Gerard Moore

Abstract This paper explores critical incident management in an Irish adult public mental health services with a population catchment area of approximately 245,000 people. Data were collected by non-participant observation, informal opportunistic interviews and formal psychoanalytic interviews. The amassed data were analysed using a Freudian/Lacanian framework. Findings indicated that due to the unconscious influence of the group, some critical incidents arise from staffs’ lack of consistent engagement with patients and failure to recognise or tolerate overwhelming levels of anxiety. Some critical incidents were managed by the imposition of restrictions or pseudo-treatment reflecting impatience, guilt, hatred and despair which compromises care. Incidents of acting out by service occupants were a consequence of the failure to work with transference. Staff interventions mirror patient and their family’s behaviours resulting in rejection, dismissal and banishment. Critical incidents may be more manageable if staff were provided with appropriate supports enabling them to operate differently: by better accepting negative feeling towards patients and learning transference management skills. The patient–staff relationship needs to be reconsidered in the light of two conclusions: firstly, that all staff are suffering from a constitutional lack to utilise their natural qualities to manage transference or more likely, membership of the group unconsciously prohibits the use of this natural skill.

This paper examines the subject of division in contemporary Ireland. Contrasting recent legalisation regarding same-sex marriage and abortion in the Republic with the socio-political approach to these matters in Northern Ireland provides an opportunity to analyse how past conflicts structure the sociopolitical landscape and are manifested in political division and social unrest. The impact of Brexit incited instability and a possible return of the border between the Republic and Northern Ireland, putting immense pressure on the political point de capiton of the Good Friday Agreement. The border that previously divided the island and had a significant impact on its inhabitants can be compared with the psychical division of a conscious/ unconscious split subject. This invites scrutiny through reading these contemporary events through a Lacanian understanding of how speaking subjects are colonized by discourses and language in a way that can symbolically oppress individuals and groups. This paper demonstrates how unconscious psychical divisions can manifest and be visible in divisive oppressive laws and can trigger a return to acrimonious conflict and violence when signifiers fail to represent past trauma. By symbolically addressing trauma, there are opportunities for conflicting political parties to coherently articulate these divisions and demonstrate unity in this period of potential transformation, paving the way to stability.

The study explored whether there are key skills that staff use to relate to service users which help with the formation of social bonds, which in turn leads to increased levels of service user engagement and retention. Data for the study was collected through a literature review, ethnographic observation, interviews and focus groups with staff and service users. The findings showed that staff are successful at engaging and retaining service users and it is their ability to form strong social bonds which is the key to its success. This is achieved through the philosophy of the project which is made up of three central tenets: a non-punitive approach, person-centred care and trauma informed care. The person-centred care approach facilitates the formation of a partnership between staff and service users in which they work together to achieve personalised recovery goals unique to each individual service user. The non-punitive approach stipulates that service users are not punished or ju...

This study aims to identify the health and social care needs of people with dual diagnosis and to identify the services provided to those with dual diagnosis across the addiction and mental health services in Ireland. The research was carried out in three distinct phases. Firstly a literature review identified the needs of people with dual diagnosis and examined best practice in treatment and service management. Secondly, and open forum, comprising of people and agencies involved in the care of people with dual diagnosis, was convened to consider the findings of the literature review in the light of their experience of dual diagnosis. Thirdly, a national survey was developed to review how mental health and addiction services manage dual diagnosis. The study found that there was no systematic co-ordination of care evident in any health board area, with 76% of services failing to offer a specific service for people with dual diagnosis. 75% of survey respondents support a fully integra...

Abstract This paper explores critical incident management in an Irish adult public mental health services with a population catchment area of approximately 245,000 people. Data were collected by non-participant observation, informal opportunistic interviews and formal psychoanalytic interviews. The amassed data were analysed using a Freudian/Lacanian framework. Findings indicated that due to the unconscious influence of the group, some critical incidents arise from staffs’ lack of consistent engagement with patients and failure to recognise or tolerate overwhelming levels of anxiety. Some critical incidents were managed by the imposition of restrictions or pseudo-treatment reflecting impatience, guilt, hatred and despair which compromises care. Incidents of acting out by service occupants were a consequence of the failure to work with transference. Staff interventions mirror patient and their family’s behaviours resulting in rejection, dismissal and banishment. Critical incidents may be more manageable if staff were provided with appropriate supports enabling them to operate differently: by better accepting negative feeling towards patients and learning transference management skills. The patient–staff relationship needs to be reconsidered in the light of two conclusions: firstly, that all staff are suffering from a constitutional lack to utilise their natural qualities to manage transference or more likely, membership of the group unconsciously prohibits the use of this natural skill.

... To estimate the extent of the affected population likely to respond to, and participate in ... Health Care Staff and Voluntary Sector Personnel on counselling and prison-based addiction treatment. ... Not everyone who applies to get on the treatment programme will be successful. ...

Clients who make repeat suicide attempts have complex needs, are at high risk of completed suicide and pose a range of challenges for clinicians. Targeted interventions are required. Acceptability, the perceived appropriateness of an intervention, is associated with successful implementation, engagement and effectiveness of interventions. Despite the advantages of group interventions, there is limited research into the acceptability of groups with this population. Using Interpretative Phenomenological Analysis, this paper reports on facilitators’ experiences (n = 9) of the acceptability of a therapeutic group intervention (PISA – a Psychoeducational/psychosocial Intervention for persons who make recurrent Suicide Attempts). Analysis of focus group data revealed how involvement with the intervention profoundly influenced facilitators’ perceptions of and approach to their work with this client group. They embraced the model, developed a deeper appreciation of clients’ resources and became unburdened from sole responsibility for the clients, the therapeutic process and outcomes. PISA provided a model that helped facilitators to work in a focused, compassionate and creative manner as they addressed the central concern of these clients, their suicidal desire, with newly found confidence and eagerness. PISA was experienced as acceptable to facilitators as it was useful to them and deemed appropriate and beneficial to the target population.

In the period of colonisation when it is not contested by armed resistance, when the sum total of nervous stimuli overstep a certain threshold, the defensive attitudes of the natives give way and they find themselves crowding the mental hospitals (Fanon, 1961, 201).

Health care in prison is an area of increasing international concern with research from countries worldwide testifying to this (World Health Organisation, 1999).  The Prison Health Care Services endorses the equivalence of health care between the community and the prison population (Irish Prison Services, 2001).Substance abuse and addictive behaviour are universal phenomena and are regarded, in the twentieth century, as a major public health problem (Rassool 1998).  In Ireland, over the last number of years there has been an increase in alcohol consumption and a growing trend in the consumption of recreational, prescribed and illicit psychoactive substances, and subsequently an increase in the health problems and crime associated with such use.  Compared with other European countries, the drug problem in Ireland is a relatively recent phenomenon and drug misuse did not constitute a social problem in any real sense until the early 1980’s (Ruddle et al, 2000).  There is extensive scope for health and social gain among problem drug users, particularly among groups that are challenging to engage, such as young drug users and those who are homeless or in prison, (Moore et al 2004).  Within the prison population, research has shown that a significant proportion of individuals have a history of illicit drug use. According to several European studies, approximately half of all drug users (Injecting Drug Users, IDU’s) continue drug use, predominantly opiates, during imprisonment (Stoever, 2002).  This study commissioned by the Bedford Row Family Project investigated the needs of Limerick Prisoners for prison based addiction treatment services in the context of planning the development of a high-quality, coherent and effective Addiction Treatment Service within Limerick Prison.  The study explores the extent of addiction treatment needs within the Limerick Prison Population, the extent of the affected population likely to respond to, and participate in, treatments/assistances made available and reports on the form of counselling service that might support and integrate well with existing health related assistance to the affected population such as methadone maintenance and detoxification.

Mental health is a pressing issue for society with approximately 700,000 of the Irish population being affected by a mental health problem over the course of their lives. Despite the extensive demand and the national reformation agenda recent reports indicate that patients are unsatisfied and readmission rates remain consistently high indicating that services do not enable recovery. Psychoanalysis has demonstrated that to enable positive change it is essential to manage transference. Transference is experienced in the immediate reactions of liking or disliking influential Others; often the subject who we suppose has knowledge that will benefit us. In services this Other is usually the health care professional. Managing transference requires a connection between consciously expressed expectations and unconscious desire. Health care delivery takes place within a therapeutic professional relationship placing responsibility on staff to acknowledge and address the quality of the relation...

Psychoanalysis emerged from the parlours of Vienne with a theory of the unconscious that challenged society by demonstrating that we are not masters in our own houses.  This lesson about the lack of personal autonomy took place in a Europe where the Masters of society were also discovering that they could be toppled and dispensed with, all be it at a great cost of individual human suffering.  The suffering generated by the horror of the Great War created a foundation for our understanding of trauma.  It provided a glut of symptoms on which the emerging psychoanalysts could test their hypothesis, develop their theories and forge their careers.  A second war (WWII) created a whole new landscape in Europe, and for a period of time attempted to eradicate human rights and freethinking.  Psychoanalysis suffered and many analysts’ Freud amongst them became unintentional migrants.  This sparked a new era of thinking about the structure of the human mind, in the war orphanages of London and the lecture halls and clinics of the USA.  Psychoanalysis was never to be the same again.  Post-war Lacan championed the dynamic unconscious around a new set of borders, language, desire and jouissance. 
Today a new wave is invading Europe, refugees seeking asylum, marching across borders and straight into our psyche via social media and the new prosthesis the smartphone.  How can we incorporate immigrants and what kind of new psychoanalysis will emerge and respond?  This paper explores what psychoanalysis says when boundaries are shattered, when new laws need to be brought into being when some new or refined law-giving Other is urgently required; urgency that the unconscious deals with in a uniquely perverse manner.  Perhaps there is a place for a creative subversive perverse talent that challenge what is failing, what is washed up on the beaches of Europe.  Should psychoanalysis, be subject to the tide, drown in the shallows or ride some favourable wave in rethinking social bonds and responding to traumatic encounters.

This paper explores critical incident management in an Irish adult public mental health services. Data was collected by non-participant observation and psychoanalytic interviews and analysed using a Freudian/Lacanian framework. Critical incidents arise from staffs' lack of engagement with patients and failure to tolerate anxiety which evokes omnipotence and aggression. The study found that critical incidents are managed by the imposition of restrictions or pseudo-treatment reflecting impatience, guilt, hatred, and despair which compromises care. Incidents of acting-out by service occupants are a consequence of the failure to work with transference. Staff activities are designed to keep patients at bay and once they reach intolerable levels they stimulate patients to act-out. Staff interventions mirror patient and their family's behaviours resulting in rejection, dismissal and even banishment of the patient. Critical incidents are reducible if staff operated differently; firstly learning the skills to manage transference and secondly learning to better accept negative feeling to patients. The patient/staff subject/Other relationship needs to be reconsidered in the light of two conclusions; firstly that all staff are suffering from a constitutional lack to utilise their natural qualities to manage transference or more likely, membership of the group unconsciously prohibits the use of this natural skill.