Well, it's been a vintage week in politics. Fine Gael has a councillor who thinks driving after three or four pints is grand, and that random breath-testing is destroying the fabric of Irish rural life. The Progressive Democrats have some interesting ideas, too.
The PDs have a Minister of State in the Department of Health and Children with special responsibility for mental health, and he isn't sure if depression and mental illness are medical conditions.
In last Monday's Irish Medical News, Tim O'Malley declared: "There's a very strong view with a lot of people that depression and mental illness is not a medical condition, that it's part of life's events that people get depressed or get unhappy. Years ago people were unhappy, they weren't depressed, they weren't given the name depressed."
Tim O'Malley is a pharmacist.
"During that time I developed an interest in the whole area of mental health particularly because of all the areas of prescribing medication, I was aware that unlike other areas of health like cholesterol, diabetes, or coronary care, where you can measure the results of taking medication, in mental health, it is impossible to measure, scientifically, the results."
Well, that will be news to hundreds of researchers. Let's just look at one set of studies: the University of Pittsburgh research on maintenance therapy, where in longitudinal studies, maintenance medication was proven to be vital in preventing recurrence of depressive episodes. In other words, if people take the appropriate medication, they have a far greater chance of remaining well. It is even more important in the case of psychotic illness.
Someone in Tim O'Malley's position saying that there is no way to measure scientifically the results of taking medication for mental illness is downright irresponsible. To imply that years ago there was no such thing as depression, only unhappiness, is to risk restigmatising those who have serious mental illnesses. It is not true that years ago there were no depressed people. What is true is that years ago, people with serious depression and psychotic illnesses were incarcerated, often for a lifetime, because there was no real alternative. Mental hospitals were shocking and frightening places because of the severity of symptoms suffered by patients.
The advent of anti-depressants, anti-psychotic and mood-stabilising medication has revolutionised the management of mental illness. It has given people back their lives. Of course it is not a panacea, and it does not work for everyone, but few people would choose to return to the so-called good old days.
Families who have a member with serious psychiatric illness are bitterly aware that there is still a stigma attached to being on medication.
Well-meaning people tell the person that they are grand now, that they don't need all those oul' tablets. As a result, people abandon medication, and after an initial honeymoon period, often suffer severe relapses. It is no help to have the Minister of State with responsibility for mental health casting doubt on the efficacy of medication, and reinforcing the idea that all that people who suffer from mental illness need is someone to talk to.
Of course other factors are important, including things that help people to cope, such as adequate support services, strong family ties and spirituality. Medication is only part of the picture, but often, it is a vital aid on the road to wellness.
There is a grain of truth in the Minister's dangerous over-statement.
Depression in particular, is often mistakenly diagnosed, and there is no doubt that over-prescription of medication happens. What else would you expect except over-prescription when public patients get 10 or 15 minutes with a doctor, and little else?
If the Minister is genuinely serious about a holistic approach, why does he not make funding multi-disciplinary teams a priority, with clinical psychologists, psychiatric social workers (not just general social workers), occupational therapists and community mental health nurses?
He declares that liaison nurses, that is, nurses who have received some training in assessing suicide risk factors, are now present in accident and emergency. He neglects to mention that in many places they are only there nine to five, Monday to Friday. Suicidal intentions are apparently expected to keep office hours.
The Minister also repeats the nostrum that there is too much emphasis being placed on the need for additional beds. He says that 95 per cent of cases could be treated in the community. He sees no contradiction in the fact that he also says that community life has been greatly eroded.
"Nowadays people are flying around in their motor cars going 70 or 80 miles an hour and people are commuting a long way to work and families and parents don't have time often to discuss things with their children."
A pre-requisite for community-based care is a community. It works reasonably well in rural areas, but often fails disastrously in urban areas, particularly in disadvantaged urban areas. You cannot treat an acute psychotic episode in a bedsit where no one knows anyone in the building.
A debate is needed on mental health, but it has to begin with recognising the reality of mental illness. No one bats an eyelid if someone with a coronary condition or diabetes requires hospitalisation, but somehow a stigma still exists if someone with a mental illness needs hospital treatment, or ongoing medication. Why are community care and hospital treatment always being pitted against each other?
There will always be a need for psychiatric in-patient treatment, and there is an even greater need for caring communities, where adequate resources are provided to help people cope.
We have a huge problem with suicide in this country. In the last edition of the journal Crisis, research from the National Suicide Research Foundation in Cork indicates that it may be even worse than we suspected. Due to the slowness of the inquest process, in recent years the registered figures for any given year may be higher by as much as 20 per cent by the time the final figures are collated.
The final figures never make it into the public arena. This is very serious, as accurate data is vital. That is bad enough, but it is worse if the Minister responsible for this area can't decide if mental illness is a medical condition, and makes deeply unhelpful comments about the impossibility of scientific proof as to whether medication works or not.