5.
Greater social inclusion for people
with mental health problems
The Programme for Government contains a welcome
commitment to establishing a cross-departmental group to
ensure good mental health is a policy goal across
Government. This commitment needs to be implemented
as a priority by the new Government and can build on the
good work already achieved by the Office for Disability and
Mental Health which has a cross-departmental remit. The
group should include representatives from the Departments
of Health; Education; Children; Social Protection; Justice,
Equality and Defence; Environment, Community and Local
Government; Arts, Heritage and Gaeltact Affairs and Public
Expenditure and Reform.
This group should set out how responsible Departments will
progress the social inclusion recommendations of A Vision
for Change and report regularly and publicly on progress. It
should also ensure that mental health is adequately
reflected within the work of other Government structures
such as the National Disability Strategy and the Office for
Social Inclusion.
6. End stigma, prejudice and discrimination
The stigma and discrimination associated with mental
health problems can be as difficult to manage as the
experience of being unwell. Research by See Change, the
National Mental Health Stigma Reduction Partnership,
found that half of those surveyed would not want anyone to
know if they had a mental health problem, while one in
four young men would delay seeking help for fear of
someone finding out.
It is clear that much remains to be done to improve
attitudes and the commitment in the Programme for
Government to reducing the stigma associated with mental
health problems is welcome. To fulfil this commitment the
Government must fund and support evidence-based public
campaigns to combat prejudice and discrimination against
people with mental health problems.
It must build on the positive work already being done by
See Change – the National Mental Health Stigma
Reduction partnership – and also work with relevant state
agencies to eliminate the barriers experienced by people
with mental health problems in achieving equality and
References:
1. The term ‘mental health problem’ refers to the psychological and emotional problems that people may experience such as depression, anxiety or schizophrenia. The term was
specifically chosen as it is non-stigmatising and avoids diagnostic or labelling language. It does not include intellectual or learning disabilities.
2. AI has published a discussion paper setting out a rationale and recommended provisions of this legislation.
“It’s horrible. It’s awful. It makes you feel like
you’re the loneliest person in the world, the only
person in the world that has a problem or is
experiencing some difficulties.”
Anonymous Service User
equal opportunity, and exercising their rights under Irish
equality legislation to challenge discrimination and seek
redress.
It also requires courage and leadership from individual
politicians to speak out and challenge prejudice and
discrimination against people with mental health problems
where they encounter it and to encourage open and
informed discussion on the topic in politics and society.
WHAT CAN YOU DO?
MENTAL HEALTH:
Support the campaigns
OIREACHTAS MEMBERS’
During the life-time of this Dáil both Amnesty International and Mental Health Reform will
be engaged in ongoing campaigning and lobbying for mental health reform. We would greatly
BRIEFING PACK
appreciate your support in attending events, signing petitions and advocating within the
Oireachtas and within your parties for the objectives we are pursuing. To be added to our
mailing lists please contact mentalhealth@amnesty.ie
Join the Cross Party Group
The Cross Party Oireachtas Group on Mental Health was established during the 30th Dáil as a
forum for discussion and an increased political focus on the issue of mental health. Deputy Chris
Andrews and Senator Frances Fitzgerald convened the group in July 2009. Its purpose is to
promote political activity, awareness and understanding of mental health issues in a non-partisan
forum within the Oireachtas. The group has become an important forum for discussion and
advocacy on the issue of mental health in the Oireachtas.
© House of the Oireachtas
If you are interested in becoming a member of the group, please email:
crosspartymentalhealth@gmail.com
Find out more
If you would like to speak to someone about any of the work we are currently doing, or if you
would like to order any of our publications or campaign materials please contact Barry Johnston Amnesty International Ireland (AI) is a worldwide movement of over 3 million people who
(bjohnston@amnesty.ie; 01 863 8325). campaign for internationally recognised human rights for all. We research, campaign and
lobby to uphold human rights. In Ireland we seek to hold the Government to account for its
obligations under international human rights law. In particular we are campaigning for the
right to the highest attainable standard of mental health to be made a political priority.
Mental Health Reform (MHR) is an alliance of organisations seeking to improve the lives of
“We are not asking for anything more than for the human rights of people experiencing mental health people with mental health problems. We are campaigning for reform of mental health services
problems to be respected. We want them to be treated with dignity and respect. To be truly given a in Ireland by increasing the pressure on those with the power to improve these services.
Members of the alliance include Amnesty International Ireland, Shine, Bodywhys, Grow and the
choice in relation to treatment. We want a system that supports everyone’s right to housing,
Irish Advocacy Network and this membership is growing.
employment and education – all essential to recovery and well-being.”
AI’s Experts by Experience Advisory Group

FOREWORD
This briefing has been produced as a resource for
members of the newly elected Houses of the
Oireachtas to inform them on key issues of concern
for people with mental health problems. It is hoped
that this will be of value to members in assisting them
to effectively represent their constituents who
experience mental health problems and their families
and friends.
All people have the right to the highest attainable
standard of mental health, as written in Article 12 of
the International Covenant on Economic, Social and
Cultural Rights. This gives people a right to mental
health services that are available, accessible,
acceptable and of good quality and requires that our
country create an environment that promotes the best
possible mental health for all people. As public
representatives you have a duty to work together to
make these rights a reality.
Internationally it is commonly agreed that one in four
people will experience a mental health problem1 at
some point in their lives and mental health problems
affect men and women of all ages, social status and
origin. Each of these people will have friends, family
and colleagues, meaning virtually everyone is affected
by the issue of mental health in some way.
Mental health is an even more important issue in the
context of the current economic situation. Financial
stress, debt and unemployment are putting a massive
burden on people’s mental health. International
evidence points to a link between times of economic
difficulty and greater demand on mental health
services and high rates of suicide.
In 2008 the Mental Health Commission estimated
that the direct annual costs of poor mental health in
Ireland was €3 billion, or 2 per cent of GNP, the
majority of that in lost earnings, absenteeism and
early retirement and morbidity. Coupled with the huge
personal suffering that is experienced, these are
problems of enormous social and economic
importance that we cannot afford not to address. A
committed response to these challenges must be at
the heart of our recovery as a nation.
This briefing sets out the barriers that we face in fully
realizing the right to the highest attainable standard
of mental health in Ireland and sets out clear
recommendations for overcoming them.
Our organizations are committed to achieving reform
of our mental health services and respect for the
rights of people with mental health problems. We look
forward to working along side all members of the
Oireachtas to make these ambitions a reality.
Colm O Gorman Orla Barry
Executive Director Director
Amnesty International Ireland Mental Health Reform
WHAT ARE THE PROBLEMS?
Mental health services
Historically Ireland’s mental health services have been
dominated by inpatient treatment delivered in Victorian
institutional settings. Successive Government policies on
mental health have called for fundamental reform of our
mental health system (Planning for the Future (1984) and
A Vision for Change (2006)), but progress has been
painfully slow.
A Vision for Change set out a policy framework for the
mental health of the whole population. In addition to
recognising the importance of mental health promotion and
primary care, it called for a person-centred, recovery-
oriented and holistic approach to mental health services.
It called for a shift from the existing system, which involves
an over-reliance on institutional care and medication, to a
system centred on community-based care provided by
multi-disciplinary mental health teams (including
psychologists, social workers, occupational therapists and
service users working alongside psychiatrists and mental
health nurses). Such services allow people with mental
health problems access to the services and supports they
choose, while continuing to live and participate in their
community, as is their right.
There are examples of good practice in services around the
country yet implementation of this plan has been
inadequate overall. Services remain widely deficient, with
very few complete multi-disciplinary mental health teams,
and limited access to community care or the full range of
psychological supports that should be part of a modern
mental health service. In 2009 only one out of five staff in
mental health services actually worked in community
settings, while many inpatient facilities remain totally
unsuitable. Fifteen of the 63 approved in patient facilities
date from the Victorian era or earlier. The Inspector of
Mental Health Services has described some of these
facilities as “entirely unacceptable and inhumane”. The
situation for older people and people with intellectual
disabilities is even worse as these specialist mental health
services are almost non-existent.
Resources
Non-capital expenditure on mental health services was cut
radically from €1.1billion in 2008 to €770million in
2009. This continues a historical trend where spending on
mental health has dropped from 13 per cent of the overall
health budget in 1986 to 5.3 per cent in 2010. A Vision
for Change recommends that the rate reach 8.4 per cent.
The public sector staffing moratorium has also
disproportionately impacted on the mental health services:
mental health represents just 9 per cent of the healthcare
work force but accounted for 20 per cent of the 1,500
posts lost through the moratorium last year.
Underlying determinants of mental health
The human right to the best possible standard of mental
health is not limited to mental health services but extends
to what are known as the underlying determinants of
health, such as housing, employment, education and social
security. In other words, the right to health is closely
related to and dependent on things like having a having a
home, a decent income, a job, and skills and training.
In Ireland, there is increasing evidence that people living
with mental health problems experience social exclusion.
Statistics compiled for AI’s report The Missing Link show
that:
■ People with a mental health problem participate in the
Irish labour force at a rate less than half that of the
general population;
■ Adults with a mental health problem are more likely to
have left their job due to their disability than people with
other disabilities;
■ Almost a quarter of the 77,665 people in receipt of
illness benefit in 2009 cited mental health issues as the
reason they were unfit for work;
■ More than half (53 per cent) of people whose mental
“My local mental health support group has a
regular meeting of about 12 to16 men and one
woman once a week. All are unemployed. This
position has remained unchanged for the last six
years and longer.”
Anonymous Service User
Prejudice and Discrimination found that people with slow progress. Previous experience with the Cancer Care
mental health problems perceive high levels of prejudice Strategy has shown the value of having a designated
and discrimination in their lives and report experiencing individual championing an issue at the highest level within
unfair treatment across a wide range of areas, including our health services.
among family, friends, in their communities, at work and in
mental health services. Their reports of isolation, We need to establish a dedicated senior executive position
marginalisation, prejudice and discrimination point to a within the health service that is responsible for
shameful lack of equality and respect and warrant a implementing A Vision for Change. Recommendation 16.3
considered response from Government. of A Vision for Change calls for the establishment of a
National Mental Health Service Directorate led by a
Director for Mental Health Services who has executive
WHAT NEEDS TO HAPPEN? powers, an implementation budget and responsibility to
publicly report on progress.
Amnesty International Ireland and Mental Health Reform
want to see all people in Ireland enjoy the highest
attainable standard of mental health and be free from 3. Amend the Mental Health Act 2001
discrimination. We believe this is entirely achievable once a
firm political commitment is made to take the necessary The Mental Health Act 2001 regulates the involuntary
steps that will lead to this change. admission, detention and treatment of people with mental
health problems in inpatient facilities. The Act also sets
It is time for politicians and parties to articulate clearly out the functions and powers of the Mental Health
what steps they will take to turn these promises into a Commission and the Inspector of Mental Health Services.
reality. The Oireachtas can finally end the shameful neglect The Act currently falls short of the latest developments in
of people with mental health problems that has been a international human rights law and standards, for example,
health problem arose before completing their full time
persistent stain on Ireland’s human rights record. It can with regard to the overly paternalistic application of the
education stopped education due to their disability;
begin by doing the following: law, the lack of a recovery focus, the way the tribunal
■ Almost half (47 per cent) of mental health service users
system works and how treatment is allowed for under
surveyed for the Expert Group on Mental Health had at
the Act.
best a Junior Certificate; and
■ Of more than 4,000 people living in long-stay residential
1. Greater accountability for mental health reform
The Programme for Government contains a commitment to
mental health care in 2007, one quarter were in
Implementation of reform of the mental health services has review the Mental Health Act 2001. For this review to be
accommodation that did not suit their needs.
been slow and uneven to date. A Vision for Change has no adequate it must be carried out with reference to the UN
comprehensive implementation plan, meaning it is Convention on the Rights of Persons with Disabilities,
impossible to measure and scrutinise progress. which Ireland must ratify. It must also take the opportunity
The rights of people with mental health problems to enjoy
Accountability for expenditure on mental health and to examine how legislation can be used to drive reform and
all of their social and economic rights is reinforced by the
transparent information on how such expenditure is used to improve accountability and transparency in community
UN Convention on the Rights of Persons with Disabilities
reform the services in line with policy has been lacking. We mental health services.
(CRPD), which Ireland has signed but not yet ratified. The
simply don’t know enough about where or how public
CRPD adopts a ‘social model’ approach to disability
money is being spent on mental health services. Many of the provisions of the Mental Health Act 2001 are
(including mental health) that emphasises the role society
also closely linked to the issue of decision making capacity
plays in creating barriers for individuals who have
A Vision for Change requires a detailed implementation and new mental capacity legislation must be published and
impairments. It expresses intent to redress the “profound
plan setting out deliverables, a timeline and who is enacted as a matter of priority to replace the out-dated
social disadvantage of persons with disabilities” and to
responsible. Given that such a plan has not been produced wards of the court law currently in place.
promote their participation in civil, political, economic,
in the five years since A Vision For Change was published,
social and cultural spheres.
it is clear we now need legislation to make binding the
level of planning and accountability necessary to track 4. Financial Commitment
progress towards reform.2 Legislation could establish a
Prejudice and discrimination
framework for sustained improvement of mental health As detailed above, mental health services in Ireland are
services and increased transparency and accountability in underfunded and have been subject to disproportionate
Throughout the world, people with mental health problems
mental health expenditure, by clarifying the obligations of cuts. Progress on closing inappropriate Victorian mental
are among the groups that face persistent and pervasive
the HSE and the principles that should guide its fulfilment institutions in particular has been slow and in many cases
discrimination, resulting in the denial of their human
of those obligations. this has been delayed by a lack of resources to develop the
rights, and profound social and economic exclusion.
Discrimination can take many forms. It can include actions
replacement community based mental health teams.
of individuals (for instance, insults, harassment, or assault)
– and the outcomes of legislation, and state policies or
2. A National Directorate for Mental Health Services We need to bring the proportion of funding on mental
practices (such as the denial of basic services and other
health services to 8% of the health budget by 2016, as set
A Vision for Change has no single senior executive within out in A Vision for Change and ensure clear reporting on
rights).
the HSE who is responsible for leading the reform mental health spending. We also need to fastrack funding
In Ireland, research recently published by Amnesty
programme. As a result responsibility falls between the to provide improved community based services and recruit
cracks and no one can be held accountable for ongoing staff to work in these services.
international in Hear My Voice: Challenging Mental Health