Colman Noctor: Mental health services need urgent large-scale investment

Mental health investment must be a ‘make or break’ political issue.

Not a week goes by when I don’t hear someone complain about the standard of children’s mental health services in this country. It can be a teacher who is trying to manage a child in acute mental distress and is unable to access any support from services or a parent who has been on a waiting list for months on end as they see their child’s mental state deteriorate. My usual response is to empathise and say: “I know, it’s dreadful”

However, it has become increasingly hard not to agree with the critics given the recent South Kerry Child and Adolescent Mental Health Service (Camhs) report and the Families for Reform in Camhs report. These come on the heels of the 2023 Mental Health Commission (MHC) Report, in which the then chief inspector Susan Finnerty stated that she “cannot currently provide an assurance to parents in Ireland that their children have access to a safe, effective and evidence-based mental health service”.

I try to avoid being overly critical of the staff working in these services because, for many years, I was one of them. I know a bigger picture is at play, which goes beyond the influence of the personnel working in these services. The under-resourcing of mental health services is a long-term issue — I remember sitting on a two-drawer filing cabinet while interviewing parents because we didn’t have enough chairs. From what I gather from former colleagues who still work in these services, the facilities have not improved, and in some areas, have worsened.

In his first report, the current mental health chief inspector, Professor Jim Lucey, highlights how 22 of the 66 in-patient services were deemed to be below 80% compliant. This is a deterioration from previous years — nine in 2023 and seven in 2022. Despite the loud discussion about the importance of mental health, these findings show how our services are veering in the wrong direction.

Community Camhs was not included in this series of inspections as Lucey has not received new powers of inspection or regulation of the service. Interestingly, many of the staff I have spoken to at Camhs would welcome an MHC inspection in the hope that it would highlight the poor conditions they work in and lead to improvement and critical investment

Underfunded services

Jim Lucey is a friend and a former colleague. He is a compassionate clinician devoted to improving mental healthcare in Ireland. He is also a pragmatist with a measured outlook and is unafraid to speak out against government inaction.

In an interview last week with Anton Savage on Newstalk, he pulled no punches. Our mental health services secure a paltry 6% of the overall health budget, and the consequences of years of chronic underinvestment are coming home to roost, he said. The reason services were deemed non-compliant, he added, included dilapidated buildings, unsafe environments, not enough therapeutic interventions, and critical levels of understaffing

Lucey’s comments could also apply to children’s mental health services. For example, a Camhs near where I live is situated in an old asylum, with a winding driveway to a grey old building. Being asked to sit and wait in a long, eerie corridor is not suitable for a child seeking emotional support.

Former colleagues working in Irish mental health services and Camhs appear to be at breaking point. 

The levels of unsafe staffing cover, recruitment embargos, and the continued deterioration of the buildings and environments have a deep impact on morale and their capacity to work safely.

I fear we have become habituated to negative reports on our mental health service. I am struck by how few column inches or news bulletins have covered the latest MHC report. We seem to have become resigned to the fact that inadequate and unsafe mental health care is a given, and the quintessentially Irish approach of ‘sure that’s more of it’ seems to have become the response of the day.

Mental health investment must be a ‘make or break’ political issue. There isn’t a family in Ireland unaffected by mental distress. With loneliness, isolation and fear being omnipresent, our need for adequate mental health services is not dissipating. We need to design a more holistic and integrated service delivery model that can respond earlier to the needs of children and young people without over-relying on pharmacological intervention. However, no matter how good our primary care or community services are, there will always be people who will need acute and intensive mental health care, and in-patient settings are where we need to get it right first.

In his report, Lucey stated there are only 66 acute services in the country and even fewer (45) Camhs teams. Surely, improving such a small number of services is achievable. Once we create safe environments for those with the highest level of need, we can address the primary care services.

Positive developments

On a more positive note, since I started working in the Irish mental health services in 1995, a notable cultural shift has occurred in these services. The recovery approach, acknowledgement of the ‘service user voice’, incorporation of the ‘lived experience’, and challenges to the patriarchal medical model have been positive developments.

I teach mental health nursing students at SETU Waterford, so I know our understanding of mental health bears little resemblance to what I learned nearly 30 years ago. However, despite the growing demand, especially among children and young people, the buildings have not changed much in the intervening 29 years, and the staffing levels and morale of the teams seem to have deteriorated significantly.

If we want our children to have the mental health support they need, we need to act now. The time for talking is over. As Lucey said on Newstalk, “We all can continue to walk into the light at 4 a.m. and wear the green ribbons to encourage conversations. But talk is cheap.”

With a general election on the way, we need a government that takes the mental health needs of our children seriously. Having adequate support for children with mental health problems, additional needs, and social and communication problems should not be considered a luxury or something exclusive to the Nordic countries; it should be a fundamental human right.

Intelligent large-scale investment is needed. In his report, Lucey stated: ‘The Irish Mental Health services are where the cancer services were 20 years ago, and we have seen a transformation in those services in that time, and so we have to believe that the same is possible for our mental health services too’.

In a recent radio interview, Taoiseach Simon Harris said, “I want to make this the best country in the world to be a child.” I suggest investing in our mental health services, whose purpose is to care for our most vulnerable and bring them, would be a good place to start.

Dr Colman Noctor is a child psychotherapist