Nowhere left to go

PUT yourself in the shoes of one of the seven residents of the Island View psychiatric unit.

Imagine how you might feel to think you are being treated as a problem, rather than a citizen. Think for a moment about the emotions, the fear and trepidation, that can stalk a mind which marches to its own beat, at a time of great uncertainty.

Island View is a high-support hostel, housed on the first floor of St Anne’s Community Hospital in Cahirciveen, Co Kerry. Its imminent fate will have a major impact on the people of the town, and the peninsula of Iveragh.

Beyond that, though, the story around the unit speaks volumes for the official attitudes to mental health that persist, and the empty rhetoric employed in documents such as the Vision For Change blueprint.

Island View was opened in 1993 with a capacity to provide 13 community residential beds for people with enduring mental illness. Its inception fed into the growing opinion that treatment for mental health was better provided in the community, rather than a major institution. Prior to the opening, service users had to travel 64km to Killarney, to St Finian’s Hospital, completely removed from the community.

In 2006, the much heralded blueprint for mental health, A Vision For Change, gave the official stamp of approval to community-based solutions. Major institutions such as St Finian’s were earmarked for closure. The hospital, which overlooks Fitzgerald Stadium in the town, is in the process of being closed.

There was much hoopla among politicians and health managers, as if they were determined to drag mental health out of the dark corner to which it has long been confined. The rhetoric was only pure magic, capable of bringing a tear to the eye.

Down in Cahirciveen, Island View served its purpose right up until recent years. Service users were able to stay in their community, near families, drawing comfort from the world with which they were familiar, rather than being dispatched to a cold, foreign place, full of strangers.

The years have taken a toll on the building, and the HSE recently determined that it was no longer fit for purpose. The HSE’s service plan for 2012 included provision to close it down. Some locally dispute the need to close it, others agree that it had reached the end of its day. The big issue then became: What now for the service users?

Back in the dark, ignorant days, the solution would have been to dispatch them to St Finian’s. But now we are in the time of Vision For Change, when the general consensus is that the community provides the best care and best outcomes for those afflicted.

In March, the staff and the local branch of the Kerry Mental Health Association drew up proposals for life after Island View. It included the development of a community mental health team, and the establishment of a local support unit of eight beds, which could be facilitated in two four-bed units.

Like most towns around the country, Cahirciveen has a surfeit of empty properties. The plan would have ensured that service users from all over the peninsula could still stay locally. Crucially, it was also a model that reflected the driving principles of A Vision For Change.

So far, the experience of all concerned with Island View is that A Vision for Change has been thrown out the window. Not just that, but the HSE has hijacked the language in the document and used it in a cynical manner. A statement from the HSE says the closure of Island View will “see a significant shift in emphasis from a largely institutional-centred service to a community based one”.

Island View is a community-based facility, and far from placing emphasis on the community, the HSE appears intent in scattering local service users to the wind. As the year has progressed, service users have been dispatched as far away as Killarney and Killorglin. According to campaigners, one man was earmarked to be dispatched to a nursing home in Milltown, 40km to the east. His condition meant that institution could not take him, so he is now earmarked to go to Kenmare, 80km in the other direction.

Stewart Stephens, whose relative has been in Island View for 12 years, says she has been offered three choices. She could move to the hospital downstairs, which is totally unsuitable; a nursing home in Killorglin, which is not designed for residents with mental health issues; or she could move to a house near the hospital.

“It looks as if there’s a box entitled ‘Close Island View’ to be ticked,” Stephens says. “And once that’s ticked, everything else is secondary.”

This is how the HSE characterises these moves. “A process of re-accommodation of the residents of Island View is underway at present to facilitate their transfer to alternative accommodation best suited to their needs.”

Locally, that statement is interpreted as really meaning the residents will be re-accommodated according to the needs of the HSE. The fate of the remaining seven residents is unclear. One proposal that has been mooted for some is they could be housed locally, living independently, but supported by mental health professionals. The support, from what locals can gather, would be limited.

Despite claiming “proposals from both staff and support organisations in the area are being considered”, local opinion has it that their proposals have been completely ignored.

Mr Stephens walked away from one meeting with HSE personnel highly disillusioned. “We were told there was an individual needs analysis of the residents being conducted,” he said. “Somebody asked what stage it was at and we were told it was ongoing. We don’t know what to believe. Everything was presented as a fait accompli.”

Assessing service users is a difficult exercise. If somebody appears to be at a relatively stable junction in their mental health, how much of that is down to the environment in which that person has lived? What prospect is there that relative stability can be maintained, if that person is put into a less suitable environment? These are matters that haunt all those concerned for the future of Island View residents.

What of the service users of the future? The local branch of the Kerry Mental Health Association forecasts that at least 25 people are likely to require some form of residential assistance in the near future. Are they also to be told that they can no longer be accommodated in the community?

Dan O’Connor, the development manager with the Kerry Mental Health Association says it is vital an alternative facility be located: “A lower support unit could be supervised under the remit of the community mental health team in the area, he says.

“What is really frustrating is that while they say it’s about consultation, none is taking place. There should be solutions found but that’s not happening. None of this is in the interests of mental health service users now or into the future.”

The issue is a depressing indictment on attitudes towards mental health that were supposed to be part of the past. A Vision For Change was to drag mental health out into the light, where it could be properly treated, where taboos and prejudices could finally be broken down. Try telling that to the people of Cahirciveen.

Empty rhetoric is not confined to the HSE’s statements on Island View. In wider society, in the current economic malaise, public figures constantly reference the need to protect “the most vulnerable” from the worst of cuts. Service users in this mental health facility are about to be uprooted, both physically and therapeutically, just as the remainder of their fellows have over the last nine months or so. If these people are not the most vulnerable, who exactly is?

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