Access To Mental Health Services


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Fiona Kennedy

Fiona Kennedy lives in Connemara, Co. Galway. She has clinical depression and borderline personality disorder.

She writes:

I am so angry right now I am literally shaking. I probably shouldn’t write when I’m this wound-up, but I have to do something because I cannot carry this anger around for the day, not on top of all the other emotion that’s currently going on.

I have been banging my head off a brick wall, metaphorically and at times literally, for months now. The last week has been horrendous. I went to my doctor yesterday because I had to talk to someone and I had literally nowhere else to go. There was nothing he could say, nothing he could do, other than give me space to vent and try and chase the hospital to get a definite answer on dbt for me.

My husband is scared, and worn out. There’s only so many times he’s going to be able to talk me down off a ledge before he cracks too. My parents have been on the receiving end of more than one distress call. My friends don’t believe me when I tell them I’m going home. I have told my psychiatrist I want to be dead. I’ve told my doctor. For fuck sake, I’ve called my husband at work and told him. How is this fair? How have we been left in this situation? I drafted a piece the other day which I had hoped to get published but no one is biting, so here it is. I would be grateful if you could share this as far as you can, because enough is enough.

I do not deserve to be treated like this. My family do not deserve to be treated like this. My friends should not have to pick up the pieces, over and over and over again. I need my life back. But I cannot do it alone. We cannot do it alone. None of you should have to do it alone either.

We are making huge progress as a society when it comes to talking about mental health, huge. Slowly but surely, the stigma that surrounds it is being chipped away.

There are several well-established national campaigns encouraging people to talk, and these are getting a bigger response year on year. It’s fantastic to see. So where’s the caveat? I write from my own experience. I’m not a mental health professional, but I’ve spent years in the public mental healthcare system in Ireland, and that is where the caveat comes in. No more than any other illness, there are varying degrees of severity when it comes to mental illness, and I think that’s where the problems arise.

Yes, it’s ok to ask for help. Seeking support is the first step towards addressing any mental health difficulty. But what about when that help is not forthcoming? What about when a call to a helpline, or a trip to the GP, is not enough? What about when professional support is needed?

The barriers are immense. First, there’s the cost. Let’s suppose I don’t need psychiatric support, but I very much need to speak to a therapist. However, I’m on a low income. Barrier number 1. I need therapy, but unless I can access a low cost service (which may still be too expensive depending on the scale they use) it’s not an option that’s open to me, so I’ve to find a way to manage on my own.

The impact that this can potentially have is far reaching. I may find myself unable to work, further compounding the financial situation and increasing the stress, which in itself has a knock-on effect on whatever the original issue was… you can see how quickly this can spiral out of control.

Let’s take it a step further. I’ve been to my GP, I’ve been fortunate enough to access therapy, but the situation still isn’t improving. I need psychiatric assessment. Barrier number 2. I have two choices – take my chances with the public system, or pay to see someone privately.

Going privately was never an option for me, so I can tell you about the public system. In the first instance, unless there’s an emergency trip to A&E, it will most likely involve a lengthy wait, and once I get in, I will be seen by a consultant.

Thereafter, I will be seen by a member of the team working under said consultant. The lack of continuity that goes hand-in-hand with this approach – new doctors at almost every appointment, trying to explain the same issues over and over again, varying opinions – is heartbreakingly frustrating.

I’m lucky that in recent months I’ve seen my consultant at every appointment for which I’m ridiculously grateful but, prior to this, there were years of rotating doctors asking me to rate my mood over the previous number of months on a scale of 1 to 10.

Given that my mood can shift dramatically a number of times in any single day, that’s a question that’s both impossible to answer and profoundly unhelpful. Again, I must emphasise that I’m writing from my own experience, and I’m at the more severe end of the scale in terms of mental illness. But, I’m far from being the only one.

Barrier number 3. Private therapy isn’t an option. I’ve made it through psychiatric assessment and a very specific form of therapy is recommended. But, there’s a waiting list. A lengthy one, with no guarantee of when a place will be available.

So what do I do in the meantime? I dig in. I hang on. I have no one left to tell that I’m not ok, because I’ve followed every avenue that I can. My bad days are horrendous. My bad days I quite literally fight for my life.

Yet I’m aware that I’m still one of the lucky ones. I have good friends, and a loving, supportive family who do the very best they can for me, but it’s not enough. More than that, it’s not fair to expect that to be enough. I don’t want to detract from the incredible work that is being done to get people talking about mental health. It’s absolutely vital, and I’m confident countless lives will change for the better because of it. It’s ok not to be ok?

Of course! It’s OK to ask for help? Undoubtedly, and it is 110% the right thing to do. It does somewhat work on the assumption that help is both available and accessible though. That’s the caveat right there. From my perspective at least, it’s quite a big one.

Fiona is an Ambassador for See Change, a national movement that tries to improve attitudes towards people with mental health issues.

It’s OK not to be OK? Sure. With a huge caveat (Sunny spells and scattered showers, Fiona Kennedy)

Saturday: Turned Away

35 thoughts on “Access To Mental Health Services

  1. Lilly

    So many things suck in Ireland at present that any politician who calls to my door will be lucky to get away before Election Day. Get well Fiona.

    1. classter

      The point is that we can’t wait for politicians to solve all our problems.

      We have to set things up, to figure things out & then drag the politicians along with us.

      They generally aren’t magicians, just vote-hungry careerists who are easier to chop than dictators.

  2. gorugeen

    I would not be alive to write this comment without having had health insurance that gave me almost instant access to the best of care. It is a very sad commentary on our so called equal society. It’s equal if you can afford it. I’m very, very fortunate. My heart goes out to this lovely, brave girl.

    1. Impoverished Arts Student

      I had a similar thing. Don’t know where I’d be without having the opportunity to go private.

      Feel really sorry/scared for anyone who has to rely on our public services

  3. Fergus the magic postman

    I know somebody who was suicidal & rang the number of some publicly funded counsellors and said he needed to speak to someone. He was told to ring back after Christmas.
    The only reason I (& others including his family) now know about this, is because his subsequent attempt at taking his own life failed.

  4. Bonkers

    I have a mate diagnosed with clinical depression. During a recent suicidal episode he contact St.Patricks Hospital, not knowing it is a private insurance only hospital. As he wasn’t insured they quoted him €27,0000 for a one week in patient stay.
    Luckily he got over his suicidal ideation but he is still waiting to see a HSE psychiatrist two months later.

    Fionas article is absolutely spot on. We are slowly breaking down the stigma of talking about mental health but when it comes to actual services backing it up the HSE are found in chaos and people are dying because they can’t get help.

  5. S

    I’ve been so angry and feeling so disempowered and confused after the years of trying to get help for mental illness in Ireland that I was planning to write a diatribe here about everything that’s happened but I don’t have the energy – and anyway it’s pretty much the same word for word as everyone else’s – turned away when suicidal even very shortly after a previous attempt, belittled, patronised, promised help that never materialised and was never mentioned again (and when I brought it up I was spoken to as if I was crazy to think they’d offer me help like that) etc, etc.

    The doctors who were the worst and left me reeling seem to rise to the top (it’s a teaching hospital and they are in the top lecturing positions, guiding the next generation how to be great psychiatrists.)

    If they only have resources to give people “help” that actually harms them and makes their lives even harder then why does the department even exist? What’s the point? I guess maybe some people have been helped but they don’t write about it as much because hopefully they’re getting on with their lives.

    Anyway, hearing other people’s stories at least I don’t feel so alone. Even anonymous internet contact helps a bit! So thank you Fiona and to others who share their stories. At least I know it wasn’t just me being singled out for punishment! Although I wouldn’t wish this stuff on anyone…

    Once when I was an inpatient a doctor told me there wasn’t really anything they could offer me as the psychologist waiting list was so long, which was a bit bleak, but I actually appreciated his honesty – it usually was implied that I shouldn’t need help and was morally flawed for asking for it.

    After my experiences my confidence is so knocked – pretty much housebound. too anxious to go to GP (although they are lovely – extremely grateful for that!) and definitely too anxious to walk into pharmacy to collect prescriptions – so not sure where to go from here…

    Oh, oops, this did turn into a diatribe in the end! Guess I had more energy than I thought!

  6. Joachim Gillespie

    Fiona’s blog is excellent, have been following it for a few years. She is a very good writer, very honest and open about her thoughts/feelings.

    I’ve learned a lot about mental health just by reading it, and empathising with her.

  7. sendog

    Im gald to see more people comign out and highlighting the utter shambles mental health services are in Ireland. i wrote this on the post the last day about the guy in Dublin.

    Mental health services are a joke in Ireland.

    Go to the clinic once every 3 months. Get seen by a different doctor each time who spends 5 minutes looking thru your file. Prescription written. See you in 3 months. The fact that you see a different doctor each time is both incomprehensible and astounding to me. you have to explain your situation over and over again. The result is the same. A repeat prescription. From a service/client point of view it makes no sense. I would go further and state that the current system is shambolic and utterly dysfunctional.

    When i asked why i see a different doctor its because they need to train up new doctors. Took 2 years of constant nagging to get to see a counselor. got to see counselor eventually but it was only for 6 weeks as cut backs and funding.

    An absolute farce.

    When i see adverts and promotions about mental health asking people to seek help i feel disgusted. There is no help. I was left to my own devices and to educate and learn to cope myself. A process that took years. A process that would have been quicker had i actual support. Support i pay well for thru my taxes.

    My whole experience with the mental health services in this country left me feeling worse. I felt more alone then ever. I wish i had never gone near them.

    1. Clampers Outside!

      I have a family member whose situation is… “to the clinic once every 3 months. Get seen by a different doctor each time who spends 5 minutes looking thru your file. Prescription written. See you in 3 months.”
      And what I thought when I heard it, mirrors yours “The fact that you see a different doctor each time is both incomprehensible and astounding to me.”

      Fair play to Fiona, and S above, for sharing too

  8. sendog

    In what other field of healthcare where your supposedly receiving treatment do you see a different doctor at each visit?

    would a cancer patient tolerate that kind of care?

    and whilst i see Fiona has strongly stated that she is in no way saying that staff are not doing their jobs to the best of their ability i on the other hand don’t entirely agree. The system of which the consultants have enormous power, a system they have largely created with the budgets provided is completely dysfunctional and broken. Ive gotten to the stage where i actively question their duty of care.

    The literature speaks for itself. Study after study clearly states that medication alongside counseling is proven to help the vast majority of mental health issues and is proven to reduce the cases of relapse. Our system seems to be completely lob-sided towards management of symptoms and leaving people for years on medication alone.

    1. ahjayzis

      I wouldn’t tolerate a different barber every time I go for a haircut. These services are set up and run by people who’ve switched off their humanity – you’d actually need to work hard to kill your sense of empathy to stand over a system like that.

  9. Neuroticapparently

    Seriously thank you for sharing this. The current system is a farce. I don’t have the option to go private either. My sister was kind enough to get me health insurance for a year but with an ‘existing condition’ I’ve to wait another 5 years to reap the private insurance benefits.

    So it’s every 3 months for a medication review with a different baby doctor. After an a&e visit at xmas I was told to hold out for my clinic apts and discharged with more meds. After telling them about my addictive personality and resistance to take meds because of severe side effects it fell on uninterested ears. I’ve surrendered I take them with no benefit just daily headaches and shocks and zaps in my face and body spasms but the head psychiatrist reckons the benefits will outweight the side effects..

    I am lucky to have a supportive family. I hate to think of anyone else fighting for their life in this country without the capability to reach out because that alone is fupp near impossible when things overtake you.

    I pray that more services are provided such as the cbt course in Aware but there should be more outpatient and day courses available from the public sector for people to learn how to manage in between the 3 months to see a random doctor and for those that want an unmedicated approach.

  10. Shayna

    Great piece Fiona. I think this could have been written by anyone who has/is suffered/suffering from depression – so, Brava! Interesting thing about depression, it can creep up on anyone, at any time – the sufferer is generally unaware until diagnosed, generally after a suicide attempt. It’s a secret. It’s a secret revealed when generally it’s too late to deal with.
    Unfortunately, there is no cure – it’s a question of ” managing”. The “managing” thing clearly doesn’t work presently. In one of tomorrow’s papers it quotes a 21% rise in the suicide rate in the UK – given we mirror the UK in most aspects, I’d be surprised if our figures don’t equal, or perhaps surpass.

  11. S

    I do totally take Fiona’s point about people on the frontline doing their best in a dysfunctional system (I’m talking about her recent blog post here rather than this article.) There are some great doctors and nurses and I would hate it if any of them saw negative comments and felt they were aimed at them. The fact that they do their jobs well in such a broken system makes it even more impressive – I’m sure it would be a tough job even in a well-run system.

    However, there are doctors and nurses who are pure mean/supercilious/dismissive. If someone is that way because of the pressures of the job that’s understandable (and comes back to the dysfunctional system again) but it’s still so damaging to unleash it on vulnerable people who are struggling to live. I guess everyone is human and a doctor who is kind and professional all day might snap at some point, but if you’re the patient with them at that moment, after struggling by yourself for 3 months waiting for your appointment, it can send you into a dangerous tailspin. But yeah, not that I should expect anyone to be perfect in every moment – all glimmers of warmth and humanity duly noted and appreciated!

    (@neuroticapparently – haha “baby doctors”. I know what you mean.)

  12. Milly

    I understand there is pain in mental health and inadequacy with the services but it is beyond anybody’s or institutions scope to be emotionally held over a barrel with someone who is perpetually suicidal and involves everyone against their will. Harsh but true. Borderline personality disorders are impossible to clinically treat. It is the nature of the disorder to seek self destructive attention

    1. ahjayzis

      If that’s your attitude to mental health, god knows what you want done to people with genuinely self-inflicted illnesses like cirrhosis or lung cancer.

    2. S

      That’s a myth that BPD is impossible to treat – more and more has been found out about what actually helps, as with any illness, and many people have been successfully treated. It’s just untreatable when it’s used to label somebody in their file, as an excuse to not offer any treatment at all.

    3. Enrica

      I am a person, not a mental case.
      My bpd it’s only a part of me, not all I am.
      A Personality Disorder is a label given by psychiatrists whom makes a living by classifying people like me. The limitations of psychiatry today, is that there are tablets for everything and not enough human contact to create a relationship of mutual trust between patients and doctors. People with BPD needs foremost to be taught how to sustain and maintain stable relationships. An optimal therapeutic model should address these vital needs.
      I am the sum of all my experiences, past and present. Only these can define what I am capable of giving as a parent, a friend, a co-worker and a member of the society. To disqualify access to mental health on the strength of your discriminating view, it would result on real people living a life of suffering needlessly.
      Bpd it’s not a life sentence: I will not tolerate passively your judgement. I didn’t ask to have Bpd, yet it came to teach me all I can be regardless of my condition.
      I have been in remission for the last 18 months, after two years of constant struggle with myself and the Hse to access fleeting resources that should have been at my disposal but were often disregarded or denied, like the Dialectical Behavioural Therapy.
      Now that I am better, i invest on the positive things that are happening in my life right now, to sustain me by example the day that the bubble will crash.
      I hope that my words will inspire others people to have faith in themselves and their abilities.
      The key concept for me was that of “Radical Acceptance” , which allowed me to explore freerly the natural strengths at my disposal and rose awareness about how to minimize my potential weaknesses.
      I embraced yoga and mindfullness as a daily routine and I would recommend them to everybody out there; even you, dear Milly, could benefit from it, replaicing judgement with compassion.
      Namaste. ❤

  13. phill sheehy

    the old guard in psychiatry in ireland are so antiquated, they wont step on each others toes diagnostically or in terms of prescribed intervention (usually pharmacuetical) when its clearly in the patients best interests to change their intervention.
    I have sat with who are considered irelands leading psychiatrists during consultations and they havent even made eye contact with their patients. and have called time on appointments even though the patients are still distressed and have questions- they have been down right rude by saying- “who d I make the bill out to?” rather than answer pertinent questions.
    that said there are a huge amount of mental health professionals here who are dedicated and work tirelessly and uphold their hippocratic oath. We need to weed out the codgers and dodgers who have been making policy and have friends and family working at legislative levels out- our policies and lack of funding for mental health is so clearly inadequate- in terms of budget they are penny wise pound stupid. there could be fundamental changes and an honest commitment by the hse and government to lay a solid foundation and new structure to support people with mental health issues.
    Fiona thank you for being frank and sharing whats happening to you. your voice is needed by many people , please keep going

    1. classter

      There was definitely a wide streak of this across all of the medical specialties in the past.

      One would hope this is changing.

  14. Lilly

    One of the biggest psychos I know is a consultant psychiatrist and senior lecturer in psychiatry, a vicious bully at school and all round nasty piece of work, but apparently not without charm when expedient. Heaven help any vulnerable person in his care. Truly shocking that he occupies such a position.

    1. gorugeen

      Sounds awfully like a consultant I know. Very difficult person to deal with as both a team member or patient. A complete bollox to work for.

  15. some old queen

    Would I be correct in assuming some if not all of these consultants work both privately and in the NHS at the one time?

  16. gorugeen

    The criteria for getting meaningful help should be based on the danger posed to self or other folk. It is, but, with a huge caveat. You have to have health insurance,/ buckets of money. A very sick system we have.

  17. Suzanne

    It is very difficult to properly treat Bpd , even with health insurance . Intensive long term therapy seems to help but alas there is none available through the HSE and its prohibitively expensive . The only remedy offered is pharmaceutical which doesn’t work for Bpd .Meanwhile some therapists struggle to secure paid work because there is very limited funding available and they are expected to work for free or do pointless internships .. Seems there is no limit on the pharmaceutical budget though .The biomedical doesn’t work alone ,how many more lives will be lost before we realise this ?. We need to adopt a more holistic approach that treats the whole person .

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