Mental Health is perhaps the most neglected and under funded sectors of the health service. People who have mental health conditions are often the most vulnerable in society. They are unique in two ways. First, they have mental and emotional problems rather than physical conditions. Secondly, to a degree and manner unlike any other health issue when their condition reaches crisis point it can result in death by suicide, in other words by their own hand. Suicide rates in Ireland, particularly amongst young men have reached alarming proportions, significantly higher than road deaths yet they receive much less attention. This situation has become even worse with the recession, while at the same time mental health services are being continually starved of vital resources. In 2009, the reported number of suicides in the state was 527, a dramatic increase of almost 25 per cent since the previous year. In addition, over 11,000 people were admitted to hospital as a result of harming themselves. There has been disproportionate number of incidents of suicide and self harm amongst the Gay and migrant communities.

Many asylum seekers have mental health problems often caused by the circumstances by which they were forced to flee their countries of origin. Their conditions are exacerbated by the fact that they are not allowed to work or take up third level education opportunities and by the direct provision regime, which they are forced to live in. 49 asylum seekers have taken their own lives while living in direct-provision centres in the last decade to the end of 2010. Also asylum seekers rarely receive counselling by someone from the same ethnic, religious or cultural background as himself or herself.

It is therefore important to have a mental health service that can match best practice internationally. In 2001, the UN adopted its Principles for the Protection of Persons with Mental Illness (MI Principles). The first of these principals’ states:

“All persons have the right to best available health care, which shall be part of the health and social care system”.

However the 'best available' standard of the UN exposes the circular logic of 'best practice within available resources'. A thimble of water to a thirsty child is best practice if you can argue there is only a thimble 'available'. In a rich country division of resources between rich and poor is the core of politics in the liberal/social democratic range.

Amnesty International has commented that we can not have proper human rights protection in mental health unless we adequately fund the mental health service. Commenting on this situation and as part of its campaign Mental Illness the Neglected Quarter, Fiona Crowley of AI, Ireland has made the following observation:

“One in four people are affected by mental health problems and, as we speak, people lack adequate supports and services. This means almost every family in Ireland is affected by successive governments’ apathy in this area”.

In January 2006 the Government accepted the recommendations contained in an independent report that it had commissioned, Vision for Change (VFC), as the basis for its future mental health policy. Since the report’s publication almost nothing has been done to realise its full implementation. There are two key related factors here. First, this year’s health plan, the HSE Service Plan 2010, stated that the spend for the health service was to be been cut yet again for 2010 by E668m down to E14.070bn. If one had any doubts of the neo-liberal philosophy of the HSE there is no need to look any further than the title of its previous four year health plan, HSE Corporate Plan 2008-2011! In the health budget for 2011Mary Harney cut E720ml and commented that

“…all the agenda items that have been pursued in recent years will be pursued even more aggressively over the next phase”.

This is code for an even more determined effort to continue her policy of neo-liberal economics and further privatisation in the health service. For mental health the situation is even worse. By EU 15 standards Ireland should spend at least 12 per cent of its overall health budget on mental health. In the mid 1980s the Irish State was spending just over this amount on mental health. For 2010 this had been reduced drastically to 5.3 per cent of total health spend. To a large extent this has been achieved by the second related factor that of the continuing HSE staffing embargo. The result of this embargo is that staffing numbers in mental health have dropped from 10,476 to 9,772 in the fourteen months up to February 2010. On the current staffing embargo, Caroline McGrath, Director of the Irish Mental Health Coalition, commented:

“This moratorium is a crude and brutal instrument that is crippling . . . A Vision for Change . . . The Government’s plan for moving from acute hospital care to a community based service was based on redeploying existing staff and expanding the total number of staff. Instead we have a service that is . . . haemorrhaging staff, reducing A Vision for Change to a mere pipe dream. . . Clearly, too, the fact that mental health problems cost the exchequer E3bn per year has not been appreciated”.

The previous minister responsible for mental health and disability, John Maloney, hoped to raise capital (not human resources) funding from the sale of long stay psychiatric institutions which should have been done years ago, but there is no guarantee that their estimated price will be realised or how long it will take to sell them.

Instead of the present chaotic health service, we should introduce a well organised service, universal and free at the point of delivery. Private health care should be banned as it is, for example, in some states in Canada. The health service must be provided for all equally on the basis of need. No discrimination should be allowed on grounds of age, disability, gender ethnicity, religion, sexual orientation or social class. Jumping the queue by buying private care should be banned. Not alone is this unfair, it is also an inefficient use of resources, as those with the most money are not usually the neediest.

To create a properly functioning and just publicly owned health service in Ireland would mean a reversal of the present government’s failed neo-liberal policies by calling a halt to putting the interests of banks and developers before people.

Meanwhile as already stated, Ireland has an appalling level of suicide and also the human rights of mental health patients remain a serious concern. Children are still admitted into adult psychiatric wards with all the dangers that that implies. Electroshock therapy or ECT, banned in many countries, is still being administered in Ireland, some times when the patient is not in a fit mental state to make a responsible decision to give their willing consent to the treatment. Not alone is this treatment not banned but its side effects including memory loss are rarely mentioned and alternative treatments are seldom suggested. The same can also be said for the use of over sedation and physical restraining of mental health patients. Also there is no adequate monitoring of involuntary detention, which should ideally be part of a totally restructured and democratically controlled health service as a whole.

The consequences of the Government’s short-sightedness is that mental health staff feel frustrated and that their dedication is being abused. Increasingly mental health patients are being issued with medication, to the delight of pharmaceutical corporations, because the government refuses to adequately fund an alternative social model or recovery model of mental health, which would provide alternatives to pills. As suggested in VFC, this model would include increasing staff numbers especially in the areas of psychology, counselling and occupational therapy. Greater funding would be provided for far increased mental health service user input and for initiatives such as for autonomous service user led drop in centres. The Irish Times editorial in October 2010 on the government’s implementation of Vision for Change commented:

“It is extraordinarily cynical of the Government to claim on the one hand to be tackling the negative stigma surrounding mental health, while on the other starving the sector of vital funding”.

Under pressure, the new Fine Gael-Labour Government with Kathleen Lynch as Minister for Disability and Mental Health, did allocate E35ml. per annum for community mental health services in Budget 2012 and that this amount would be ring-fenced for future annual investment in the service. However, Orla Barry of Mental Health Reform, has argued that none of this is new money. It represents a transfer of funds from hospital based services to community based services and in fact the mental health budget will suffer a cut of one per cent for 2012. As none of this E35ml. has yet been spent and as none of the promised 370 additional posts has been filled, Barry argues that we could actually be looking at an effective cut of almost six per cent in mental health funding by the end of 2012.

At the beginning of September, the current government’s Minister for Health James Riley the transfer of the additional E35ml promised to community mental health services to offset the deficit in the HSE. This was met by a demonstration outside government buildings by those demanding that the Government continue to stand by its commitment to mental health funding. This is precisely the type of direct action by service users, their advocates and families, linked to all those opposing cuts and charges which will force the government to reverse its neo-liberal agenda.