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My experience taking this course in Ireland was exuberantly transformative in nature and will be an experience that I will carry with me throughout my career and personal life. Through hearing lived experiences and seeing the impacts of historic and current mental health practices in Ireland, I was able to develop and enhance my critical thinking skills which are essential for life. A weaknesses of mine that I identified when creating learning goals for this course was that I often find comfort in and will quickly nestle into taking a positive perspective in difficult situations. While I value this quality of mine and think it will be a wonderful trait to have as an occupational therapist, I did want to push myself to see the other side of those difficult situations and be able to identify key points of change to create a space that is inclusive and healing for future clients that I work with. To facilitate my learning while enrolled in this course, I created the following SMART goals:
SMART Goals Ireland 2024
#1: By the end of this course, I will have enhanced my critical thinking skills and take on critical perspectives of global mental health systems through successfully analyzing experiences through journal reflections and engaging in discussions with peers, professionals, and persons with lived experiences.
#2: I will have developed an empathetic understanding of how global mental health systems (especially those in Ireland) have impacted clients/ex-patients/survivors who have or currently are experiencing mistreatment and abuse while seeking mental health services.
#3: By the end of this course, I will have learned how to have critical perspectives of OT and identify creative solutions to ethical issues and continue to utilize and enhance these skills throughout my career. Some of the actions I have taken to enhance this skill while engaged in this course were taking time to reflect on my experiences then discussing issues with peers with similar and different perspectives, seeking out mentorship from experienced professionals, and asking questions of people in positions of power.
#4: By the end of this course, I will have cultivated an active awareness of sanism and sane privilege by educating myself through resources (Wolframe, 2012 and others) and identify how to utilize my sane privilege for change in everyday life and global mental health services.
What is critical thinking/critical perspective taking? What does being "critical" mean?
What is critical thinking/critical perspective taking? What does being "critical" mean?
There have been several ways that people have come to define critical thinking over the years. These definitions though are certainly subject in nature and field-dependent. Some of the phrases I came across while researching were things such as “thinking to produce judgment” or “well-thought out” or “thinking carefully”. However, I found that these various definitions and phrases do not necessarily relate to our occupational perspectives. Some of these definitions either felt too simple or held some degree of sanism. I suppose that it is important to make the distinction that we are not just critically thinking, but we are also shifting perspectives in a way that is critical. To most, the word “critical” can often have a negative connotation. Being critical is not simply looking at and judging all the negative aspects of a situation or dilemma, but holding non-judgemental space to interpret and make sense of these things. Once you have collected a wide range of observations, then it is important to understand how these aspects all contribute to the experience of those who are actively involved in these situations. This is exactly what our challenge has been while enrolled in this course and will continue to be throughout our career. It’s really about paying attention to what is going well and what should be re-evaluated, called in or called out, and changed to support our clients' experiences while engaging in the systems and programs we provide. As OTs, we claim to value client-centeredness and taking on a critical perspective of what we are doing to meet that is one of the most important skills to have.
Jigsaw - Dublin
Jigsaw - Dublin
Jigsaw: a free mental health charity for youth between the ages of 12-25. Their services, which are preventative in nature, aims to collaborate with young people who are dealing with mild to moderate mental health challenges to make sense of what they are going through and get support from their team of clinicians. With numerous ‘hubs’ across Ireland, Jigsaw aims to be accessible, provide more timely care, and be inclusive. Some of the actions they take to be accessible and inclusive is by expanding the means in which their services can be accessed. For example, the clinicians we spoke to reported how some are referred to them through their parents or school, some clients walk by their hub and come in, and Jigsaw has a variety of online services available so their services can be accessed from anywhere. In fact, recently they started a texting service as well. It is a short term service, as clients receive 1-8 sessions.
Tran-disciplinary team - a team of professionals with different backgrounds and professions, however they all go by “clinicians” which eliminates hierarchical and power dynamics
Make changes in the community by partnering with and advertising through local businesses and community spaces, educating adults in the community who work with young people
Mission statement: “Together, we will achieve better mental health outcomes for young people (ages 12-25) by delivering therapeutic services, promoting youth mental health and mobilizing community societal change, while ensuring our organization evolves to support all aspects of our work”
I think their vision statement/ values “Our vision is for an Ireland where every young person’s mental health is valued and supported” really carries over into practice
Critiques: need more occupation-based practice (more “doing” interventions out in the community); only short term services; a lot of talk therapy
Mindfreedom Ireland
Mindfreedom Ireland
Mindfreedom is an organization of people who identify as psychiatric survivors or are advocates for humane treatment in mental health. Their aim is to abolish the power of psychiatry and transform the way we are caring for our clients who are seeking mental health services. During the course we hear from Mary, who has lived experience and is a psychiatric survivor herself. She is passionate about ending the inhumane practices that harmed people for many years. It is extremely important to continue to highlight lived experience and hear from survivors and seek their advice on how we can improve our practice. Mindfreedom Ireland makes connection with local organizations to change legislation and policies surrounding the practices that have contributed to abuse such as ECT, forced feeding, isolation, occupational deprivation.
Solutions:
consent
banning involuntary treatment practices
education and visibility/informed consent when prescribing medication
Trans-disciplinary approach to care
Calling in or out saneist pespectives
MF Ireland Goals:
Full human rights for people experiencing emotional distress.
Challenge abuse by the psychiatric drug industry.
Campaign for full legal recognition of Advanced Directives.
Promote safe, humane and effective alternatives.
Campaigns to abolish electroshock and has had 8 public electroshock protests.
http://www.mindfreedomireland.com
Sli Eile (Another path)
Sli Eile (Another path)
A non-profit mental health organization funded through the HSE and state. Sli Eile offers an alternative mental health service where up to 8 residents can live on the farm with peer and staff support while recovering from addiction. The residents are paying a low cost to live and work on the farm. Some of the critiques I have identified are that there are limited vocational opportunities through their social enterprises which only include working at the bakery, market, thrift store, or farm. These vocational opportunities coupled with their person-centered care values allow for an easier re-integration into society after being isolated and abused through other public services like homeless services and MH services (such as going through the GP). While residents don't earn an income from the work they do at the farm, they do have a chance to save during their stay at the farm which is about 10 months to 18 months. I observed that there is still a transactional relationship at play here as the good they produce on the farm are being distributed to the community which poses an ethical dilemma. The biggest critique I hold is that while they try very hard to be person-centered, they are still running discretely under a medical model by tracking and overseeing medication management as well as invading privacy through doing bed checks. I appreciated their commitment to making the farm a peaceful, peer and staff collaboratively ran place to be while they are recovering from addition and perceived mental health distrubances. Some of the ways they implemented the elimination of power dynamics between staff and residents are through encouraging independence (going into town alone, etc.), there are no uniforms (not able to tell who is staff and who is a resident), and meeting them where they are at (allowing them to make mistakes, grading up activities). To counter this, it does seem like staff do ask them to come back on certain days and do something each day.
Dehumanizing Practices
Dehumanizing Practices
Institutionalization
being held in a locked unit without any say or control
Occupations being used as a means of control and abuse
occupational deprivation and limiting choices/conditional access
stripping away identify through uniform, using different names, cutting hair, etc.
Humanizing Practices
Humanizing Practices
Freedom and Humanity
basic needs are ALWAYS being met on top of providing services that are occupation-based, supportive, accessibility, inclusive, and sustainability
humanity through advocacy in policy change, breaking down power dynamics, maximizing freedom, and autonomy is respected
Seeing the person as an occupational and whole being and giving them respect and kindness is every single interaction she
Standing up for inhumane practices as a professional and choosing to work in areas where real change in being made
Vision for the Future: Mental Health in Humanity
Vision for the Future: Mental Health in Humanity
"The culture of occupational therapy education is becoming one that gives primacy to technical knowledge and basic skills rather than the humanistic aspects of the profession" (Battaglia, 2016).
As future OTs, if we go into the field relying on these skills and comfortable practices under a system that is doing harm in any ways shape or form, our routines and mindset are then vulnerable to comfortability and collusion. If we want change to happen we need to stop being okay iatroenic harm. If we want to change the MH systems globally we need to step into a brave space ourselves and advocate for our clients. OTs are often praised for being so empathetic, creative, caring, kind, etc.; however if we limit ourself to doing meaningless activities, we are doing much more harm than good. Connecting with each other on a human-level is of upmost importance and we need to work together to eliminate mental health services that hold saneist perspectives. Something I can do is utilize my sane privileges as a platform for change and to prioritize/highlight the voices of clients/ex-patients/survivors. Actions I can take to make change are: having discussions and educating people on history of mental health harmful practices, calling out harmful language, and viewing the client as the expert and utilizing their knowledge to guide my future practice.
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