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Increasing numbers of youth experience mental illness, and also require and benefit from specialist child and adolescent mental health services (CAMHS). Worldwide, such services are underfunded and under-resourced, and services in Ireland are no different. It is vital that existing services are regularly reviewed for both efficacy and acceptability. Our objective was to review published studies evaluating service user satisfaction with CAMHS in Ireland and CAMHS therapeutic efficacy.
MEDLINE, PsycINFO and CINAHL databases were systematically searched. Studies were included if they reported on service user satisfaction or an evaluation of CAMHS in Ireland.
From an initial 125 articles identified, 15 studies meet the inclusion criteria: four reporting on overall CAMHS satisfaction, three on satisfaction where a specific diagnosis was present, while eight evaluated various interventions offered. Whilst most service users perceived services to be satisfactory, important issues relating to accessibility were present. Evidence of efficacy was present for a small number of interventions, but studies were limited by methodological issues.
There is a dearth of studies evaluating CAMHS in Ireland. The extant literature suggests a positive experience once accessed, but long waiting times and poor collaboration are seen to limit services users’ experience. More robust methodologically sound studies are urgently required. Given the expected increased demand linked to the current COVID-19 pandemic, coupled with the resultant compromised financial position, it is essential that scant resources are appropriately directed.
To evaluate the reliability of balloon coronary compression testing during percutaneous pulmonary valve implantation.
Despite the widespread use of the ‘balloon coronary test’ as the preferable method to rule out the risk of coronary compression, this adverse event has been described after pulmonary valve implantation where coronary balloon test suggested no risk or low risk, calling into question the accuracy of the test.
We performed a retrospective chart review of 84 patients who underwent pulmonary valve implantation between January 2018 and December 2019 and selected 36 patients whose archived imaging was suitable to perform quantitative analysis of the ‘balloon coronary test’. We focused on the spatial disparity between the right ventricular outflow tract position defined by the inflated testing balloon and the eventual implanted valve position, to classify the test as inaccurate or accurate.
In total, 36.1% of cases were classified as having an inaccurate coronary balloon test. Among the baseline characteristics, right ventricular outflow tract substrate was identified as a significant predictor of test accuracy. Related to this characteristic, the type of testing balloon used and the size of the eventually implanted valve were found to be associated with test accuracy.
Based on our findings, balloon coronary testing is not an accurate method of predicting final valve position with respect to fixed structures in the thorax. This may translate to a high false positive rate for the likelihood of coronary compression in pulmonary valve implantation.
With the implementation of the European Green Paper on Mental Health, and the development of the Mental Health Pact, the strategic importance of Mental Health promotion and illness reduction as keystones of a European mental health policy and practice has never been greater.
The PROMISE project is a EU project and is financed by the European Commission, Directorate General for Health and Consumers, DG Sanco. It aims to develop and disseminate guidelines for generic training and education with respect to Mental Health Promotion and Illness Reduction. The best practice guidelines will specifically focus on the prevention of suicide, depression, and alcohol and drug abuse, and the promotion of healthy living.
A specific innovation is the involvement of mental health service users as non-traditional actors by developing multi-disciplinary training guidelines and training programs with a special emphasis on positive mental health, healthy living, diet and exercise project.
Project partners are all ‘multiplier’ organizations from 8 different European countries and have extensive previous expertise in their designated roles.
The role of Parc de Salut Mar, Barcelona PROMISE is: Identify best practice media guidelines for engaging press and media with the mental health promotion agenda through the use of positive role models. Monitor the implementation of the best practice guidelines through the design and development of local case studies in 7 sites across Europe.
Outcomes are an integrated and comprehensive set of training guidelines and model training programs accessed through an interactive website, endorsed by European level professional body and university networks.
Between July 1972 and February 1974, the British Conservative government focused on creating a power-sharing settlement with the constitutional parties. In the meantime, the security and intelligence services would try to reduce IRA activity to a level at which it could not obstruct the power-sharing government. But once the power-sharing executive collapsed in May 1974, the British government's political policy radically shifted. Between May 1974 and December 1975, the British Labour government under Harold Wilson and Merlyn Rees envisaged an agreement on Northern Irish independence between Irish republicans, Ulster loyalists and others as being possible. This idea was not irrational. Various leading IRA and UDA members had demonstrated a willingness to contemplate an independent six-county Northern Ireland. Nonetheless, the Labour government refused to give the public or private declaration of intent to withdraw that the IRA wanted. The British feared that any declaration would provoke a loyalist uprising and civil war. The ceasefire collapsed as the IRA was not willing to forgo a British declaration of intent to withdraw. Nevertheless, the British Labour government under Harold Wilson had been willing to explore withdrawal from Northern Ireland, if republicans and loyalists could agree to independence.
Chapter 9 begins by evaluating the intelligence war's effectiveness against rural IRA units, particularly in the republican heartlands of south Armagh, east Tyrone and Fermanagh. The East Tyrone and Newry IRA did face setbacks. Nonetheless, in many rural areas the IRA’s elusive nature made the organisation difficult to infiltrate and restrain. I explore why rural IRA units were often hard to infiltrate. The resilience of rural units, particularly in south Armagh, provided momentum for the IRA’s campaign in terms of arms, explosives and expertise, which had even been transferred to high-profile IRA operations in England by the 1990s. I also detail how, in England, IRA activity had increased in intensity by the 1990s. IRA attacks in England alongside the ability of the IRA to import various consignments of heavy weapons from Libya suggests that the IRA leadership had not been infiltrated at its highest levels. I provide reasons to explain the lack of infiltration of IRA units in England and the IRA leadership. Examples discussed in the chapter include the effectiveness of the British Army watchtowers in south Armagh, and intelligence operations carried out against the IRA in England during the 1980s.
This chapter explores the intelligence war’s impact on the IRA in its urban heartlands of Belfast and Derry City between 1976 and 1998. In Belfast, there was a decline in IRA attacks during this period, partly as a result of infiltration and surveillance. Nonetheless, I argue that there was also a decline in IRA attacks, primarily because of the need to avoid civilian casualties occurring on a regular basis, in order to sustain Sinn Féin’s vote. By the 1990s, the Belfast Brigade had recommenced a commercial bombing campaign that would cause extensive financial damage and necessitate the continuation of security installations and patrols. In Derry City, the IRA’s campaign was more of a persistent nuisance by 1994. But this decline was not because of the intelligence war. Rather, it was largely that the SDLP had begun rebuilding the city for nationalists. The IRA risked a decline in electoral support if they attacked the city infrastructure again. The evidence provided does not suggest that the Belfast and Derry City IRA Brigades called a prolonged ceasefire in August 1994 primarily because of the intelligence war. Chapter 8 also debates the impact of suspected agents and informers on the Belfast and Derry City IRA, including the Stakeknife and Raymond Gilmour cases.
Between August 1969 and March 1972, the British government focused on reforming but maintaining unionist-majority rule at Stormont to appease both unionists and nationalists. Fear of provoking a civil war and getting entangled in Northern Irish politics - which counted for little at Westminster - explains the British government’s reluctance to attempt significant reforms prior to 1972. In addition, Edward Heath’s government was reluctant to negotiate and grant significant concessions to violent opponents of the state. Yet allowing Stormont to delay and dilute reforms and to influence British security policy dragged the British Army into conflict with the nationalist population. As nationalist anger increased, the non-violent Social Democratic and Labour Party (SDLP) pulled out of Stormont in the summer of 1971. IRA activities increased. Escalating violence eventually forced the British government to suspend Stormont and assume direct rule. By March 1972, the British government had realised that the IRA could not be militarily defeated, and tried instead to reduce violence to 'an acceptable level' to enable political solutions to emerge. But IRA violence continued and influenced both the SDLP and British government to talk to the IRA in June 1972.
The intelligence war had had minimal impact on the IRA’s campaign by June 1972. Various factors explain the limited infiltration by intelligence services of the city and rural areas where the IRA was operating at that time. In urban areas, IRA support increased following the active role played by republicans in defending nationalist areas, indiscriminate British Army actions against the nationalist community and the lack of political and socio-economic reform by Stormont and Westminster. Other factors unique to rural areas restricted intelligence, included republicans’ long-term sense of injustice at being forced into a unionist-dominated Northern Ireland state in the 1920s. British forces also conducted various indiscriminate security operations in nationalist areas, such as in County Tyrone. These operations provoked further tension. The failure to coordinate British military and RUC Special Branch intelligence on a consistent basis made containing the IRA harder. In addition, IRA barricades in Derry City and Belfast, and the ability of some rural IRA units to use the border to evade detection, meant that surveillance of the IRA via vehicle- or personality-checking systems was difficult. The intelligence war’s failure to significantly erode the IRA’s capacity for conflict partly explains why the British government talked to the IRA in June 1972.
This chapter investigates the intelligence war’s effectiveness against each regional IRA group between July 1972 and December 1975. Whilst the Belfast IRA suffered some operational difficulties because of British intelligence efforts, the Derry City IRA, rural republican units in Fermanagh, Tyrone and south Armagh, and the cells operating in England had not been damaged to any considerable extent by 1975. It is true that the number of deaths caused by the IRA had declined since 1972. But the republican movement had spread further across Northern Ireland and the borderlands of the Irish Republic. The IRA maintained a persistent campaign for reasons explored in this chapter. Northern Ireland remained politically unstable in 1975, and when the IRA called a prolonged ceasefire, this was not out of desperation. This chapter discusses important events in the intelligence conflict between 1972 and 1975, included the discovery by the IRA of the Four Square Laundry intelligence operation in Belfast in 1972.
The conclusion presents the key points of my argument that the intelligence war did not force the IRA into the peace process. I summarise the primary political factors that led to peace. The conclusion also identifies key themes for further research, including the regional nature of the conflict. In addition, I explain why this book demonstrates that the practice of 'talking to terrorists' in Northern Ireland and the politicisation of Irish republicanism were both fundamental to the creation of the Good Friday Agreement in 1998.
A majority of IRA leaders agreed to a ceasefire in late December 1974 because the British government suggested privately that they were contemplating political withdrawal. This chapter also suggests that the ceasefire collapsed because the British government would not announce their withdrawal before a political settlement had been agreed. The British government feared that a declaration of intent to withdraw would provoke a loyalist uprising. Republicans did not trust that the British government would withdraw without a public or private declaration. Many grass-roots republicans felt tricked by the British government into a ceasefire that they began to believe had been designed to degrade the IRA’s armed capacity. However, evidence suggests that, in 1975, the British government wanted gradual political withdrawal from Northern Ireland. Many leading republicans were willing to politically compromise during that year and potentially accept an independent Northern Ireland. But pressure from grass-roots republicans meant that the leadership had to demand a British declaration of intent to withdraw.