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HSE Cuts Mental Health Funding Even Further

category national | rights, freedoms and repression | opinion/analysis author Friday March 12, 2010 19:48author by Kieran McNulty - People Before Profit/Tralee Report this post to the editors

In January 2006 the Government accepted the recommendations contained in an independent report that it had commissioned, Vision for Change (VFC), as the basis for its future mental health policy. In the four years since the reportís publication almost nothing has been done to realise its full implementation.

In Kerry, Vision into Action (VIA) that would see the roll out of the policy in the county is officially on hold because no progress is being made on establishing community mental health teams. I was told this in last January during a telephone conversation with a member of HSE staff in Kerry involved in VIA.
There are two key related factors here. First, the over all health plan for this year, the HSE Service Plan 2010, states that the spend for the Irish health service has been cut yet again for 2010 by E668m down to E14.070bn. ( For mental health the situation is even worse. By EU 15 standards, Ireland should spend at least 12 per cent of its overall health budget on mental health. In the mid 1980ís the Irish State was spending just over this amount. By last year this figure had dropped to 6.9 per cent, and for 2010 it has been cut even more drastically to 5.4 per cent of total health spend. To a large extent this has been achieved by the second related factor, that of the continuing HSE staffing embargo. The net result of this embargo in terms of mental health is that staffing numbers in this sector have dropped from 10,476 to 9,772 in the last fourteen months up to February of this year. If one had any doubts of the neo-liberal philosophy of the HSE there is no need to look any further than the title of its current four year health plan, HSE Corporate Plan 2008-2011!
On the current staffing embargo, Caroline McGrath, Director of the Irish Mental Health Commission, commented:

ďThis moratorium is a crude and brutal instrument that is crippling the Governmentís reform programme, as outlined in . . . A Vision for Change . . . The Governmentís plan for moving from acute hospital care to a community based service was based on redeploying existing staff and expanding the total number of staff. Instead we have a service that is not even maintaining the status quo but is haemorrhaging staff, reducing A Vision for Change to a mere pipe dream . . . Clearly, too, the fact that mental health problems cost the exchequer E3bn per year has not been appreciated.Ē

The consequences of the Governmentís short-sightedness is that mental health staff feel increasingly frustrated, and that their idealism and dedication is being abused. Increasingly mental health patients are being issued with medication -- to the delight of pharmaceutical corporations-- because the government refuses to adequately fund an alternative social model, or recovery model, of mental health, that would provide alternatives to pills.
As suggested in VFC, this model would include increasing staff numbers generally especially in the areas of psychology, counselling and occupational therapy. Greater funding would be provided for far increased mental health service user input and for initiatives such as for autonomous service user led drop in centres, perhaps as community development programmes. The minister responsible for mental health, John Moloney, is hoping to raise capital (not human resources) funding from the sale of long-stay psychiatric institutions, which should have been done years ago, but there is no guarantee that their estimated price will be realised or how long it will take to sell them.
Meanwhile Ireland has an appalling level of suicide, and the human rights of mental health patients remains a serious concern, as highlighted by Amnesty International. Children are still admitted into adult psychiatric wards with all the dangers that that implies, and ECT is still being administered despite being banned in many other countries, while there is no adequate monitoring of involuntary detention.
Mental health is in an emergency situation and everyone including mental health advocates and members of the health unions need to campaign together urgently for its proper reform and funding.

---Kieran McNulty
People Before Profit/Tralee

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author by Correctorpublication date Sat Mar 13, 2010 01:09author address author phone Report this post to the editors

Caroline McGrath is director of the Irish Mental Health Coalition. The Mental Health Commission is a completely different, and Government run, organisation.

Otherwise, I agree with your points.

author by An tSionainn - date Sat Apr 03, 2010 11:50author address author phone Report this post to the editors

We've just attended a Mental Health Tribunal for a family member who has been involuntarily detained for several years. The Mental Health Act, 2001, whilst well meaning has become its own antithesis in its construction by the courts. Tribunals circumvent the intent of the Act and allow patients to be warehoused in crumbling outdated "treatment" centres by accepting testimony from 'responsible' consultant psychiatrists that mere sedation is a 'material benefit' that neednít have a beneficial or ameliorating affect during the period of proposed renewed detention. In addition, the psychiatrists are being advised by HSE legal teams and CMH forensics to issue the maximum 12 month detention periods to avert the cost that shorter, more reasonable, medically-necessitated detainment periods would entail (shorter detentions means more tribunals and higher costs for both HSE and the Mental Health Commission).

Apparently Mental Health tribunals are absolutely privileged and no details of their internal proceedings can be published by the press. I have attended two tribunals and can say that there is gross unfairness in their implementation as patients are not allowed to face their accusers and not afforded the right of reply. Nor are patients allowed to call witnesses or request that documents be produced in evidence (in contradiction to the information on the MHC website). I was shocked and sickened. The appeal process, too, is flawed in that only patients who can bring in their own independent medical specialists stand a chance of overriding the findings of the Tribunal, and independent psychiatric opinion is most rare in this country. If you seek independence you must bring in a specialist from far abroad (beyond Ireland/UK), as the community of psychiatrists form a stark grey line that protects its own at all costs.

The Mental Health Commission must sharply discipline the psychiatric establishment in Ireland now, particularly the forensic psychiatrists who stand over responsible consultants and dictate the treatment of patients in contradiction to the provisions of the Act, as well as the proprietors of approved centres where patients are warehoused for years without real benefit or recuperative therapy.

Close theses centres of Bedlam and open community treatment centres now.

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