Fine Gael Mental Health Manifesto #GE2020

In the fourth of this series of blogs analyzing the pre-election manifesto’s on mental health of each of the main political parties, next up we have Fine Gael.

The first issue I have with this review, and it may be a stylistic one that doesn’t bother anyone else but in the table of contents it was very unclear where the mental health aspect of the manifesto might be as it’s not titled that way, I eventually found it on page 18 after scrolling for a while. Even on page 18 it’s not titled under a heading of “Mental Health” but is noted under “The refreshed Vision for Change“. I know what A Vision for Change is in reference to but will the majority of the general public, I suspect not.

The refreshed Vision for Change

Where is this refreshed Vision for Change? We still only have the 14 year old original document published. There were some consultations in 2019 about the refresh but despite a number of whispers about when it might be published there’s still no sign of the very long overdue refresh. Given the lack of any HSCP representation on the oversight group I’m sceptical about what the refresh will look like, I suspect will be a continuation of the archaic mental health governance models of the past but we’ll wait and see, whenever its published. I wonder about the wisdom of basing a manifesto on a document that no-one has seen and doesn’t know what it recommends

The mental health budget is now over €1 billion a year, an increase of 17% since
2017

And still that only represents 6% of the overall Health budget vs the 10% of the budget that’s required. Given the recruitment freeze for staff in 2019 (But it wasn’t a freeze – said no worker on the ground) I wonder what the extra 17% was spent on??

These increases have provided for a range of mental health services, including an increase in Child and
Adolescent Mental Health Services(CAMHS) Teams

How many? Fully staffed teams? Not based on the published HSE figures that show that Psychologists in CAMHS are only at 38% of recommended Vision for Change levels, which represents a shortage of 112 psychologists in CAMHS (based on 14 year old recommendations).

The appointment of assistant psychologists and psychologists in primary care

Finally creating a grade of Assistant Psychologist and paying them a salary was long overdue and much welcomed. The minister (despite my pointing it out to him on twitter on multiple occasions) insisted on saying they had hired 114 additional Psychologists. However these Psychologists are pre-training and require significant additional training and supervision and are not equivalent to hiring 114 additional fully qualified Psychologists. We need the Assistant Psychologist grade for early career psychologists AND we need more (and funded) professional training places so that Assistant Psychologists have a career pathway to progress.

We will fully implement and resource a refreshed Vision for Change and use a ‘stepped care’ approach, ensuring that each person can access a range of options of varying intensity to match their own needs.

When will we expect to see this Refresh, what does it recommend? What resources do we need to make sure that each person can access a range of options, what are these options?

Under this refreshed approach, we will:

Increase access to a range of counselling supports and talk therapies in the community

In what setting, by who, what type of talk therapies, for how many sessions?

Strengthen Multidisciplinary Community Mental Health Teams as a cornerstone of service delivery
in secondary care

Strengthen to what benchmark? Which disciplines? What will the model of care be that will best meet the needs of those who use the service and is there a plan to ask them?

Provide a comprehensive specialist mental health out-of-hours service for children and adolescents in all geographical areas

Great vision, but provide it where and who will staff this service? We don’t need more children presenting to A&E unless there is a specific need for medical intervention. Most mental health crises for children and young people do not require A&E. Will it be a medical model of support or a bio-psycho-social one? Given the lack of a nationally agreed (or any) overtime rate for health and social care professionals how will an out of hours service be staffed and funded?

Ensure that Speech & Language Therapists are core members of CAMHS Teams

SLT’s have been on every CAMHS team I’ve worked on for the past 15+ years, I’ve never worked on a CAMHS team without SLT colleagues, how / why is this now a new recommendation?

Pilot out-of-hours Crisis Cafes as a new referral option, providing access to talk therapies, coping
strategies and one-to-one peers in a supportive environment

This is contradictory in the first few words. If it’s a crisis cafe that you can access when you need support why would you need a referral to it? That just creates more unnecessary barriers to help seeking for what seems to be thought of as a less formal supportive environment. Who will work in these Cafe’s and / or support the peer’s volunteering there/

Ensure better alignment between the Department of Education and Skills, the Department of Justice and Equality and the HSE on primary/post-primary schools, mental health services and supports such as National Educational Psychological Services (NEPS), GPs, primary care services
and specialist mental health services

Alignment to achieve what? This is a list of lots of departments and services with a recommendation to align them, what’s the identified need and what’s the goal of this? If there isn’t one then it’s just a list of services to make up a paragraph

Develop a dedicated National Mental Health Promotion Plan

Another one instead of the ones we already have like Littlethings.ie or Your Mental Health.ie these campaigns have been very positive (Disclosure: I’ve had involvement in both so I’m biased) but the responsibility of any government when they engage in Mental Health promotion or the next recommendation for a National Stigma reduction Programme is to make sure that there is someone there to listen and to help if someone feels less of a burden of stigma to reach out and look for help. I firmly believe it is more harmful to encourage people to help seek when you know the help isn’t there or is so underfunded, so under resourced that it can’t respond in a timely manner that is meaningful to the person seeking help.

We will establish an overarching National Implementation and Monitoring Committee to drive
these measures, monitor progress overall and ensure delivery on the commitments.

To monitor progress on anything you need to have concrete and measurable goals that are clearly defined. I haven’t seen much evidence of these in the manifesto so far. Will this committee be in a position to recommend where funding streams should be directed to drive these measures or will it just be an advisory talking shop?

We will continue to support the expansion of Jigsaw services in the community.

Agree completely and fully support, should be a core recommendation in every political parties manifestos on mental health.

As recommended by the Youth Mental Health Taskforce, we will invest in age-appropriate, digital youth mental health supports, ensuring that all young people have access to an active listening service and signposting tool.

This is an infuriating point. Huge work was put in by the Youth Mental Health Taskforce over 2 years ago with a suite of specific recommendations that would have, if funded and implemented made significant improvements to youth mental health in Ireland. If FG are believe in the importance of the Task Force recommendations why have the rest of them not been implemented and are far past their implementation / completion dates as outlined in the report? Again signposting, what a buzz word, sounds great, but imagine the experience of a depressed and/or anxious 16 year old who is signposted to what is the recommended service to then discover it has a 2 year waiting list because of a legacy of under funding and under resourcing?

We will continue to develop the range of e-mental health initiatives, including tele-counselling, tele psychiatry and a Crisis Text Line, as alternatives to traditional service mechanisms.

The evidence here is clear (but being ignored), online counselling mental health supports are a useful adjunct to, but not an alternative to, face to face person to person supports.

Connecting for Life is Ireland’s national strategy for suicide prevention; it has delivered considerable progress and is well regarded internationally. We will extend the timeframe and funding to
build upon the success of the strategy, and to implement further actions.

We are talking about suicide more than we ever have before and working hard on reducing the stigma of help seeking. I’d like to know how long the timeframe would be extended for and how much funding will be committed to the strategy

We are committed to establishing PathFinder, a cross-governmental youth mental health team with participation from the Department of Health, the Department of Education and Skills and the Department of Children and Youth Affairs.

Pathfinder as a concept and proposal is a good idea, but it’s not a new one, it’s been talked about for a few years but is not yet fully operational, why?

Verdict

Overall pretty disappointing from Fine Gael. The section that focuses on mental health talks about how much extra funding has been allocated to mental health but no specific commitments in that section to how much more (if any) would be allocated to bring it up to the minimum recommended levels of 10% of the health budget. The majority of the manifesto seems to be built upon premises contained in A Vision for Change Refresh that no-one has had sight of yet and no indications of when it might be published. It conveniently ignored that the vast majority of the Youth Mental Health Taskforce recommendations have not been enacted two years later. There are lots of buzz words / sentences that sound good to the casual observer but contain such little specific details that it would be impossible to tie them down to specific operationalised targets to be evaluated against.

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