‘The mental service is the Cinderella of the medical services in Ireland’

The mental health services in Co. Roscommon have changed beyond recognition in the past half century. One woman who is well placed to assess those changes is Dr. Mary McGuire, Consultant Psychiatrist at Roscommon Hospital, and she, while acknowledging that greater funding is needed for the mental health services, is upbeat about the changes which have taken place and the future outlook for the mental health services locally. Mary describes herself as a "local girl". The family lived in Tibohine, a townland situated between Ballaghaderreen and Frenchpark. She now lives in Boyle. Having been educated as a boarder at Roscommon Convent she then went on to UCG to take her six-year degree course in medicine. It was within the walls of the science laboratory that a Sister of Mercy led her pupils into exciting and unknown territory. "When I was in the Inter Certificate class I had an excellent science teacher, Sr. Mercy. She showed us dissections and cross-sections of a sheep’s brain, and made this subject fascinating and highly interesting. It was at this stage that I thought I’d like to study medicine". Most of her friends were either going into the civil service or teaching and it was probably unusual at that time to be taking on a career that would mean years of study – and at great cost to her family. ‘Being the eldest of seven I should have sought employment. My mother was a nurse and my father a small farmer and they were very encouraging and supportive. I got a scholarship to Trinity but as most of my friends were going to Galway, naturally I wanted to go there. After my degree course I did a year of internship, general medicine and locum GP in Frenchpark. Following this I did my postgraduate training in Psychiatry in UCHG’. Mary’s first permanent post was in St. Patrick’s Hospital, Castlerea and when it closed she moved (in 1992) to Roscommon hospital. ‘We are the only facility in the country that hasn’t long stay beds, only an acute inpatient wing’. The whole area of psychiatry has changed and developed over the years and she spoke about the obvious changes she has seen. ‘When I first started in the 1980s there were people with very serious illnesses like major depressive disorders and severe psychotic disorders coming into the hospital. Now we see individuals suffering from alcohol related problems, anxiety, depression, drug addiction and personality disorders. Also many more young people come into the service now. Past generations had to get on with their lives and their lot. They had to sort out their own problems. Very few expressed their feelings, there was a lack of openness and therefore, many underlying problems remained unacknowledged, unrecognised and untreated. ‘I believe it was related to the stigmatisation attached to mental hospitals. People were terrified to go there, knowing they would probably remain there, abandoned and forgotten. Life was very harsh in Ireland in the fifties and sixties and in many cases emigration or admission to the mental hospital could alleviate a family’s financial burden. There were people who were indeed well enough to go home but couldn’t and some stayed because they could not face the community still shouldering the stigma of being in a mental hospital. ‘The old mental hospital system was a tragic one with people ‘buried alive’ for forty years or more and for the most obscure reasons. There is a very poignant case in the 1930s when a sixteen year old orphan travelled from Dublin to Ballaghaderreen and because he was found loitering and not wearing a cap he was admitted to a mental hospital.’ At the beginning of the nineteenth century St. Patrick’s hospital, Dublin was the only one dealing with the mentally ill. Throughout the rest of the country people were confined to prisons, verminous cells in the county infirmaries or in the houses of industry in Cork, Dublin, Limerick and Waterford. There are three consultant psychiatrists, Dr. Byrne, Dr. Cullen and Dr. McGuire, covering the Roscommon region, middle, north and south sectors. Dr. McGuire covers north Roscommon and also the eastern corridor of the county, from Arigna down as far as Lanesboro. ‘Mondays and Fridays I am in the acute unit here in Roscommon, Tuesdays, Wednesdays and Thursdays in Boyle. In addition there are Family Life centres employing counsellors and therapists and support groups who deal with a large volume of people. These family life centres are separate from the mental health service.’ Figures for 2006 show that 400,000 people in Ireland suffer from depression. One must acknowledge that there is a very serious and sometimes tragic side to depression, if treatment and support is not sought. Suicide rates show that suicide is higher than road deaths, now the single biggest killer of young men between the ages of 15-24 in Ireland. Dr. McGuire commented, ‘Society expects men to be strong, dominant, rational, in control and women to be emotional and dependent, but able to express their emotions and needs. There are many factors involved, the great expectations people have, stress, alcohol, and drugs which disinhibit and impair one’s judgement, lack of religion or the move away from it. Religion did cushion us along the way, gave us hope and in the past society had a long involvement in the social structures of religion.’ Is the Celtic Tiger carrying us along, thrusting us into an affluent but very materialistic and threatening society? We have a booming economy, more jobs, opportunities, a better lifestyle, but there are casualties along the way. ‘Almost every family in the country has some member who accessed a mental health service. It is very difficult to know why. There is a totally different mindset now from when I was growing up in rural Ireland. Survival was of the essence. One didn’t expect a perfect and easy life without problems. Society and our media, TV etc., seem to portray and create a delusion that life should be carefree and stress free and people are just not able to cope with it. Also life has changed, more people working trying hard to maintain a family and home. Everyone has an Achilles heel, no-one is perfect. All of us can succumb to stress, a lot depends on conditioning in early childhood and the way in which we have grown up. In the last ten years there has been a dramatic increase in the amount of people suffering from drug addiction and alcohol problems. For various reasons we see a lot of married women and young single men. ‘Alcohol was always problematic. I believe that down through the years it wasn’t the doctor who cured it, it was the bank manager, but now with the accumulation of so much money it is on the increase. There is this great rush to consume it. Patients are now de-toxed on medical wards as it is considered a medical condition, since so many serious health problems can occur during withdrawal from alcohol." She went on to describe the normal procedure when someone presents for the first time. ‘You make your assessment on the individual and his or her behaviour and attitude, study the family history as a lot of the problems may be familial. You would also do a brain scan to see if there was any organic problem, for example a brain tumour. You then decide on the most appropriate form of medication. Treatments have changed, there is much more psychotherapy, "talking therapy", where one would has access to all kinds of counsellors through the mental health service and family life centres. They are highly skilled in the specialism that they are dealing with. ‘Although antidepressants work well for many, they obviously do not alleviate the problems that might have caused the depression. Therefore many benefit as well from psychotherapies designed to help them cope with difficult life circumstances or personality vulnerabilities that put them at risk for depression.’ The GP plays a very important role. ‘I believe that about one-third of patients going to a GP surgery have a mental health problem and it can be dealt with there without referral to the Mental Health Services.’ ‘There are many support groups around the country like Aware, Grow, Out and About where help is readily available’. Dr. McGuire emphasised that most of the problems presented can be cured and overcome. ‘People do recover by expressing their feelings and prioritising the worry and problems which are causing the illness. However, in a lot of cases antidepressant medication is necessary. Shock therapy (ECT) is rarely used and only used selectively in cases of severe depression where medication has proved unsuccessful. Looking back on case notes of fifty years ago it was commonly used and an accepted form of treatment. When it first came on the market it was heralded as "the wonder treatment". It has been established beyond doubt that there are biochemical abnormalities in the brain. I can’t see it happening in my lifetime, but a time will come, a time when doctors will be able to take a blood test and find out what is going on in the brain. "We are in contact with a lot of Leaving Certificate students who can’t cope because of the very high points system. It is causing so much anxiety and stress amongst teenagers and concern to parents. I believe the education system is now offering more choices than were ever available. Parents and children seem to think that high points have to be achieved to get the top courses at university. The IT colleges were a great asset in this country. In my opinion they have a great system of education, they monitor the students and have far more support systems than the university. The points system for medicine is being altered. It isn’t always the brightest people who go into this or similar disciplines, market forces dictate the high points system. If the number of places is increased the points will drop. ‘Children and parents should relax, there are many opportunities out there. Children should be made aware at an early stage that it is all right to say they are upset or worried. They should be encouraged to talk about it. There is nothing wrong with being psychologically upset. Even though the mother and child relationship is very close we still see so many young people who have not conveyed their worries to anyone.’ Dr. McGuire spoke about the working woman and its effect on the family nucleus. ‘The role of the working woman needs to be addressed. The pressures on her are horrendous at the present time. Childcare costs are exorbitant, mothers have to commute long distances to the workplace while children are separated from them for many hours. As a working mother, my advice to a young mother would be to stay at home with her children if at all possible. I would also encourage them to attend parenting classes held in various centres. The best type of learning is from one’s peers and having group meetings with parents who have similar problems and stresses can be a very enlightening experience. These groups came about with the intervention of a very innovative priest – Fr. Padraig Greene in Boyle twenty years ago, and they have proved very beneficial.’ The rushed circuit we are on at present could create even more serious problems for our society and Dr. McGuire commented on this. ‘I do think we will get more social problems. Children in general are leading more isolated lives. They miss their parents who are working. This can be very difficult to deal with, especially for the mother who already has her own pressures. It’s a very different world from the world of thirty years ago when a mother was nearly always there.’ Dr. McGuire expressed her feelings about the ongoing and urgent need of funding. ‘The mental service is the Cinderella of the medical services country wide. When you look back to the figures of the eighties we were allocated ten percent of the health budget, now it is six percent. We are happy with the number of beds, but we urgently need Day Hospitals in the county. We have a Day Hospital in a bungalow in Roscommon Town but this space is quite inadequate. There is also a Day Centre hidden away at the back of the Plunkett Home in Boyle and other Day Centres in Ballaghaderreen, Strokestown, Athlone and Castlerea.’ The integration of people back into the community has been ongoing and she gave her views on this. ‘This happened in Ireland because most of the long stay hospitals have been closed down. There are approximately 2,000 people in the remaining ones, that figure at one stage was 60,000. People were moved to group homes and hostels. That has now changed and the emphasis is on independent living. Recently we had a 68-year-old lady who had been in an orphanage, a psychiatric hospital and a group home. Now she is getting her own apartment, it will be her own home for the first time in her life.’ Every day is different and she enjoys her role within the service. ‘I find it highly interesting, have really got to know people and developed a good working relationship. I’m into my third generation of some families, it is good to see that they all survived and now enjoy good health. Making time can be difficult with appointments, clinics, meetings. If I were to change I would probably like to write or perhaps to teach but I am very happy in what I have already chosen to do. ‘Tutoring is part of my normal working day. We deal with medical students from NUIG and UCD and young doctors in training. It is great to meet so many young people, we need them too to ‘dust off the cobwebs’ and to see things through their eyes. It is very important and I enjoy it immensely.’ She spoke about how she unwinds at the end of a hectic day. ‘In the earlier years I had my children there of course, now I go home and read or just watch TV. When I can I travel and see parts of the world I never had time to see before’. Dr. McGuire’s vision would be for the service to embrace a whole new concept of caring and to remove the stigmatisation, to lift the veil of secrecy and bring it out from behind closed shutters into the public domain. ‘I would like to discard the word ‘mental’. My aspirations would be to see more Day Hospitals and home care teams. The best environment for anyone is their own home. People could attend a Day Hospital and go back home and care teams would monitor them in the comfort of their home. There are plans for a county day hospital. I would love to see centres on the main thoroughfares where the public would have access and not be hidden away up an avenue or down a back street. They would be ‘health centres’ incorporating all medical conditions without any distinction.’