The lack of demand for better mental health services is remarkable when one in nine Irish adults has mental illness, writes Padraig O'Morain
The idea of mental illness still frightens many people, and the briefing documents issued to local election candidates today by Mental Health Ireland (MHI) suggests some good explanations for that fear.
To have a mental illness is to be left dependent on a health service which has been forgotten. Health services for physical illnesses are constantly in the news but people who are mentally ill are treated by a system starved of resources and to which neither the public nor politicians pay attention.
As MHI says, to be mentally ill is to run the risk of being hospitalised or homeless because local authorities have failed to provide sufficient housing for people with the condition.It runs the risk of being poor: people with mental illnesses very often have to leave their jobs in the market economy. Getting back to work with the stigma of having or having had a mental illness can be very difficult, if not impossible. The best that can be done may be to get work on a Community Employment Scheme. These schemes, however, are under threat, modest as they are.
MHI, a non-governmental organisation, knows what it is talking about. Its 100 local Mental Health Associations work with mentally ill people and their families. They are at the receiving end, or the non-receiving end, of the mental health services. In issuing their document today they are trying to get politicians, and especially those who are running in the local elections, concerned with mental health issues. On the face of it, that seems a thankless task.
Michéal Martin once complained that when he visits towns, local delegations meet him to press for better hospital facilities for physical illnesses but that they have nothing to say about mental health facilities.
It might be said that the solution to the under-provision of mental health facilities is in Mr Martin's hands, but it isn't as simple as that. Politicians respond, by and large, to public demand. When was the last time the public demanded better mental health services?
Yet, research commissioned by MHI in 2003 and carried out by IMS Milward Brown shows one in nine adults have personally experienced a mental illness and 73 per cent of the population know someone who has experienced a mental illness.
Moreover, the need for better mental health services is widely recognised, with nine in 10 adults (89 per cent) agreeing the best therapy for many people with mental illness is to be part of a normal community.
No doubt it is the stigma attached to mental illness that discourages people from pressing these views publicly. A proposal to establish, say a mental health clinic or a residence for people with mental illness on any road in any town would stand a good chance of generating local opposition. Yet, it is a certainty that on any road in any town there are people with mental illnesses who are receiving some sort of outpatient services which the rest of the residents of the road don't know about. But it cannot be easy to reveal this to a public which includes people with a jaundiced view of mental illness.
Advocating for better services is left up, therefore, to bodies such as MHI. But it is not alone. In a recent submission to the Joint Oireachtas Committee on Health and Children, the Irish College of Psychiatrists outlined what it called the "deplorable" state of mental health services.
Why don't psychiatrists refer patients to psychotherapists and family therapists instead of relying on medication? Because, ICP chairwoman Dr Kate Ganter told the committee, the majority of mental health teams don't have any psychotherapists or family therapists to whom patients can be referred.
If the MHI document begins to get local politicians interested in mental health services it will be worthwhile. But that's a very big 'if' indeed.
Mental health: the main issues
Mental Health Ireland:
• People with mental illnesses are in hospital or homeless because local authorities have failed to provide housing for them.
• Since 1985, funding for mental health services has been halved as a proportion of overall health service spending, from 12 per cent in the mid-1980s to less than 7 per cent this year.
• More than one person in 10 has suffered a mental illness.
• People who leave work because of mental illness face discrimination when they try to return to work.
• Because of the employment difficulties affecting people with mental illness, Community Employment Schemes which provide them with work and an income should be maintained.
• Disability legislation needs to be rights-based and confer an entitlement to an independent assessment of need, to services to meet that need and to advocacy services if required.
Irish College of Psychiatrists:
• Over our lifetime one in four of us will be affected by mental ill health, "yet development of services are neglected year after year".
• There are only 20 postgraduate training place for clinical psychologists compared to the 100 needed. q Fewer than 20 per cent of consultants have access to a psychotherapist for their patients and fewer than 25 per cent have access to a family therapist.
• Funding per capita for mental health services in urban areas is only half that in rural areas, though urban areas have twice the rate of severe mental illness.
• The 3,000 extra hospital beds promised by the Government do not include one psychiatric bed.
• Some psychiatric patients in beds in the ERHA area (Dublin, Wicklow and Kildare) are in facilities that are dark, cold and damp.
• An estimated 144 psychiatric beds are needed for children up to 16 years old but only 20 exist.