Madam, - The six professors of psychiatry who signed the letter in your edition of November 16th have rightly been criticised for their narrow and dogmatic stance on the use of medication. They are very well aware of the long-running international debate on the over-prescribing of psycho-active medication by psychiatrists and general practitioners. Minister of State Tim O'Malley is far from the first responsible politician to raise questions in this regard.
It would, however, be misleading to say that what we have is a clash of ideology between proponents of the medical model and those who espouse the talking therapies.
It is known that 95 per cent of patients presenting with mental health issues in Ireland are treated by GPs at primary care level. Most prescriptions for psycho-active medication are written by GPs and not by psychiatrists.
Irish and international research on primary care shows that GPs tend to prescribe such medication not out of conviction but largely because of high case-loads, poor support and a lack of time to devote to individual patients.
Recent research on the attitudes of GPs in Ireland also indicates that most are reluctant to refer patients to psychiatrists. The vast majority are anxious to have adequate resources available at primary care level, such as psychologists and psychotherapists, to provide a realistic alternative to medication.
The recent expert group report on mental health services, "A Vision for Change", strongly endorses the provision of psychotherapeutic services at primary care level. Given that group comprised a majority of senior psychiatrists it would appear that the six professors do not represent a consensus, even within the ranks of their own specialism. - Yours, etc,
EDWARD BOYNE, Psychotherapist, (Member of Expert Group on Mental Health 2003-2006), Tivoli Institute, Clarinda Park East, Dun Laoghaire, Co Dublin.
Madam, - I wish to respond to Breda O'Brien's column of November 11th based on an interview I gave to the Irish Medical News of November 6th.
I am committed to developing a world-class mental health service for the people of Ireland. This will involve the continued development of our service in line with "A Vision for Change", which was launched last January after wide-ranging consultation with all stakeholders, including - most importantly - service users and their relatives. It outlines a set of values and principles that will guide the Government, the Health Service Executive and others in developing a modern, high-quality mental health service over the next seven to 10 years.
The report, which have been accepted by Government, proposes a holistic view of mental illness and recommends an integrated multidisciplinary approach to the biological, psychological and social factors that contribute to mental health problems. It recommends a person-centred treatment approach which addresses each of those elements through an integrated care plan reflecting best practice and, most importantly, evolved and agreed with both service users and their carers.
It is in the context of the recommendations of "A Vision for Change" and indeed my own experience both as a pharmacist and as a Minister who has met with many groups in the mental health arena, that I hold the view that there continues to be an over-reliance on medication in the treatment of mental illness. I did not at any stage question the role of medication within psychiatry; rather, I raised concerns, as I have done on many occasions, about the level of prescribing in the treatment of mental illness. Clearly prescribing is one therapeutic response to mental health conditions. There are other responses to deal with the very wide range of mental health problems and indeed the difficulties which individuals encounter in their lives.
I accept that there is pressure on beds in certain parts of the country but it is envisaged that with the further development of properly resourced community-based treatment services more cases can be managed without the need for hospitalisation. There will always be a need for in-patient treatment and the appropriate bed capacity will be provided. A properly resourced, community-based care model is needed and again the actions to achieve this are outlined in "A Vision for Change". I accept that traditionally our mental health services have been under-resourced and, of course, action plans need to be properly funded to be effective. This year an additional €26.2 million was provided for mental health service development, bringing our annual revenue spent in the area to €835 million. Further additional funding will be provided in 2007 to progress the modernisation of our mental health services.
I welcome the debate that has arisen out of my article in the Irish Medical News. I will continue to listen to the views of all stakeholders in this very important debate, as I have been doing for the past four years.
I expect all service providers to work together over the next seven to ten years in a spirit of co-operation to develop a top-class mental health service that we can all be proud of. - Yours, etc,
TIM O'MALLEY TD, Minister of State with special responsibility for Mental Health, Dáil Éireann, Dublin 2.
Madam, - It is worrying that the traditional fault lines have emerged so quickly in the recent debate on mental illness. I remain unconvinced that this is really a debate between psychosocial and biomedical views on mental distress. Mr O'Malley's comments seemed, more simply, to be dismissive of the severity of these conditions.
Ireland needs leadership in promoting good mental health services - medical and psychosocial. It seems instead to have a Minister who is unsure about whether depression existed in the past at all. This surely is a concern. - Is mise,
Dr PÁDRAIG COLLINS, Clinical Psychologist, Walthamstow, London E17.