Kenny’s promises on mental health were pure guff
Analysis from Irish Independent on 5 June 2015.
Mental health “is so central and so sensitive to our communities that it deserves the very best from the Government and that it shall have”. These were the words of An Taoiseach Enda Kenny at the opening of a Console counselling service in Mayo in 2012.
This week’s publication of Mental Health Reform’s progress report on the delivery of the national mental health policy – ‘A Vision for Change’ – tells a very different story. The report details a litany of failures by Government and health services to meet the mental health needs of the Irish population.
Virtually all of this Government’s intent on mental health as specified in the Programme for Government remains unacted upon. Mr Kenny’s government promised an additional €35m annually for mental health.
While some of this was delivered, more was cut from mental health than invested, so nine years on from the publication of the strategy just 6pc of the total health budget goes to mental health, compared to 7.2pc in 2006. In the UK, mental health gets double that.
Despite a greater need for mental health services, there are 1,200 fewer mental health staff now than there were in 2006. In very simple terms, this means that people who need mental health services do not get them.
While there are 24/7 mental health services for adults in acute mental distress in some parts of the country, they do not exist in other parts.
It’s similarly with old age mental health services.
Just 27 of the 46 old age mental health teams required are in place, resulting in very varied provision. Currently, if you are an old person with mental health needs in Wicklow, Kildare, parts of Cork city and county, Roscommon and half of Mayo, your needs will not be met. It is no wonder that at least 8pc of over-50-year-olds with depression or anxiety are undiagnosed and untreated.
The situation is even worse for people with intellectual disability who have greater mental health needs. Just 13 of the 300 posts recommended in ‘A Vision for Change’ are in place. Just five of the 150 mental health intellectual disability posts for children have been filled.
Despite absolute commitments that no child or adolescent would be placed in an adult psychiatric unit, last year 83 (out of a total of 290) children and adolescents admitted to hospital were placed in adult psychiatric wards. This Government has increased the numbers of inpatient child and adolescent beds, yet just 58 of the 108 beds promised are open for admissions.
There has been investment in child and adolescent mental health teams but just half that which was recommended in a ‘Vision for Change’ and not enough to meet the 50pc increase in demand for the service. In January 2015, 429 children were waiting more than a year to be seen by that service.
While there is a strong emphasis in ‘A Vision for Change’ on delivering mental health services in primary care, these remain at an embryonic stage and the number of primary care psychologists is unknown. The absence of a continuum of mental health services means cases are dealt with only when they become a crisis and there is a huge over-reliance on medication.
‘A Vision for Change’ was praised for taking a holistic approach to mental health, stating that “equal opportunities for housing, employment and full participation in society must be accorded to individuals with mental health problems”. Yet, people with a mental health disability are nine times more likely to be out of work than those without a disability. Meanwhile rehabilitation, training and recovery services have been cut over the last five years.
A study of Dublin and Limerick homeless people in 2013 found that 58pc had at least one mental health condition. There was a 36pc increase of admissions of homeless people to psychiatric units between 2006 and 2013. There is no funding to support tenants who have mental health needs. Poor mental health supports are contributing to the Irish housing crisis, while the housing crisis exacerbates poor mental health through the lack of appropriate accommodation for mental health service users.
There have been some improvements in the stigma associated with mental health. Yet a 2012 survey found that people were less likely to disclose that they had a mental health difficulty, in personal and professional relationships, than they had been in 2010.
‘A Vision for Change’ called for a specific mental health directorate in the HSE and annual independent monitoring of the mental health strategy.
It took the HSE seven years to set up a mental health directorate. Meanwhile, this Government disbanded the independent monitoring group in 2012 and has not re-established it.
Quite clearly, mental health services remain the Cinderella of all health services. The words of An Taoiseach are pure guff as long as the mental health needs of our most vulnerable – the young, the old, people with intellectual disability – are largely ignored.
This Government has no intention of giving them the very best, even though they clearly not just ‘deserve’ it but have a right to it.