often thought why isn't there someone like me who could sit down and be able to argue my case to the professionals?" he says.
In 1999 he helped found the Irish Advocacy Network, which was based on a similar model in place in Britain. Since then, the service has evolved and advocates are now widely available to mental health service users.
"Service users were being told they were of no value to the local community or to themselves. This was a case of service users standing up for themselves. In a way it was an emancipation for them in that they were no longer going to be victims and would no longer allow themselves to be third-class citizens.
"We're entitled to have the same responsibilities as everyone else," he says. "Mental health services in Ireland have been improving but there is still work to be done. We need to start looking at community- based care models carefully and think maybe we don't need the amount of beds that are tied up within mental health services and look at bringing service users back into the community and society.
"That way we can teach them to work in that environment rather than lifting them out of it for long or short periods of times and then dropping them back to their communities unprepared," he says.
"I see it is as tearing down brick walls and opening up mental health services across the country for anyone that needs them. They should be accessible to anyone that needs them and they should be available close to their homes."
Martin Rogan, the HSE's assistant national director with responsibility for mental health services and who worked to have the post created at DCU, agrees. "In the past you had to surrender yourself to the institution. They chose when you got up and what you did.
"We've moved away from that and are looking at developing services further by placing a major emphasis on the role of a service user. That's hopefully going to happen a lot more across the board over the next few years," he says.
"Mental health is the only area in health where you can supersede the wishes of the person's wishes, that wouldn't happen anywhere else and it unbalances the relationship."
The HSE plans to include McGowan in discussions on mental health service provision. In the past he sat on the expert group which reviewed mental health services in Ireland and came up with the Vision for Change report.
"I see myself as a resource that can be used by the HSE, and by the mental health services on the ground. The term 'ambassador for mental health' is being used in terms of being able to understand the system and open doors," says McGowan. "But, I would like to see others like myself. Mine is very much a pioneer role to encourage other institutions to adopt the philosophy that the HSE and DCU have adopted here. Service users need to be at the heart of planning services, and HSE and DCU need to be congratulated for putting their money where their mouth is.
"I believe the time is right for changes like this. We have the right people within the service, the right service users, strong family and carers linkage - so all the ingredients are there it's now about how we go about making the cake.
"It will take a bit of time to get the recipe right but when we do it'll be a tasty cake."