Talk Is Cheap

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oisinOisin McKenna

Professional help is not.

The price of being depressed in Ireland.

Oisin McKenna writes:

“This week, Twitter was inundated with urges to Please Talk. This happens every few months, often at a time when poor mental health has affected someone in the public eye, and resulted in tragedy. Spurred on by the tragedy of the event, masses of people surge towards Twitter to express their upset, and urge anyone also suffering from mental illness, to make sure this does not happen to them. #PleaseTalk. This is the advice given to them.

I am a long term sufferer of chronic depression and an anxiety disorder. To those of you urging myself and others suffering from similar diseases to just talk, I want to know; who are you suggesting I talk to? What do you think I should say to them? What action would you advise this person to take? And what do you think would be a positive outcome? Seriously. When you advise me to “Please Talk”, what do you actually mean? Talk, and then what?

I have been talking for years.

Let’s make it clear from the start, that talking only constitutes a tiny part of the solution to poor mental health. A real solution requires massive economic, social, and cultural shifts in the provision of medical care for mental health. Centring the narrative on the importance of victims simply “talking” about mental health, moves the responsibility and blame to the sufferer, and away from the society and social policies that so often inhibit their recovery. It places the impetus for recovery on the victim, not on the services, support and treatment they require and should be entitled to, that are too often, simply not available to them.

It is tempting to reassure a vulnerable person that if they only just seek out help, that there will be an abundance of help available, help that is financially accessible, broadly available, and of a high quality. However, this undermines the fact that there is a huge deficit in the quality and accessibility of support available. We need to be able to say that services and attitudes in relation to mental health are catastrophically inadequate, whilst still reassuring the vulnerable that they can get better.

Urging the mentally ill to talk is absolutely not enough. By simply encouraging people to talk and not thinking about what the consequent aftermath of this is, we are essentially ignoring the entire fraught process of recovery.

Let’s talk about that.

I talk regularly to my boyfriend, parents and close friends about my condition. I’ve spoken with them about it for quite a while. They are supportive and kind and I appreciate that very much. But what are they meant to do? My boyfriend is not a medical professional. My parents are not medical professionals. My friends and co-workers are absolutely not medical professionals. And none of them are in any position to administer medical treatment, for my medical condition.

Naturally the next port of call would of course be to speak to actual medical professionals. This is a much more difficult thing to do than just “talking” however, because medical care for mental health in this country is really, really expensive.

I am 23. Like many people my age, I work in low-paid, unsecure, administrative and service work, but I do have a full time job. My weekly earnings are €16 too much to be eligible for a GP card, but paying for treatment is a huge strain that sometimes I can’t afford. I now pay for GP visits and my monthly prescription of sertraline. I used to go to counselling too, but after applying for an overdraft to keep up with payments for the sessions, was no longer able to go. I still haven’t paid off the overdraft.

Just because someone is employed, and thus not eligible for a medical card, does not mean they can afford even basic medical treatment. A huge proportion of those living in poverty in this country have jobs.

The economic realities of austerity and poverty in which many young people find themselves, are huge contributing factors to poor mental health, but they are also the barriers that can block off any viable hope of professional medical treatment. There are free and low cost services available like Pieta House and the Samaritans, but these are emergency, temporary solutions, and do not necessarily aid in day to day recovery.

Let’s imagine economic inequality was no barrier, and we could all comfortably afford to receive all the medical treatment we require. Unfortunately, this would not mean that this medical treatment would be administered in a professional manner, in line with best international practice.

Provision of care for mental health is too often left up to the GPs’ own personal biases and beliefs, without any solid grounding in actual medical experience. I have encountered GPs who have been aggressive, flippant, and completely reductive when dealing with mental health issues. My own experience, and that of so many of my peers, has been of full-on dismissal when discussing mental health with a GP. I have been to several GPs who could not understand why I was depressed. As a young person, they expected me to have no major reason to be mentally ill, despite being a 20-24 year old male, and thus within the one of the most at risk demographics for suicide in this country.

I have been to too many GPs who don’t really think mental health is a real thing. I have been to too many counsellors more interested in opening chakras or passing judgement than in following best psychotherapeutic practice. There is a proud tradition in Irish medicine of not following best international practice, but instead, following the individual “ethics” of the practitioner or institution. This has been particularly evident in maternity care. My own experience has led me to believe it is true of care for mental health as well.

My worst experience with a GP was when after confiding in him that I was suicidal, he brusquely prescribed 3 months citalopram, and told me to make sure I didn’t “top” myself before I returned.

At the end of this prescription I did not have enough money to renew it, and the GP’s behaviour had badly dented my trust in medical support. Because of this, I did not try to seek any help elsewhere. I stopped taking my medication, and went into a period of breakdown, where I found it extremely difficult to get out of bed or leave the house, and seriously considered suicide. This was not because I was too afraid to talk. It was because, economically, I was not in a position to continue treatment, and the treatment I had received was poor, disrespectful, and completely contrary to best medical practice.

Who is responsible for this? What standard of care can we expect? Who regulates this? What’s the protocol?

I am aware that there are some excellent GPs out there, capable of providing outstanding care to those suffering with poor mental health, but frankly, I do not earn enough money to be fucking around with multiple GPs, until I find one in a position to provide an adequate level of care. GPs need to display a minimum level of sensitivity, empathy, and knowledge when it comes to mental health issues. There is no room for error or individual “ethics” on this.

I am not discouraging those suffering with poor mental health from reaching out and talking about it. I would absolutely encourage it. But we need to get specific and pragmatic about what we mean when we say to these sufferers, “Please talk”.

What I am saying is, I am talking all the time, and have been doing so for years.

But talking does not improve the availability and accessibility of proper medical treatment. Talking does not in any way alleviate the economic and social barriers to receiving this treatment, and talking does not ease the access to pragmatic, medical information on how to cope with your illness. Talking does not guarantee the quality of this medical service, and it does not guarantee best medical practice and non-biased attitudes from the GPs and other professionals who administer it. Talking does not suddenly mean that your friends and family will have access to the information, expertise, sensitivity and strength to adequately support you in your illness, and it does not mean they will even chose to support you at all.

Talking is not always the issue. I have been talking for years, and I am still as sick as I have ever been. I am talking right now. Now what?

Again, I am not in any way suggesting that people suffering with depression and other mental illnesses should not seek help. What I am calling for is a massive and collective improvement of the services and support offered to those victims when they do seek help, and a re-evaluation of the patronising and reductive attitude of those who see “Please talk” as a solution that is in any way adequately befitting of the problem.

What I am calling for is a redistribution of focus away from simply urging people to seek help, but to ensuring that there is help for them to seek in the first place – help that is immediately accessible, of exceptionally high quality, and available irrespective of the patient’s financial position. It takes a huge amount of courage and strength to seek help for mental illness. When anyone does so, it is imperative that the help they seek is provided.

Oisin McKenna

Please Talk To Who? – A thing about mental health treatment in Ireland Oisin McKenna)

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63 thoughts on “Talk Is Cheap

  1. The Lady Vanishes

    Very well written piece.

    What is now needed is a follow up piece defining what good quality help would be.

    1. Medium Sized C

      There is, I believe, counselling services available to people who can’t afford counselling, can’y remember what they are.

      Affordable counselling services would be a start.
      It could probably help a lot of people who do not suffer from chronic clinical depression.

      Accessible affordable psychiatry services would be another.
      Probably more useful for people with more severe disorders.

      This is pretty straightforward stuff here.
      Course, it would be expensive.
      And given how the narrative of criticising the Health Services is, it will never get done.

      1. Sarah Murphy

        i don’t even have a tenner to spend on food and you’re telling me to throw it on wineglasses and shirts, cop on

        1. Medium Sized C

          You might get a tenner for whatever device you are posting this dumb shit from.

          Just to underline what an asshole you are being, Grouse didn’t tell you to spend anything on anything.
          Similarly the fact that you just went ahead and assumed that one photo of the guy is ample evidence to comment on his financial status is seriously dumb.

          1. Sarah Murphy

            An event with free wine? i dont even get free wine at communuion, only bread, where do i find out about places that give out free wine? dont know where ye are from but it sounds way better than here

          2. Sarah Murphy

            you have de typical reaction of de snobs here violet, wouldnt expect any better. just cos im not some poshie with time to be writing novels of letters? no job, no education and i still able to have 5 kids, no fear of me

        2. bob

          Well said Medium C, but to reiterate: you are a dumb , Sarah… or rather what you have posted here was ill-considered and leads me to conclude that in this instance you have behaved like a dumb poo.

          The fact that you even replied without realising how wrong you are is astounding.

        3. AC

          Like the non-poshie Sarah I got kids spilling out of me. I post from Ballybendover in the year diggity-six. Remember Irish College? Well, imagine that, but imagine Eamon de Valera bringin’ sexy back, with a whip. I DON’T GOT TIME FOR DEPRESSION. I IZ OIRISH.

          1. Dean Ryan

            Oh congratulations Sarah you have brought 5 more kids into the world.
            Who’s paying for your kids?
            Let me guess..

    1. AC

      You being so articulate and pooooor using ‘Da’ instead of ‘the’, well done Sarah, hope you get what you want in live. That promotion n Xtravison.

  2. The Lady Vanishes

    Because, in this country (any country?) if work isn’t put into defining exactly what is wanted, you won’t get it.

    What forms of help do people suffering from depression, who have received treatment, feel could or should be available?

      1. The Lady Vanishes

        Good point.

        What advice would you or anyone else give to a GP dealing with someone suffering from depression?

        Not just ‘what not to do’ though that is useful.

        What they should do.

        1. Buzz

          Displaying a little empathy would be a good start. Everything I’ve heard suggests GPs just want to get the depressed person in and out in record time, scribble a description for an anti-depressant and off you go. That’s not health care, it’s business.

          1. Nigel

            Like any other specialised problem, the GP should be able to give you a timely referral to a specialists who would assess your treatment needs. If the specialists aren’t there, they can’t refer you, and there’s limits to what a GP can do themselves, though obviously that could be improved. Medication and counselling are the basics, and while you could do counselling without the medication, you really shouldn’t to medication without the counselling. Unfortunately counselling can be hard to come by these days, but drugs are plentiful.

        2. John E. Bravo

          They should follow their training properly and continue to modernise your practice in accordance with international guidelines. They should not seek medical training in BTL comments.

        3. Totoro

          I’ve been battling depression for more than 8 years and to be honest I don’t know how to advise a GP on dealing with patients with depression as I am not a medical professional; it is much easier for me to list the things that I have heard from GPs that were hurtful, unhelpful, discouraging and outright dangerous.

          There are countless numbers of studies available for consultation and I’m sure there are specialists who could advise on best practice. Perhaps the Medical Council of Ireland could hold seminars and “strongly encourage” GPs to attend – maybe it is something that should be mandatory, done periodically so that information remains current. There is little excuse for a GP having outdated views on mental health issues, it’s not really good enough.

        4. Chamos

          What advice would you give to a paramedic who has arrived to an unresponsive individual?
          “Follow the training that you’re required to have to perform your job” would be mine.

          If that training isn’t present and required currently, then it should be. Mental health is difficult. At the very least, a GP should be able to identify an issue and send the person to a specialist who can deal with it well. It’s the same standard we expect for any other illness.

      2. Medium Sized C

        GP’s are referral machines.

        Training them in this case would be teaching them to refer to services that are mostly non-existant.
        Like affordable psychiatric care.

        1. AC

          In fairnesss, the ‘why are you sad’ and ‘well, why are you promiscuous?’ questions could be jettisoned

    1. Nigel

      A lot of the stuff is there, but chronically underfunded with massive waiting lists that would be even longer if they hadn’t been ruthlessly disqualifying people for services and allowances since the crash.

  3. Rafter

    Great honest piece and I agree from personal experience. When I lived in the James St catchment area the public services available to me were rubbish, no help at all and just drugs that didn’t work thrown at the problem which lead to me having a complete breakdown. A few years later when depression came again I was living in the John of Gods catchment and the treatment was amazing, helped by the fact that I had a fantastic GP, I was referred to a day hospital, anxiety groups and got lots of help. It baffles me that where you live can define what help you get. The only bit I wouldn’t agree with is that the impetus to recover is always on the patient, while I agree that the services are essential and the lack off affordable counselling or help is the responsibility of our heath service, there is only so much doctors and medicines can do without you meeting them head on to try and get better.

  4. The Lady Vanishes

    Rafter, could you list what you found best about the good treatment and bad about the not so good treatment. Other people (like me!) might find it useful.

    1. Sup

      Are you dishing out homework? Why would someone waste their time doing this for you? Go read a book.

      1. The Lady Vanishes

        Possibly because they want to help others, and improve things.

        Two things that clearly you’re no good at.

        ‘Go read a book’ is not really very constructive. There are lots of books out there but not all of them give the right information.

        Why are you butting into other people’s conversations anyway? A bit peeved about something perhaps?

    2. Rafter

      I don’t mind the homework! If it helps. When in James Street I went in through casualty on a particularly bad Friday night (bad for me that is) they sent me home after 14 hrs with a referral to St Martha’s on the following Thursday, leaving me alone in my state for 5 days. When I went to St Martha’s clinic, I was seen by a doctor who had a 10 min meeting with me, prescribed an extremely high dosage of Effexor despite me telling him that I had tried that before and it gave me bad side effects, and signed me up for an occupational therapy course in 3 months time. None of this obviously was in anyway helpful and I ended up in a really bad way and eventually moved back in with my parents which moved me into a different catchment area.

      When living in Killiney my GP was fantastic, he talked through medication options and started me on a combination and referred me to John of Gods that afternoon, I was interviewed and admitted into the day hospital where I went every day for 6 weeks, the day hospital includes group sessions, meditation, art therapy etc and you are seen by a consultant twice a week. I had a really bad weekend 2 weeks in and was able to contact my counsellor in the day hospital and was admitted immediately for a couple of days. My medication was altered and I was home in a few days and back attending the day hospital. After 6 weeks I was discharged from the day hospital and was referred to a 6 week anxiety management course in Cluain Mhuire, 1 evening a week and weekly appointments with a cognative therapist. I did not pay for any of this. That was in 2008, I am now 2 years off anti-depressants.

      1. The Lady Vanishes

        Thank you very much for taking the trouble to reply.

        This sort of information not only helps other individuals suffering from depression to get better treatment, it also helps change.

        1. Rafter

          I meant to add that I had to quit my job and so was on a medical card which is why I didn’t pay for any of the services.

      2. Leela2011

        Wow Rafter, thanks for sharing that. Really highlights the differences people can encounter. As Oisin points out, often the person suffering reaches out but the system is not adequate enough to deal with their situation

      3. Mick

        I can’t thank you enough for wiring the second half of your post. I hope there is a day when every vulnerable person who is brave enough to seek help from a GP for suicidal thoughts is treated with such a response.

  5. seany_delight

    He uses the word victim interestingly. In my dealings with depression, or others I have encountered, I never once heard the use of the term. Victimisation points the finger as I would understand it, somewhere else. Depression in my experience is from with-in. Obviously we all cope in different way’s.

    Well written, but how many well written pieces will be needed. Its not the first succinctly summarised article on the poor provision for mental health in Ireland. There seems to be no will to improve it.

  6. johnthebaptist

    I suffer anxiety and ironically, losing my job was the best thing that happened to me.

    I got a medical card and could access CBT through the health service rather than 70 quid per session if I was still in work. Not only that, I can actually afford my medication! I’m actually feeling I might be able to get on with my career now and get back into work. Which is bullpoop.

    We need fully universal, fully free, public health services. Most private sector providers are great people no doubt, but allowing people profit from misery and ill health is barbaric – and leads to situations like mine (lucky?) and his (definitely unlucky), when this simply should not be an issue.

  7. Niall

    Apologies if this sounds simplistic, but could he not ask his work to drop his pay by 16 euro and get a medical card ?

  8. Conor

    Agree totally with all his points re: mental health treatment. In particular, the notion that your GP is remotely equipped to deal with anything more than a mild case of the blues is laughable.

    That said, the objective of the Twitter trend is not to cure mental illness; it’s a Twitter trend ffs. The objective is to get people who might not be as open and forthcoming about their illness to feel that they don’t have to suffer alone. Oisin is obviously a confident, outgoing bloke and fair play to him for opening up about it; is he representative of most depression sufferers? I wouldn’t have thought so.

    1. Mulch

      Fair play to him.
      I think his article is trying to highlight the fact that whilst taking the first step and talking about it is essential, people further down that road feel no better off having been courageous enough to open up about it.
      I would imagine its quite frustrating to see numerous media outlets all telling them him to take the first step and talk, when he has done that and is getting very little in terms of support.
      But i would agree with you that at least getting people into the system is a start, and a positive one.
      We just need to fix the system now.

  9. Wayne

    I work with an organisation that provides free counselling and support to people considering suicide, or people bereaved through suicide. Unfortunately I’ve met many people in Oisins position, and it’s not pleasant. But I do have some advice.

    Through this work I’ve met with many people working with other groups that also provide some free amount of service to people in their communities. While it would be ideal if the state and HSE provided this counselling/intervention the fact is that right now they don’t. But with a little time anyone who wants help can usually find it, (again not ideal, but we do what we can).

    The National Office of Suicide Prevention has a list of funded organisations which are mostly pretty great and can be called for advice. Here it is: http://www.nosp.ie/html/funding.html

    Beyond that I strongly recommend The Samaritans on 116 123 if you need to talk, or if you happen to be in the North East, my own organisation (SOSAD Ireland http://www.sosadireland.ie/contact.php) could be useful.

    Oisin hit a lot of great points about people falling through the gaps and services not being available. Hopefully some of those links will prevent that from happening to some people.

  10. downtowntrain

    Agree wholeheartedly. First GP prescribed st John’s wort (!), gave up on her and found a new Gp after a year, prescribed citalopram and counselling. Took both for as long as I could afford. Bottom line, the money just isn’t there. hopelessness, eh? In a funking nutshell.

    1. Conor

      Well that’s exactly it. The money isn’t there. Every penny that goes into mental health is a penny that doesn’t go into some other aspect of the health service. No easy answers.

      {note: unhelpful rants about money being diverted to bankers, bondholders, Irish Water etc are unhelpful}

  11. Buzz

    This tallies with the woman who wrote last week about feeling suicidal and having nowhere to turn. Worrying since the public perception is that help is available.

  12. eamonn moran

    This is a very well written article with solid points relating to people who are suffering from depression and have been trying to deal with it constructively in a country that has no joined up policy in this area and where treatment and meds can be unaffordable..
    I suspect when people say “Please talk” they are referring to people with depression who are suffering in silence. Talking is the first step. So telling them to talk is good advice.

    I have two pieces of advice for the author that are not supposed to be any kind of Panacea but I think both are constructive.
    1. Have you asked your employer if you could work an hour or 2 less per week so you would be entitled to a GP card?
    Given the cost of GP visits, that would seem economically a good idea.
    2. Do you exercise regularly? You look as though you are young and fit.
    Pick out route. Go for a light jog or cycle on that route and time it. Then repeat and try to beat the time but not by much. That way at least there one thing in your day where you have evidence of improvement.

    All the best and I hope you take Waynes advice as well.

    Good luck.

  13. Humans eh!

    This country is all fur coat and no knickers.
    When my family broke up. I left our home (I thought temporarily) and being unemployed (I was a stay @ home Dad) became isolated and very depressed (sleeping in your car can do that)

    All across the media etc Was the message to talk if you are depressed, see your gp, get professional help.
    I did,

    It was good in fairness and many people helped me greatly. I did all I was told – meds – counselling and self improvement techniques.
    And came out the other end more or less intact.

    Trouble came when I foolishly assumed that unwed fathers had rights in Ireland.
    Going to family court (what a f**kin joke!) to gain access (not custody) of my children.

    The fact that I was actively participating in the mental health system was used against me as ‘proof’ that I was mentally unstable and unfit to spend a weekend with my babies.

    Yeah I’m so glad -I talked!
    I’m sure I’m not the only idiot conned by irelands bullshit culture of ‘doublespeak’

    So I say to all who need help, by all means seek it out. Just remember it can be used as ‘proof’ that you are ‘cracked’ as they say round here.

    1. downtowntrain

      Christ, that’s grim. Sorry things are as Irish as they do be. What would you say to someone who could fall into the same situation?

      1. Humans eh!

        Buy a van, with a mattress in the back, sleeping in a small car is crap.

        Sorry :-) just trying to lighten the mood.

        There’s not much one can say. To find yourself in a similar situation there’s not much you can do but seek out whatever help you can afford, accept help (some great people out there working with little support) and just realise that once you get into the ‘system’ it becomes a part of you and it becomes a little note attached to your file (metaphorically)

        And I can attest to the fact that it can be used against you…. by ‘sane’ people in a court of law.

    2. Buzz

      That’s really screwed up. I knew the family courts used to be anti-fathers but I heard from someone who practices family law that things had changed. Apparently not then. What year was that? Sorry for all you have been through. Life can be so tough.

      1. Humans eh!

        Thanks buzz. Appreciate it.
        I haven’t seen my children since 2011.

        I have resigned myself to getting back on my feet (starting a business) and seeing my children when they are old enough (6 years to go) :-)
        They are well looked after, happy (I hope) and safe.
        As long as they are ok I will happily dwell in my own hell

        I smile every day though my heart is wrapped in chains. I understand how poor Robin Williams felt.
        But when I look at Gaza and all the children in fear and pain I realise how lucky I really am and this is but a season of my life that will pass.

        Sorry for derailing this thread folks – back to the studio!
        :-)

        1. Buzz

          You are very brave; your children are lucky to have you and will understand some day what has happened. Speaking as a woman, there is a special place in hell for women who deny their children a relationship with their father, and vice versa, unless he poses a threat to their safety. It’s great that you’re able to see the bigger picture and keep on keepin’ on.

  14. Mort

    There are no immediate decent free services. Any councillor will charge €50 a pop, if you want to get on the waiting list from some public help you’ll first have to fork out €60 for a GP visit then wait. “My Mind” where you can go without a Doctors recommendation will still cost you €50 a visit. If you’re lucky enough to be on the medical card it will still cost you €20 a pop. all these numbers and groups you’re told to contact, very little of them provide FREE PROFESSIONAL help. It’s all bullsh1t!!!!! Look after your mental help…..lets hope you can afford a Psychiatrist! Lip service

  15. isintheair

    Here we go again. Another depressed person with some stories to tell. Just pat him on the back and tell him he’s wonderful for speaking so openly. That should sort him out for now.

  16. Suzanne

    I can certainly empathize with you and fair play to you for writing such a poignant piece. There is minimal access to therapy/counseling and the main remedy prescribed for any kind of mental illness seems to be medication . Which in some cases maybe helpful, though in other instances is only blocking people from feeling and processing their thoughts and issues , also medicating is leading to dependency and people are sometimes overwhelmed when they try to come off their medication as they still feel the same because the underlying problems have not been addressed .
    Meanwhile our archaic mental hospitals are closing down and there are very few beds/ facilities available for people who really need them .
    As difficult as it is enduring mental illness the shame and fear about other people knowing and judging is equally as hard. Although things are improving we are still fairly old fashioned regarding our reactions and it is still a taboo subject .

  17. Sean Kelly

    Oisin,
    You’re 23 and as such, you can avail of the services/support of organisations like Headstrong, who through their Jigsaw centres provide mental health services and support for Young People in Ireland. They will point you in the direction of someone who can provide the services you need. There are currently 12 centres nationwide with more in the works.
    I realise that this only applied to young people (under 25) but it’s something at least.

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