In this blog I’ll be analyzing the pre-election manifesto’s on mental health of each of the main political parties, first up we have Sinn Fein:
“Decades of mismanagement and underfunding of mental health services, despite the hard work and dedication of frontline professionals”
Off to a good start here, what has been achieved in mental health services for the past number of years has only been because of the dedication of front line staff who have had to try to provide a service with no-where near the numbers of staff needed and despite this felt daily pressure to reduce waiting lists but without the resources necessary to do so.
24/7 Care
Sinn Féin priorities include:
» Delivering 24/7 crisis services within the 1st term of government
» Establishing a Crisis House in each HSE catchment area
» Ensuring that every A&E, garda custody suite, and prison has a Mental Health Nurse available
on a 24/7 basis
Again positive aspirations, mental health crisis services are grossly inadequate. In particular the aspiration towards establishing a Crisis House is a positive one. Not all people in a mental health crisis requires or is appropriate to present to A&E. The only detail that’s missing here is the model of care in these Crisis Houses. Traditionally mental health crises have been viewed through a predominantly medical vs bio-psycho-social model and new initiatives need new approaches so that there are multi-disciplinary approaches, perspectives and supports available 24/7, not just medical.
Patient Centred Model
Sinn Féin priorities include:
» Legislating for a statutory right to advocacy for all patients
» Increasing funding to advocacy services to meet demand, establishing a dedicated service
for children in the services and initiating a campaign to raise awareness of advocacy services
» Legislating for Advanced Care Directives to allow patients to have input into their future
care
» Ratifying the Optional Protocol of the UNCRPD
» Fast-tracking a regulatory body for counsellors and therapy services to ensure best practice
Advocacy for people accessing mental health services in my experience has been largely paper / based / tick box exercises and not as it should be, truly collaborative. Without a dedicated advocacy services, as is being proposed we risk continuing with a piecemeal approach. We do not need a new regulatory body for counsellors, we have CORU, but for some professions the time taken to establish statutory regulation is taking excessive time, we need to bring statutory regulation in to protect both the public, standards and the professions.
Primary Care
Sinn Féin priorities include:
» Investing in Primary Care Mental Health services to ensure access for all to the care
and support they need in their community regardless of income.
» Ensuring that all primary care teams include at least one mental health post
» Providing additional resources for primary care teams in areas with higher need or
levels of deprivation
» Free universal counselling services with a GP referral
» Issuing guidelines to allow longer term (20 sessions rather than the current limit of 8)
access to primary care counselling on a case by case basis
» Developing plan to address local suicide epidemics through local taskforces
encompassing the Primary Care Team and other relevant community bodies to focus
resources.
» Implementing recruitment changes recommended by Oireachtas Mental Health
Committee to attract new Psychologists for the service
This is the key pillar that all mental health manifestos should contain, primary care & early intervention. It allows timely access when issues arise, is effective and saves money. We need to be front loading out primary care services to reduce the ultimate burden on acute and long terms mental health services.
If we want to recruit new Psychologists into primary care and other areas of mental health then we have to address the barrier to recruitment, of which two are the most obvious, the national panel system and the barrier of lack of funding for Counselling and Educational psychologists during training. If Sinn Fein is to follow through on it’s aspiration to attract new Psychologists into services and retain them then one way of achieving this would be to introduce individually allocated Continuing Professional Development budgets. Most practicing psychologists in Ireland today end up self-funding their CPD when other colleagues in the health service receive generous annual CPD budgets. Treat staff equally in terms of CPD and it will be easier to attract, recruit and retain them.
Fostering Good Mental Health at an Early Age
Sinn Féin priorities include:
» Developing curriculum for Positive Mental Health classes at Primary and Second level
» Providing age appropriate suicide prevention training to all second level students
through the National Office of Suicide Prevention
» Ensuring full time Guidance Counsellor for every secondary school and an additional
position for schools over 500 pupils.
All positive proposals. In relation to Positive Mental Health classes proposal. This one is worth further consideration about who might be best placed to deliver these. Our teachers are already carrying the burden of increased expectations of what they are to deliver to pupils, We need more actual integrated delivery of services rather than aspirations towards it. One possible way of achieving this might be a joint endeavor between the Dept of Health & Education to utilise the Assistant Psychologist grade under supervision in schools to deliver these programmes.
Suicide Prevention
Sinn Féin priorities include
» Building a more fair and equal Ireland
» Delivering 24/7 crisis intervention services including a national 24/7 crisis hotline
working with existing services.
» Ensure mental health posts covering all A&Es, garda custody suites, and prisons and a
full complement of Suicide Crisis Intervention Nurses across the state
» Increasing funding for Primary Care counselling to cut waiting times
» Providing suicide prevention training for frontline public sector workers such as
Gardai, Nurses, Teachers and those working in public offices.
» Providing age appropriate suicide prevention training in schools
» Increasing funding for the National Office of Suicide Prevention
It is important that a 24/7 crisis intervention service works with existing services. The challenge is going to be again in building capacity within services to be able to respond in a timely and holistic manner to the crisis that arises. If a person is struggling with thoughts of ending their own life the last thing they need are any barriers to access or having to wait for support.
Drugs & Addiction
Sinn Féin priorities include:
» Ensure that a Minister who sits at the Cabinet table is given responsibility to tackle
this crisis.
» Increasing investment in the Drugs Strategy and Drug and Alcohol Task Forces by 12
million and mandating all relevant agencies to fully engage in working together on
the delivery of the strategy.
» Increase support for services which treat mental health and addiction in conjunction
» Amend existing legislation and publishing guidelines for dealing with Dual Diagnosis
of mental health and addiction and establishing a No Wrong Door Policy to ensure
that no one goes without treatment because of their addiction
» Increasing the number of medical detoxification and rehabilitation beds by 20
» Ensure a structured outpatient treatment program incorporating an inter-agency
partnership approach for everyone released from prison including homeless and
mental health services.
» Commencing the biggest Garda recruitment drive in the history of the state bringing
the service strength to over 16,000 Gardaí, with a focus on community policing.
» Recruiting 2000 civilian staff to free up Gardaí from behind desks
» Increasing the number of Gardai and resources in the National Drugs Unit and the
establishment of area-based Garda Drugs Units.
» Establishing Drug-free zones of radius of 300m of a primary or secondary school with
increased penalties for illegal drug-related activities in such Zones.
» Establish Prescriptions Drug Monitoring Programme (PDMPs)
A focus on a no wrong door policy and recognising the inter relatedness of substance misuse and mental health is a welcome one. Tackling silo approach of the health service to this issue will be a significant challenge.
VERDICT
Overall this manifesto has positive aspirations and is focusing on most of the key principles and factors that would improve mental health services, Some of the proposals as you would expect will need more detailed implementation plans.
Most manifesto’s will be missing some aspects, in this one there was no focus on Perinatal Mental Health, huge existing gaps for people with autism / intellectual disabilities and how their mental health and other additional needs can be met by services so they don’t continue to fall between the gaps, the negative impact of Direct Provision on the mental health of those who access it and the impact of homelessness, poverty and educational barriers. The maifesto also fails to specify overall how much it would allocate in additional funding to mental health services or costings for the proposals they’ve outlined.
Wandering Minds 