Standard of mental health care should not be tolerated

Mental health difficulties affect every family in Ireland — so why aren’t we protesting in the streets, asks Paul Gilligan

Standard of mental health care should not be tolerated

Mental health difficulties affect every family in Ireland — so why aren’t we protesting in the streets, asks Paul Gilligan

This week, the president of the High Court, Mr Justice Peter Kelly, described the condition of a man with mental health difficulties being held on remand in Mountjoy Prison because of an inability to move him to a more suitable treatment setting as “a truly awful situation, and one that should not exist in a civilised state”.

This would be bad enough if it was an isolated incident, but it follows on from pictures in this newspaper some weeks ago of a person with mental health difficulties sleeping on the floor in an emergency department.

In August, the HSE outlined to the Dáil that there were 244 children and young people on waiting lists for specialist mental health services across the country.

Staff working in mental health services tell us of the seriously high levels of vacancies they are contending with, alongside the growing numbers seeking help. They are working tirelessly to meet the needs of those requiring help, risking burnout and dejection.

The evidence tells us that our society is failing our most vulnerable citizens. Yet nobody is protesting on the streets or on social media because the people who are most affected are — through the very nature of their difficulties — disempowered and disenfranchised.

Many, like the parents of young people requiring help, fear creating a storm in case they further disadvantage their children. Those whose anger spills over look for somebody to blame, but this does not fix the problem — it simply creates defensiveness and withdrawal.

The right to mental health care is a basic human right, the economic cost of not treating those with mental health difficulties is substantial — 4% of GDP — and the social cost even higher.

Six things need to be done.

Existing staff resources should be brought together and utilised to establish whatever number of fully-manned community and residential services their capacity enables us to deliver, providing the highest quality care. Every part of the country should be serviced by one of these teams and residential units.

Innovative interventions, including online mental health services should be encouraged. All sectors including the voluntary and independent sectors should be asked to play their part.

Using existing personnel and complementing them with mental health practitioners operating independently within the community, a comprehensive primary care mental health service should be established. A new tier of highly specialised services, catering for the small number of adults and children with extreme difficulties, should be established.

The new mental health helpline recently launched by the HSE should be linked with the other existing voluntary helplines across the country to provide comprehensive telephone support to those whose needs are most appropriate to this type of intervention.

A national prevention and awareness-raising strategy should be developed and implemented by all relevant voluntary, statutory, and independent organisations.

Most importantly, service users need to be empowered to have more involvement, choice, and influence in the shaping, delivery, and evaluation of services.

Of course these six steps would require additional funding, but they are essential if we are to move our mental health services forward.

They are initial steps that would require the support of establishing additional community and in-patient services over time as new staff are recruited.

Existing staff turnover would be curtailed by creating a more supportive working team, providing better care.

For too long mental health has been the Cinderella of the health services in Ireland. Development has been stunted by a rigid commitment to an impressive, but as yet unachievable strategy, Vision for Change, by a leakage of staff from the sector and by a disintegration of the fabric of in-patient services.

Some new money has been invested over the last few years and some new projects have begun, particularly and quite rightly in the areas of prevention and early intervention.

However, specialist and in-patient services are still severely under-resourced and underfunded.

Mental health difficulties affect every family in Ireland, but few complain. We are shocked when we hear of the heart-wrenching stories of the untreated people behind those statistics that we have, at some level, become immune to — but our deeply embedded stigma surrounding mental health difficulties still prevents us from speaking up for those who need care.

Despite having closed our asylums, starting the public discourse about mental health, and supporting the emergence of extensive awareness campaigns, we are still in some way reluctant to demand acceptable mental health care.

The saddest aspect of this is knowing that, with the right care, those who experience even the severest mental health difficulties can live fulfilling lives with the right interventions and support.

We cannot, as a civilised society, continue to tolerate this situation. We cannot continue to allow our loved ones and those we care for to suffer needlessly.

It is time to look into our hearts and generate the same societal pressure that has been generated regarding climate change and other civil rights movements to obtain real change on mental health care.

Paul Gilligan is a clinical psychologist and CEO St Patrick’s Mental Health Care. He is also the author of ‘Raising Emotionally Healthy Children’.

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