We must introduce mental health reforms quickly and uphold the rights of the mentally ill, writes Dr Ian Daly
Ireland is in breach of the European Convention on Human Rights in relation to the committal and detention of the mentally ill. The existing Mental Treatment Act dates back to 1945. It is overly inclusive as to who can be committed and is overly restrictive on those who are committed.
Today, we continue to await the full implementation of a new Act which was legislated for in 2001.
Why can we not implement this Act speedily and redress the gross infractions of civil liberties that are the consequence of our continuing adherence to an outdated one?
Instead, we seem to be shaping up for a row - between the Department of Health and Children and the Mental Health Commission on one side and the consultants representative bodies on the other.
The usual rituals of condemnation and vilification will be entered into; meanwhile, patients and families wait on the sideline.
Among the many marginal groups who have gone on to establish their rightful place in our society, we, as a society, have been slowest to accord proper position to those with mental disorders, fundamentally for reasons of shame, fear and stigma. Once confronted, this shame and stigma will diminish, as it has done in other areas of life.
It is of fundamental importance, therefore, that civil rights legislation is proceeded with as speedily as possible. That is insufficient, however, to guarantee one's rightful place in society or to ensure the disappearance of stigma.
Most would agree that our mental health services need two things - greater resources and modernisation. Within the last four decades a steady process of de-institutionalisation of in-patient care provision has occurred in the developed world. There is general agreement that this process was marked by widespread failure to redirect sufficient resources into alternative community provision.
The large proportions of those with mental illness comprising our homeless or our prison populations represent the most glaring examples of this failure of funding. The second challenge - of modernisation - has not always proceeded smoothly either. Many traditional services have failed to be reconfigured so that they can respond flexibly in delivering high quality care.
Now what does one do if one's service does not work as it should? Find out who is to blame? This is exactly what has been happening, with services purchasers (governments) saying that practitioners will not change and apply themselves with sufficient vigour to the new changed circumstances. Providers of services - me and my like - argue in turn that one cannot run mental services on a shoestring.
The current dispute encapsulates this tension perfectly. If the new Act were to be implemented in spirit rather than simply in line, recommendations from the Mental Health Inspectorate about increased clinical teams in a number of areas would be implemented.
Special provision for the care of children and adolescents, or those with learning disabilities, would also be provided.
The practitioner, sceptical of Government commitment to real, ie financial change, insists that more must be done if the Act is to have real meaning for detained people. Reports from other jurisdictions indicate that, in general, legislative change does not of itself improve care quality, so that the argument that these improvements will come naturally in the wake of new legislation has little bearing in experience.
The alternative viewpoint is that this issue is primarily concerned with fundamental human rights and that it overrides the former consideration. In other words, this is not the time to bargain for resources if, in doing so, there is a continuing denial of civil rights to a number of our civilians.
Must one side "win" here? This is not a dispute, say, in the nature of a pay rise, where an acceptable compromise is eventually reached. Rather, it is one where the central concerns of both sides have real legitimacy. New legislation can lead to real change if rights and standards of care go hand in hand.
Can both of these positions be respected? Of course they can. We know what needs to be done. The resource issues are essential and not prohibitive in cost.
Public avowals to agree implementation dates for both the commencement of the Act and the institution of the necessary resource requirements are achievable and urgently required at this point.
Recent unjust criticisms of psychiatrists who have been blamed for deliberately delaying the introduction of the legislation are a tactic that our association abhors.
It distracts attention from the responsibility of all concerned to improve both rights and care.
The United Nations' principles for the protection of persons with mental illness focus equally on establishing people's rights and setting down resource standards. Why can't we?