ALMOST FIVE years after the Government adopted a blueprint to modernise our mental health services, it is alarming to see how progress has slipped. About 1,000 people continue to reside in outdated and often inhumane mental hospitals. Hundreds of children continue to be admitted into inappropriate adult units. Community mental teams are under-resourced and woefully incomplete.
If we are to look to the future for signs of progress, there are precious few reasons to be optimistic. There is no sign in the Health Service Executive’s (HSE) service plan for this year that it will be possible to develop new services to replace institutional care. Spending on services has reduced dramatically, despite official pledges to invest more. The number of staff in our mental health services has fallen by 700 over the past year as a result of a recruitment embargo.
In a civilised society, we should not tolerate this. The State's treatment of people with mental health problems has for years amounted to a grievous violation of their dignity and human rights. Yet the blueprint aimed at modernising this service, A Vision for Change, is now being starved of funding and crippled by under-staffing. If anything, demand for mental health services will grow this year as a result of pressures linked to the economic downturn. Instead of making progress, it is difficult to even see how existing services will stand still this year.
To its credit, the Mental Health Commission is using its powers to force the closure of some of the worst institutions. It has ordered that three hospitals cease admitting new acute patients from later this year. These are positive developments – but they are accompanied by uncertainty. Where, for example, will these patients in need of urgent treatment go? Will vulnerable patients face early discharge or join waiting lists for care in the community? As of now, we do not have full answers.
Against a backdrop of under-resourcing and painfully slow change, it is increasingly clear that we need to reassess how we fund services and drive change within our mental health services.
The HSE belatedly appointed a national assistant director with responsibility for this area last year. This falls well short of what is needed. As set out in A Vision for Change, we need a national directorate with a strong executive and budgetary powers. We need real targets, timelines, guaranteed resources and assigned responsibility.
Urgent issues need to be resolved such as spreading resources more equally across regions; placing more emphasis on community-based services; better ways to measure outcomes for patients; fulfilling the aim of building a recovery-oriented mental system.
It will be clear that progress is being made only when young people receive a timely response to their conditions and when patients are no longer incarcerated in grim settings that are an affront to human dignity. People with mental health problems have waited far too long for a service which respects their dignity and rights. They must not wait any longer.