May 23rd 2018
Thank you Shari McDaid and all at Mental Health Reform for inviting to the Oireachtas tomorrow. I have been writing as an activist about the inadequacies in provision in both dignity, care and attention of people who are diagnosed as mentally ill. I take this opportunity to return to the essays/dissertations I would have written while studying at Trinity College Dublin as a mature student, using whatever opportunity given to me to write about my personal experience and expectations regarding mental health provision:-
A brief outline from Mental Health Reform http://www.mentalhealthreform.ie/
Briefing note on the Mental Health (Amendment) Bill 2017 http://www.mentalhealthreform.ie/…/2017/…/Briefing-note-on-the-Mental-Health-A…
- There is a Bill going through the Oireachtas at the moment which would update the Mental Health Act, 2001 in a few key ways. It has been proposed by Fianna Fáil and passed report and final stage in the Dáil on 14th July 2017. The Bill is due to go to report and final stage in the Seanad at the beginning of May 2018.
- The Bill contains certain significant changes that strengthen the rights of people when they are in hospital for mental health care.
- The Bill will also support the right of inpatients to make decisions about their own treatment by linking the Mental Health Act, 2001 with recent law that affirms everyone should be presumed to have capacity to make decisions.
(This includes providing people with the supports they need to be
able to make decisions.)
9th February 2001
Student number 97810959
C\TRINITY\DISSERTATION PROPOSAL: 10/02/01
ADVOCACY FOR THOSE WHO ARE CLASSIFIED MENTALLY ILL?
WHO REPRESENTS THE INTERESTS OF THESE PEOPLE?
(I was one of the 15 trainees of Cycle 1 of the Trinity Horizon project so therefore the methodology used is reflexive.)
Michel Foucault said that we each use the template but each revision of the source, produces a new schemata and with it a new image of the world. Within this context, I want to review primarily the findings of the Trinity Horizon Project, an EU Human Resources Initiative. This was both a training and research programme to facilitate the entry/re-entry of women recovering from Depression to the workplace. I do not wish to differentiate between men and women, and Mental Illness will be referred to instead of depression so I will be selective in findings chosen to reflect this. Mental illness is the term that refers collectively to all diagnosable mental disorders. It has a significant impact on the functioning of society and the quality of life of citizens. ‘Some 400 million people in the world suffer from mental and neurological disorders or from psychological problems such as related to alcohol and drug abuse (World Health Day 2001, WHO).
Concept of the Problem:
Stigmatisation. demonisation, classification of mental patients functioned as a procedure of objectivisation and subjection. Foucalt differentiated between the document and monument and its a poignant analogy. The reality now is a move from medicalisation to a more sociological based, less State economically draining option.
Advocacy for those who suffer from Mental Illness
My approach is to briefly review work completed by the World Health Organisation, United Nations, European Union and the UK. The UK have enacted the Human Rights Act in 1998 and there is a draft Bill for Mental Health under review. The NHS, the Charity Organisations, and Philanthropic concerns all acknowledge the impact of Mental Illness, the impact on social structure, the affect on many members of the labour force and participate at National policy compilation and implementation. From the US, to the UK, to Ireland, the process is removal from the ‘Asylums’ to the community. However, this process has implications. First there is adjustment, medication compliance, contact links, support, basic necessities of keeping home or sharing, the issue of homicide and suicide subsequent media interpretation. It takes a very short time to be institutionalised but it is very difficult to adapt to being ‘outside’ as the revolving door situation of return to hospital establishes. The argument is that the medications have improved, the hospital options are a stigmatised, non financial propositions and Ireland must follow the approach taken in other countries.
Advocacy is required urgently. Someone who can represent the interests of people who by virtue of illness, hospitalisation, sedation, concentration impairment, no physical exercise, no dealing with ‘everyday life’ are discharged into a non developed community care system to survive. There are day care centres available but they tend to be understaffed, and without a proactive system for rehabilitation.
Literature provides the framework for further research
This is a critical summary and assessment of a range of existing materials dealing with knowledge and understanding in an given field. Its purpose is to locate the research project to form its context or background and to provide insights into previous works.
Overall from the readings the following policies in relation to mental illness are encouraged:
- to reduce the number of people who develop mental health problems
- to help those with mental health problems to improve their overall quality of life
- to eliminate the stigma associated with having mental or emotional problems
- to provide effective interventions in areas in need
- to promote ongoing research into causes and treatment of mental disorders (WHO).
‘We recognise that the brain is the integrator of thought, emotion, behaviour, and health. Indeed, one of the foremost contributions of contemporary mental health research is the extent to which it has mended the destructive split between ‘mental’ and physical health. Common sense and respect for our fellow humans tells us that a focus on the positive aspects of mental health demands our immediate attention….The investment does not call for massive budgets; rather it calls for a willingness of each of us to educate ourselves and others about mental health and mental illness and thus to confront the attitudes, fear, and misunderstandings that remain as barriers before us. It is my intent that this report will usher in a healthy era of mind and body for the Nations’ (Satcher, M., Mental Health Organisation)
The policies outlined and the foregoing statement establish sound principles and guidelines but are removed from the exposures mentally ill people encounter, in their changing society.
My personal experience of the Trinity Horizon project consolidates the foregoing. It was a research and training programme with an objective of providing work or study to prevent participants becoming long term unemployed. Employment outcome was 51.7% as compared to the control group of 26.7%. Further education was 80% for Cycle 1 and 50% for Cycle 2 (Trinity Horizon Project, Centre for Women Studies, 1998: 139). The participants were introduced to subjects as follows:- Creative Writing, Women and Society, Group Work, Computer Training, Personal Development, Physical Activity, Counselling Support Programme, Women and Health. Cycle 1 lasted 6 months whereas Cycle 2 lasted 9 months. Cycle 2 derived the advantages of a Mentoring system and a work exchange programme abroad. The approach was innovative but did not gain support to continue. The Consortium consisted with Aware, a national voluntary organisation which provides support for people with depression. Dr. McKeon was a member of the Advisory Committee and Dr. Sheila Greene of the Department of Psychology was also involved. They contributed advice to the design of the research.
Advocacy is imperative to guard the interests of those who albeit are a small minority but all the same exist: Electric Shock treatment as detailed in the Mental Health Inspector’s report is still used in Ireland. The 1981 Pippard Report stated that ‘an 1980 survey carried out provided ‘a catalogue of blundering and dangerous incompetence’. 100 locations were visited and only 22 met the prescribed standards of the Royal College guidelines. A high percentage delivered an unnecessarily large electric charge. When survey’s were held in 1998, no significant improvements had occurred. A large number of people are not aware that Shock treatment is still used as part of Psychiatric treatment. The Irish report provides no similar checks so no similar report to the Pippard Report carried in the UK. Do we really know what is happening?
In the UK, a non family member can be appointed to act on your behalf while ill. This we need too. The introduction of divorce leaves certain members of society without control and vulnerable to an ex-partner whom they cannot and may not be well enough to divorce and if able to, not for a minimum period of 4 years. Likewise, the choice of an independent member to family is probable when the new Mental Health Legislation is passed in the UK.
Ireland requires a system of advocacy, a representative body, comprising of a spectrum of people. This is proposed in the UK legislation. It would review the law, aim to protect the individual rights, monitor the voluntary organisations and initiate policy. As it stands we rely on the media and people like Vincent Browne and Joe Duffy to probe.
In relation to psychiatric illness, sociology, medicine and the health sciences will have to work together and multi-disciplinary teams will exist with an overall objective of rehabilitating the ‘mentally ill’ person. In the UK, social workers work as part of the multi-disciplinary teams in community work.
Further background to the Hypothesis.
‘Part of the cost of excessive drinking is found in three major problems; road traffic accidents, recurrent drunkenness and true compulsive alcoholism’ (Parsons, V., 118)
Link with alcohol the 4,000 in the UK who commit suicide, the majority of whom have excess alcohol in their blood stream, this quote, written in 1967 remains harrowing. Suicide is the major killer of young men under the age of 24 in Ireland. Road Traffic Accidents are responsible for 40 deaths already this year. RTA’s involve mainly young people with high levels of alcohol. I want to raise the query of state of mind of the drivers. A car and the risk factor is an attractive suicide option yet it is not mentioned. Again, one could add in Drug Addiction for assessment. All three areas stand independently and in a hierarchy of ‘Shame’. Where is the vested interested? The ‘Drink’ market – now a Global entity of an MNC, while Psychiatry might be said to be a pawn of again a global entity of the merged Glaxo, Wellcome and SmithKline Beecham. It is interesting to note that Glaxo have moved into ethical/socially motivated type investments and inter alia have established a Global mental health resource centre. This I want to review also. Illegal drugs – many of the Third World countries rely on these exports for their existence. We need funds in Ireland to sponsor Mental Health programmes and Alcohol and Drug abuse programmes.
The hypothesis is that Education opportunities be made available for those who have attended a 1 year course based on the outcome of the Research and Training of the Trinity Horizon project. These participants qualify for back to education assistance. Cycle 2 reported positively about the Mentor programme and I would strongly recommend a mentoring system in the provision of future Rehabilitation programmes. University lecturers should sponsor such programmes pre-University intake as should people in a variety of professions and business interests. Those participants who gain access to full or part-time employment should have a mentor assigned to them. I recommend something similar to psychometric testing be completed to identify areas suitable to the person’s personality.
The Irish Constitution was of paternalistic nature, this followed by a subsidised health care system or privately funded system backed by Voluntary Insurance payments fostered the institutionalised approach of the Mental Health Care Provision. The economics now alter this. It is necessary for a change in attitudes of those affected by Mental Illness so that they can assume a ‘Take Responsibility Attitude’ and to foster this Mentoring provides an ideal method. A ‘Spotter’ network has invaluable benefits to maintenance of mental health.
In 1992, the donations made to mental health charities by the general public amounted to £6 million but to animals the amount was £43 m and to those diagnosed with cancer £82 m. (Clare, A., 1993: Depression and How to survive it). I suspect inspite of a decade nearly passed this will not have substantially changed. I aim to review this.
Stigma – ignorance. Life is around a person’s potential to compete in the structured market of today. Social policy determines fate. People who may not be well enough or for whom adequate support is not provided are released from hospital. The media, the police, and many ‘ordinary’ people are not briefed to deal with mental illness issues. The shooting dead of Pat Carty near Granard leaves a lot of questions to be answered.
The Royal College of Psychiatrists provide free of charge a video – The Changing Mind Campaign two-minute film’ 1 in 4′. We need this awareness for a proactive approach to education of school going population.
Lack of education or knowledge about mental illness, drug addiction and alcohol addiction by people working in the medical profession, involved in education at primary, secondary and Third Level is far from acceptable. The whole area of Adolescent and child psychiatry is only opening up now when precipitating factors apply to children whose parents qualify under the above health categories. We see today but not tomorrow. We need to learn from countries that are legislating now on these topics.
Sainsbury Trust for Mental Health was established in 1985. It is also heavily involved in the design of mental health policy. This project is built on research and development findings and is designed to influence national policy information. Mind another voluntary organisation is involved in influencing policy through campaigning and education in the UK. Aware, Grow, and others are similarly involved in advancing the views, needs and ambitions of people with experience of mental distress but have no provision for rehabilitative programmes is provided by them.
UK legislation is fully compatible with the Human Rights legislation. Objectives
At local level:-
– there must be mental health promotion
– high standard
– ease to re-connect with team
– care plan
– support for the carers
– positive efforts to combat social exclusion.
– sort out the stigma
– Care programme Approach
Education, mentoring, training programme, are all imperative to attain this level of service.
One issue that is causing concern in the UK regarding the reform of the Mental Health Act is that the Health Laws sanction the treatment of the person in the community (removing the person’s freedom to choose) and to make them comply with their medication regime. This previously could only be done in hospital. The implications are with the person’s right to freedom.
A methodological framework for the analysis of documentary reality:
Initial Letter followed up by Interview:-
Dr. Peggie Fine-Davis/Mary McCarthy/Sheila Greene/Patrick McKeon
The Trinity Horizon model of training provides the basis for ongoing education/work/mentoring system that forms part of my hypothesis. Access to the data sources will mainly be via the Internet as most sources have a Web site.
Dr. Jim Maguire/John Kearns. Dr. Maguire is Consultant Psychiatrist in the North Eastern Health Board. This is the public health service which is at present engaging in the movement of patients from the hospitals to the day care centres. The internet will provide EHB data source but direct contact with Dr. Maguire will also be possible to ask questions.
Bernie, Ann, Helen, Noreen, Maura, Mary, Clare, Una – participants of cycle 1. They will provide feedback, opinions, answer questionnaires if necessary. Interviews are also possible.
Brian Gallagher, Gallagher Shatter, Chairman of the Mental Health Review Commission. By letter or appointment. He will advise on matters of advocacy and protection (lack of protection) of the person labelled mentally ill.
Internet will provide most information. Further clarification can be gained by letter and if necessary a meeting.
Access to the Neuropsychology Department in Trinity – concentration, memory problems due to medications.
Occupational Therapist (partially sighted) who has worked in several psychiatric hospitals and has interesting ideas.
In certain instances, perhaps where letters are required, I will take a positivist approach.
The area I am reviewing is embedded in Law and Health and vast amounts of written documentation exist. It means sifting through it to arrive at questions that are not already answered. Then I can be positivist. Others question may merit the interactionist approach. Basically the approach will be semi-structured. I want collective stories and to give voice to those who are marginalised or silenced by society. I will where necessary engage in a creative technique using mutual disclosure. However, I do not intend to focus on this as my experience is that people are numbed to sad stories, they listen, they don’t hear.
The template exists, resources exist to be tapped, the market is unfortunately an expanding one and particularly for those under the age of 24. Social anxieties exist, what is unknown is that many people mask the social anxiety disorders that result in later problems of mental illness, alcoholism and drug addiction. People need to see and hear again!!!
I have not completed a pilot study as the research report by the Trinity Horizon team is comprehensive. I will review this again at the time I prepare for the dissertation.
9th February 2001
97810959 C\TRINITY\DISSERTATION PROPOSAL: 10/02/01
Health and Saftety 1974 – If you knowingly allow an employee under the influence of excess alcohol to continue working and this places the employee or others at risk, you could be proscecuted. It is estimated between 3% and 5% of the workforce are over the alcohol threshold during working hours. ICI employees are required to attend work with no impairment of alchol. Terminate employment otherwise. Likewise, Whitbread plc, have an alcohol policy. They have an advice/support programme for employees. Overcome the Drink Culture – media.
Alvarez, A., 1974. The Savage God. Great Britain: C. Nicholls and Co.
Clare, A., 1983. Depression and How to Survive it. London. Ebury Press.
Kelleher, M.J., 1996. Suicide and the Irish. Dublin: Mercier Press.
Parsons, V., 1967. Ethical Responsibility in Medicine. A Christian Approach. Edinburg and London: E&S Livingstone Ltd.
Fine-Davis P., and McCarthy, M., Trinity Horizon Project. Dublin. Centre for Women Studies.
Reforming the Mental Health Act – Department of Health UK
Hyper Guide Proposals for New Health Bill
NHS Direct Health Care
Royal College of Psychiatrists
The Sainsbury Centre for Mental Illness
Mental Health and the Workplace
Challenges and Opportunities – 13th March 2000
Reforming the Mental Health Act
The new Legal Framework.