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Counselling often beats pills
Dear Editor,
Éibhir Mulqueen draws welcome attention
to the challenges presented by mental illness
(‘Counselling often beats pills’, Village, October-
November ). In Europe, . million
individuals are affected by mental disorders each
year, of whom only one third receive treatment.
Mental disorders account for .% of Europe’s
total illness burden. These figures are replicated at
global level: depression is now the leading cause of
disability worldwide. Over
, individuals die by
suicide every year.
Despite these figures, the
majority of low- and middle-
income countries spend
less than % of their health
budget on mental health. In
Ireland, the proportion of
the health budget devoted
to mental health was %
in , but by had
fallen to .%. This decline
is attributable, in part, to
the dismantling of Ireland’s
psychiatric institutions. The
recent RTÉ documentary,
Behind the Walls, presented
a vivid picture of certain
problems in these institu-
tions. What is less well-recognised is the dramatic
reduction in the numbers of psychiatric inpatients
in Ireland in recent decades: between and
the number of inpatients decreased from
, to ,, a decrease of over ,
(%). This extraordinary decline was attrib-
utable to a mix of societal change, increased
emphasis on human rights, and the policy
document, Planning for the Future. In , a
new policy document, A Vision for Change, re-em-
phasised the importance of community-oriented
care and presented a renewed commitment to
reform mental health services.
Also in , the Mental Health Act
introduced new involuntary admission proce-
dures and independent reviews of detention
by mental health tribunals. The Mental Health
Commission now oversees standards of care and
protects patients’ interests. The new legislation
brings Ireland into greater accordance with the
European Convention on Human Rights ()
and United Nations’ Principles for the Protection
of Persons with Mental Illness ().
In , the College of Psychiatry of Ireland
was established to address issues of relevance to
its psychiatrist members and broader issues for
mental health services and services-users. The
College is the sole body recognised by the Medical
Council and HSE for competence assurance and
training in psychia-
try, to help ensure high
standards. The College
provides a broad range
of information about
mental health and illness
(www.irishpsychiatry.
ie).
Public interest is
mental well-being
has never been higher.
There are countless
examples of progressive,
collaborative initiatives
at grassroots level in
communities and mental
health services around
the country. Moreover, it
is now estimated that the
proportion of the heath
budget devoted to mental health will rise from
.% in to .% in .
All of these reforms are timely and important.
But this momentum needs to be maintained and
intensified. There is, in particular, a need to exam-
ine the balance between resources provided for
psychological therapies (as discussed by Éibhir
Mulqueen) and provision of medication, which can
be extremely helpful when used appropriately.
In , the cost of mental illness in Ireland
exceeded € billion, according to The Economics
of Mental Health Care in Ireland (O’Shea and
Kennelly, ). This includes just over € billion
for the cost of health care, social care and other
forms of direct care, and over € billion attribut-
able to lost economic output. This is an enormous
loss to the Irish economy – a loss that is exceeded
only by the incalculable personal suffering of indi-
viduals with mental illness and their families.
The irony is that mental health care is highly
cost-effective: in the United Kingdom, a course
of psychological treatment for anxiety or depres-
sion costs € and, as well as reducing the
individual’s symptoms, greatly increases the
possibility of a return to work, resulting in an
average increased economic output of €
per person, within two years (Layard, BMJ ;
: -).
This is especially important for Ireland, as
the country builds a recovery from the eco-
nomic and social stresses of the past few years.
Unemployment, a particular problem at the
moment, has an especially negative impact on
wellbeing: the reduction in wellbeing associated
with unemployment is three times larger than that
associated with poor physical health. The negative
effects of unemployment do not diminish with
time and often persist even after new employment
has been found.
Psychology and then Economics demand an
enhanced focus on mental health care in Ireland.
Yours faithfully,
Brendan Kelly MD PhD MRCPsych FRCPI
Senior Lecturer in Psychiatry
University College Dublin
Climate change and peak oil
Dear Editor,
A quote sometimes attributed to Gandhi may
shed light on where we are in the peak oil and cli-
mate change debate: “First they ignore you. Then
they laugh at you. Then they attack you. Then you
win”. It appears that we are now in stage three of
a four-stage process. So for example, per Kevin
Myers (th February , writing in the Irish
Independent), “no one has the least idea of the
loss of life that might result from the EU embrac-
ing ‘green’ energy policies”. But real winners will
there be none.
Yours faithfully,
Pól Ó Cionsalígh, Garrán Lorcaín,
Seantrabh, Báile Átha Cliath
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Village reserves the right to edit
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of reply or clarification to readers.
CORRECTION
A reader has pointed out that in our Presidency special
edition (Village, Oct-Dec 2011, page 29) we mis-stated
Michael D Higgins’ pension. In fact he receives around
€110,000, comprising a €90,000 Dáil and ministerial
pension and a €20,000 university teaching pension
from NUI Galway.
