Dr. Fiona Keogh:

Mental Health Ireland would like to thank the committee for the invitation to participate in the meeting today.

We welcome the opportunity to discuss the significant need for investment in mental health and the need for support for people impacted by Covid-19. There was a huge mobilisation of mental health services and the entire health system in response to Covid-19 and great agility was shown in many aspects of the health service to respond to the unprecedented challenge. The unstinting work of all those involved is very much appreciated. In the midst of Covid, the new mental health policy was launched. Sharing the Vision set out to reframe our understanding of mental health and how we can respond to the full spectrum of mental health need through harnessing the wide range of resources in the community and the health system. It acknowledges the range of determinants of mental health from housing to employment to the physical environment and more and influences across the lifespan from infancy and early childhood experiences through to later life. As a leading organisation in mental health promotion, Mental Health Ireland is fully committed to playing a strong role in the implementation of Sharing the Vision.

Covid-19 provides an excellent analogy for understanding how we might respond to the spectrum of mental health need. We all became expert to some extent on a public health approach to a serious disease - how the most effective strategy was a population-wide approach to avoid getting the disease. It brought home to us all the power of small collective preventive actions in preventing serious illness and deaths - ultimately ensuring that Covid would not overwhelm our hospitals. The effectiveness of the public health approach has long been recognised and underpins Sláintecare - accessing care at the most appropriate and cost-effective service level with a strong emphasis on prevention. In a prescient way, the mental health policy Sharing the Vision emphasised the importance of prevention and mental health promotion - broadening the base of the mental health system so that people can easily access support at the primary care level and in their local community only escalating to a specialist mental health service when that is the level of support they require and not because it is the only source of support. A timely, appropriate response is essential to avoid potentially compounding mental health difficulties through long delays.

What does this mean in terms of our response to the mental health impact of Covid-19? It means that we should respond to need as it arises in different individuals and in different settings, for example, schools and workplaces. We know that the Covid-19 crisis has affected individuals' mental health in different ways resulting in loneliness, fear, trauma, unemployment, anxiety, increased alcohol consumption and increased domestic abuse. These effects require responses from a range of services and agencies. Specialist mental health services are an essential element of the response for some but certainly not for all individuals. The challenge in Ireland is that Covid-19 has landed on a mental health service that is already fragile and over-stretched. Broader-based services in primary care settings and the community and voluntary sector all have an essential role to play. However, resources for mental health have almost exclusively been directed towards specialist psychiatric services to the neglect of primary care mental health services. Mental health promotion and building resilience, which we now know constitute the cornerstone of a public health approach, have not been seen as the core business of either mental health services or health promotion services and have not been resourced accordingly. It is important to say that the choice here is not between specialist mental health services or non-specialist services. Just as mental health needs exist along a continuum the response to this need requires a continuum of services. I will not revisit the requirements here, which are set out in detail in Mental Health Reform's pre-budget submission, but investment is needed to maintain existing levels of service as well as to develop the continuum of services recommended in Sharing the Vision. New capital investment is needed to build new acute mental health units. Some essential elements of the system have never been built, for example, psychiatric intensive care units to enable safe and effective care to be provided for individuals with a high level of complex need. In Ireland, we often depend upon the Prison Service to respond to acute need. Opportunities can be maximised in other capital projects, such as in primary care centres, to co-locate mental health services, which facilitates the provision of integrated care.

In terms of the Government or State role in supporting mental health, where does responsibility lie? Of course, the Department of Health and the HSE have a central responsibility but the Covid experience has demonstrated how an effective public health response requires many Departments and agencies to contribute to a societal and economic recovery as well as recovery in individual health. The same is true for mental health. We know many factors have a role in determining and influencing a person's mental health and we need to become much better at working together. There are some examples to build on such as the joint policy statement on housing options for older people and the make work pay initiative of the Department of Social Protection. Over the past year, Mental Health Ireland employed 80 people with lived experience of mental health difficulties but more needs to be done for people with mental health difficulties who have fluctuating conditions so that there is a flexible approach to supports increasing and decreasing as a person's needs change. Modern and sophisticated social protection systems need to better accommodate this reality in people’s lives.

Looking positively to the future, we can use the opportunity provided by Covid to build a mental health support system that Irish people can be proud of. What might this look like? It would be an equitable mental health support system with access based on need and not ability to pay with an equitable distribution of resources across the country. It would be a co-produced mental health system that actively involves people with lived experience, families and supporters in the design, delivery and evaluation of mental health services. Crucially, it would be a broader-based mental health system with resources allocated to build existing services as well as developing a full continuum of supports. It would be an agile and innovative mental health system building on the use of e-mental health supports, which played such a crucial role during the pandemic, while recognising that these are just a tool and not a substitute for face-to-face interaction. It would be a mental health system that provides good value for money with long-standing existing services subject to the same scrutiny as new initiatives and with the confidence to decommission services that are no longer fit for purpose. It would be an outcome-focused mental health system with multi-annual budgets directed towards achieving the outcomes of Sharing the Vision and using funding mechanisms to incentivise integrated cross-Department and cross-agency working. It would be an implementation-focused mental health system. One of the reasons implementation does not happen in this country is that the implementation process itself is not resourced. It would be a system with a credible workforce plan that includes retooling and refreshing the skills amongst the existing workforce, which has shown its commitment to the sector.

We know from our experience with Covid that we can do this. When faced with a big enough challenge, the individuals and systems involved rose to the challenge and overcame it. We need to bring the same energy, resources and effort to improving mental health for all. Mental Health Ireland is hopeful for a better future. We must now decide to grasp this opportunity.