Focus on mental health services


Sir, – Rosita Boland’s articles about St Ita’s psychiatric hospital in Portrane were powerful and moving (“Portrane asylum in the 1950s”, Life, June 10th; “St Ita’s: your responses to an abandoned hospital”, News Review, July 9th).

Mental health services have changed substantially since the 1950s but real challenges remain.

People with enduring mental illness might no longer be in psychiatric institutions, but they are more likely to be unemployed, under-employed and homeless, compared to those without such illness.

They are also more likely to be arrested in similar circumstances and remand is more probable even for lesser offences. Prisons are toxic for the mentally ill.

This inequality sets in early in life: people from lower socio-economic groups develop mental illness at a younger age than those from higher socio-economic groups, and have longer durations of untreated illness (associated with poor prognosis).

Globally, fewer than 50 per cent of people with depression receive any treatment, and in some countries that proportion is under 10 per cent.

The key human rights issue in most countries is no longer protection from over-enthusiastic psychiatric intervention, but access to effective, empowering, person-centred health and social care.

The solutions to these problems stretch well beyond continued improvements in mental health services.

There is an urgent need for better physical health care for the mentally ill, as 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 chief causes are heart disease and cancer.

Reforms of social and criminal justice policies are central to promoting the rights of the mentally ill and their families.

Such reforms need broad political and public support across all sectors of society.

To this extent, Rudolf Virchow (1821-1902), the German pathologist, anthropologist and politician, was correct: “Medicine is a social science, and politics nothing but medicine on a large scale”. – Yours, etc,


Professor of Psychiatry,

Trinity College Dublin,

Dublin 2.