Mentally ill need to be treated with care and respect

The woman on the phone - let's say her name was Catherine - was upset

The woman on the phone - let's say her name was Catherine - was upset. The protest this week by a number of residents in Swords, Co Dublin, against the opening of a home for six mentally ill people had struck a rather personal chord.

Her son had been diagnosed with schizophrenia, at the "more serious end of the scale", when he was 20. She and her husband found themselves middle-aged, having raised a happy, loving family, looking forward to their retirement but facing the greatest challenge of their lives.

A few years on, beyond the tears and the questioning, they now look after their son at home. He has friends and a good social life, and they consider themselves lucky to be in a position to help him.

But they worry about his future when they die and whether he, too, might eventually need a place in a health board house, like the one in Swords. Catherine was at pains to say her son posed no danger to anyone. His condition was entirely under control with medication, she said.

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Nevertheless, there are people who don't know about her son's illness and, due to the taboo that still surrounds it, she likes to keep it that way. There is still a certain lack of understanding among older people and, in some cases, family members.

"If he had cancer, they would be around to help me. But with an illness like this, you can't cry on anyone's shoulder, because they don't understand it and they see a fine, strapping lad and say there's nothing wrong with him."

Their local health board has been a rock of support.

"The public psychiatric services are amazing in this country. We have received nothing but the greatest of help. We have been in hospitals and seen patients treated with the greatest of care and respect even though the conditions in them aren't great," said Catherine.

Some 30,000 Irish people are admitted for psychiatric treatment every year, the vast majority of them voluntarily. It's almost 1 per cent of the population.

One in a hundred Irish people will suffer from schizophrenia at some stage in their lives, but any number of conditions may technically bring a person under the umbrella of mental illness; like depression and eating disorders, ailments that are distressing and not discussed in polite company.

Some studies have shown up to 40 per cent of patients in general hospital wards may display some signs of untreated mental disturbance, according to one senior psychiatrist.

Most of those who do come forward for treatment, however, are treated outside the stereotypical psychiatric hospital setting. They may attend day services in their own communities for a number of weeks or months, and most will, eventually, make a full recovery. A few need continuous support, in either in-patient or community settings.

The Mental Health Association of Ireland (MHAI), which has as its twin aims the care of those with mental illness and the promotion of "positive mental health", has an uphill battle if this week's events are anything to go by.

But while protests such as the one in Swords may be dismissed as just another manifestation of creeping "nimbyism" - people with a not-in-my-back-yard attitude - they are perhaps more the result of a lack of understanding of mental illness and a fear of the people coming to live among them; people on medication and with, perhaps, some physical manifestation of illness.

The Swords situation is a "highly regrettable stance taken by some members of the community", said the MHAI chief executive, Mr Brian Howard. As early as 1984 there were 121 community homes offering 900 places for mentally ill people in rural and urban settings around the State. Today there are 400 such hostels offering 3,000 places, 79 of them either owned or managed by the MHAI and staffed by the health boards.

"I'd be telling a lie if I said there weren't objections to some of them," Mr Howard says. But in most cases, he adds, these homes were opened with the support of local communities.

The MHAI's public speaking programme for secondary schools and a new Mental Health Matters project for transition year will, Mr Howard hopes, make some small dent in attitudes.

But teetering on the other side of the scales, images of mental illness in film, advertising and the news media may continue to contribute to a culture of ignorance.

On its website, MHAI takes some newspapers to task for what can be an astounding lack of compassion in dealing with issues such as schizophrenia, an illness often treated as a joke or used to make an appalling pun for the sake of a headline.

And TV ad campaigns for certain beverages may, depending on one's viewpoint, be borderline offensive, depicting as they do people driven to the verge of apparent dementia by alcohol, itself a factor in many cases of psychiatric treatment.

It is worth asking whether health boards are behind the times in implementing government policy on mental health, given that Planning for the Future, the bible in these matters, is now 17 years old.

Mr Howard, who has a Department of Health background, insists that this policy, even then at the "cutting edge" when other European countries were just beginning to introduce community hostels, is still as relevant today as it was in 1984.

He suggests the main reason health boards around the State are still moving mentally ill people from institutions into hostel accommodation is, as is sadly the case with so many other things, that funding is only now beginning to catch up with political aspiration.

Communities need to be geared for this shift in policy, however. With the help of volunteers in 90 regional MHAI groups and a commitment on the part of health boards to involving local people in the process, can it really be so difficult to accept those with mental illness into our lives and our communities?

After all, the line that separates "positive mental health" from something slightly less than that is a fine one for most of us.

The Mental Health Association of Ireland, which relaunches in May as Mental Health Ireland, may be contacted at 01-2841166 and on the web at www.mhai.healthyirish.com