Mental health services in a ‘sorry’ state
“There are moments in the history of our nation when we come face to face with the past,” he said. “When a door, long kept shut, by fear, or neglect, or design, is forced open, and a light shines on the country we think we have left behind. Today is such a moment.”
The last line of his speech hit on a familiar theme. “Never again, as a people, as a society, will we walk past a high wall, and fail to ask what lies behind it.”
As individuals, the politicians were undoubtedly heartfelt and sincere. As politicians, they were comforted knowing they were dealing with the past, a country for which they could not be held personally responsible.
The speeches were delivered as if from a new Ireland, where there is an enlightened approach to people cast out to the margins as a result of a life or family event.
But is that the case, or will a report in a few decades time outline how appallingly this country is dealing with mental health?
This society no longer houses people with mental-health difficulties behind high walls.
For decades, psychiatric institutions were treated as quasi prisons, housing individuals whose ailments could not be properly addressed by health services.
In some cases, those condemned to live behind the high walls were merely shunted away, because they could cause discomfort for powerful people, whether in the home or in wider society.
Those days are fast-fading. Over the last 20 years, the policy has been to shut down large psychiatric institutions and replace them with more locally based services. The policy got further impetus with the blueprint for mental health, A Vision For Change, published in 2006.
On the face of it, this is all positive, dragging mental health out from behind the high walls, into the light, where it should be treated as seriously as any other branch of human health.
However, the reality is a long way from that fluffy notion. The idea that out in the open mental health would be afforded its proper status has proved to be entirely wrong.
Right now, the problems of mental health are glaringly out in the open, but little is being done to address them.
Suicide has become something of a plague around the country, particularly among young males. The issue is no longer wrapped up in euphemisms, or pushed into some unspoken corner by affected families. The country is aware of the problem.
Suicide is often debated on the national airwaves. Yet reaction to it has been scant. Last year, one national suicide prevention officer resigned due to lack of resources. This was not regarded as a national scandal. One hundred and seven adolescent mental-health teams were earmarked for last year, under A Vision For Change. At a time when adolescent mental health is scaring the living daylights out of parents and medical professionals, just 63 designated teams were operating by year’s end.
Within the health services, mental health is still the poor relation. If budgets are tightened, or shortfalls have to be made up, mental health must go without.
Last year, €35m, which was to have been used to hire mental health professionals, was siphoned off to cover over-runs in other areas of the HSE.
Four hundred and fourteen staff were to have been hired, but by year’s end the complement barely touched 20. Among those who were to have been hired were dozens of specialised suicide-prevention officers. Political imperatives within the HSE demanded that the money be diverted elsewhere. Instead of shovelling the issue of mental health behind high walls, the policy now seems to be to sweep it into a corner of the public square.
These kinds of results are not just reflective of a country in an economic crisis. The same attitude was in place when times were good. Quite simply, mental health does not have much purchase on political will, and that, rather than any fidelity to the idea of a proper nation state, drives the scramble for resources and action.
The situation is so bad that, in some instances, Vision For Change is used more as a cover to cut resources than as a blueprint to deliver the best service. One example of this is the closure of the Island View mental health unit in Cahirciveen, Co Kerry.
Local people are resisting the policy of closing the unit and scattering the clients to wherever they can be accommodated. Already, clients have been dispatched as far as 50 miles away.
At least one of these clients was relocated to a nursing home. By and large, nursing homes are not equipped to deal with mental health.
According to the HSE, the plan is in keeping with A Vision For Change, which recommends treatment in communities rather than in large institutions. Island View was a small unit, in the community, that is no longer fit for purpose.
But instead of relocating clients in the same community, and providing a viable alternative facility, the clients are now being treated as problems rather than as patients. The architects of A Vision For Change hardly had that in mind when detailing how to drag mental-health treatment out from behind high walls.
A similar scenario unfolded in Tuam, Co Galway, when the HSE proposed to close Toghermore House, which caters for 16 residents. Only a major political and public campaign ensured that a small sum was made available to upgrade the facility, instead of scattering clients to wherever else they could be accommodated.
How will these policies look in future years, when some researcher compiles a review of mental health in the early decades of the century? Will the research conclude that despite the platitudes, despite the grand plans, mental health was still treated in a manner more befitting attitudes in a developing society, rather than one that claims to be fully developed?
We’re getting good in this country at looking to the past and concluding that things were done very badly then. We have great sympathy for those who were victims of a society and mores that were in thrall to power centres like the Church. There is now an understanding of how wrongly some people were treated, and how most others simply turned away and pretended it wasn’t going on.
Yet, today, while physically, and in terms of rights, things have moved on, major shortcomings persist in how mental health is treated in this country. Some issues don’t have to be hidden behind high walls to be ignored. Sometimes, it’s possible to have a great vision for change, but to do precious little about fleshing it out.
CONNECT WITH US TODAY
Be the first to know the latest news and updates
