Mental health services - We cannot renege on reform plan

SOME of the facilities we offer to people with mental health issues seem as likely to exacerbate illness as to contribute to recovery.

The inspector of Mental Health Services, Pat Devitt has told us that two wards at St Loman’s in Mullingar, were “unfit for human habitation. Others were “dilapidated, desolate and depressing”. In St Ita’s, in Dublin, rooms stank of urine. St Brendan’s, also in Dublin, broke more than half of the care regulations.

Mr Devitt reminded us of what we too easily put to the back of our minds – we tolerate mental health service practices we would find unacceptable should we, or a relative, need to turn to them. This challenges us all but, thankfully, it is just one side of the coin.

A recent survey of 536 service users found that just over half were happy with their treatment. However, 39% were not and a further 9% said they were not sure.

Improvements are being made but at a terribly slow pace. The survey, undertaken by the National Service Users’ Executive, was published to mark the fourth anniversary of the publication of A Vision for Change, the Government’s plan to modernise services.

A lot has changed in the four years since those proposals were made, not least our ability to fund it. Nevertheless, the core issues are the same. We still offer too many services based on containment and fear rather than on the possibility of recovery. One of the cornerstones of A Vision for Change was replacing institutions like St Loman’s and St Ita’s with community-based care.

This has not happened. The Irish Mental Health Coalition this week pointed out that the Government moratorium on recruitment is hitting services. Yesterday the health minister responsible, John Maloney, concurred and conceded that without some relaxation of the embargo, A Vision for Change cannot happen. He has made that point to Cabinet. Mr Maloney, like so many of us, may not have the resources to match his ambitions so this raises several questions.

One might be directed at professional organisations, unions and doctors’ groups. Are they providing the flexibility needed to implement A Vision for Change? Or, are they delaying reform to protect their interests? Unless they can answer “yes” and “no” they must explain why.

We, all of us, must ask ourselves why we accept services for mental health that we would not accept for other illnesses. Imagine if we reported that a breast cancer ward stank of urine or that a children’s ward was unfit for human habitation? Even the most stoical health minster would have to resign in the face of the protests. Yet, we find it perfectly tolerable for those enduring psychiatric illnesses.

Government must ask itself if, in these straitened times, it has sufficiently differentiated between lifestyle funding and life-or-death funding. Even today we spend vast sums on lifestyle projects while life-or-death projects – like mental health services – are curtailed.

Until we accept that this is a societal rather than a governmental issue we cannot expect real change.

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