Dr. Shari McDaid:

I thank the Chairman and members of the committee for inviting Mental Health Reform to appear before it. I believe the committee has received our pre-budget submission in advance.

I am the policy officer with Mental Health Reform, which is the national coalition advocating for improved mental health services and implementation of the governmental mental health policy. We want to bring to the notice of members the voices of some of the people who receive mental health services. I will share some comments from individuals who have shared their views with us in the past month or so. One person said that if one does not have good mental health one has nothing.

Another person said that if funding is cut, mental health services will not evolve and will instead return to the old times that were experienced 15 years ago, with more readmissions and less care. We also heard from someone who said that they do not want mental health services to go backwards and that it is all very well for the Government to try to cut the mental health budget, but it does not realise the impact these cuts have on people on the ground.
The reality is that more people are experiencing poor mental health in Ireland. A survey that was recently published by the national stigma reduction campaign, See Change, found that 15% of the population claims to have experienced a mental health problem in 2012. That is more than double the number of people who said they had a mental health problem in 2010. Irish mental health services are under significant strain. The current staffing level is 23% below the level recommended in A Vision for Change. Irish mental health services are short 2,645 whole-time equivalents at present. As a result, staff are stretched. This kind of pressure leads to people not getting the follow-up care they need after being discharged from hospital. There are no early follow-up appointments. It leads to nurses not being able to provide timely follow-up in day hospitals when people are going through a difficult time at home. If a person who has experienced hospitalisation in the past, but is now successfully living at home, begins to feel they are becoming unwell and goes to their local day hospital for an appointment, they may be told they cannot get a follow-up appointment as early as they need because of the lack of adequate staff. There is Irish evidence that comprehensive community-based mental health services cost less than a hospital-oriented service. A study conducted in Kildare and published this year found that a community-based service is 21% cheaper per capitathan a traditional hospital-based service. The main differences between the two services is that the provision of day hospital and home treatment in the comprehensive service is absent in the hospital-oriented service.
Mental Health Reform has made a number of specific recommendations for budget 2013 to keep reform on track. First, the Government must keep its programme commitment to allocate €35 million next year for the continued development of community-based mental health services. Mental Health Reform welcomed the Government's commitment in budget 2012 to allocate €35 million for the development of community-based mental health services, suicide prevention and access to counselling through primary care. We have not yet sees this commitment realised, but we remain hopeful that the promised staff will be in place before the end of the year. Given the significant gap in staffing, we are asking the Government to keep its commitment to an additional €35 million for next year along with an exemption from the moratorium for the relevant posts. It is important to note that the €35 million allocated this year was not really additional funding, given that the mental health budget included a 5.6% cut in regular spending. Even with the planned provision of €35 million this year, there was an overall 1% cut in the budget for mental health services. One can imagine what the situation is now that the €35 million has not been realised.
Mental Health Reform also welcomed the commitment in budget 2012 to provide €5 million specifically for the development of counselling services through primary care. We consider this to be a positive mental health promoting initiative. Given the links between poverty and poor mental health, it is particularly important for the Government to consider in budget 2013 how those on low incomes as well as those on medical cards can access counselling services. The Minister, Deputy Reilly, has made a commitment to appointing a director for mental health as part of the restructuring of the HSE. We are concerned that without the necessary staffing resources, a director will have little impact to assist in managing the change programme. If the directorate is to fulfil the intentions of A Vision for Change, it must have multidisciplinary input. It also requires budgeting expertise and administrative support if it is to be effective. It is difficult to plan mental health services because we have no information on community mental health services in Ireland. If one was running a business, one would want to know how many customers one has, how often they shop and how satisfied they are with one's service. We have no idea how many people are using community mental health services. We had more information about community mental health services in 1984 than we do now.
Mental Health Reform believes that partnership between public mental health services and the voluntary sector is vital to implementing A Vision for Change. Mental health voluntary organisations provide vital support services such as peer and family support, telephone helplines and information in the community. HSE-funded mental health voluntary organisations cannot afford to incur additional cuts without affecting front-line service delivery. It is vital that the Government continues to support the reform of Ireland's mental health services. We ask the members of the committee to champion the issue of mental health in the run-up to budget day in December. In particular, we urge members to write to the Minister for Health, Deputy Reilly, to impress upon him the economic good sense of investing in community mental health services.