Mental health 'a heavy title to bear'

The attitude of those working in mental health is as crucial as funding, the Pfizer/’Irish Times’ health forum heard

‘REMEMBER THAT words are signals, counters. They are not immortal. And it can happen . . . that a civilisation can be imprisoned in a linguistic contour which no longer matches the landscape of . . . fact.”

Words from Brian Friel's play, Translations, were quoted by Headstrong founder Dr Tony Bates in Galway last week to describe how language can shape attitudes to mental health.

"Language" is very powerful, as it "alienates us from what is wrong", Dr Bates told the Pfizer/ Irish Timeshealth forum in Galway-Mayo Institute of Technology (GMIT).

In the 27 years he worked in St James’s Hospital in Dublin, he had never met a “schizophrenic”, but had met people with particular views, he explained.

“I remember one student working with me who remarked with wonder that everyone was so sane there,” he said. It was very important to treat people as individuals, and to “hold a vision” of the person, he said.

Mental health in Ireland: Is Ireland on the Edge?was the theme of the forum, chaired by Dr Jacky Jones, and also involving NUI Galway law lecturer Dr Mary Keys, Jigsaw youth panel member Rowan Marshall, and the HSE assistant national director for mental health, Martin Rogan.

The issue of language had been raised during audience questions by Fine Gael councillor Peter Roche, who spoke publicly last year about the impact on his family of the suicide of his son Colin (24) in November 2010.

Cllr Roche noted that many young people, particularly men, had been unable to bring themselves to seek help directly from support services, but quite a number had contacted him and he had made referrals.

Cllr Roche said he had a problem with the term “mental health” as it was a “very heavy title” and something “less threatening” would be more appropriate.

Responding, Mr Rogan said that HSE media advisers had been opposed to the term’s use for a recent campaign, but there were people who were comfortable with it.

More than 500 people take their lives in Ireland each year, about 12,000 people present in emergency departments with evidence of self-harm, but there were an estimated 60,000 people who harmed themselves and did not seek help, he said.

For every 1 per cent increase in unemployment, there was a corresponding 0.79 per cent increase in suicide, and if Irish society valued care and support for people with mental health issues, it would have to commit to giving far greater resources, he said.

Expenditure in this area has dropped from the internationally recommended figure of 12 per cent of health budgets to just 5 per cent, Mr Rogan pointed out.

Some 88 per cent of that HSE allocation was spent on staff costs, he acknowledged, but some 1,500 staff had been lost in the past 18 months and some 600 more were due to leave.

Mr Rogan said Ireland had one of the "world's best policy documents" on mental health – the 2006 document, A Vision for Change– and was moving away from large "granite" psychiatric institutions.

However, he was criticised by Jim Quinlan of the Limerick Mental Health Association, a member of the audience, who said the HSE was “talking about statistics, improvements and options” while the reality was that a referral to a psychologist could take “weeks or months”.

Mr Tommy Roddy, who said he was involved with groups such as the Critical Voices Network, said he had been given a “life sentence” when diagnosed with manic depression at the age of 20, and had spent two periods in a psychiatric hospital.

He was prescribed lithium but was taken off it at the age of 28 by a psychiatrist who offered him counselling. While psychiatric hospitals might be closed, psychiatric units were still prescribing anti-depressants, he said.

There was also a “huge problem with attitude” among those working in the profession, Dr Mary Keys said.

While there were “pockets of excellence” around the country, people were “not seen as individuals”, Dr Keys said. “A lot of it is about changing mindsets, and it is not just about money.”

People are “still angry” with the way mental health services had engaged with people, even though there were indications of significant change, Dr Bates acknowledged.

The Jigsaw drop-in centre in Galway, which Headstrong was instrumental in founding and funding, provided an option for many young people.

Some might meet criteria for clinical depression, but this was to “miss the point” that they were struggling with heartache, loss, bullying due to homophobia, and other issues.

However, people who were suicidal did not want to be “airlifted out” of their own crisis, but wanted to grow out of it, he noted.

Dr Bates said he still believed change was happening, and Ireland was shifting to a “very different recognition” of the fact that it was not just one in four people who was affected, but “everyone was struggling”.

Revolutions always began at the margins, never at the centre, he noted.