Please Make Mental Health an Election issue!

Originally posted at Plain of Pillars

Back in 2006, the government promised to act on the recommendations of The Report of the Expert Group on Mental Health Policy. The romantic subtitle of the report was A Vision for Change. But can we honestly expect to see this vision realised?

Based on the election campaign to date, I’d have to say that full implementation of the report’s recommendations seems highly unlikely. Given that no strict timetable has been announced and substantial funding has not been allocated, we can expect plenty of positive rhetoric and little action for years to come.

This applies regardless of who wins the election. Mental health has barely got a mention from any of the parties, so don’t expect it to receive priority over tax cuts or stamp duty reform. It’s not as though it received a headline booking in Enda Kenny’s famous contract.

The lack of media attention the issue receives is also shocking. A recent editorial by Vincent and Emma Browne in Village magazine highlighted the fact that the proportion of the overall budget allocated to tackling mental health issues had declined by 6% since 1988. That is a horrifying statistic, but this decline will continue until the issue starts to eat up more column inches. The Browne’s deserve praise for highlighting the issue, but even they failed to give the issue prominence. It was included almost as an after-though in an article about the general failings of the government.

What is most perplexing about the whole situation is that one in four people will suffer from a mental health disorder at some point in their life.

Please, think about that for a moment.

That means that a quarter of the people on your bus, on your train, in your office, in the pub or in your school will need help because of a mental condition. It means that one in four members of your family will need help. And in Ireland, a large portion of the people who need help will not receive it.

What happens to people when they don’t receive this help?

Well in some cases, they get better. Everyday in Ireland, people fight against mental illness. They win, but these victories are more difficultly achieved than they would be if the government were truly committed to helping people who suffer from mental illnesses.

Other individuals are not so lucky. Their conditions deteriorate and often end up in the hell holes we call mental hospitals. These ‘hospitals’ have been described as “unacceptable” for treating patients by the Inspector of Mental Hospitals, yet they are still used. Four years after Amnesty International described the plight faced by those suffering from mental illness in Ireland as a violation of human rights, no action has been taken and casual acceptance remains the rule.

In many cases, those who did not receive the support turn to suicide. Today in Ireland, more people die as a result of suicide than in car crashes. Over the past decade, more people have died as a result of suicide than during all of the North’s troubles. Road deaths, appropriately enough, receive a great deal of attention in the the mainstream media. However, you can’t help but feel that this has a lot to do with the high visibility of the situation. A Honda Civic crumpled up like tinfoil make for a great front page splash, a suicide does not not, and yet, it is really only as a result of a tragic suicide that mental health receives attention from the media. It is also the focus of many government initiatives, but really, suicide is only a small, if important, part of a much wider problem.

So. What do we need to do?

Well, first and foremost, we need to implement the The Report of the Expert Group on Mental Health Policy as soon as possible. We need to increase spending on mental health. We need to recruit more social workers, more psychologists and more psychiatrists. We need to focus on care in the community. We need to have campaigns that encourage people to talk about suicide.

Other, more deeply rooted problems will be more difficult to tackle. Many psychiatrists do not have access to psychologists. This needs to be changed, but the difficulty is that it psychologists are in short supply.

To become a psychologist, you must first gain entry to a degree course in psychology which entitles you to graduate membership of the Psychological Society of Ireland once completed. To do this, you must get more than 500 points in your Leaving Cert, a very crude way of selecting those best suited to what is essentially a caring profession. Entry to undergraduate psychology courses reflects the fact that the universities have very few limited resources for the teaching of psychology. Clearly, the government needs to increase the funding available to the Psychology departments of universities, and sooner rather than later.

However, if there is to be an increase in spending, there needs to be reform. The training one receives when completing such undergraduate courses has very little to do with the practical realities of acting as a counselling or clinical psychologist, the species of psychologist the mental health services requires in large numbers. In fact, undergraduate courses tend to focus almost entirely on academic debates within the field and on the performance of experiments.

It is this focus on experimentation that leads the P.S.I. to restrict entry to undergraduate degree courses so severely, as such experiments are costly and require a low teacher-student ratio. These experiments are almost entirely irrelevant to the creation of good counselling or clinical psychologists, yet the P.S.I. demands that if the completion of a degree course (or equivalent) is to result in the award of graduate membership of the organisation (which one requires before they can begin almost any postgraduate study in psychology), then that course must include a large component of practical experimental work. The removal of this obstacle would mean that more individuals would be eligible for postgraduate study. It would not however address the issue of the shortage of places for postgraduate study, but by making the production of psychology graduates cheaper, it would free up more funds to finance the production of postgraduate counselling and clinical psychologists. It is most important that any increase in funding is ear-marked for postgraduate courses in clinical and counselling psychology and is not wasted on the production of postgraduates whose skills do not benefit the mental health system.

The relationship between psychiatrists and psychologists needs to be examined re-examined also. As it stands, if a psychiatrist and a psychologist share a client, the balance of power is such very much in the favour of the psychiatrist who is free to disregard the psychologist’s advice as and when he or she pleases. This is generally not a problem. From what I’ve heard, most psychiatrists are glad of a psychologist’s help, but in some rare cases, arrogant and ignorant psychiatrists disregard psychology as a disciple. This should not be possible, as it is akin to having practicing medical professionals who refuse to believe that condoms are beneficial in hindering the spread of AIDS. It might also be useful to allow psychiatric nurses and psychologists a limited role in the prescription of certain drugs, though treatment solely through the use of drugs should be avoided.

Social workers need an image revamp. Today, the knock of the social worker is a little like the knock of a Garda. No family wants to see a social worker at their door. This reflects the fact that as it stands, social workers prioritize difficult cases. People need to see social workers as resources, not as a declaration of incompetent parenting. Ideally, I would like to see a situation where every medium sized school was assigned a social worker, who interacted with the parents and teachers of every student, identifying their needs and helping parents access psychologists and psychiatrists when necessary. We cannot wait for people to summon up the strength to visit their G.P. to discuss a potentially embarrassing situation. We must be proactive, making sure that at all times, people know what services are available to them.

Next time a candidate calls to your door, ask them about their parties policy on mental health. Ask them what commitments they will make in regards funding and the timing of any commitments they make. Visit Amnesty International’s webpage as they provide many resources.

Most importantly, talk about mental health issues, especially suicide. Talk to your family. Talk to your friends. Write to newspapers and blog about your experiences. We need to raise the profile of the problem. We need to raise people’s consciousness about mental health. We need to let politicians know that mental health is just as important to us as physical health. We need them to know that we care about well-being more than wealth. If we don’t, then people who could have lived long and happy lives will die. That may sound overly-dramatic. It’s not. It is a cold, hard fact. You might not think it, but it could be you or one of your loved ones who becomes the next victim of our health services.

Please remember that when you cast your vote.