Concern grows as strains on mental health policy intensify
Dwindling staff numbers and poor governance have taken their toll on mental health services
While some posts are taken up at the tail-end of the year, these time-related savings aren’t fooling anyone. Photograph: Getty Images
There is an alarm bell ringing across the mental health service. It’s the sound of anxiety that as demand rises and concern grows over suicide, cutbacks to crucial supports are placing badly needed services under real strain.
Latest figures show the number of suicides and people self-harming is up, while mental health groups such as Pieta House and others say they are struggling to meet demand for assistance.
There are some encouraging projects on the ground and new governance arrangements aimed at ensuring mental health has a greater level of priority. We are also making good progress in closing down out-dated institutions. But just when mental health services are needed most, say many campaigners and professionals, they are in danger of fraying at the seams.
You can’t fault the policy. A Vision for Change, published in 2006, set out a world-class blueprint on how to modernise mental health services within a decade, moving from old-style institutional care to a community-based model. It also promotes a recovery-based model where patients have a say in their care and where there is access to a wide variety of supports.
The problem is the implementation. Ongoing cutbacks to the public sector, a recruitment moratorium, delays over spending “ringfenced” money for community mental health teams all mean that progress in turning rhetoric into reality has been – in the words of the Mental Health Commission earlier this year – “slow and inconsistent”.
The Government and the Health Service Executive have difficult choices to make trying to spread scarce resources across a sector where everything seems to be a priority. But, in the case of mental health services, cutting back will simply store up problems for the future. As the Mental Health Reform lobby group argues, implementing a Vision for Change involves cost-effective solutions that, ultimately, would lead to more efficient and effective services.
The Government often points to its pledge to ringfence €35 million annually for the recruitment of hundreds of specialist staff as a sign of how committed it is to modernising the sector and fulfilling its policies.
It was a bold and ambitious pledge. But there is more than a hint of smoke and mirrors around it.
For one, a pattern has emerged over recent years where this ringfenced money ends up being diverted into containing cost-overruns in other parts of the health sector. Then, in order to keep up the pretence, some posts are taken up at the tail-end of the year, so authorities claim they have met their spending pledges.
These time-related savings aren’t fooling anyone. Last year, for example, the HSE announced a total of 414 posts would boost community mental health teams, suicide prevention and other crucial services.
By the end of the year, the vast majority of the posts weren’t in place. In fact, just 62 staff had taken up their positions in December. Mid-way through this year a majority of these 2012 posts were finally in place, but there were still major gaps.
Some 80 or more had yet to be appointed. The same pattern has emerged this year.
Why does this matter? Nurses and nurse managers say unfilled posts are resulting in professionals being pulled out of community services to plug gaps in inpatient care, a move that flies in the face of Government policy.