ESRC Festival Event: Relationships Matter Putting Children at the Centre of Professional Practice

Dr Karen Winter: Relationships Matter Putting Children at the Centre of Professional Practice

An ESRC funded ethnographic research project underway in the South Eastern Health and Social Care Trust (SEHSCT) that seeks to:

Identify how social workers communicate with children in practice;

Enable practitioners to reflect on specific practice encounters, helping to identify the barriers and enablers to attuned communication;

Identify how practice in this domain could be improved and develop paper-based and video/digital resources to enable these improvements to be realised.

The event represents an opportunity for practitioners and policy makers to engage with the findings of research in which they have been involved and consider their practical applicability.

Learn more about this project at:

Lisburn Civic Centre

12.30 – 4.30

5 November 2014

Further details available from: k.winter@qub.ac.uk

Inside Probation and the Possibilities for Penal Reform

Irish Criminology Research Network

When viewed alongside international comparators the use of supervised community sanctions (such as Probation and Community Service Orders) in Ireland is relatively low. The marked increase in the prison population in Ireland in recent years has focused attention once again on the under-utilisation of community sanctions. The recent report of the Strategic Review on Penal Policy echoes calls made in numerous policy documents over the past 30 years, to reduce the use of imprisonment, particularly for short prison sentences, and to strengthen the range of community sanctions available to the courts. Alongside cost imperatives – prison is an expensive sanction – the detrimental effects of prison have been noted. Temporary incapacitation, particularly in the form of short prison sentences does not help to reduce offending in the long-term. In fact a wide range of evidence suggests the opposite effect.

However, lessons from other countries suggest that caution should be…

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Residential care and sexual exploitation: sound bites versus reality

Watching the recent Stephen Nolan show regarding the ongoing police investigation into allegations about the possible sexual exploitation of 22 young people who have gone missing from residential care in the last 18 months, I was struck by the fact that the discussion centred on panel participants providing a ‘yes/no’ answer to the question ‘can care workers restrain young people to prevent them leaving care homes when there are real concerns about the risks they may be exposed to?

Although based on the understandable desire to find a quick and effective solution to address the problem, setting the parameters of the discussion in this way does a disservice to everyone involved. The public may well be left with the impression that, once again (bearing in mind the horrific examples of historical institutional abuse), residential homes can never deliver on their promise to safeguard the well being of the young people they care for; that care workers are ineffective and that young people living in children’s homes are out of control to the extent that they need to be restrained. The reality is, of course, far more complicated than these sound bites.

Sexual exploitation involves the coercion or manipulation of a young person under the age of 18 years into engaging in some form of sexual activity usually in exchange for gifts (money, cigarettes, alcohol, clothes), affection and/or status. It can happen to any young person from any background and of any age. It is largely hidden. It is therefore wrong to make the assumption that it is only young people who live in residential care who have been or who will be sexually exploited.

With regards to residential care there are 41 children’s homes in Northern Ireland, which provide care for about 250 children and young people. There are also 9 other residential homes that provide respite and longer term care for disabled children[1]. Of the 41 children’s homes most young people enter residential care when they are in secondary school and most stay there for short periods of time and often return home. Given the numbers that the police are concentrating their investigation on, it is clear that the focus is not all young people in residential care and neither is it all children’s homes. It is wrong to conclude therefore that residential children’s homes per se place young people at risk.

The role of residential care in parenting young people has recently been the focus of positive policy and practice initiatives. In May 2013 the DHSSPS published draft Minimum Care Standards for Children’s Homes, which have been developed with the involvement of children and young people who live in children’s homes. The new standards will strengthen the role of the Regulation and Quality Improvement Authority in its legal duty to inspect all residential units. The publication of these new standards alongside the launch of recent regional guidance regarding police involvement in residential units when children go missing[2] and the introduction of therapeutic approaches within children’s homes across Northern Ireland[3] indicate that there has been a lot of work behind the scenes to improve residential child care in Northern Ireland. It is inaccurate to imply that during the period covered by the police investigation, nothing has been happening.

The children and young people who live in children’s homes have said that they value residential care and that they want ‘the home to be their home, to be homely and similar to those of their friends not in care’ (DHSSPS, 2013, p. 1). Most young people experience residential care as a good place, value their relationships with their care workers and feel that their time in residential care has helped them deal with their problems. We also know that there are care workers who go ‘over and beyond’ what is expected of them to make connections with young people in attempts to address risks in their lives.

Underpinning young people’s positive experiences of residential care is one common element – the development of trusting, consistent and meaningful relationships with staff. If we think about our own families and our wider communities it is only within the context of trusting, positive and meaningful relationships that opportunities are forged to effectively educate, reason with and role model the knowledge and skills required with children and young people to help them identify and manage risk effectively and appropriately. Fundamentally the aim of residential care is also to provide these opportunities.

From what staff, children and young people tell us we cannot say that the work of care workers is ineffective. We do know though that it can be time consuming and resource intensive to build relationships. It can be very difficult to ‘reach’ children and young people when they have had few positive relationships in their families and their communities.

Within this context restraint cannot be relied on as an effective and reliable intervention for preventing risk of exposure to sexual exploitation and is not a solution. Restraining young people is traumatic for them, an intrusion into their private space and maybe experienced like another violation of their person. It is almost certainly unlikely to be experienced by them as providing a platform for the development of meaningful relationships. The process is also traumatic for staff and places them at much greater risk of complaint and investigation.

What all of this should indicate is the need for an informed discussion and one that recognizes that there are no ‘quick fix’ solutions regarding the sexual exploitation of children and young people. One issue that needs much more careful consideration is whether being in residential care per se increases the risk of young people being sexually exploited. It is convenient to ‘box off’ sexual exploitation as connected with residential child care and makes it much harder to push for the development of a shared sense of responsibility, across agencies and communities towards the children and young people living in our areas.

The recently established Safeguarding Board Northern Ireland has a vital role to play in this regard and its newly published guides on sexual exploitation have been developed on a model of shared professional responsibility and effective working relationships between professionals. Translating the principles and practices of these guides into the daily practices of people who work in settings with children requires more opportunities for adults and children to develop trusting, respectful and meaningful relationships with each other. Supporting the development of these requires resources so that we have the right number of people with the right training in the right place and at the right time.

Dr. Karen Winter is a lecturer in social work at Queen’s University Belfast and has researched and written widely on the subject of children in care. Most recently she is one of a team commissioned by the Northern Ireland Human Rights Commission to undertake a review of research, policy and practice concerning children and young people on the edge of care and in care and their right to family life.

Sept 29^th 2013

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[1] DHSSPS (2013) Children in Care in Northern Ireland

[2] HSCNI/PSNI (2011) Regional Guidance. Police Involvement in Residential Units. Safeguarding of Children Missing from Home and Foster Care.

[3] SCIE (2012) Therapeutic Approaches to Social Work in Residential Child Care Settings.


Experience of conference participation

After reading a call for papers for a seminar organised by the BSA ‘New Variants on the undeserving poor: current perceptions and experiences of disability and illness’ to be held in Coventry University on 24^th May, I submitted an abstract for consideration.  The abstract was based on research I had carried out for the final assignment of a third year undergraduate module, Disability and Society.  My abstract was accepted, and I was asked to be one of the speakers. 

The title of my presentation was: To what degree has the concept of social exclusion been applied to the education of children with disabilities in Northern Ireland?  The paper discussed the change in the education system in Northern Ireland from segregation to inclusion, and detailed arguments both for and against the existence of ‘special schools’.   It argued that while the current policy of inclusion has resulted in more children with disabilities attending mainstream schools, the underlying structure remains unchanged and is failing many of our children. A report by the Education and Training Inspectorate in 2010-11 found that 18% of primary schools and 38% of post-primary schools failed to meet the required standards of arrangements to identify, assess and meet the needs of Special Educational Needs (SEN) pupils.  There are fears that the assessment procedures for the new SEN system which is due to be introduced this year will lead to further inconsistences between schools.  Another cause for concern is the change from ‘Statements’ to ‘Coordinated Support Plans’ (CSP’s).  It is estimated that up to 50% of children who would have previously had the legal protection of a Statement will not now meet the much more stringent criteria needed for a CSP, and therefore also lose the right to appeal if any recommended support provision fails to materialise.  However, my paper concluded by highlighting the fact that children with disabilities themselves are rarely, if ever, included in the decision making surrounding their support provision, and until their voices are heard, SEN will remain a sub-system of education, and their social exclusion will continue. 

I was unsure of my ability to deliver a paper at such an event, but with encouragement from School staff and great support from Dr Byrne, (not to mention an offer from the School to cover my travel expenses), I decided that it was too good an opportunity to miss.

The seminar was attended by people with a wide range of interests, and this was reflected by the other speakers: Paul Grant, a lecturer from Wolverhampton University, Jamie Beddard, an actor with disabilities, Dr Sarah Woodin from Leeds University, and Debbie Jolly, a representative of Disabled People Against the Cuts (DEPAC).

I informed the organisers of the event that this would be my first time presenting a paper, and from the start they were extremely understanding, promising a supporting atmosphere.  From the moment I arrived at the venue I was made to feel comfortable, everyone was very welcoming, and interested in what I had to say.  I learnt a lot, met some fantastic people, and came away feeling very positive about the whole experience, and really glad that I had been given the opportunity to attend.  I would encourage any Post Graduate student – Taught or Research – to submit papers if they hear a call for any in an area they are interested in.  Yes, the thought of standing up and talking in front of academics is a daunting one, but the rewards make it worth putting yourself out there.

Elizabeth Martin

Elizabeth is currently studying on the MA Sociology programme.

The Grief Study

Mark McCann, John Moriarty and Aideen Maguire are working on a project exploring the effects of bereavement on mental health. You can follow their progress on blogs.qub.ac.uk/griefstudy.

The Grief Study aims to estimate the prevalence of poor mental health outcomes among people who have suffered bereavement. To do this, we will combine data from the Northern Ireland Longitudinal Study, the Northern Ireland Mortality Study and the Electronic Prescribing Database. The Northern Ireland Longitudinal Study (NILS) is a random anonymised sample of 28% of the Northern Ireland population whose responses to the 2001 UK Census have been held and linked to GP registration information. Like all of us, a proportion of this sample will have lost someone close to them since the beginning of the study. It is possible to identify those who have lost someone living at the same address as them, and to compare their mental health outcomes to the rest of the population.

Our proxy measure for poor mental health is prescription of anti-depressant or anxiolytic drugs in the post-bereavement period. This Distinct Linkage Project (DLP) allows for comparison of mental health outcomes between bereaved and non-bereaved individuals and for extensive analysis of particular populations of interest. The following five research questions illustrate the scope of the project and the particular bereaved groups whose experiences we want to better understand.

1.  Does bereavement lead to an increased risk of poor mental health?
2.  Does the likelihood of poor mental health following bereavement vary according to the cause of death?
3.  To what extent do individual, household, and area characteristics mitigate or compound the risk of poor mental health following bereavement?
4.  Does the ‘risk profile’, in terms of the magnitude of risk conferred by individual, household and area characteristics, differ between those bereaved following an expected death, sudden death, violent death or suicide?
5.  To what extent does bereavement confer an increased risk of mortality, particularly when accompanied by poor mental health?

Question 1: Does bereavement lead to an increased risk of poor mental health?

Evidence suggests that bereavement is a major life event and considered a major stressor. Losing a loved one can hasten one’s own death, but we don’t know to what extent this is preceded by suffering which is significantly greater than that of the general population at large. By comparing the additional likelihood of being prescribed anti-depressant or anxiolytic drugs following a bereavement, we can attempt to measure how much suffering bereavement causes.

Question 2: To what extent do individual, household, and area characteristics mitigate or compound the risk of poor mental health following bereavement?

Grief reactions won’t be the same for everyone. By comparing bereaved individuals who have poor mental health outcomes with other bereaved individuals, we can develop a profile of individual characteristics and social factors which dispose someone to a more intense grief reaction. For example, we will be looking at whether grief reaction is more or less severe depending on sex, age, area deprivation and whether the bereaved individual provided care to the deceased.

Question 3: Does the likelihood of poor mental health following bereavement vary according to the cause of death?

The circumstances of an individual’s bereavement and the nature of the death of their loved one has potentially huge impact on their ability to cope. For example, there is widespread public concern over how a person copes after the sudden death of a young or middle-aged member of their family, particularly where the person has died by suicide. This concern reflects an appreciation for how the circumstances of death can potentially confer severe risk on a bereaved person.

Question 4: Does the ‘risk profile’, in terms of the magnitude of risk conferred by individual, household and area characteristics, differ between those bereaved following an expected death, sudden death, violent death or suicide?

This is an exploratory question to which studies to date give no satisfactory answer. If question 2 asks whether different some categories of person are differently affected by bereavement and question 3 asks whether some categories of death cause people to be differently affected, question 4 asks whether those particular deaths have a greater effect on everyone or only on particular categories of person. For example, we look at whether the extra mental ill-health suffered after a suicide is more pronounced for women or for men; whether better education protects against suffering following particular types of death, but not others.

Question 5: To what extent does bereavement confer an increased risk of mortality, particularly when accompanied by poor mental health?

Mortality is the more commonly studied outcome from bereavement, and several studies indicate that a bereaved person will die sooner than someone of the same age and physical health. However, none of these studies have had the measures available to examine why a bereaved person is at risk of dying and whether this risk is due to mental health deterioration.

We’re grateful to the Grief Study’s Knowledge Exchange Working Group for their input to date on these questions. If you would like more information about any of these research questions, please leave a comment, send us a tweet (John_ICCR ; Aideen_ICCR ; Mark_ICCR) or email j.moriarty [AT] qub.ac.uk. If you have information or insight which you think could be of value to the team, please share it with us.

Public Lecture: Reflecting on the death of Savita Halappanavar, could this happen in the North?

Reflecting on the death of Savita Halappanavar: Could this happen in the North?

Social Society

School of Sociology, Social Policy and Social Work,  Queen’s University Belfast

Room 01/035

Tuesday the 4^th of December 5pm to 7pm

Speakers:  Anna Lo (MLA), Anne Rossiter, Judith Thurley and

Dr Lisa Smyth

 

Lisa Smyth on: Marie Stopes in Belfast: cultural identity or women’s rights?

Why has the opening of a Marie Stopes clinic in Belfast generated such a storm, driven by an unlikely coalition of opponents who cross the usual divisions of politics and religion? Were those protesters who gathered in Belfast’s city centre for the clinic’s opening on 18^th October motivated solely by moral commitments? Is there more that can be said about these recent events? Does this and similar protests instead tell us something about the peculiar character of identity politics in Ireland, north and south?

Those who resist legal access to abortion tend to portray their views as representative of what ‘the people’ think. Protesters in Belfast described their position as part of a wider struggle for ‘the soul of Northern Ireland’. Claims such as this are common in public debate on abortion access around the world, despite the deep disagreement this issue actually generates on the island of Ireland and beyond. It does seem particularly surprising to hear statements such as this in a society which is usually instead understood to be deeply divided. It raises questions about whether a society can be said to have a soul, and whether we all know and agree on what that soul might be. Are democratic societies, whether deeply divided or not, ever based on the sort of deep moral consensus these protesters see themselves as defending?

While it may seem that claims of this sort are simply empirical statements about social attitudes or cultural values, they can also be understood as the political claims of moral entrepreneurs, who seek to position themselves as authoritative representatives of the ‘collective conscience’.  It is possible to understand the occurrence of protests such as this not only as a specific reaction to the opening of the clinic, but also as a struggle to secure recognition, from Westminster, Stormont and the region’s inhabitants, of Northern Ireland as a single moral community. Of course, such claims that Northern Ireland is ‘more moral’ than the rest of the UK, and should be treated as such, are caught in a zero-sum struggle. Their success depends on compromising women’s status as individual moral agents, capable of making meaningful decisions in difficult circumstances. Indeed, this conflict echoes that of the Republic of Ireland, where opposition to abortion access has also provided a focus for a much broader conflict over the status of women and the authority of the patriarchal family. While bitter experience has changed the character of this politics south of the border to some extent, as pregnant young rape victims, wards of court, cancer victims and others have all made their way through the courts, the conflict in Northern Ireland has been more muted. It has played out in an apparently ‘exceptional’ region of the otherwise relatively liberal UK, and so tends to remains below the radar of international attention. The opening of the Marie Stopes clinic in Belfast takes place against this background, in a context where women’s entitlement to make major decisions over their own reproductive lives has long been compromised by the claims of culture.

From the Olympic Games to the Demands of Motherhood

On Thursday, October 5^th, the school will mark the beginning of a new academic year with a special event marking the production of ten new books within the school in 2012. The titles span a vast array of topics including social deprivation, welfare, motherhood, rural life and the social significance of the Olympic Games. Each book will be introduced in brief by the author or editor, all of whom will be available for comment and discussion afterwards.

The launch was initiated by the Identities, Lifestyle and Culture research cluster. Cluster director Robert Miller said that the list of titles underlined the diverse strands of research being pursued to a high standard across the school. He added, “The event itself is a great opportunity to acknowledge the work and dedication of these authors and editors, as well as for others to hear what goes into getting books like these completed and out into the world.”

“The Evolution of European Identities: Biographical approaches” (Palgrave) is edited by Miller and explores the lack of identification by ordinary citizens with Europe and European institutions. Using state of the art analysis of in-depth interviews by renowned practitioners, the book provides a unique “bottoms up” perspective on the development (or its lack) of a sense of “European mental space”. Linking conceptual findings with case studies, the book provides unique insights into groups that have been especially sensitized by their life experiences to question what it means to be European in the twenty-first century. In this book, the editor brings together explorations of diverse groups, including adults who experienced European education exchanges when young; transnational workers; civil society organization activists; persons involved in cross-border intimate relationships; farmers who are subject to European markets, regulations and subsidies; and migrants into “fortress Europe”.

In “Poverty and Deprivation in Europe” (Oxford University Press), Brian Nolan and Chris Whelan attempt to redress the reliance on primary household income measures to capture poverty in rich countries. Awareness of the limitations of income has heightened interest in the role of non-monetary indicators. This book takes as its starting point that research on poverty and social exclusion has been undergoing a fundamental shift towards a multidimensional approach.

The difficulties encountered in applying a multidimensional approach reflect limitations in the information available but also in the conceptual and empirical underpinnings provided by existing research.  This is salient not only for individual countries but also for the European Union post-enlargement. The central aim of this book is to contribute to development of those underpinnings and to provide ways of employing non-monetary indicators. The book maps out the current landscape and the best way forward, concluding by offering a critical evaluation of the EU’s 2020 poverty reduction target.

“The Olympic Games, Mega-Events and Civil Societies.  Globalization, Environment, Resistance” by John Karamichas and Graeme Hayes (Palgrave) explores sports mega-events; their social, political and cultural characters; the value systems that they inscribe and draw on; the claims they make on us and the claims the organizers make for them; the spatial and ethical relationships they create; and the responses of civil societies to them. Sports mega-events are not simply sporting or cultural phenomena. They are also political and economic events, characterized by the generation and projection of symbolic meanings and by social conflict. Because of their peculiar spatial and temporal organization, they raise questions about the relationships between global cultural and economic flows and particular local and national spaces. Because of their evolutionary characteristics, they ask us to consider not simply the time of the event but also the effects of the event on the long-term direction, implementation and consequences of public policy.

In “Demands of Motherhood: Agents, Roles and Recognition” (Palgrave),Lisa Smyth returns to the deeply contested and emotionally fraught role of motherhood.  Motherhood is the focus of much public scrutiny, situated as it seems to be at the frontier of processes of social order and change. Much has been written about the difficulties of mothering in a context of ever-expanding expert advice, as well as apparently increasing expectations that the mother-child bond be cultivated through intensive care-giving.

In this study, Smyth returns to neglected sociological questions concerning the connections between agency and normative complexity, through the pragmatist interpretation it offers of the recognition dynamics shaping motherhood. Drawing on qualitative interviews with forty mostly middle-class mothers across two research sites, Northern Ireland and the US, this book offers a three-party typology of the coping strategies women adopt. The various combinations of expressivism, instrumentalism and pragmatism taken up by respondents as they go about asserting normative authority and seeking esteem for the competence and quality of their mothering, provides the focus of attention.

“Post-Qualifying Mental Health Social Work Practice” (Sage) is an extensive treatment by Jim Campbell and Gavin Davidson of the complex and difficult practice dilemmas faced by social workers working in the area of mental health, and the demanding policy and legal landscape surrounding practice in the area. The authors draw on theoretical and research perspectives on the subject, before outlining how professionals can achieve best practice. Topics covered include: models of mental health and illness; discrimination and social exclusion; addressing service users’ needs; carers’ perspectives; and working with individuals, families and communities. The chapters are accompanied by exercises, which encourage readers to critically reflect on their own professional and personal experiences. The book will be particularly useful for social work practitioners taking postgraduate courses in mental health and for those training to become Approved Mental Health Professionals.

Mary Daly’s “Welfare” (Polity Press) examines how welfare is understood across a range of disciplines and considers the relevance of the concept in the light of recent debates and scholarly developments. Not alone is welfare challenged by new concepts but it is also challenged as a political goal. Hence, the discussion of welfare raises large issues about policy. The book is especially concerned with three aspects of welfare – as a focus of academic thinking and research; as it has informed and been taken up by public policy (in the context of the welfare state especially); and as a way of understanding people’s decisions and actions in their everyday lives. The book takes a fresh look at the case for the continuing relevance of welfare and in so doing offers a novel approach, drawing especially on a multi-disciplinary approach.

In “Blades, Blood and Bandages” (Palgrave), the taboo phenomenon of self-injury is examined. Author Theresa McShane draws on the experiences of 25 people who cut, burn or otherwise injure themselves who present their perspectives through interviews, diaries and poetry. The book explores issues of causation and suffering, stigma and ritual, and presents a helpful alternative to medical classifications of self-injury.

The book uses an original theoretical concept – the trajectory of suffering – to explain patterns of self-injury, from “causation”, through “ongoing injury” to “post injury”. It finishes with an explanation of the social face of self-injury and the structural influences on self-injury of both popular culture and the internet.

Asylums, Mental Health Care and the Irish 1800-2010 (Irish Academic Press) is edited by Pauline Prior, and comprises fascinating historical essays from well known scholars on a wide variety of topics in relation to mental health services in Ireland during the past two centuries. Topics covered include a major strike in 1919, when nurses flew a red Soviet flag over the building and rallied leaders of the trade union movement to their cause; poetry and prose from patients at Holywell Hospital in the 1960s; stories of Irish emigrants who went to Australia and New Zealand in the 1800s to find gold, but who ended up in asylums; changes in law and approaches to mental health care in Ireland in the twentieth century; and detailed studies into approaches to care and treatment at Ballinasloe, Belfast, Dundrum and the Richmond.

“Irish Social Work and Social Care Law” (Gill & MacMillan) is a new textbook by Claire Hamilton introducing students to the law governing the practice of social work and social care in Ireland. The book provides a clear and concise guide to both the legal framework and the substantive law relating to social care and social work. It presents social care and social work law in an accessible manner, focussing on the specialist functions performed by social care professionals such as child protection, adopting and fostering, disability and mental health. It also considers the broader issues that affect service users in a social care context such as domestic violence, youth justice and the asylum system. The impetus for the book was the absence of a legal text dealing with social work and social care law in the Republic of Ireland equivalent to Ciaran White’s text in the North.

In Rural Transformations and Rural Policies in the US and UK (Routledge), editors Mark Shurcksmith, David Brown, Sally Shortall, Jo Vergunst and Mildred Warner set about illustrating the transformations that have occurred in rural areas and related policies. The political, social, economic, cultural and environmental landscapes of rural areas have changed utterly. Processes of globalisation and related decentralisation, population shifts, technological and industrial changes have resulted in the transformation from one rural societal form to another. This transformation does not only consist of the visible or tangible changes in rural areas, but it also includes the narratives and social construction of rural areas. In this comparison of the US and the UK, we examine four key components of rural transformation; rural policies and governance, economic transformations, social and demographic transformations, and rural environments. In each case we examine the evidential and philosophical nature of these transformations.

Pauline Prior – Asylums, Mental Health Care and the Irish (1800-2010)

Edited by Pauline Prior, Senior Lecturer in Social Policy at QUB, this fascinating book is a collection of historical essays from well known scholars on a wide variety of topics in relation to mental health services in Ireland during the past two centuries, with additional chapters on the Irish in Australia and New Zealand, poetry and prose from service users and a comprehensive chronology of mental health policies and laws since 1634.

For the twentieth century, Anton Mc Cabe (journalist) and Ciaran Mulholland (psychiatrist who also works at QUB) write about the major strike at Monaghan Asylum in 1919, when the nurses raised a red Soviet flag over the building and rallied leaders of the trade union movement to their cause, leading to improved salaries and conditions of service for psychiatric nurses throughout Ireland. Gillian Mc Clelland (QUB social policy) explores the Holywell Hospital magazine Speedwell published throughout the 1960s, looking for staff and patient views on psychiatric care of the time. For a critical discussion of trends in mental health services in the Republic of Ireland from the 1950s to the present day, we hear from one of the most influential doctors of his time, Dermot Walsh (psychiatrist and former inspector of mental hospitals in Ireland)

For the nineteenth century, Brendan Kelly (psychiatrist who also works at UCD) and Margaret Crawford (QUB historian and dietician) discuss new insights into the causes of death and of disease in the Richmond and Dundrum Asylums, within the context of current knowledge on TB and beri-beri. Oonagh Walsh (UCC historian) reflects on the role of doctors (Visiting Physicians and Medical Superintendents) in Ballinasloe Asylum, while David Griffiths (QUB historian) and Pauline Prior tell us about a major legal battle between the Lord Lieutenant of Ireland and the governors of the Belfast Asylum over the appointment of chaplains in the 1850s. Pauline Prior also examines some of the issues that came to the attention of the Inspectors of Lunacy in their oversight of the asylum system – issues such as the growing demand for beds, the ever increasing cost of the services and unexplained or accidental deaths, which may have been caused by suicide or by abuse of patients by staff.

Moving beyond Ireland, and giving us another perspective on mental health and illness among the Irish, historians Elizabeth Malcolm (University of Melbourne, Australia) and Angela Mc Carthy (University of Otago, New Zealand), explore the stories of Irish emigrants who left Ireland during the nineteenth century to find gold or new opportunities but unfortunately succumbed to illness and institutionalisation on the other side of the world.

This collection of studies is complemented by an analysis of overall trends in institutionalisation within the mental health services by Damien Brennan (TCD sociologist), and of the laws underpinning these services in both Northern Ireland and the Republic of Ireland by Pauline Prior. A truly remarkable publication.

Radio interviews on Downtown Radio:Listen to Pauline Prior being interviewed by Bobbie Hanvey on ‘the Ramblin Man’ programme at 10.00 pm (after the News) on 12^th and 19^th August. You can listen to Pauline’s interview here. 

Details of book: (Available at any bookstore or directly from IAP):

Prior, P. M. (ed) 2012, Asylums, mental health care and the Irish 1800-2010, Dublin; Portland, Oregon: Irish Academic Press. ISBN 978 0 7165 31524.  

Read the Irish Times review: http://www.irishtimes.com/newspaper/weekend/2013/0202/1224329541003.html

Mike Tomlinson – Children of ‘The Troubles’ more prone to suicide

Until recently, the most politicised public debate about suicide in Northern Ireland was around the 1981 hunger strikes. While Irish Republicans saw the deaths as tantamount to ‘murder’, Unionists – the current First Minister Peter Robinson among them – saw the deaths as ‘self-inflicted’ and a matter of free choice.[1] These deaths were, in fact, classified as ‘suicides’ by the Registrar General’s office, a label avoided by the Catholic church at the time.

When public protests around suicide emerged in 2005, the Secretary of State for NI was quick to frame the issue in terms of violent conflict and the need to end paramilitary attacks on young people. This was completely off-target. The protesters, community groups from North and West Belfast, were responding to an ‘epidemic’ of suicides among young people in their areas, though it took some time for the official death registration statistics to record what was going on. A suicide prevention strategy was finally put in place in 2006, four years after England and Scotland. By 2010, Northern Ireland’s suicide rate was almost double what it was in 1998, the year of the Good Friday Agreement.

From a negligible rate in the 1960s, the suicide rate rose steadily during the 1970s and 1980s, up to a rate of 10 per 100,000 by 1988, low by international standards. It then fell slightly over a ten-year period. But from 1998 there is a strong upward trend rising from 8.6 per 100,000 of the population to a rate of 16 per 100,000 by 2010.  Suicide rates for men went from 13 per 100,000 of the population to 24 per 100,000 by 2008; for women the increase was from a rate of 3.9 to 7.3 over the same period. Northern Ireland is now in poll position among the jurisdictions on these islands, even ahead of Scotland. Whereas the 10-year trend is gently downwards for the Irish Republic, England, Scotland and Wales, the reverse is true for Northern Ireland. Why?

Having examined 45 years of death registration data and reviewed the suicide trends alongside changes in violence, politics and the economy, we can rule out ‘social constructionist’ explanations in terms of influences on reporting and registration processes. Apart from the period 1970-77, there is little evidence that social processes affected the broad reliability of the data. Nor can we explain the rise in suicides in terms of unemployment – from 1998 to 2007 the employment rate reached record levels and unemployment was below the UK average.

What the data show is that men in their late thirties up to their early fifties are the group contributing most strongly to the upward suicide trend since 1998. In other words, those born into the conflict or who were children during the worst years of violence are the cohort which now has the highest suicide rates and the most rapidly increasing rates of all age groups. For instance by 2010, men aged 35-44 had a suicide rate of 41 per 100,000 (age standardised) followed closely by 45-54 year olds and the 25-34 age group. The youngest age group (15-24) which attracts most of the media attention has a trend line that has changed very little since the late 1970s. Similarly for women, the weakest upward trend in recent years has been for the youngest groups and the strongest for 45-54 and 55-64 year olds. The overall gap in rates between men and women has widened in this period.

The rise in suicide rates in the last decade coincides with the move from conflict to peace in Northern Ireland and is most likely related to it.  The increase can be attributed to a complex range of social and psychological factors. These include the growth in social isolation, poor mental health arising from direct experience of conflict, and the greater political stability of the past decade. Those born and growing up in the conflict are the most acculturated to open expressions of violence, division, authoritarianism and hatred – they experienced no other political and social context until the late 1990s.  The transition to peace means that cultures of externalised aggression are no longer socially approved or politically acceptable.  Violence and aggression have become more internalised instead. We seem to have adjusted to peace by means of mass medication with anti-depressants, non-prescription drugs and alcohol, the consumption of which has risen dramatically in the period of peace.

Northern Ireland’s suicide prevention strategy has so far made little impact on the upward trend. It may well be missing the target by over-emphasizing interventions with younger age groups and failing to focus on those occupational groups and communities which experienced the worst of the violence. There remains a huge gap between those in psychic pain and support services – almost three-quarters of those who succeed in taking their own lives have not been seen by a health professional in the last year. It is cliché to say that mental health is the Cinderella of the National Health Service but it’s true. We spend far more on road safety than suicide prevention yet more die by suicide than through traffic accidents. Very few people realise that about 1,000 more people died by suicide than were killed in the conflict yet vast resources were committed to controlling the later. Suicide is a major legacy issue.

Tomlinson, M. (2012) ‘War, Peace and Suicide: The Case of Northern Ireland.’ International Sociology 27 (4): 464-482.

Listen to discussion of research findings on RTE’s Morning Ireland

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[1] Peter Robinson (1981) Self-Inflicted, An Exposure of the H-Blocks Issue. Belfast: Democratic Unionist Party