Jonathan O'Brien (Cork North Central, Sinn Fein) | Oireachtas source

I also congratulate the Minister of State on her appointment. I do not have much time but I could speak for an hour on this issue. I am glad the three Ministers in the Department are present because one of the issues I have come across is that of dual diagnosis where somebody has a mental health issue and an addiction and how they are dealt with. There is no single solution. Everyone has to be treated on a case-by-case basis. It is important to remember that everybody's mental health is different and their needs and responses will be different.

Deputy McDonald referred to the issue of stigma. Great work has been done on this, particularly when it comes to self-harm, suicidal ideation and depression, but a major taboo is still associated with many other mental illnesses such as schizophrenia, post-traumatic stress disorder and personality disorders. We do not have the same focus on breaking down this stigma. A great deal of work, therefore, remains to be done on the issue.

We are encouraging people to be more open when it comes to speaking about mental health but if they suffering from depression, anxiety or another mental health illness, their first port of call in most cases is their local GP. I am frustrated that it is not mandatory for GPs to do basic courses to enable them to deal with people who may have suicidal ideation such as SafeTALK, or the ASIST programmes. It is also not mandatory for gardaí. These professionals, who are on the front line dealing with people when they first seek help, therefore, do not have the basic skills to deal with them. In many cases, the response from some GPs is to medicate but that is not always the solution. Medication may be part of a solution but every individual is different. Many of the individuals who end up in therapy find cognitive behavioural therapy, CBT, and talk therapy helpful and, therefore, sometimes a combination of medication and therapy is needed. Something that could be done instantly at a low cost is to encourage doctors and members of front-line services to engage in programmes such as SafeTALK and ASIST to give them the basic skills to deal with people in order that they do not always instantly reach for a prescription, which is counterproductive.

We have not got our head around understanding how to treat mental health. I read a number of WHO reports from 2015. One report states: "Mental health can negatively be affected by low income. Those who cannot afford private therapies or care are the most at risk of crisis which exacerbates the issues at hand." While income does not discriminate against whether someone has a mental illness, it is a factor in accessing services. The report also states: "An environment that respects and protects basic civil, political, socioeconomic and cultural rights is fundamental to mental health promotion." We need to take that on board as a State because we have citizens whose cultural rights have not been recognised and others whose socio-economic and political rights are not on the same footing as everyone else. Equality, income and socio-economic issues and the societal and public health response to them are all critical in helping to address this. While money is important, it will not in itself solve this.

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