Ireland’s Health Service Executive puts forth great effort in preventative care for our physical health. Off the top of my head:
- Semi-socialized healthcare. The Medical Card insurance system ensures that affordable primary care is within reach of the financially vulnerable.
- Subsidized general physicians, prescriptions, and emergency hospital treatment.
- Preventative screening for certain cancers and physical conditions, along with free/good-as-free winter immunization clinics.
- Anti-smoking laws that are rather harsh by American standards.
- A burgeoning movement to introduce laws that will restrict junk food in a like fashion.
- In schools, our children are encouraged into physical activity.
And so on, but for our physical health. I am at a loss when it comes to a description for a mental health equivalent. There are no awareness campaigns at primary or secondary levels in schools that I am aware, nor much discussion between friends and family; indeed, there are big taboos still because mental illnesses are invisible-if I am physically fit to participate, why don’t I participate? So there remains deep-set misconceptions, ignorances, expected silences, and occasions of outright and disgusting bigotry around mental health issues in Ireland, especially among the older population.
My mum is case in point: No matter how I explained my problems her, despite whatever carefully-picked words I used, and in blithe ignorance of my painfully-written letter, she simply could not and cannot grasp my flirtations with self-harm, self-hatred, suicidal ideation, and depression.
She resolutely puts the horse before the cart: I’m not idle at home because I’m ill, but instead I am ill because I’m idle at home. A job will break me out of this. I may as well have spoken Klingon when I tried to explain for the fifth time that I there was no point in trying to find a job if I was unstable and at risk of another breakdown. My mother truly cares, but she is completely unable to understand it, because it was simply never discussed.
Even in the younger population, there can be pressure on you to sit down, shut up, fit it, and be healthy. Although I’ve had the immense luck to be surrounded by understanding friends and housemates in Galway who had their own demons to wrestle, I have seen firsthand people who were pressured by friends and coworkers to just get over it and be well again. Any whisper of mental problems at all in the workplace may as well be a death knell for your career-in my own job hunt, I’ve already run into concerns from potential employers that, at best, I’m a risky investment. Sure, Mark’s intelligent, but eh. You know? What if he goes all crazy again?
Despite all this, preventative care for mental health is nonexistent in Ireland, and post “incident” care is limited. A GP can issue a tentative diagnosis for stress and depression, but his or her ability to treat this is restricted beyond a referral to HSE services and a prescription for Lexapro. It is crass and unfairly reductionist of me to to word it so, but a GP can be looked at as a human version of WebMD or Google: They can diagnose and refer you, but they simply do not have the time, expertise or resources to treat you at the root.
I have had four encounters with therapy services between 2010 and 2014, and every single one was inadequate, although I didn’t cop onto this until later
I tried to commit suicide in 2010, realized just what was going on, and presented myself in the casualty department of UCHG. In conjunction with my family GP, I was trialled on several antidepressants, and referred to an emergency counselling service at Shantalla in Galway.
She helped with the immediate anxiety, but there was no cross-examination or any other questions asked. She sat there and listened while I talked myself down over the course of five or six sessions, then pet me on the back, and send me on my way. There were not attempts to uncover issues that I only became aware of in hindsight.
The second time was on campus at I.T. Sligo in late 2012. This counsellor was provided through the college, and just first, she did work talking me down from an anxious high, but like the first she wasn’t able to tackle them before I hit the limit on allocated sessions.
I tried to commit suicide after this, just before Christmas in 2012, and I turned to my GP in Sligo for help . He was useless.
He stuck his fingers in his ears, chanted “won’t prescribe anything, can’t help you, go to therapy, goodbye” and shoved me out the door with a blister pack of sleeping pills and a letter of referral to a community service in Sligo that at the time I mistakenly thought was provided through the HSE. This third counsellor told me to pray for respite and salvation, because the service was in fact provided through the Roman Catholic Church. I was in a room with a crucifix on the wall after I had attempted suicide, and I was being told to put my hands together and “…appeal to a higher power for respite and solace from your troubles.”
I’m not religious, I have never been religious, I am likely never will be religious, and although I could less who or what you may believe in, I still feel offended over the situation-would it have been possible for her to ask me?
In each case, I can’t blame the counsellor in question for how they interacted with me; I’m one patient among many, the services in each case were metaphorical boxes of sticky plasters, and there simply wasn’t enough time for them to build enough of a rapport with me-even Prayery McAwful in Sligo. If you’re feeling down or stressed, these are the services for you. If you have gone through major trauma, don’t even bother.
All of this is a roundabout way to come back to my fourth ncounter with counsellors, this time through the HSE’s Counselling In Primary Care (CIPC) service in Newcastle, Galway. I had a bad trigger event come at me unprepared, I snapped, I retreated to my attic basement, and I quietly sobbed and cut my arm up for a good week until friends prevailed upon me to see my doctor.
My GP in Galway proverbially hugged me, apologized for the lack of care in Sligo, put me back on Lexapro for anxiety, gave me a letter of referral to CIPC, and sent me back out the door. I was stuck in waiting list limbo until the middle of February because of a mix-up in the correct contact number for me, but I was finally reached and given an early March appointment.
I had a single thirty minute interview with a CIPC counsellor wherein I was interviewed for suitability, and basically found to be too damaged for the service. CIPC is supposed to be for people who have clear-cut problems. Bereavement and stress are the lynchpins of the service, where I have clinical diagnosis of PTSD, Major Depressive Disorder, and enough time on my hands for introspection that I’ve been able to put my finger on some of the deeper causes. Yeah, no, sorry Mark, there’s the door.
All of my experiences have led me to believe that Ireland has awful mental health care on the whole, although there is pretty solid crisis care both from the HSE and from the community if a person threatens to self-harm-there is widespread awareness of suicide and its hidden danger-but meaningful long-term therapy either nonexistent or simply out of reach if you live outside of a major city.
I’m loathe to bitch and whine about faireness, because we both live in a world where I’ve seen precious little and because karma, but after I turned to the HSE for help I was put into a weird bind that required me to get better, find a job, and make money so that I could pay for the kind of serious treatment that I needed to get better, find a job, make money, and pay for treatment.
In the end I got well in own time with the almighty assistance of close friends, and now I’m trying to find a job so I can make the money in order to pay for treatment. Yay.