Opinion
09 Dec 09

Dicing With Mental Health

Although no official announcement has been made yet, mental health services are about to receive another major cutback. Hot Press spoke to one patient about how he will be affected by radical changes to the ‘psychiatric scheme’ being planned by the HSE.

Rory Stokes will be known to many readers as former frontman with Dublin punk band The Sussed, who shot to prominence in the 1980s with their hit song about Sellafield, ‘Don’t Swim on the East Coast’. In the 1990s he became a DJ on the acid house scene, organising raves in the Point Depot and around the country that have become the stuff of legend.

It was while DJing at a holiday resort abroad that Stokes – a cousin of HP editor Niall – had a terrible experience that led to his first breakdown. In a library one evening, he found himself one of only two people left in the building.
“The guy didn’t realise there was anyone still there,” says Rory. “He got kerosene and poured it all over himself and set fire to himself. He turned around and saw me and he was screaming and screaming and bawling for mercy. I couldn’t get out to get help or do anything.”
In the wake of what was a terrifying and appalling experience, Rory began to suffer from panic attacks characterised by palpitations and sweating, though at first he did not know what they were. Although he had previously been an extroverted person, he began to find it tough even to go outside. He was subsequently diagnosed as suffering from post-traumatic stress disorder.
For twelve years, Rory has taken anti-depressant and anti-anxiety medication (Zispin and Xanax), as well as medication to help him sleep. Something as simple as a car misfiring or a car door slamming can bring on a panic attack – but with the help of his medication, he has made a good recovery. He works in a mobile communications company.
However, Rory Stokes has learned that – if planned cutbacks currently being hatched within the HSE come to fruition – he will soon be unable to afford his medication at its current dosage. The medication has been provided free for many years under what is loosely called the ‘psychiatric scheme’. The scheme, which has been in operation since 1998, allows some psychiatric patients, like Rory, to receive their medication without charge if they are being seen at an outpatient clinic rather than at their GP’s surgery. Strangely, the scheme is only operational in the area that was previously covered by the Eastern Health Board. However, that fact doesn’t make the proposed cutbacks any less dramatic or potentially damaging for those who will be affected.
While it has been impossible to extract any kind of official confirmation, Hot Press understands that the scheme is now to be significantly scaled back, if not abandoned altogether. Under the proposed new regime, psychiatric or mental health patients who have a medical card are to be seen at their GP’s surgery rather than at a clinic – and those who do not have a medical card will be forced to pay for their own medication.
The HSE had not responded to requests for information by the time of going to press. However, a spokeswoman for the Irish Pharmacy Union did confirm that changes were afoot. “The Irish Pharmacy Union was recently informed by the HSE that it was introducing changes to the psychiatric scheme,” she said, “and that it was implementing these changes retrospectively back as far as July 2009.”
No one is quite sure precisely what that means – but it surely spells bad news.
“The union has expressed concern to the HSE about these changes as it is unclear what impact this will have on patients who avail on the scheme. The union has requested a meeting with the HSE on the issue,” the spokeswoman added.
Hot Press spoke to a number of pharmacists to see if they had been informed about the proposed scrapping of the scheme. Some were completely unaware that changes were planned; others said that they had recently been informed that the scheme is to be scrapped retroactively. A number of these pharmacists say that they have not received payments owed to them under the scheme since August – and, in a twist that seems typical of the Kafkaesque world of the HSE, their understanding is that the HSE does not intend to provide these payments.
“There’s still negotiation ongoing,” one Wicklow pharmacist revealed, “but I’d be surprised if that [scrapping the scheme] isn’t the final outcome. We’re just the messenger – the HSE has made the changes but we have to inform the patients. We haven’t been paid for the scheme since July. Some pharmacists are out of pocket by a large amount.”
Meanwhile, the HSE’s handling of the issue has been strongly criticised by John Saunders, director of mental illness support organisation Shine. “There has been no official announcement” he told Hot Press. “They’re doing the patients and their families a huge disservice by being so covert. It seems pharmacists have been told about the plan and no-one else.”
Saunders added that the rationale for scrapping the scheme is thoroughly unsatisfactory.
“It’s being done as a budgetary mechanism rather than a rational programme to improve mental health services,” he said. “The HSE needs to make a clear public statement and explain how they are going to respond to any hardship created. If you don’t have a medical card and you don’t have a high enough income, you’re caught. If there’s a situation where someone now can’t afford their medication, they HSE are putting their mental health at risk. It’s going to come back on the HSE because they’ll have to deal with people becoming unwell – it’s a false economy.”
Rory Stokes has decided to go public on the issue because he sees it as being of huge national importance. He makes the same argument as John Saunders, but does so in very stark and compelling terms.
“People who work and pay their taxes will end up on the dole or in an institution,” he says. “It’s going to be mayhem if people stop taking their meds. When you think of all the money spent on getting people out of institutions – but with this move they’re now going to get people back in.”
From next month, Rory’s medication will cost him €117 per month, which he can’t afford. The problem is compounded by the fact that, like many Irish people, he recently took a 10% pay cut. Unable to afford his current medication, he will have to cut his dosage by 33%. This is a serious cause for concern as both Zispin and Xanax are highly addictive, so if the dosage is being reduced it has to be done gradually.
“For me, it just means I will probably get depressed and have more panic attacks,” he says. “I work in an open-plan office where it is impractical to attempt breathing exercises, so if I have an anxiety attack, everyone can see it because I won’t have the Xanax to take.
“I guarantee you that there will be many people in my situation who will stop taking Psychiatric meds because they can’t afford them,” he adds. “These people will either become suicidal or homicidal like that guy from Dalkey who stabbed those people in Bray before stabbing himself. My fear is that this type of thing will become way more frequent.
“There are 500+ suicides in Ireland every year compared with 350 road deaths. Nearly every ad break has an ad about driving carefully – yet there are no ads on suicide prevention. I presumed it was because the Government had elected to spend the money on the ground, on meds for people like me. If the Government think they are saving money – what are they going to do when most of these people that stop taking their meds end up institutionalised and inevitably costing the State a lot more?
“That’s why I am appealing to the Government to reverse this decision to withdraw free meds under the Psychiatric Scheme. It is crucial that they should do it before someone dies. Before someone stops meds and kills someone. Before someone tries to buy dud meds online with who knows what consequences. Before people stop taking their meds and end up in an institution or worse. That’s what’s at stake. It isn’t too late for a change of heart.”