Mental healthcare needs strategic vision and action plan
Even within current budget constraints, it is possible to make progress towards more equitable, accessible, responsive and effective care
According to Budget 2015, key among the Government’s health policy commitments is to further develop community mental health services. While this explicit commitment to progressing mental healthcare is laudable, there is little to indicate that this Government has the strategic vision to do what successive governments have failed to do: to create an efficient and effective mental health infrastructure that meets the needs of all Irish citizens.
The latest budget allocation for mental health is wholly inadequate to respond to the burden of disease that is associated with mental ill-health. Our most recent epidemiological data suggest that, by the age of 25, more than half of the Irish population will have experienced mental ill-health.
The impact of mental ill-health extends far beyond the individuals affected and is felt by families, communities and wider society. Although the potentially devastating personal costs associated with the experience of mental ill-health are impossible to quantify, a report by the Mental Health Commission’s Economics of Mental Health Care in Ireland Report (2008), estimated the economic cost of mental ill-health to be approximately €3 billion, or about 2 per cent of GNP. Of this, about €1 billion related to direct costs for the provision of care to people with mental ill-health and €2 billion accounted for costs associated with lost economic output as a consequence of mental ill-health.
Eight years later, evidence of the economic and social consequences of mental ill-health have been exposed in the recent Mental Health and Integration report by the Economist Intelligence Unit. It found an unemployment rate of 82 per cent among people in Ireland with serious mental health difficulties, with Ireland’s efforts at ensuring the social integration of those experiencing mental ill-health ranking at 14 out of 30 among the European countries reviewed by the unit.
Given the scale of need and the history of underinvestment in mental health, it is all too easy to focus only on the stark fact that the proposed funding for mental health in Budget 2015 is yet again insufficient to resource the kind of transformative change that is needed in our systems of care.
There is no doubt that it reflects a lack of understanding of the personal, health, social and economic consequences of mental ill-health and a reality that mental healthcare continues to be viewed as a type of healthcare luxury.
Even if there was a political will to invest in mental healthcare, the type of resources that are required to transform mental healthcare in Ireland will certainly not become available for some time.
Underinvestment is not the only risk to the future of mental healthcare in Ireland. Even within the current budget constraints, it is possible to make progress towards more equitable, accessible, responsive and effective mental healthcare.
The real risk to progress lies in the continued absence of any strategic vision and action plan. To have any chance of making meaningful and lasting change the Government must take the following actions as a matter of urgency:
1 Develop a comprehensive mental health strategy
It is imperative that a comprehensive and cohesive mental health strategy is formulated as a blueprint for the future development of the infrastructure of mental healthcare, from mental health promotion to the provision of specialist psychiatric assessment and treatment. Policy alone is insufficient to drive meaningful change. Policy lacks specificity in where and how scarce resources will be allocated to achieve the type and quality of services that it espouses. That is reflected in the legacy of ad-hoc and reactive approaches to the development of mental healthcare in the six years since Ireland’s mental health policy, A Vision for Change (2006), was published.
2 Use evidence to inform the strategy and action plan
The provision of equitable and efficient healthcare must be informed by evidence, such as rates of illness or disease in the population; data about populations at high risk for mental ill-health; evidence for the health- and cost-effectiveness of targeted interventions; and outcome data on the effectiveness of mental healthcare.
The absence of this type of evidence has and will continue to impede the strategic development of services in Ireland. Equitable and effective distribution of resources does not always mean equal distribution.
To have any hope of developing an evidence-based mental health strategy, the Government must commission targeted research. Every mental health service should integrate standardised outcome measures to evaluate its effectiveness and efficiency.
3 Audit, co-ordinate and reconfigure mental healthcare
Mental health services could be vastly improved if they were co-ordinated and reconfigured. These types of simple changes to how we structure our services have the potential to transform the delivery of care and are largely cost-neutral.
The number, quality and effectiveness of mental health services within the NGO sector needs to be audited as a priority. Most of these services receive Government funding and an audit of the NGO sector would highlight duplication and inefficiencies. It would also help co-ordinate organisations to maximise their effectiveness and the efficiency of their funding.
Areas of our public mental health services need to be reconfigured to make them more efficient and responsive. For example, it is more than achievable to develop colocated models of care that involve both child and adolescent and adult mental health services to ensure the seamless delivery of mental healthcare during the transitional phase from adolescence to adulthood.
In time, it is expected that the mental health of populations across the world will worsen. The latest World Health Organisation estimates suggest that by 2030, depressive illnesses will be the leading cause of disease in high-income countries.
If these predictions are accurate, we can expect a mental health pandemic over the next 20 years unless we focus our efforts on a co-ordinated and strategic action plan to enhance our mental health infrastructure and to protect against a future mental health crisis.
The Government must take a position of leadership in the mental health sector and translate the long-standing vision for mental healthcare into a credible strategy that is fit for purpose for a modern Ireland.
Helen Coughlan is clinical research fellow at the department of psychiatry at the Royal College of Surgeons in Ireland, and part of the RCSI Psychiatric Epidemiology Research across the Lifespan (PERL) Group, which is concerned with understanding the prevalence and determinants of mental ill-health. You can watch Coughlan’s RCSI MiniMed lecture “Mental Health Matters: a guide to nurturing your mental health and to recognising and responding to signs of mental health problems” at youtu.be/CJOScqtMvQ0