There are more than 2,600 fewer staff working in mental health services than recommended in the official Government policy for the sector, the HSE has revealed.
The HSE also said in an answer to a parliamentary question tabled by Fianna Fáil health spokesman Stephen Donnelly that it would cost an additional €189 million to fully meet the employment targets set out in the national mental health policy document, "A Vision for Change".
Staffing and funding shortfalls in the sector are also criticised in a submission to the Oireachtas committee on health by the Mental Health Commission ahead of a hearing on Wednesday.
In an opening statement, the Commission's chief executive John Farrelly said the decision by the HSE to remove the post of national director for mental health had sent out "a clear and unambiguous, although perhaps unintended, message that mental health is not a priority".
“It is also evident to the Commission that this has negatively impacted on the delivery of services nationally. ”
The Commission is the regulator for mental health services in Ireland. However, it said that under existing legislation the statutory scope of regulation was limited to in-patient services only.
"Though the Inspector of Mental Health Services can inspect all mental health services, there is effectively no regulatory oversight of the majority of services that are delivered outside of inpatient facilities. We welcome the work of Minister for Mental Health and Older Persons Jim Daly to drive change in this area by commencing a process to amend the current Mental Health Act."
Separately, trade union Siptu argued that the focus of management in the HSE, Department of Health and the Department of Public Expenditure was centred almost entirely on cost cutting from the first day of every year.
The union's health division chief Paul Bell told the committee "the system of approval for the filling of vacancies or for submitting business cases for the replacement of new/existing posts is designed to frustrate and most importantly not do what is needed, fill vacancies".
“Line managers and staff within the system are left totally demoralised at the extensive effort and repeated procedures required in order to fill vacancies for essential posts. Even where replacement of a post is approved, it is common that recruitment takes well over a year to complete. During this time, staff are left carrying the demand of the service all too often with insufficient staffing levels. This does not just affect the replacement of vacancies as it is the same procedure which also undermines the replacement of maternity leave etc. In such circumstances, it is commonplace the HSE may confirm replacement of a maternity leave literally weeks before the staff member is due to return to the workplace.”
Mr Bell said the current model of funding for the health service was “destined to fail each year” .
Mr Farrelly in his statement said that mental health services in Ireland had significant resourcing challenges, not least in relation to staffing. He said that to make progress in these areas, adequate funding was required.
He welcomed additional money earmarked for mental health services this year but said current expenditure in the area was still less than the 8.24 per cent target envisaged under the national policy.
“The HSE’s workforce planning document, published in October 2018, outlined that the mental health workforce is at 76 per cent of the levels recommended in ’A Vision for Change’.”
“Based on our inspections, we are aware of the serious effect that a lack of adequately trained staff has on the quality and quantity of services that can be provided. “
The Commission said while funding was fundamental to transforming mental health services, there was a need to change how the State used the money currently available.
“For example, creative and innovative approaches, improved team working, building up community services and changing work practices are having an impact in certain community health organisation areas, while others appear to be stagnant, trapped in a closed loop of unhealthy logistical and clinical practices from the traditional institutional system.”