Justin Frewen

We need to strike a balance between community-based and hospital care in our mental health services. By Justin Frewen and Dr. Anna Datta

The majority of economically 'developed' countries have experienced three main stages in the evolution of mental health careThe first one, between 1880 and 1995, was dominated by the concept of providing treatment in 'asylums', large medical institutions that were generally located far from the patients' communities.

The metamorphic transformations inflicted on their human victims by Ovid's capricious gods have serious or even fatal consequences. When Jove's wife Juno, jealous of Callisto's relationship with her husband, changes her into a bear, Callisto is forced to wander alone for many years, still in possession of her human feelings but trapped in a bear-like form. After fifteen years she runs into her own son Arcas, who fails to recognise his mother. He is only prevented from killing her by the intervention of Jove, who turns them both into neighbouring constellations.

All art is at once surface and symbol

Those who go beneath the surface do so at their peril

Those who read the symbol do so at their peril

It is the spectator, and not life, that art really mirrors.

Oscar Wilde (The Picture of Dorian Gray Preface)

The concept of metamorphosis has provided a rich vein of material for artists throughout history. Hundreds of artistic and literary works have benefited from characters gifted with shape altering abilities or who have been cursed to involuntarily change their form.

Saturday next, the 12th of February, will mark the 202nd anniversary of Charles Darwin's birth and 152 years since the publication of On the Origin of Species. Every year organisations around the world celebrate this day by commemorating the works and life of Darwin. However, Darwin Day is also an occasion for highlighting the significant achievements brought about by the application of human inquisitiveness, resourcefulness, and ingenuity in improving all our lives.

Ireland is no exception in this respect.

The last two weeks have seen a flurry of government members fleeing the political field. Whether one is cynical and attributes this with reference to the old adage regarding the reluctance of rodents to remain aboard the sinking political vessel of the state or fear of a vengeful electorate, the exodus is striking. Fortunately, those decamping have had their loss of employment and return to the 'real world' softened by liberal financial parachutes.

According to a 2008 report by the Commission on the Social Determinants of Health, 'Social injustice is killing people on a grand scale.' Justin Frewen and Anna Datta examine the health effects of inequality, and argue that an equitable health service alone is not enough to ensure equal health for all.

(A longer version of this article originally appeared as The Socio-Economic Realities of Health on Tasc's website in December.)

The swingeing cuts in health funding that have been – and continue to be - implemented over the past couple of years have seriously debilitated the public health service. Its overall prognosis continues to decline as does the outlook for those of us obliged to avail of its failing facilities. Even if the economic situation in Ireland should improve, the damage that has been inflicted on the health service will make it far more difficult and costly to restore in the future.

As we entered the New Year, the health service was once more on the front page for all the wrong reasons.

50,000 people a day die from poverty related causes. 22,000 of these fatalities are children under the age of five. The current global financial and food crises have greatly aggravated the plight of the world's most impoverished and vulnerable people. The United Nation's Food and Agricultural Organisation (FAO) estimates that these international instabilities resulted in a massive increase of over 11% between 2009 and 2010 - 915 million to 1.02 billion - in the number of chronically hungry people.

The mental health concerns of lesbian, gay, bisexual and transgender people (LGBT) are similar to those of the rest of the population. Of course, being lesbian, gay, bisexual or transgender in no way constitutes a mental health issue in itself. Furthermore, although LGBT people are frequently referred to as a single category, due to the similarity of stigma and discrimination they face as a minority group, they are not an homogenous entity. The sexual orientation and gender identities of LGBT people are different and at the individual level they can experience varying mental health problems.

The term financial exclusion was first coined in 1993 by geographers who were studying the impact bank closures had on those left unable to access basic banking services. During the 1990s there was a significant increase in research focusing on people experiencing difficulties accessing modern financial services. By the turn of the millennium financial exclusion began to be applied in a broader sense to denote people whose access to mainstream financial services was restricted.

[Photograph of the IFSC by Eoin McNamee]