The Irish mental health system facilitates two types of admission to a psychiatric hospital, Voluntary or Involuntary. It is as simple an explanation as you would think. Voluntary is where you say “Yes I will sign myself into the psychiatric ward”. Involuntary is where you say “No I will not sign myself into the psychiatric ward”, but then someone with a higher degree of power can overrule your decision. I want to say from the outset, I am not against involuntary hospitalisation as there is definitely many situations where it is needed. I want to instead focus on the voluntary aspect of hospitalisation.

I use inverted commas on the word “voluntary” in my title as from my experience there is nothing voluntary about it (for the majority of times I’ve been hospitalised). A person typically admits themselves voluntarily under threat of, or just before, being involuntary committed. Voluntary admission is almost the paperless version experience. Yes you can say I want to go home, and you can, once the doctor says it’s ok. If they say no, back comes the “voluntary” option of staying a patient. I do not want to sound like I’m saying they are essentially the same as they are NOT. Involuntary admission is a way more complex version with several tribunals and paperwork to allow you to be discharged. You also can be forced to take medication and have less of a say. Voluntary patients do have significant more choice and input in comparison, it is the ever returning involuntary threat that hangs over any bigger decisions. Another aspect of control for voluntary patients is how much easier it is to be discharged when you really should not be. All they have to do is lie to the doctor consulting on your discharge.

I did this in a different context, with the Gardaí. I have been taken into Garda custody twice under the Mental Health Act. The first time I had the most lovely Gardaí, a doctor was called in and I lied. I hate lying but I needed to be out of that situation. Being honest it all just happened I did not consciously choose to lie, it was self-preservation in the moment. One of the Gardaí followed up with a phone call a few days later, where I had already admitted myself to hospital for the first time. The second time, the same thing pretty much happened except I didn’t admit myself to hospital after and one of the Guards was a pr**k.

Admission to a psychiatric ward irrespective of it being voluntary or not does have certain social, employability and legal considerations. Even after recovery there are limitations put on your life in many ways. Examples include travel visas (USA, Canada, Australia), difficulties with certain professions (aviation, army, Gardaí), insurance (health, car) and a social stigma associated with being admitted to a psychiatric ward. I understand some of these limitations are in place for protection but it feels as if it is a lifetime consequence of seeking help. The example that is used repeatedly when discussing seeking help for mental health, or in my case my doctor using it when I was deciding to start medication, the “would you not seek help if you broke your leg?” question. This question infuriates me so much when I hear it, a simplification of such a complex issue. If you add some additional information to that question using a mental health perspective would it be such an easy yes?

Now fortunately this is an example of extremes, most people with mental health issues do not experience these. However more worryingly, I also would not be surprised to meet someone who fit this exact description.

Back to hospitalisation… It is unfortunate that the consideration of admission is not health, which often is one of the last motivating factors after it has significantly worsened. Most people know dealing with a problem early on typically results in faster and easier recovery, as the illness has not progressed to a critical level. The question is though, how do we move from “hide it under the covers” to openly discussing mental health and finding acceptance? I don’t think there is one clear answer. Yes, more people are opening up about their mental health and this really does help but I don’t think it is moving at a needed speed to see any change in my lifetime.

Reflecting on this post I feel I am sounding very negative about the whole situation. This is not my intention, I just want to highlight the real life aspects of mental health treatment.

JF