Prioritising mental healthcare
Mental healthcare is in crisis in Ireland. Time after time we read reports of poor-quality services, long waiting lists, staff shortages and, throughout 2019, as over the last number of years, we have heard the tragic stories of how individuals are affected by these failures.
Prioritising mental healthcare
Of course, there are many social and financial issues facing the country over the coming years, but I believe there are 13 compelling reasons why mental healthcare should be the priority issue of the forthcoming election:
- People’s human rights are being infringed within the mental healthcare system daily. A creaking, under-resourced mental health service is treating too many people inhumanely. Most recently, the President of the High Court, Mr Justice Peter Kelly, described the condition of a man with mental health difficulties being held on remand in Mountjoy Prison because of an inability to move him to a more suitable treatment setting as “a truly awful situation and one that should not exist in a civilised state”. Few approved centres providing inpatient treatment meet the Mental Health Commission regulations and standards with too many being rated “High Risk” or “Critical”on many of these regulations.
- Many people requiring care do not receive it on timely basis and for some it is too late. Access to mental healthcare is poor in most parts of the country. At any given time, there are thousands of people on waiting lists for specialist community care. These delays cause further distress and deterioration in mental health and, in some cases, people give up hope completely.
- We are failing hundreds of children with mental health difficulties. At any given time, over 2,000 children are waiting for a first appointment with a Child and Adolescent Mental Health Service, with over 200 waiting for more than a year. There are less than 100 inpatient beds available to treat children nationally and, at any moment, a significant percentage of these are not operational. Every year, over 50 children spend some time in adult inpatient units and some are sent abroad for treatment. In February 2019, the Children’s Rights Alliance, through its annual Report Card process, awarded the Government a D- Grade for its performance on meeting its own promises to children’s mental health. While this in itself is distressing, it is even more unacceptable in the context of the fact that, over the thirteen years of publication of the Report Card, Government has never achieved higher than a C+ grade on mental health. Some years, it has received an F grade. This damning analysis by the Children’s Rights Alliance is supported by international bodies such as the United Nations Committee on the Rights of the Child and the European Network of Children’s Ombudsmen.
- Specialist mental health services - particularly for people with disabilities, age related difficulties, specific ethnic groups and those who are homeless - are under-resourced, leaving vulnerable members of society with further challenges.
- Stigma remains a persistent challenge. Despite significant awareness-raising and more open discussion about mental health, many still hold inaccurate and unhelpful attitudes about those who experience mental health difficulties. A survey conducted by St Patrick’s Mental Health Services this year indicated improving attitudes to mental health, but also revealed that one third of people surveyed say they would not tell their partner if their child was experiencing depression. One quarter of adults reported they would not tell anyone if they were experiencing suicidal thoughts. When very distressing, difficult to comprehend violent acts are committed, many are still inclined to attribute them solely to mental health difficulties.
- We are not investing enough in mental healthcare. The proportion of the health budget spent on mental health care - 6% - is significantly less than what other countries spend and significantly less than the 10% recommended by the Sláintecare strategy. Despite this, the emphasis remains on reducing expenditure and fuelling the myth that services are costing too much.
- Underpinning the failings of the services is an unprecedented staffing crisis. Few mental health teams have the required full complement of staff; fewer mental health professionals are being trained; and working in mental health in Ireland is becoming increasingly challenging and unattractive.
- The economic and social impact of untreated mental health difficulties is substantial. We know that the chances of becoming unemployed, homeless or of dropping out of education increase if a person experiencing mental health difficulties does not receive treatment. Carers and family members are also often absent from school or work. The economic cost of not treating those with mental health difficulties is substantial, representing 4% of Gross Domestic Product (GDP).
- The physical health impact of untreated mental health difficulties is also significant. Much of the demand placed on Accident and Emergency Departments comes from those with acute episodes of mental health difficulties who cannot access other services. Untreated mental health difficulties can lead to alcohol and drug abuse.
- Evidence and experience tell us that those with mental health difficulties, even the severest forms, can live happy, healthy and productive lives, if they are given the right support and treatment. Failing to give them this opportunity is not only an infringement of their human rights, but also impacts on the health and productivity of our society.
- We have the opportunity to create a world-class mental healthcare system. There are some excellent services being provided in Ireland by dedicated and committed staff. These can be replicated and learnt from. As an immediate first step, we could consolidate the existing staff resources to enable the provision of as many fully-staffed, highest quality community and inpatient services as possible. By leveraging tele-mental health services and the voluntary and independent sectors, it should be possible to provide every part of the country with a fully-manned mental health team providing the highest quality care, no matter where this team is based. In time, at least five centres of excellence could be established servicing the entire country and providing the full range of care options. This should be supported by a vibrant all-inclusive primary care system and access to a full range of helplines. There is an opportunity to establish a national prevention and awareness-raising strategy that which should be implemented by all relevant voluntary, statutory and independent organisations.
- Service users and those experiencing mental health difficulties want to, and can, shape and lead a new recovery-based approach to mental health care. The current system, through blocks and delays in accessing services, poor quality and disrespect, can disempower service users. However, the newly emerging awareness and emphasis within Irish society on human rights is serving to energise and strengthen the resolve of those needing care and their families and carers. Through the right support, service users and those requiring services will begin to take more control over their treatment and will come to expect more choice and decision, not just on the services they receive, but also in the shaping, delivery and evaluation of these services.
- Every family in Ireland is affected by mental health difficulties. Every family in one way or another is aware of the daily struggle needed to obtain high-quality, effective and accountable mental health care. Each of us is aware of the strain and destruction that failing to get this care can bring. These struggles can be all-consuming, not leaving energy or time for political activism. But this election needs to be different.
The time has come to put mental health at the centre of the political agenda. Each party, each candidate, each pundit needs to be confronted and held to account on their intentions regarding the mental health care system in our country. Vague promises or excuses need to be dismissed and specific promises to reinvest in, restructure and rebuild our mental health system need to be obtained.
Without this, we are failing our society, our loved ones and ourselves.
A version of this piece appeared in the Irish Examiner on 20 January 2020: you can read it here.
Paul Gilligan, B.A, M.A, DipClin Psych, ApPSI, RegPsychol, is a clinical psychologist and Chief Executive of St Patrick’s Mental Health Services, the largest independent provider of mental health care in Ireland. He is an internationally recognised children’s rights and child protection advocate and provides consultancy services to a number of child protection organisations in Ireland and Europe.
He is former Vice-Chairman of the National Children’s Advisory Council and the Children’s Rights Alliance. He is also former President of the Psychological Society of Ireland. Before taking up his current post with St. Patrick’s, he was Chief Executive of the ISPCC. He is the author of “Keeping Your Child Safe” and “Raising Emotionally Healthy Children” and is a regular contributor to T.V., radio and print media.