I’m a doctor. I’ve had cancer and I’d rather get it again and take my chances than be diagnosed with schizophrenia, psychotic depression or bipolar disorder in this country.
Seems extreme? Let me explain where I’m coming from.
This week an Oireachtas debate took place about the possible diversion of ring-fenced funds from mental health care to other areas of the health service. Points were raised about hospital beds, emergency departments, surgical waiting lists - these things are all urgent. There was genuine concern and reasoned debate about how we should balance health priorities.
We can’t balance health priorities unless we know what they mean. When we talk about mental health care, people think they know what we mean, but I’m not sure they do.
I am the typical doctor working in psychiatry. You don’t see my patients, you don’t hear my patients, and you don’t meet my patients. They are young men with psychosis, barricaded into their homes with their rooms covered in layers of newspapers to block out terrifying messages from the walls. They’re young mothers with post-partum depression who have become catatonic and can’t stand or speak. They’re manic middle-aged men talking about jumping out the window because they can fly. Or elderly women in nursing homes who have stopped eating because they “know” they personally caused the Holocaust.
It sounds grim. The thing about it is, all these people can recover fully and live normal lives if they get the support and treatment that science has shown to be effective. That means inpatient psychiatric care with intensive, specialised nursing. They’ll need a psychiatrist, psychologist, occupational therapist, physiotherapist, and social worker. If these things are not provided, the prognosis for each of these patients is bleak.
Let me tell you what it’s like to be the junior doctor on call for psychiatry, in any hospital. You assess these four people with their distraught families in the emergency department and you try to understand their problems so you can make a judgement call on the level of risk they pose. You know they all need admission for treatment, but there are only two free beds on your unit. Even this is stretching your nurse colleagues to the limit, they’re short on numbers and you know that by admitting these people you’re creating a dangerous situation for patients and staff, but you have no choice, and they support you. You ring around all the other hospitals in your region or beyond, to see if there are any beds in other hospitals, and eventually find a safe place for your third patient. One person has to be sent home with their bewildered family and a referral for an outpatient clinic. You are awake for several nights wondering if they’ll make it.
You don’t need to be a doctor to want to help someone in pain, and you didn’t need me to tell you any of this to know that cutting funds to psychiatry services is a bad move.
It’s been heart-warming to see mental health problems become increasingly normalised and talked about. Anyone who works in mental health has been genuinely overjoyed to see campaigns that help people recognise and deal with symptoms of low mood or anxiety. These are real ways to reduce the numbers of people who develop more serious mental health problems. Most people with these symptoms never need to see a psychiatrist and recover with help from GPs, family, and therapists. But people with serious mental health problems will always exist and will always need care.
Psychiatry has never enjoyed parity with other medical specialities, has never been adequately funded, and has always had to wait its turn, cap in hand. There was no Celtic Tiger for people who have serious mental illnesses. It simply did not exist for them, did not touch their lives. With the promised ring-fenced funds there was a chance that our mental health system could benefit from the recovery. It's what we live for in psychiatry - meaningful recovery.
We pay our taxes for my patients to get the care they deserve. We do this because we know that mental illness does not care who you are, where you live, where you went to school, how many children you have or if you pay your taxes - this could be you, me, or anyone you love.
As far as I know, nobody in mental health services around the country was looking for eternity pools or Nespressos for acute psychiatry units. We want to be allowed to continue providing services that save lives. Maybe even build on them so that finally mental health care will be as well-developed as other medical services. We’re not looking to reinvent the wheel, just to bring services up to scratch.
Ring-fenced means the money stays, come hell or high water. My patients go through hell and high water every day and they should not have to wait at the back of the line any longer. .