Crisis in mental health services

 

Sir, – I read with sadness but no great surprise the article on mental health services in Ireland in last weekend’s Irish Times (Patrick Freyne, “Ireland’s mental health pandemic: from crisis to emergency”, January 23rd).

As a psychiatrist in practice for many years, it is deeply frustrating to me that the experience of so many people in the public mental health system is such a negative one. The article alluded to many of the reasons for this distressing state of affairs – the low percentage spend of the health budget on mental health services at 6 per cent, patchy resourcing of community mental health teams, failure to provide cover for staff on periods of extended leave and the knock-on effects of demoralisation on patients and professionals alike. The failure to implement properly successive strategy documents is responded to by the production of yet another document rather than addressing the deficits in a creaking system that is not for for purpose. The atrocities perpetrated in the mother and baby homes occurred behind closed doors and we console ourselves that such prejudices have no place in modern Ireland. Yet within plain sight the stigmatisation continues of mental illness, people with mental health problems and the professionals who treat them. In relation to Covid-19 for example, the majority of acute mental healthcare units, rehabilitation units and long-term psychiatric care settings have been excluded from the initial vaccine rollout. Only a minority of staff in community mental health teams have received the first dose of the vaccine, with reports of people being told that they do not qualify as frontline healthcare workers.

These are not isolated incidences; they signify a deeper malaise endemic in Irish society where people with mental health problems do not enjoy parity of esteem with patients suffering physical health problems and where mental health professionals are constantly fighting a rearguard action to justify our existence. – Yours, etc,

Dr AISLING DENIHAN,

Consultant Psychiatrist,

Castleknock,

Dublin 15.

Sir, – We would like to congratulate Patrick Freyne on his excellent article. Very wide ranging, it correctly identified many of the serious problems with our mental health services.

These fall into two main categories. First, there has been, and continues to be, a chronic and scandalous funding deficit for mental health services for too many years. They receive between only 5 per cent and 6 per cent of the health budget, despite numerous budget submissions, with clear reasoning, to successive governments highlighting the need for 12 per cent.

Second, as your reporter pointed out, Ireland is rich in wonderful policies relating to models of how a quality mental health service should look, with the latest being Sharing the Vision. However, these excellent policies continually fail to be implemented due to consistent underinvestment and a lack of urgency and ambition.

This state of affairs preceded the Covid-19 pandemic and, as we all know, pandemics exacerbate inequalities.

One example of our inaction prior to, and during the pandemic, has been the lack of development of a fit for purpose IT infrastructure nationally, with relevant capabilities and support, for mental health services.

This includes failure to develop a basic secure electronic patient file for all service user information and a continuing failure to introduce compatible electronic platforms nationally to allow online medicine and psychiatry to operate effectively. Yet this is in an era when many very young children can use a smart device and many adults can manage their lives using available electronic apps.

One could contrast this with the speed and efficiency with which the Government rolled out the pandemic unemployment payment for those affected by closure of business due to the Covid-19 situation.

The one glimmer of hope in these difficult times has been the development of vaccinations to deal with Covid-19. Yet, even here, we note that within the Covid-19 vaccination framework implementation document, plans for vaccination for those with moderate to severe mental illness, their psychiatrists and other healthcare professionals involved in their treatment are omitted.

One has to ask whether we as a society, together with our representatives in Government, are serious about providing mental health services and supports for those with moderate and severe enduring mental illness, such as schizophrenia and severe depressive disorder. Services that will help them to lead the full, quality lives to which they are entitled . – Yours, etc,

Dr MAEVE DOYLE,

Director,

Communication

and Public Education,

College of Psychiatrists

of Ireland,

Dublin 2.