Mental health and direct provision: "Everybody was having their own mental breakdown. There was nobody to talk to"

Today, October 10, marks World Mental Health Day, when discussions about mental well-being come to the forefront of public consciousness. Amid these welcome conversations, a vulnerable section of the population suffers in quiet agony.

Direct provision, introduced as a stopgap measure at the dawn of the millennium, was meant to be a temporary solution for housing asylum seekers in Ireland. Yet, over two decades later the system persists, with over 30,000 people currently in its purgatory.

There were plans for its abolition in 2021, a commitment abandoned by the Government earlier this year when it published a new accommodation strategy for international protection applicants, emphasising “a large, core State-owned supply, concurrently delivering contingency, short-term and long-term accommodation solutions.”

Though it’s pretty outrageous that companies were allowed to generate sometimes massive profits from this situation in the first place, moving away from the current model appears a step in the right direction. Still, many of the proposed changes – outlined in the plan in March – seem to be merely a rebranded continuation of the same flawed process – one which erodes the mental health of those it’s supposed to protect.

“It’s never ending,” says Alex. “My normal life has been snatched away from me.”

Alex is not her real name. I can’t tell you her country of origin, or what she worked as. I can assure you however, that she has gone from one nightmare to the another.

“In the beginning I was sleeping with 13 people in a room,” Alex continues. “Everybody was just having their own mental breakdown. There was nobody to talk to.”

KAFKAESQUE EXISTENCE

Since then, Alex has been moved to a more ‘manageable’ space with three strangers as roommates.

“I can barely sleep,” Alex continues. “Everybody is talking on the phone past midnight or really early in the morning. There’s fighting because people coming from different countries don’t have the best English and can’t resolve things properly. Nobody trusts each other. Your mind is not able to relax. You’re constantly expecting something to happen.

“There’s no space for studying, no prayer rooms, we don’t have any recreational space whatsoever. It’s just the room – the corner that you have – the kitchen and the toilets with showers that are hardly working with no hot water.

“These things put people on edge, especially if you are coming from a bad situation in the first place. It’s like you are being punished for it.”

The consequences are serious.

“Some people have tried committing suicide,” Alex says. “I can understand the feeling of literal hopelessness, and then being treated like you should be grateful for whatever you are getting. Some have what we’ve named ‘sugar daddies’. They have somebody they sleep with and they give them money in return. The whole process is so gruesome to your mental health that people turn to alcohol.

“People from the far-right tend to think we’re cruising and having a good time, but for some of us it feels like a concentration camp. It goes after your mind, your dignity, your human rights.”

When questioned about incidences of suicide in Direct Povision in 2011, then-Justice Minister Alan Shatter said 49 people had died in the system over a nine-year period. Post-Traumatic Stress Disorder (PTSD), according to the College of Psychiatrists of Ireland, is also ten times higher amongst asylum seekers than the general population.

“People go through horrific situations on their way to get somewhere safe, so psychiatric illness can be triggered by that,” says Dr Rachael Cullivan, an experienced psychiatrist who has previously worked with refugees in direct provision.

“They may already have an illness or condition triggered by the awfulness of their experiences at home. What you’ll often see is anxiety disorders, depressive illness, and then post-traumatic stress issues.”

The challenges faced by asylum seekers in accessing mental health support only exacerbate these existing issues.

“Technically, once somebody is in direct provision, they’re entitled to a medical card,” Dr Cullivan notes. “But GPs are overwhelmed in our system, so when they’re asked to take on new people, they can’t. If you have a medical card and can get to a GP, the practical stuff gets in the way. Logistical things like transport and finding childcare.”

Cultural and language barriers add to the pressure.

“You have to be aware that for some people, their culture might not be very accepting of psychiatric illnesses,” Dr Cullivan says. “They don’t necessarily have the language or the understanding themselves. I represent Irish psychiatry on a European board, and we’ve had this conversation a lot. There’s a view that you can do talking therapies through a translator, but I would say that unless your therapists are very well supported, well-trained and capable, it’s difficult.”

DEGREES AND CREDENTIALS

Alongside improving access to appropriate health services for refugees, removing individuals from direct provision is a solution so clear it hardly needs stating. While the government’s poor management of the housing crisis is no justification for subjecting vulnerable people to a mentally torturous, Kafkaesque existence, the shortage of suitable accommodation remains an obstacle.

A more straightforward way of improving the situation would be to enable those in direct provision to access employment more easily. Under the current system, they have to wait six months before they can even apply for permission to seek work.

It’s a rule that’s created a lot of frustration, given that plenty of asylum seekers, like Alex, have qualifications and experience. Not allowing people to work creates unnecessary hardship, forcing skilled people to live off a €38.80 weekly allowance (anything under a weekly income of €318 is considered below the poverty line) and preventing them from integrating.

Photo: MASI

“The majority of people here were working before they fled their country for whatever reason,” Alex observes. “They had steady jobs and are educated. They’ve got certificates and awards, but you come here and it’s like you’re stripped of everything and starting from scratch. We could contribute to the economy, pay taxes. We don’t mind that.

“I was doing some volunteering work with the elderly, at local festivals and the community garden,” Alex continues. “I get to see Ireland and its people. I get to experience the culture, the mentality and the community. It’s kept me sane. I leave the premises and come back tired, which makes it easier to sleep.

“You don’t want,” Alex says, “to jeopardise your chances of actually getting help from Ireland by working illegally. So you abide by their rules.”

Dr. Cullivan considers the situation further.

“I remember seeing someone, and the first thing he wanted to show me in the consultation were his degrees and credentials,” she adds. “He was a social worker in his country of origin. He was so proud of that and felt that it had been swept away from him.

“We all know the benefits of a routine, regular work and a sense of contribution. So it is vitally important that people find some way of getting back into work or a work-like situation.

“I appreciate that a country receiving somebody has the responsibility to check that people’s credentials are what they are, so there is a balance between taking people’s word for it and having some sort of evidence. But having said that, it’s absolutely important that people are afforded the chance to work.”