Wednesday 17 July 2019

Mental health services are too important to be allowed fall victim to short-term plans

'As the horse-trading over wish lists gets under way, my plea is for a commitment to ending the postcode lottery that people with mental health difficulties are forced to play.' Stock photo
'As the horse-trading over wish lists gets under way, my plea is for a commitment to ending the postcode lottery that people with mental health difficulties are forced to play.' Stock photo
Eddie Molloy

Eddie Molloy

Just days away from the General Election, speculation about the outcome is now rife. Paddy Power is offering odds on winners and losers and on which combinations will coalesce to form a government.

The current election campaign has been dominated once again by a daily catalogue of promises, however unaffordable, designed to achieve the short-term goal of getting elected. Immediately after the election the horse-trading will begin to thrash out a Programme for Government for the next five years. We can only hope, then, that when the serious business of constructing a Programme for Government gets under way, the new government will take heed of the multiple traumas suffered by the Irish people precisely because of the short-term mind-set that is deeply embedded in our political culture.

We have seen the curse of short-termism visited upon us with entirely predictable crises in homelessness, health, flooding, water, organised crime and the hollowing out of rural towns. A long-term perspective and plan is needed to address such matters.

One key public concern that cannot be shoe-horned into five-year election cycles is the poor state of our mental health services. It is too important, too all-encompassing to be allowed to fall victim to short-termism.

The need for long-term thinking was acknowledged with the publication in 2006 of 'A Vision for Change', the 10-year mental health policy. There has been some progress since 'A Vision for Change' was published, like an increase in the number of multi-disciplinary staff on mental health teams between 2008 and 2014. This means more people now have access to the support of psychologists, social workers and occupational therapists, and consequently less reliance on medication alone.

However, the overriding picture of our mental health services is one of patchiness. We hear of exciting, innovative projects in various parts of the country that foster recovery and social inclusion of people with mental health difficulties. But, welcome as these individual projects are, they do not add up to a national mental health system. Very few innovations have gone national. These isolated islands of progress can create a false impression of national progress, but don't amount to systematic execution in an orderly fashion.

Implementation of 'A Vision for Change' - a national policy, in place since 2006, that sets out the direction for Mental Health Services in Ireland - has always been a problem. This was evident early on from reports by the Independent Monitoring Group, the expert group tasked with monitoring progress. Having repeatedly reported disappointment at the rate of progress, this vital oversight group was disbanded in 2012. Since the group's demise, monitoring has fallen to the HSE, and to voluntary groups like the national coalition of NGOs, Mental Health Reform.

There is an enormous human impact of this failure to fully realise the promise of 'A Vision for Change'. One in seven adults in Ireland will have experienced a mental health difficulty in the last year, and we have one of the highest rates of male suicide in Europe. People with a mental health disability continue to face exclusion and social isolation and are nine times more likely to be outside the labour force. Those with severe mental health conditions die between 10 and 25 years earlier than the general population. The impact on families of a member's life-long mental health problem can be crippling. The economic cost of poor mental health is also considerable. Ten years ago, it was estimated that the cost to the Irish economy was €3bn, or 2pc of GNP. And yet the scale of what needs to be done seems to have escaped successive governments.

We need to have parity of esteem between mental health and physical health, and for mental health services to get the attention and financial investment so long overdue. Compared with other developed countries, the proportion of our total health budget spent on mental health is shamefully low - 6.5pc compared with 13pc in our nearest neighbour, the UK.

It is imperative that the Programme for Government includes an unqualified commitment to a new, long-term vision for mental health services, together with a time-lined implementation plan. Crucially, this plan needs an independent oversight structure to monitor its implementation and hold the next Government to account.

Until we get this kind of explicit government plan, then the mental health services will continue to be the Cinderella of our health services. Fixing the "nine hours on a trolley" problem will continue to drown out the pleas of distressed parents seeking help for their seriously disturbed child or suicidal teenager, who currently may have to wait months to be seen and properly cared for.

As the horse-trading over wish lists gets under way, my plea is for a commitment to ending the postcode lottery that people with mental health difficulties are forced to play in order to get help. It is high time for political parties to show they are serious and declare their commitment to "parity of esteem" for mental health services, as they have done in the UK.

Eddie Molloy is non-executive director of Mental Health Reform, which represents over 50 organisations involved in improving mental health services

Irish Independent

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