Address by Minister of State, Mr. Tim O’Malley TD, at the official launch of the Third European Reality Therapy Convention in University College Dublin on Thursday 7th July 2005

I am delighted to be here this morning to address the 3rd European Reality Therapy Convention on “Mental Health not Mental Illness”. I would like to thank the William Glasser Institute Ireland who organised this event. A convention of this nature provides a forum where those interested in mental wellbeing can meet and exchange views. At the outset, I would like to emphasise the Irish Government’s commitment to supporting both the development of quality mental health services in Ireland and to learning from and contributing to the development of Services in Europe. The convention provides us with an opportunity to consider the changes which have been taking place in the delivery of mental health services throughout Europe and to exchange views on the direction which our policies might take for the future. I am particularly pleased that delegates from Australia, Bosnia & Herzegovina, Canada, Croatia, England, Japan, Jordan, Korea, Kuwait, Slovenia, Spain and the United States are here with us today.

I welcome and acknowledge the theme of mental wellbeing rather than mental illness. As we are all aware, there was in the past a reluctance to even discuss the issue of mental illness. Thankfully, this situation has now changed. In Ireland, the level of discussion and openness on mental health issues has increased significantly in recent years. This is a very welcome development. However, we do need to ensure that public discussion and media coverage of mental illness remains measured, well informed and sensitive to the needs and well-being of psychologically vulnerable and distressed individuals in our society. In particular, we need to continue to work as a society to create a culture and environment where people in psychological distress feel able to seek help from family, friends and health professionals.

I understand that reality therapy is a method of counselling which teaches people how to direct their own lives, make more effective choices, and how to develop the strength to handle the stresses and problems of life. It seems to me that this would a useful tool for all of us, as we have to face reality and choices on a daily basis.

A core objective of counselling is the empowerment of the individual. The personal resources of the person are drawn upon to help bring an undesirable personal situation to one where the person is in control of his/her own life and free from damaging influences. The fundamental principle of encouraging genuine personal communication and listening in our encounters with each other, and in particular with whose who are going through a “bad patch” needs to be emphasized. This helps to foster the confidence in the individual to face life events and to discover a way to cope with difficult situations.

I know that Dr. Glasser believes that the key to mental wellbeing is having healthy, satisfying relationships. Thankfully, we can all improve our relationship by adopting seven “caring habits” which are: supporting, encouraging, listening, accepting, trusting, respecting and negotiating differences.

Each of us will however, face some sorrow and disappointment in our lives. Any loss, be it of a loved one, a satisfying relationship, a job, your good health etc., and its resulting grief is preoccupying and debilitating. What you will be focusing on for the next few days is the specific help that is needed to enable one to face such problems and to recover and learn from the experience.

The experience of loss is a unique, individual and intensely personal experience as are the responses to it. No two people experience the journey in the same way, even those who are grieving the same loss. Each person has to make their own journey. The power of self-help is a critical factor in any healing process. A sense of being able to share and discuss ones fears and emotions within an understanding environment is invaluable and of tremendous solace at a time of crisis. That is the core of what advocacy is about.

The development of advocacy services in Ireland is a very recent occurrence, but it is another example of the significant improvements which are taking place in the provision of mental health services. An advocate can be someone who can represent and defend the views, needs, wishes, worries and rights of individuals who do not feel able to cope themselves. Advocacy can also help service users to participate in and make decisions about their care and treatment. It can be a mechanism for changing attitudes of the public and media towards mental illness and those experiencing it.

Advocacy is something that many people do for others on a daily basis. Parents speak up for their children everyday. Relatives and friends speak on behalf of vulnerable persons when necessary, and defend their basic rights and entitlements as human beings. Self-advocacy is the act of speaking up for oneself. It allows the person concerned to express his or her concerns but it may also foster recovery by assisting people to take control of their lives and their future. With the right support in terms of advice, information and encouragement, self-advocacy is something that many individuals can achieve.

There is thankfully, a growing awareness and concern in Ireland about mental health matters and the National Health Promotion Strategy 2000-2005, in conjunction with the health strategy “Quality and Fairness”, see mental health as being equally as important as physical health in the overall wellbeing of a person. Increasingly, good mental health is being recognised as a major challenge facing health services in the twenty-first century.

Mental health promotion is a very broad concept as it emphasises the promotion of the psychological health and wellbeing of individuals, families and communities. I see it as a key task of the health services not just to treat mental illness but more importantly, using the principles of health promotion, to try and improve the mental health of all the population.

The promotion of positive mental health will contribute significantly to combating the ignorance and stigma, which often surrounds mental illness. Better understanding of mental illness encourages people to access professional help sooner rather than later and this facilitates early recovery. Eventually, with time and education, the stigma will fade further away, and it will mean that at long last, society will have accepted people with disabilities, in every form, and they will be treated with human kindness and given the rights they deserve.

My Government established an Expert Group on Mental Health Policy in August 2003 to prepare a new national policy framework for the mental health services, updating the present policy document Planning for the Future which was published in 1984. This Group consists of 18 widely experienced people who are serving in their personal capacity. The membership encompasses a wide range of knowledge and a balance of views on many issues affecting the performance and delivery of care in our mental health services.

During 2004, a comprehensive consultation process was undertaken on behalf of the Group which comprised written submissions, questionnaires, two public consultation days and a one-to-one consultation process with service users in the Adult Mental Health Services. Two reports were published by the Expert Group arising from that process: ‘Speaking your Mind’, and ‘What we Heard’. These reports reflect the wide ranging knowledge and expertise that exists among professionals and service providers with regard to mental health issues. They also give a very clear indication of service users’ views in relation to the present state of the mental health services and how they should be developed in the future. The three central findings from the consultation process, on which there was greatest agreement, were:
1.A mental health service where the service user is at the centre of the service;
2.The need to look at alternatives to medication for people with mental health difficulties;
3.The need for a community-based mental health service with people treated in their own homes or in nearby centres rather than in psychiatric hospitals, as was the case in the past.

There is a growing awareness among both service users and service providers that drugs are simply one form of treatment for people with mental health difficulties. It was acknowledged throughout the consultation process that, while clients/ patients showing signs of mental health problems may well need medication, there was an over reliance on medication in the treatment of many mental health problems. A drug-free approach to mental health problems with a comprehensive range of psychological therapies provided at primary, secondary and tertiary levels was suggested as a desirable alternative. I understand that the Group has had a number of very intensive meetings recently and is on target to complete its work and publish its report later this year.

As a Pharmacist, an issue of particular concern to me is the widespread prevalence of polypharmacy; that is, the simultaneous prescribing of large numbers of drugs. Traditionally, polypharmacy has a negative connotation, implying an inappropriate or irrational use of multiple medications. While the use of multiple medications can sometimes be an effective clinical intervention, the degree of risk and benefit associated with polypharmacy varies depending on the medications used and of course the characteristics of the patient concerned.

Whilst alternatives to medication is a consistently strong theme when considering the future direction of mental health services, there must also be a very strong emphasis on the need for a far greater availability of mental health professionals within the community, particularly mental health nurses, psychologists, counsellors, occupational therapists and social workers. Whatever initiatives are established in the future, it is of the greatest importance that they are person-centred and take account of the resources and wisdom that already exist within the community.

In conclusion, I would like to thank the William Glasser Institute for bringing such an eminent speaker as Dr. Glasser to share with us his beliefs on Reality and Choice Theory. I am sure it will be a very fruitful and rewarding few days here in Dublin.