New information highlighted in the Dáil in recent days shows just how bad things are in our mental health services: 2,908 children and adolescents waiting for a first appointment with mental health services; 6,000 children waiting for primary care psychology appointments. Much of the country has no out-of-hours specialist mental health service available for individuals in crisis, giving people no choice but to go to A&E when in severe mental distress. People trying to get early intervention for a mental health difficulty are waiting several months for an appointment. And for pregnant women, there are no specialist perinatal mental health services outside of Dublin.
These facts speak of a mental health system that is stretched and unable to cope with the increasing need for mental health support.
What happens when people wait too long for mental health care? Some people will find that their difficulty will resolve itself – that through a combination of inner resilience, time and their natural network of support they are able to regain their equilibrium. But for most, their relationships with friends and family suffer; they can end up off work for longer than necessary. Young people in education may find that their studies suffer as their mental distress reduces their ability to concentrate. Resorting to self-medication in the form of alcohol or drugs to ease their pain, some may even end up on the streets or in the prison system. For children, a relatively short-term problem can turn into a lifelong challenge.
We know that investing in mental health care makes economic sense. The Healthy Ireland framework reported that the economic cost of mental health problems in Ireland is €11 billion per year, much of which is related to loss of productivity. In 2008, it was identified that mental health difficulties cost 2% of GNP annually and most of the costs are in the labour market as a result of lost employment, absenteeism, lost productivity and premature retirement. Moreover, the World Health Organisation has recently reported that every US$ 1 invested in scaling up treatment for depression and anxiety leads to a return of US$ 4 in better health and ability to work.
Yet year-on-year mental health services have lost out to other parts of the health budget. In 1984 mental health spend represented 13% of the health budget; in 2017 it was just 6%. Currently we spend less than half the proportion spent by our new neighbor, Britain. A Vision for Change recommended that mental health spend go up to 8.24% – instead it has fallen. Sláintecare recommended that the mental health allocation go up to 10%, but this seems like wishful thinking in the current context.
The core issue is that there simply are not enough staff in the HSE to provide the mental health services we need. The HSE is short 20% of the recommended staff overall, and in child and adolescent mental health services they have only half of the staff they need. Even when the HSE can advertise new posts, they have been unable to fill vacancies due to uncompetitive salaries and the high cost of living in some parts of the country. And these staffing shortages get compounded as frustration and low morale lead to more and more professionals leaving the public mental health services.
So what can be done to fix our current mental health service crisis? Firstly, this Government needs to allocate additional funding to meet the core funding gap in the HSE’s mental health budget. It is estimated that €65M is needed just to meet the current level of demand for care. This is not extra money; it is core funding to ensure that there are adequate beds for people with highly complex, severe mental health difficulties who need long-term residential care; it is the funding that provides residential services for people with eating disorders; it is the funding for services that have a shortage of inpatient beds for people in acute mental distress. It is the resource needed to respond to the 26% increase in referrals to child and adolescent mental health services between 2012-2016.
Secondly, our Minister for Health and his cabinet colleagues need to sort out the pay and conditions for doctors and nurses so that the HSE can become a competitive employer. Mental health care is a people business – 80% of the costs of mental health care are in human resources. It is simply absurd to instruct the HSE to develop services and recruit staff on the one hand, but give the HSE an uncompetitive pay package with which to attract people. Our public health service operates in a competitive national and international marketplace for mental health professionals. The Government must get realistic fast and put in place the type of terms and conditions that will make it possible for skilled people to take up positions here.
So, there is plenty of scope for investment in Ireland’s mental health system, and good reason for the Government to fulfil its commitment to invest €55M to develop mental health services in 2018.
We have all been hearing a lot from the Taoiseach, the Minister for Health, the Minister of State for Mental Health and TDs across the Dáil about how important Ireland’s mental health is to them. The Taoiseach has acknowledged that there are unacceptable delays for children and young teenagers attempting to access mental health services. It’s time the Government ‘put its money where its mouth is’ and give our public mental health services the funding they need to respond to the thousands of people in this country struggling with mental and emotional distress.
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