Research going back to the 1890’s demonstrates suicide and mental illness increase at times of recession. The World Health Organisation, WHO, stated “It should not come as a surprise that we continue to see more stresses, suicides and mental disorders”. The director of the WHO also stated: “There is clear evidence that suicide is linked to financial disasters. The potential psychological impact of economic recession on public health is severe. Job loss, job insecurity, job uncertainty, economic strain, loss of income, home repossession and restricted access to credit lead to a reduction in mental well-being, an increase in mental health problems and mental ill-health, increased substance misuse, especially alcohol and drugs, and intimate relationship breakdown and divorce. There is a loss of perceived social worth.
There is a loss of purpose and daily structure, reduced social contacts and an increase in social isolation. An increased risk of suicidal behaviour occurs, both non-fatal self-harm and completed suicides.
People who are unemployed are two to three times more likely to die of suicide than those in employment. This high rate is partly because people with psychiatric illness are at a greater risk of losing their jobs. There is an association between unemployment and suicide.
However, even among people with no record of serious mental illness, unemployment is associated with a 70% greater suicide risk. Prospective individual level studies show that unemployment has a casual influence on depression and suicidal thinking.
Job insecurity is associated with a 33% greater risk of common mental disorders, mainly anxiety and depression. People with mental disorder are more likely to be in debt than those who have no mental disorder. A United States research document indicates that a loss of income rather than low income was associated with suicidal ideation. In Hong Kong, 24% of all suicides in 2004 concerned people in debt.
Alcohol consumption rises during recessions, and this correlates with suicide. The figure for the 1990’s in this country was a 44% increase in alcohol consumption and a 41% increase in suicide.
Analysis of suicide rates in Latvia during a period of massive economic and social change showed that the sudden decline in GDP was associated with a rapid increase in suicide. In Russia, mortality, especially suicide, increased substantially after the economic crisis in 1989.
Mental ill health is not only damaging to the sufferer, their family and community, it is damaging to the economy. In 2008, the Mental Health Commission published a Report which estimated the direct annual cost of mental health at a staggering €3bn in 2006! This is the cost to the taxpayer of decades of Government neglect and the isolation of services.
Mental Health is central in building a healthy, inclusive and productive society. Illness like depression and schizophrenia can be treated successfully for the vast majority of sufferers and with early intervention and treatment people can live healthy lives, fulfilling their individual potential.
In January 2006, the THEN Government adopted A Vision for Change as the basis for the development of mental health services in Ireland. The policy framework set out in A Vision for Change , was greeted by near universal approval as the best model for a modern, comprehensive, world-class service to meet the mental health challenges facing our society almost universally accepted by all.
However, SIX years since its announcement, there is a lack of progress in implementing A Vision for Change.
The Independent Monitoring Group reported in July of last year that specialist services promised as part of the strategy has not been developed. These include forensic mental healthcare services, rehabilitation and recovery eating disorder services, psychiatric services for older people, services for co-morbid severe mental illness and substance abuse problems and intellectual disability services.
A Vision for Change set out a policy framework for the mental health of the whole population. It called for a person-centred, recovery orientated and holistic approach to mental health services. It also called for a shift from the current system, which is excessively reliant on institutional care and medication, to a system centred on community based care provided by multidisciplinary mental health teams. These teams would include psychologists, social workers, occupational therapists and service users who would work alongside psychiatrists, mental health nurses, psychotherapists and counsellors.
It is important people with mental health problems are allowed access to the services and supports they choose while continuing to live and participate in their community, as is their right. Ireland is more reliant on institutional mental health care than any other country in Europe. While there are examples of good practice in certain areas, implementation of the plan to which I referred has been inadequate overall.
Services remain widely deficient with few complete multidisciplinary mental health teams in place and limited access to community care for the full range of psychological supports that should be part of a modern mental health service.
In 2009, only one in five staff in the mental health service was working in a community setting. In-patient facilities remain completely unsuitable, with 15 of the 63 approved in patient centres dating from the Victorian era or earlier. The Inspector of Mental Health Services has described some of these facilities as entirely unacceptable and inhumane. The position in respect of older people and people with intellectual disabilities is even worse as specialist mental health services in these areas are in need of comprehensive reform.
The Programme for Government contains a commitment to establish a cross-departmental group to ensure good mental health will be a policy goal across Departments. In the recent budget, there was an allocation, as promised of €35 million for the implementation of A Vision for Change. This sum has been ring-fenced because when the former Minister for Health & Children, Mary Harney, allocated funding to the HSE it was hived off for other purposes. In the recent announcement by the Minister for Health in relation to the reorganisation of the Directorate of the HSE, the Mental Health Service is included in the directorship where previously it was at the level of assistant director. This is in line with the recommendation of A Vision for Change.
I wish to raise an issue of the inclusiveness of patients and carers in the recovery plan of patients suffering from mental ill-health. There is an urgent need for a change in the mind-set of the majority of the mental Health professionals to recognise the need and opportunity in involving family of patients being treated for mental ill-health in the patient’s recovery. While there are some very progressive members of the psychiatric profession in relation to this, the majority do not recognise the need to involve family in the treatment of the patient. Continually we are contacted by family members regarding the lack of communication in relation to the treatment. This is especially so at the times of discharge from a mental health facility. Family members have a unique insight to the difficulties and mental condition of the patient. Too often we are contacted regarding the concern of the discharge of a patient whom they know to be suicidal and the failure to discuss this concern with the health professionals. Too often we subsequently learn of the tragic death of the patient.
While accepting the clinical expertise of professionals, the failure to consider the families experience and concern is a lost opportunity to include vital information in the decision of the professional in deciding a care and recovery plan for the patient. Advice on the treatment and aftercare of discharged patients by their carer is surely vital for the successful convalescence and full recovery. The general health professionals have no difficulty with this approach while recognising the confidentiality of the patient.
Providing the patient agrees, the carer or other family members should be given information about the patient’s situation if they request it. However, there are times when the information needs of the carers and family may conflict with the patients wish for privacy, While the right of confidentiality for the patient must be respected, a way forward should be agreed that the needs of the carer’s and family in the interest of the patient are met.
An approach based on the patient’s needs covering all aspects to health as well as social care will both highlight and moderate these conflicting rights, offering advise on how to deal with situations which may arise when the patient may not be well enough to make decisions his or herself, working with the carer and providing information about the illness, with due regard to the sensitivities and the confidential rights of the patient.
Carers provide an enormous amount of care in the home for people with mental health problems. There is a need to formally recognise and support through practical means and crucial role of family care in mental health service provision. Carers often feel excluded from the care of the patient and in many situations are not given any information, while at the same time being expected to provide shelter for the patient and look after their day-to-day needs. Carers need to be valued for their role and input. This means, for example that a mental health service should consult with the career and inform the carer in advance that the patient is being discharged into their care. It is often appropriate and helpful for the carer, with the agreement of the patient, to be involved in the care planning process.
Involving patients and their families in mental health services goes beyond caring out a consultation process. Patients and former patients must be at the centre of decision making at an individual level in terms of the servies available to them, through to the strategic development of local services and national policy.