Mental health is the Cinderella of the HSE and we're all losing out as a result
Published 06/10/2015 | 02:30
Tánaiste Joan Burton recently said that the Budget isn't a "parlour game in which everybody puts out what they would like".
However, the Government cannot reasonably expect long-neglected sectors to sit quietly and wait for crumbs from the table.
Game or no game, mental health services, in particular, have for far too long been on the losing side in Ireland.
The real losers in all of this are those who experience mental distress and reach out to a service that is overstretched, understaffed and lacking in system-wide, accountable leadership.
The response that people get depends very much on where they live, a fact that exposes the inequity in our system - inequity in terms of resources, scope and quality of the mental health services and supports on offer in different parts of the country.
The HSE's plan for 2015 shows the difference in mental health spending in the newly established Community Healthcare Organisations (CHOs) - geographical boundaries dividing the country into nine administrative areas.
In CHO 7, which covers Kildare/West Wicklow, Dublin West, Dublin South City, and Dublin South West, we see that just 10.2pc of the mental health budget is spent, despite this area having 13.8pc of the population of Ireland.
In other areas, it swings the other way.
CHO 2, comprising Galway, Roscommon and Mayo, gets 12.6pc of the budget, although its population is only 9.7pc of the national total.
At public meetings held by the national coalition Mental Health Reform this year, people voiced again and again what this inequity means on the ground.
They spoke of having difficulty accessing mental health supports in a crisis, losing out on key therapies due to staffing shortages and of being offered a medication-only approach.
And, something that gives us hope and frustration in equal measure, we heard about pockets of innovation and excellent service in some areas that should be available to all, but are not.
Despite budget commitments in recent years for funding for community-based mental health services, Ireland's spending on mental health is still less than half that of our nearest neighbours in the UK when taken as a percentage of the overall health budget.
At the moment Ireland spends about 6pc of the overall health budget on mental health.
In 2014, this amounted to €735 million; in the UK, though, spending is at 13pc of the overall health budget.
Mental health services have seen decades of neglect and have traditionally been the Cinderella service. There is a lot of ground to make up.
It would be helpful if Minister for Health Leo Varadkar showed more explicit commitment to improving mental health services and recognised in his public utterances on health that there is "no health without mental health".
Parity of esteem between mental and physical health has been a high-profile political issue in the UK for a number of years.
The National Health Service in England has even established a Parity of Esteem Programme to "focus effort and resources on improving clinical services and health outcomes".
The Programme includes efforts to improve access to talking therapies as a way of enabling people to manage their difficulties and recover their well-being.
Investment in such a programme makes sound economic sense when you consider that mental health problems impose a total economic and social cost of over £105bn a year in the UK.
Here in Ireland, the equivalent cost of mental health difficulties is estimated at 2pc of GNP.
Since the move to community-based services starting in the 1980s, mental health services have had little measurement system, with no data being kept on the numbers of people using mental health services in the community, treatments provided, waiting lists, or the health and social outcomes for people, and so on.
When she stepped down from her role as head of the State's health watchdog, The Health Information and Quality Authority, last year, Tracey Cooper shared some cautionary words.
She said that the health service "doesn't know how many patients it is killing and harming".
To turn this on its head, shouldn't a health system know how many people it is healing and helping?
Shouldn't a mental health system know how many people it is helping to recover?
To this day, many mental health staff do not even have access to computers to perform basic tasks like sending emails.
It begs the question as to how you can exercise the kind of clinical governance and the management planning needed if you don't have the information.
This same lack of effective, clinical governance was highlighted in the recent Mental Health Commission report on the Carlow/Kilkenny/South Tipperary mental health service.
The report found that "16 and 17-year-olds in South Tipperary were not receiving an adequate, safe service" and that the clinical governance groups in the service were "not an effective forum".
As a first step to a solution, the Department of Health should ensure that the HSE implements a national mental health information system in 2016.
This system would report on the extent of service resources, provision, quality and outcomes for community-based mental health service delivery.
There is also an urgent need to put in place statutory regulation and inspection of community-based mental health services.
Ireland also needs to have an independent body in place with the power to set national clinical guidelines.
Only then will we know if the investment in mental health services in recent years has brought about real improvements in the service being offered and the lives of those who experience mental or emotional distress.
A sustained focus on reducing variation across the country is of the utmost importance.