Medical Matters: Recent revelations in the report by the Inspector of Mental Health Services, coupled with views expressed by Dr Michael Corry and others in The Irish Times, must leave one in little doubt the abysmal state of psychiatric services here.
While the main focus so far has been on the psychiatrist and the general milieu, I wish to dwell on the psychiatric nursing profession.
The current role of psychiatric nurses in Ireland is still rooted in the traditional medical model. The core philosophy which underpins this model is that the patient is essentially sick as a result of some putative biochemical abnormality. Accordingly, the basic assumption is that he should be treated by the administration of drugs and should this regime be unsuccessful following various empirical trials with different drugs, then perhaps try a bit of electrical treatment - electro-convulsive therapy (ECT).
Psychiatric nurses spend much of their time engaged in those treatments. Most of their other work tends to be of a fairly routine nature involving monitoring patients' behaviour. Otherwise, their activities comprise a wide range of general duties involving much paperwork.
They operate within a culture whereby they are either unwilling or incapable of applying a psychological approach based on the formation of a therapeutic relationship with patients. Their utilisation of effective professional communication and inter-personal skills tend to be conspicuous by its absence.
Essentially, the modus operandi peculiar to psychiatric nurses generally reflects a total lack of empathic understanding of their clients. More often than not, they are devoid of effective listening skills. They lack mastery of the most elementary counselling and psycho-therapeutic skills.
Sadly, as widespread clinical research has demonstrated, it is a rarity to find a psychiatric nurse engaged in planned, structured verbal interaction with patients so often miserably isolated, dejected and ignored.
My own personal experience of a short period last year as consumer of the psychiatric services following a bout of stress-induced anxiety and depression, was quite unforgettable.
I initiated my own admission to a private psychiatric hospital which proved to be singularly lacking in any therapeutic input by the nursing staff. Frequently, seriously ill patients sat passively in the day-room, their eyes glued to the television, the nurses apparently oblivious to their obvious boredom and lack of social contact.
Most of the nurses' time was divided between administering drugs, preparing some patients for ECT and enforcing patient adherence to a rigid timetable for those well enough to attend occupational therapy or arts and crafts, both of which I found to be of rather dubious therapeutic value.
During the mornings, when nurses were not immersed in the physical and custodial duties already alluded to, they congregated en masse, waiting on junior medical staff!
Abruptness, discourtesy and invasion of privacy were the order of the day. Each morning I was rudely awakened by the sudden charging into my private room without knocking, of nurses greeting me by such an incongruous salutation as "Good morning - what a beautiful morning" often to the accompaniment of torrential rain and howling gale-force winds outside.
The only person who spent any quality time with me was a general trained nurse with no psychiatric qualification. The only communication which I experienced from psychiatric nurses was the occasional "How are you?" followed by a hasty departure.
The only positive experience I had related to my consultant who was excellent and thoroughly skilled, dynamic and caring in his clinical work.
One must question the cost effectiveness of the current four-year university degree programme encompassing vast volumes of theoretical input on the social sciences when practitioners subsequently fail or are not afforded the opportunity of applying this knowledge in clinical psychiatric nursing practice.
What precisely can psychiatric nurses do that general nurses could not do with a minimum amount of post-graduate training and perhaps clinical supervision by psychiatrists and clinical psychologists?
Finally, it must be acknowledged that there is a massive gap between theory and practice in psychiatric nurse education and training.
There is a disparity of enormous magnitude between theoretical input and dedicated training in communication, interpersonal and other psychologically centred therapeutic skills, including group dynamics and behaviour therapy. Students are coming out of college with their heads bulging with factual knowledge and no competence in applying this in practice.There is an urgent need for a complete overhaul of the psychiatric nursing curriculum. Until this happens, psychiatric nurses will continue to operate the "asylum-keeper mentality" of former times and this branch of nursing will fail to attract high calibre students and will continue to lack professional credibility.
Patrick J O'Brien M. Ed. is a former associate lecturer in psychiatric nursing at Trinity College Dublin, a freelance lecturer in psychology and psychiatry and a former examiner in psychiatric nursing with An Bord Altranais.