A sense of abandonment

It has been four years since A Vision for Change, a blueprint for reforms to be made to mental health services in Ireland was published. The publication outlined plans to shift the focus of mental care from hospital care to more supportive community-based methods. While some progress has been made on how we treat people with mental illness, has it been enough?

Colm O’Gorman, Executive Director of Amnesty International doesn’t believe so. Speaking recently, O’Gorman said that the hope generated by A Vision for Change had now turned to disillusionment.

“By its own admission, the Government has not brought about the changes necessary to deliver a modern mental health service. This has happened in part because mental health is not given the priority it deserves. We urgently need a renewed political commitment to mental health from all parties,” O’Gorman stated.

When A Vision for Change was published in 2006, Brian Howard, Chief Executive of Mental Health Ireland warned that the report’s plans needed to be implemented.

“While the Report will be welcomed by everyone involved in the mental health community, it will also be regarded with an understandable degree of scepticism, in view of past failures. People need to see urgent action.”

Howard continued on to say: “The previous policy document, Planning for the Future, published in 1984 contained many recommendations which, if implemented, would have transformed the outdated approaches and slow rates of progress experienced in mental health services. ”

“It’s 22 years on, and some important recommendations still have not been implemented and surface again in this A Vision for Change Report.”

When asked about the progress being mean towards a better mental health system, a HSE spokesperson said that: “The mental health service has changed considerably over the last 20 years or so. These changes have been and are driven by Irish government policies, changing patient populations and the closure or dismantling of the large mental institutions.”

This statement would seem to be contradicted though by recent government decisions. On February 10, plans were announced for the site of the State’s new Central Mental Hospital which is to be built on the grounds of St Ita’s Psychiatric Hospital.

It has been well-publicised about the decline of St Ita’s Psychiatric Hospital in Portrane. St Ita’s is under the care of the HSE. The only other mental health facility in Dublin at the moment for residential treatment of mental illness is St Patrick’s University Hospital. However, St Pat’s is a independent organisation and patients must pay for treatment in its facilites.

Up until recently, St Ita’s Hospital was still in operation and treating patients. While patients used to be divided by gender in the hospital, distinctions are now made between those with mental illnesses and those with intellectual disabilities.

This means that anyone suffering from a mental illness is kept together on the same ward; which can range from schizophrenia and psychosis to depression.

The Clinical Director of St Ita’s, Dr. Richard Blennerhassett, said “Here we look at St Ita’s which ironically has become almost a by-word for all that is wrong with the psychiatric system and it is startling to think that when it was established in the early 1900s it was considered a model of what a psychiatric service would be.

To see the neglect that such a service has suffered during the latter part of the 20th century, I think, reflects very poorly on our society and the priorities we have within our society.”

Many people with mental health issues feel there is a lack of support from the government to help them in their day to day life. While the country is in a difficult economic situation, calls to the Samaritans by those looking for help have increased dramatically.

“The deepening financial and economic crises could lead to an increase in suicide rates as people face unemployment, mounting debt and housing insecurity,” a Samaritan spokesperson said.

“This is not only because more people become unemployed and are therefore more psychologically vulnerable, but also because those in employment feel threatened too.”

“The fear of losing one’s job or pressures caused by a downturn in business, demotion and pension plan cutbacks can be bad for mental health and therefore increase suicide risk.”

Research shows that people who are unemployed are two to three times more likely to commit suicide than those in employment.

According to the Samaritans’ spokesperson: “It’s true that unemployment results in poorer mental health. It leads to anxiety and depression, lowered self-esteem and feelings of hopelessness – all of which increase the likelihood that someone will think that life is not worth living.”

The World Health Organisation estimates that around one million people worldwide die by suicide every year. For every person who does take their own life there are about 20 more people who make an attempt.

At DCU, there are a variety of services available for students who are worried about their mental health. DCU Education and Welfare Officer, John Murphy, believes that there is a huge range of mental health supports available to students.

“Practically every third level institution in the country would have at the very least both a counselling service and an SU Welfare officer. These combined provide a great service to students,” he said.

But the question still remains on whether the government will keep their promises made in A Vision for Change, or will it become yet another non-implemented plan for reform.

How do you get help if you feel depressed?

The first step to getting help for depression is acknowledging that something is wrong. Is it vital for anyone suffering from depression to get a correct diagnosis.

Seeking accurate information about depression so that you can understand your symptoms and treatment options puts you in a better position to deal with the problem.

There is nothing shameful in admitting you need help; it is a brave step in order to help yourself.

• Depression plus… relationships
Depression and mood disorders can impact on your personal relationships. Once you have acknowledged that you are suffering from depression you can take steps to minimize the effects.

If somebody you care about is suffering from depression, they will need unconditional and non-judgemental support.
Listening to them can help a lot and make them feel like they have support.

Small gestures of kindness such as driving them to their appointment or meeting a friend for coffee can go a long way in making a person suffering from depression feel like they are not alone.

Difficult behaviour is part of the problem with depression. If you are upset by a remark or comment, try and not react angrily.

Once the depressive period had passed, you can speak openly to somebody who is depressed about how they hurt you.

• Depression plus… college
Dealing with day to day situations can be difficult when you are suffering from depression and treatment doesn’t happen overnight.

Once you have spoken to you doctor and taken steps to get help, your situation will start to improve. But if you are worried about your college work being affected by your mental health, let somebody know.

Speak to the head of your course or a lecturer you feel comfortable with who can point you in the right direction so that you can get additional help.

If needs be, you can also fill out an Exonerating Circumstances Form which makes your lecturers aware of any relevant information that could affect your exam marks.

• Living with Depression
Like with any mental health illness, there is no overnight recovery. But with the help and support of friends and family you will feel less alone. Your GP may recommend you take an anti-depressant to help deal with the chemical imbalance caused by depression.

This is usually one tablet a day and it will take three or four weeks before you begin to feel a difference from the tablets, so it is important to take them everyday. Most anti-depressants have no ill side effects.

It is also important to talk regularly to somebody. Your GP may recommend that you see a counsellor or psychiatrist. But don’t be afraid to talk to friends and family about your worries. Small steps are all that need to be taken to prevent somebody reaching the point of feeling suicidal.

If you think you or somebody you know is feeling suicidal you need to discuss is with somebody. AWARE run a depression phone-line which people can contact on 1890 303 302. If your not sure you are suffering from depression, AWARE also offer an excellent method of judging if you are depressed or simply going through a bad patch which is available at http://www.mymoodmonitor.com/.