Chronic mental illness carries with it more than just a social stigma. It can be very difficult, even for those with a knowledge and understanding of the system, to wade through the many barriers to care.
A consultant colleague recently recounted the frustrations he has experienced as a relative of someone with mental ill health.
In his opinion, the lack of co-ordination between service providers and the inability of the system to monitor psychiatric patients in the community were two key barriers to quality care.
The number of psychiatric in-patients in the State has dropped from 21,000 to 4,500. While this is a welcome trend, it does mean that community care of the mentally ill is playing catch-up in terms of resources.
There are inadequate numbers of community psychiatric nurses, psychologists and other paramedics. The present staffing levels can do no more than offer good quality acute care. Preventive and outreach services receive lip service, but resources are nor provided in any meaningful way.
For patients with severe depression or schizophrenia, it means they receive excellent care when they become acutely ill, but the level of service falls away sharply when they are discharged back to the community. It is relatively easy for them to drift away from the service and from preventive help. A chronic cycle of treatment followed by relapse is the result.
Dr Peter Tyrer, a psychiatrist at St Mary's Hospital in Paddington, London, has demonstrated that early intervention can improve the quality of outpatient care. By pursuing an active outreach policy, visiting patients' homes and hostels for the homeless, Dr Tyrer's unit has reduced both the number of hospital admissions and the length of hospital stay for those who require admission.
In the bigger population centres, such as Dublin and Cork, provision of acute mental health services is a problem. Prof Patricia Casey, consultant psychiatrist at the Mater Hospital in Dublin and professor of psychiatry at UCD, said the hospital's service has only 10 beds for a catchment population of 28,000.
"I regularly have to send patients to Ardee in Co Louth to obtain a bed. This is after failing to secure accommodation for the acutely ill patient in St Ita's, St Loman's, St James's, St Patrick's and even in Newcastle, Co Wicklow, and Naas, in Co Kildare. On one occasion recently we had to send a patient as far as Portlaoise," she said.
The demands on the inner-city service provided by the Mater psychiatric team have multiplied with the influx of refugees, who are a vulnerable group in mental health terms.
Prof Casey also wants to see psychiatric units located in general hospitals. "It will integrate psychiatry into mainstream medicine. It is very important that patients and psychiatrists are part of the general medical population, rather than being seen as some strange and isolated group."
The Republic has an abysmal approach to the homeless mentally ill. There is no policy of outreach by psychiatric teams. Each health board urgently needs to appoint a clinical director who will take responsibility for this disadvantaged group.
Psychiatric services in the State are organised in a system of sectors, which are based on geographic divisions rather than patient need. The present system also militates against patient choice.
If you become mentally ill the system chooses your psychiatrist for you, which goes against the accepted practice whereby patients should be allowed to choose their doctor. The division of psychiatry into sectors clearly needs to be addressed if services are to improve.
People who have a personality disorder currently have no specific service which caters for their often demanding needs. Other Cinderella services include those for eating disorders, with just one unit in the State specialising in this area.
And the milder mental health disorders such as anxiety, phobias, social anxiety and panic disorder need an investment in nurse therapists and clinical psychologists to deliver the non-drug treatments which patients require.
The Minister for Health, Mr Martin, has pointed to the Mental Treatment Bill as a significant step forward. "The Bill will provide a modern framework for the care and treatment of persons with a mental disorder," he has said.
However, many commentators have pointed out that the new Bill will not, on its own, mean better mental health treatment. There is a need to establish minimum standards of care, with proper resources, in order to deliver a quality service.
The proposed legislation has itself been criticised for various deficiencies - it does not provide for children, adolescents, the elderly, those with learning disabilities or forensic psychiatry.
John Gallagher's recent escape from the Central Mental Hospital in Dublin illustrated the many inadequacies in this latter area of psychiatry.
For many observers the simple fact of life for mental health services is that they are not an area with obvious political gain. The Minister could do worse than disprove this cynical view during the remainder of his term in office.