"Sligo Mental Health services"

The team co-ordinators had contacted me requesting feedback on any changes I felt had been made since the time of logging this initial story.

My own personal situation has again, markedly improved.

That being said, the reason as to why this has come about, is manifold.

Firstly - allow me to say that, I have found the service the HSE sligo services has provided, overall, to be phenomenal.

One thing I would not question, is the work ethic of those involved. The nursing staff, the team co-ordinators, the psychological and psychiatric staff.

The multiple opportunities the HSE provides, all locally, to assist in dealing with mental health issues, be it occupational therapy, psychological therapy, medical administration, support groups - in terms of the Eolas program - family assistance in terms of aiding and reassuring family members of those afflicted.

I have partaken in everything available that I felt, or those whose care I was under, felt would be of benefit to my recovery, and like I said - the effort and passion of those involved at assisting patients to recovery, is unquestionable.

So just so there are no misconceptions, that everything the HSE has done and provided for me - is appreciated and valued, absolutely.

That being said - unfortunately - there has been, and to some degree, remains to be, one terrible hindrance in terms of the nature of treatment administered, and resultingly, the potential outcome of that treatment.

And to be perfectly honest - given what I've outlined, the dedication of those involved, and their commitment to providing the best possible service - I have reservations about even commenting, criticizing.

But the reality is, from a very general, service users point of view, I feel there are some improvements that could be so very easily applied, that could, and should, make the difference of night and day to the treatment outcome; at least, there is no question that that would be the case relative to my own situation.

And very simply, the main hindrance, roadblock, that I have experienced - and this opinion was profoundly shared by other service users whom I met through the Eolas program - that the conflicting opinions of the medical consultants/doctors, and that of the patients, can often lead, ultimately, to the administration of medicine, medication, to an almost counter productive outcome.

Now initially I had considered this to be an issue, purely with the psychiatric staff.

The consultant doctors, the medical professionals who make the decisions regarding diagnosis, and thus, the course treatment would take.

But given consideration of the situation, and a more in depth look at - and pardon me if this sounds a little much coming from a meager service user - but a more in depth look at what transpires behind the scenes in terms of communication and liaison between all members of staff, that insight given to me by the application to view my medical record and files through the freedom of information act, it is clear that, it is, exactly that, communication and liaison - where the service falls down, and thus, the treatment administered, the administration of medication, lacks - pertaining to myself, and my situation.

As I feel I made abundantly clear in the initial story logged here, my "clinical presentation", does not correlate to that which, perhaps even requires medicinal treatment.

I'm in shape, I present well, dressed and groomed, energetic upon consultations - "euthymic", I believe is the psychiatric definition, or that's what doctors have been writing on my file at least.

Now, in terms of a clinical presentation that meets the diagnostic criteria for depression, by example?

Is there a requisite for the doctor to incorporate the phrase, "reeks of urine", on his evaluation sheet, to meet the criteria for such a diagnosis?

The point being - I feel, even with the most outstanding, boarding on a divine, sense of intuition, it would be extraordinary to have the ability glean a life time behavioral breakdown, years and years worth of information, on a two to three minute observation and handful of general questions.

Yet this seems to remain to be the means by which "clinical presentations" are evaluated - and the basis for the administrations of these potentially life altering, life restoring, or potentially life crippling side-effect inducing, medications.

The doctor must make his decision based on this presentation.

And, the information he reads in the patients file, outlined by the other team members.

The psychologists, the occupational therapists, the family therapists, and so on.

Yet - using myself as a means to evaluate the degree to which this is being done?

Well, apparently there remains to be a lacking.

Perhaps not just a lacking; more, I would say, a deficit.

My file in no way seemed to reflect my genuine symptomolgy.

The symptomology consistent with depression; a severe, functionality purging depression.

I had spent session after session, hour after hour, with an occupational therapist.

One on one meetings, where I could not walk, could barely talk, complained terribly of crippling lethargy, distress, weakness from not having eaten.

And I have to question why there wasn't material in my file, with large bold print stating, "this guy can't finish one slow-paced-stroll lap of the park. When I leave him, he's hunched over on a park bench, and he's so uncommunicative, that the meeting itself is terribly awkward for me as a fully functioning person who's used to regular verbal communication"??

But upon examination of my file - there was some information mentioned about how, "he seems to have a slight slowing of motor function......".

I mean - if I'm a doctor, and I read that, in addition to a "clinical presentation" of a "euthymic" young man - well, I can see how it may be difficult to arrive at a diagnosis of endogenous refracted depression.

The psychologist I attended; we did a number of written examinations. Lengthy examinations.

I think four or five in total.

Each one demonstrating a severity of anxiety, and severity of depression, a severity of energy loss and distress.

Yet upon reviewing the psychological report compiled and submitted to my file, there was a well written outline of the course of therapy, the interpersonal issues that I experienced, the possibility of some kind of personality disorder, but nothing definite, and a note that a follow up evaluation may be in line at some point in the future - as ultimately, they didn't feel talk therapy really offered any benefit or relief -something which myself and the psychologist had discussed and agreed upon.

Again, in terms of assisting a medical doctor to evaluate symptomology, which is tasked to those who have extended periods of personal interaction with myself, as oppose to the 5 minute psychiatrist interaction - I would fail to see how such a report or articulation of my condition would assist that doctor of arriving at a conclusive diagnosis of some kind.

Coupled with the fact that the written examination result charts - compiled in graph format, which had very acute spike at the denominators for "anxiety" and "depression" - were not included in the report, nor submitted to my file - thus, available to the medical doctor?

Apparently not.

The overall point I'm making, is very simply - the real issue I experience with the service, on the surface, is the administration of psychiatric medication; which, given that I have a psychiatric condition, an endogenous condition, responsive solely to medication, not to therapy - is rather important to my recovery.

But, as I said, upon further consideration and examination of the root cause of this issue in the system - I wouldn't even say it's with the evaluation process, or if that is the case, I would say it's only minor tweaks that that requires.

I had been thoroughly evaluated, from multiple points of view - as I clearly outlined above.

It appears the real issue, is the degree, the thoroughness, the professionalism that is shown in terms of the liaison of the various system support networks, to reach a multi-model, well informed end product, upon which the consulting medical doctor can make a diagnosis - on the strength of which he can incorporate something additional to a "clinical presentation", a five minutes visual observation a handful of general questions, in terms of deciding what medication, and perhaps the degree of medication, a patient requires.

I understand this is the public system, and of course they're inundated with patients, dealing with such a vast number in any capacity deserves acclaim.

But having dealt also, albeit briefly, with the private system - the degree to which that consultant emphasized inter staff liaison, was extremely noticeable.

His go-to approach seemed to be, to send this patient (me), to every evaluatory possibility; CBT, psychotherapy, constant (more than one; several), medical registrar evaluations - as well as a minimum of a half an hour private and personal evaluation with myself, before deciding a course of treatment.

His liaison consisted not only a viewing of the medical reports delivered, but also telephone conversations with the therapists delivering them, and then intercommunication between those therapists - and ultimately all that information then relaid back to him.

Given the numbers, would it be possible to do this on the public system?

Are the resources there?

Given the recent budget cuts, it would appear unfortunately, that perhaps - attaining that level of evaluation and care provided by paying patients in private hospitals, may be a stretch for the HSE.

And again, I'm very aware it may sound a little much, a little rich perhaps, for a mere service user to present with such profound criticisms.

But resources aside, there are multiple very straight forward an inexpensive means to improve this situation.

One example was raised by the mental health pharmacist during a talk delivered during one Eolas program meeting.

Fill in a tick-box-box series of surveys and questionnaires, online, previous to each psychiatric consultation, or consultation of any kind, where evaluation is necessary.

And I must point out that, having lived in the Netherlands for an extended period and having dipped in an out of mental health services during my time there - this particular approach, questionnaires, very simple to complete, and scored by computer, is absolutely the norm, across the board, for both psychological and psychiatric staff.

And in terms of financial support to put such a system in place; honestly, having studied computer science, it would be very much a fractional impact on their resources to instate such a system; more than quite trivial.

And to organize staff briefings where the level of liaison and comprehensiveness of reports submitted for the information of the medical doctors, is stressed, outlined, and a taught how to be performed in the most functional and efficient manner, to yield the best and necessary insightful outcome.

Apart from some time and thought, I fail to see how that has a financial impact at all.

That appears to me to be solely a task of modifying/improving the approach that's currently in place - and given the nature of the modification that's necessary, I can't say it's exactly a tremendous intellectual burden on those involved either.

There was mention of medical information meetings to be established, chaired perhaps by a pharmacologist, for service users, to assist with understanding their medication regiment, the effects of their medications, and to raise their awareness of the actual pharmacology/kinetics/dynamics of specific medication categories and subtypes within those categories etc.

Thus far, six months on - the outlook appears bleak for the fruition of this.

I had been invited to attend meetings known as "connecting for life", which basically appeared to be a gathering of various mental health staff member from the Sligo/Leitrim area, in an attempt to establish an "action plan" to deal with the rates of suicide in Ireland.

There were some positive ideas raised there in.

One in particular that jumped out at me was the creation of an Irish based mental health community forum, website, a chat forum, for all intents and purposes.

Now - these are in place on the internet of course, but mostly opperrating from US based servers.

The creation of such a website specific to Ireland, I feel would be a tremendous addition for service users, and, indeed in terms of my own recovery, I have made significant use of the US based forums as a means of attaining information links, literature resources, the study of neuropharmacology, the medications specific to my condition etc.

In fact - I suppose, I mentioned at the top of this (more length than expected) reply, I had alluded further significant improvement for myself.

This - I must point out, came about solely on the basis of self research, self education, effectively self diagnosis - the determination specifically of what my condition entails and, on the basis of medical research performed and documented, and clinical trial data, what has proven effective at dealing with my own specific symptomolgy - what medications I should take, in short.

Upon compiling case studies of this data and presenting it to my GP (not affiliated with HSE mental health services), he agreed to prescribe me off license medications, medications not approved for treatment of depressive conditions in Ireland (though approved and widely used in other countries; the US, Canada etc).

And as medical research and clinical trial data found and thus predicted, significant impact was made, and thus significant improvement in my condition.

At the present moment, I have reached somewhat of a happy medium with the consultant I am attending (to whom I recently switched to, given the lack of progress with the former, as a result of the difference of diagnostic opinion, as previously outlined), where he will make recommendations, but in terms of actually prescribing, given our difference of opinion, based on "clinical presentation" and that outlined above, he will write to my GP outlining his points of view and recommendations, but the responsibility of the prescribing itself, will be in the hands of my GP.

Back to the point of an Irish based mental health and mental illness support discussions internet forum, as I alluded to, there were several good ideas put forth.

Though, it seemed that the administrator self appointed to instigate the website, felt it would be a "long and expensive" task.

Again - assuming as it may sound, having studied the basics of web design, the reality is, under the supervision of the most reasonably competent programmer, and with the input of medical staff to influence the layout, such a website could and should be up and running in less than a fortnight - with the potential for further customization of course - at minimal expense, given there are multiple online templates available offered through businesses who specialize in providing such a service, and on which several very well known and highly successful and popular Irish and British websites are based.

However - that falls into the category of what may happen.

Along with what may happen regarding the improvement of in house communication and liaison and file documenting, along with the instigation of medical exchange support groups.

To conclude, regarding my own situation; I will say, that when I determined a base medication which incited gradual reform of my cognitive impairment, self study regarding my own condition and its potential treatment has been invaluable and absolutely instrumental in my further recovery.

As I made clear, it's on the basis of this, that I'm effectively being treated - which I am perfectly fine with, as it stands.

I would just hope that perhaps in time the above points gradually improve as, in terms of the administration of certain medications, which are again off license in Ireland, they are on occasion provided, but done so solely upon the consent of a consultant, a doctor of such rank, and not a GP.

So there is a bridge that has yet to be crossed, it's not yet quite clear how that may be done but, for this moment, I will continue to work on it, and work with what's available.

I've come a long way, but I still have a long way to go.

And the day I reach a point where I can apply for even a part time job, to know that I have the functional stability to do so, will be a tremendous success, and although I'm optimistic, I am also tentative.