Oireachtas Joint Committee Speech 8 November 2012
Thank you Chairman and thank you to the committee for inviting Mental Health
Reform to appear before you. We have circulated our pre-budget submission to you
in advance. I am Policy Officer with Mental Health Reform which is the national
coalition advocating for improved mental health services and implementation of A
Vision for Change.
Ireland’s mental health services are in a time of transformation and transition, from
the old, institutional model of hospital-based care to a new model of holistic
community-based services. Notwithstanding the country’s current economic
difficulties, it is crucial that the Government’s commitment to reforming mental health
does not waver. Important structural and cultural change is underway and any further
cuts to the mental health budget risk undermining work already done.
The reality is that more people are experiencing poor mental health in Ireland. A
survey recently published by See Change found that 15% more people say they had
experience of a mental health problem in 2012 than in 2010.
The Irish mental health services are under significant strain. Current staffing is 23%
below the level recommended in A Vision for Change, short 2,645 Whole Time
Equivalents. 425 nurses retired in January and February, and the 370 community
mental health team staff promised for this year have not yet been put in
place. The result is that staff are stretched. This kind of pressure leads to people
not getting the follow up they need after being discharged from hospital – so no early
follow-up appointment. It leads to nurses not being able to provide timely follow up in
day hospitals when people are going through a rough patch at home. So someone
who is living at home and begins to feel that they are becoming unwell, then goes to
their local day hospital, may be told that they can’t get as early a follow-up
appointment is they should because of lack of adequate staff. It also leads to
important services like day centres reducing their hours. These are a key lifeline for
people with long-term poor mental health, giving them social support that can
prevent isolation and deterioration in a person’s mental health.
The extensive use of overtime to cover gaps due to retirements also contributes to
lower quality of care. Mental health is a people service – it’s provided by people and
based on relationships built between individual mental health professionals and
those receiving support. Being treated by one person on one day and then another
the next and then another a month after that does not enable the kind of relationship
that can promote recovery.
There is Irish evidence that comprehensive community-based mental health services
cost less than a hospital-oriented service. A study conducted in Kildare published
this year found that the community-based service is 21% cheaper per capita than a
traditional hospital-based service. The main differences between the two services
was the provision of day hospital and home treatment in the comprehensive service
where these are absent in the hospital-oriented service.
Mental Health Reform has made a number of specific recommendations for Budget
2013 to keep reform on track. The first is for Government to keep its programme
commitment to allocate €35M next year for the continued development of
community-based mental health services. Mental Health Reform welcomed the
Government’s commitment in Budget 2012 to an allocation of €35 million from within
the health budget and 414 posts for the development of community-based mental
health services, suicide prevention and access to counselling through primary care.
We have yet to see this commitment realised but remain hopeful that the promised
staff will be in place before the end of the year. However, given the gap in staffing we
are asking that Government keep its commitment to an additional €35 million for next
year along with an exemption from the moratorium for the additional posts.
It is important to note that the €35 million allocated this year was not new funding;
the mental health budget included a 5.6% cut to regular spending, so that in fact the
real effect of budget 2012 was an overall 1% decrease even including the €35
milllion.
Mental Health Reform also welcomed the commitment in Budget 2012 to €5 million
specifically for the development of counselling services through primary care. This is
a positive mental health promoting initiative. However, the funding in 2012 was set to
cover only those on medical cards, leaving many people on low incomes with
difficulty accessing counselling. Given the links between poverty and poor mental
health, it is particularly important that those on low incomes as well as those on
medical cards have access to counselling services.
Minister Reilly has made a commitment to appointing a Director for Mental Health as
part of the re-structuring of the HSE. However, a Director will have little impact
without staff to assist in managing the change programme. In order to fulfil the
intentions of A Vision for Change, the Directorate must have multi-disciplinary input.
The Directorate also requires budgeting expertise and administrative support to be
effective.
We also have no information on community mental health services in Ireland. If you
were running a business, you would want to know how many customers you had,
how often they shopped with you, how satisfied they were with your service. We
have no idea how many people are using mental health services. We had more
information about community services in 1984 than we do now.
Mental Health Reform believes that partnership between the public mental health
services and the voluntary sector (mental health and other voluntary organisations)
is vital to implementing A Vision for Change. Mental health voluntary organisations
provide vital support services such as peer and family support groups, telephone
help lines, information and education programmes that are integral to recoveryorientated mental health services. Community and voluntary organisations can
educate members of the community about mental health and provide mental health
promotion programmes in schools. NGO-provided services such as housing and
vocational training services can provide essential supports for an individual's
recovery. HSE-funded mental health voluntary organisations cannot afford to incur
additional cuts without cutbacks in frontline service delivery.
In conclusion, we believe that it is vital that Government continues to support reform
of Ireland’s mental health services and we ask Committee members to champion the
issue of mental health in the run up to Budget Day in December. In particular, we
urge members to write to Minister for Health Dr James Reilly, to impress upon him
the economic good sense of investing in community mental health services.
Thank you for your time.