The Celtic Tiger has bolted and austere economic times have returned. Finance Minister Charlie McCreevy has expressed dismay that the vast sums of money pumped into the health services have not produced the expected results. Waiting lists have grown and the health services seem to require unending injections of cash, just to survive. What has gone wrong? Have all the investments been wasted? If waiting lists were the only performance indicator worth monitoring then surely little appears to have changed.
This summer as we prepare to welcome people with intellectual disabilities from around the world for the Special Olympics World Games, it is worthwhile reflecting on some of the real changes that have taken place in our health services since the last economic slump. Those of us who remember the ’70s and ’80s will recall the type of service provision that was the norm then. Most people with an intellectual disability in residential care lived in large wards in institutions. They had little privacy, few possessions and were seldom seen in their communities. I can recall a visit to one such institution where a well-meaning person offered to give me a tour. As we walked down a long corridor, I was told that we were going to visit some ‘children’. As we entered the first ward I was surprised to meet a large group of adults—apparently these were the children. The ward sister greeted us warmly and mentioned that there were four ‘Downs’, three ‘PKUs’, others with less common conditions, and still others without any known cause in her ward of 27 people. The people themselves were seated in chairs or wandering aimlessly around the ward, some smiled in our direction, though most seemed not to have noticed our presence. Later we visited another ward that was home to those with profound disabilities. They were all were in neat rows of beds in a large, sparsely furnished room. Nobody looked in our direction apart from a few staff in uniform who were busy feeding their ‘patients’. In another institution, which prided itself on its progressive behavioural management practices, I recall seeing a young man in a straight jacket and a woman being pinned down to the ground. Overall, most services were gloomy places to visit and offered little hope to those who lived there.
Sadly, at that time, many managers saw little wrong with the services they administered. Indeed there was a belief that ‘standards of care’ were among the best being offered anywhere. When we look back today, we realise that services for people with an intellectual disability then were just another part of the ‘hidden Ireland’ that has now come painfully into focus. Just like the recent media attention on the abuses that occurred in industrial schools and Magdalene homes, we as a nation need to acknowledge the wrongs that were done to the most vulnerable in our society so that we can ensure that these can never be repeated.
Gradually over the years, government policies in Ireland began to reflect the principles of normalisation and to acknowledge the rights of people with disabilities. Today, greater emphasis is placed on ensuring that people with an intellectual disability have a presence in their community, in terms of using local amenities, attending their local school or living in houses as equal citizens alongside other people. Families and service users are demanding, and beginning to be supported, to have a greater say in the way services are delivered. Individual programme planning, supported employment schemes and inclusive education are becoming more common. However, while great progress has been made in some areas, the recently published Amnesty International Report on Mental Health Services in Ireland reminds us that much more needs to be done.
It is unfortunate, therefore, that the achievements that have been accomplished have received so little recognition from the Department of Finance. The recent health cuts may put in jeopardy the fragile start towards the reorganisation of services. As a nation we seem to have become more concerned with the state of the economy than with the health of our communities. You could be forgiven for believing that communities exist to serve the needs of the economy, and not vice versa. We seem to have forgotten that taxation should be about the redistribution of wealth, so that the most vulnerable in our society can enjoy a decent standard of living. During hard times it should not be acceptable to cut services to the weak and vulnerable in order to protect the interests of the wealthy.
Hopefully, this summer when Ireland hosts the Special Olympics we as a nation can take pride in the achievements of people with an intellectual disability and discover the importance of supporting and cherishing all our citizens as equal members of our community. Perhaps, also we will recall a time long ago when people with an intellectual disability were referred to as ‘duine le Dia’ (persons with God) and were considered valued members of our communities.