Dr. Paul D'Alton:

I thank the Chairman. On 18 March 1968, three months before he was assassinated, Robert Kennedy said:

The gross national product does not allow for the health of our children, the quality of their education, or the joy of their play. It does not include the beauty of our poetry or the strength of our marriages; the intelligence of our public debate or the integrity of our public officials. It measures neither our wit nor our courage; neither our wisdom nor our learning; neither our compassion nor our devotion to our country; it measures everything, in short, except that which makes life worthwhile.

The same can be said about our approach to well-being and mental health. We seem to disregard the things that make life worthwhile – the beauty of poetry, the strength of our relationships and the intelligence of public debate. We seem to forget the central role that compassion and wisdom play in shaping a society where individuals can live good lives. We seem to forget that the health of our children, the quality of their education and the joy of their play lay the very foundations for later well-being and mental health. Until we approach mental health from this perspective, sadly nothing is going to change.

Over the past three decades there has been growing evidence that we need to work with whole systems if we are to improve health and well-being. We are faced with a very serious systemic problem when it comes to well-being and mental health in this country. That problem requires a very serious systemic response. I believe that if we continue to think in terms of mental health and well-being, we will go nowhere quickly. We know intuitively that the alarming increase in self-harm and the consistently high rate of suicide here is a whole society issue. It is tragic that the annual figure for the number of people who end their lives by suicide here is unchanged over the past decade or more. In 2001, for example, there were 519 suicides and in 2012 there were 507 suicides.

This national tragedy, made up of life-shattering loss for those left behind and beautiful lives lost to suicide, needs a whole-of-society response. As long as we continue to seek solutions from one particular Department or one particular service - such as the mental health service - the HSE provides, we are destined to continue repeating the national tragedy of more than 500 lives lost to suicide each year. We cannot continue to abdicate the entire responsibility for well-being and mental health to specialist mental health services or to the Minister with responsibility for mental health. Well-being and mental health are whole-of-government responsibilities and we have to stop thinking in terms of segments and in artificial departmental divides.

I am very pleased to say the Government’s recent suicide prevention strategy, Connecting for Life, is a good example of a whole-of-government approach. However, we need to start much earlier than at the point of suicide prevention. We need to adopt a proactive whole-of-government approach to well-being as the foundation of mental health. If we fail to adopt an entire-system approach to well-being and positive mental health, then, to put it simply, we will be at the wrong end of the pitch. To do this, we must recognise the well-established determinants of health. I refer here to the social, economic, political, cultural and environmental factors that determine health. If we are serious about the mental health of our citizens, we must radically embrace a multi-factorial approach to well-being and mental health. The World Health Organization says that some of the major determinants of mental health are located within social and economic domains and include: social inclusion and access to supportive social networks; stable and supportive family; physical and psychological security; and access to meaningful employment, education, income and housing. Too often, decisions taken by Government are made without consideration for the social determinants of mental health, or as Kennedy said, things that make life worthwhile, such as the health of our children, the quality of their education, the joy of their play, the beauty of our poetry and the strength of our relationships. Decisions and debate that happen in the absence of compassion and wisdom - in the absence of knowing what really makes life worthwhile - will never be effective in achieving well-being for our citizens and the collective mental health of our nation.

The well-being of our citizens will never be advanced if we simply see ourselves as an economy. If we continue to measure our success only by growth in GDP, we will lose sight of ourselves as a society and an interdependent collective. We are a collective and interdependent species. From the very first moments of our lives, we are dependent upon the kindness and love of others. We need to move away from the understanding that well-being is simply the result of some magical internal psychological process. We need to be very cautious of the insidious mentality that places excessive responsibility for well-being and mental health in the hands of the individual. We need to fully credit the power of deprivation and inequality to erode the capacity of the individual at an emotional, spiritual, psychological and intellectual level. There are of course other factors at play but social injustice and inequality play a pivotal role. We know this from decades of research in the field. As a psychologist and educator for almost 20 years, I remain even more convinced on one thing - equality is the best therapy.

It is abundantly clear that the chronic stress inherent in disadvantaged communities has significant impact on their mental health. An extensive body of research confirms the relationship between social inequalities, general health and poor mental health. The well-being that we seek as a nation will not be achieved until our policymakers and leaders address these inequalities. We need to radically reorient our approach in the evidenced-based knowledge that social and economic development are two sides of the same coin and a flourishing economy is only built on a flourishing population. There is not a citizen in this State who does not want radical change to well-being and mental health of the people of this country. There is not a citizen in this country whodoes not want desperately to stem the national tragedy of suicide which we endure year after year. However, if we keep doing what we are doing, we will keep getting what we are getting. We need to start at the foundations of mental health. We need to adopt a whole-of-government approach to promote well-being and positive mental health.

How do we do this? We have to determine prospectively the potential implications of Government action upon the social determinants of mental health. Just as we are now accustomed to conducting environmental impact assessments for proposed projects we need to adopt a mental health and well-being impact assessment. This can be done by legislating for the provision of mental health proofing and well-being impact assessment for all future Government actions. There are some well-recognised tools available and in use in other jurisdictions, including the mental well-being impact assessment, MWIA, tool. The MWIA tool assess the impact thatpolicies, programmes and services have on mental well-being at individual, community and structural levels. It focuses on the determinants of health, namely, control, resilience, community assets, participation and inclusion. It is only by proofing all future Government actions that we can ensure our citizens enjoy mental health as defined by the World Health Organization.The latter defines mental health as a state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to her or his community. It is only by proofing all future Government actions that we can measure what matters most, what GDP misses and what mental health is built on - the health of our children, the quality of their education, the joy of their play, the beauty of our poetry, the strength of our relationships and communities, the intelligence of our public debate, our wisdom and our compassion.