OPINION: Mental-health care is a dysfunctional shambles

Tuesday, October 10, marked World Mental Health Day. Established in 1992 as a global advocacy and awareness programme by the World Federation for Mental Health, now an initiative of the World Health Organisation, it aims to raise awareness of mental-health issues around the world, and to mobilise efforts in support of mental health. It’s a day for conversations, for stakeholders in working in mental health and for those who have personal experiences to share their thoughts.
Mental health is a topic that has frequently been touched upon in this column, sprinkled with a small bit of personal experience. My first experience of writing publicly about my own relatively mild, but still occasionally debilitating depression was nearly 15 years ago. It was back in the days of blogs (remember those?) when the topic was just starting to emerge from the darkness and cast off rhetoric like ‘a bit of trouble with the nerves’. I’m not sure at the time whether I realised that it would still be a topic close to my heart today, but a bit like childhood asthma it has become a lifelong and familiar companion.
The theme of this year’s World Mental Health Day was ‘Mental health is a universal human right’. And I have thoughts and questions. Mostly about what this most insipid of statements actually means.
We all have mental health by default, be it good or bad. The phrase ‘mental health’ does not equate to ‘good mental health’. Health can be good, bad, excellent or downright woeful, whether physical or mental. A statement like this therefore feels rather meaningless, but let’s give the WHO the benefit of the doubt and assume they mean ‘Good mental health is a universal human right’. Or even ‘excellent mental health’. Fine.
But that too, raises questions. Should we really regard good mental health as a ‘right’, any more than good physical health? Sometimes we’re healthy, sometimes we’re not, and frequently it’s out of our control. To imply that anyone is entitled to good health is a bit of an overstep.
But one thing we should all be entitled to, and have the right to, is fit-for-purpose health care. So what really needs to be said? ‘Access to timely, fit for purpose, affordable mental-health care is a human right’? Well, that’s a whole other level of ambition, isn’t it?
To be fair to the WHO, they do elaborate: “Everyone, whoever and wherever they are, has a right to the highest attainable standard of mental health. This includes the right to be protected from mental-health risks, the right to available, accessible, acceptable, and good quality care, and the right to liberty, independence and inclusion in the community.” But that doesn’t really trip off the tongue, so instead, we get this bland tagline. Anyway, semantics. (But words matter.)
Even in a wealthy country like Ireland, the WHO’s ambition feels unrealistic and unattainable. Mental-health care in Ireland is a shambles. It is a dysfunctional system from the top down, at government and health-service level. Critical staff shortages; poor wages; post-code lotteries; children unable to access child and adolescent mental-health services, and serious deficiencies within those services; long waiting times; an over-reliance on psychiatry and medical interventions over psychology and other therapies, and a lack of access to both of these; dual diagnosis issues; lack of community mental-health care; the expense of medication; and extortionate therapy fees. The list is far from exhaustive. And mental health is not just about depression, though the popular discourse may have you forget about the rest of the very broad spectrum of illnesses that exist and are rarely acknowledged.
Combine this with the external factors that people are dealing with. A post-pandemic/lockdown hangover, an unprecedented housing crisis, a cost-of-living crisis, frontline services across the country creaking towards breaking point, and a lot of things feeling very much broken right now. On top of it all, we are exposed to every disaster and calamity out there via our mobile devices, putting extraordinary pressure on our minds.
World Mental Health day is indeed a noble idea – discussion and awareness building is never bad. But I remember the day being marked in a previous job by free cupcakes in the office and the hiring of a chair masseuse for a half day, with much back-patting among senior executives for their generosity towards a tired, underpaid and grossly overworked staff. (That company, funnily enough, no longer exists.)
We know that ‘it’s okay not to be okay’. We know we should ‘just reach out’ and ‘talk to someone’ if in distress. But to whom? Where? When? And at what cost?
Until the conversation around mental health moves away from the aspirational, until governments are compelled to act, then is World Mental Health Day really anything more than another expensive, tokenistic measure?