Wednesday, 11 July 2012
Mental Health Services
In December last, I praised the budget 2012 commitment to invest €35 million in mental health services, of which €23 million was dedicated to developing community mental health teams for adults and children.
Along with many others with an interest in mental health, I was alarmed to read in a newspaper report over the weekend in The Irish Times that part of the €35 million investment in mental health services could be used to offset overruns in the HSE. This report was swiftly countered by the Minister of State's Cabinet colleague, the Minister for Public Expenditure and Reform, who gave assurances on the RTE Radio 1 programme "This Week" on Sunday that the promises of additional posts for mental health services would be delivered. My first request is that the Minister of State take this opportunity to give me the same assurances in this regard.
In budget 2012, a further commitment was made to recruit 414 staff for community mental health teams, of which 250 posts were to be in dedicated adult teams. I am extremely disappointed that not one position has been filled although it is now July 2012. The Minister of State is, more than most, acutely aware of the wide-ranging benefits of community-based mental health services. Among many other benefits, community-based mental health services enable people to be treated for mental distress in their communities, either at home or in a hospital, minimise inpatient and day-case hospital stays, liaise with local community services such as vocational training, education, housing and voluntary support services to provide integrated recovery support for the individual, and support primary care staff in providing mental health support. Furthermore, having accessible mental health services in the community can help normalise mental health and destigmatise mental health problems, reducing the prejudice and discrimination that people currently face. Community mental health teams are a vital part of the recovery ethos which is central to A Vision for Change. The community-based mental health services envisaged in A Vision for Change are specialist services with staff who have particular expertise in supporting people's mental health.
Core services offer a holistic range of supports and include staff from a range of specialist disciplines such as clinical psychology, mental health nursing, occupational therapy, psychiatry and social work. However, the specialist disciplines mentioned remain significantly understaffed. Back in 2010, a report by the Inspector of Mental Health Services on an audit of community health staffing showed that only 50% of the required number of psychologists and only 60% of the required number of occupational therapists were in place.
In addition to my concern about the existing under-staffing, I am concerned by reports from the coalition group Mental Health Reform that the Irish Mental Health Commission is no longer collecting data on staffing levels in approved centres. This gap in data will make it extremely difficult to assess whether staffing levels are reaching the recommended level as set out in A Vision for Change. My second request is that the Minister of State tell us what information has she in this regard. Perhaps she can provide me with assurances that data will be collected.
The Minister of State recently confirmed that 31 of the promised 414 posts in community mental health teams under the HSE service plan 2012 will be converted to nursing posts for acute inpatient services in Dublin-mid-Leinster region. Mental health services in Ireland have for far too long been the Cinderella of the health services. The 414 staff promised in the HSE service plan should not be deployed in inpatient services and must remain in the community. Staffing needs to be ring-fenced. The continuing uncertainty over the future of the mental health budget does nothing to allay fears about the Government's commitment to invest the dedicated €35 million I mentioned at the start. My third and final request is that the Minister of State confirm that the badly needed posts in community mental health teams will be in place by September, and that the posts will be ring-fenced to ensure they are not diverted to inpatient services.
I am always reluctant to read a script. As the last script got me into so much trouble, I am even more reluctant. I am always reluctant to read a script when it comes to mental health, but there is an element of this that Senator van Turnhout needs to hear.
Dublin-mid-Leinster has had a significant shortfall of nursing staff in mental health services but compares favourably with other regions in terms of numbers of allied health professionals. The nursing staff ratio in the region is far lower than that of other HSE regions and the number of allied health professionals in Dublin-mid-Leinster, as I stated, compares favourably. It should also be noted that Dublin-mid-Leinster has made considerable progress in reducing acute bed numbers and usage in line with A Vision for Change. It is now at a point where existing acute bed numbers need to be broadly maintained to ensure a safe and regulation-compliant level of service.
What happened with regard to the conversion of the 31 posts was that Dublin-mid-Leinster had reached the level that A Vision for Change required far more quickly than any other region. Then, with the exodus in February and March, the numbers fell below the safe level that the commission recommends and insists on, and it was necessary to convert some of the posts into nursing posts. That did not affect the allied health professional posts; we managed to put those in place as well.
Senator van Turnhout was not the only one who was surprised at the weekend reports that the €35 million could possibly be used for other areas. That week, I had been in consultation again with the Minister for Public Expenditure and Reform, Deputy Howlin, and had it confirmed to me that the €35 million was still safe and sound in the Department. By the way, it is still in the Department. As normally happens with budgets for any health service, when the mental health budget and the €35 million were announced, the regional directors of operations, who do an extraordinary job in delivering the service, including in Dublin-mid-Leinster, contacted the Department and asked for the €35 million to be split and sent down pro rata. That is always how it is done: they state that their budget for last year was X and they need X this year, and they ask the Department to send it down. We said "In this instance, no". We asked them to carry out a gap analysis and tell us what they were missing, where it was missing from and what was required, and we told them that until the exercise was done, none of the €35 million would be released. That, as Senator van Turnhout can well imagine, takes a degree of work and investigation. Also, once it had been signed off, they then had to go away to recruit and appoint from existing panels. However, for some allied health professionals we did not have enough people on the panels, and some of the panels had run out as they only last two years. That has all now been done. The people will be in place by September and then the funding will be released. Some might say there is a lack of trust. However, we all know what happened to budgets for mental health in the past and we were determined it would not happen this time. They will be in place come September and we will have a full complement of allied health professionals. There are areas which did not get anything this year. Child and adolescent mental health services, for instance, got 150 new posts, but the payback is that it will have to treat persons between the ages of 16 and 18 because they are children. There are 250 posts in adult psychiatric services and ten new posts in the national counselling service. All of that is being put in place.
There were three areas in which we did not do anything this year. We have met with representatives of these areas; they know they will be prioritised next year, and they are happy enough about that. The areas in question are old age psychiatry, intellectual disability psychiatry and forensic psychiatry. We could not do it all in one year. It will be done over a period of years.
On the issue of data, as I have stated previously, we have real-time data for children - who is being treated, where they are being treated, what they are being treated for and by whom, what are the pathways involved and how long they will be in the service. These data are from a service that has been in existence for 12 years. In adult psychiatric services, we still do not have that type of detail. When one considers that such information used to be gathered by pencil and biro, and the systems we have in place now, one realises that such real-time information needs to be provided for adult psychiatric services as well. Some are good at it, some not so good. That is just not good enough.
Another difficulty we faced - the conversion of posts was part of this - was that, because the Mental Health Commission licenses the acute units, there are levels of staffing and so on that need to be complied with. We intend, under the review of the Mental Health Act, to license the community teams as well so that there will be parity.
I would like to have half an hour to talk about this. It is probably my favourite subject, and I think that tells Senator van Turnhout something about me. We are moving ahead. The capacity legislation, which will need to dovetail with the review of the Mental Health Act, will provide a safety net. There are already community mental health teams in operation; for example, in Cork North-Central, where Mr. John McCarthy lived. I am sure the Senator is familiar with the work being done there. The team is working extremely well and those who need them receive daily visits. I have received great reports about this service, which should be in place everywhere. I thank the Senator for raising this issue.
The Minister of State knows the value of community-model mental health services. While I appreciate her comprehensive response, she need only come to the House for the Order of Business on any day to hear about the effects of the ongoing failure to provide community mental health services. The issue is raised repeatedly by Senators. The process of filling posts must be fast-tracked. I will continue to follow up on this issue, on which the Minister of State has the support of the House.
We must manage expectations. When the teams are in place we must be conscious that they will require a settling-in period and must gel if they are to work well. They also need to know what we expect from them. A Vision for Change set out where the teams should be, whom they should serve and what should be on the table. We now need to start looking beyond that and plan the process. What do we expect of the teams and of mental health services?