Wednesday 28 September 2016

Campaigns can be powerful, but can they tear down walls?

Published 20/09/2016 | 02:30

Bressie at the 10k Vhi A Lust For Life Phoenix Park Run. Picture: Fergal Phillips.
Bressie at the 10k Vhi A Lust For Life Phoenix Park Run. Picture: Fergal Phillips.
Local students pose beside the mural painted by Joe Caslin at the Municipal District Office in his hometown of Tullamore

Ar scáth a chéile a mhaireann na daoine - this is the name of the mural painted by artist Joe Caslin as part of the Waterford Walls International Street Art festival. This piece covers the wall of the now empty Ard Rí Hotel which - once majestic but now empty and forlorn - overlooks Waterford city.

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The image is very powerful and shows a muscular man entwined by and joined with other arms, as if to reinforce his strength.

According to the artist, it is a symbol of support and it achieves this very powerfully.

The stimulus for this mural was the opening of a new Pieta House in Waterford city, in collaboration with A Lust for Life organisation.

Pieta House is well known to me as I work closely with the organisation in Dublin, referring many patients there and in turn accepting its referrals.

This exceptional organisation is devoted to offering interventions for those who self-harm and have suicidal impulses or thoughts. As regular readers of this magazine know, A Lust for Life is a website which provides tools and information about mental health, emotional well-being and resilience.

Niall Breslin, aka Bressie, who himself has had to deal with anxiety and depression, is the co-founder.

The aim is to make this the "go to" platform for those wanting to improve their "holistic wellness". Both organisations rightly want to destigmatise mental illness and to stimulate discussion and acceptance of its reality for hundreds of thousands of people in this country.

But stigma is Janus-faced.

The first, social stigma, is thankfully changing and the ease with which people are increasingly discussing mental illness in public is helpful. The pretence that it is rare and only occurs to "them not us" is dissolving.

This is the stigma that most organisations and commentators focus on. Less well recognised is self-stigma. This is a phenomenon in which the person with mental illness internalises the myths, stereotypes and prejudices that the public has/had about mental illness. It engenders feelings of hopelessness, helplessness and self-blame.

The person erroneously assumes they will be unable to work outside the home or have children.

Arguably the most significant effect is to reduce willingness to accept a diagnosis of mental illness leading to missed appointments, non-adherence to interventions and opinions about mental health professionals as eccentric or odd.

Much more work needs to be done on reducing this but arguably as social stigma diminishes, so too will self-stigma as the misperceptions of the wider community will no longer be internalised by the individual.

Even if social and self-stigma diminished or disappeared, there is the further problem of providing adequate resources to assist those with the range of mental health problems from low self-esteem through to acute schizophrenia.

In Ireland, the mental health services are woefully inadequate.

In the 1980s, 13pc of the health budget was devoted to mental health - now it is 6pc, while in Britain it is currently 10pc.

This has resulted in significant salary reductions for frontline workers resulting in a brain drain of nurses and doctors to other countries.

There are 600 vacancies for psychiatric nurses both in hospitals and in the community. We currently have eight consultants per 100,000 while 16 per 100,000 are recommended to match the numbers in other countries.

The same problems exist with regard to junior doctors training in psychiatry.

Fifty per cent emigrate to Australia, Canada and Britain for better terms and conditions.

There are 500 junior doctor posts in psychiatry of which just 200 are filled from our national training scheme.

The remainder are either filled by locums (who earn 1.5 times the salary of those in training), by doctors wanting a brief period of experience in psychiatry, or they are left vacant.

This is not a safe way to staff a service already under strain.

So while a powerful mural can change perspectives, the question is, is it enough?

Will the funding to buttress the interventions that changing attitudes to mental health problems require be sufficient, when it is already a diminishing drop in the ocean of overall health spending?

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