Although Ireland has not used the false excuse of the death of a grandmother - as he did before - for pulling out of the Republic squad for games against Germany and Cyprus, his absence is another embarrassment for player and manager.
Steve Staunton said: "Obviously the player's health is the most important thing here and we fully respect Stevie's wishes and fully understand what he's going through. He has to get this sorted out himself.
"I think at this moment he feels safe in the Manchester environment. And obviously his treatment is just around the corner. That's playing a vital part for him. So to come away for 10 days could be detrimental to him.
"It's a personal issue. We know he's got problems. Man City, myself, the FAI, we've tried everything in our power to try to get round him but he's obviously not mentally ready or prepared to play for his country.
"There are no implications for his future. We want the boy. We know he's being well looked after. Sven Goran Eriksson and Man City are doing everything for him. It's down to the lad now."
Ireland said: "I have thought long and hard about whether I would do my country and myself justice if I joined up with the squad. Unfortunately, I don't believe I would on this occasion.
"The support I have received from Mr Staunton and the FAI has been excellent and everybody at Manchester City has also been superb. However, I do not believe I can make a positive contribution to our efforts to qualify."