Providing mental healthcare and restoring dignity on Dublin's city centre streets

From North Dublin, via the Copper Coast, the UK and Jersey, alumnus Ciarán Lanigan, Clinical Nurse Specialist and Registered Nurse Prescriber is this year’s RCSI Humanitarian and Community Awardee. We sat down to chat to him about his nursing career and his motivation to care for the most vulnerable people in our capital city.

“It’s funny because I wasn’t particularly attracted to nursing in secondary school. I didn’t even do biology. But growing up, all my summers – to keep me out of trouble – I was dispatched to my mam’s homeplace in Dungarvan, Co. Waterford. Although I probably ended up getting into more scrapes there. When I finished school, I went to work in the UK and a couple of my friends from Dungarvan, Roddy Healy and Mike Veale, were nursing there in a hospital in Surrey. I went down to see them, and they asked, ‘would you think about doing nursing, they’re recruiting?’ I said I’d give it a go. That was 36 years ago, and I’m still at it.”

Ciarán trained as a psychiatric nurse from 1988 to 1991 in Long Grove Hospital, formerly Long Grove Asylum, in Epsom, Surrey. “Training then was an apprenticeship,” he remembers, “and it was really, really, good in terms of practicalities. It was all in the NHS. We did six weeks in school, then out on the wards. I have more memories of those three years that any other period in my life, I think that’s because you’re young and surrounded by people your own age and you’re up to divilment!”

Returning to Ireland in 1991, Ciarán secured his first post at St John of God’s Hospital, Stillorgan, Dublin, recruited by the then Director of Nursing, Dr Tom Houlihan. According to Ciarán, “they were much better resourced than we had been in the UK. However, Ireland was still using the 1945 Mental Health Act, which I felt wasn’t very patient focused at all. A GP and a next of kin could sign someone into hospital with no recourse to legislation. But now, we have the 2001 Mental Health Act here in Ireland which is much more patient-focused and has surpassed the UK’s legislation.”

Ciarán subsequently went on to work in both St Patrick’s Hospital and St Vincent’s Hospital in Dublin, where he met his future wife, Melissa. They moved to Jersey for five years, before returning to Ireland again with their young family, when Ciarán took up a role as Clinical Nurse Manager and subsequently Clinical Nurse Specialist with the HSE in Dublin North City.

In 2022 Ciarán was instrumental in the establishment of an outreach community mental health service for homeless people in north Dublin city. “I’ve always had empathy and time for homeless people,” Ciarán says. He goes on “as a nurse, I’ve always been asking ‘Where’s the need?’ and there was a huge need for an outreach service in Dublin city centre for patients with severe and enduring mental health problems who are homeless”.

“There has been a service for the past 25 years in Ushers Island (Dublin 8) led by Dr Kevin Kilbride for patients with mental health problems who are homeless. They do a brilliant job but there are not enough resources. I had a discussion about the needs with my boss, funding was sought, and a psychiatrist, a social worker and myself were appointed to the homeless service. We’re a small but dynamic team. Day to day, I’m on my bike getting around the city centre, trying to find our patients – often they are rough sleepers so that can be tricky, and our catchment area is probably a mile square radius around O’Connell Street. A lot of my patients are on depot injections as it takes away the need to rely on medication; medication can often be a currency or can get stolen. Many have dual diagnoses of an enduring mental health disorder and a substance abuse issue.”

Advocacy is a huge part of the job. “It’s nurses who are with patients 24/7, so absolutely, 100%, it is up to us to advocate for patients. My biggest challenge is trying to get accommodation for patients once they are discharged from hospital. Myself and the social worker will do as much as we can to get them sorted. Even small things can make a difference. People often need clothes or shoes; their things may have been stolen and they have nothing. We try to allow patients to look and feel like normal members of society as they may have had the last six months with no sense of dignity, either in hospital or people stepping over them on the street. Even if patients can be challenging, we still have to advocate for them.”

As well as advocating for his patients, Ciarán is a huge advocate of ongoing learning and professional upskilling. “In 2007 I did a Graduate Diploma in Healthcare in DCU (Dublin City University) because I was in a Clinical Nurse Specialist post. I was always interested in prescribing, and in 2007 the Misuse of Drugs Act was changed to allow nurses to prescribe. In 2013 when my kids were more independent, I applied to do the Nurse Prescribing course at RCSI. It was the hardest course and needed the most study I’ve ever done in my life! I remember thinking ‘how are we ever going to remember all this?’ But I did, and along with colleague Emma Snee we became the first nurse prescribers in Dublin North City. It’s the best course I’ve ever done. Prior to being able to prescribe, I might be on a home visit and a patient would need medication. I’d have to go back to our base, try to find an NCHD or a consultant to write a script, then head back out again.”

Whilst the course was challenging, it was a positive experience for Ciarán and has since led on to further qualifications. “Chanel (Dr Chanel Watson) was really supportive. She was brilliant in fact, still is. She asked me to come back to RCSI and talk about prescribing in psychiatry and I’ve been involved in that now since 2018. In 2015, I decided I’d go back and do a Masters here. Prof. Declan Patton was my supervisor and he was excellent. I hate giving up my Saturdays to study, even though I enjoy the study itself! But I got through the Masters in 2015. Then I was invited to do the exams for the Fellowship in the Faculty of Nursing & Midwifery, which I did, and was awarded a Fellowship in 2016.”

Ciarán is this year’s RCSI Humanitarian and Community Awardee, but certainly wasn't expecting to receive the news that he had been nominated. “I saw a missed call from Prof. Tom O’Connor. I thought he wanted me to come in to do a lecture, but I was speechless when he said I’d been put forward for this award. I was quite shocked and honoured. There’s a great buzz about RCSI, and a lot of the doctors and consultants I work with would have been through here too. RCSI has a place in my heart.”

Throughout his career the person who supported him the most was the student nurse from the Mater Hospital whom he met in St Vincent’s Hospital in Fairview – his wife Melissa. “There is not a chance I would have progressed through my academic qualifications without her help and support through proofreading and giving me time and space to study in a very busy household! I dedicate this award to Melissa, Liam, Eoin and Caitlin, all of whom I am incredibly proud of.”

The 2024 RCSI Alumni Awards is kindly supported by FRS Recruitment, an award-winning healthcare recruitment agency that works with healthcare professionals seeking career opportunities in organisations throughout Ireland.