Mental health policy in Ireland avoids uncomfortable truths about how we treat and view mental illness. It is a policy of denial and neglect. Ireland is no longer a backward or disadvantaged country. And yet vulnerable citizens who are living with severe mental illnesses such as schizophrenia often remain disadvantaged, marginalised and excluded and without hope for change.
Ireland is not investing in centres of excellence for research into the most severe mental illnesses in the way that other developed countries are doing. This is due to institutional stigma which is defined as policies of government and private organisations that intentionally or unintentionally limit opportunities for people with mental illness. It is not intentional but it is damaging: policymakers in Ireland prefer to avoid the topic of centres of excellence for research into severe mental illness and philanthropy does not pick up the slack.
Now is the time to support both a centre of excellence for treatment of severe mental illness and a centre for translational research, as happens for other diseases and in other modern developed countries. Translational research takes cutting-edge research laboratory advances and applies them for the benefit of patients. Establishing both centres would improve outcomes for severely mentally ill people. The alternative is to continue with a “bare foot” system – an impoverished, under-resourced and ineffective service that claims a false superiority.
Today, the busiest pathway into treatment for the most severe psychoses starts in prisons and progresses to secure forensic hospitals
Schizophrenia and other severe mental illnesses are life-shortening brain disorders. The life expectancy of people with schizophrenia is about 16 years fewer than that of the general population. This is comparable to many forms of cancer. The main causes of premature death are not what you might think. The incidence of suicide is higher but bigger problems include excess rates of heart and lung diseases and cancers. People with severe mental illnesses age prematurely.
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During the Covid pandemic, it became clear that people with severe mental illnesses were at increased vulnerability to the worst complications and death from Covid.
Health policy in Ireland and elsewhere has been to demedicalise these severe life-shortening brain disorders. Demedicalisation occurs when the physical and biological basis of disease and its treatment is denied and removed from policymaking and management. The official language used for “mental health” policy is almost Orwellian in its avoidance of these uncomfortable truths. These severe illnesses cannot always be managed in general practice and voluntary community services, they cannot be prevented by counselling or cured with psychotherapy.
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The dignity and right to health of people with severe and enduring mental illnesses, that are incapacitating and life shortening, would best be addressed through providing the best treatments currently available and increasing research and development of new and better treatments.
Now is the time to invest in research and development of treatments that address these pressing problems. Most modern developed countries have a centre of excellence that drives better outcomes for people with severe mental illnesses in the same way that there are centres of excellence for cancer treatment, cardiac illness and lung diseases.
Hope is central to recovery – real hope rests in medical advances in the treatment of the most severe forms of schizophrenia and other severe mental illnesses
They include the the Institute of Psychiatry, Psychology and Neuroscience in London; the Karolinska Institute in Stockholm; KeFor in Belgium; CerF in Aarhus, Denmark; the Institute for Forensic Psychiatry and Psychology in the Netherlands; IRCCS in Brescia, Italy; the Centre for Addiction and Mental Health in Toronto; the Institute Philippe Pinel in Montreal, and many others. Ireland has no such centre for translational research and development. Establishing such a centre in Ireland would offer hope and a pathway forward for patients, family members and carers throughout the country.
Today, the busiest pathway into treatment for the most severe psychoses starts in prisons and progresses to secure forensic hospitals. This is a failure of the existing policy of denial and neglect. Ireland has an international reputation in forensic psychiatry, providing intensive care and treatment for the most severely mentally ill and this is where the centre of excellence should be located.
Not only do severe mental illnesses such as schizophrenia shorten life expectancy, they also cause real suffering for the person and their distraught families, they lead to homelessness and loss of dignity. A serious re-evaluation of how we care for our most unwell and most vulnerable people is required. This must start with investment in a centre for excellence in forensic psychiatry and re-integration of such services into the mainstream of medical progress.
Hope is central to recovery – real hope rests in medical advances in the treatment of the most severe forms of schizophrenia and other severe mental illnesses, and as it has done for other life-shortening illnesses. Cancer services offer a well-proven road map. A centre of excellence in forensic psychiatry that is biological, caring, clinical and ethical is the way forward.
Harry Kennedy is clinical professor of forensic psychiatry at Trinity College Dublin