Mentally ill: the silent constituency

Political Editor Harry McGee reports on the response of the political establishment to mental illness.

In 1990, I visited a psychiatric hospital for the first time. The 'client' we were visiting was a relation of a friend. He was middle-aged, had a profound intellectual disability, and had lived in the hospital since childhood. We were taken down a bare and gloomy corridor to a heavy door. The nurse who accompanied us opened the door with one of a large set of keys and disappeared for a few minutes.

He steered the client out in the corridor, where the poor man, clearly confused and with no verbal skills, stood for a few minutes staring mawkishly around. A bowl of mashed bananas was produced which he whooshed up. Then the nurse gave him one of the Woodbines that we had brought for him. He sucked it with massive drags that came from the bottom of the lungs. And then when it had been whittled down to near the butt-end, he inverted the still-lighting cigarette with his tongue and swallowed it whole. Two minutes later, he was brought back into the room. The nurse noted the visit down on an index card we were the first who had visited him for some time.

The man had an intellectual disability and 15 years earlier a minister for health, Brendan Corish, had acknowledged that psychiatric hospitals were inappropriate places for treating people with intellectual disabilities.

Ten years later in 2000, I wrote an investigative piece on psychiatric hospitals for Magill magazine. The man we visited in 1990 had since died, but what struck me forcibly at the time was that if he were still alive, he would still be there. And the likelihood is that he would still have been in a spartan and locked ward, with no stimulation, with nurses and aides being unable to do anything more than corral him from bed to day room to dinner table and back to bed again.

In 2000, this is the ward that those with similar conditions to him were kept in in the same hospital: "The upstairs ward was a dreary room in which mentally handicapped adults some profoundly so wandered in repetitive always-moving patterns.

"Along (another) ward, the patients seemed to prefer the corridor of this rather dreary ward to their day room."

As a constituency, people with mental health remain largely powerless, largely silent. As an issue, mental health remains an issue that has failed to come within radar range for the Irish political establishment.

It's 20 years since the landmark policy document, Planning for the Future, was published. Back in 1984, its ambition was awesome: moving mental services away from psychiatric hospitals to the community.

At the time the population who spent their lives in these massive Gothic institutions still numbered over 10,000. In the two decades since then, some of the hospitals have closed, and the number of long-stay patients has reduced dramatically. After a very slow start, the transfer of people with intellectual disabilities has gathered pace in the past few years. In October, 2002, there were 452. By the time Amnesty International published its report, 'Mental Health, the Neglected Quarter', last year, it had dropped to 197.

One of the commitments of the National Healthy was to transfer all patients with intellectual disability from psychiatric hospitals to more appropriate settings within 2006. However, simply moving these persons to a de-designated setting isn't a panacea. Unlike psychiatric hospitals, the alternatives do not come under the remit of the Inspector of Mental Hospitals.

Four years ago, the then inspector, Dr Dermot Walsh, said: "Intellectually disabled patients should be de-designated and placed in appropriate accommodation in community-based units. They need proper people to deal with their problems and needs. In some places, they are herded together with psychiatrically ill patients, which is totally unacceptable."

He also stated his view that de-designated services also needed an inspectorate: "Every system that looks after human beings should have an inspector. Any group that is in need and defenceless needs protection. It is our responsibility as a society to protect these people who are the most vulnerable in our community."

Just because they are no longer in mental hospitals does not mean that their human rights to live the fullest possible lives are being upheld.

The title of the Amnesty report, 'The Neglected Quarter', was apposite. The Government, when defending its policies in virtually every departmental policy area, seems to rely on comparing spending and performance now with what it was in 1997. Fair enough, but the economy has grown exponentially since then, and a high tide lifts all boats.

The one statistic that stands out like a sore thumb is that the proportion of health services funding devoted to mental health had reduced from 12% in 1985 to 6.8% in 2004. As Amnesty pointed out last year in relation to the drop of numbers: "Notwithstanding these welcome advances, while people with intellectual disabilities remain inappropriately accommodated in psychiatric institutions, Ireland is failing to comply with human rights standards."

It's only 12 months since the Special Olympics were held in Ireland but, in terms of continuing impact, it has been consigned to ancient history. The Irish Examiner/Prime Time poll conducted during the election campaign found that a clear majority of people felt it had only a brief impact, or no impact, in bringing to the fore the issue of disability in Ireland.

One of Amnesty's conclusions was that in Ireland "the systematic discrimination against people with mental illness is an abuse of their human rights, and that this situation of inequality will persist for as long as society tolerates it".

Inequality, as the Cabinet's own Socrates recently pointed out, may be necessary for a liberal and dynamic economy to perform. Unfortunately, society continues to tolerate it, as it has done for decades. Tackling mental health, grasping the nettle of introducing rights-based legislation will come at a cost. And in the low tax regime Ireland has locked itself into, there seems little appetite among political parties to broach the possibility of raising taxes.

Amid the screeds of election material sent to the media, a briefing paper for the local elections prepared by Mental Health Ireland (MHA) got unsurprisingly lost. Nowadays political campaigns seem increasingly like life imitating art as parties and candidates seem to learn most of their rules and tricks from Reality TV shows. Still, the salient points raised by MHA brought home a couple of uncomfortable home truths. "Apart from €1m allocated to the Central Mental Hospital, there has been no increase in the financial allocation to improve the mental health services in 2004. Moreover, resources are not concentrated in the areas of greatest need but paradoxically have been best developed in areas of greatest influence."

Worse, it points out, those worst affected by the neglect will never be in a position of any influence, shorn of even the most basic right of casting their votes. "People with mental illness in hospitals are quite literally a silent constituency."

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