Paul Gilligan


Paul Gilligan: Crisis in mental health should be voter priority in upcoming election

The forthcoming general election is an opportunity to highlight the failings of our psychiatric services, such as bed and staff shortages and waiting lists, says Paul Gilligan

Paul Gilligan: Crisis in mental health should be voter priority in upcoming election

The forthcoming general election is an opportunity to highlight the failings of our psychiatric services, such as bed and staff shortages and waiting lists, says Paul Gilligan

MENTAL health care is in crisis. Time after time, we read reports of poor-quality services, long waiting lists, staff shortages, and lives affected by these failures.

There are 13 reasons why mental health care should be the priority issue of the forthcoming election:


People’s human rights are being infringed within a creaking, under-resourced mental health service.

The president of the High Court, Mr Justice Peter Kelly, recently described a man with mental health difficulties being held on remand in Mountjoy prison, because of the lack of a more suitable setting, as “a truly awful situation and one that should not exist in a civilised state.”

Few approved centres for in-patient treatment meet the Mental Health Commission regulations and standards.


Many people who require care do not receive it on time.

Some 25% of people referred to primary care psychology services wait over 52 weeks for an appointment. Access to mental health care is poor.

At any given time, there are thousands of people on waiting lists for specialist community care. These delays cause further distress and deterioration in mental health.


We are failing hundreds of children who have mental health difficulties. At any given time, 2,000 children are waiting for a first appointment with a Child and Adolescent Mental Health Service and 200 are waiting more than a year.

There are fewer than 100 in-patient beds to treat children nationally and many of these are not operational. Every year, 50 children spend some time in adult in-patient units and some are sent abroad for treatment.

In February 2019, the Children’s Rights Alliance, through its annual report card, awarded the Government a D- grade for its performance on meeting its own promises about children’s mental health care.

This is distressing, and unacceptable given that, over the 13 years of publication of the report card, government has never achieved higher than a C+ grade. Some years, it has received an F grade. This damning analysis is supported by the United Nations Committee on the Rights of the Child and the European Network of Children’s Ombudsmen.


Specialist mental health services (for people with disabilities, from specific ethnic groups, and for the homeless) are under-resourced, further exposing vulnerable people. The suicide rate among Traveller men is 6.6 times that of the general population and accounts for one in 10 Traveller deaths.


Stigma persists. Despite increased awareness and more open discussion about mental health, many people still hold inaccurate and unhelpful attitudes about people who have mental health difficulties.

A survey conducted by St Patrick’s Mental Health Services, in 2019, indicated improving attitudes to mental health, but also found that one third of people said they would not tell their partner if their child was depressed.

One quarter of adults reported they would not tell anyone if they had suicidal thoughts.

When violent acts are committed, many people still attribute them solely to mental health difficulties.


We are not investing enough in mental health care. The proportion of the health budget, 6%, spent on mental health care is significantly less than what other countries spend and less than the 10% recommended by the Sláintecare strategy. The emphasis remains on reducing expenditure and fuelling the myth that services are costing too much.


There is an unprecedented staffing crisis. Few mental health teams have the required complement of staff, fewer mental health professionals are being trained, and working in mental health in Ireland is challenging and unattractive.


The economic and social impact of untreated mental health difficulties is substantial. The chances of becoming unemployed, homeless, or of dropping out of education increase if a person experiencing mental health difficulties does not receive treatment. Carers and family members are also often absent from school or work.

The economic cost of not treating those with mental health difficulties represents 4% of GDP.


The physical impact of untreated mental health is also significant. Much of the demand placed on accident and emergency departments comes from those who have acute episodes of mental health difficulties and who cannot access other services. Untreated mental health difficulties can lead to alcohol and drug abuse.


Evidence shows that people with mental health difficulties, even the severest forms, can live happy, healthy, and productive lives, if they are given the right support and treatment.

Failing to give them this opportunity is not only an infringement of their human rights, but also impacts on the health and productivity of our society.


We have the opportunity to create a world-class mental health care system. There are some excellent services in Ireland, provided by dedicated staff.

These can be replicated. As an immediate first step, we could consolidate the existing staff numbers to enable the provision of as many fully staffed, highest-quality community and in-patient services as possible.

By leveraging tele-mental health services and the voluntary and independent sectors, it should be possible to provide every part of the country with a fully manned mental health team and the highest quality care.

In time, at least five centres of excellence could be established, servicing the entire country and providing the full range of care options. This should be supported by a vibrant, all-inclusive primary care system and access to a full range of helplines.

There is an opportunity to establish a national prevention and awareness-raising strategy to be implemented by all relevant voluntary, statutory, and independent organisations.


Service users and those experiencing mental health difficulties want to, and can, shape, and lead, a new recovery-based approach to mental health care.

The current system disempowers, through blocks and delays in accessing care, through poor quality services, and through people being disrespected.

However, the new emphasis on human rights in Irish society is strengthening the resolve of people who need care and the resolve of their families and carers.

With the right support, people will begin to take more control over their treatment and will come to expect more choice and decision, not just on the services they receive, but also in the shaping, delivery, and evaluation of these services.


Every family in Ireland is affected by mental health difficulties. Every family is aware of the daily struggle to obtain high-quality, effective, and accountable mental health care. Each of us is aware of the strain and destruction that failing to get this care can bring. These struggles can be all-consuming, not leaving energy or time for political activism. But this election needs to be different.

The time has come to put mental health at the centre of the political agenda. Each party, each candidate, each analyst needs to be confronted about their intentions and attitudes towards the mental health care system in our country.

Vague promises or excuses need to be dismissed and specific promises to reinvest, restructure, and rebuild our mental health system need to be obtained. Without this, we are failing our society, our loved-ones, and ourselves.

Paul Gilligan is a clinical psychologist and CEO at St Patrick’s Mental Health Care and author of Raising Emotionally Healthy Children

More in this section

News Wrap

A lunchtime summary of content highlights on the Irish Examiner website. Delivered at 1pm each day.

Sign up

Some of the best bits from direct to your inbox every Monday.

Sign up