The panel:
Prof Brendan Kelly, psychiatrist and professor of psychiatry at Trinity College Dublin; Antoinette Moriarty, psychotherapist and director of solicitor services at the Law Society of Ireland; and Dr Moira Kennedy, principal psychologist and director of The Children’s Clinic, Ireland
What do you find most rewarding and most challenging about the work you do?
Brendan: I’m a psychiatrist, a medical doctor who treats people with mental illness. From a clinical perspective, I see people with schizophrenia, bipolar disorder and severe depression. These are severe conditions which can be very distressing and confusing for people who have them and for their families. That’s what is challenging. What’s rewarding is that some of the treatments for schizophrenia are very helpful when we can deliver them but it can be difficult to deliver some of the treatments to people with schizophrenia, which often involves a degree of disorganisation in the person’s life.
Antoinette: My job is collaborating with leaders in the legal profession to develop a healthy work culture. Part of that involves training lawyers and judges to be high-impact professionals using professional wellbeing tools. These are high-achieving people who are not in any kind of acute clinical need but who may, over their lives, dip in and out of having greater need of services. They are a fascinating cohort of people to work with. It’s really rewarding to be able to integrate my training in psychoanalysis, primarily, into people’s professional development.
It’s not about repairing people who burn out or break down. The context I work in is with people who will expect to have challenges to their minds and to who they are in the world.
Moira: I’m a principal child and educational psychologist. Myself and my colleague Davida Hartman set up The Children’s Clinic, Ireland’s first neurodiversity affirmative clinic, about 10 years ago. We support babies, children and young adults in a neuro-affirmative way, identifying mostly autism, but other neurodivergences as well. Hopefully, over time, you see them thrive and be their true, authentic selves.
The hardest part of the work is when you’re working as a psychologist with children and young people who experience high levels of distress and families who are highly distressed. It’s often not having their needs identified in a timely manner. The other challenge is that it can be difficult to advocate for people within systems that are overstretched. And as someone who has worked in the public service for a very long time, I see that from both sides.
How has your profession changed in recent years, and what forces have driven those changes?
Moira: There has been a rise in neurodiversity awareness. There’s been a shift from fixing to understanding, from apologising to embracing. This is now a human rights movement, an identity-affirming movement. There are no two autistic people in the whole world who are alike; we all have our own individual needs, and that has been really helpful for people. In psychology there has been a massive increase in demand for psychological services, particularly in child adolescent psychology.
Children are presenting with needs that appear to be more complex. I wouldn’t go as far to say there’s an epidemic. We’re just getting much better at identifying [conditions]. I’d still say we’re under-identifying, or under-diagnosing. I also think there’s been a societal shift since Covid in that the language of psychology is less stigmatising and has become more mainstream. And this has been a really good thing. It opens up the conversation. Irish people are very prone to saying, “sure, everything is grand”. But of course a lot of the time things aren’t grand. As a society we have become more accustomed to talking about this in a psychological sense.
Brendan: In my view, the other big change in the past couple of decades is that since the year 2000 the rate of suicide in Ireland has fallen by about 30 per cent. And this is consistent with global trends. Even one suicide is one too many, but what it does tell us is that positive change is possible and happening. If the rate of suicide can go down by a third, you know what, it can go down by another third. So what this says to me is that we need to devote more resources, not fewer, to suicide prevention.
I need to stress that statistics and numbers are no consolation to a person bereaved by suicide, which is always an individual tragedy. But I think if you ask about my profession in the past few years, there is a part of me as a researcher that must stand back and say, look, positive change is possible and it’s happening. This doesn’t mean the job is done.
The increased awareness of mental health and mental wellbeing is a huge opportunity to try and prevent the emergence of more serious conditions or more distressing states of mind
— Prof Brendan Kelly
Antoinette: About five years ago, the International Bar Association, the largest network of legal professionals in the world, set up a professional wellbeing commission, so that is a huge and welcome change in my sector. We’ve since had the first global mental health study, which was published a couple of years ago, and it actually put figures on the rates of burnout. That’s one change, ready access to data.
And this might be controversial but another good development has been the role social media has played in giving voice to people’s internal world. Some of it is indulgent and annoying, but I think it is also very therapeutic, and it’s developmental, and we’re exploring these issues in public in a way we’ve never seen before. The idea that you would speak into your phone about the state of your mental health on a Monday morning is amazing. In the past, you couldn’t even say these things in confession. So I think that’s been a fantastic change.
What opportunities and risks do you see ahead for your field over the next decade in Ireland?
Moira: A good development is that psychologists will finally get what they call statutory registration with Coru, [Ireland’s multi-profession health regulator]. At the moment, in theory, anybody can call themselves a psychologist, so this has been a long time coming. It hasn’t been an easy road but it’s certainly very welcome and is a great opportunity to ensure public safety is front and centre of everything we do.
I’m also hopeful that there will be greater diversity and specialisation in psychology; this certainly seems to be the way that we’re going. In addition to this, there’s growing attention for the importance of psychology at policy-making level. In terms of risks, I’d worry about “neurodiversity lite”, where it’s treated almost as a buzzword but doesn’t result in any meaningful change for people who are neurodivergent. We are talking a lot about autism and disability and yet the ableist culture we live in perseveres so that is something to flag.
Brendan: The increased awareness of mental health and mental wellbeing is a huge opportunity to try and prevent the emergence of more serious conditions or more distressing states of mind. In terms of risks, if we identify the way we feel as a mental health issue, this can be experienced as disempowering rather than empowering. I’m talking about medicalisation of unhappiness, of mild anxiety or states of normal distress.
It’s really important that the discussion about mental wellbeing and psychological symptoms and mental health is an empowering one that lets people navigate things themselves, supports them to find their own solutions, and doesn’t disempower them by over-medicalising the problems that life brings.
I guess the other risk I’d always point to is with the lack of resources that are afforded to the public mental health service. It’s a constant battle to make sure this gets sufficient attention on the political agenda.
Antoinette: In my work I am able to sit with somebody weekly for 10 years or 15 years. In that time, they might have gone from being a trainee solicitor to being a busy parent. They might have gone from being somebody who was very isolated, very unsure of themselves, very low confidence, to being the partner or managing partner of a big legal workplace. That’s an immense journey to have and I relish the opportunity to be beside that person in their thinking.
The risk I see is that there is still quite a lot of emphasis on the ill mind rather than on the healthy or the high-functioning mind. The roots of our relationship with our mental health are really in the pathology and the problem areas and the breakdowns and in serious illnesses. And yet actually, that’s a very small part of our experience. Most of us will also benefit from knowing more about how our heads work and how we grapple with big transitions such as having a serious illness, losing a partner, gaining a partner. These are ordinary events, but they can create chaos in our minds and we don’t really speak about that enough. We often fall in love with the problems, and I’d like us to fall in love with the solutions.
What do people most often misunderstand about your work or your industry?
Moira: There’s an idea in some circles that the neurodiversity rights based movement is a bit woke and, of course, that’s completely untrue. What we know is that in the past people felt really unsafe and clinically very unwell and developed very significant mental health difficulties because they spent decades masking and pretending and not being themselves.
Brendan: If I’m out socially, and I say I’m a psychiatrist, people often say: are you analysing me now? And the answer is: no, I am not. The other big misunderstanding about psychiatry tends to be the notion that psychiatrists believe medication is the answer to all states of distress. Certainly, like a great number of psychiatrists I know, I believe that for some people with moderate or severe conditions, medication can make a contribution but it tends not to be enough on its own ever. Ireland’s rate of prescription of psychiatric medications is actually quite low internationally. And indeed, if I had a single wish for people with severe mental illness, it would be that they all had supported housing in the community. It would transform the lives of many, many people with schizophrenia, bipolar disorder or severe depression.
Antoinette: I suppose one misunderstanding is the idea that lawyers are any different to anybody else. Lawyers have a very tough relationship with themselves. In my experience, they’re also very hard on themselves. The general public would have no sense of how they really want to get it right all the time. They worry more than people might imagine. They also have a very high degree of imposter syndrome, which is a hard thing to carry when you’re presenting yourself in court or in negotiations, and the environment itself is quite inhospitable to vulnerability.
On another subject, there is a lot of misunderstanding around mental health advice: mindfulness apps, yoga, Pilates classes, getting enough sleep, getting your steps in, all of that. All of that talk is like nails down a blackboard for me. None of that is going to bring somebody back from burnout in the same way somebody with severe and enduring mental illness is not going to be made better by counselling.
Brendan: A lot of distress people feel is because of their context. It’s because they’re homeless, because they’re unemployed, because they can’t buy a house, because they can’t move out, because they’re in a difficult job, because the expectations are too great. Their basic needs are not being met. We need to support people but also keep in mind that there is a landscape that shapes risk, that shapes access to treatment and shapes outcome. So, I think what I’m arguing for is a complete social and economic revolution, but in the absence of that, we need more resources to help people deal with distress.
When you think about the future – for yourself, your career, and for Ireland – are you optimistic? Why or why not?
Brendan: I am optimistic for lots of reasons. I’m optimistic because many key indicators of mental health are improving, as I mentioned earlier. These do not suggest any of these problems are solved; it means positive change is possible, and we need to focus on that more. I’m also optimistic based on young people, teenagers, young adults. They are better able to navigate the complex social media landscapes than middle aged people like myself. The internet and phones entered my life at a certain age so younger people are obviously way ahead. And contrary to a lot of the hysterical talk, I think young people are likely to prove much more emotionally attuned and able to build a better world.
Antoinette: I’m fundamentally optimistic, I think. But at the same time we in psychotherapy are like the foster child of the sector and, while I appreciate what Moira said earlier, some of the recent advances with Coru have been to the absolute decimation of any hope for psychotherapy as a profession. What’s happening now with Coru is that they’re removing the obligation on trainee psychotherapists to do any personal therapy work of their own. Most of my best colleagues have been in analysis for a very long time, and that’s why they’re as good as they are and as busy as they are. And to take that away is to really, I think, remove its potential contribution.
Moira: I’m optimistic generally but I’d feel cautious around exactly what Brendan said earlier around people’s basic needs not being met. How is it 2025 and disabled members of our community, citizens of Ireland, still don’t have jobs, can’t get jobs, can’t go to college, can’t attend school? How is that still the case? Those basic things like housing are not there for so many of our people in our community. So I’m optimistic, yes, but we’ve still got a lot of work to do in terms of looking after the more vulnerable members of our society.
- Keep an eye out for other articles in the series: the teachers, the tech workers, the creatives
