Dr Philip McGarry's presentation on alchool’s impact on mental health in Northern Ireland. Dr McGarry is a Consultant Psychiatrist at the Mater Hospital in Belfast and was Chair of the Royal College of Psychiatrists in Norther Ireland from 2009 to 2013. This presentation was given at Alcohol Action Ireland's conference, Facing 'The Fear': Alcohol and Mental Health in Ireland, on November 20, 2013.

2. I wish I was in sweet Dungloe,
And seated on the ground,
And in my arm a bottle of wine,
And on my knee a bride,
I’d call for liquor of the best,
And pay before I was done,
And hold my Mary in my arms,
In the town of sweet Dungloe.

3. 
Only Country to celebrate its national addiction
‘Arthur’s Day’

Mythology of ‘uisce beatha’ or as Joyce calls it
‘wine of the country’ is interwoven in Irish stories,
songs and folklore

4. 
“ There is a crisis with problem alcohol
consumption in Ireland . Increasing death rates
from liver cirrhosis and increasing rates of hospital
admission in young women tell a story of a bitterly
unhappy relationship between the Irish and cheap
alcohol.”
Professor Frank Murray, Chair of RCPI ‘s Alcohol Policy Group. Medical
Independent, 2013.

8. Behan
 Kavanagh
 Best
 Alex Higgins

Waste of genius!

11. Binge Drinking per 100 drinking occasions:
Europe
Ireland
UK
Sweden
Finland
Italy
Germany
France
Female
30
21
16
16
12
7
5
Male
59
40
31
29
13
13
9
Strategic Task Force on Alcohol, Sept . 2004

12. Age at Onset of Drinking by Gender: Ireland
Age Onset Drinking
 Under 14 years
 15-16 years
 17 years or older

Females Males
17.3% * 21.4%
48.6% * 46.9%
34.0% * 31.7%
Total
18.9%
48.0%
33.1%
The Health of Irish Students, Health Promotions Unit,
 Dept of Health & Children , 2005

13. IRELAND
 UK
 NEW ZEALAND
 AUSTRALIA
80%

66%
53%
38%
BJOG 2013

14. 
At 15 weeks 33% Irish women report two or more
binges* (New Zealand 4%)

20% report moderate* to heavy drinking
*Binge 6 or more units
*Moderate 7-14 units per week; heavy≥ 14
BJOG 2013

15. Home
 Societal
 General Practice
 Emergency Department
 General Psychiatry
 Addictions Services


17. Violence – Unpredictable Behaviour
 Children – Direct and Indirect
 Financial Problems
 Unplanned Pregnancy
 Relationship Breakdown


19. Late night atmosphere on streets
 Violence – e.g. alcohol in over 50% of rapes
 Road Traffic Accidents
 Other Accidents
 Days Lost at Work


23. Alcohol affects almost every organ
 GI system – gastric pain to liver failure
 Psychiatry – depression, anxiety to suicide
 Neurological – neuropathy to dementia
 Cancer – increases many cancers
 Sex life affected, both short term and long term


25. •Prenatal
alcohol exposure can exert its negative effects on the
developing fetus directly by acting on fetal tissues or indirectly
by interfering with the maternal support of the growing fetus.
•Indirect
Mechanisms include altering the placenta’s ability to
provide necessary nutrients to the fetus, impairing the mother’s
physiology through malnutrition or may be combined with other
drugs of abuse.
Dr Nneka Orankwve

26. At weekend nights alcohol an overwhelming factor
in presentations
 ED can be an unpleasant environment
 Alcohol the major precipitant of self harm


In Northern Ireland (2011- 2012) – 7,767
admissions due to alcohol related diagnoses
(DHSSPSNI)

27. 
Always ask!

Background factor in other conditions (‘Dual
Diagnosis’)

Often the reason for admission to hospital

In mental illness alcohol increases morbidity and
mortality

28. 
In Northern Ireland 70% of under 25’s known to
psychiatric services who later killed themselves
had had problem drinking (National
Confidential Inquiry 2011 ).

This was significantly greater than England and
greater than Scotland

29. 
Public Policy

Enhanced Services

Always ask how much – and why

33. 
Drug users usually more honest!

Embarrassment, or not thinking it a problem

Middle classes forget can put cork back in!

Alcohol is a depressant; stops AD’s working

34. 
Addiction Services often under resourced

Dual Diagnosis Services

Specialist Support to General Psychiatry

?Most female alcoholics sexually abused

41.  Minimum
Pricing 1

Targets young people and the alcohol dependent

More effective than increasing duty

Cost free, but improves health significantly

Supported by publicans

42. 
Law approved by Scottish Parliament 2012

Scottish courts rejected appeal by Industry May
2013

Ministers White and Reilly keen to follow Scotland

NI Executive likely to follow

47. 
Tobacco advertising is greatly restricted

Will alcohol advertising be limited?

Sports sponsorship a disgrace!

Strong (well funded) lobby against restrictions

49. 
Enjoy alcohol wisely

Drunkenness is an embarrassment, not a matter
for banter

Careful about language ... ‘great time’, ‘can’t
remember’ ... ‘legless’ ... ‘hammered’

Think how others would see us!

51. ◦ illness
o mortality
o suicide
o cancer
o road traffic accidents
o domestic violence
o marital breakdown
o sexual abuse, accidents
o abortion rates
They can easily – and for no cost – do this
BUT WILL THEY?