Dr. Shari McDaid:

I thank the Chairman and committee members for inviting the representatives of Mental Health Reform to appear before the committee. Some of the issues we will discuss were contained in our pre-budget submission which was circulated to the committee.

Mental Health Reform is the national coalition of 48 NGOs interested in working towards improved mental health services and implementation of the Government’s mental health policy, A Vision for Change. There is no doubt that in recent years there have been positive developments. However, the reality is that despite the appointment of 727 staff in the past three years, at the end of July there were just 63 more staff in the mental health services than there had been at the end of 2012, and still almost 1,000 fewer than in 2009, showing that the huge losses the mental health services incurred in the early part of the recession have yet to be made up, never mind increasing the staffing the levels that were envisaged to provide the holistic service set out in A Vision for Change. The scale of the challenge before us is clearer when one considers that full implementation of the policy would entail having 12,482 staff and as of July we had fewer than 9,000. It is in this context that I would like to outline our perspective on the recent progress made on the policy.

In our view, recent years have brought some significant positive developments. For the first time in the modern era, the national public health service has a leader at the head of the mental health services who sits at the senior management table, with a national director for mental health and a distinctive mental health division within the HSE. The Government had ring-fenced funding amounting to €90 million to develop specialist community-based mental health services and for suicide prevention between 2012 and 2014, and a further €35 million has been allocated for 2015. We certainly appreciate the additional investment. However, it is important to understand that much of this funding has gone to replace staff leaving the service, so that the net increase in funding up to the end of 2013 was quite marginal.

As in prior years, we are concerned that the HSE has delayed recruitment of staff under this year’s allocation so that the funding of €20 million allocated under budget 2014 is not likely to be spent this year. On a positive note, the proportion of non-medical staff, including social workers, occupational therapists and psychologists, within the mental health services has more than doubled since 2009. This is very positive as it reflects the strong desire expressed by people who use mental health services to have access to a less medicalised service and access to more complementary or non-medical supports.

The HSE’s recent decision to mainstream its culture-change project, Advancing Recovery in Ireland, on a national basis provides a basis for driving the culture change needed within mental health services towards a recovery-orientated service that works in partnership with service users and family members. The appointment of someone with personal experience of using mental health services as a member of the national management team for the mental health division is also a very welcome symbol of how service users need to be at the centre of planning.

However, Mental Health Reform is very concerned about the continued gaps and very real strains in the mental health supports available for people across the country. We still do not have in all parts of the country the model of 24/7 crisis intervention within the specialist mental health services that was set out in the policy. Not all services are providing home treatment and there are very few crisis houses to provide alternatives to inpatient beds. This is unacceptable in a context where we still have upwards of 500 people each year taking their own life, the majority of whom will have had some contact with a health professional during the previous year.

The waiting list for child and adolescent mental health services is still too high. In July 2,757 children and adolescents were waiting to be seen by CAMHS. Although this was a 2% decrease on a year earlier, it still means that quite a large number of children are waiting to be seen. There are also too many children and adolescents being admitted into adult wards. The most recent information from the HSE shows that for this year out of 158 admissions up to the end of June, 53, which is more than a third, were to adult units. This is despite the fact that under the Mental Health Commission’s code of practice, no child under age 18 should be admitted to an adult ward, save in exceptional circumstances.

We are also concerned about the large increase in the numbers of homeless people being admitted to inpatient units. The information for 2013 is that 245 people of no fixed abode were admitted to inpatient units, an increase of 40% on 2012. We are concerned therefore that the wider housing crisis is having a very real impact on people with mental health difficulties.

We continue to be concerned about staffing shortfalls, as mentioned earlier. In order to fully implement the policy, the HSE would need 12,482 staff. As of the end of July of this year, there were fewer than 9,000 posts and the services were short 231 doctors and 567 nursing posts. More than 1,000 nurses have been lost to the service since 2009. The combination of the moratorium along with the wider difficulties of the levels of remuneration for people taking up positions as nurses and doctors are clearly impacting negatively on the ability of the HSE to recruit and retain staff for mental health teams.

We are also concerned that mental health services in primary care are not able to cope with demand. We have been told by the HSE that there are waiting lists for the new counselling in primary care service. This is a service which is intended to be available free to medical card holders by referral through their GPs. It was only initiated nationally in July 2013 and as of the end of August 211 people were waiting between three and six months for an appointment and 70 people had waited more than six months. Clearly, timely access to a counselling service is vital to give GPs confidence in referral and also to make it an effective early intervention.

Despite recent positive developments, there are still huge challenges to bringing about the type of primary care and specialist mental health services set out in A Vision for Change. These challenges reflect the continued vulnerability of mental health services within the overall health system and the need to have sustained political will in order to redress decades of neglect.