Young need action, not words, on mental health
Fine words have been exchanged in the Dáil in recent days about the need to address deficiencies in the mental health services.
The Taoiseach has acknowledged that waiting lists for child and adolescent mental health services are unacceptably high; Micheál Martin has said that mental health must be a priority in the Budget. But on Budget day on Tuesday, will these fine words translate into action?
Will we see the public mental health services receive the funds promised in the agreement between Fianna Fáil and Fine Gael when this Government was established? Will mental health be given parity of esteem with physical health? Or will we see once again, as in years past, that the pain of mental distress is considered less important than our physical ailments?
The omens are not good. Year on year, mental health services have lost out to other parts of the health budget. In 1984, mental health spend represented 13pc of the health budget; in 2017 it was just 6pc.
Currently, we spend less than half the proportion spent by Britain. Sláintecare recommended that the mental health allocation should go up to 10pc, but translating aspirations into reality has been the difficulty over and over again.
Of course, you get what you pay for. The HSE's own information shows that Ireland is suffering with a mental health system reflective of its low resources.
As of July, 2,419 children and adolescents were waiting for a first appointment with mental health services and 218 had been waiting for more than a year;
6,000 children were waiting for primary care psychology appointments;
Much of the country has no out-of-hours specialist mental health service available for individuals in crisis, giving people no choice but to go to A&E when in severe mental distress;
In April of this year, 20pc of people referred to Ireland's national free counselling service had been waiting at least three months;
There is no specialist perinatal mental health service outside Dublin.
It is estimated that €65m is needed just to meet the current level of demand for care.
This is not extra money; it is core funding to ensure that there are adequate beds for people with highly complex, severe mental health difficulties who need long-term residential care; it is the funding that provides residential services for people with eating disorders; it is the funding for services that have a shortage of inpatient beds for people in acute mental distress.
It is the resource needed to respond to the 26pc increase in referrals to child and adolescent mental health services between 2012 and 2016.
When people wait too long for mental health care, their difficulties can escalate, leading to worse outcomes and higher social costs in the long term.
Aside from the human and social costs, there is a strong economic basis for investment in mental health services. The Healthy Ireland framework reports that the economic cost of mental health problems in Ireland is €11bn per year, much of which is related to loss of productivity.
In 2008, it was identified that mental health difficulties cost 2pc of GNP annually and most of the costs are in the labour market as a result of lost employment, absenteeism, lost productivity and premature retirement.
Of course, it's not all about more money. More than 11 years after publication of the national mental health policy, there is still no information system that reports regularly on what services that money provides, to whom and how often. Nor do we have any idea of how well our community-based mental health services perform.
How many people recover after receiving support from a mental health team? How many return to work or education?
That information is not available because the HSE still operates on paper records throughout the mental health services.
Still, the core issue is that there simply are not enough staff to provide the mental health services we need.
The HSE is short 20pc of the recommended staff overall and in child and adolescent mental health services, it has only half of the staff it needs. And these staffing shortages get compounded as frustration and low morale lead to more and more professionals leaving the public mental health services.
So the next time you hear a politician say that mental health is important to them, ask them if they are voting for €55m to be in the 2018 Budget to develop the services.
Ask them if they are putting in place the funding for mental health nurses, psychologists, social workers, psychiatrists and other social care workers - the human resources that must be there to help children and adults recover from a mental health difficulty.
And on Budget day, listen out for the sign that our politicians have turned their fine words into fine deeds.