Gateway pioneers recovery-oriented approach to mental illness

The colourful handcrafted sign across the large front window of a shop in the heart of Rathmines, Dublin 6, is a clear shout-out that Gateway is open to all. Together with Áras Folláin in Nenagh, Co Tipperary, this mental health project is a pioneer in the recovery-oriented approach to mental illness, where people with lived experience become advocates for others on their shared journey to wellness.

A group of 10 Gateway members volunteer to speak to The Irish Times about why they come here. Richard Moloney has been a member of Gateway for many years. "I have a sense of belonging here. It's a holistic space because it takes care of all the elements: there are practical courses, creative courses and relaxation/meditation classes. It's a place to regain myself and get a sense of hope and responsibility," he says.

Cathy Bennett says the fact that everyone has had some kind of mental health difficulty is a positive thing. “I thought my working life was over, but here I meet people who have similar experiences to me and it will help me go back into the working world again. I now feel that the negative experience of being unwell might be of use to me moving forward.”

We are sitting around a table in Gateway’s front room. A pool table lies to the right of us. Beyond that is a “listening space” where people can sit quietly. Then, there’s a computer hub where the newsletter is published and another large room for other activities.

Project co-ordinator Fionn Fitzpatrick is keen to point out that there aren’t any therapy sessions, although many of the activities can be therapeutic. “We also offer members the option of going for low-cost counselling through our partnership with My Mind [counselling service],” says Fitzpatrick.

Safe place

Mary Quinn has been coming to Gateway for about seven years. “I was scared when I first came. I was very quiet and shy – you wouldn’t think it now – but I still have my quiet days. I find it is a very safe place to be. I work on the newsletter and do the creative writing workshops. Sometimes I just sit on a chair or play games on the computer.”

Kevin O’Beirne is another longstanding member of Gateway. “I often feel quite low here. I’d feel the same if I was in Easons. I don’t expect to feel great on every visit. I don’t expect people to make it alright. I might feel lousy one day and better another. I may get to the point when I need to leave for a while.”

Maureen Quinn has been coming to Gateway for a year. “I feel you are accepted as you are. It’s easy to feel relaxed and comfortable. Gateway has been a hugely valuable support to me. I’d be lost without it. I’m not working at the moment and facilitating craft sessions and being in the singing group gives me a sense of purpose.”

Fitzpatrick says that because Gateway is a member-led organisation, all the activities are decided on year by year. “We also get information about community employment schemes and we prioritise Gateway members and provide training for any positions that arise.”

Another Gateway member will talk on first-name basis only. “Battling fear is my biggest problem. With all the rhetoric about mental health, there is still nowhere for proper rehabilitation. That’s frustrating for me, but Gateway fills the void,” says Tom.

“I’ve had two breakdowns and the fear of going back into a psychiatric hospital is so great. I was a high achiever in business and I lost everything. It’s a very low place to come back from. Now, I’m ruthless about my mental health. I’m ruthless about staying well. I walk, I come to Gateway. I attend another mental health group called Recovery and I keep in touch with people who understand mental health difficulties.”

His remarks spark nods of agreement among the other members. Their efforts to stay well need acknowledgement in a society that still doesn’t fully recognise their struggles. Fitzpatrick argues that people with ongoing distressing experiences and mental health challenges still get minimised or trivialised in spite of better mental health awareness.

“Whether you see mental health problems as an illness or a response to inequality and dysfunction in society, people still need community spaces to recover their sense of identity and social contact and support is a really important part of that.”

FIRST IRISH STUDY INTO PEER-LED MENTAL HEALTH PROJECTS

“It takes a community to support a person in recovery,” said Helen McEntee, Minister for Mental Health and Older People, at the launch of the first Irish study into peer-led support projects for people recovering from mental-health difficulties.

“To talk with others who have come through similar difficulties gives people hope and allows them to be happy in their own communities,” she said.

Her presence and that of Anne O’Connor, the head of the HSE mental health division at the presentation of research into the peer-led projects, Gateway in Rathmines and Áras Folláin in Nenagh, Co Tipperary, was both a political and health services validation for the work these community-based projects do.

“We can work with well-established and well-run projects such as these. And we want to see more peer-led organisations which provide a safe place and a social outlet,” said O’Connor, who spent a half-day in Gateway to observe the work there.

The six-month research by Trinity College Dublin (TCD) school of nursing looked specifically at the impact of the peer-led mental health projects. “Our research found that the vast majority of members of Gateway and Áras Folláin are extremely satisfied with the services offered,” said Rebecca Murphy, a postdoctoral researcher at TCD. “These places offered a sanctuary, a social and educational space which was underpinned by being peer-led. No one asked about their diagnosis or medication, which made people feel very safe and unpressurised to speak if they didn’t want to.”

Peer support

Prof Agnes Higgins, lead researcher from the TCD school of nursing, spoke about how peer support has emerged from the Vision for Change mental health policy document (2006). "Peer support is non-hierarchical space to explore issues in a safe context and bear compassionate witness. It doesn't assume a problem orientation. It normalises experience and gives people courage and resilience to move forwards."

The services offered at Gateway include arts and crafts workshops, meditation and relaxation, as well as meet-ups in local cafes in Rathmines.

Fionn Fitzpatrick, Gateway co-ordinator said: “It’s based on equality, participation and social inclusion. Many of us were excluded and left without a voice – distanced from social, workplace and education, our homes and having families.

“At Gateway, we work on a level playing field, challenging and changing attitudes and living life to the fullest on our own terms.” Mutual support and friendship are at the core of all activities. “We need the right to fail and the right to thrive and succeed,” she said.

Áras Folláin hosts meetings from mental health support organisations such as Grow and Shine, as well as running art & craft and wellbeing workshops. Both Gateway and Áras Folláin are funded on a year-by-year basis by the HSE through its funding to Mental Health Ireland. “People tell us that it’s very different to a day hospital, which is about illness. Here it’s about wellness,” says Margo O’Donnell-Roche, the co-ordinator of Áras Folláin.

Other peer-led mental health support groups exist throughout the country. Orla Barry, the outgoing chief executive of Mental Health Ireland said peer-led projects give people a sense of nurturing. “It’s like a feeling of being home. It’s important to note that these projects are organically driven. They emerge themselves and develop incrementally as they need to.”

However, Murphy noted that the funding model is problematic. “Both projects lack financial certainty and some of their core work is diverted towards fundraising. And volunteers who are diverted toward fundraising are more likely to withdraw. Peer-led services such as these need to be seen as an integral part of quality mental health services in our communities.”

Following the publication of this research, members of Gateway and Áras Folláin are keen to build a network of solidarity with peer led projects around Ireland.