Address by Mr. Tim O´Malley T.D., Minister of State at the Department of Health and Children, at the Ministerial Panel Discussion in Athens, on Thursday 27th March 2003 on “Mental Illness and Stigma in Europe: facing up to the challenges of Social Inclusion and Equity”
As Minister of State at the Department of Health and Children with special responsibility for mental health, I am very pleased and honoured to have the opportunity to participate in this important conference on mental illness and stigma in Europe.
In organising this conference, the Greek Presidency has provided a valuable opportunity for us all:
- to improve visibility and raise awareness of the issues of mental illness and stigma
- to put the matter firmly on the European mental health policy agenda, and
- to enhance information exchange on this topic and on other relevant issues.
We are all aware that good mental health is an integral component of general health and well-being which allows a person to realise his or her abilities. With a balanced mental disposition, one is more effective in coping with the stresses of life, can work productively and fruitfully and is better able to make a positive contribution to his or her community. Thankfully, society now recognises more fully the burden that mental illness places on sufferers and their families.
In Ireland, people with a mental illness were excluded, for many years, from full participation in community life as a result of widespread stigmatisation of mental illness.
While researchers and clinicians have made important advances in reducing suffering and accompanying disability, the battle against the stigma and social exclusion caused by mental illness is ongoing. I am very conscious of the importance of fostering an awareness of positive mental health while also highlighting the services that are available locally to people, particularly in times of crisis.
Mental Health Promotion
In Ireland, priority is being given to education awareness and to promoting a better understanding among the public of mental health issues.
Mental health promotion is a very broad concept as it emphasises the promotion of the psychological health and well being 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 the population at large.
There is a growing awareness and concern throughout the country about mental health matters and the National Health Promotion Strategy, 2000-2005, in conjunction with the health strategy “Quality and Fairness”, sees mental health as being equally as important as physical health in the overall wellbeing of a person. Increasingly, mental health is being recognised as a major challenge facing health services in the twenty first century.
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 may fade further away, allowing sufferers and their families to participate fully in society in every way.
Development of Psychiatric Services
Recent years have seen dramatic changes in both the concept and practice of mental health care delivery in Ireland. Enormous strides have been made and continue to be made in developing a service which is comprehensive, community-based and integrated with other health services.
“The Psychiatric Services – Planning for the Future” published in 1984 recognised that old institutional hospitals are unsuitable for the delivery of a modern mental health service and developed the concept of a comprehensive community orientated psychiatric service.
The shift in the delivery of services from predominantly hospital-based care to care in the community has been extremely successful in Ireland and undoubtedly the quality of care for persons with a mental illness has been enhanced by this development. It has resulted in a continuing decline in the number of in-patients, with a corresponding increase in the range of care facilities based in the community. At 31st December 2001, there were 4,256 patients in psychiatric hospitals and units in Ireland compared to 12,484 in December 1984.
The World Health Organisation´s 2001 Report, “Mental Health: New Understanding, New Hope”, was aimed at raising public and professional awareness worldwide of the burden of mental illness and its costs in human, social and economic terms. It is a comprehensive review of all aspects of mental health, from prevalence and treatment to service provision and planning. It concludes with a set of ten broad recommendations for action.
Steady progress has been made in this country over recent years in many of the areas covered by the World Health Organisation’s recommendations, for example, in the shift from institutional to community-based care and in the reform of mental health legislation. The Government is committed to continuing this progress and to increasing its efforts in the area of mental health, as resources become available.
The Irish National Health Strategy, “Quality and Fairness – A Health System for You”, published in 2002, recognises that there is now a need to update mental health policy to take account of recent legislative reform, developments in the care and treatment of mental illness and current best practice. The Strategy gives a commitment that a national policy framework for the further modernisation of the mental health services, updating the 1984 document, will be prepared. Work on this is expected to begin later this year. The recommendations of the World Health Organisation will be among the matters to be considered in the formulation of this new framework.
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.
The importance of advocacy is far reaching. Not only does it allow the patient concerned to express his or her concerns but it may also foster recovery by assisting patients to take control of their lives and their future. The power of self-help is a critical factor in any healing process. A sense of being able to share and discuss one´s 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.
My Department supports these developments and is currently funding peer advocacy services which are being developed in the voluntary sector.
Mental Health Act, 2001
Alongside these important developments, the enactment of the Irish Mental Health Act, 2001 was a very significant achievement. The primary objective of the Act is to address the civil and human rights of the mentally ill. I would like to take this opportunity to touch on a few important aspects of the Act. Its purpose is twofold. Firstly, the Act provides a modern framework within which people who are mentally disordered and who need treatment or protection, either in their own interest of in the interest of others, can be cared for and treated. In this regard, the Act brings Irish legislation in relation to the detention of mentally disordered patients into conformity with the European Convention on the Protection of Human Rights and Fundamental Freedoms.
The second purpose of the Act is to put in place mechanisms by which the standards of care and treatment in our mental health services can be monitored, inspected and regulated.
The Mental Health Commission, established in April 2002, will be the main vehicle for the implementation of the provisions of the Mental Health Act. It is an independent statutory body whose primary functions are to promote, foster and encourage the establishment and maintenance of high standards and good practices in the delivery of mental health services and to protect the interests of people who are detained for psychiatric care and treatment. The Commission’s independent status will be crucial, in driving the agenda for change and modernisation in the Irish mental health services in the coming years.
The Mental Health Commission will also be recruiting an Inspector of Mental Health Services, as provided by the Act, and assisting him/her in putting a system of annual inspections and reports in place.
At present, funding for mental health services amounts to 7% of the total Irish health budget. In the period 1999 – 2002, an additional €70.7m was invested in the mental health services. In the current year, additional revenue funding of €7.6m will be provided for on-going developments in mental health services, to develop and expand community mental health services, to increase child and adolescent services, to expand the old age psychiatry services, to provide liaison psychiatry services in general hospitals and to enhance the support provided to voluntary agencies.
Substantial progress has been made in recent years in Ireland in ensuring that those in need of mental health services receive care and treatment in the most appropriate setting. However, I accept that much remains to be done. The Irish Government is committed to the provision of quality care in the area of mental health, to upholding the civil and human rights of those who suffer from mental illness and to encouraging measures aimed at combating the stigma that is often associated with such illness. During my term of office as Minister of State with special responsibility for mental health, I will be endeavouring to secure additional funding for the mental health sector in the coming years. I will also be overseeing the development of the new National Policy Framework for mental health, to which I referred earlier, which will devise a sound policy base for the further enhancement and modernisation of our mental health services over the next decade.
In conclusion, I would like to thank our hosts, the Greek Presidency, for holding this important conference and I look forward to a very fruitful and rewarding few days here in Athens.
Thank you for your attention.