Sir, – Paul Cullen makes a compelling case for health equality in relation to physical health (“Tackling health inequalities is a lifelong struggle”, Health & Family, September 17th, 2013). The situation is even starker in mental health.
Individuals from lower socio-economic groups develop mental illness earlier in life and have longer durations of untreated illness. Individuals with mental illness also have increased rates of under-employment and homelessness, further deepening inequality.
The problem of mental illness in Ireland’s prison system was well illustrated recently by Joe Humphreys in the Prison Trap series (September 14th-17th , 2013). In essence, individuals with mental illness are more likely than those without mental illness to be arrested in similar circumstances and remand is more likely even for lesser offences. The fate of the mentally ill after release from prison provides further evidence of persistent inequality and social exclusion.
In 2011, the think tank TASC published a report on health inequality in Ireland, Eliminating Health Inequalities: A Matter of Life and Death. It noted a range of inequalities in physical health in Ireland and pointed out that "the social gradient is also evident in mental health scores. People from higher social classes tend to experience better mental health. Levels of depression and admissions to psychiatric hospital are also socially patterned, with higher prevalence among less affluent socio-economic groups".
This is not just an Irish problem. Depression is the world’s leading cause of disability, affecting more than 350 million people worldwide.
The solutions to these problems are complex but achievable. In Ireland, reform of mental health policy, along the lines of A Vision for Change (2006), is an important step. Reform of legislation matters too, and Ireland's Mental Health Act 2001 is currently being reviewed and an assisted decision-making Bill was published this year.
These steps towards reform are positive but they need broad political and societal support. Social and housing policies, for example, are vital in promoting social justice for the mentally ill and their families.
The solution to these problems will stem from broad-based, ongoing reform of mental health policy, law and social policy, underpinned by deeper societal and political awareness of these issues. To this extent at least, Rudolf Virchow (1821-1902), the German pathologist, anthropologist and politician, was demonstrably correct: “Medicine is a social science, and politics nothing but medicine on a large scale”. – Yours, etc,
BRENDAN KELLY, MD,
PhD, FRCPsych, FRCPI,
Senior Lecturer
in Psychiatry,
University College Dublin.