Cries for help fall on deaf ears

The economy is in crisis, but services to people with mental illness have been in crisis since the ’80s and the consequences are all around us, writes Claire O’Sullivan.

MICHAEL Christopher Lane was watching Tipperary play in the All-Ireland minor hurling final with his wife when a gunman entered the living room, holding a double-barrelled shotgun.

Christy, 50, yelled at him to put down the gun, but the gunman aimed and shot him twice — once in the stomach and once in the arm.

His killer? His 25-year-old son, a young man who had been hearing voices since the age of 20 and who has been diagnosed as schizophrenic. For weeks before the attack, he had been experiencing religious delusions, “the good forces left me and the dark forces took over” he told his psychiatrist. Mr Justice George Bermingham described it on Thursday as an “appalling tragedy” as he committed Paul Lane to the Central Medical Hospital and found him not guilty but insane.

Then there is the case of Thomas Connors. On three occasions, he sought help from the Health Service Executive (HSE).

Connors, who had a history of psychosis and had been hospitalised on a number of occasions, thought he was God and everyone around him Lucifer.

Connors was a schizophrenic, but in spite of his delusions, he had sufficient self awareness to realise he needed help. But when he went knocking, he wasn’t offered the care he needed. St James provided him with a triage nurse on the first occasion, then he left. On the second occasion, with his wife and child, he was sent off with some pills after he told them he wasn’t taking medication. Finally, on the third occasion, upon arrival at St Vincent’s he was told that he was not within the right catchment area and was sent to St James’s. He was gone before the ambulance arrived.

In the run-up to Christmas 2007, he spotted Michael Hughes asleep on the stairwell in an adjacent apartment block. Brandishing a pair of garden shears, he came crashing through a glass door and savagely attacked Hughes, inflicting 143 stab wounds on him. Mr Justice Bermingham described the case as being of “mind-boggling sadness”.

In April last year, an incident occurred with similarly tragic consequences. Gardaí had to be called to Fermoy town centre when 26-year-old Trevor Clancy was began waving knives around, declaring himself an archangel and yelling he was going to stab himself. Clancy did just that, also stabbing a garda as they tried to restrain him. Speaking at his inquest his father Eamonn said he thought he should never have been released from hospital the previous October. In the days leading up to this death, he had been “drinking heavily, hearing voices and seeing angels”.

“I don’t know should he have been discharged. They failed him,” his father said.

And, then there’s the case of Dr Aneth Pullela, a Limerick psychiatrist who was left fighting for his life after a patient at a psychiatric day-care centre went on a knife rampage. The patient, Anthony McMahon, had just completed a seven-year sentence for manslaughter. One observer described the scene as being like an “abbatoir”.

Such an attack had been signalled by four consultant psychiatrists who wrote to the HSE the month previous, lamenting the lack of secure psychiatric beds. They warned that the absence of secure psychiatry beds would result in denial of treatment to patients, enormous risk to their families and similar, possibly fatal, risks to staff in existing, low-security facilities.

At the time, Professor Harry Kennedy, director of the Central Mental Hospital, also spoke about his inability to free beds in Dundrum because there “is a great shortage of structured support places” in the community for psychiatric patients who have reached the point in their recovery where they no longer need a bed in a secure psychiatric hospital. He estimated that 12 out of 80 patients at the Central Mental Hospital could be moved on. The economy is now in the midst of a crisis, the consequences of which we are only beginning to comprehend.

But the mental health services have been in crisis since the mid-eighties and the consequences are all around us. For years now the mental health services have been declared the “Cinderella” of the health services — a line that now rolls off the tongue so easily that it has lost its oblique sadness. If you have mental health problems in this country, if you are amongst the most vulnerable and you can’t afford private care, experts claim you will never get the full multi-disciplinary care that your condition requires. One in four people will suffer a mental health problem, with this number rising to about 40% in deprived areas yet the Government has been accused of slowly starving it of resources for nearly 20 years. And so, year after year, we have become nearly immune to the suicide epidemic that has gripped this country and the high percentage of the deluded and insane in our courts.

Cork Institute of Technology economist Tom O’Connor has long expressed shock at this disregard for lack of investment, comparing the 7.76% spent on mental health services with the 14% spent in the mid-eighties.

“It is a long way short of the €10 billion allocated in tax avoidance expenditures by the Government to the developers of private nursing homes, apartment blocks and expensive holiday homes and other expenditures, between 1998 and 2005. To their numbers have been added 46% capital tax write-offs to developers of private hospitals,” he said.

The Department of Health and the Government have been accused of stage-managing glitzy launches of various reports, but few of their conclusions move from the final chapter to reality. It is three years since the much-lauded Vision for Change was published and the Irish Mental Health Coalition says its progress has been “painfully slow”, with the HSE confirming last June that only about half of the €50 million in finances set aside for the reform process had been used for mental health.

Under this document, the antiquated institutional model was to be replaced with a community-based model where people can live at home, but easily access a wide range of expert services from a multi-disciplinary mental health team. According to Mental Health Ireland, only 10 of 129 planned mental health teams are fully in place and GPs are still crying out for more training in mental health issues and better access to teams (which generally comprise a psychiatrist, psychologist, a therapist amongst others).

Because of this yawning gap between what they need and what they can receive, patients are just being sent home with prescription after prescription in the hope that it will normalise their moods. The psychotherapeutic services that could lead them to full recovery do not exist. Chairman of the Irish Mental Health Coalition John Saunders says local industrial relations issues and assertions by doctors that their clinical judgment is being undermined by Vision for Change are all being used to slow the development of community mental health.

“There is a great reticence to go near it in many areas. Nurses and other staff don’t want to move from hospital to clinics and don’t want their working days changed. Doctors then believe that patients should go where they see best and not where the document sees best. The biggest issue however is the lack of posts being advertised for clinical staff,” he said.

The HSE, however, has said that up to €950 million will be invested in Vision for Change over seven years, with much coming from the sale of lands in mental health services to be re-invested back into the service. A HSE spokeswoman said: “Crucially, the strategy will focus on the service user and ensuring they and their families have access to a user-friendly system.” So far, there is little evidence of this land sale — and in the present economic climate it won’t be anything near as lucrative as it would have been.

Referring to the harrowing case of Thomas Connors and his three attempts to access psychiatric care from Dublin hospitals, a HSE spokeswoman said an inquiry had taken place into the events prior to his killing of Michael Hughes. “It is not yet known whether the report will be published. It was carried out so that lessons could be learnt. We are looking into it,” she said.

A forensic psychiatry source has said it must be published as they believe that the hospitals failed Connors. “There needs to be an examination of how these two units operated. There is an abject failure in not admitting him immediately under section 23/24 of the Mental Health Act. To send him back to another hospital was to miss the point entirely, a sick man needs to be treated immediately and it doesn’t matter where he’s from,” the source said.