If we are to progress our mental health services, we must connect our health and education systems.
Earlier this month I was speaking in a school on the themes of resilience and mental fitness, when after speaking I was politely approached by an elderly lady, who asked me could she have a quick chat away from the crowd. My assumption was that she was looking to speak to me about the health of a loved one, or indeed herself, so I invited her into a quiet room so we could talk. At first she told me that she enjoyed the talk and took a lot from it, and also complimented our website, but then the tone of the conversation changed dramatically.
She spoke to me about how a niece of hers was struggling severely with depression and OCD, and how she has found it virtually impossible to get professional help. She was on a waiting list for almost five months and still had not received any word on when she would be seen by a professional. She was self-harming and finding it hard to leave her bedroom, while in the meantime she fell further behind in her studies which added to her pressures.
The distress this caused her grandmother was overtly evident as she was shaking with anger and frustration. She said something that really impacted me, and made me think. She said that although she admires the fact I am trying to raise awareness, I have a responsibility to also highlight how difficult it can be to get the support and treatment required for so many.
I thought of nothing else on my long drive home. I thought back to my own journey with my mental health struggles and was so thankful that I was able to get access to support when it was required and when I decided to engage with it, but the reality is so many people aren’t as lucky. Perhaps they live in an under resourced area when it comes to mental health services, or perhaps the services in that area are not adequately supported at a macro level. Perhaps they can’t afford private health care insurance and struggle to get immediate help through the public hospitals when they require it.
I have to admit it brought a cloud of anxiety over me, unsettling me, but also awakened me to the fact that although we are starting to normalise the conversation around mental health in Ireland, and help seeking behaviour is being promoted and not judged, the resources available to deal with this professional demand are not being supplied.
Mental health economics; demand doesn’t equal supply
As a mental health campaigner I really don’t want to be in a position where I am asking people to take the step towards asking for help, an incredibly frightening and arduous decision for many, only to find out that quite often the help is not available.
I recently spoke with our Minister for Health Leo Varadkar, a man that I actually like and feel wants to progress our health system, but in reality has a poison chalice of a ministry, which could take decades to revolutionise. I asked him about the long term mental health strategies the government are putting in place and I got the feeling it certainly is not a high priority, as issues such as overcrowding in hospitals and other more pressing problems needed to be prioritised.
I also questioned him on the strategic communication between the health and education departments when it comes to developing a more effective education system that could perhaps ease the long term burden on our health system, by way of developing life skills in our youth. Although he suggested that he and Minister for Education Jan O’Sullivan do indeed communicate quite often, he didn’t elaborate on any practical blueprints being looked at by government apart from perhaps introducing wellness and mental health as a subject on our Junior Cert curriculum, a box ticking gesture at best.
Minister Varadkar spoke of the ring fenced budget for mental health which he pointed out was hard fought for by himself and Minister for Mental Health Kathleen Lynch, and I have no doubt they did fight for this, but the truth is it doesn’t come close to providing the financial resources we will need to develop effective services for the population now willing to seek help.
I recently spoke with GP, broadcaster and A Lust For Life contributor, Dr. Ciara Kelly about her experiences on the ground when it comes to how our mental health services are resourced. She has major concerns of the effectiveness of our Child and Adolescent Mental Health Services (CAMHS).
Dr. Kelly points out a few worrying issues within the service;
“In my area there is no consultant at all. We can now only refer kids who are actively suicidal, while nothing else gets seen. It’s very difficult for GP’s to rule out suicidal tendencies in those who self-harm, but self-harm as a condition is not being accepted by referral. There is no public counselling, no public psychology except through CAMHS, and this is not operating in my area. There is no proper public eating disorder service. GP’s, who in general are not adequately trained in talk therapies are trying to help their patients in a 10-15 treatment window which is just not suitable, while 17 year old patients aren’t accepted by either adult or adolescent mental health services. Also GP’s in areas such as mine that don’t have current psychiatry consultants can’t refer to areas outside the catchment of their region so often the teenagers are left in limbo”.
This is totally unacceptable in a country such as ours.
CAMHS’s is not being adequately resourced to deal with the issues our youth are facing. It angers me that I am asking people to seek help, and it’s often the case that it’s too hard for them to find it. We have to get real and develop a system that can sustain the level of people now coming forward to learn how to deal with their mental health more effectively. We must demand this.
In fairness to balance, I have heard some positive stories regarding our mental health services. The positive feedback seems to come from a result of the work of some incredible individuals trying to deliver a strong service with limited resources, something I have noticed quite a lot. Great people pushing hard, not getting the funding and resources they require from a macro level to deliver an effective service in all areas of Ireland and to all demographics and all ages. These great passionate people deserve more support.
Focussing our collective energies on prevention is essential
It seems that a vast majority of this budget is also aimed at providing doctors, hospitals and medication for those perhaps most in need of acute care. While this must be maintained and in fact dramatically increased, so as everyone requiring this type of care can access it without waiting lists and without private health insurance, we sincerely have to push towards a gargantuan increase in resources and budget to primary care and community led initiatives which aims to prevent rather than react, using talk therapies, education and counselling.
Minister Varadkar suggested it’s not all about providing more money, and on one hand I agree, we all have a responsibility to help break the stigma, but the services have to be provided to help put people back together who feel broken, people who have made the courageous decision to take control back, when it comes to their mental health.
Our education system, our teachers, are key to prevention
We also have to recognise the importance of education. For me, our educators are the most important sector within society. Recently, I heard a piece on The Last Word on Today FM, where people were attacking teachers for an abundance of reasons. It angered me to the core, and I am not even a teacher. It once again was a political debate about pay, but when you strip it all back and observe what our educators have to deal with on a day to day basis, a lot of the arguments being made on the radio seemed petty and trivial.
I have spent so much time travelling to schools around Ireland to speak about mental and emotional health and I have spoken with many teachers. They would speak to me about the serious emotional stress they would feel when they were aware of someone in their classroom who is struggling and how it’s virtually impossible to leave it at the school gates when they leave after the bell goes.
Teaching in general is a very caring profession, and often those that care too much can take on the burden of other people’s problems. Now some of you may read this and say they get well paid for it and loads of holidays, but I disagree. No salary or extended holidays will make up for some of the emotional stresses teachers have to deal with in many cases.
I had one case where a teacher asked me to come into a classroom where one of her students was shaking with anxiety and in floods of tears, almost inconsolable. The only person on the planet who knew of this girl’s pain was her teacher, who was supporting her and helping her, privately and without question through her darkest days. Luckily, that girl spoke to her parents that evening and is now receiving help, but for months it was her teacher that acted as her only light in this world.
Granted there are teachers out there who aren’t like this, but the vast majority are, and I feel it’s important I stick up for them and highlight some of the incredibly humane work a lot of them do.
Teachers want to be able to implement mental health strategies into the curriculum but they simply do not have the resources to do this from a government level. Many schools are taking it upon themselves to create awareness and environments of non-stigma, but it needs to be more than this, much much more. It must become priority number 1.
I won’t listen to another parent tell me that their child’s wellness or mental health should come second to their academic achievement. This attitude is a side effect of societal conservatism and fear of change that has been bombarded into us for decades now. We have been programmed like robots to conform and take a certain path in life, where we are told we must fit in, but some people don’t want to fit in. Our schools need to be giving our youth real life skills they can take forward into the world of adulthood. By investing in these, our youth will by default improve in all aspects of their lives, including their academic ability.
Listening to The Last Word, I thought to myself ‘why do we always get angry at the wrong people?’ It’s not the teachers’ fault that we fell into a deep recession, it’s not our nurses’ fault, it’s not the fault of the Gardaí nor the majority of our private sector workers. It’s the fault of greed, corruption and an inability to effectively manage capitalism and all its pitfalls. We should direct our anger towards the right people and support and respect those who had to at times, pull themselves and their families through a horrendous and frightening few years in this country.
Taking care of generations to come
We need to recognise that it’s our teachers who are going to educate a new generation, hopefully a new Ireland, hopefully a happier, healthier and more understanding Ireland. We need to resource them to do this, not just financially, but emotionally. We need to demand that our Minister for Education and Minister for Health stop ticking boxes and start joining the dots so that in twenty years’ time our health system is not under the intense pressure it is now.
The reality is that if we don’t invest in longer term strategies we will have the same mental health service issues we have now in twenty years’ time. But, it doesn’t have to be this way. A key problem with government and how the political system operates in the current paradigm is the ‘short term win’ agenda some politicians and parties utilise and spin, to win, and get into power. It’s apparent that many politicians don’t really want to meaningfully engage with more longer term 10 – 30 year strategies as they believe they need these short term ‘wins’ to win over the masses and get them elected.
Also if indeed a political party was trying to establish a longer term plan, as soon as the hands of power change, visionary plans are re-shaped and re-shuffled meaning longer term visionary plans simply never become real. Real change takes real time. It’s up to all of us to no longer abide by nor collude with this ‘short term win’ political ideology. We simply have to plan for future generations and we can do this now, by investing in wellbeing and mental health education, prioritising it as part of everyone’s schooling in this country, which will reduce the acute stress on people and indeed services in years to come.
Of course we also need to deal with what is happening now, but we must in addition plan wisely for the future so that this continual never ending fire-fighting does not burn us all out in the process.
We have some brilliant minds in this country, brilliant groups of people doing great things. We just have to join the dots, bring all of these great ideas and passions together to change attitudes, and develop bright new systems that truly serve the people. It can be done. Headhunts and political wars won’t do it, action will. Real strategic and focused action, and if I am being honest, now feels like the right time to do it.
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