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Mental Illness and Structural Violence   Back Bookmark and Share
BD Kelly
Ir Med J. 2012 Jan;105(1):30
Sir,

A recent report from Tasc, an independent think-tank dedicated to combating inequality, draws welcome attention to links between ill-health, inequality and social injustice.1 In relation to mental ill-health, the report notes that “levels of depression and admissions to psychiatric hospital are also socially patterned, with higher prevalence among less affluent socio-economic groups” (p 9). This matters deeply. Mental health is closely related to social arrangements. Individuals from lower socio-economic groups develop mental illness earlier in life and have longer durations of untreated illness. The mentally-ill are at increased risk of homelessness and under-employment. They are more likely than those without mental illness to be arrested in similar circumstances and remand is more likely even when lesser offending is associated with mental illness.2

The adverse effects of these economic and societal factors, along with the stigma of mental illness, constitute a form of “structural violence” which amplifies the effects of mental illness in the lives of sufferers.2 As a result, many individuals with mental illness are systematically excluded from full participation in civic and social life, often constrained to live lives shaped by stigma, isolation and denial of rights. The past decade has, however, seen substantial reform in Ireland.  The Mental Health Act 2001 resulted in the removal of indefinite detention orders, new involuntary admission procedures, independent reviews of detention by mental health tribunals, free legal representation and independent psychiatric opinions for detained patients. The Mental Health Commission was established to oversee standards of care and protect patients’ interests. 

The legislation was a step forward in a time of challenge: in 1966, the proportion of Ireland’s health budget devoted to mental health was 23%; by 2007, it had fallen to 7.8%; and in 2010 it stood at 5.3%. For 2011, however, it is estimated this figure will rise to 7.5%.  In addition, service-users, families, clinical staff and health service managers are working very well together to provide the best service possible. There are myriad examples of progressive, collaborative initiatives taking root in hundreds of communities and mental health services around the country. These reforms require broad societal endorsement if they are to realize their full potential, and social justice for the mentally-ill is to be achieved. This matters to everyone. One in four individuals will develop mental illness at some point in their lives.  Deeply and urgently, this matters.

BD Kelly
Department of Adult Psychiatry, University College Dublin, 63 Eccles Street, Dublin 7
Email  brendankelly35@gmail.com

References
1. Burke S, Pentony S. Eliminating Health Inequalities: A Matter of Life and Death. Tasc, Dublin, 2011.
2. Kelly BD. Structural violence and schizophrenia. Social Science and Medicine 2005; 61: 721-730
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