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Reflections on the Changing Direction TeleHealth Conference

Posted on 19 September, 2018 at 9:35

I attended the Changing Direction conference on September 17 2018. The conference was initiated with efficiency by Minister Jim Daly and it was subtitled "Augmenting Mental Health Solutions through Digital Technology". I live-tweeted (@finianfallon) my attendance and posted highlights on my LinkedIn account . Here are a few brief reflections, very definitely written from my talk therapy lens, on the conference:

1. Minister Daly seemed certain that there would not be significant additional spending in the area of mental health in the near future. He expressed an opinion that existing resources need to be optimised. This is despite the continued fall of spend in  mental health services in Ireland over many years and the lack of psychiatric support in hospitals and excessive waiting lists for children and adolescent services around the country. I am not sure that many in the coal face of the mental health field would agree with his view. There appeared to be a consensus around the pressing need for administrive support among many psychiatrists at the conference.

2. I was disappointed that the focus of the conference was so much on psychiatry. The Minister acknowledged this, but it seems to me that there was an assumption by many of the attendees that psychiatry should and will always lead the way in mental health services. My question from the floor about the challenges to psychiatry and diagnosis and increasing awareness around issues with medication did not appear to land and the question was not substantially addressed, I felt.

3. Related to this issue, towards the end of his speech Dr John Hillery, President of the College of Psychiatrists of Ireland made a jocular reference to what seemed to me the possibly unecessary medical training that psychiarists receive. Though his comments were in jest, I have long wondered why psychiatry has such a prominent place in our mental health services when most psychiatrists do not deliver psychotherapy and most clients/patients have a preference for talk therapies. If psychiatrists do not complete medical training, they are no better placed to provide services than highly trained psychologists. Remember, there are nurse specialists (including in Ireland) and psychologists around the world who have prescribing rights. Someone attending the conference asked me why there were such problems recruiting psychiatrists: he suggested that aside from issues with salaries in Ireland, less and less medical students were choosing psychiatry as it is increasingly seen as a problematic, unscientific branch of medicine.

4. While the American psychiatrists and telepsychiatry experts present obviously had the same good intentions as any practitioner, the US approach seems more volume and process than outcome oriented. It has to be said that the enhanced access and equity benefits that arise from telehealth are unquestionable, but to my mind psychiatrically led mental-telehealth will only serve to embed a diagnostic and medication form of mental health treatment. Both of these approaches are increasingly being critiqued. Indeed the 2006 Vision for Change policy document recommended a move towards a case formulation approach.

5. I also asked a question about including an explicit reference in our telehealth policy to independent and private sector practitioners who provide significant supports to many thousands of Irish citizens each year. Again, this seemed to go over the heads of the psychiatrically dominated panel who replied by saying that GPs are in the private sector. It seems clear that the very existence of psychologists, psychologists and counsellors is secondary, if it is very much recognised at all, to the importance and dominance that psychiatry maintains for itself in Irish mental health services.

6. I wrote in my doctoral thesis a few years ago that technological impacts on talk therapy and psychotherapists are imminent. These solutions are literally knocking on our door now. Therapists, practitioners and accrediting bodies need to get on this train very quickly and get up to speed with marketing and providing online services. Someone spoke to me during my thesis work about how quickly the ship building industry in Scotland pracitcally disappeared: this could happen to the talk therapies, or at least there could be a drastic shift in the structure of the market in favour of online, cheap services. Minister Daly was adamant that the comparison between online and face to face therapies is moot, based on the available research. One of the conference speakers said that practitioners had greater resistence to online technology / telehealth than patients: pracitioners need to get on board with this reality.

6. Minister Jim Daly and his team (he also thanked Tom O'Brien) are to be congratulated on arranging such a conference at short notice.

Finian Fallon 19/09/2018

Categories: Future of Psychotherapy in Ireland

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