Dáil debates

Tuesday, 2 July 2019

Mental Health Services Reports: Motion [Private Members]

 

9:10 pm

Photo of Alan KellyAlan Kelly (Tipperary, Labour) | Oireachtas source

I commend the motion on behalf of the Labour Party. We have tabled an amendment in a genuine attempt to strengthen the motion. The findings made in the Mental Health Commission's report go a long way towards highlighting the significant governance and management problems in services, but the report deals primarily with the top tiers of the pyramid of mental health care services. These should be the services of last resort, but recently they have tended to be the only service delivered, which is a problem. I speak regularly to providers and practitioners on the ground who tell me the same story about people who are forced to present at acute services such as CAMHS owing to the absence of primary care services. In many cases, they have reached a crisis point owing to the absence of early intervention services. We see this not only in mental health services but across all services. Our motion on carers last week was yet another example of the overuse of expensive acute services and the underuse of cost-effective and efficient primary care servoces. We then wonder why Ireland has one of the highest health spends in the Organisation for Economic Co-operation and Development, OECD, yet it has some of the worst health outcomes among advanced countries. The problem is not with the quality of staff in the HSE or overall resources, as evidenced by the current overruns. The problem is that we lack an holistic strategy for mental health services at Government level and a coherent system to match the objectives set out in A Vision for Change.

Young people are experiencing unprecedented levels of anxiety and stress in their everyday lives. Everything has changed in the past ten years. Up to one third now experience mental health difficulties and, shockingly, suicide remains the most frequent cause of death among those aged 15 to 24 years. We need to ask why these difficulties are arising among young people. The increase in inequality is one reason. The evidence shows that unequal societies have greater rates of mental distress. As the gap between rich and poor in society continues to widen, so too does the number experiencing mental health difficulties. There is also obviously a serious social cost.

Perhaps it is better to speak in a language the Government will understand. Economically, the cost of the mental health crisis was put at €8.3 billion by the OECD in 2018. To put it in context, that is approximately half the total health budget. We need a radical change of direction. We need to see expenditure on mental health services not as a cost but as an investment. That is why the upcoming budget should, at a minimum, increase mental health spending in line with what was set out in A Vision for Change.

The amendment calls for a paradigm shift in the delivery of mental health services. We need to move from a reactive approach based on expensive acute care to a preventive and proactive approach based on community-led, cost-effective early interventions. That is the most important thing I will say to the Minister of State, Deputy Jim Daly, and I think he agrees with me. To achieve this, we need an holistic, integrated approach by the Government that moves beyond narrow economic measures to focus on societal well-being. A simple but relevant example is trees in a city. Researchers have repeatedly found evidence of improved mental health from exposure to nature. We all know that a walk in the park reduces our stress levels and improves our mood and mental health. Ultimately, more trees means reduced treatment costs and improved worker productivity. That is just a tiny example. As part of the BusConnects plan, more than 1,000 trees will be felled. Where is the joined-up thinking? Meanwhile other European cities such as Paris are planning the development of urban forests in city centre locations. The Government's approach shows a lack of joined-up thinking in these measures.

We need to redirect spending to primary level interventions that have nipped problems in the bud. Let me give an example. I recently attended a CAMHS briefing which I think the Minister of State may have hosted. This figure was prominent and is worth emphasising. According to the HSE mental health division, 90% of mental health needs could be successfully treated within a primary care setting. That is a fraction of the cost and would reduce the burden on top-tier psychological services.

Let me give another example from another briefing I attended. I recently spoke to representatives from Jigsaw, of which I am a supporter and about which I have spoken to the Minister of State. It provides an excellent early intervention service for young people. Some 71% of those aged 17 to 25 years who came through its doors saw a reduction in the levels of their psychological distress. We have spent a long time trying to roll out these excellent services. I hope there will soon be an announcement of a location for the Jigsaw service in County Tipperary since a decision was made to provide one there. The service has supported more than 30,000 young people and upskilled more than 200,000 adults to foster support of young people's mental well-being. The models are in place and we know that we can produce results if we can expand the services provided. The Minister of State should turn the ship around in the port, let the service be community led and ensure it is facing the community, rather than concentrating on acute services.

Services suffer from the silo effect within the system in which they operate in the HSE. Let us consider, for example, a person who is aged over 18 years who presents to Jigsaw but needs a referral to CAMHS. Under the current system, he or she will need to be sent back to his or her doctor for a referral letter. This means another layer of bureaucracy, a day off work, another €50 to be paid in general practitioner fees, etc. The Minister of State sees where I am going with this. I do not think that is necessary. In reality, the person may never present again to his or her doctor for a referral letter. Is there any way the Minister of State can quantify the number of such events? I am not sure if it is possible to do so, but it would be interesting to know. What is happening is that they will present again later with a more severe problem because they will be lost in the loop.

We should not put bureaucratic or cost barriers in the way of people in mental distress. It should not matter which door a person walks in through. He or she should not have to worry about the convoluted way in which he or she will access services. He or she should just be able to access them. The mental health service should be seamlessly integrated, with different providers having the ability to refer to the most appropriate service in a timely manner.

The Labour Party generally supports the findings by the Mental Health Commission and the implications outlined within the motion, but we believe it is time we moved beyond painting over the cracks. We all know the old adage that prevention is better than cure. It is very simple. Staffing resources and adequate governance must be addressed at every level of mental health care, but as I have repeatedly said, we need to turn the ship around, get rid of bureaucracy and make it face towards the community rather than its current top tier, which is acutely driven. The service does not work to the level required and is also overtly expensive.

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