Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

While the principle of the Bill is one I wholeheartedly support, it represents only a starting point. I think that is generally accepted. The experience in the UK shows that similar legislation, while having a positive effect on the provision of mental health services, is by no means a panacea. The 2012 Health and Social Care Act in the UK enshrined in law parity of esteem for mental health and is defined as valuing mental health equally with physical health. Despite being a central plank of NHS policy for six years now, serious issues remain with mental health services in the UK. It is a system that, even when parity was introduced in 2012, was years ahead of our own in terms of service delivery and treatment provision.

While the concept has merit, it is not a silver bullet. We all know what is needed to fix out mental health services - funding, a reform plan and the political will to deliver on both of those. The absence of these things has hampered the effective implementation of A Vision for Change almost since it was first published. This is partially due to economic circumstances and partially due to the political decisions that were made as a response to those circumstances. The slashing of mental health funding during this period, aside from being wholly unjust, was a classic example of short termism. Individuals who would have benefited from earlier interventions to address mental health issues at the lowest level of complexity were abandoned or offered inappropriate pharmaceutical treatments in the absence of any kind of talk therapy. We simply do not know the impact it will have in the future and it is likely that it is having an impact now. Studies have shown that later, more complex interventions for mental health illness are less effective and more costly. Long-term planning and not panicked crisis-to-crisis reaction is the truly transformative measure that has been sorely missing from not only our mental health services but our health services in general.

The implementation of the Sláintecare report would represent a grounded first step towards achieving parity for mental health. The 2018 budget for mental health services is €917.8 million, 6.3% of total health spending. This is below the level advised in A Vision for Change and compares very badly with similar states. A Vision for Change recommended it should be over 8%. The Sláintecare report recommended as an initial target 10% of the overall health budget being ring-fenced for mental health services. A Vision for Change recommended well-trained, fully staffed, community-based, multidisciplinary mental health teams be rolled out across the community health areas. The report also detailed the additional staffing requirements for these teams. Indicative funding needed to deliver on this amounts to just over €120 million, adjusted for population growth. The Sláintecare report recommends this funding be phased in over five years. This includes funding for child and adult mental health teams, child and adolescent liaison, old age psychiatry and mental health services for people with intellectual disabilities.

People with medical cards can avail of counselling through referring clinicians. This is a new service which 9,374 people utilised in 2016. For this service to be extended to the whole population, a budget increase is needed over time. Given the limited availability of talk therapies and community mental health teams, extending counselling in primary care would represent a way to address mental health needs at a lower level of complexity and in a much more effective way. The Sláintecare report recommends the provision of universal access to six to eight counselling sessions for those whom their GP determines are in need of this service. The allocation for this service in 2016 was €6.5 million. The report recommends doubling this spend over a three-year period. A further allocation of €5 million would allow additional psychologists to be hired as part of primary care services to work with people who do not need a referral to community mental health teams.

The Sláintecare plan offers the only grounded and achievable roadmap for achieving the transformation in our mental health services which is badly needed and which would allow us to reach the minimum level of care that was promised 12 years ago in A Vision for Change. We can only hope the Government does not allow to slip through its fingers this once-in-a-generation chance for real reform of our mental health services and an achievable way of ensuring parity for mental health. We must act on implementing Sláintecare as a matter of urgency.

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