After the Asylum
People with mental-health problems were once locked away in asylums. Now most live in the community, like Mags Kelly, whose story is told here. But they can easily fall through the cracks of an underfunded service.
About 3,000 former long-stay inpatients now live in State-funded group homes, of which there are about 300 in Ireland. A report for the Mental Health Commission found the climate and culture of many of these residences “reflected those of a ‘mini-institution’ rather than a home-like environment, especially in the high-support residences”.
As a result, it found many didn’t work towards independent living in the community in any real sense. In addition, community mental-health services are supposed to offer patients – or service users – access to a broad range of treatment to give them the best chance of recovery.
But the Inspector for Mental Health Services has found that most people are still offered a more traditional, medicalised version of mental-health treatment rather than the holistic service envisaged in our policies.
Minister of State for Mental Health Kathleen Lynch says services are still being developed, but insists the jigsaw pieces for effective community-based services are being put in place. “We hope to have all the [multidisciplinary] teams in place soon. We’re hiring hundreds of additional posts . . . We’re going to focus more on enhanced rehabilitation and different types of services. We don’t have everything we want, but we’re a long way down the road.”
Pilot “deinstitutionalisation” projects are under way across number of HSE regions which are trying new ways of supporting patients in the community. In addition, local and regional bottom-up initiatives are providing high-quality community services, driven by local leadership.
Slí Eile, near Charleville, in Co Cork, is one of them. Once a stately mansion, it is now the setting for a therapeutic community residence for up to eight former psychiatric patients.
“We are not caring for people here, but we care about them,” says Joan Hamilton, who founded the centre. “It’s supported living, so it’s a stepping stone to something more permanent.”
Her search for an alternative model of recovery came from seeing the lack of support available for her daughter. Slí Eile’s aims are simple: help residents to believe in their own potential, develop the skills to manage their mental illness and, in time, create a transition to a more independent form of living.
All the residents play a role in running the house, such as cooking, cleaning and managing household budgets, as well as running a bakery, which sells bread and scones to local shops. It has had remarkable successes over the past few years, with residents who once seemed destined to languish in the psychiatric services progressing to living on their own in social housing.
“This isn’t rocket science,” says Hamilton. “It’s what people want. It gives people a sense of structure and purpose, a reason to get up in the morning, in an atmosphere where they feel safe and accepted. It’s all about making choices.”
Mags returned to give the community residence another go.
“I couldn’t settle down at first. I was going around at the start, bringing my handbag everywhere. I was afraid my cigarettes or money would be stolen,” she says.
“I found it hard: I was going to bed during the day, I’d sleep anywhere because I’m so used to it . . . I’d sleep on the chair here. I just felt mentally drained and exhausted . . . But that went. I began to like it here.”
She started seeing a counsellor. She began to steadily lower her levels of medication, with the advice of a psychiatrist.
She discovered health problems she wasn’t aware she had: diabetes, emphysema and liver problems, linked to her life on the streets. There were also internal injuries she had suffered from assaults.
Recovery is still a step-by-step process. There have been slip-ups along the way. But, for the first time in a long time, Mags feels she’s heading in the right direction and is hopeful about the future.
“I cry a lot in my room. I think of the past. I lost a lot of friends. I had sixteen friends – only two of us are alive. Overdoses, suicides. I was only young. I’ve seen too much. I grew up too fast,” she says.
Studies suggest that between a third and half of homeless people in Ireland have a diagnosed mental health condition. But a lack of specialised community-based services means many end up ricocheting in and out of homeless shelters, emergency accommodation and the street.
Mags is fortunate to be able access to the kind of community support she needs.
“I never thought I’d last this long . . . I still feel panic over the smallest things. I was so used to being beaten, mugged, or sleeping in a homeless shelter with 50 others. But these days. I can turn off the light and be safe.”
For an interactive narrative version of this story see aftertheasylum.com
Photographs by Bryan O’Brien