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“The Price on Changing Attitudes in Healthcare is More Cost Effective than High-in-the-sky pre-Budget Figures”

The first two weeks of Government is already witnessing TDs, Senators and lobby groups drafting pre-budget submissions in advance of the 15th October 2016. Once again, the term “ring-fencing” will be attached to huge figures alongside a scattergun approach to objectives and little reflection on the real worth of pre-budget submissions.

Such high-in-the-sky approach in the Mental Health Sector shows little appetite for cost effective and model based change that could prove to address the staffing levels that beset this industry.

In 2015, €35 million euro of additional funding was, to use a simplistic term, “ring fenced” for deployment in the mental health sector, a public health service which is drastically lacking in Consultant Psychologists and Psychiatrists, local community and child appropriate services across the country.

When we take into account that our staffing levels are a long way off the 12,000 levels recommended by A Vision for Change in 2006, the redistribution of €12.5 million (whether temporary or not) was an obscene and haphazard approach to the provision of mental health services in Ireland.

Though the funds were returned to the budget following public outcry, I still do not understand why this money cannot be allocated when gaping holes are visible in employment levels and staffing is well below levels recommended to the Government over a decade ago. Why can’t the HSE recruit staff? How many staff have been recruited in the Mental Health Service since October 2015?

In my new role as Senator, I have learned the hard way that the answers to these questions are not readily sought from the HSE, making the absence of a public service which monitors the delivery of mental health services (and arguably health services generally) is a serious issue.

My own view is that the reluctance and/or inability to hire staff could be addressed in the long term by closely examining the emigration of Irish-trained doctors and enhancing their working conditions in this country by reference to studies such as that submitted by Non-Consultant Hospital Doctors to the Oireachtas Joint Committee on Health and Children in 2011.

But in the face of recruitment paralysis, there are additional ways and means of addressing staffing provision in Ireland by way of producing solutions, rather than strict figure-led demands.

I want the Government to commit to making a number of budget driven changes that are focused and involve practical and achievable ways of addressing shortcomings which have been highlighted by a number of expert reports into the provision of mental health services in Ireland.

One of the gaping holes in provision of services is that children are being detained in adult psychiatric units, while at present 2,273 children are currently awaiting clinical assessment.

The increased number of children presenting for clinical assessment translates into the inadequate reality that 1 in 7 children will wait over one year for mental health treatment in Ireland.

The pre-budget submission which would be cost-effective and solution oriented within the bounds of existing models:

  1. To increase the engagement between the HSE and private sector providers of mental health services so that waiting list backlog and appropriate psychiatric care can be administered to children, in a cost-effective but expedient way. This is a service user solution which would involve a change of attitudes and would provide services within existing structures.


  1. Clearing the backlog of children waiting assessment by creating a project for clinical assessment of children on existing waiting lists that uses recently qualified psychologists under the supervision of senior staff. Again, this would require a minimal amount of funding, but a change of attitudes.


  1. The creation of a separate inpatient and step-down unit for children with mental health difficulties incorporated into the world class National Children’s Hospital in St James’s Hospital. At present it is unclear what services for mental health services will be provided, I propose to bring this issue up in the Seanad as a matter of priority and propose figures to the Government for the creation of inpatient care.

More tangible suggestions in pre-Budget submission may lead to more tangible outcomes, or at least that is the assumption.

*Senator Joan Freeman is an Independent Senator nominated to the Seanad in May 2016 by the Taoiseach. She is founder of Pieta House.