Oireachtas Joint and Select Committees

Wednesday, 7 February 2018

Joint Oireachtas Committee on Future of Mental Health Care

Medication and Talk Therapy: Discussion

1:30 pm

Dr. Brendan O'Shea:

We are keen to reflect on realising the potential of GP-led teams. If additional funding is made available, as per the Sláintecare report, how will this be applied and what will be achieved with it in terms of care for people with mental health problems in communities? We are not short of good policy but incredibly bad at implementing it.

An important aspect of applying this funding is to closely consider distributing additional funding on a deprivation weighted model, which, given the level of detailed knowledge available on Health Atlas Ireland, can now be factored in with adequate detail. Additional funding should be used to increase the numbers of GPs along with appropriate supports, including practice nurses and allied health professionals in counselling and family therapy. This will enable the targeted organic growth of GP teams where they are most needed. In turn, it will enable greater provision of talk therapy services and related supports in the areas of prevention, earlier detection and better follow-up care. These are all areas which get lost in the tightness of the system which we are currently trying to operate.

In the intermediate term, this will result in improved capacity at general practice and community levels to address volumes of activity in prevention, including tobacco use, alcohol, exercise and stress management. For example, people often self-medicate with alcohol and cannabis. Their eating habits deteriorate under the stressful situations in which they find themselves. Having a greater capacity in the general practice setting will allow us to address these and will be effective in the primary prevention of a range of mental and physical health problems. Additional funding will enable GPs to incorporate a broader mix of allied health professionals. This, together with more GPs, will enable a greater proportion of mental health care to be delivered in the community.

Second, building these capacities will result in more systematic activity in the management of anxiety, depression and pain in chronic disease management. We sometimes forget this. There is another part of the jigsaw puzzle where we have a large number of older people with complex multimorbidities. We increasingly understand that the mental health aspect of these conditions is important to address. If these are ameliorated, it will lead to better outcomes for those involved. People with heart failure and diabetes who are anxious or depressed have a poorer quality of life and survival, as well as higher costs when their anxiety and depression are not properly cared for.

The ICGP supports the policy elaborated in the Sláintecare report and in the recent HSE report, A Future Together. We have good policies but we need to implement them. Both of these policies underpin a shift to the left in terms of a greater proportion of health spending in primary care. In addition to building capacity in mainstream GP-delivered services, such a shift will enable the embedding of greater volumes of allied health professional care, as well as a more rapid translation of new modalities and new technologies relevant to mental health care, including telemedicine, social prescribing and evidence-based use of social media for improved care for the younger demographic.

The ICGP recognises the value and impact of the voluntary sector in the development and delivery of mental health services, as well as the importance of the work done for particular patient groups. It is the view of the ICGP that the financial emergency measures in the public interest cuts to the PCRS, primary care reimbursement service, funding model, together with a sustained failure to negotiate a new contract for general practice for 39 years, are both major impediments for the delivery of essential community-based mental health care for Irish citizens. If we can move on this, the ICGP and the GP-led part of the health care system can and will develop the necessary capacity and innovation which Irish citizens require to achieve better outcomes in both mental health and in the long-term care of frail complex individuals with comorbidities and associated mental health problems.

Through its main activities of training, research and postgraduate education, the ICGP is well placed and ready to enable capacity and innovation leading to more and better mental health care which can be delivered in communities. The emphasis will be on prevention, talk therapies and lifestyle modification, supporting greater availability and integration with allied health professionals and reduced reliance on pharmacotherapy and distant hospital and specialist services. We know what we need to do collectively. In the past, we have failed to do it. We are now at another threshold.