Teams of professionals needed to assist people treated in the community

Society will pay heavy price if we don’t invest in community-based mental health services

Psychiatry artefacts at Grangegorman Community Museum: while the closure of outdated asylums   is to be welcomed, we need to be able to look after patients released to the community. Photograph: Bryan O’Brien

Psychiatry artefacts at Grangegorman Community Museum: while the closure of outdated asylums is to be welcomed, we need to be able to look after patients released to the community. Photograph: Bryan O’Brien


It looks like major progress, on the face of it. Most of our Victorian-era asylums have finally closed and the number of inpatient beds for people with mental health problems is tumbling.

The State’s policy is now to provide care in the community where possible, rather than confine vulnerable people behind the high walls of outdated mental institutions.

Community-based care is a more effective – and humane – way of helping patients to recover, compared to the narrower “medical model” of institutional care.

But doing this right requires the development of teams of professionals: psychiatrists, therapists, nurses and social workers are all required to support those with mental health difficulties in a home environment.

But yesterday the Mental Health Commission warned that modernisation of our mental health services is in danger of “stagnating and moving backwards”.

As the human fallout from the economic collapse leads to an ever-rising demand for support and assistance, the gaps in community-based services are of real concern.

Staffing across mental health is about 3,000 below the levels set out in official policies eight years ago.

The programme for government – signed in 2011 – committed the Coalition partners to ringfence €35 million a year from the health budget to develop community mental health teams and more appropriate services for adults and children.

While many staff have been hired and services developed, there appears to have been a deliberate strategy to delay recruitment for as long as possible to save money.

For example, hundreds of additional staff promised last year are still not in place. And this year, just €20 million – rather than €35 million promised – is being made available.

This means there will be fewer additional posts for community-based services, suicide prevention and other supports this year.

If there are lessons to be learned, the UK is a good place to start. Its policy to close institutions and provide care in the community took place mainly during the late 1970s and 1980s.

But support services needed to help people with psychiatric problems live successfully in the community weren’t fully delivered.

The numbers of mentally ill people in jail or on the streets climbed significantly.

Today, as rents continue to rise and community supports are under threat, there is a real danger that vulnerable people will pay the price for under-investment and broken promises.

Community care means much more than simply closing down old units and providing new housing. It requires the right kind of staff to provide the right kind of support to help recover people’s shattered sense of self.

It’s also cheaper in the long run. There is less demand for costly inpatient services and it may even free up resources.

We shouldn’t be asking whether we can afford to do this – but if we can afford not to.

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