MEDICAL MATTERS:It's the perennial Cinderella of our health system, writes MUIRIS HOUSTON
WITH FINANCIAL Armageddon staring us in the face, it can be difficult to focus on specifics. If the International Monetary Fund does darken our doorstep, deciding which parts of our health service to cut may look like very small beer indeed. Nevertheless, we are still masters of our own destiny and it is important to try to make the most sensitive cuts within the context of the looming budget.
One area that cries out for protection is mental health. The reader response to a recent special issue of this supplement highlighted how psychological health issues affect so many of us. Yet mental health remains the perennial Cinderella of our health system. It has never been adequately funded, with just over 5 per cent of the health budget set aside for mental health services in 2010.
But mental health doesn’t stop from the neck down. Our physical health is intertwined with our psychological well-being. Depression doubles the risk of developing coronary heart disease. People with schizophrenia and bipolar disorder die on average 20 years earlier than the rest of the population because of the physical health problems they experience as part of their psychological illness.
A report just published by the Royal College of Psychiatrists – No Health without Public Mental Health: the Case for Action– shows how public health strategies have concentrated on physical health and overlooked the importance of mental well-being. "Including mental health at the heart of the public health agenda will improve people's lifestyles and reduce behaviours that put people's health at risk, thereby both preventing physical illness and reducing the burden of mental illness", it says.
The report points out that most mental illnesses begin before adulthood and often continue through life. One-half of all lifetime cases of diagnosable mental illness begin by age 14; three-quarters by the time people have reached their mid-20s.
Not surprisingly, the College of Psychiatrists’ report recommends early intervention: “Tackling mental health problems early in life will improve educational attainment, employment opportunities and physical health, and reduce the levels of substance misuse, self-harm and suicide, as well as family conflict and social deprivation. Overall, it will increase life expectancy, economic productivity, social functioning and quality of life.”
Meanwhile, the Irish Medical Organisation used its pre-budget submission to highlight the importance of mental health services. It says the recession is affecting mental health in particular, with suicide rates increasing by 24 per cent in 2009. It points out that higher levels of psychological stress, depression and anxiety disorders are found among lower income groups and those who are not in paid employment.
“Some 25 per cent of people in receipt of illness benefit in 2009 cited mental health issues as the reason they were unfit for work”, the doctors’ representative group says.
Already estimated to cost the State about €3 billion annually, the economic burden of mental ill-health can only worsen as long-term unemployment increases.
Another group facing a bleak future is carers. Already limited state support will be diluted by financial cuts, leaving those caring for the disabled and older people exposed to even greater stress.
A survey carried out by the College of Psychiatry and the Carers Association of Ireland has found that more than half of carers have been diagnosed with a significant mental health problem.
An estimated 161,000 carers save the exchequer approximately €2.5 billion a year. Many are already on a knife-edge: destabilise them further and this €2.5 billion saving could quickly be reversed.
The absolute nightmare scenario is for mental health spending to be cut by the same percentage as the rest of the health budget. Because it is chronically under-funded even in the “good times”, a top-slicing approach for the mental health sector will have a disproportionately negative effect on services. We simply cannot allow this to happen.