Ireland needs a center of excellence for the treatment of serious mental illness – The Irish Times

Mental health policy in Ireland eschews uncomfortable truths about how we deal with and perceive mental illness. It is a policy of denial and neglect. Ireland is no longer a backward or disadvantaged country. And yet, vulnerable citizens living with serious mental illnesses like schizophrenia often remain disadvantaged, marginalized and excluded and hopeless for change.

Ireland does not invest in centers of excellence for research into the most serious mental illnesses as other developed countries do. This is due to institutional stigma which is defined as the policies of government and private organizations that, intentionally or unintentionally, limit opportunities for people with mental illness. It’s not intentional but it’s damaging: Irish policy makers prefer to avoid the subject of centers of excellence for research into serious mental illness and philanthropy does not take over.

Now is the time to support both a center of excellence for the treatment of serious mental illnesses and a center for translational research, as is the case for other illnesses and in other modern developed countries. Translational research takes advances from cutting-edge research laboratories and applies them for the benefit of patients. Establishing the two centers would improve outcomes for people with severe mental illness. The alternative is to continue with a “barefoot” system – an impoverished, underfunded and inefficient service that claims false superiority.

Today, the busiest path to treatment for the most serious psychoses begins in prisons and progresses to secure forensic hospitals.

Schizophrenia and other serious mental illnesses are life-shortening brain disorders. The life expectancy of people with schizophrenia is approximately 16 years less than that of the general population. This is comparable to many forms of cancer. The main causes of premature death are not what you might think. The incidence of suicide is higher, but the biggest problems include excessive rates of heart and lung disease and cancers. People with serious mental illnesses age prematurely.

During the Covid pandemic, it became clear that people with serious mental illnesses were more vulnerable to the worst complications and death from Covid.

Health policy in Ireland and elsewhere has been to demedicalise these serious, life-shortening brain disorders. Demedicalization occurs when the physical and biological basis of disease and its treatment is denied and removed from policy-making and management. The official language used for “mental health” policy is almost Orwellian in its avoidance of these uncomfortable truths. These serious diseases cannot always be taken care of in general medicine and in voluntary community services, they cannot be prevented by advice or cured by psychotherapy.

The dignity and right to health of people with serious and persistent mental illnesses, which are disabling and life-shortening, would be best addressed by providing the best treatments currently available and by increasing research and development of new and better treatments.

Now is the time to invest in the research and development of treatments that address these pressing issues. Most modern developed countries have a center of excellence that improves outcomes for people with serious mental illnesses in the same way that there are centers of excellence for the treatment of cancer, heart disease and lung disease .

Hope lies at the heart of recovery – real hope lies in medical advances in treating the most serious forms of schizophrenia and other serious mental illnesses

They include the Institute of Psychiatry, Psychology and Neuroscience in London; the Karolinska Institute in Stockholm; KeFor in Belgium; CerF in Aarhus, Denmark; the Institute of Forensic Psychiatry and Psychology in the Netherlands; IRCCS in Brescia, Italy; the Center for Addiction and Mental Health in Toronto; the Philippe Pinel Institute in Montreal, and many others. Ireland does not have such a center for translational research and development. The establishment of such a center in Ireland would offer hope and a way forward for patients, family members and carers across the country.

Today, the busiest route to treatment for the most serious psychoses begins in prisons and progresses to secure forensic hospitals. It is a failure of the current policy of denial and neglect. Ireland has an international reputation in forensic psychiatry, providing intensive care and treatment for the most serious mentally ill patients and this is where the center of excellence should be located.

Serious mental illnesses such as schizophrenia not only shorten life expectancy, they also cause real suffering for the person and their distraught families, leading to homelessness and loss of dignity. A serious reassessment of how we care for our sickest and most vulnerable people is needed. This must begin with investing in a center of excellence in forensic psychiatry and bringing these services back into the mainstream of medical progress.

Hope is at the heart of recovery – real hope lies in medical advances in treating the most serious forms of schizophrenia and other serious mental illnesses, and as it has done for other illnesses that shorten the life. Cancer services offer a proven track record. A center of excellence in biological, benevolent, clinical and ethical forensic psychiatry is the way forward.

Harry Kennedy is Clinical Professor of Forensic Psychiatry at Trinity College Dublin

Comments are closed.