Sir, – The excellent articles by Shauna Bowers highlight the problems faced by people with mental illness in prison (“Crime and psychosis: ‘Significant’ number sought help before committing violent crimes”, News, September 2nd).
The challenges start early, with an education system that does not teach basic mental health skills or sufficiently accommodate children who are neurodivergent or have disabilities; a value system that overvalues particular models of economic production and undervalues social participation and family support; and a society with high levels of drug-taking but inadequate addiction services, despite increased recognition of cannabis-induced psychosis.
Recent openness about mental health is welcome, but there is still profound cultural denial about conditions such as schizophrenia.
Some people with enduring mental illness require ongoing treatment and structured living arrangements which support all of their human rights, including the right to a healthy, dignified life.
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Many who are committed to prison previously sought treatment (“‘I tried to get my son help … but instead all he got was a criminal record’”, September 2nd). There might be “a record funding level” for mental health, but the baseline was desperately low. Ireland has the third lowest number of psychiatry beds in the EU, per capita. Mental health accounts for 5 per cent of Ireland’s health budget, compared to 13 per cent in the UK. Sláintecare recommends 10 per cent.
There is also a lack of connection between social services and the mental health system (“Homelessness and addiction can almost be ‘manifestations of mental health difficulties’”, News, September 4th). Taken together, these problems – poverty, poor education, inadequate housing, limited services, stigma – constitute a form of structural violence that amplifies the impact of mental illness, deepens social exclusion, and violates rights.
What are the solutions? Enhance inclusion in education. Expand addiction services and social support, and link these with the mental health system. Increase the mental health budget to 10 per cent of the health budget. Revise the Mental Health Bill 2024 so that it facilitates access to care, rather than further complicating it. For people who fall between the cracks, triple the level of psychiatric care and social support in prisons and homeless hostels.
Finally, we need to change the social, economic, and political landscapes which generate so much suffering in the first place, which magnify the disability associated with conditions such as schizophrenia, and which decisively shape the likelihood of treatment and recovery. This should be a huge election issue. – Yours, etc,
BRENDAN KELLY,
Professor of Psychiatry,
Trinity College Dublin,
Dublin 2.