John Farrelly: Stand-off at CMH just one symptom of failed system25 March 2021
We need to build a new mental healthcare system, not expand or patch up a broken one.
Mental illness is not a personal failure. If there is failure, it is our societal response to people with mental and neurological disorders.
Last week’s stand-off between gardaí and mental health professionals at the gates of the Central Mental Hospital evidenced the lack of access to expert mental health services in Ireland.
The new national forensic mental health service, opening this year in Portrane, will increase both quality and quantity of forensic beds. However, it will not solve the service strain and access issues that dominate all mental health services in Ireland.
For many people, including children in most parts of the country, an inpatient bed or an essential community service cannot be provided in a timely manner.
Access to mental health services is a human right. It is the key issue. We do not have enough acute inpatient beds or essential community services. In addition, Covid-19 is both lowering the amount of beds available and also contributing to a rise in the numbers of people suffering.
The public system offers very few options, other than a brief GP visit and medication. Most critically, young people and marginalised groups are not being helped early enough. By continually and systemically failing to rapidly intervene, we are condemning young people with mental health issues and their families to misery. A place on a long waiting list for specialist essential treatment is not a service, but a sentence. This sluggish response time is wholly unacceptable and needs to change – and change quickly.
Put simply, we cannot continue to ignore the reality of mental illness. We do not tolerate waiting lists for passports, driving licences or, indeed, vaccinations. Yet for mental health treatment, waiting lists are normal and accepted. At the start of Covid-19, I presented to the Special Committee on Covid-19 Response in Dáil Éireann where the numbers of children on waiting lists for access to services barely raised an eyebrow in media or political circles.
Covid-19 is helping to dispel long-held prejudices and mark the dawning of new ways of thinking about mental health care. Many people now understand that physical and mental health are inextricably linked to one other and to our wellbeing as individuals. Covid-19 has forced society to understand and appreciate the necessity of access to essential mental health services.
The pandemic has forced many to experience the reality of anxiety, depression, isolation, grief and being restricted for our own good. People who are ordinarily well have been given a brief glimpse and insight into the reality of life with a mental illness.
The reality of living with poor mental health has been laid bare in Ireland through reports published by the Mental Health Commission. Reports that repeatedly reveal the need for reform. While Ireland closed the old asylums, for many, essential expert acute mental health care has been replaced by institutionalisation in prisons and homeless services.
We seem so stubbornly determined to warehouse people in congregated settings rather than put adequate community services in place. We have invested in cardiac, cancer and stroke care, yet we continue to neglect mental health. Covid-19 is challenging Ireland to move on from a coercive, paternalistic, and exclusionary model of care to systems based on research, quality interpersonal relationships and personalised care.
To modernise, we must become holistic. Creating a proper, evidenced-based and integrated community mental health care system must be a key goal of the Covid-19 generation. We must transform what in the main is essentially a psychiatric medical model into a holistic mental health service. A service with people at the centre; responsive to different ages, backgrounds and perspectives; and centred on community-based support and local hubs led by expert clinical workforces. A comprehensive community-based addiction service must be integrated into our mental health services to stop people falling through the cracks. We must quickly put in place a broader range of therapies based on need rather than ability to pay. We need solutions that are based on solid scientific evidence and which are now available and affordable.
Speedy and targeted implementation of Ireland’s mental health strategy, “Sharing the Vision”, is required to enable change. We must reform the Health Service Executive to create a governance structure to roll out the strategy in a co-ordinated way across the entire country. We must put in place a mental health national leader who will drive the new strategy to help ensure funding for mental health is increased and ring-fenced; that more clinical staff are recruited; that the number of teams is increased; and all buildings are made fit for purpose. Clear political oversight and scrutiny is required to ensure transparency and accountability on how resources are allocated and spent on the mental health of our people.
We need to build a new mental health care system, not expand or patch up a broken one.
We have been talking about the ongoing failures of Ireland’s mental health system for far too long. We have made strides over the last half century, but we still have a long way to go. Imagine if the Covid-19 generation finally and comprehensively demanded and delivered person-centred, holistic mental health care. Imagine an Ireland with adequate mental health services for children, adults and older people. Imagine an Ireland where you receive timely treatment based on needs rather than ability to pay.
We are at a tipping point. It’s time for our health services and political system to make these entirely achievable dreams a reality. There needs to be less talk and more action so that a mentally ill person is not forced to wait at a hospital gate while gardaí and clinical staff argue their case. Or children are not placed on a waiting list instead of receiving compassionate, evidenced-based mental health care in a timely manner.
The time for change is now.