A 2013 paper by the Irish College of Psychiatry on youth mental health was distressingly blunt: “the reality is that young people’s psychological and mental health has never been worse”. Highlighting substantial distress among young people in Ireland, the paper warned that disorders are often left untreated or unaddressed, and are of greater prevalence than in many other countries in Europe. The My World survey in 2012, which obtained data from 14,000 Irish young people between 12 and 25, found that over one-third of people were outside the normal, healthy range for both depression and anxiety. Of individuals between 17-25, 51 per cent had experienced suicidal ideation. Seven per cent had attempted suicide, and of these individuals less than half had accessed support following an attempt.
Suicide is the leading cause of death and neuropsychiatric disorders are the main cause of disability for Irish young people, according to the World Health Organisation. Primarily, these disorders comprise depressive disorders, bipolar disorder, schizophrenia, alcohol abuse and self-harm. But the complex relationships between these disorders continue to stymie families, friends, and mental health professionals in Ireland, as do the best methods for treating them. While talking about mental ill-health has seen a huge surge in recent years, led by high-profile celebrities publicising their own struggles and by a spate of campaigns aimed towards normalising mental illness, we remain largely in the dark as to the best way to provide comprehensive, reliable care that catches all individuals in distress.
What is the point of our political parties continuing to commit to “implement” these policies if they haven’t been implemented in the last decade?
Efforts thus far towards treating mental health problems – and even, optimistically, preventing their manifestation entirely – have been curtailed by poor government policies that have brought us funding cuts and broken promises instead of extensive change. Lacklustre efforts by previous governments have meant that vital services have had to curtail their work, that new treatment centres cannot be opened, and that, more starkly, money is not being poured into saving lives. While the two largest parties in the general election, Fine Gael and Fianna Fáil, were both kind enough to mention mental health in their manifestos, each committing to the implementation of A Vision for Change, the substantive and extensive 2006 expert group report on mental health policy, this may not be sufficient enough to engender improvement. A Vision for Change is now ten years old, an outdated foundation upon which to base decisions about the future of mental health treatment and funding in this country. Though the report is extensive – it comprises nearly 300 pages and details services for a variety of disorders – it is limited mainly by time. Ten years have passed, and the provision of mental health services has arguably not improved. What is the point of our political parties continuing to commit to “implement” these policies if they haven’t been implemented in the last decade? Who’s to say that anyone will bother implementing them now?
Speaking to The University Times, Aoife Ní Shúilleabháin, Vice-President for Welfare of the Union of Students in Ireland, lamented the poor handling of A Vision for Change over the past ten years: “there has been no proper implementation and no proper funding to realise this strategy”. It is essentially outdated as a plan of action at this point. In the absence of a viable alternative policy plan, Ní Shuilleabhain points to strategies that universities themselves must implement to tackle the costly and debilitating impact of poor mental health. “We want better on-campus services and shorter waiting lists,” she says. “We need to ringfence funding so [the Counselling service] know what budget they have to work with”.
While Trinity itself has better services than many universities in Ireland – with a fully-fledged Counselling service, group meetings, one-to-one counselling, Wellbeing Wednesdays, peer support and Niteline – the services within College have been hit hard by funding cuts and a lack of resources. Yvonne Tone, student counsellor with the Counselling service, emphasised that they “continue to fight for services” in order to continue to expand and improve, and help more students with their mental health. They have a long waiting list for one-to-one counselling and greater funding would allow them to see more students more quickly. However, Tone emphasised that long waiting lists “are a good thing rather than a bad thing, as they show a demand for the service” and a decline in stigma associated with help-seeking. The Counselling service is a valuable component of Trinity’s health services, but must be supported more in its essential work.
More generally, crisis services in Ireland must swiftly improve. When it’s a matter of urgency, any delay literally costs lives, and at present the services just aren’t sufficient to catch those in distress. Outside the opening hours of student counselling services, Trinity students can call Samaritans 24-hours-a-day, can call Niteline between 9pm and 2:30am, and can call Aware between 10am and 10pm. They can call College emergency services and they can call an ambulance for themselves, although that may not arrive for some time. They can call an out-of-hours doctor, but what if they don’t want to be charged or can’t afford to pay? And what if they need emergency help but don’t want to face the insanity that is A&E? Grim news stories surface in Irish media regularly, telling of the heartbreaking wait for emergency care and the stark inadequacy of the care received in busy departments that are not specialised to deal with the unique array of symptoms and concerns of an individual experiencing mental distress. Though A Vision for Change committed to providing every community with a specialised 24/7 care service, this has not happened. You have to wonder how many people have been abandoned to A&E for lack of options in the ten years since that recommendation was made.
Every young person should be educated on the best way to access support if they need it, as well as how to recognise mental illness in themselves and others, and strategies for improving their own health.
Ní Shúilleabháin proposes a 24/7 crisis intervention service for those experiencing debilitating psychological distress, adding that A&E is not appropriate for individuals feeling suicidal due to long waiting times that might deter them from seeking help again. For Ní Shúilleabháin, “the more of these services we have, the more catchment we have”, as well as potentially reaching individuals who may not respond well to traditional forms of therapy, or who may not be willing to seek help until it’s almost too late. The 2010 International Declaration on Youth Mental Health is clear on this point too: services must be extensive, collaborative, and sufficient in order to engage individuals who may have different needs. In fact, they believe that every young person should be educated on the best way to access support if they need it, as well as how to recognise mental illness in themselves and others, and strategies for improving their own health. Ní Shúilleabháin advocates for more radical ideas on mental health education, proposing that students could receive course credit for taking modules on coping skills and healthy behaviours. While this seems simplistic, many people don’t know the breadth of techniques that can stave off mental ill-health. Education should begin earlier, be more extensive, and be sure to include young people from all backgrounds and communities.
The Declaration states that they “do not accept that the death of any young person by suicide is inevitable”. I would go so far as to say that leaving any individual to struggle with psychological distress without adequate help is also unacceptable. Whatever new Government we end up with should not accept that. We, as students, friends, family members, activists and voters, should not accept that either. While the occurrence of mental illness in some individuals may be inevitable, there is no reason why anyone should be left without support. The future of mental health services in Ireland is at a turning point now, and only substantial pressure from us upon our fledgling new government will see any change. Ten years from now, we don’t want to be looking back at the same report and the same broken promises, wishing we had done more.
If you have been affected by any of the issues raised in this article you can contact Trinity Counselling at (01) 8961407 and www.tcd.ie/Student_Counselling, Niteline at 1800 793 793 and niteline.ie, or Samaritans Ireland at 116 123.