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Where there is no Couch: The possibilities for psychoanalysis in the public mental health service

The Letter, Issue 38, Autumn 2006, Pages 39 - 44



Angela Noonan

The public mental health service in Ireland consists of mental health teams which are increasingly becoming multi-disciplinary. Child and adult services are separate. In many areas there are old age teams that provide a service to people over the age of sixty-five who develop mental illness.

The vast majority of teams are general adult mental health teams but there are some specialist services in the area of learning disability, rehabilitation, liaison, forensic psychiatry and substance misuse. Each mental health team serves a geographic sector. Teams are community based in the sense that people are seen in their own communities in health centres or their homes.

Those requiring admission usually go to the psychiatric unit of a general hospital though there still exist stand-alone psychiatric hospitals. Those that require ongoing support attend day hospitals, day centres or live in supported community residences. Teams consist of a consultant psychiatrist and junior doctors, community mental health nurses and to varying degrees social workers, psychologists and occupational therapists. (Several teams may share these professionals). Junior doctors rotate to other teams or services after six to twelve months. Members of teams may have qualifications in psychotherapy, usually cognitive behavioural therapy. Most psychotherapy is practiced by psychologists or nurses with varying degrees of training. Consultant psychiatrists often have qualifications in psychotherapy or psychoanalysis but their practice is limited by a lack of protected time.

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