The Government has been accused by Amnesty International of failing to recognise good mental healthcare as a basic human right in a major new report on psychiatric services in Ireland.
The report, titled Mental Illness: The Neglected Quarter, to be published today, claims that mental healthcare here is "seriously out of step" with international best practice.
The Amnesty report claims that under-funding is a key reason why the Republic has failed to achieve a reasonable standard of mental healthcare, saying expenditure on mental health is disproportionately low when compared with other health sectors.
Mental health spending accounted for 9.4 per cent of total health (non-capital) expenditure in 1994, but this had dropped to 7.2 per cent by 2001, the report claimed.
While acknowledging that change has taken place in mental healthcare over the past 50 years, the report says advances have been slow and piece-meal.
" In in-patient care and the community, services remain inadequate, inconsistent in their availability throughout the country and severely under-resourced in staff, money and available therapies," it states.
The international human rights organisation singles out mental health services for children and adolescents, the homeless, prisoners and other vulnerable groups as being particularly deficient.
"Stigma is a barrier to the utilisation of available services by people with mental illness and their families. The Irish Government is obliged not alone to ensure that suitable services are provided, but that people are assisted and enabled to access these services," the report states.
It calls for a comprehensive system of personal advocacy on behalf of people with mental illness, pointing out that many are not in a position to assert their rights and that family members are sometimes not best placed to act on their behalf.
The report also claims that Ireland's treatment of people with mental illness is part of a wider discrimination against people with disabilities.
It calls for the State to deliver new disability legislation in line with UN recommendations.
The director of the Irish section of Amnesty International, Mr Seán Love, told The Irish Times that Amnesty backed its call for a reform of the mental health system by "placing the issue firmly in a rights context".
He said that as Ireland celebrated the European Year of People with Disabilities, people with intellectual disabilities were languishing in long-stay psychiatric units in violation of international law, when they should be in suitable community alternatives.
Referring to the issue of funding, Mr Love said Amnesty International wanted an end to the blatant neglect of mental healthcare.
"This is hardly a mountainous task given our relative wealth. It is time for the highly disproportionate Government spending on this sector to change." he said.
Mr Love said priorities were all wrong when just 7 per cent of the total health budget went on mental healthcare, while an estimated 10 per cent of the population would have a mental illness which needed treatment.
The Amnesty report is based on a wide-ranging review of mental healthcare in the Republic, which it undertook between May and October last year.
It consulted agencies and individuals involved in the area and met non-governmental organisations at a round-table conference in November 2002.
Referring to those employed in the mental health sector, Mr Love told The Irish Times: "We were impressed by the dedication of people who are trying to offer the best possible service in adverse circumstances. It is often not recognised that this can be a difficult and thankless task.
"Amnesty International hopes to highlight the difficulties they are faced with every day and thereby contribute to the development of a better working environment."
A TV3 documentary, Out of Sight, Out of Mind, based on the Amnesty report, will be screened tonight at 8 p.m.
Mental healthcare in Ireland: On the ground
The patient's experience
1) Alan, a 17-year-old suffering from schizophrenia:
On my 16th birthday, I was taken to the psychiatric unit. I was discharged from hospital after a couple of months. I spent my time at home in the health centre talking to psychiatrists. After I left the day hospital, things were tough. I was desperate for somewhere to go. I felt alone, rejected and heartbroken . . . I was alone because there was no designated area for people with my disability to go. There was no support because I was under 18. My whole life was completely out of balance . . . There was nowhere for me to turn to - only the waiting room door".
2) A person admitted involuntarily to a psychiatric hospital:
"There was nothing to do except take meals and medication. We have no one listening or talking to us . . . We live in here in a television room and a small rather dirty smoking room, all the other doors are locked . . . I am isolated in my room when not smoking. I don't watch TV."
The relative's experience
The parent of a person with autism:
"Living alone I was unable to cope with her full-time and had to hand her over to the health board. She was placed in a psychiatric hospital . . . I was assured . . . that the placement was a temporary measure until such time as a place arose in a more suitable centre. This was in 1994 and she was there until I rescued her in 2002."
The doctor's experience
A concerned doctor's perspective: "People with serious mental illness can get a raw deal. Services vary hugely from one part of the country to the next. Inner-city psychiatric services are seriously overstretched because of the accumulation of the homeless and refugees in these areas.
No doctor wants to 'section' a patient anymore [when a doctor signs a patient into a psychiatric institution against the person's will]. With a proper advocacy service, you would at least feel that some- one was there to challenge your professional decision on behalf of the disturbed patient. Advances in medication have made a huge difference for patients with schizophrenia and severe depression. But there are still gaps, especially in the community, in the availability of psychologists, therapists and other healthcare professionals who could speed up the person's recovery. This means that drug therapy is often the only treatment option, rather than it being part of a range of therapies as you would find in physical illnesses".