Dr. Shari McDaid:

What do we mean by parity of esteem for mental health? The Deputy is correct that it is not all about money but money can be an indicator of intent. For example, in our thinking around the budget for next year, we recommend the Government meets its commitment on €55 million which the Minister for Health has indicated would be invested next year in additional development funding. We also recommend that mental health services would not lose out any more in the overall health budget. This is important because if it is not done, it sends a message that mental health is less of a priority than other parts of the health system.

Parity of esteem can be thought of in another way, namely equivalent outcomes and quality of service in mental healthcare to those expected in physical healthcare. For example, take the case of somebody receiving a diagnosis of cancer. Imagine if he or she went into our cancer services and was told that he or she will get chemotherapy but not radiotherapy because we do not have enough of the right disciplines to provide it. This would mean that they might not recover fully and may actually die but that is the best we can do. That would not be considered acceptable by the public. However, that is what we are doing every single day in our mental health services. We are saying that we do not have the adequate supports in place for someone in mental distress. In turn, this means that he or she may not recover as quickly or, in the worst-case scenario, he or she may lose his or her life. We are saying this is acceptable. We need to change that and start having a conversation about having the same standards of care and the same expectation of outcomes from mental health services as we do from physical health systems. That brings the parity of esteem issue to a different arena.

Silos are the bane of our system. We orientate illnesses around a certain category and then it becomes hard to bridge that category to another. Accordingly, we have services for children with disabilities and services for children with mental health difficulties. If one happens to be a child who is in both categories, then one is bounced from pillar to post rather than getting a coherent system.

We have advocated generally for a no-wrong-door approach. In other words, if one seeks help from a public service that is, broadly speaking, relevant, then it should be the service’s job to co-ordinate, integrate and find the supports one needs and then bring them to the patient. It should not be a case of the services saying that the patient is on the wrong list or not in our group and, therefore, it is up to the individual in need to navigate and find the services he or she needs. We have spoken about this in terms of individuals with mental health difficulties and substance abuse. If the committee were to endorse that principle on a higher level, namely, that the entire mental health system should adopt a no-wrong-door approach, then that could apply anywhere. That would drive services to have to be more integrated and to engage more with their peers because they would not be allowed to simply kick matters to touch. They would instead have to find and engage with the myriad services that exist. There are other specific examples on how to improve co-ordination.