After the asylum – mental health today


Sir, – The Irish Times is to be congratulated for again drawing attention to the opportunities and challenges of mental healthcare (“After the asylum”, Weekend Review, July 13th, and News Agenda, July 15th).

Last month, the inspector of mental health services highlighted both examples of “good governance” and areas for improvement, especially in relation to human rights (“Mental health services ‘stagnant’ and in danger of slipping backwards”, Home News, June 13th). The inspector noted that “a human rights approach to practice requires education in human rights theory, a change of philosophical focus and a commitment to maintain beneficial change”.

This commitment needs to extend well beyond mental health services.

Mental health is closely related to social arrangements. Individuals from lower socio-economic groups develop mental illness earlier in life and have longer durations of untreated illness. The mentally-ill are at increased risk of homelessness and under-employment. They are more likely than those without mental illness to be arrested in similar circumstances and remand is more likely even when lesser offending is associated with mental illness.

The adverse effects of these economic and societal factors, along with the stigma of mental illness, constitute a form of “structural violence” which amplifies the effects of mental illness in the lives of sufferers. As a result, many individuals with mental illness are all too often systematically excluded from full participation in civic and social life, constrained to live lives shaped by stigma, isolation and denial of rights.

The past decade has, however, seen substantial reform in Ireland. The Mental Health Act 2001 resulted in the removal of indefinite detention orders, new involuntary admission procedures, independent reviews of detention, free legal representation, independent psychiatric opinions, and establishment of the Mental Health Commission to oversee standards of care and protect patients’ interests.

Notwithstanding the challenges facing Ireland, there are continuing signs of progress. The Mental Health Act 2001 is being revised. Legislation for supported decision-making is being developed. Mental health service users, families, clinical staff and health service managers are working very well together to provide the best services possible. There are myriad examples of progressive, collaborative initiatives taking root in hundreds of communities and mental health services around the country.

These reforms require broad societal endorsement if they are to realise their full potential.

This matters to everyone. One in four individuals will develop mental illness at some point in their lives.

Deeply and urgently, this matters. – Yours, etc,


MD, PhD, FRCPsych,

Senior Lecturer

in Psychiatry,

University College Dublin,

Dublin 4.