Mental health services are under-resourced and overstretched
Opinion: Ireland invests a much lower proportion of our health budget on mental health care than the UK
Last year more than 40,000 people with severe mental or emotional distress sought support from community-based mental health services and 13,000 people received inpatient services.
However, the decades of neglect are showing, and services that are under-resourced and over-stretched are having difficulty meeting the need. Both the demand and waiting lists for Child and Adolescent Mental Health Services have continued to increase between 2013 and 2014, while the staff available are less than half the number recommended. There’s no doubt that the Government has made significant progress in reconfiguring existing resources towards a more holistic model of support.
Worthy initiatives are under way within the HSE to recruit new staff, drive reform of the service’s culture and improve clinical practice. But there are still major gaps to be filled.
Importantly, by the end of 2013 we had yet to see any significant increase in expenditure. Compared to our near neighbour, Britain, Ireland still invests a much lower proportion of our health budget on mental health care at just 6.5 per cent of health service spending. Overall staffing levels are still a quarter below the levels set in the Government’s mental health policy, and basic services have yet to be developed in many areas.
Those who have been touched by a mental health difficulty (and most people in Ireland have been) will know how important it is that Government continues to invest in mental health services as part of Ireland’s recovery. Mental health services need to be adequately staffed to provide seven-day-a-week support. Each community should have access to an integrated 24/7 crisis intervention service incorporating home-based treatment, day hospital, crisis house and telephone support alongside access to an inpatient bed, if necessary.
A full complement of skilled multidisciplinary staff is needed to ensure a high-quality, holistic model of support is provided. Despite the recruitment of 652 new posts to date out of the 2012 and 2013 allocations, there was a net decrease in mental health service staff from January to December 2013. At the end of last year, the HSE was down more than 1,000 full-time posts from March 2009 levels, despite recommendations in 2006 that more than 1,000 additional staff were needed to implement the mental health policy. GPs need access to Suicide Crisis Assessment Nurses to provide specialist support in situations where the GP is concerned about a patient at risk of suicide.
People also need easy access to counselling so that low-level mental health difficulties don’t escalate unnecessarily. Mental Health Reform welcomed the Government’s investment last year in a counselling in primary care service for medical cardholders, but the limit of eight sessions will mean some clients’ need will not be fully met. In last year’s budget, Mental Health Reform members and supporters were disappointed when the €35 million promised for developing community mental health services was reduced to €20 million. Minister of State Kathleen Lynch has signalled her commitment to getting the shortfall of €15 million is reinstated in budget 2015, along with €35 million – for continued investment in services next year.
Mental Health Reform is calling on the Government to allocate this additional €50 million for community mental health services in budget 2015.