Time to save time not money
It is time for the Government to stop paying lip service to community-based facilities and mental health budgets when a clear focus and a comprehensive plan is required. Medical Independent column from 17 January 2013 It is just not possible to believe that suicide prevention is a priority for this Government, when €2.1 million out of a €7 million budget allocated for 2012 was not spent. Seven million euro is a tiny fraction of the overall health budget and less than one hundredth of the mental health budget. Yet even this tiny amount allocated to it, was not spent last year.
If one looks at the bigger mental health picture, the arithmetic is not much prettier. There has been an €80 million reduction in the overall mental health budget between 2009 and 2012, when €707 million was allocated to it. There were 1,200 fewer mental health staff in November 2012 compared to March 2009.
The decline in the mental health budget and staffing levels could be explained in two ways. Firstly, the 2006 mental health policy A Vision for Change places a large emphasis on shifting people out of institutions, closing them down and providing more and better care in the community. This, in theory, requires fewer staff and resources. The second explanation is that cutting budgets and staffing is directly in line with the Government’s austerity policy.
While many long-term residents have been transferred out of those institutions, some remain, seven years after the policy’s publication. The most recent report of the Inspector of Mental Health spoke about residents in an institution in Wexford who were withdrawn, without stimulation, presenting maladaptive behaviours. He concluded that if these residents were living in an appropriate place with the correct therapies, they could live much better lives. That such places and therapeutic staff are still not available is a strong indicator of the failure to deliver on mental health reform.
Slow to change
And while hospitals and institutions have been closed, the corresponding development of community services has just not happened. One could explain this as unlucky, with the economic crisis looming at the time or one could conclude that mental health services are neither a political not public policy priority.
Commenting on the “slow and inconsistent” implemen-tation of A Vision for Change, the most recent report of the Independent Monitoring
Group of A Vision for Change, details how community mental health teams are “poorly populated with an estimated 1,500 vacant posts”. The report also highlights how the continued absence of a National Mental Health Service Directorate (and director) “with authority and control of resources” and a comprehensive, costed, time-lined implementation plan contribute to the “lack of coherency in the planning and development of community based services”.
The Fine Gael/Labour Programme for Government specified that they would ring fence an additional “€35 million annually… to develop community mental health teams and services as outlined in A Vision for Change”.
Minister Kathleen Lynch, the Minister under whose remit mental health falls, has repeatedly stated that €35 million was delivered in 2012 and that there will be a new, additional €35 million in 2013. Yet, when questioned on this, she has been unable to give a breakdown on how it was spent in 2012. When the Department of Health was asked for this breakdown, the question was referred to the HSE. The HSE was also unable to give a breakdown, but communications confirm that most of the €35 million was not spent in 2012 and was used to shore up spending in other areas.
A key factor in not spending the €35 million in 2012 was the tactical delay in appointing the much-needed 414 new posts for mental health. By the end of December 2012, just 58 of those posts were in place, and another 54 posts filled but not yet in place. Whither the 306 other posts?
Extraordinarily, the HSE is unable to give a breakdown of what those posts were, even those already in place, as no such information is collated nationally.
From experience, we know that successful service reform can be delivered where there is determined political and clinical leadership, good management, sufficient and ring-fenced budgets, and staffing.
The post of first National Director for Mental Health is to be advertised shortly. If they can get the right person (preferably with international experience), and give mental health reform the political priority and resources it deserves, this Government has a chance to start saving lives not money. And it would be one sure way that it could show its word on this is for real.