Mental illness and homelessness

People with mental illness sleeping rough, imprisoned, or languishing untreated at home

Letters to the editor

Sir, – Martin Wall writes that “untreated mental illness is a very significant issue” in the US and notes the “interconnection between mental illness and homelessness” (“Treatment of mental illness in US moves towards involuntary committals”, World, December 3rd).

Frontline workers in health and social services will recognise similar issues here. Ireland has the third lowest number of psychiatric beds per capita in the EU and an involuntary admission rate that is half that of England, the latter reflecting long overdue respect for liberty.

But devoting just 5 per cent of our health budget to mental health comes at a price: people with mental illness sleeping rough, imprisoned, or languishing untreated at home.

The first step must be expanded primary care mental health services and more accessible voluntary treatment, especially for children and adolescents. In parallel, we need integrated addiction programmes, enhanced social support, and criminal justice reform.


We also need to address cultural denial of severe mental illness. For a minority, voluntary care and support are not enough, so admission and treatment without consent are needed for periods of time. Rightly, all such patients get legal representation, independent assessment, and robust reviews by tribunals.

Our Mental Health Act, 2001, currently being revised, should permit such care when the person has severe illness, and treatment would help “to a material extent”, cannot be otherwise provided, and “is necessary for the health or safety of the person, or for the protection of other persons”.

We know that treating schizophrenia not only alleviates symptoms but, despite side-effects, is associated with half the risk of dying over 14 years.

Neglecting people with severe mental illness does not protect their right to liberty, and violates their rights to health and life. – Yours, etc,


Professor of Psychiatry,

Trinity College Dublin,

Dublin 2.