ArticlePDF Available
The
Ulster
Medical
Journal,
Volume
63,
No.
1,
pp.
123,
April
1994.
Book
review
Mental
Health
and
Politics
in
Northern
Ireland.
By
Pauline
Prior
(pp
194.
£32.50)
Avebury,
Ashgate
Publishing,
Aldershot.
1993.
ISBN
1
85628
540
5.
Commonly,
when
chatting
with
visitors
to
Northern
Ireland,
or,
when
at
meetings
abroad,
one
is
asked
".
.
.
and
how
does
the
situation
in
Northern
Ireland
affect
people's
mental
health?"
One
generally
responds
that
it
is
a
remarkable
testimony
to
the
human
spirit
that
despite
the
trauma
experienced
by
individuals,
there
is
little
hard
evidence
of
adverse
effects
on
the
population
generally.
One
will
also
refer
to
publications
by
Alex
Lyons,
Peter
Curran
and
his
group,
and
of
course
the
work
of
Fraser,
Cairns
and
Wilson,
and
others.
Until
now
however,
no-one
has
attempted
to
cover
the
whole
gamut
of
relationships
between
mental
health
and
politics
in
Northern
Ireland.
The
author
of
this
study
has
scanned
the
range
of
available
government
records,
and
some
of
the
research,
from
before
the
foundation
of
Northern
Ireland,
up
to
the
present.
She
attempts
to
provide
an
overview
of
the
changes
in
service
provision,
and
gives
an
opinion
on
how
these
were
related
to
and
affected
by
the
particular
political
developments
of
the
day.
Later
she
addresses
the
available
research
on
the
direct
impact
of
'the
troubles'
on
individuals,
and
describes
from
case
notes
the
histories
of
half
a
dozen
patients
whom
she
regards
as
illustrative,
though
not
representative,
of
psychiatric
patients
during
the
period.
The
result
is
very
critical
in
tone,
and
while
there
are
occasional
acknowledgements
of
innovative
developments,
and
credit
given
to
a
few
who
worked
within
the
service,
there
is
a
general
impression
that
those
who
established
this
political
entity,
and
the
various
authorities
who
have
held
responsibility
for
mental
health
care
over
the
years,
have
little
of
which
to
be
proud.
At
times
this
finds
expression
in
some
remarkable
phrases,
as
when
the
term
'legitimate
target'
(used
in
Northern
Ireland
by
terrorists
to
justify
certain
murders)
is
applied
to
those
who
receive,
or
do
not
receive,
mental
health
care
from
the
service
(p
1
15).
One
certainly
would
not
come
to
the
end
of
this
book
and
know
that
training
in
psychiatry
and
the
development
of
some
specialist
services
is
much
more
advanced
in
the
North
than
in
the
Republic,
or
in
Wales.
The
higher
per
capita
spending
in
Northern
Ireland
until
recent
times
gets
little
credit,
and
the
advantages
for
hospital
and
community
care
of
the
integration
of
Health
and
Social
Services
in
Northern
Ireland,
are
not
fully
appreciated.
The
view
to
the
future
is
similarly
gloomy
because
it
is
informed
largely
by
expenditure
projections,
rather
than
by
close
acquaintance
with
the
service
at
the
point
of
delivery.
There
is
a
temptation
in
Northern
Ireland
to
attribute
such
a
partial
and
censorious
critique to
the
local
political
propensities
of
the
author.
It
is
my
own
impression
that
the
work
has
failed
to
reach
its
full
potential
because
of
the
author's
view
of
society
generally.
Instead
of
seeing
a
particular
service
in
its
proper
historical
context, or
comparing
a service
in
Northern
Ireland
with
like
services
in
the
rest
of
the
island,
or
similar
areas
elsewhere,
and
giving
an
objective
assessment,
she
usually
moves
immediately
to
a
critique
whose
justification
is
not
well
founded.
A
crowning
example
is
the
claim
that
the
expansion
and
contraction
of
mental
health
service
provision
has
had
little
to
do
with
need.
She
seems
to
base
much
of
this
judgement
on
a
crude
bed
count,
which
she
rightly
rejects
as
inadequate
when
used
by
others.
The
greatest
value
of
the
book,
and
it
is
expensive
for
its
size,
lies
in
the
extensive
referencing
and
the
bibliography.
It
is
a
very
useful
starting
point
for
anyone
wishing
ready
access
to
the
literature,
though
again
I
note
an
absence
of
reference
to
Northern
Ireland-based
advances
in
the
understanding
of
mental
illness
and
mental
health
generally,
as
distinct
from
'troubles-based'
literature.
Sadly
then,
the
author
has
chosen
an
important
area
of
study,
but
has
produced
a
text
which
will
be
useful
for
reference
to
the
interesting
facts
and
figures
it
brings
together,
rather
than
for
the
perspicacity
of
the
conclusions
drawn.
J
T
ALDERDICE
ERRATUM
Due
to
a
printers
error
volume
63
has
been
printed
instead
of
Volume
62
on
the
page
headings
in
most
papers
in
Volume
62
No.
2,
October
1993.
©D
The
Ulster
Medical
Society,
1994.
Article
Full-text available
The aim of this paper is to analyse the effects of decentralization on the political careers of regional elites. We observe on the trajectories of the heads of governments of the regions of Spain, France and United Kingdom, focusing on their political careers through multilevel arenas. We ask what are the main career patterns (national or local) and whether there are differences in these patterns by type and evolution of decentralization process. The data analysis reveals the existence of different career patterns, in which local and national experience tend to dissociate, creating different cursus honorum. The institutional structure and timing of the evolution of decentralization also produced differences in the type of careers. In France the regional presidents tend to follow a traditional career pattern, while in Spain are specific territorial trajectories. Furthermore, consolidation of regional institutions seems to contribute to the emergence of distinct political careers for regional leaders.
Article
Full-text available
This article provides an overview of the literature on the impact of ‘the Troubles’ on mental health in Northern Ireland. It identifies three main phases of professional and policy response from concerns about the effects of the violence in the early 1970s, through many years of collective denial and neglect, until acknowledgment, following the Good Friday Agreement in 1998 (Northern Ireland Office, 1998), of high levels of trauma and unmet need. The issues of inequality and stigma are also considered and it is argued that peace is necessary but insufficient for promoting mental health. The development of mental health services in Northern Ireland and the relatively recent focus on promoting mental health are also outlined and examined. It is suggested that attempts to address the needs arising as a result of ‘the Troubles’ and more general mental health promotion strategies have, to some extent, developed in parallel and that it may be important to integrate these efforts. The relative under-development of mental health services, the comprehensive Bamford Review (2005; 2006) and the positive approach of the Public Health Agency mean that, even in the current economic climate, there are great opportunities for progress. Routine screening, in primary care and mental health services for trauma, including Troubles-related trauma, is recommended to identify and address these issues on an individual level. It is also argued, however, that more substantial political change is needed to effectively address societal division, inequality and stigma to the benefit of all.
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