“In mental health, it’s not hard to get away with bad practice,” Elliot Sweeney ruefully notes of his chosen career.
A nurse in this field for 20 years, he is ideally placed to comment on how some in the profession, are “more interested in cutting corners, publishing papers and booking holidays than doing some good”, while also sympathetic to how difficult the work is, and the gaping holes in provision.
The term “firefighting” is repeated.
Sweeney writes specifically of the crumbling NHS, but Irish readers will find many points of comparison with overextended mental health services here, and understand that “without gallows humour, the bleakness would overwhelm”.
Some reminders – for example, that mental health is “a serious business” – may feel a tad obvious to younger generations, used to a certain amount of lip service on this issue, but Sweeney jumps right into the less palatable cases.
A mother poisoning her children, suffering from factitious disorder, more colloquially known as Munchhausen’s by proxy (a diagnosis medical dramas and crime novels are fond of), is not an immediately sympathetic character.
Nor is someone wielding a knife in public – knowing that severe mental illness means one is more likely to be the victim of, rather than perpetrator of, violence does not magic away the real danger of such moments.
Sweeney is aware of the tensions between an individual’s agency and the risk they pose to themselves or others; with a novelist’s eye, he shows rather than tells of the bind health professionals often find themselves in. He knows the system is broken and how many have fled; he’s still there.
His case studies – careful composites, as is the usual practice in books of this kind – illustrate a variety of suffering and labels, and explore what it means to help in such cases. Sometimes he can’t. One particularly volatile patient demonstrates how essential professional boundaries are.
[ ‘Immense progress’: Use of restraint and seclusion in mental health centres fallsOpens in new window ]
Psychiatrists tend to be the ones writing memoirs such as these; nurses – those who are “hauled in for answers” if something goes wrong – are less represented.
This is a welcome addition to the mental-health-workplace canon from someone not yet burned out: “Beneath the crackle and static of paranoia,” he writes, “I hear the pathos of a human in pain. It’s this I try to focus on.”
