“Don’t ask what’s wrong with me, ask what happened to me.”
This slogan on a double decker bus in London resonates with many people suffering from mental health problems who are sick and tired of being labelled with diagnoses and instead want health professionals to understand the circumstances that led to their poor mental health and lack of wellbeing.
Prof Peter Kinderman, president of the British Psychological Society, and a speaker at Mental Health Ireland’s recent 50th anniversary conference in Dublin, says health professionals need to “help patients by recognising their distress and how they live, work and manage in difficult circumstances”.
“We should replace diagnoses with a description of our problems and learn how we understand the world. Recognising the experience of depression – for example how and where people are living their lives – is more important than diagnosing it. We need empathy rather than sympathy,” says Prof Kinderman.
We are at an important juncture in Ireland regarding mental health, 10 years on from the policy document A Vision For Change, which charted the move from care of the mentally ill in large psychiatric hospitals to mental health services in the community.
Nowadays, it seems like everyone is talking about looking after their mental health as celebrities front campaigns and speak frankly about their personal experiences. But, is there a risk in all of this that there are still people deeply suffering in the shadows?
In the 1950s, Ireland had the highest admissions to psychiatric hospitals in the world with almost one per cent of the population (22,000 people) as in-patients in large Victorian institutions. These psychiatric hospitals began to close in the 1980s with numbers of in-patients dropping to 12,000 in 1984 and 1,227 in 2015. Ironically, Ireland now has one of the lowest numbers of acute psychiatric beds in Europe.
The Vision for Change document optimistically suggested that the total number of beds required should be 650. However, experts now question this figure, mainly because the full roll-out of community-based services has not yet happened with community-based teams lacking between 20 and 50 per cent of their full staff. Many also believe there is still a need for places of sanctuary where people can go when in crisis.
Akiko Hart is director of Mental Health Europe, an umbrella group of mental health associations throughout the EU. She says, “acute psychiatric units are often the places people stay when they are in crisis but a real sanctuary is a comfortable, homely and beautiful place, where people can bear witness to your distress in a non judgemental, supportive and respectful way.”
According to Hart, disassociating from traumatic experiences such as abuse and rape can be a coping mechanism in itself which needs to be better understood. “We also need more funding for alternatives to state services as places of sanctuary for people, as well as more focus on education, housing and employment rather than just on mental health services themselves,” she adds.
Focus on recovery
The idea of getting well again after a bout of depression, a manic episode or even a diagnosis of schizophrenia is slowly being embraced in Ireland with the focus on recovery rather than cure. The power of friendship as a therapeutic tool is not to be underestimated. According to Martin Rogan, the incoming chief executive of the community-based organisation Mental Health Ireland, relationships are critical to recovery. “People who have three friends who are not staff or other patients halve their re-admission rate,” says Rogan.
People with lived experience of mental illness are now also taking on roles as peer supporters and advocates within mental health services and in community based drop-in centres such as Gateway in Rathmines, Dublin, Áras Folláin in Nenagh, Co Tipperary and many other support groups throughout Ireland.
However, psychiatrist Dr Pat Bracken cautions against the hijacking of the recovery model by the mental health services. “There are organisations such as the UK-based Recovery in the Bin who say that recovery has become an add -on to the medical model and taken over by professionals. The big challenge for professionals working with the person and the family to formulate problems and solutions is to shut up and allow the patients and family to talk about the problems,” he says.
“The recovery model must see people beyond their problems to their possibilities, interests, relationships and dreams which give life value and meaning. It doesn’t reject medication or therapy but sees it as secondary,” says Dr Bracken.
Professor Agnes Higgins from the School of Nursing in Trinity College Dublin also cautions against bringing so-called “experts by experience” into a system that isn’t ready to work collaboratively. “If the practitioners aren’t trained to work with peer supporters, these peer workers will become marginalised,” she says.
Stigma and fears
Meanwhile, the stigma of mental illness remains another barrier in society, according to broadcaster Olivia O’Leary, who spoke out recently about her experience of depression as a young woman, working long hours in a stressful, male-dominated environment.
“Stigma hurts all of us and particularly those who suffer. Irish society still retains fears and memories about historic mental care which deters us after three decades of community mental health care of having faith in recovery,” she says.
“These cultural issues deter people from getting help. We need to inject hope and optimism around the fact that people recover from mental health disorders.”
Speaking at Mental Health Ireland’s conference, O’Leary echoed the sentiments of many others. “Timely access to a psychiatrist or a psychologist is a human rights issue but if, deep down, we don’t believe people will get better, the money will be diverted to other parts of the health services.”
In some ways, building resilience is now seen as the panacea to dealing with mental health problems.
“Resilience is about having the skills to bounce back from setbacks,” says Ilona Boniwell, an international trainer of resilience skills. But, as experts such as Prof Pat Donlon from the National University of Ireland in Galway says, fostering resilience is something communities need to do together. We need other people to care for us and believe in us to keep being resilient. It’s a life long journey for us all. Remember that slogan on the bus.