Madam, - We were pleased to read the position taken by Minister Tim O'Malley in your Letters page of November 21st - a position which reads very differently from the views he expressed to the Irish Medical News two weeks previously, when he suggested that mental illness was not a medical condition and was not amenable to scientific assessment.
It was these extreme and ill-informed views about mental illness which provoked our letter of November 16th, and not the issue of whether antidepressant medications are over-prescribed for mild conditions, as several subsequent letters suggested. Indeed one of us (PC) has published several papers in peer-reviewed journals on the over-diagnosis of "depression" and overuse of antidepressants, including an Editorial in the British Journal of Psychiatry in December 2001.
Another of us (KM) has received international charitable funding to explore brain function during suicidal depression. Another of us (TD) has received funding from the Irish Health Research Board - a Government-funded research agency - to conduct advanced research into the biology of depressive illness. These studies seek new knowledge about significant biological factors evident during depression.
In light of these facts, surely the Minister did not wish to undermine his own research funding agency (nor those of prestigious international charities) by his misguided comments about biological factors at play during major depression - a condition that by definition is "qualitatively and quantitatively different from normal sadness/unhappiness".
Like most clinical psychiatrists in a modern mental health service, we endeavour within the scarce resources available to operate a multidisciplinary model of care where psychosocial interventions, including psychotherapy, form a vital part of clinical practice. Our letter called for greater provision of trained professionals to deliver non-medication-based approaches, such as psychologists, psychiatric social workers, occupational therapists and clinical nurse specialists. Indeed the views expressed by the Minister two weeks ago, when he indicated that not just depression but mental illness generally could be cured by having a friend to talk to, was equally disparaging of treatment with psychotherapy as it was of treatment with medication.
Mental health clinicians in Ireland and the patients we care for have seen the proportion of the health budget devoted to mental health reduced by nearly 50 per cent in the past two decades, as the funds saved by closing hospital beds have been diverted elsewhere instead of being reinvested in psychiatric community services. This has left services grossly under-resourced and struggling to cope. To correct this imbalance, we need a properly informed Minister who can act as a strong advocate for the best resources for people with mental illness, rather than one who seriously questions the existence of such a condition. This position is hurtful and stigmatising to patients and their families who struggle with severe, enduring and incapacitating mental illness.
We hope the Minister will act on his stated commitment to improving resource allocation and will help psychiatric services in this country to catch up with the level of care taken for granted by most of our European neighbours.
We sincerely thank The Irish Times for facilitating this important debate. - Yours, etc,
PATRICIA CASEY,
Professor of Psychiatry,
UCD and Matermisericordiae
University Hospital;
TIMOTHY DINAN,
Professor of Psychiatry,
University College Cork;
MICHAEL GILL,
Professor of Psychiatry,
Trinity College Dublin;
COLM McDONALD,
Professor of Psychiatry,
NUI Galway;
KEVIN MALONE,
Professor of Psychiatry,
School of Medicine
and Medical Science,
SVUH/University College
Dublin;
KIERAN MURPHY,
Professor of Psychiatry,
Royal College of Surgeons
in Ireland and
Beaumont Hospital.