Concern with funding for Mental Health Services. Dan Neville TD on Finance Bill

Speech by Dan Neville TD on Finance Bill in Dail Eireann 6th November 2013

Deputy Dan Neville: I want to deal with the funding of mental health services, an issue which has been neglected for decades.  While €20 million was allocated for the development of mental health services, there is concern that the promised €35 million did not accrue in the budget.  In the last two budgets the Government contributed €35 million each year for the development of the services and the programme for Government guaranteed that the Government would ring-fence €35 million annually from the health budget to develop community mental health teams and services as outlined in the recommendations in “A Vision for Change” to ensure early access to more appropriate services for adults and children and improve integration with primary care services.  While the €20 million is welcome, there is disappointment that the expected €35 million did not accrue in the budget.

The College of Psychiatry in Ireland points out that just over 5% of the overall health budget was spent on mental health services in 2013, down from 13% in the 1980s.  Meanwhile, funding for mental health services overall has fallen from €937 million in 2006 to €733 million in 2013.  The College of Psychiatry in Ireland notes that just over 5.2% of the overall health budget is spent on mental health services, a far lower figure than is recommended for a developed country.  In 2006 the Government published a blueprint for mental health services, ‘A Vision for Change’.  It recommended gradually building up the mental health budget to 8.24% of the entire health budget, but this has not happened.  It is interesting to note that in the United Kingdom the mental health budget is 12% of the total health budget.  The College of Psychiatry in Ireland has called on the Department of Health and the HSE to ensure mental health services receive the percentage of the health budget envisaged in ‘A Vision for Change’ over a period of time, as promised.  The president of the college, Dr. Anthony McCarthy, said:

How we treat the most vulnerable in our society is a measure of what kind of society we are, and when people are unwell they may not be in a position to advocate for their needs, and those entrusted with responsibility have a duty of care to ensure their voice is heard.

The mental health association Grow also expressed concern about the funding allocated for mental health services in the budget.  While there was some welcome for the Government’s providing €20 million to support these vital services, Grow’s CEO, Ms Michelle Kerrigan, criticised the fact that almost half of the funding promised in each of the last two budgets had not been allocated this year.  She said:

This will have significant effects on community mental health developments and the services people could have and should have on their doorstep.  Now more than ever there is a huge demand on community mental health services and [the budget] will see even more people being forced onto ever-lengthening waiting lists.  It will result in more people turning to thoughts of suicide and self-harm, and will place greater pressure on voluntary organisations like Grow to step in and bridge the gap.  It is going to put a huge strain on mental health services in this country.

While we recognise that €35 million was allocated in the past two years, the low level of implementation of the programmes that were to be implemented was very frustrating.  In 2012 the €35 million was primarily to be used to further strengthen the community mental health teams in adult and child mental health services, advance activities in suicide prevention and initiate the provision of psychological and counselling services for service users in institutional and community-based care.

Some 414 positions were approved for the community mental health services under that plan, but we are told that budgetary pressures within the HSE delayed the full utilisation of this funding in 2012.  However, it was made available subsequently in an additional budget in 2013.  Of the 414 posts approved in 2012, some 397 have been filled or are awaiting clearance.  This is reasonably close to the target, but it is two years since the allocation of the moneys by the Minister for Finance.  Some 477 posts were approved for last year’s budget for mental health services, but by August this year, just 220 of these posts had been accepted, with a further 24 offered to candidates.  This implies that nobody had been appointed up to August.  I understand filling posts takes time, but I cannot understand why it takes so long.

In 2012, the first recruitment took place as late as October, despite the moneys having been allocated in the budget for that year.  We all understand there is a procedure to be followed for recruitment and that some posts are difficult to fill.  I know from discussions on the issues that it is difficult to recruit some professionals.  These positions are to fill vacancies in the community based mental health services, so we are talking about psychiatrists, psychotherapists, occupational psychologists, family psychologists and a range of professionals.  Of the 233 posts remaining to be filled for last year, 162 are at various stages in the recruitment process.  Therefore, while funding was allocated in 2013, there are still a considerable number of posts where recruitment has not even started.

The national recruitment service creates national panels in anticipation of vacancies.  It points out however that on occasion it is difficult to fill posts for various reasons, including availability of qualified candidates and geographical location.  That is understandable, but my concern is the time lag that exists in regard to implementing recruitment provided for by the moneys allocated by the Minister.  In addition, specific specialist staff are required to fill 91 of these posts.  The national recruitment service and the mental health service tell us they are working to improve the process.  On the issue of child and adolescent mental health services, there are currently 61 teams in place.  The recommendation in A Vision for Change was 100 teams.

In 2012, some 150 of the 414 additional posts for mental health were allocated to community mental health services.  The budget for the National Office for Suicide Prevention was increased from €4 million to €7.9 million in the past two years.  Now, from a budget of €20 million, just €4 million has been allocated to the National Office for Suicide Prevention.  I ask the HSE to look at improving funding to that office.  In each of the old health board areas there are suicide liaison officers who deal with communities in difficult situations.  These officers should be brought under the auspices of the National Office for Suicide Prevention to ensure co-ordination between all suicide prevention initiatives from the HSE.  Gerry Raleigh has been director of the National Office for Suicide for the past 12 months and with him as director there is an excellent opportunity to co-ordinate all the activity of the HSE on suicide prevention and research.