Time for advocates to push mental health agenda

Advocates of Mental Health could pressurise government into delivering on its 2006 policy document 'A Vision for Change'. By Justin Frewen and Anna Datta.

According to the 2005 WHO report, The Economics of Mental Health in Europe, the cost to society of mental illness is estimated at approximately 3-4% of the GNP of EU member states. Ireland is no exception. In 2006, alone, the cost of mental health problems was estimated at €3 billion with €2 billion lost in economic output and a further €1 billion disbursed on health and social care together with other forms of direct care.

Clearly, then, the issue of mental health is a critical one for Ireland on both social and economic grounds. Every effort should be made to not only provide the required and appropriate treatment to mental health service users but also to alleviate the economic burden mental health problems are placing on the Irish exchequer.

However, as highlighted in the policy document A Vision for Change, the Irish mental health system is in urgent need of improvement in several key areas. Unfortunately, many of the necessary reforms that were identified in this document are still awaiting implementation.

It is in the furtherance of these reforms that advocacy can play a critical role. As the WHO has emphasised, advocacy can be extremely useful in raising the awareness of both the political community and general public as to the possibility of effectively treating most mental disorders.

There are a range of mental health issues in Ireland, which could benefit from advocacy. These include, inter alia, highlighting the gradual proportional reduction in the health budget allocated to mental health; the lack of parity in how mental and physical health issues are addressed and handled; the inequitable delivery of mental health services nationwide; the allocation of funds according to historical rather than current needs; the shortfall in adequate housing for mental health patients in transition, a significant factor in the 70% readmission rate and; the scarcity of employment opportunities for mental health service users trying to ‘reintegrate’ into society.

A well-resourced advocacy infrastructure can play an invaluable role in mobilising the political will to tackle these issues and ensure the allocation of sufficient resources to improve service delivery and close the current treatment gap.

Indeed, efforts have been made in this direction with, for instance, the establishment of the National Service User Executive, which attempts to provide greater links between mental health services users and providers. In parallel, there are a number of mental health organisations that are engaged in advocacy activities. A prominent example is Mental Health Ireland (MHI), which is a national voluntary organisation with over a hundred local Mental Health Associations and Branches nationwide. Advocacy organisations including the MHI, the Irish Mental Health Coalition the Children’s Mental Coalition Amnesty, together with human rights bodies such as Amnesty International, are campaigning for mental health to be made a political priority. 

In addition to these mental health advocacy groups, there is also peer advocacy. The foremost organisation in this field is the Irish Advocacy Network (IAN). The IAN is an all-Ireland body and has peer advocates in place in most health board areas in Ireland, north and south. Peer advocates are ex-mental health service users who have successfully overcome their particular mental difficulty and undertaken a peer advocacy training course. These regional advocates regularly visit hospitals and day centres in their area in order to provide support and information to mental health service users. As IAN outline on their website, peer advocacy does not judge people or instruct them as to what they should do. A peer advocate assists people in their efforts to assume control of their own lives.

These advocacy organisations play an essential and critical role in bringing mental health issues to the fore and deserve widespread public and political support in their efforts. In this respect, they could certainly benefit from well-targeted support and closer collaboration with the Department of Health (DoH).

A first step might include the compilation of an updated survey of all relevant advocacy organisations, including consumer and family groups, peer advocacy networks and NGOs. This review should clearly indicate the respective roles of all stakeholders, their particular advocacy interests and areas of expertise. The completed census should then be distributed to all concerned parties and updated on a regular basis. This approach would ensure all organisations and individuals – whether service users or carers - were aware of the advocacy support structures in place and the potential for collaboration and cooperation with other relevant stakeholders while also helping to avoid unnecessary duplication.

At the same time, the Department should support advocacy and mental health consumer groups in the formation of larger alliances and coalitions that will help increase their advocacy capabilities and capacity. The DoH could also work together with advocacy bodies to ensure that particular advocacy activities are concentrated amongst those groups with the greatest capacity and experience in the relevant areas.

In order to develop the capacity of advocacy organisations, support and counsel could be provided to ensure they are fully apprised of their rights, the services they are entitled to access and the situation with respect to involuntary procedures, complaints and appeals processes, civil rights, housing, education and employment.

Training opportunities could be made available for advocacy bodies on how to work with user and family groups on human rights issues. This would include information and instruction on how best to uphold and defend the rights of mentally ill people, tackle the issue of stigma in the community, and increase advocacy awareness and activities for mental health workers. Such support activities would be of great benefit in increasing the capacity of the various advocacy bodies and thence their operational efficacy.

As a second step, the DoH should enlist the active participation of representatives from existing advocacy groups in mental health related activities. Their involvement and input should particularly be sought in the formulation, implementation and evaluation of mental health policies and programmes. For instance, they should be included on the visiting board for mental health facilities and any committee that protects the rights of people with mental disorders.

This process could initially be implemented at the national level but should later be disseminated to the regional and local level. This would ensure the optimal geographic inclusion of mental health stakeholders as well as providing them with a sense of ‘process ownership’.

Similarly, the DoH should work with advocacy groups to reduce the levels of stigma and discrimination that currently exist against people with mental disorders. This could be achieved by raising awareness, increasing knowledge of and altering attitudes towards mental health through educational campaigns.

Targeted information campaigns could be developed in partnership with the advocacy bodies that will increase mental health service users’ choice and involvement in their care, particularly in the areas of addressing stress, depression, alcohol and substance misuse, and suicide. This educational material should be made available in the form of slides, videos, multimedia, websites and electronic bulletins for widespread public circulation. Conferences and workshops, rallies, art exhibitions and even informal ‘get-togethers’ should be organised to facilitate face-to-face interaction between mental health service users and the general public.

The DoH and HSE could assist the mental health advocacy sector in keeping policy makers and planners fully informed as to the social and economic consequences of mental health issues as well as the best and most cost-effective treatment interventions. Meetings could be arranged with key decision-makers where issues of mental health policy and legislation and equity in mental health might be discussed. Furthermore, policy makers and planners should be encouraged to visit mental health facilities and attend relevant conferences and congresses in order to improve their awareness on the subject.

As the WHO has highlighted, advocacy is an "important means of raising awareness on mental health issues and ensuring that mental health is on the national agenda of governments. Advocacy can lead to improvements in policy, legislation and service development".

Given the significant public and economic costs of mental illness together with the social, political and legislative challenges involved, the development of an active and viable advocacy structure, which includes mental health professionals and policy makers, should be a priority for everyone involved in the mental health sector.