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Mental Health Services In Ireland – The way I see it.

One of our members – Jill from ‘Not Quite Dead‘ asked me for my take on the Mental Health service provision here in Ireland and also made reference to the provision made in England.

As it happens I am and Englishman living in Ireland, having moved over here to Ireland some several years back.  Thus I have some experience of both the provision here in Ireland and the provision in England.

Additionally, due to the work I used to do before my health crashed and burned, and whilst I was still living in England, I was very involved with both Mental Health Practitioners and Clients over there.  Although I should point out that this was some years back now and at that time I was keeping my own mental health difficulties a very closely guarded secret.  [It can, for numerous reasons, be very difficult for folk working within the field to come-clean about their own mental health issues – especially back then.]

So I feel I should clarify a couple of things before I go any further…

1.  What I am about to share I share in specific response to the question I was asked and about my personal experiences of what is in my opinion an over-stretched and poorly managed Mental Health system here in Ireland and NOT in criticism of the Mental Health Practitioners themselves.

2. I love Ireland and the people here and consider Ireland to be my home far more than I do England.  Whilst I appreciate that it is possible that some folk may respond with the attitude – ‘well if you do not like it then go back to your own country’ – it is extremely unlikely, knowing what I know of the Irish people, that this will be the reaction of very many.

3.  In terms of Population, the town I live in is about 40th out of the top 100 towns and as such is relatively mid-range to smaller in population size and this does have an affect on provision.

4.  I share this now only in response to the  fact that the question was raised.

So, having prefaced what I am about to share with those four points just what is my experience of the Mental Health Service provision here in Ireland?

Well, I have accessed the Mental Health Service here in Ireland shortly after and ever since I first came here some 8-9 years ago.

Knowing that we were moving over here we had all of our medical records (including my psychiatric records) printed out along with letters of referral and brought them with us, handing them to the relevant departments shortly after our arrival.

In terms of my own mental health whilst in England and immediately before coming over here I had the following mental health practitioners working with me…

A Psychiatrist.

A Psychologist

A cognitive Therapist.

A Clinical Psychiatric Nurse

A Psychiatric Social Worker.

I and my family knew each of them by name and I had a good rapport with them seeing them on a regular basis – some weekly and some monthly.

When I moved to Ireland I did so with full expectation that this level of care would NOT be available to me here in Ireland but not knowing what level of care would be available and having determined that the change of lifestyle, the better living standards and the fresh start all made the move a viable proposition.

What I did not know however, and did not anticipate, is just how greatly that level of care would drop by moving here.  Nor did I know that what I would end up with would be just one 3 monthly visit to the psychiatrist and that the psychiatrist I saw each time would never be the same psychiatrist 2 visits in a row.

Ignoring the obvious problems with the extremely reduced level of care, the constantly change in psychiatrists means that it is in fact impossible to build up any form or relationship, rapport, or trust.

Add to this the fact that the service is so over-stretched that in order to cope with demand for each time slot they sometimes have to book in two or even three clients to see each of the one (or if you are lucky two) psychiatrists on duty, and you are left with a system whereby clients are being seen by a psychiatrist who is…

a) over-stretched,

b) over-stressed,

c) unable to dedicate enough time to truly offer any detailed assistance,

d) too rushed to even fully read or even (in my opinion) adequately consider your case notes and thus to familiarize his or herself with your case, and/or

e) afford you the client/patient with any sense of being respected or adequately cared for.

(Again I point out that my criticism is of the mental health practitioners themselves but of the system they are forced to work with.)

In respect of my own mental health symptomatology, I can tell you that I experience; low self-esteem and bouts of extreme worthlessness, a tendency towards self-harm, suicidal thoughts, paranoia, fluctuating mid to extreme  problems with focus and memory, depression, mania and numerous other things.

So I ask you, look again at the above list of results in respect of the psychiatrists working under these conditions and consider the knock on effects to someone like me?  And remember I am one of the fortunate ones as although I do experience all of the symptoms I mentioned above (plus some I have not mentioned) I am, in the main and outside of severe episodes, fairly high functioning and am able to cope and to rationalize most things – although trust me it is so very difficult at times.

But the facts remain that…

1. I had (to the best of my knowledge) been attending the mental health services here for some four years before anyone thought to mention that if I experienced any difficulties I didn’t need to wait for or to ring for an appointment and could just  call in.  Something which was in fact only mentioned not during one of the rushed 3 monthly appointments I mentioned above but at a wellness clinic I volunteered to attend.

2. Even though my memory and focus problems are well documented on my notes, when I forgot to attend an appointment one time, I was made to wait several months before being given another one.

3.  Even though I myself have always provided the psychiatrists with an up-to-date list of medications which I am on (and admittedly there are a few) each time one of my medications change.  At my last appointment I was seen by the consultant in charge (as opposed to a duty psychiatrist) and he was..

a) upset by the fact that I had been on the wrong anti-psychotic, and

b) annoyed over the fact that the anti-depressant I was on should never have been prescribed to someone with a serious heart condition like mine.  (Obviously he immediately changed both of these meds.)  In fact I have had my heart condition for years and was prescribed both those meds here in Ireland, by that team, and have been taking them for years.

I am sure you will agree that each of these are likely to be resultant from the overstretched and unsatisfactory conditions I mentioned above.

So to summarise, in essence it seems to me that there is a huge need for reform in respect of the Mental Health Services provision here in Ireland.  And certainly I am not alone in this opinion – there is an organisation here in Ireland called ‘Mental Health Reform‘ and whose goal is…

Mental Health Reform’s goal is an Ireland where people with mental health difficulties can recover their good health and live their lives to the fullest. Mental Health Reform promotes improved and prioritised mental health services in Ireland. To read our mission and vision and value statements, click here 1

And there is, in my opinion, a fundamental reality that needs to be acknowledged and responded to here and it is this…

In any health care service provision, be it mental health or physical health.  Where the funding of that provision is inadequate and the subsequent level of that provision far too limited for the needs placed upon it.  The resultant focus will inevitably be forced towards that of crisis management rather than proper client or patient care.

And I make that claim not as a result of any cynicism or annoyance at my own personal experiences, but rather as a result of many years working in management both within the social care sector and in conjunction with many health care practitioners and numerous government funded bodies in England.

The comment leading to my writing this article reads as follows…

“(Did I read you’re in Ireland? I was wondering about the mental health system there as I have a friend in a London suburb who is devastated by a lack of availability to sophisticated care for her son…)”

And I want to say thank you for that comment and I hope that this has gone some way to answering it.  But before ending this posting (and I do apologise for its length) I did want to raise one last very important point and that is about Advocacy.

The need for good independent advocacy – especially in respect of Mental health clients has been recognised for some time now and actually appears in the Mental Health Act in the UK  – “From April 2009, statutory access to an Independent Mental Health Advocate (IMHA) has been available to patients subject to certain aspects of the Mental Health Act 1983. IMHAs exist to help and support patients to understand and exercise their legal rights. IMHAs are available to most detained patients as well as patients on supervised community treatment or guardianship. Other patients whose treatment is subject to the special safeguards provided by the Act are also eligible for the services of IMHAs.”  1

In respect of your friend I recommend that you (or she) take a look at The Department of Health’s page on this subject and also contact an organisation called ‘Mind’ which is the UK’s leading Mental Health Charity and which offers excellent services including an infoline – the number for which is 0300 123 3393.

Additionally, and perhaps more appropriately in respect of your friend they also have a Legal Advice Service which “provides legal information and general advice on mental health related law covering mental health, mental capacity, community care, human rights and discrimination/equality related to mental health issues.” 2  and the number for that service is 0300 466 6463.

So there you have it,  the way I see it at least 🙂  I apologize again for the length of this post but I do feel it is important and I do hope it has been useful.

I would also very much like to hear from our UK members as to their experiences of Mental Health Service provision in the UK 🙂

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