Time to spend more on mental health

FAR too many people, individuals and communities, have been forced to come to terms with the terribly sad reality that a loved, but distraught, relative has killed another, or others, in their family and then taken their own life. This all-too-regular tragedy is made even more difficult if children are, as they so often are, victims. There have been at least 27 such tragedies in Ireland since 2000.

Failed relationships, loneliness, financial stress or even homelessness are issues that can drive this lethal dysfunction but mental illness is a recurring, powerful and central player in these implosions. So, too, is the confidentiality around doctor-patient relationships. Because of this families are not always fully informed about the level of instability in a loved one’s life. Simply put families may not always know how very unwell a person is or be in a position to take proportionate measures to help that person or protect the wider family. A recent review of this principle concluded that it would be unwise to change current arrangements. However, families who have been sundered when a loved one breaks down and commits murder followed by suicide have challenged that view and it is very hard not to have great sympathy with their position. It is difficult, too, to exonerate a system that, in a different context, might be described as colluding in an arrangement that puts lives at risk by putting patient confidentiality before the safety of those living with that unfortunate and unwell person.

These are not the only issues challenging mental health services, a wing of our health system so very often treated in a way that suggests it is seen an afterthought. This perception remains despite commitments to introduce new systems and procedures to give patients the greatest chance of a full recovery and the prospect of resuming a normal life. Yesterday, in a prebudget submission, the College of Psychiatrists of Ireland expressed “dismay” over how very slowly the national mental health policy A Vision for Change is being delivered. This programme was to be a game-changer in the provision of mental health services and introduce a degree of humanity that was not always apparent in those services.

Yet, figures produced by College of Psychiatrists show an ongoing neglect and a lack of commitment to resolve a situation pretty close to health and cultural crisises. They show that as a percentage of overall health spend, the mental health budget has fallen from 13% in the 1980s to 6.2% in 2015. This compares very unfavourably with other countries where investment is much higher, for example the UK at 12%, and Canada and New Zealand at 11%.

A Vision for Change, which was published nearly a decade ago, recommended that we spend 8.24% of the health budget on mental health but, unsurprisingly, the target date for that milestone has long since passed. There are myriad excuses for missing that deadline but as our economy recovers they are not as convincing as they once were. Next Tuesday’s budget affords an opportunity to recognise the consequences of this neglect and make a contribution, even a modest one, to realising the goals set out in the 2006 A Vision for Change.