I PEN this article as someone readers may call a veteran of being in a family who have worked in Muckamore Abbey, Holywell and the Royal.
I was privileged to have been brought up in the grounds of Holywell, who provided semi-detached bungalows for 12 of the families employed there - staff from all disciplines.
If one is familiar with the Abbey, Holywell, Purdysburn, Gransha, St Luke’s and so on, they all have something in common. They were all built a few miles away from the nearest town - out of sight, out of mind.
The stigma still exists. Mental health remains the Cinderella of the NHS.
If one listens to local radio you occasionally hear requests for family and friends who are in hospital. How many do you hear for a relative in any of the above?
Many changes for the better have taken place for Service Users (SU). Holywell once had over 950 residents. The Abbey and Purdysburn many more.
People now refer to Knockbracken or Tobernaveen.
So why have these changes come about?
There is no single answer but a combination of events ranging from better education about mental health to more appropriate medication and treatment regimes.
Significantly the Service Users’ voices are finally being heard. Just because you have an illness, why should you be locked away from society if you pose no risk to yourself or others?
The biggest changes came about after indepth research showed that people could recover just as quickly at home or in supported accommodation in local towns and villages.
This coincided with the development of staff who also made the transition from hospital to the community.
It was not an overnight shift, nor one that was fully supported by society - some simply did not want people being decanted from psychiatric units and moved into their street.
A lot of hard work on the ground was done. I recall the new manager of the Praxis scheme in Antrim going around knocking doors in 1990 to explain the proposal of re-opening vacant dwellings for a supported living scheme. There were no objections. People were glad to hear that the houses were going to be occupied rather than left to go to wreck and ruin.
It was not only the NHS involved in these schemes. Local sister agencies like NIE, the DHSS and St Vincent De Paul helped too, the latter providing furniture.
New benefits were made available like DLA and grants and loans became available.
A lot of work was put in to ease the movement of these people back into the community.
This thrust was managed with very little support from local politicians, however. They have not been following the ball in regards to mental health.
COVID-19 has helped show the bigger picture of how mental ill health affects the individual, families, the community, the workforce, education. It is also having a major impact on all disciplines throughout the caring sector.
Have any of our politicians who are spear-heading change ever actually visited a mental health unit, either in hospital or in the community? Have they spoke to any of the front-line staff face to face, or are they just going to rely on what senior managers, Band Eights, tell them?
Staff are a little scared to speak out despite talk of transparency. How many whistle blowers survive in their posts?
Mental health issues can impact every class, colour or creed. The effects can be very different, as can the causes.
It can’t be treated by NHS staff alone.
Much can be prevented by early education, intervention and a mind set change.
No amount of change, money, medication or therapy will work, however, unless the person is prepared to make lifestyle choices, if their current lifestyle is a contributing factor in their illness.
A lot of mental health issues are now attributable to the use of alcohol, street drugs and over the counter medication. The medication that mental health staff offer people will not be effective if the above continue to be used at an unhealthy level.
We have a duty of care to help people in need - but that help is being negated by the substances they use recreationally.
This has major budget implications for the NHS, never mind the clinical risk of giving someone medication which they can then sell to others.
The legal guidelines of NICE are now being rigorously stuck to, to help safeguard the Service User, the clinician and the Trust.
Society today seems to think that government departments are there to provide for all their needs. A lot of people abdicate their own responsibilities, expecting others to pick them up.
We all need to accept that we need to take control of our own actions and behaviours.
I have friends who work in the Housing Executive, the DHSS, Council and education who have come across the same issues. People are all too ready to complain.
If you are in a Housing Executive property, you are expected to care for it. If you applying for benefits, you should be honest.
People complain about the Council and litter. But who puts it there?
As for education, parents need to teach their children daily living skills.
If a service is free of charge it is open to abuse ad we lose it - even those who need it.
Earlier I mentioned the DLA benefit, which has been replaced by the Personal Independence Payment, or PIPs. The number of people who have been denied PIPs is scandalous and the assessment process is flawed.
People who have a severe and enduring mental illness or a life long physical disability should not have to be assessed on such a frequent basis. I see the impact of this process having a major psychological and financial impact on individuals and families.
There is a gentleman in Antrim who had been on DLA. Then PIPs came and he was refused and he won’t reapply due to the stress of the paperwork and having to go over the same stuff again. He feels he is begging.
This man was a civil servant until he was involved in a road traffic accident which left him with a head injury. No PIPs?
The arrival of COVID has brought about many changes which we thought were going to be temporary such as lockdowns, contact restrictions, PPE and working from home.
Lifestyle changes were forced on everyone, whether they were vaccinated or not.
COVID has made us look at things from a different perspective.
Despite all the vaccines and interventions, people are still being adversely affected - perhaps for life.
We have all been asked to change how we conduct ourselves. This should be the same for mental illness.
Good mental health should be taught from an early age. It would certainly have a more positive influence and help people to deal better with daily life events, relationships and work. It would also deter people from starting risky behaviours or becoming reliant on others to solve problems.
The crisis facing mental health services today has not just come about because of COVID.
A lot of new generation conditions like ASD, PTSD, personality disorders have been added to the menu of mental health.
This is not helped by society believing that there is a cure for it all.
Like some physical ailments, there is no 100 per cent cure. There are changes, adaptations and medications that can reduce the impact.
Have we become too reliant on medication? It depends who you ask, but one thing for certain is that the mental health service, whether it be at hospital or in the community, is struggling.
It would help if people sought early intervention. If you have a mechanical appliance that was not working right you get it fixed as soon as possible to prevent a more expensive outlay further down to road.
It’s okay to let our bodies malfunction because it will be fixed free of charge by the NHS.
There are other supports that have been diluted down, such as structured day care and drop in centres.
Mental health is akin to council waste services. Once, like the NHS, they were the only ones providing the service but now it is a multi-billion pound business. But does that really make it better?
I remember my first ward in Muckamore - Moylena.
One of the Charge Nurses did a bit of tutoring and the first paper hand out I received was reality orientation, or RO.
It’s applicable today as it was then - though we don’t apply it the way we should.
Things have changed in the NHS too. Staff are fed up hearing false promises fro the suit who never come to the shop floor.
This applies to the politicians at Westminster and the Assembly. The purse holders need to hear how the money is being spent.
This is where huge sums of money are lost in poor procurement and expensive consultants, telling the front line how to suck eggs.
Management need to look at how they are bleeding staff, many of whom are young and well-trained but have become disillusioned. People forget that sometimes the young professional does 50/50 Agency NHS - quite often they are the main bread winner.
People should be asking if the Agency is offering £10-12 more than the NHS, what is the real cost of that hour?
It is good that the courts are taking a sterner approach to the thugs that verbally and physically abuse staff. A tough line is needed for those who feel that it is their right to hurl abuse because they ‘pay our wages’.
More must be done to address the question of staffing levels. The Royal College of Nursing confirmed that 500 nursing staff will retire from the service this year, yet only 300 will be newly qualified. And how many of those will stay on these shores?
In conclusion I would like to return to one central point: we have to train society to take more care of their mental health, to rely less on others and on medication.
The politicians also need to talk to the service users and the band of unpaid carers - many of whom are in their 70s and 80s - to learn what sort of service they want delivered.
The health service is a little like global warming. The government needs to waken up and deal with the reality of the situation.
I have mentioned the NHS a lot in this article, but they are by the means the only players in the care of the mentally ill. I mustn’t neglect the private and voluntary sector and the army of relatives out there.
At a time when the service is stretched I would also point out, if the government statistics are correct, that one in four people have a psychological disturbance of mind. As Boris Johnson said at the start of COVID - ‘we are all in it together’.
We all have a part to play in our health care - and we must be more preventative rather than reactive.
Talking, listening and education can help reduce the reliance on medication or, if you are lucky, hospitalisation.