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Major staffing deficit in mental health care must be addressed – Ó Caoláin

1 July, 2014 - by Caoimhghín Ó Caoláin TD


Introducing a Sinn Féin Dáil motion on mental health and suicide prevention which will be debated this week, Sinn Féin Health spokesperson Caoimhghín Ó Caoláin TD said that the serious deficit in mental health care staffing must be addressed by Government.

He said:

“Only 44% of psychiatric hospitals and mental health facilities in this State are compliant with staffing level regulations.

“The latest report of the Mental Health Commission shows that since 2007, staffing in mental health services has been reduced by the implementation of recruitment embargoes and employment moratoriums. The effect of such policies is to endanger the delivery of community-based services as envisaged in A Vision for Change.

“At the end of December 2013 the overall staffing level for Community Mental Health Teams was still about 25% less than recommended in A Vision for Change.

“This points to the need for continued and enhanced investment.

“We call on the Government to commit to an annual allocation of €35 million for the development of community mental health teams, to make good any shortfall in any given year in the subsequent year’s allocation and to properly resource mental health services across the board, including the provision of appropriate and adequate staffing and with a key focus always on recovery.

“This is the outcome we all want to see and we need to have a shared determination in this Oireachtas to achieve it.”

ENDS

Full text of Deputy Ó Caoláin’s speech follows:

Sinn Féin Private Members’ Time debate 1.7.14
Mental Health & Suicide Prevention
Caoimhghín Ó Caoláin TD, Sinn Féin Health Spokesperson

Molaim an rún ar son Teachtaí Dála Shinn Féin, rún tábhachtach atá dírithe ar sláinte intinne agus atá sé mar aidhm aige an Rialtas agus an Oireachtas agus an pobal i gcoitinne a spreagadh chun go mbeidh sláinte intinne mar fíor-príóireacht againn.

We in Sinn Féin have chosen to return to the theme of mental health and suicide prevention for our final Private Members time debate in advance of the Dáil summer recess.

We think it is vital to focus again on these fundamental aspects of public health in Ireland. These issues are of vital concern to the nation in general and should be of special concern to us as policy-makers and legislators.

The motion is timely in that it comes immediately in the wake of the latest Annual Report of the Mental Health Commission.

Some of the findings of the Report are indeed alarming.

The report of the Mental Health Commission shows that only 44% of psychiatric hospitals and mental health facilities are compliant with staffing level regulations.

The Report also makes clear that since 2007, staffing in mental health services has been reduced by the implementation of recruitment embargoes and employment moratoriums.

The authors of the Report pull no punches when they state that such policies are endangering the delivery of confident and responsive community-based services as envisaged in A Vision for Change, the Government’s mental health strategy.

It is also of huge concern that the Commission reports that children are still being admitted to adult units. There were 91 such admissions in 2013. That was 22.3% of all child admissions.

These are some of the highlights of the Report to which I will return in a moment.

In most cases motions such as this, tabled in Opposition Private Members Time, come in the form of indictments of Government failures, and in most, cases, deservedly so. There is more than ample material to take such an approach.

However, in this case we have taken a different approach, recognising where progress has been made and encouraging, prompting and pushing for improvement and progress at all times. This is the outlook of the Oireachtas All-Party Mental Health Group and one we are continuing in this debate.

It was all the more disappointing therefore to find this afternoon that the Government had decided to put down an amendment to this motion.

It is my earnest wish that we not only continue but that we build on the spirit of inter-party co-operation and working together on these issues, and I will therefore proceed with the all-party approach that I have intended from the outset.

I appeal to all Deputies to support our motion as tabled. We will identify both the positives and the negatives and endeavour to be constructive.

Fundamental change in the care of mental illness has been undertaken. Guided by A Vision for Change, it is a very significant, but, regrettably to date, a long-term project. It requires maximum support to ensure that it proceeds apace and that it is not allowed to stall as has happened too often in recent years.

And that is very much the purpose of this motion and this debate. It is to give a further push to a stalled process and to re-focus on the needs and rights of those who use our mental health services.

The Mental Health Commission Report acknowledges that there have been “significant improvements in many areas of patient care” since the passage of the 2001 Mental Health Act and the subsequent establishment of the Commission.

It is positive that, as the Commission states, there is considerable commitment to the policy of A Vision for Change.

However, the reality is also that the policy is being implemented unevenly and inconsistently across the country and the Commission identifies the requirement for innovative actions to be supported and reinforced by strong corporate governance at national level. This requirement will hopefully be fully addressed following the welcome appointment in 2013 of the Director of Mental Health Services and the creation of the National Mental Health Service Management Team.

As our motion states there needs to be independent monitoring of the roll-out and progress towards full implementation of A Vision for Change.

Regarding the focus on recovery, again, there are two sides to the coin. The Commission finds that the concept of recovery, where services are designed to assist in a person’s recovery rather than to ‘manage’ their illness, is now well understood. It welcomes the continuing development of the systematic initiative ‘Advancing Recovery in Ireland’ by the HSE.

But it is also the case that implementation is uneven. The Report points to “a serious deficiency in the development and provision of recovery-oriented mental health services”. It identifies the absence of psychology, social work, occupational, and other multi-disciplinary team members. And it calls for a change in attitudes and behaviours and for training in recovery competencies.

As our motion states, mental health services must be designed and delivered to aid the recovery of the individual and a person-centred approach is vital to the achievement of the best results.

It is people who deliver mental health services. Visions, plans, systems are nothing without dedicated trained personnel to implement them. And adequate staffing is the biggest deficit in our mental health services.

To recognise the positives first – it is positive that 652 staff have been appointed in Community Mental Health Teams over the past two years. As the NGO, Mental Health Reform, states, this has the potential to transform the type of mental health care people receive to a more holistic approach, since the new appointments are resulting in more input from a range of disciplines including psychology, social work and occupational therapy.

But again, as the Mental Health Commission reports, the input of the latter professionals is still too limited. And the Commission’s findings on staff levels and the adverse effects of the recruitment embargo is the most worrying aspect of its report. I have already noted its finding that only 44% of psychiatric hospitals and mental health facilities are compliant with staffing level regulations. It goes further and states:

Since 2007, staffing in mental health services has been reduced by the implementation of recruitment embargoes and employment moratoriums. The medium and long term effect of such policies is to endanger the delivery of confident and responsive community-based services as envisaged in A Vision for Change.

At the end of December 2013 the overall staffing level for Community Mental Health Teams was still about 25% less than recommended in A Vision for Change.

Unquestionably this points to the need for continued and enhanced investment.

I cannot emphasise enough the importance of that part of the motion which addresses staffing.

We call on the Government to commit to an annual allocation of €35 million for the development of community mental health teams, to make good any shortfall in any given year in the subsequent year’s allocation and to properly resource mental health services across the board, including the provision of appropriate and adequate staffing and with a key focus always on recovery.

This is the outcome we all want to see and we need to have a shared determination in this Oireachtas to achieve it.

I want to address now some of the other key elements of the motion.

The Government needs to promote awareness of the unacceptability of certain practices and continue to discourage their use. The prime example is the application of ECT (electro-convulsive therapy) on detained persons against their will. The Mental Health Commission Report expresses continuing concern at this practice.

In 2011 a Code of Practice under the 2001 Mental Health Act came into effect and stated that “no child under 18 years is to be admitted to an adult unit in an approved centre from 1 December 2011”. This was only to be breached in exceptional circumstances. Yet in 2013 there were 91 such admissions. While this was a decrease on 2012 it is still not acceptable and the practice needs to end.

Relevant legislative undertakings should be progressed, including completing the ongoing review of the Mental Health Act 2001 and to bring the Assisted Decision-Making (Capacity) Bill 2013 through Committee and remaining stages.

The last survey of psychological well-being and distress was carried out in 2005-2006 and it is time, we believe, for the Health Research Board to carry out another such survey and to proceed to do the same at regular two or three yearly intervals.

We are all conscious of the continuing toll of suicide and self-harm, especially, but by no means exclusively, among young people. The work of the National Office for Suicide Prevention is to be highly commended. We need to ensure a cross-departmental response to the risk of suicide and self-harm, including from the Departments of Health, Education & Skills, Children & Youth Affairs and Environment.

It is absolutely crucial that a 24/7 crisis support service for people experiencing severe mental or emotional distress is put in place, properly resourced and sustained. It is frankly an insult to expect that such emergency support can be provided on an office-hours or even part-time basis.

These quotes from public meetings organised by Mental Health Reform speak for themselves:
We need a system to bypass A&E … Admissions in A&E are not working – it comes up time and time again – waiting around….

Last time I was in A&E I was there for hours and started getting paranoid that people were talking about me…

They need to change the environment (of A&E) to make it more friendly for people in distress. All it does is compound their difficulties…

When you are sick with a mental health difficulty, you can’t wait until 8 or 9 in the morning for a doctor to show up or for a certain place to open….

An alternative to general A&E presentation for those who self-harm and a 24/7 crisis support service in conjunction with local Community Mental Health Teams are what is required, in line with A Vision for Change.

There also needs to be greater co-ordination of all existing suicide prevention initiatives across all sectors and groups working in the area.

Marginalised communities often have more acute and more particular mental health needs. Indeed, the treatment of some sectors of society by this State is undoubtedly damaging the mental health of many individuals.

I need only cite the disgraceful conditions in which people are detained in so-called direct provision centres. This, I believe, is creating a legacy of mental and physical illness, especially for the children held in these centres.

The Government needs to guarantee that the new National Strategic Framework for Suicide Prevention will place mental health awareness among children and young people at the top of its programme.

I want to pay tribute to the work of Mental Health Reform who have been of invaluable support to the Oireachtas Cross-party Mental Health Group especially Dr. Sari McDaid & Lara Kelly & to Amnesty International who previously provided secretarial support to the cross-party group.

Our motion commends the work of the Mental Health Commission, the National Office for Suicide Prevention and those non-governmental organisations, national, regional and local who actively promote positive mental health and seek to reduce the incidence of suicide and self-harm.

The funding supports of those organisations needs to be restored at the very least. The reduction in core funding year on year since 2009 has placed serious pressure on their work while demand on their services is certainly increasing.

Much has been done in recent years to educate our society about mental health. Tribute should be paid above all to those people who have experienced mental illness and who have used that experience to help right the wrongs in a society which for decades stigmatised, criminalised and institutionalised those with mental illness. Hopefully those attitudes and practices have receded into the past. But much, much more remains to be done.

We need to see the mental health of each citizen and of the nation as a whole as a positive resource that contributes to our general social, cultural and economic well-being.

I will conclude by quoting from the World Health Organisation which in 2007 stated:

Mental health is an indivisible part of public health and significantly affects countries and their human, social and economic capital. Mental health is not merely the absence of mental disorders or symptoms but also a resource supporting overall well-being and productivity. Positive mental health is a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and can contribute to his or her community.

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