IRELAND HAS A rather effective way of keeping a certain class of miscreant off the streets. They are people who are a nuisance to have roaming the streets at best; and a danger to themselves and others at worst.
The state keeps many of these people under permanent lock and key, a great number of them in quaint and dank institutions. For their crimes they are stripped of their privacy, made to eat what cheap meals they are given and contemplate their sins as they stare at blank walls. Misbehaviour from these delinquents may be met with physical force and restraint. For many of them there is no opportunity for parole, even if they improve their behaviour; for there is no parole officer assigned to track their performance.
I am not, of course, referring to any old criminals; be they rapists or garlic smugglers, drug dealers or car thieves. Their human rights are well looked after. I am referring to the mentally ill, be they at the temporary mercies of our health system or its permanent residents.
I pray that I will never in my lifetime see the inside of a high dependency mental ward as a patient; but I do hold dear a friend with whom I would trade places if I could to save them the torment. This has given me an interesting perspective over the years, visiting places few enough will ever venture and meeting people who have been in and out many times, or are permanently hosted within their walls.
Mental health has been the poor relation within our health care system for many years. Even during the boom the sector received meagre resources compared to some of the more PR friendly health initiatives. Though we may not all understand mental illness, there is not likely a soul among us who would knowingly do those afflicted out of proper care. Nevertheless there remains a stigma that is translated into policymaking.
Last year there was to be an additional €35 million earmarked for mental healthcare provision that was simply sucked into covering the wider HSE overspend. Instead of hiring an additional 414 posts in mental health, the bureaucrats looked at this €35 million and thought, “This’ll generate a few headlines, but nobody will care the same as if we closed down an A&E department”.
The 414 positions that were planned are sorely missed in a variety of areas. Dozens of the roles were focused on suicide prevention – Ireland has one of the highest suicide rates among young men of any country in the EU, and we have tragic cases emerging from our schools on a regular basis. Our solution is to point people to fine charities like The Samaritans while the state fritters money away.
Reports from the Mental Health Commission last year pointed out that in many residential institutions patients have to do without any care plans and in several institutions there were no psychologists available to work with patients. That’s like having a surgical hospital with no surgeons. It would be ridiculous… But these are only mental health patients we’re talking about.
Institution after institution and ward after ward have been found wanting in the care they offer their patients. As an effective prisoner under the Mental Health Act, it is sickening to consider that patients are held without any chance of reprieve when they have no care plan to help them win their freedom or even an improved standard of living. The sloppy care is not down to poor staff, but a lack of good people. Those 414 roles that weren’t filled so James Reilly could look moderately less incompetent are the roles that would fill some of those gaps.
When a person becomes mentally ill and needs to be committed under the Mental Health Act you generally need specialist teams to perform an ‘assisted admission’ – which is to say, forcing a person who is ill into treatment. There aren’t enough of these teams. I know of a case recently in which a GP, who is the first to assess a person for referral to an assisted admission, was run out of a house by a mallet-wielding person suffering from a manic episode.
It took 25 hours for a specialist team to become available to take that person to hospital against their will. It was only by the grace of good fortune and the care of those around that sick person that they did not come to harm during that day. This is quite normal. The alternative to a specialist team is the Gardaí, and while they are trained to deal with the mentally ill they are not nearly as likely to achieve as painless an admission as possible versus a team of nurses.
When you see a person acting strangely, even violently, on the streets you assume it’s a criminal; not someone who was referred for urgent care 20 hours ago but never got it. If that person is lucky enough that it’s only the Gardaí they manage to get violent with, you possibly might think the rough handling they receive on their way to a holding cell is their just desserts, instead of the result of a pen pusher kicking €35 million into the black hole of branded drug payments and senior management pensions.
There are teams of mental health professionals operating in our communities, attempting to keep those who suffer from recurrent illnesses on their outpatient care plans and away from major harm. These people sometimes operate from the boots of their cars. There aren’t enough of them and they have too much ground to cover, leading to more admissions for acute care when people who aren’t looked after slip into predictable episodic behaviour.
In such a small country I have met people in boardrooms and pubs and politics who I originally or subsequently ran into while they were high as a kite or swinging digs at the nurses trying to administer their medication on a ward. Perhaps it is this experience that gives me a strong perspective on the lack of proper care afforded these people, who are you and me minus or plus a few chromosomes or particularly influential life events.
They don’t deserve to be stigmatised. They don’t deserve to be kept in squalid conditions. They don’t deserve to be held under the enormous powers of the Mental Health Act without proper care plans or professionals to look after them and ensure a speedy recovery. Those who are permanent residents deserve better than to become, as the bureaucratic parlance puts it, ‘institutionalised’; or, as you and I might understand it, all but chained to their chairs to watch the damp spread across their walls.
If a prisoner in Mountjoy were tackled to the ground by five guards and forcibly injected with tranquilisers there would be a human rights case in the courts before dusk. Of course, this is part of treatment for some sick people and is unfortunately right and proper. But, what if that patient could recover faster with a proper care plan and a psychologist to look after them? Instead of spending eight weeks locked up they could be out in four with proper care… Would the additional four weeks of being held down and shot up with drugs constitute a breach of their human rights?
I reckon it would. But who cares?
Aaron McKenna is a businessman and a columnist for TheJournal.ie. He is also involved in activism in his local area. You can find out more about him at aaronmckenna.com or follow him on Twitter @aaronmckenna. To read more columns by Aaron click here.