Interview by Alan Roche with Fr Peter McVerry
If you read the publications and policies of our elected representatives and civil servants you could be forgiven for believing Ireland still to be that Isle of Saints and Scholars, where words of wisdom promote justice and harmony. Contained within the texts of documents like the National Development Plan 2007 – 2016 and the Towards 2016 Partnership Agreement are aspirations of the very highest order.
To quote the National Action Plan For Social Inclusion 2007 – 2016, “Access to quality health services is a prerequisite for participation in the social and economic life of society. Working to improve the health status of all, and particularly vulnerable groups such as people with disabilities including those with mental illness, drug users, the homeless and Travellers, is an essential element of social inclusion.” (1)
Fine words indeed, ones that sound most equitable and have the ring of truth to them. So then Dual Diagnosis Ireland should have no work to do because the powers that be know the way that we need to go.
Things look even better in the A Vision For Change report commissioned by the Government on mental health and published in 2006, “Mental health promotion should be available for all age groups, to enhance protective factors and decrease risk factors for developing mental health problems. A recovery orientation should inform every aspect of service delivery and service users should be partners in their own care. Care plans should reflect the service user’s particular needs, goals and potential and should address community factors that may impede or support recovery. Links between specialist mental health services, primary care services and voluntary groups that are supportive of mental health should be enhanced and formalised.” (2)
However in 2008 ‘Ciaran’ says, “In Ireland, dual diagnosis means you go from Billy to Jack and never really get a service that helps you.” (3) This despite the fact that the recommendations of A Vision For Change are committed to as a specific objective in the Government’s own Towards 2016 Partnership Agreement, “Developing a high-quality community-based mental health service in accordance with the recommendations of the Report of the Expert Group on Mental Health Policy, A Vision for Change.” (4)
So somewhere along the line the theory and the aspirations seem not to be finding their way into practice, at least not for ‘Ciaran’. Father Peter Mc Verry has been providing accommodation to homeless boys in Dublin since 1979. In all that time he has offered safety and sanctuary to those whom the rest of society seemed to have forgotten. His understanding of dual diagnosis issues comes from decades of dealing with homeless boys suffering from addiction in conjunction with one or more mental health issues.
He says, “The holistic needs of the individual are not being addressed. There are too many borders between homelessness, drugs, mental health; you need to be in one category or the other to be dealt with, when you are in multiple categories the system breaks down. And it’s when you are in ‘multiple categories’ that you are most in need of assistance. I don’t see any joined up thinking, or at least the practical delivery of services in a joined up manner. We need to develop multi-disciplinary teams that are capable of dealing effectively with the totality of the problems that people have.”
He continues, “I’ll give you an example. I won’t name any people or places or institutions because I don’t want to compromise anyone’s identity. But this story, or ones very similar are happening all the time as well. I had a young man stay in the hostel, homeless, with mental health problems and a recovering heroine addict on Methadone treatment. I wanted to seek help for his various issues, so we went to the local hospital – we’ll call it hospital A. Now upon learning the youn man was homeless, hospital A tells us it cannot treat him and refers us to hospital B. Hospital B will treat the homeless, but because the youth is on Methadone they cannot provide treatment and refer us to clinic C. Now clinic C would help a homeless youth on Methadone, but they discover he receives his Methadone from a different catchment area and we are referred to clinic D. However, clinic D has no facilities to treat the serious mental health issues that the boy suffered from. . .
“That young man is now in jail. It is so tiring trying to deal with health, mental health, homeless state services, you seem to have to fight for everything and there never seems to be any internal communication. If you look back at that example, even if hospital A had just taken all the boys details and figured out that the other hospitals and clinics couldn’t treat him for the various reasons, well it would be far from a perfect world but it would be a quantum leap forward and it would have saved me and that boy a lot of stress, struggle, disappointment and wasted effort.”
In closing he says, “There are a many reports on the importance of multi-disciplinary approaches to treatment, on the importance of patient participation in treatment, on the importance of holistic approaches by varying branches of state and voluntary services; the Government’s own literature is peppered with similar ideas and has been for years. But I don’t see the delivery of it, the theory is fine and the aspiring to do it is great, but where is the implementation? To put it in the simplest terms if someone has multiple problems you make treatment more difficult by treating each problem in isolation. If the Government actually delivered on its aspirations, in a practical way, the benefits to those in need would be enormous. It would change lives for the better. So I would love to see those promises become reality, but I won’t hold my breath.”
The National Development Plan 2007 – 2016 states, “A national policy framework for the modernisation of the mental health services ‘‘A Vision for Change’’ — Report of the Expert Group on Mental Health Policy has been accepted by Government as the basis for the future development of mental health policy.” (5) But in a time when impossible sums of money are being used to guarantee banks and a possible slash and burn budget looms, does it seem that the urgency of those in the most need is really understood, is really going to be addressed? Should we wait for, hope for, pray for, or demand an answer?