Fianna Fail Mental Health Manifesto #GE2020

In this blog I’ll be analyzing the pre-election manifesto’s on mental health of each of the main political parties, next up we have Fianna Fail

Giving Mental Health a Priority

We believe mental health should be on a par with physical health in policy development.

Fianna Fail is committed to reducing the burden of mental illness and to promote mental health
well-being. This will be achieved by closing the gap between what is available and what is currently needed to those seeking help, by providing a strong suite of measures of early intervention and by programmes designed to prevent mental ill-health developing in the first place.

We are committed to implementing a “Vision for change” and have allocated the €200m in additional spending required by that policy to finance the specific measures included in this
section.

Mental health needs not just to be on a par with physical health in terms of policy development but on a par in terms of funding. Policies are just aspirational documents that achieve very little without concrete implementation plans, and funding.

The original A Vision for Change document is now 16 years old and because of a lack of an implementation plan and funding to support its roll out it has stayed in some aspects just a vision. A “refresh” of the document was due to be published in 2019 but it’s yet to come into the public domain so can’t be evaluated yet. Whatever it contains without implementation plans, oversight, funding and review it runs the risk of sadly continuing to be just an unrealised Vision.

Improve Children and Youth Mental Health Services

Prioritise recruitment in Children and Adolescent Mental Health Services (CAMHS) with a special focus on areas such as the south east counties and south west Dublin where less than half the required staff
are in place.

Prioritising recruitment in CAMHS is welcomed. This recommendation needs a lot of nuancing. Yes we need to end the post code lottery for children and young people to make sure that there is equitable access to CAMHS whatever part of the country you happen to be in. What we also need to do is move away from quoting stats that are team based in CAMHS. Published breakdown figures from the HSE shows that there are much bigger disparities in staffing amongst specific disciplines in CAMHS. The issue is not just about increasing staff in CAMHS but which disciplines are depleted the most and which disciplines are required to meet the outcomes the young people and their families are hoping for.

Ensure multi-annual funding for Jigsaw, the National Centre for Youth Mental Health
to build on their existing network of early intervention and prevention services and
supports.

A welcome commitment, Jigsaw provide excellent young person centred early intervention and support services

Neither of the above commitments gives specific costings or funding commitments so it’s difficult to gauge the extent of the commitment here.

Support Older People’s Mental Health

Make it a priority to reach a full complement of staff within five years

Given well known issues in recruitment and retention of staff in mental health services, how Fianna Fail will achieve this remains to be seen.

A focus on Older People’s Mental Health was not included in the Sinn Fein manifesto.

Ensure Strong Community Supports

Ensure that any new contract with GP’s contains specific provisions for mental healthcare.

Not sure what this means? That GP’s have to provide a certain commitment to mental health care (they already do), seems very vague without further explanation as to what’s being proposed.

Improve health outcomes for people with dual/multi diagnosis by ensuring greater
collaboration between drug and alcohol services and general mental health services

Similar to the observations on the Sinn Fein manifesto, this is welcomed but how Fianna Fail would ensure this would occur remains to be seen as silo’s are great big things that stand apart from each other and don’t move quickly or easily.

Strengthen Mental Health supports for people with Intellectual Disabilities

The need for nationwide specialised mental health services dedicated to the needs of people with Intellectual Disabilities was outlined in 2006. Yet in 2019, Adult Mental Health Intellectual Disability teams stood at 32% of the recommended levels and the CAMHS Intellectual Disability teams were at just 9%. Within our €200m in additional funding for Mental Health we will progressively expand the
teams to provide 29 for Adult MHID to and 17 for CAMHS-ID.
We will:
• Provide 29 for Adult Mental Health Intellectual Disability teams
• Put in place 17 teams for Children and Adolescents.

This is a significant gap within mental health services and the recognition of its importance is welcomed. I would welcome more detail in how much of the 200m for the overall additional funding is for this (and the other areas). The words “we will progressively expand” the teams is an interesting choice of phrasing, over what time frame? 14 years later A Vision for Change has not progressed to the levels anyone would be satisfied with. We also need to recognise that the recommended levels that are noted here are 14 years old

Deepen rights and inclusion at the heart of policy

Ensure that HSE mental health services are proactive in outlining to service users how
they can make a complaint and encourage both negative and positive feedback.

The HSE already has a Your Service Your Say feedback loop. It would be better to find evaluate how much it’s used, if there are barriers to service users using it and most important what people’s experience of it has been. There’s no point in proactively encouraging people to use a system without knowing if it is working for the people who are using it.

Conduct a nationwide needs assessment for independent one-to-one advocacy services
for mental health service users.

We don’t need a needs assessment to tell us what we already know that one-to-one advocacy services for mental health services are much needed and are overdue. What we need is a plan for how they will be recruited, trained, retained and how the service will integrate with existing services.

Strengthen suicide Prevention

We will:
• Work closely with the National Suicide Prevention Office and the Mental Health Evidence Research Team to develop specific suicide prevention policies and to ensure a whole of government approach to suicide
prevention.

NOSP have great detailed existing suicide prevention policies, I don’t think we need more new policies but increased and continued commitment to the policies that NOSP already have such as the continued roll out of Dialectal Behaviour Therapy teams nationally in adult and child mental health teams.

• Ensure that there are effective nonstigmatising plans to prevent unnecessary early deaths by suicide.

Again NOSP are the leaders in this area, they plans exist, the need to be supported to roll them out with the resources and funding to make them more effective in terms of their reach and impact

Expand recruitment and retention

Recruitment of mental health staff has simply not been given the priority it deserves. There is a
strong case for clinical and frontline recruitment being carried out at a local level rather than
nationally as is the case currently.

We will:
• Review current recruitment practices with a view to streamlining them and ensuring
faster recruitment.
• Carry out a pilot scheme for local recruitment in a specific CHO and if successful extend it to all areas.

This is a very very welcome commitment and if Fianna Fail are successful in getting into government it will be a priority item for implementation not just for Psychologists but for all Health & Social Care Professionals. A number of HSCP bodies have expressed their continued belief from feedback from their members that the current panel system of recruitment is not fit for purpose.

In Psychology if we have additional barriers to recruitment in that our trainees in both Educational and Counselling Psychology are not funded during their three years of professional training. If we are to get much needed additional capacity into the system we need to remove the financial barrier precluding people from being able to afford to complete training.

Target Homelessness and Mental Health

We will:
• Ensure that people who are homeless are named as a target group in health and
mental health policies and strategies. •Develop in conjunction with the Department of Housing a specific housing policy for
persons with mental illness to include housing first and assisted living policies.
• Aim to provide a dedicated Community Mental Health Nurse in each CHO area to
support the needs of people who are or at risk of homelessness.

All welcome proposals, however the obvious way to reduce the mental health difficulties of those who are homeless is to focus on meeting their primary need of having somewhere to call their home.

Tackle eating Disorders

Care services are underdeveloped. Fianna Fáil is committed to providing that care.
We will:
• Ensure we can treat people with eating disorders within our own mental health
services
• Work to provide 16 specialist eating disorder services teams – half of them for CAMHS – across the country.

In my work I’ve observed a significant increase in the numbers of young people struggling with eating disorders. To achieve what Fianna Fail are aspiring towards they will need:

• Fully resourced mental health teams
• Ongoing ED training, CPD and supervision for staff

Introduce political and administrative Changes

We will:
• Establish on a permanent basis a Joint Oireachtas Committee on Mental Health.

Very much welcomed. The Oireachtas Joint Committee on Health has been trying to keep mental health as a focus of their work but if the soundbites of every political party about bridging the gap between physical and mental health are to be realised then we need to show that commitment through a dedicated Oireachtas Committee.

• Appoint a Chief Psychiatrist in the Department of Health.
Why specifically a Psychiatrist? We need to move beyond historical beliefs and policies around leadership in mental health being the sole remit of any one discipline. We have many fine Psychiatrists who would play a valuable role in advising the Department of Health around mental health matters and it is also true that we have many fine Psychologists, Nurses, Social Workers, Occupational Therapists who work in mental health who would have the competencies to fulfill such an important leadership role. Roles / job descriptions should be based on ascribed competencies needed for the role, not what discipline you happen to come from.

• Review the decision to discontinue the position of Director of Mental Health
Services in the HSE.

Again very much welcomed, was a retrograde step to remove this post in the first instance without any logic.

Update Mental Health laws

We will:
• Expand the powers of the Mental Health Commission to regulate service providers and to ensure compliance.

It’s not just about expanding their powers its about (again) providing the Mental Health Commission with the resources needed to perform their existing regulatory role and extra resources to expand into other areas such as community mental health teams.

• Amend the Criminal Law (Suicide Act) 1993 to make it an offence to coerce or incite another person to take, or attempt to take, their own life.

This one on the surface makes sense, how it would be monitored or policed is another matter. My suspicion is that it relates to social media communications. Given that much of the time when this has occurred it’s been on platforms that provide anonymity or the platforms are hosted outside the state / EU how enforceable this would be is open to debate

VERDICT

I’m giving this a slight edge over the Sinn Fein manifesto as it gave a specific commitment to 200m of additional funding. Although while saying that there is no detail in how much any of the commitments would cost and I am doubtful that much of what is proposed could be achieved with just 200m.

It had specific & concrete proposals that if implemented would improve mental health services but as with all manifestos, the devil will be in not only the details (some proposals vague and lacking in detail of how they would be operationalised) and seeing the funding promises being delivered in actual budgets.

In terms of gaps in this manifesto this also did not include a focus on Perinatal Mental Health or the negative impact of Direct Provision on the mental health of those who access it