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A change in attitudes to mental illness is as essential as legislation

Mental health care is a complex, challenging and deeply rewarding area (‘Psychiatric patients feel coerced into hospitalisation’, Irish Examiner, August 8).

Ireland’s mental health services have been transformed over the past 50 years: in 1963, there were 19,801 people in Irish psychiatric hospitals, and by 2013 that was reduced to 2,401. Ireland’s involuntary admission rate is now lower than that of England, and the Mental Health Act, 2001, provides additional protections for detained patients.

Notwithstanding these reforms, clear challenges remain.

As your article highlights, there is a need for continual improvement of involuntary admission procedures, and the recent review of the Mental Health Act, 2001, highlights useful ways forward.

More broadly, people with enduring mental illness face problems in the social sphere, being at increased risk of unemployment, homelessness and imprisonment.

This is a vicious cycle: mental illness increases likelihood of arrest, and imprisonment increases disability, deepens stigma, and all too often fuels substance misuse.

People with enduring mental illness also experience problems with physical health and access to health care: men with schizophrenia die 15 years earlier, and women 12 years earlier, than the rest of the population. This is not a result of unnatural deaths: the leading causes of death are heart disease and cancer.

The life-long effects of these adverse social, economic and political factors, along with stigma, constitute a form of ‘structural violence’ which greatly amplifies the effects of mental illness in the lives of those affected and their families.

The solutions lie in reforming legislation (as is currently underway), continually improving mental and physical health care, and addressing social exclusion through an all-of-government approach, in partnership with the voluntary sector, people affected by mental illness and their families.

Social care also needs to be improved but, most of all, there needs to be a root-and-branch change in attitudes.

One in four of us will develop a mental illness at some point in our lives. We all know a family affected by suicide.

This matters to everyone; this matters now.

Prof Brendan Kelly

Department of Adult Psychiatry,

University College Dublin


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