A system failing our most vulnerable

Axing €50m earmarked for developments in mental health provisions will cost lives, writes David McCarthy

PICTURE the scene: HSE chiefs huddle with Department of Health officials and James Reilly’s advisers around a conference table looking to find €130m to fill a recently noticed budget overrun.

Suddenly they spot it, €50m in the mental health budget. “Well hello,” they say, “this is could be a winner.”

I imagine this is not too far from the reality. It must be remembered this €50m was earmarked for crucial developments in mental health provision, long promised under A Vision For Change — the Government’s roadmap to better mental health care. So it is money not yet spent and therefore those making the decision could argue they are not, technically, cutting any services with this strategy. Yet what they are doing is far more pervasive and far more serious, they are putting the development of mental health care back to the archaic institutional-lead system that has been failing vulnerable people for centuries.

This is a shameful and crude measure and a slap in the face to all those staff in the HSE who have advocated change, and have worked with groups like Mad Pride Ireland and others to find a better way to deal with emotional distress.

The over-reliance on the medical model, the continued power of psychiatry, and the lack of equality of human rights in the Mental Health Act have all been solidified by this decision. The HSE will now have to retreat to the outdated model of incarceration, forced treatment and a reliance on pharma- based solutions because a compliant patient is a manageable patient.

There had been hopes that we were heading to a more human approach to mental health. An approach that had the individual and their needs at its core. “Community care” was the phrase we heard repeatedly from our political masters. They not only told us this was a better method of care but a more cost-effective method also. So how short-sighted is this cut? Our most vulnerable citizens are being subjected to a system they fear, a system that has failed them. They may now have nowhere to turn. It is easy to see why this area has been targeted. The people it affects are the least likely to protest and so will be seen as a soft touch. What they have failed to notice is that emotional distress is now in almost every household in the country, and the parents, siblings, and friends of those suffering will not accept these cuts quietly.

It is the job of groups like Mad Pride Ireland and others to step up our activity in the media. We need to show those suffering and those who support them that they have a voice and that we will make sure it is listened to. A protest will take place today at Government Buildings to highlight that this cut will not be accepted without a fight.

Protest is not the only route, as a state we have signed up to the provisions of the UN Convention on the Rights of People with Disabilities (UNCRPD). This commits political parties to ensure basic human rights are available to all citizens equally. I had an issue with our compliance with the UNCRPD in the past. Now I know we are in no way compliant. If the State continues down this road they are leaving themselves open to possible litigation.

The other question is what becomes of Kathleen Lynch, the junior minister with responsibility for mental health. A huge section of her budget, a budget she had been told was ringfenced, is now gone. Can she continue? I believe she should, but does this now mean the Directorate of Mental Health will not materialise? Does it mean we need to abandon community care, multi-disciplinary teams and alternative therapies? Does it mean we need to abandon the vulnerable?

Since the start of the recession we have seen an increase in the number of people taking their own lives. The logical reaction to this should be to put in place a strategy that will help those suffering emotional distress. It should see us put in place interventions and supports that will offer people an alternative to this sad and permanent solution. Yet what have we done? We have cut budgets, weakened supports and abandoned the vulnerable.

The cold reality of this decision is that lives will be lost. At a time when we are seeing increased stress in the family home and ever increasing suicide numbers, we are yet again weakening our approach to mental health care. Commitments have, in the past, been made by Taoiseach Enda Kenny and his colleagues in relation to better mental health care and we now need to see the mettle of Ms Lynch to stand up to these cuts.

These cuts will cost lives. It’s that simple. Mr Reilly and his colleagues should think on that.

* David McCarthy is chief executive of Mad Pride Ireland