HEALTH PLUS:Delay in treating mental illness increases the risk of self-harm and the economic cost of recovery
THE KEY to success in any mental health situation is detect and treat. Early recognition and immediate intervention are crucial. The World Health Organisation is clear about the importance of this in “controlling symptoms and improving outcomes”.
In mental health, there is a critical time in which intervention is most effective and full recovery is most likely to occur. Delay increases the risk of self-harm. The cost of delay in human misery is immeasurable. The economic cost is staggeringly high. The metrics are clear. The ethics are clear. Identify and intervene as quickly as possible for everyone’s sake.
Apart from the ethical dimension of leaving people in misery, the magnitude of the impact of mental illness on individuals, their families, their friends and on society is enormous. People who are suffering psychologically often self-medicate, using addictive behaviour, alcohol or other drugs to alleviate their pain, unaware of the extent to which such substances exacerbate their problems.
We have seen the high societal cost of distress in young people. From the economic perspective, cost-of-illness studies on mental ill health highlight the tragic loss of talent, personal attainment, employment and productivity that arises from delay in dealing with those who need help. State coffers are also depleted by public ill health which costs more than necessary because of a lack of early intervention. The term losing the ship for the hap’worth of tar comes to mind when resources are stingy and in the current recession, the potential for more people to sink for lack of support takes on titanic proportions. Of course the ultimate tragedy of delayed intervention can be death and too many families in Ireland have shed too many tears for the loss of young life.
Psychosis is defined as a common illness, the first episode of which is experienced in Ireland by about 1,200 people a year, of which some 700 have schizophrenia. Psychosis usually develops in males in late teens/early adulthood. Up to one in six people will have a psychotic symptom. Common signs of the onset of psychosis include anxiety, social withdrawal and withdrawal from family, suspiciousness, sleep disturbance, poor motivation and concentration and then there may be bizarre or false delusional beliefs, confused thinking and mood changes.
The decline may be gradual. Help is always required. In the acute phase immediate help is required. Suicidal risk is high and rises the longer psychosis is left untreated.
The tragedy of this is that psychosis is so treatable, prognosis so good with early intervention and so grim when that is not available. Yet statistics show that people may wait alarming periods of one to two years suffering with untreated psychosis. Irish teams have researched levels of suicidality in first episode psychosis. Put simply, they have found the longer psychosis goes untreated, the higher the risk.
Which is why all support at every level should be put into Detect – the tailormade programme designed to tackle this problem. Detect is a free service that is part of the existing public mental health services. It is funded on a day-to-day basis by the HSE and St John of God Services. Its object is early intervention and recovery, which begins with treating the distressing symptoms, promoting recovery, back to study, work, personal self-confidence and self-belief,recovering one’s life and returning to living without the oppression and confusion of being mentally unwell.
The research on Detect shows it is an efficient, efficacious, cost-effective service. It works.
None of us is immune from becoming mentally unwell. The potential to become emotionally distressed, psychologically overwhelmed, occupationally depleted and to break with the weight of life can happen to any of us. We are lucky to be in a country with professionals with expertise. We are unlucky that we have inadequate access to treatment and that too often we have to grovel to the Government for what we need. This must be remedied by sensible, sensitive investment in mental health.
And if the human cost does not convince those who fund services, let the economic argument convince for it has been well made by those who have researched the benefits of Detect.
mmurray@irishtimes.com
*
Clinical psychologist Marie Murray is director of the UCD Student Counselling Services
*
An international conference, Psychosis: Improving Outcome, will take place on Tuesday, 13th October 2009 in St John of God Hospital, Stillorgan. For more details, e-mail therese.morgan@sjog.ie or tel: 01-2771419/2771561 Also see www.detect.ie