The Government’s mental health policy, enshrined in Sharing the Vision, foresees an Ireland where early intervention is guaranteed and those who experience mental health difficulties are provided with community-based services which cater to their individual needs.
This focus on mental health early intervention to prevent costly and radical hospital-based psychiatric intervention is welcome. Indeed, we have come a long way since the early 20th century when 20,000 people, with and without mental illnesses, were imprisoned in ‘asylums’ across the country. Unfortunately, I fear the pace of change is still not quick enough to meet the growing mental health crisis.
A Vision for Change, the predecessor of the current policy, was intended to move us towards a policy of care in the community. Then, why do we still have a situation where very distressed men, women and children, experiencing mental health crises are waiting for hours in emergency departments?
The simple answer is that excellent policy derived by intense stakeholder collaboration and robust mental health research has been allowed to fail by chronic under-investment in primary, secondary and tertiary mental health services. Dr Anne Doherty, a consultant liaison psychiatrist in the Mater, recently revealed to Journal.ie readers, that no liaison psychiatric team in the country is resourced to the minimum standards required by A Vision for Change which was published 14 years ago. UCHG’s liaison psychiatry team is only resourced to 30% of the minimum standard.
At the community level, people with mild-to-moderate mental health problems are waiting as long as six to eight months for referral to Counselling in Primary Care, a community-based intervention.
This means that people in distress are languishing on waiting lists which only serves to exacerbate mental health difficulties. Of course, a few will have the means to access costly private mental health services. Others will access voluntary or charitable services in the community. There are many, however, who will end up in mental health crisis in our emergency departments. For the vast majority, if they get the support they need, when they need it, this is an entirely preventable situation.
Early intervention, where those showing the early signs of mental health difficulties and/or risk factors for developing mental illness are identified and resourced with the supports they need, greatly reduces the likelihood of hospitalisation, suicide risk and the suffering caused to families of those experiencing mental health problems. Sharing the Vision, published last year, recognises the value of early intervention and calls for greater investment in early intervention supports to prevent the need for “expensive acute and crisis response services”.
Early intervention across the lifecycle is crucial to preventing the continuing flow of people in mental health crisis to our emergency departments. It involves provision of additional supports for children who have experienced trauma such as alcohol and drug abuse and domestic violence in the home; resourcing schools to provide comprehensive mental health promotion programmes to our young people; providing adults with easily accessible ‘talk therapies’ for mild mental health difficulties and older people with the resources to combat poor mental health risk factors such as isolation, poor physical health and bereavement.
'Taking care of employee wellbeing not only increases productivity and profit, but also prevents long term unemployment and the need for mental health services intervention'
Significant investment in early intervention not just beneficial in preventing the suffering of an individual and their family. Mental Health Reform have calculated that for every €1 spent on early intervention services there is a return of investment of €18 for other areas of government expenditure. Several studies support the ‘return on investment’ (ROI ) argument for early intervention across the lifecycle. In the UK, parenting programmes and emotional supports for children have been estimated to have a ROI to the health system alone of €8 for every €1 spent.
Absenteeism and presenteeism
In the workplace, poor mental health is a significant risk factor for absenteeism and presenteeism. Workplaces who provide comprehensive mental health interventions such as EAP counselling and psychotherapy have demonstrated a ROI of €9 for every €1 spent. Taking care of employee wellbeing not only increases productivity and profit, but also prevents long term unemployment and the need for mental health services intervention, a further saving for the public sector. Provision of counselling to the long-term unemployed builds resilience and confidence and is associated with increasing the likelihood of a return to work, therefore reducing welfare payments.
In 2011, the World Economic Forum projected that in 2030, mental illness will account for 50% of the global economic burden attributable to non-transmissible diseases. The UN has warned of a global mental health crisis due to Covid-19 so this percentage should be revised upwards. If we are to mitigate the impact of this dire forecast and prevent the suffering of our citizens, it is vital that the mental health services are resourced to ensure we meet the strategic objectives enshrined in Sharing the Vision.
In their 2021 budget submission, Mental Health Reform stated that €30m was required just to maintain existing levels of service. Just €12m has been allocated to meet existing need. The overall additional allocation of €50m for 2021 is wholly inadequate. At least an additional €80m is required to meet existing service need and begin to work towards the strategic objectives of Sharing the Vision.
Labour Galway City West councilor, Niall McNelis is chair of Let's Get Talking, a non profit counselling and psychotherapy service providing accessible, professional, non-set fee counselling and psychotherapy nationwide. Over the last few months, its services have moved online and requests for counselling have increased. It is his opinion that early intervention is key to tacking what is coming down the line with mental health.