Mental health is nothing less than the leper of the Republic's health system, writes Muiris Houston, Medical Correspondent, and there is a burning need for each citizen of the State to highlight this collective issue
Prisoner told to wait months for treatment for life-threatening heart disease.
Fifteen-year-old must wait until she is 18 before she is eligible for hospital diabetes treatment.
Can you imagine the outcry if either of the above headlines appeared in tomorrow's newspapers? Yet, if you substitute severe depression for heart disease in the case of the prisoner and mental illness in place of diabetes in the second headline, both could truthfully be written.
Monday's Amnesty report, Mental Illness: The Neglected Quarter, is driven by the international organisation's desire to see mental health placed in a rights-based context. Although the Government has signed up to various UN conventions in the area of human rights, economic, social and cultural rights are not enforced by law in the Republic.
The UN Principles for the Protection of Persons with Mental Illness (MI Principles) were adopted in 1991. They elaborate the basic rights and freedoms of people with mental illness that must be in place if states are to fully comply with the International Covenant on Economics, Social and Cultural Rights.
The MI Principles apply to everyone with mental illness, whether they are cared for in the community or as in-patients. They clearly elaborate on a state's obligations towards people with psychological ill-health, including standards of care, the rights of people in mental health facilities and the provision of resources.
Not alone has the Government here failed to fully respect the human rights of people with psychological illness, but it does not appear to have paid much attention to a series of national and international reports critical of its failure.
But it is at the coalface of mental healthcare that the deficiencies are perhaps best illustrated. Psychiatric admission wards can be grim places; some are situated in old-fashioned Victorian buildings, filled with severely ill people wandering in a dishevelled state or lying in beds staring vacantly at the walls.
Admittedly, this is in part due to the acuteness of their condition, but one is left wondering if their surroundings could not be improved. If we had a broader approach to treatment, with the full involvement of psychologists, therapists and specialist nurses, then maybe the grim reality of acute assessment and treatment could be lightened.
There are two particular black holes in our psychiatric services. One is the care offered to prisoners, which has been described by the medical director of the Central Mental Hospital as a barometer by which we can measure the well-being or otherwise of the rest of the system.
We know that one in seven inmates suffers from a mental illness which could lead to suicide, with prisoners much more likely than the general population to have psychosis or major depression.
Yet we have a situation where the already inadequately resourced Central Mental Hospital recently had to stop accepting admissions from the prisons because of inadequate bed numbers. Despite guidelines which state that "the transfer of a mentally ill prisoner to a psychiatric facility should be treated as a matter of the highest priority", it is not unusual for it to take weeks for such transfers to occur.
As a result, acutely unwell prisoners, despite having been medically assessed, are left in a wholly unsuitable environment at a time when they are at risk of self-harm. Because of failures within the general system, more and more people with mental illness are remanded to prison, thus creating a vicious circle of neglect.
The other area where we struggle to provide even the basics of a service is for adolescents with mental health problems.
"Most areas are seriously short of adolescent psychiatric facilities, and in some areas there are none at all," the Amnesty report notes.
This in turn creates a knock-on effect on child psychiatry services, as staff are pulled away to respond to adolescent crises.
It must be said that the staff who work in the Republic's mental health service are nothing short of heroic. To turn up for work in the conditions many have to endure shows real dedication and a true sense of vocation.
Amnesty acknowledges this: "We were impressed by the dedication of people who are trying to offer the best possible service in adverse circumstances."
A formal system of patient advocacy is badly needed here. Unlike some other European countries, there is no facility for severely ill people to be represented by an advocate, at least until such time as they have regained insight and can fully participate in decisions such as consent to treatment.
There is a burning need to highlight a collective issue which each citizen in this State must address. That is the problem of the stigma attached to mental illness.
There is a huge lack of awareness of what constitutes psychological disability. Misconceptions about the nature of mental illness abound.
It is a measure of our collective attitude to psychological ill-health that the headlines referred to earlier reflect reality.
Often labelled as the "Cinderella" of the health system, mental health seems always the first in line for cutbacks at times of financial difficulty and the last to benefit in times of success.
But such is the severe neglect of the sector that Cinderella is now too nice a term, reflective as it is of happy endings. Mental health is nothing less than the leper of the Republic's health system.