Dáil debates
Wednesday, 16 October 2019
Saincheisteanna Tráthúla - Topical Issue Debate
Mental Health Services Funding
3:55 pm
Paul Murphy (Dublin South West, Solidarity)
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This matter was originally scheduled to be taken last week to coincide with World Mental Health Day but it is appropriate that we discuss it today in light of the incredible and tragic situation of people who have lost loved ones to suicide being forced to protest outside the Dáil. They carried placards reading "She died waiting" and "24-7 Mental Healthcare Access Now", in a clear appeal to the Government to save people from suicide, and they referred to the budget of last week.
Does the Minister agree that we have a mental health crisis? The last census saw an 29% increase in people with mental health problems and over one in 15 young people has engaged in deliberate self harm. By the age of 24, up to one in five young people has experienced suicidal ideation and ten people tragically die by suicide every week. There is an immense crisis in our society but it is unmatched by the response of the Government. Between 20% and 25% of overall ill health is caused by mental health problems but only about 7% of the health budget goes on mental health. Last week's budget included €39 million for mental health but two thirds of that is going towards pay increases, which are deserved and necessary, and addressing the existing level of services which means the increase in availability and access, at a time when there are massive waiting lists, is extremely small.
The impact of this on our society and economy is immense and an OECD report from 2018 stated that mental health problems cost the economy over €8 billion annually. However, the introduction by the Government of the Your Mental Health information line simply directs callers to one of over 1,000 other helplines and does little to assist those in dire need. Suicide support services may alleviate someone's situation in the immediate term but they are not a long-term solution for anyone with severe mental health difficulties and for the Government to suggest that it is a solution is a slap in the face for those who struggle with such difficulties on a daily basis. It is proven that calls increase with new helplines but what does that mean when we lack consistent State-funded mental health support such as specific centres, support groups and particular treatments for certain illnesses? At the end of last year, over one quarter of the people on the waiting list for psychology in primary care had been waiting more than 12 months to be seen. Helplines will typically advise someone in urgent need to go to an emergency department but they wait there for ten hours and end up on a waiting list, which does not resolve the situation.
A helpline is the bare minimum we need to have. What we need is sufficient investment, the implementation of A Vision for Change and 24-hour access to appropriate care. We need to get rid of waiting lists so people can access, publicly, the mental healthcare services they need. This needs to be linked to a struggle for a society without alienation and where people have control over their lives, their housing and their jobs and do not suffer from eco-anxiety or eco-guilt because of a sense of a climate that is headed for a catastrophe. These services are linked to a fundamental socialist change in our society.
Jim Daly (Cork South West, Fine Gael)
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I thank the Deputy and express my appreciation to him for withdrawing this matter last week. He had wanted it to be dealt with during Mental health Week but it is every bit as appropriate today. I acknowledge the parents who are at the front gate today. I went out and said hello to them and it is heartbreaking to see parents who have lost their gorgeous children and are wearing T-shirts with pictures of their children on them. They have nothing to gain from improved services but they care enough to try to provoke movement on behalf of other families to spare them the same fate. It is a wake-up call for all of us. None of us can imagine what it is like to be one of the parents at the gates of Leinster House with a picture of their child who was lost to suicide. I acknowledge their bravery and the contribution they are making.
I will not read my script because a lot of it is already on the record and the Deputy is up to speed on the issues. I have gained a good insight into the issues but I do not have all the solutions or a monopoly of wisdom on the right thing to do. Money is a very important part of the service and the Government will respond to this. There has been a 44% increase in funding the past number of years, from €700 million to over €1 billion. I am far more interested, however, in what we are doing with that €1 billion than arguing every day about how much of the €39 million increase is going to pay increases and how much to new developments. I am concerned as to whether we are doing the right thing with the money because throwing another €50 million at it may get me off the hook but I need to be more responsible.
One of the things I have championed are lower-level interventions because that is how I believe we will tackle the waiting list issue which has bedevilled CAMHS for so long. I can throw €3 million or €4 million at a waiting list initiative, as my predecessors have done, but doing that means that, while the numbers initially go down, they come straight back up again as soon as the money is spent. I have tried to structurally reform what we do and how we do it. I have put in a lower level of psychology in the infrastructure. While psychiatry is a specialist intervention, led by a consultant psychiatrist with a highly disciplined team, some 2,000 children are waiting to access the service so 134 psychologists have come into primary care to reach out to children earlier.
The Deputy referenced the helpline and I do not mind people questioning its validity but we should also acknowledge progress when it is made. There are 1,027 different services funded by the HSE and the State but if a person is in trouble, I am not sure they know who to call, whether it is Aware, Pieta House or Jigsaw or some other service.
By calling our phone number, one can access 1,027 services, including face-to-face therapies and complementary therapies. It is about ensuring a lower level of intervention is available such that problems do not escalate to needing psychiatry and medication. That initiative is working. I do not like talking about waiting lists going down because they may go up again tomorrow. That said, since the beginning of the year, there has been a 20% reduction in the waiting list for CAMHS, which is a significant development. More important, the reduction is sustainable. I am not interested in a headline figure of a 20% reduction in the waiting list; I want it to be sustainable. Having the lower level of psychology infrastructure in primary care centres has lessened the demand for CAMHS. The reduction has come at a time when there has been a 24% increase in demand for the services. We must acknowledge what is working while recognising that there is far more we need to do.
4:05 pm
Paul Murphy (Dublin South West, Solidarity)
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To put it bluntly, the Government is failing to listen or to address the needs on the required scale. I agree that, in addition to increasing funding, it is about listening to affected communities about what is really required and what works. Funding is part of the solution.
On the staffing gap, there are approximately 10,000 mental health whole-time equivalents, but A Vision for Change recommends having 13,000 such posts. How will that be addressed without a substantial increase in funding? What about the argument - with which I agree - of Mental Health Reform that the office of a national director of mental health should be reinstated in order to properly co-ordinate funding across the country? It is striking that when the State fails to deal with its responsibilities to provide these services as part of a properly funded national health service, the burden falls on many others across society. There was a briefing of community groups in the audiovisual room earlier today. They are struggling to provide help to those who need professional mental healthcare.
There is a broader point about what has been referred to as the mental health plague in our society. Mark Fisher, the late socialist author, wrote: "Capitalist realism insists on treating mental health as if it were a natural fact, like weather ... we need to ask: how has it become acceptable that so many people, and especially so many young people, are ill?" There has been an explosion in mental health problems not just in Ireland but across the world. That relates to the levels of alienation and oppression in our society.
Jim Daly (Cork South West, Fine Gael)
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I agree with the Deputy's last point. I am not trying to pass the buck but there are wider questions to be answered on a societal level. We need to look at the cause of these issues and what is driving them rather than treating the symptoms.
The Deputy referred to recruitment. There are challenges in that regard but, as I have said repeatedly to officials in the Department, that is no excuse. We must do more. There is a global scarcity of highly specialised trained mental health professionals. The Deputy asked what we are doing about it. Money is one aspect of the issue. I have limited control over the budget.
I have looked at how it is done in other countries. Of great interest is how other countries are utilising the online space to deliver consultant psychiatry. Rather than having a consultant psychiatrist in the emergency department of Cork University Hospital waiting for one or two presentations in a 24 hour period, another in Waterford hospital and another in Kerry, one consultant could cover the three sites using a screen. Mental health care can be delivered online. That is being done in other countries such as the United States and Australia. We are making psychology available online 24-7. Many people are more comfortable availing of it online. The anonymity involved suits people as they do not have to go in and register their name and address and so on. Mental health is an area in which that can be done.
We have also developed a crisis text line which will be live before the end of the year. That is a very significant investment which will cost approximately €2.5 million per year. Similar initiatives have enjoyed phenomenal success worldwide. I do not have time to go into its merits. We also offer other digital supports such as cognitive behavioural therapy. We are embracing the role of technology and seeing how it can assist in dealing with the lack of availability of specialists by maximising their contribution while making services more accessible.
I refer to the serious mental health crisis among the Traveller community. Suicide prevention is key and safeTALK training needs to be rolled out in those areas. We need to look at new ways of dealing with old problems rather than trying to blame it on a recruitment and retention challenge.