Irish Medical Organisation Doolin Memorial Lecture 2019: rhetoric and reality in mental health—Ireland and the world

This Doolin Memorial Lecture presents six suggestions for positive change in Ireland’s mental health services, focused on legislation and rights: (a) revision of the Mental Health Act 2001 in line with existing recommendations, to better protect and promote a broad range of rights, including rights to treatment and liberty (which are related); (b) enhanced forensic mental health care to better protect and promote both treatment and liberty in this population; (c) prompt full implementation of the Public Health (Alcohol) Act 2018 to reduce alcohol-related harm and the opportunity cost of alcohol problems in the health service; (d) implementation of the Assisted Decision-Making (Capacity) Act 2015 to provide decision-making supports to the 29.4% of medical/surgical inpatients and 52.6% of psychiatry inpatients who lack full decision-making capacity for treatment decisions; (e) judicious medicalisation of our response to individual cannabis use (although legalisation is not advised); and (f) enhanced recognition of the social rights of the mentally ill, especially the right to housing. Attention to these areas would improve the quality of life and quality of liberty of people with mental illness and their families. Progress in these areas needs to be underpinned by enhanced involvement of service-users in planning and provision of care, increased funding of mental health services and particular attention to groups who are currently underserved, including children and adolescents. Enhanced attention to these areas would also help advance Ireland’s national mental health policy, “A Vision for Change”, which has yet to be implemented in full. That, too, would help.