Pre-Budget Submission 2010 Reformed Mental Health Services Vital To Recovery
Pre-Budget Submission 2010 Reformed Mental Health Services Vital To Recovery
The Government mental health policy A Vision for Change provides a blue
print for reform of mental health services. While the Government has
consistently stated its commitment to implementing mental health reforms,
progress to date has been painfully slow. Implementation must be
accelerated and underpinned by clear measures to protect mental health
investment and accountability for how funding is used.
At the centre of mental health reform is the need to develop community based
mental health services, the provision of which is dependant on skilled and
multi-disciplinary staffing and an adequate infrastructure to support service
delivery.
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nursing homes in the absence of appropriate services remain the daily lived
experience of people struggling to cope.
“It is essential… to learn from past mistakes and counter this period of economic downturn
by increasing investment in health and the social sector.” (Secretary General of the World
Health Organisation)
‘For the first time, we have an estimate of the overall cost of mental health problems for the
Irish economy, which at 2 per cent of GNP should leave no one in any doubt about the
national significance of the overall economic burden.… All of the economic evidence
suggests that the individual and social returns from judicious investment in mental health in
Ireland are likely to be high and sustained’. (Eamon O’Shea and Brendan Kennelly in ‘The
Economics of Mental Health Care in Ireland’ 2008)
What we have seen recently with respect to financial cutbacks is the tendency to reduce
staffing in community programmes to maintain acute in-patient programmes. This short-term
type of solution will cause further problems in the future. The effects of cutting resources to
mental health services are often only apparent on a gradual basis after a number of years.
This factor may make mental health cutbacks a soft target for administrators, but the
detrimental effect on vulnerable people is no less devastating in the longer run. (Dr Patrick
Devitt, Inspector of Mental Health Services in 2008 Report of the Inspector of Mental
Health Services)
The review highlighted the fact that there remains an over-reliance on traditional acute and
long-stay inpatient beds within the Mental Health Services compared with the
recommendations of A Vision for Change and this is unlikely to be consistent with achieving
the best value for money;.. In order to ensure the most effective use of scarce public
expenditure and to improve value for money, an increased focus is required on reducing the
overall dependency in Mental Health Services on acute and long-stay inpatient beds, and
community residences, and to continue to increase the provision and usage of community-
based services and teams. (2009, Indecon International Consultants in ‘Review of
Government Spending on Mental Health and Assessment of Progress on Implementation of A
Vision for Change’ submitted to Amnesty International Ireland)
While many community facilities simply do not exist or are not subject to
Inspection, the following extracts from the Report of the Inspector of Mental
Health Services regarding in-patient facilities are illustrative:
The unacceptable conditions within the hospital have been highlighted by the
Inspectorate each year for a number of years… There were insufficient
bathing facilities in the acute admissions wards and the furniture in
Willowbrook was unacceptable. (St Ita’s Portrane)
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This was an old institution unsuited to the needs of a modern therapeutic
mental health service. The layout was unsuitable for the needs of the
residents and restrictions on funding and planning permission do not allow for
the facilities to be adapted to any significant degree to allow for privacy or
modernisation. (St Brendan’s, Grangegorman)
St. Joseph’s Hospital was an old psychiatric hospital built in the nineteenth
century. The Inspectorate had repeatedly stated that the hospital was
unsuitable and that there was a need to transfer residents to more suitable
accommodation based on needs. (St Joseph’s, Limerick)
The sale of the lands at these sites and others will provide a significant
contribution towards the costs of providing the infrastructure needed to
support the reform of mental health services.
1
2009, Indecon International Consultants in ‘Review of Government Spending on Mental Health and
Assessment of Progress on Implementation of A Vision for Change’ submitted to Amnesty
International Ireland
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equates to half of the number required to meet the recommended ratio
of 2 teams per 300,000 persons in the population, i.e. 26 teams. 2
There are currently only three dedicated but partially complete Child &
Adolescent liaison teams nationally with these teams based in each of
the Dublin Pediatric Hospitals. These teams are currently operating at
around 36% of their recommended staffing levels set out in A Vision for
Change.3 Meanwhile children continue to be admitted to adult wards in
the absence of adequate specialist services. The situation is
intolerable, with staff in adult wards unable to offer adequate treatment,
leading the Inspector of Mental Health Services to note that such
admissions as ‘almost purely custodial in nature’. The situation for
young people with eating disorders is illustrative of the absence of
specialist services. There were 406 admissions for children and
adolescents under 18 years to psychiatric in-patient services in 2008.
18% of these admissions (73) had a diagnosis of eating disorders. Yet
there is no public specialist child and adolescent services to treat
children or adolescents with eating disorders.
Rehabilitation teams provide support to individuals with serious
mental health problems, many of whom may have been in institutions
for many years. There are currently 20 Mental Health Rehabilitation &
Recovery teams nationally employing a total of 156 whole time
equivalent staff (WTEs) – this represents a shortfall of almost 750
WTEs on the staffing levels set out in A Vision for Change4. Speaking
of the absence of adequate rehabilitation services in his 2008 Report,
the Inspector of Mental Health Services notes ‘As the most seriously ill
group, these individuals should have the most intensive treatment but
instead many are left to live out cold, empty, colourless lives in old
institutions, forgotten and neglected’.5
2
ibid
3
ibid
4
ibid
5
Inspector Report, p.64, 2008
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This includes Occupational Psychology, Clinical Psychology, Social Work, Cognitive Behavioural
Therapists, Family Therapists, Addiction Counsellor and other therapist posts
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Includes Care Assistant and Attendant Posts
4
A report of the Health Research Board published in 2008 identified
employment status as the most important predicator of psychological distress,
with 30.4% of those unemployed reporting mental health problems, with the
unemployed more than four times more likely to exhibit psychological distress
than those employed.8 It is to be expected that the recent rise in
unemployment as well as associated difficulties of debt are placing increased
demands on already overstretched services.
Emerging information is worrying and there is a real risk that progress made
in recent years will be undermined in the absence of enhanced prevention
and support services to individuals experiencing personal crisis. Official
figures from the National Suicide Research Foundation show there were a
total of 11,700 cases of deliberate self harm at hospital emergency
departments in 2008. Overall the national reports of self harm increased by 6
%, with an 11% increase in the level of reported self harm amongst men – the
highest rate since records began six years ago.
While cuts in mental health budgets does not necessarily led to cost savings,
conversely increasing spending does not necessarily lead to better services or
better outcomes. Investment in mental health services must be linked to clear
accountability, and improved outcomes for mental health services.
8
Health Research Board (2008) Psychological distress, mental health problems and use of health
services in Ireland.
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The Mental Health Commission Report Economic of Mental Health Care in Ireland (2008) notes that
the health care system accounts for less than one quarter of overall costs.
5
The vulnerability of mental health funding must be addressed by clear
accountability as to how funding is allocated and used by health services.
The absence of adequate accountability for mental health funding is
highlighted by Indecon Consultants in a report prepared for Amnesty
International Ireland. The authors note ‘gaps in the availability of detailed
data/information required to facilitate the ongoing monitoring of funding and
expenditures, and human resource allocation, across the mental health
services and the assessment of progress on the implementation of A Vision
for Change’.
10
Report of the Inspector of Mental Health Services 2008 at p. 60
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IRISH MENTAL HEALTH COALITION
The Irish Mental Health Coalition campaigns for improved and prioritised
mental health services in Ireland.
The organisers of the campaign are Amnesty International, Bodywhys – The
Eating Disorders Association of Ireland, GROW in Ireland, the Irish
Advocacy Network and Shine (formally Schizophrenia Ireland).
The Coalition seeks to improve the lives of people with mental health
difficulties by advocating for people’s rights to the highest attainable
standard of mental health and mental healthcare. The campaign aims to
increase the pressure on those with the power to improve mental health
services.
The Irish Mental Health Coalition campaign was launched in June 2006. The
campaign will put mental health on the political and public agendas,
including in the run up to the next General Election.
One in four people in Ireland will experience a mental health problem at
some point in their lives. Many will never need to seek services and
supports, but for those of us who will, our future, and that of our children and
families, will depend on the right help being available when we need it. At
the moment, this is not what many people around the country are
encountering when they reach out for support. The Irish Mental Health
Coalition campaign believes that we can and must confront the issues and
take practical steps to improve mental healthcare in Ireland.