Let’s stop pretending we’re making progress on mental health services

WHY don’t we admit it? Instead of talking all sorts of gobbledegook about mental health and how much we care, why don’t we admit it is so low down on the list of national priorities it would take some sort of disastrous epidemic for us to begin to take it seriously. We will publish reports, evaluations, strategies, policy documents and manifestos until everyone is fed up talking about it.

But for some reason I don’t understand we’re never going to make the mental health of our people a public policy priority. Instead we get, every year, a statement from the Government that celebrates the progress we’ve made. It’s as if someone has decided that pretending to address the problem will fool us all.

I’ll come back to the celebratory statement in a minute. The latest report is a document called Slán. In fact, it’s the latest in a series. Slán was a nationwide survey of lifestyle, attitudes and nutrition in Ireland, conducted a couple of years ago among more than 10,000 Irish adults.

Since then, experts have been analysing the data and producing reports. The latest one, published only recently by the Department of Health, is what they call the Mental Health and Social Wellbeing Report.

You might say it’s what we (the plain people) say about our own mental health, as interpreted by the experts. It’s not as if each and every one of us was assessed and diagnosed — if the report says there are mental health problems in Ireland, they are the problems we have told them about, as it were.

And naturally, by and large, most of us reported ourselves as being happy enough — in fairly decent mental health. So I don’t want to give the impression the Slán report paints a terrifying picture.

But there is food for thought, if not worry, in some of the following. These are my shortened, but I hope not distorted, examples of what the report says — and I’ve only picked a few.

* Men, and better-off people generally, report better mental health than women and poorer people. People on low incomes and with low education are twice as likely to suffer mental health problems than those at the other end of the spectrum.

* One in 16 of us (again, differentiated by gender and income) report a “major depressive disorder”.

* The majority of people don’t want any mental health issues they have to be known about. There is a high level of stigma.

* One in seven of us is frequently lonely, and that figure increases with age.

Now, of course, what’s different about Slán is that it’s a report of a survey. It’s only the latest indicator of mental health stress in Ireland and because it’s based on self–reporting, it’s far from the most devastating. Several years ago, for example, the Government published Reach Out — a national strategy document on suicide prevention. The introduction to that document made it clear that when the strategy was published, youth suicide rates in Ireland were fifth highest in the EU. Deliberate self-harm was also seen as a significant problem, with more than 11,000 cases being seen in hospitals each year — apart from the many more that are never reported.

These are only some of the pressures that add up to a need, and we have had an acknowledged need in Ireland for many years for a radical overhaul of mental health policy. It has always been seen as the “Cinderella” of health policy — less debated, less accounted for and certainly less resourced. That’s why, when a new policy was introduced a few years ago, called A Vision for Change, it was widely welcomed.

It highlighted the deficiencies in present policy. It called for the closure of mental hospitals and the integration of better facilities in general hospitals. It called for significant investment — in the hundreds of millions over a number of years — in new facilities and in much better community care approaches. Some of that investment was to be funded by the sale of mental hospital buildings and land.

And every year, on the anniversary of the publication of A Vision for Change, the Government issues a statement designed to ensure we all know they are still committed to the policy. But that, it seems, is as far as it goes.

The most recent statement, for example, was issued at the end of January by John Moloney, Minister of State with responsibility for Equality, Disability and Mental Health. Nice man, decent man. But what did he mean by this rather bizarre statement in the middle of his press release: “The Government has given a commitment that funds raised by the disposal of old-style psychiatric hospitals will be reinvested in the mental health service. The proceeds of the sales in recent years of St Loman’s Hospital, Verville Retreat in Clontarf and two other Dublin properties amount to over €42m. This funding needs to be made available now to fund new mental health infrastructure if we are to progress A Vision for Change in the next few years.”

“This funding needs to be made available”? Surely, of all people, the minister with responsibility should know whether it has been made available. And if not, why not? Where has that €42 million gone? Is the minister really trying to tell us that another promise has been broken and that money earmarked for mental health has gone elsewhere?

It certainly hasn’t gone into the HSE to help that body honour its mental health commitments. If you look at the HSE’s service plan for 2009 (the one that preceded the latest round of cuts), you’ll find the following on page 33 — €2.8m for child and adolescent mental health facilities; €1m for suicide prevention efforts and about €750,000 to fund what looks like a public awareness campaign to “progress the vision for change”.

GO back to look at the Government’s strategy itself, and you’ll find commitments for hundreds of millions. By comparison, this isn’t even lip service.

But we’re making progress on the central recommendation, aren’t we — the one that called for the closure of mental hospitals and the development of integrated and community care facilities?

Yes — we’re making massive progress there. Minister Moloney was able to announce a whole range of hospitals for which the HSE is developing — or may have already developed, even — “closure plans”. These are hospitals like St Brendan’s in Dublin (built in 1814), St Ita’s in Portrane, and a whole host of others — the vast majority of them well over 100 years old and most of them in an entirely unacceptable condition.

But these hospitals, all now subject to “closure plans”, house almost 1,500 patients. There is little sign of a better plan for them.

Until we start planning for people who need help; until we start investing (even in these hard times) the money that should be protected for mental health; until we start taking it seriously as an issue of policy priority —until we do the things we have promised we’ll do, could we at least stop pretending we’re making progress?