Social Democrats Mental Health Manifesto #GE2020

The final party to be reviewed for their Mental Health Manifesto for #GE2020 is the offering from the Social Democrats

The Social Democrats have come out with a Mental Health specific manifesto which is helpful and to be welcomed.

Mental health care in this country is currently a piecemeal system that lets many fall through the cracks. Primary and community care is much disorganised and varies greatly across the country, and emergency care is not fit for purpose. This results in unnecessary distress for patients and families, and, too frequently, avoidable tragic outcomes. While the government has repeatedly launched initiatives urging people to ‘get help’, people in distress often find that that help is not forthcoming.

Great opening statement that reflects the reality on the ground, the first manifesto I’ve read that has acknowledged this so clearly.

Growing demand for mental health services throughout the system has not been met with proportional increases in staff and resources for mental health services. There are huge waiting lists, as we have highlighted many times, for referrals to child and adolescent mental health services, and at the end of 2019, more than 8,000 people were waiting for a primary care psychology appointment, many of whom were children.

It’s actually not that the system has not been met with proportional increases to meet demand, services have been behind demand for 15+ years. We’ve a long long way to go if services are equipped to meet demand. 8000 children waiting for a Primary Care Psychology appointment is an indictment of the failure to adequately resource primary care psychology services

Sláintecare had a key focus on mental health. It recognises that much of the mental health services are difficult to access and focussed on acute services which were significantly understaffed, that community mental health services remain significantly under-resourced and that services were overly reliant on medication rather than on psychological and counselling services

Accurate statement on every level, understaffing, difficult to access and overly reliant on medication, pretty much summarises the main difficulties with mental health services in Ireland today. Seems simple to say but no other political party has described it as accurately or so succinctly so far.

A global revolution in mental health care is underway, and Ireland should be a leader in care rather than a country clinging to outdated and under-resourced models.

Again the only party so far to make any reference or recognition to the fact that we continue to utilise outdated models of mental health care in this country and they need urgent revision and replacing

Our commitments on Mental Health:

Increasing funding to 10% of health budget for Mental Health

Currently only at 6% of the overall budget, 10% is a target all parties should be aiming for

  • Fully staff Child and Adolescent Mental Health Teams by year 5.
  • Expand Adult Community Mental Health Teams by year five
  • Expand Old Age Psychiatry – by year five
  • Expand Child and Adolescent Liaison service by year 5.
  • Expand Intellectually Disability Mental Health services by year five

A positive that there is recognition of each of the main areas of mental health provision, especially ID Mental Health that has been under resourced and neglected arguably more than most other parts of mental health services for years. My main issues here are “fully staff”, by what measure is fully staff, A Vision for Change fully staffed? “Expand” other services, you have to “fully staff” these services before you can expand them and none of them are fully staffed.

Education and Prevention:

Ensure that all primary schools have referral access to a child psychologist, who would also engage with schools and pupils on topics such as mental wellbeing and anti-bullying.

Positive aspiration, I assume under remit of Primary Care?

Ensure that all secondary schools have a guidance counsellor, and referral access to educational and clinical psychologists.

Similar to above, positive aspiration but will need clarification by what is meant by “access”, at the moment some schools have “access” to a Psychologist twice a year, not great for pupils or schools in terms of potential effectiveness.

Ensure good funding for mental health research.

Only the second manifesto to mention the importance of mental health research, welcomed.

Significantly reduce waiting times for Child and Adult Mental Health Services and address the significant regional imbalances in waiting times – an issue the Social Democrats have continually highlighted.

How is it proposed to reduce waiting times, through increased staffing? Regional imbalances are impacted by inconsistencies of how referrals are processed / accepted and the national panel system being a direct impediment to regional recruitment.

Massive investment in the recruitment of extra psychologists for the National Educational Psychology Service and the Child and Adolescent Mental Health services under Sláintecare.

Great, how many, how much will it cost, staff grade psychologists or seniors, how many of each?

Every GP would have a mental health team to refer to, consisting of psychologists and a psychiatrist, counsellors, and access to allied professionals.

They do already, they’re just not resourced enough to be of practical assistance of GPs.

Ensure adequate facilities for all services.

The only party to recognise and state that the accommodation and facilities for many services are less than adequate and need an overhaul

Ensure timely and effective access and referral process for adjunct professionals, eg social workers, occupational therapists, mediators and marriage counsellors, etc.

I like the idea but not the terminology. “Adjunct professionals” ? Social workers, OT’s etc in my view are not “Adjunct” but core and much valued professionals working in mental health. Reforming referral processes will require a complete overhaul in how referrals to mental health services currently operate, it’s a massive undertaking that will be met with significant resistance, a task worth trying though.

Provide support groups and advice/education for family members.

Absolutely crucial, well resourced and supported family members are key to improving the outcomes of people who are struggling with their mental health but are often overlooked as such a key resource.

Vital services currently provided by state-funded non-profits will be
incorporated into more unified public system. The role of non-profits in advocacy and adjunct service provision will still be supported.

Similar to another manifesto that recommended this, a worthy aspiration but will be a potential minefield in terms of clinical governance expectations.

Increased neuropsychology services (for issues like dementia and brain injury).

Overlooked in mental health sections by all other parties but an important area to advocate for

Acute and In-patient Care:

Establish dedicated mental health emergency services. These would be co-located with a general emergency department and have access to a sufficient number of psychiatric in-patient beds.

Co-location is an important factor. Most mental health emergency services do not need to be and should not be in general A&E. There will be some times where medical intervention is required, say for example following an overdose, but for the majority a holistic bio-psycho-social assessment is more appropriate and helpful.

Establish a 24 hour HSE mental health crisis and advice line, accessible to all and promoted in particular to vulnerable populations

We have lots of crisis text lines provided by ISPCC, SpunOut and the Samaritans, do we need another HSE one or greater links and referral pathways between these established services and HSE intervention services?

Legislation:

Bring forward legislation to update the 2001 Mental Health Act so that it
complies with international human rights standards

Agreed but would have liked a little more detail here about which aspects of the legislation require updating, eg consent for u18s, capacity etc.

Verdict

None of the manifestos from the main political parties were perfect, and I wouldn’t have expected them to be. However in terms of the ethos and overall the manifesto that came closest to “getting” the reality of where we are at with mental health and where we need to go, the Social Democrats have come the closest. It recognises the importance of Primary Care, NEPS, research, legislation, adequate, accomodation, neuropsychology & non-A&E crisis options for mental health. It talks about the importance of reaching the 10% aim for overall health budget but gives no indications of how much this would cost.

Each of the party manifestos could score 10/10 in terms of aspirations and commitments but not one of the manifestos will be of use to anyone who requires mental health services unless these commitments are named in and funded in a programme for government with a parallel implementation plan and evaluative process. Whether any of these manifestos will result in the much needed systemic changes needed to reform our services and adequately fund and staff them remains to be seen. We need to maintain a watchful waiting and not let up on calling out inaction.

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