Sir, – Yet another article (“Fresh take on mental healthcare”, HEALTHplus, August 21st) about Pat Bracken and the “new” version of psychiatry! One might think from reading The Irish Times that individualised care planning (now a mandatory requirement of the Mental Health Commission for all patients) was not part of mainstream psychiatry. Personalised medicine, a relatively new concept in general medicine, has been the guiding principle in psychiatry for decades. Media coverage in Ireland appears to be unrelenting in presenting psychiatry as being fixed in a “medical model”. This may be why Dr Bracken’s views of an individualised approach to mental illness are being presented as novel.
There are real differences, hidden in the rhetoric, between Dr Bracken’s “new” version of psychiatry and mainstream psychiatry, most of which relate to treatment. For example, Dr Bracken stated that, “I do prescribe antipsychotic medication to my patients when they want them.” Mainstream psychiatry, however, accepts the necessity of sometimes giving antipsychotic medication to individuals who are experiencing a severe psychotic illness and will not consent to treatment. We do this usually when an individual is “in immediate danger of harming themselves or others”, and only at the request of the individual’s family and their GP, using transparent legal processes (the Mental Health Act, 2002). This is what Dr Bracken describes as “the powers invested in psychiatry” that are “a legacy of the asylum era and can no longer be justified on moral or legal grounds”.
It is disingenuous to ignore the responsibility placed by society on psychiatry to protect individuals with severe psychotic disorders from harming themselves or others; and it is a denial of the complexity of mental illness to appeal to a superficial sense of squeamishness in this regard.
Treating psychotic individuals without their consent is entirely compatible with an individualised non-medication focused recovery plan. – Yours, etc,