Kathleen Lynch Interview

The last time Hot Press was in Dáil Éireann to meet Aodhán Ó Ríordáin the place was looking a bit shabby. Now, however, following the steam cleaning of carpets and re- hanging of wonky parliamentarian portraits, carried out over the summer recess, it’s quite the des res.
The TDs don’t officially return till tomorrow, which means that the corridors of power are eerily deserted, to the point where you half-expect a little boy to come riding round the corner on a tricycle à la The Shining.
There’s nothing scary though about Kathleen Lynch, Labour Deputy for Cork North Central and, more pertinently to today’s discussion, the Minister for State at the Department of Health with special responsibility for Primary Care, Social Care (Disabilities & Older People) and Mental Health, which not surprisingly appears in abbreviated form on the plaque outside her office.
All beaming smiles as we sit down, she says, “I think it’s brilliant Hot Press is doing a Mental Health Special. We have to be open and honest about the different issues involved, even if sometimes that can be difficult and painful for people. I’m also really looking forward to reading Bressie’s book – someone who’s as successful and outwardly confident as him saying, ‘I have my problems too’ is enormously powerful, and helps to de-stigmatise mental illness. He appeals to a certain age group that politicians never will do.”
The Minister has asked for a brief outline of what we want to discuss but, as with her aforementioned party colleague Aodhán Ó Ríordáin a few months back, there are no pre- conditions or civil servants ready to jump in if the questioning gets too tricky.
Appearing on Newstalk 106-108 in August, the Minister said she was “confident” of securing an extra €35 million to be spent on mental health services in the next budget.
“It might come as a surprise to Michael Noonan and Brendan Howlin that I’m announcing this publicly,” she said on-air, “but that’s the aim.”
Stuart Clark: Minister, I hope that Michael Noonan and Brendan Howlin weren’t too surprised and that you now have cabinet approval for that €35m.
Kathleen Lynch: Every single year there’s a doubt that it won’t happen but, yes, that money is now ring-fenced. A key area is staffing levels. Although we’ve managed to recruit almost a thousand people to new posts, we’re still about 180 short of our target. There are a few people within the mental health services who I’d rely on for advice and one of those is a psychiatric nurse called Kevin Plunkett. Kevin did a lot of the training with young nurse graduates and is now part of the team that goes to England, Scotland and Wales to attract them back.
Have you had to dangle a bigger financial carrot in front of them?
One issue is the sort of transition payment they get to return to Ireland. Another was further education – that’s now been addressed. We’re roughly 22% below the ideal staffing rates and it will go up and down. Within the psychiatric services, people can retire at 55; that’s because of the rigours of the type of service that they deliver. That was introduced when the service was delivered in the main by big institutions. It’s a different and, I think, far more attractive service now.
In what way?
There’s far more opportunities for advancement. We want people to advance. The last time I was talking to my colleague in Cork he was telling me that one of his nurses is now doing a Mental Health & Psychiatric Care Masters in Oxford. Working in a community base is far more attractive than every Monday going up that long drive into a community centre where everyone’s completely dependent on you. I don’t blame them for leaving and going where the work is – this country did collapse.
The Kerry coroner, Terence Casey, said in our last Mental Health Special that, “We had 550 suicides in 2011, which was an extraordinary figure, but the government seem to ignore it. They’re not putting the thought, the money or the expertise into addressing the issue.” Fair comment?
The numbers are down recently, but not down enough of course. Suicide is a very complex and difficult area. When, during my first two years in this job, we were putting so much into the prevention side of it and the numbers were still going up, I asked the expert in all of this, Professor Ella Arrensman, “Should we be doing something differently?” She came in to see me specially – incidentally Ella’s now our World Health Organization representative – and said, “Look, you know you’re doing the right thing. It’s just that it takes time.” I was invited to participate in the launch of the WHO’s Suicide Prevention Strategy. We were the only government there because we were doing exactly what they wanted.
Terence Casey believes that the massive increase in the number of over-30s killing themselves is largely due to Ireland’s economic downturn.
There’s not a doubt in the world about that. You had people working very, very hard to maintain a house and a family. They were putting food on the table and suddenly it just vanished from them. I keep saying to people, “Can you imagine what it’s like having to tell your children that you’re going to lose your home?” If the economic collapse caused the number of suicides to go up, the recovery must have an impact on the numbers going down. Another massive issue is rural isolation, people going days, sometimes weeks with virtually no human contact. You can’t have different laws for different parts of the country, and there’s never an excuse for drink-driving, but the closure of so many country pubs has taken away one of the few social outlets elder people had. Being put off the road in rural Ireland has entirely different consequences to being put off the road in an urban area.
Do you have a clear plan of how to bring the suicide rate down further?
I go to funerals in Ireland where people have died by suicide. It used to be that what had happened was talked about only in hushed tones at the back of the church; that’s not the case anymore. I’m a great believer in ‘out loud’. The only way to get rid of the ghosts is to talk about it. We have to say to people who feel the only option left to them is to kill themselves, “Stop, talk to someone. There’s help and support available to you.” It’s that irreversible action, which I don’t think young people especially understand entirely. You can’t have government on every street corner though. It has to be a combination of forces from the GAA and schools to organisations like Console and, of course, government. We’re all stakeholders in this.
Terence Casey is extremely critical of the short-form death certificate introduced by Joan Burton that avoids having to use the word ‘suicide’, and totally goes against your ‘out loud’ philosophy. At no point, he says, did the Tánaiste consult with him or his fellow coroners about what was in the public interest.
I was actually a speaker at the Coroners of Ireland dinner last week, and the Department of Justice was there as well. The coroners are a very vocal and knowledgable group and we’ll be closely liaising with them to iron out issues like that.
So do you feel a mistake was made by the Tánaiste?
The difficulty is we’re coming from a place where it wasn’t talked about. There are still families who do not want that, I suppose, verdict so sensitivity is important. What is central to all of this is the type of discussion that goes on before the inquest. The staff in the coroner’s office are very sensitive and do contact people in advance.
One of the things Niall Breslin and myself discussed the other day was the seven teenage suicides directly attributable to bullying on peer- to-peer social networks. Or antisocial networks as the bear pit ones like Ask.fm have become.
The notion that you can say horrendous things to young people like “go hang yourself ” and once ‘send’ has been pressed absolve yourself of responsibility is appalling. Because of the international nature of the internet, this clearly has to be dealt with on a Europe-wide basis. Imagine the headlines in North Korea if Ireland unilaterally put a blocking mechanism in place! The individuals posting these comments and the sites facilitating them have to be held to account. We also need to put together a whole new area of education in which teachers talk to young people about their engagement with these sites.
A bête noire of Bressie’s, and I’ve had it said to me by teachers too, is that so few schools have dedicated counsellors that kids can go to with problems if, for whatever reason, they don’t feel able to talk to their families.
In the main, it usually starts off as an emotional difficulty before becoming a mental health issue. We’ve all been there – relationship breakups, being misunderstood, the whole range of problems you experience at that age. What myself and the Minister for Education, Jan O’Sullivan, have done is introduce the Well-Being In Post-Primary Schools: Guidelines For Mental Health Promotion and Suicide Prevention. The aim being to create an environment in which young adults feel they can approach any member of staff or wider school community with their problems.
Under the terms of the Long Term Illness Scheme, those suffering from schizophrenia, bipolar disorder and major depressive order only have their medication paid for up to the age of 16. The cost of their antidepressants and mood stabilisers thereafter is around €140 a month, a substantial sum if you don’t qualify for a medical card. Given that these conditions often don’t emerge or aren’t diagnosed until people are in their late teens, and the potentially life-threatening consequences if for financial reasons they come off their medication, shouldn’t this be changed?
We did consider extending the Long Term Illness Card, but the expert group we set up to look at how we’d do this actually came back to us and said, “That’d be the wrong way to go. You’d have to have a hierarchy of diagnoses and a hierarchy of illness.” I’m reluctant to put anything relating to mental health into a separate bracket. I have for years been trying to get people to talk about it in a mainstreamed way. I’m not saying it’s the same as a broken leg or appendicitis – it’s clearly different but do I want to go down the road of having it separated out again? I’m not sure.
But aren’t you’re putting schizophrenia, bipolar and MDO into a separate bracket by not including them?
Yes, well in terms of the treatment and the medication, clearly it is an issue. We’re going to have to deal with it in other ways, like looking at prescription fees and the cap being set at €140 a month. It is hugely important that people with these conditions stay on their medication because the consequences to them and their family if they don’t is so horrendous.
You angered some and delighted others a few years ago when you told Pat Kenny on TV that you “have problems” with antidepressants. What exactly did you mean by that?
Clearly there are conditions such as the ones we’ve just been talking about and depression, both severe and mild, where people need medication – and often over a long period of time. What worries me more than anything else is the lack of review. There has to be a process in place where it’s not just “up the dose, lower the dose.” Sometimes with mild depression medication can work over a short period of time on its own, but when it’s more prolonged and entrenched clearly something else is needed. That, hopefully, being the type of counseling we’re putting into primary care. I know that after the prolonged negotiations we had on the under-sixes and over-sevens they may not believe this, but I’ve always felt terribly sorry for GPs because if you had a difficulty with your mental health and went to them they had only two courses of action; they could either prescribe or send you to an acute unit. What we’ve done is give them the piece in the middle. Now when someone comes to them with a mild to moderate depression they can send them for eight weeks of counselling. So successful has it been that we ran out of money for it quite quickly, but we’ll be putting additional money into that next year.
The Investment In My Mental Health Campaign says that, with the necessary funding and staffing levels, 600 people could transition from HSE supported accommodation into mainstream community living. Do those numbers stack up?
Yes, they do. The people who would be more adventurous and visionary in terms of mental health and disability – and sometimes the two do crossover – say to me there’d be less than 1% of people who couldn’t make that transition. My view has always been, “Let’s suck it and see.” In the event that we find a few people who can’t make that transition, that’s okay. Let’s put a service in place, which ensures they’re safe and living the best way possible. Surveys suggest that 60% of people don’t want to live next to a person that has a difficulty with their mental health. I always smile at that because I have news for them – they are but just don’t know it!
Broadening things out a bit, do you agree with your colleague Aodhán Ó Ríordáin that instead of waging a futile War on Drugs we need to go the Portuguese decriminalisation route?
A young lad of 15, 16, 17, 18 – they tell me that the frontal-lobes in the male don’t develop until they’re 25! – can be caught with a little bit of hash and have their lives destroyed. They can’t get jobs, which is something we have to take a serious look at. I’m not talking about the people dealing in bigger quantities. His idea of safe heroin injecting areas makes a great deal of sense because if people are addicted it’s very difficult to engage with them in terms of rehabilitation, if that’s what they want. Clearly the legislation at the moment says “no” so that’s a difficulty which has to be overcome.
Does Labour as a party support decriminalisation?
No, I would’t say that’s where we’re at as a party. As a party, we would say that the softer drugs like hash, for personal use, shouldn’t ruin your life. That could be addressed at a court level, but judges would have to be instructed and of course be willing to accept that instruction.
Now that the Same Sex Marriage Referendum has been won and the court objections to it thrown out, a lot of people would say repealing the Eighth Amendment is the next battleground. Do you agree?
Yes, I believe that. I campaigned against it originally and it wasn’t very pleasant. Brendan Howlin and myself were saying recently that we both still bear the scars, It got very nasty and personal. I can only imagine how vicious it could become with social media. Hopefully people will exercise restraint. We need to repeal the Eighth Amendment on the grounds that we need our doctors, women and their partners to make decisions without the worry of others looking over their shoulder.
How far down the abortion route are you personally prepared to go?
I would have serious reservations about abortions beyond 14 weeks. But on the other hand there are circumstances that women find themselves in that will require intervention beyond that time, but I’d have to say to you, “Not my business.” The decisions people make in the privacy of their own homes are truly their own business.
Would you proudly identify as a socialist?
Yes, absolutely, I’ve been called far worse!
What do you make of Jeremy Corbyn?
I’m not certain. It’s a wait-and see. I know of his record in relation to CND and the anti-nuclear movement, which I was part of myself, and he called it right in relation to Iraq. But then again so did a lot of other people. I’m extremely interested to meet and gauge him for myself.
As a conviction politician, do you ever look at the likes of Mick Wallace and Clare Daly enviously and think, “I’d love the freedom of not having to follow the party whip”?
No, because most socialists are actually very disciplined people. I’m very disciplined and don’t like the notion that you’re a voice in the wilderness. The strength of any political party is that you persuade people that what you want to do is the right thing. We’ve done that to a great extent with mental health and disability.