"Today is not a good day for me, for today I found out I was mad / My madness is still new, fresh in my mind so to say, so I can understand it more / It has come to my attention that over the past year and a half I have acquired a condition known as acute paranoid schizophrenia” – Whipping Boy, ‘A Natural’.

I spent early March in Malawi. In Lilongwe airport on the way home, a young security guard named Matthew enquired after my trip. I told him I’d been working with the families of people with schizophrenia; he didn’t understand. Mental illness? Still nothing. So, I reached reluctantly for Whipping Boy’s term. “Madness?”
He lit up. “Madness? Like my cousin… my cousin is mad!”
Minutes later it was clear that Matthew’s cousin had a psychotic illness, probably schizophrenia. She had been psychotic for two or three years and had received no real care in that time. And I thought: this is just like home.
Schizophrenia is a severe, enduring mental illness characterised by delusions and hallucinations – psychotic symptoms. It is present in every culture and though much misunderstood, affects vast numbers of people. 35,000 people in Ireland have the disorder.
The symptoms start early, in the teens or twenties, and they may persist for decades; this is one of the reasons why the WHO rates schizophrenia as a world health problem of a similar gravity to war. Another is that 10% of people with schizophrenia die by suicide, usually in the five years after diagnosis.
Unless you’ve been there (or, a distant second, unless you’ve seen A Beautiful Mind) it’s hard to imagine how disabling psychotic symptoms can be. To experience delusions is to believe, with utter unshakeable conviction, things that are false and almost always frightening: other people are reading your mind, controlling your thoughts, or plotting to hurt or kill you; and to experience an auditory hallucination is to hear a voice, indistinguishable from any other, that other people can’t hear. Again, it is usually a terrifying experience. (Donnie Darko does this well.)
There have been effective treatments for 50 years, but a key difficulty with improving the outcome for people with schizophrenia has been delivering the treatment in the first place.
Research by a team based in the Cluain Mhuire community psychiatric service in Blackrock has shown that it takes typically 1-2 years, from the time that psychotic symptoms emerge, for an individual to receive effective mental health care – a figure for Dublin that is average for the developed world, and probably not much better than obtained in Malawi.
For this reason, the DELTA project – Detection, Education and Local Team Assessment – was launched from its base in Dun Laoghaire on February 14th. Niall Turner, an occupational therapist with ten years’ experience in Cluain Mhuire, heads the new initiative, which has a staff of four taken from across the range of mental health disciplines, and covers the Dublin South-East area.
“In every other type of health problem, the earlier you get in the better,” he says. “Heart disease, respiratory disease, diabetes, and so on. There hasn’t been the same urgency about schizophrenia until recently. But we know that the longer someone is sick before getting proper care, the longer it will take them to respond to treatment. And when they recover, people are more likely to stay well if they get care early.
“Often, people don’t get help because they don’t recognise that they’re ill, and people around them don’t recognise it either. It’s hard always to be sure, even when you’re trained, when someone is showing the early signs of psychosis. But we know it’s possible to show people how to recognise the signs earlier and to get help when it does the most good.”
The DELTA team will provide education for any group of people that might come into contact with young people with psychosis (“Friends, families, neighbours, teachers, priests, journalists, gardai, nurses, doctors, football coaches,” lists Niall, non-exhaustively).
The team will also meet people and their families individually, after referral by GPs, to give advice and direct people to prompt specialised care when necessary, and to reassure when possible. (So the advice is: if someone close to you shows any of the early signs, or if you notice them in yourself, consult your GP.)
The results of the project will be scrutinised and if shown to work, the pressure will be on for funding to roll the service out across the country.
“It makes sense to us that that would happen,” asserts Niall. “There are early intervention services right across the UK, the US, Australia and Europe – and there should be funding for them here. When we say that, we’re thinking of young people with psychosis, getting increasingly withdrawn, for one, two years, maybe more, at a really important time in their lives. It’s the prime of your life! It’s when you should be building your career, building your relationships; really building your whole future.
"Missing out on those years because of mental illness can be devastating. And it’s avoidable.”

DELTA, phone: (01) 2366730
Schizophrenia Ireland, Schizophrenia Ireland 1890 621 631.
www.sirl.ie