Mental health recovery helped by 'small dignities' as report warns of public/private divide

Barbara Brennan found private centres often offer external spaces and these “small dignities” helped with her recovery. Picture: Andres Poveda

When Barbara Brennan read a new report indicating people who can pay for private mental health care get better treatment than in the public system it struck a chord with her.

She was previously an in-patient at public and private services following suicide attempts and now works with See Change Ireland to reduce stigma around mental health.

“I have a very visual memory of being in a hospital that was painted really dark brown, with very long corridors and all artificial light,” she said. 

“It had a very heavy feel, with not only no outside space but no windows or not enough windows.” 

She recalled old chairs which “didn’t smell very good”, placed on carpets next to paint-chipped walls.

“There were obviously very big differences,” she said. “I have also visited people in other hospitals that I hadn’t been in, public sector hospitals, and I was quite upset leaving them on seeing the quality of the space they were in.” 

Public centres were described in the Mental Health Commission’s report last week as including many “outdated, unsuitable buildings which have suffered years of environmental neglect”.

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She said: “The physical buildings need to be changed, there is no doubt about that,” but added this is often down to funding, not choice.

In contrast, she found private centres often offer external spaces.

“They put paintings on the wall, they keep it light and airy,” she said. “They generally try and keep plants in place.” 

She was on a locked ward in one facility which would normally mean no outdoor access but they had created a very small internal courtyard.

These “small dignities” helped with her recovery, she said.

'Overwhelmed' staff

In terms of interaction time, she said public staff are “overwhelmed”. This can mean creating individual care plans is seen as a luxury, she said.

“The HSE themselves have detailed the importance of care planning, and yet a lot of services are not implemented. It is there on paper,” she said.

“I would guarantee that the people working in the services, who are being targeted and told to improve their services, are probably well aware that it would help. But they are overstretched.” 

However, she welcomed changes she has experienced across all services, saying patients are listened to more and the overall impact of medication is taken more into account.

“I started being very unwell when I was 14 years of age, so that was 26 years ago. The psychiatric services were based on the medical model completely, at that point,” she said.

Barbara Brennan: “The HSE themselves have detailed the importance of care planning, and yet a lot of services are not implemented. It is there on paper.” Picture: Andres Poveda

"When I would go and say this medication is making me put on a lot of weight and I’m developing an eating disorder, it was a matter of ‘we have to deal with your initial mental health complaint first, so don’t mind that’."

Mental Health Reform also welcomed the report’s focus on investing in public services.

Interim CEO Roisin Clarke said: “It is unacceptable that independent private inpatient mental health centres offer a better level of care than facilities in the public system. The two-tier system is endemic across our healthcare services which is causing inequities for individuals with mental health difficulties.” 

The report also found involuntary admissions by gardaí increased again.

“Additional funding and resources are required to increase the number of Authorised Officers. We cannot allow applications by the Gardaí to continue,” she said.