Don't deny them this treatment
Sir - Your news report under the heading, 'Mentally ill still forced to endure shock treatment,' (Sunday Independent, 15 November), dealt with whether it should be possible for a person with impaired mental capacity to receive ECT without consent.
Most mental health care is entirely voluntary - 89pc in 2013. Similarly with ECT, 85.5pc of treatments in 2013 were administered with the patient's consent.
But for those who, even with decision-making support, lack mental capacity to decide about ECT, the current position is that a person must first be detained under the Mental Health Act 2001 - a three-step process requiring that someone, such as a family member, apply for involuntary admission; a doctor (such as a GP) examine the patient and agree that it is necessary; and, finally, a consultant psychiatrist examine the person and also agree that it is necessary.
The patient is then assigned a solicitor under a free legal aid scheme and the Mental Health Commission sends an independent psychiatrist to examine the patient. A mental health tribunal then reviews the involuntary admission order.
The tribunal is independent of the hospital; has a lay (non-medical) majority; decides by majority voting; and has the power to discharge the patient. Patients are provided with further legal aid and funding for psychiatric opinions if they appeal to higher courts.
Once detained, a patient can receive medication without consent only if certain additional conditions are fulfilled. If he or she is deemed to require ECT and is either "unable or unwilling" to consent, there is a further requirement for another examination and opinion.
The use of the "unwilling" (as opposed to "unable") part of these ECT criteria is uncommon: in 2012, there were 1,921 involuntary admissions and the "unwilling" criterion in the ECT provisions was relevant to just four of these, three of whom also lacked mental capacity to decide about treatment.
As a result, ECT without consent was administered to just one patient solely on the basis of the "unwilling" criterion in 2012. In 2013, that figure was unchanged, with, again, just one patient receiving ECT solely on the basis of the "unwilling" criterion.
Nonetheless, every single person matters and there is widespread agreement that "unwilling" will be deleted from the legislation, probably by the end of this year. This will just leave the "unable" part of the criteria for ECT without consent - that is, people with depression so severe, or intellectual disability so profound, that they cannot understand the options, even with decision-making support.
Should their lack of mental capacity mean that they are denied a National Institute for Health and Care Excellence (NICE)-approved treatment for depression that would be available to them if they possessed mental capacity?
The UN Convention on the Rights of Persons with Disabilities (CRPD) is very clear that "persons with disabilities" must receive "the same range, quality and standard of free or affordable health care and programmes as provided to other persons".
Just as no one would dream of denying medical or surgical care to persons with impaired decision-making capacity for specific decisions (such as some people with intellectual disability), we should also ensure that all approved mental health treatments, ranging from psychotherapy to ECT, are available to all, regardless of mental capacity.
For those with impaired mental capacity (such as severe mental illness), additional safeguards are clearly needed and are in place, but impaired mental capacity should never be used as an excuse for denying treatment.
To do so would be a profound violation of the equal right to medical care and, on rare but very real occasions, a denial of the right to life.
Department of Adult Psychiatry,
School of Medicine and Medical Science,
University College Dublin
A word for the unpaid carers
Sir - I feel a certain empathy for the writer of last week's epistle on her difficulties as a carer (Sunday Independent, 15 November). She sounds like a caring lady, but her gripe should be with her employers as she seems to be short changed by them, not by any Government agency.
If she wishes to step into my size 10s she will see what a "carer" actually is: an OAP, who still must go to work two or three days a week, 51 weeks of the year (Christmas week is free, with no pay).
The remainder of the week is as an unpaid carer at home. I must arrange for a family member as cover while I go to work. I know another three households in the same position where the carer is on the edge, due to the pressure/strain.
I personally have not had a break/holiday for three years and were it not for kind family/friends I think I would have cracked-up long ago.
Don't take this as a "poor me" whinge, as we have enough of these in our society.
There are thousands like me who get on with it for no pay and no respect or recognition from our overpaid politicians who spew lip service to our unpaid hard work. These are carers, who are not trained and got no certs to validate their efforts.
I genuinely hope your letter writer gets her Santy list. She sounds genuine, so she should place an ad in her local paper and supermarket noticeboard and take hours/times that suit her. Her employers are in business to make a profit, not provide her with a livelihood or to help the elderly.
Her story did all of us a big favour
Sir - The person who wrote about carers (Sunday Independent, 15 November), must be thanked for having done the State some service by telling the reality of carers as so many experience it.
We must salute those carers whether they are family members or professional carers or nurses. They are the real heroes in keeping our thousands of old, elderly, disabled and vulnerable people in a dignity and relative quality of life and well-being, allowing us able-bodied to have fun.
So many young people are trapped for life in being carers, some of course as a long-term parents' investment, some out of need for minimum income. Shame on the State, the politicians and the HSE for being indifferent to those great people who give so much in tending, cleaning, moving and making elderly, vulnerable and disabled people comfortable for every day of every year.
The cosseted politicians and the senior civil servants in the Department of Health and the HSE know the State would seize up if carers were to down tools. Of course the smug decision-makers at the top will have the wherewithal to pay more than most of the rest of us for care and will be removed from or indifferent to any understanding or any plea of those less well off.
It's up to us plain ordinary people to change all that.
The real meaning of love
Sir - In 1941 my mother was widowed at 43 with 10 children aged between three and 17. She got on with her life with no help from anyone.
We never felt deprived and if welooked for something she could not give, she would say "you don't want that, it is common". We believed her and were happy.
As a child I hated Friday because that was black baby day and we had to bring a penny to school. Mam could not afford to give us all a penny. If you did not have a penny it was three slaps. That was when I found what love was. My older brothers gave me their pennies and they took the slaps.
Joyce and the Nobel Prize
Sir - Kieran Griffin wrote that James Joyce should have been awarded the Nobel Prize for Literature, (Sunday Independent, Letters Page, 15 November). Shortly after the formation of the Irish Free State in 1922 Desmond FitzGerald, Ireland's Minister for Foreign Affairs, attended a meeting in Paris, after which he visited his friend, and fellow poet, James Joyce.
FitzGerald sought Joyce's permission to nominate him for the Nobel Prize for Literature. Joyce's (spot on) response was: "It would do you more harm than me good!"
A mental health uplift
Sir - We must give fair praise to Independent Newspapers for their contribution to the health, wealth and happiness of the nation.
Through the lively articles of specialist columnists on positivity-orientated topics, over recent weeks, all your publications have done just that.
Suzanne Donohue gives us the 'key to beginning the process of change in our lives by identifying our limiting beliefs' (Sunday Independent, 15 November).
Aileen Quinlan examines psychologist George Dieter's suggestions to becoming aware of our personal boundaries (Sunday Independent, 15 November), and Dr Paul D'Alton gives us a five-day series of excellent tips in the Irish Independent on 'how to be happy, stop living on automatic pilot and challenge our thinking.
Agreeably, all are wonderful themes for overcoming the winter blues. They buck the trend as we leave austerity on the back-boiler and gear us for a heavy dose of auto-suggestive medication; aggressive hypnosis and psychological brainwashing - inevitable - in the run-up to the General Election in the New Year.
It is not a new thought-line; simply a reinvention, in finer garb, of former thinking in vogue through books and courses over two score years ago; at a time when every publication you picked up had a front page display ad for the booklet - 'I Can, and, I Will'- published by the British Institute of Practical Psychology.
Just be wary, the politicians may have studied them better than you!
James Gleeson, Thurles,
Joe's meditative magnificence
Sir - Thank you for the excellent information you provided on Mental Health (Sunday Independent, 15 November).
Also the beautifully-written article by Joe Kennedy on the Irish bird, the Grey Heron. If ever a species represented hope and optimism, it is surely this tall and noble creature. Try watching it at a river bank, concentrating on achieving its next big meal.
The words Joe uses - "patience" "tolerance", "sentry-duty" and "comforting talisman" - exude a certain meditative magnificence which we could all tap into.
I was certainly in a better mood after both pieces.
Damien Boyd, Cork
Tales of battles fought long ago
Sir - There were letters in the Sunday Independent (8 and 15 November) about Bishop Casey's work for the Irish in Slough "where he bought up derelict houses, and cajoled building workers into refurbishing them" so they could be used by the homeless.
When I came to England in 1953, I worked in a hospital in Littlemore, a village a few miles from Oxford city. There was then a large enough number of Catholics at the hospital to warrant, in the mind of the local priest, Fr McKenna, a designated church. He too 'cajoled' Irish labourers from among his congregation and when the church was completed, the hospital authorities thought it fitting to hold a dance in honour of the Irish labourers.
The Paddies turned up in large numbers. I was having a drink at the bar when a large genial Kerryman said: "By Jaysus, it'll be dog-rough here tonight yet". He was right. They fought like savages and wrecked the place.
Some time later I attended an Irish dancehall adjacent to Fr McKenna's church. Not long into the proceedings, a vicious fight broke out engulfing most of the hall. It eventually spilled outside and Fr McKenna, with great courage, tried to position himself between the contenders.
He was promptly grabbed by each arm and propelled up against a wall while a third held a hand over his throat.
On another occasion the fighting extended on to the band stage. While on the one hand it was reprehensible and shameful to see the bandsmen flee for their lives, it was, in a macabre sort of way, funny.
Such was the enthusiasm of one of the assailants that he drove his shoe through the bass drum, penetrating one layer only. It was a sight to behold to see him run around the stage, drum attached to foot, as he wreaked havoc on what remained of the musical instruments.
I was recently reminiscing with an elderly lady who declared ruefully: "Many is the time I crawled on my knees, wearing my ballroom dress, under trestle tables to escape".
I recall attending a dance at The Elephant and Castle. The hall was owned by Paddy Casey, brother of the famous Steve Casey, the wrestler. Naturally there was a fight.
There were about 10 men on a gallery at one end of the hall. Gestures and insults were being exchanged between them and a bank of men on the ground floor at the other end. Eventually the men on the gallery leaped over the protective rail and dropped to floor level. But the floor was very slippery which meant that they glided like swans towards the opposition, only to be helplessly picked off by sturdy right-handers, one at a time. Paddy Casey, a giant of a man with evident years of gym-work behind him, eventually appeared on the scene. He did nothing but smile benignly like a benevolent big daddy.
Amazingly, the hall was cleared - and the last memory I have is of Paddy standing smiling at the door as the boys stole quietly away. As ever, by this time the girls had fled.
Another time at Leytonstone near Stratford in the East End, there was a hall run by a coterie from Mayo, among them the Neary brothers and the Clancys. What sticks in the mind about this one is the variety of instruments that were deployed, but the chair easily took precedence.
Again the whole hall was engulfed and gradually cleared. The last impression I have is of Val Clancy with one or two of the Nearys in hand-to-hand combat, using chairs, with a group of about five or six others. They didn't just stand there and deliver blow after blow, instead they pirouetted around each other like dancers.
Some months later I was having a drink with a colleague and Ted Neary in a bar in Leytonstone and met a man who had been in the local battle. He was one of a group of sailors docked at Tilsbury. They were bored so they decided to come up to Leytonstone to pick a fight with the Pads.
I myself recall counting 25 uniformed policemen outside the hall at Leytonstone at closing time. In those days the Irish were wanted nowhere else except the pub, and even there we had to be selective. I can easily empathise with these men as I recall the rage, bitterness, sense of betrayal, disappointment and above all, confusion, evident in their eyes.