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Providing good mental health services is a necessary investment in the future
There is an urgent need to address the area of mental health. This arises not least in light of a World Health Report IN 2001 showing that mental health and behavioural disorders are common, affecting 20–25 per cent of people at some time during their life. As well as having a major impact on individuals, they have large direct and indirect consequences. For example, in 2000, mental and neurological disorders accounted for 12 per cent of the total disability-adjusted life years (DALYs) lost due to all diseases and injuries. By 2020, it is projected that the burden of these disorders will have increased to 15 per cent. This has serious implications for services in all countries in coming years. In Ireland, the Pfizer Health Index suggested that about a quarter of Irish adults have reasonably direct experience of mental health issues, and almost 3 in 10 had experienced an incident of depression within their family circle or close peer group.
The policy blue-print, published in 2006, A Vision for Change – Report of the Expert Group on Mental Health Policy, offered many worthwhile pathways to adequately address mental health issues in Irish society. Unfortunately, as noted already the pace of implementation has been extremely slow. Between 2008 and 2012, there was almost no increase in the transfer of either budget or staff from hospitals to the community resulting in the under-provision of community services and the overmedication and increased hospitalisation of people with mental health problems. Readmission rates were also found to have increased.
Funding has been allocated in recent budgets for mental health services. Social Justice Ireland welcomed these, including a considerable allocation announced in Budget 2019. However, progress in implementation has continued to be slow related partly to recruitment difficulties. According to the HSE, at the end of 2016, for example, staffing levels in General Adult Community Mental Health were still at approximately 74.8 per cent of the clinical staffing levels recommended in A Vision for Change. The mental health services are going through a significant change process at a time when demands on services are growing in line with population increases. It is vital that ongoing reductions in inpatient beds are matched by adequate and effective alternative provision in the community.
There is a need for effective outreach and follow-up programmes for people who have been in-patients in institutions upon their discharge into the wider community. These should provide:
- sheltered housing (high, medium and low supported housing);
- monitoring of medication;
- retraining and rehabilitation; and
- assistance with integration into community.
In the development of mental health teams there should be a particular focus on people with an intellectual disability and other vulnerable groups, including children, homeless people, prisoners, Travellers, asylum seekers, refugees and other minority groups. People in these and related categories have a right to a specialist service to provide for their often complex needs. A great deal remains to be done before this right could be acknowledged as having been recognised and honoured in the healthcare system.
The connection between disadvantage and ill health when the social determinants of health (such as housing, income, childcare support, education and so on) are not met is well documented. This is also true in respect of mental health issues.
Research and development in all areas of mental health are needed to ensure a quality service is delivered. Providing good mental health services is a necessary investment in the future wellbeing of the country. Public awareness-raising should continue, to ensure a clearer understanding of mental illness so that the rights of those with mental illness are recognised.