Today's Amnesty International report on mental health and homelessness emphasises the close relationship between being homeless and having a psychological disability.
The report quotes Dr Joe Fernandez, the director of the only specialist programme for homeless people in the Republic, as estimating that 75 per cent of homeless people have psychological problems.
"Of these, 42 per cent are believed to have a history of mental health problems which are a consequence of their social deprivation and homelessness. The remaining 33 per cent are believed to suffer from severe mental and /or behavioural disorders which contribute significantly to their homeless state and are exacerbated by it".
Clearly, homelessness and mental illness represents a chicken-and-egg situation. If you are psychologically unwell, then you are more likely to be homeless. Equally, the severe stress of being homeless can and does induce mental illness.
If such a clear relationship existed between a physical illness and a social reality, then it is almost certain that dedicated services would have been set up to address the problem. Not surprisingly, because the issue concerns psychological illness and a vulnerable group of people without a ready voice, a vacuum in treatment and prevention exists.
Amnesty's earlier report, published in February this year - Mental Illness: the Neglected Quarter - illustrated the relative neglect visited upon psychiatric services in the State. With funding that is declining in percentage terms and a lack of non- pharmacological treatments for psychological disease, it is clear that mental health generally is nothing less than the leper of the Republic's health system.
But within a grossly inadequate psychiatric service, the homeless draw a particularly short straw. A transient group, made up of people who have lost their representative voice, the homeless suffer from the lack of advocacy within the health system. We badly need a formal system of patient advocacy in the Republic. The medical director of the Central Mental Hospital has described the care offered to prisoners as a barometer by which we can measure the well-being or otherwise of the rest of the psychiatric service. This is especially relevant for the homeless, many of whom are part of a vicious circle between homelessness, prison and psychiatric hospitals.
Significant numbers end up in prison because of minor offences related to their homelessness and mental health or addiction problems. This is of concern in two respects: where a person's primary reason for the commission of a relatively minor crime is mental illness, proper mental health care, not imprisonment, should be offered to them; and the mental health services available within the prison system are, despite the best efforts of staff, most unsatisfactory.
While the recent adoption of a number of government homeless strategies is welcome and elements of the Criminal Law (Insanity) Bill 2002 may also improve the situation, there is one fundamental difference between the Republic and other states. This is its failure to see good mental health as a basic human right.