Health Budget 2022 Critical Moment for Mental Health Services
Hospital consultants are calling on Government to set funding for Ireland’s mental health services at realistic levels, as the impact of Covid-19 continues to expose the decades-long detrimental effects of severe deficits across the service.
Commenting on the launch of its Mental Health Pre-Budget 2022 Submission, the Irish Hospital Consultants Association (IHCA) says that there is now an opportunity to ensure that the mental health services are able to provide for ongoing increasing demand.
However, there was a stark warning that providing psychiatric care to patients while living alongside Covid has and will continue to present significant challenges because of the overwhelming capacity deficits that have existed for more than a decade.
With record numbers of people on waiting lists to be assessed and treated by a hospital consultant, as well as unprecedented numbers of patients presenting to Emergency Departments for mental healthcare, the IHCA says that targeted funding, beds and staffing is required now to deliver timely access to quality care for all patients.
Funding Inadequacies to be Addressed
While the 2021 Mental Health Budget of €1,114.1m is 9% above the equivalent 2009 expenditure level, given the population growth since then, the current mental health budget is actually €2,000 per 1,000 population below the spend 13 years ago.
At 5.4% of the overall health budget, the mental health budget in 2021 is also half the level of spending compared with other European neighbours and is low by international standards. Germany, the Netherlands and Sweden all spend approximately 11% of government health spending on mental health, with France allocating 13%.
For Budget 2022, the IHCA urges the Government to increase capital expenditure for Ireland’s mental health services and for its allocation to be expedited to address the physical infrastructure deficits that have resulted from more than a decade of capital cuts and underinvestment.
Immediate Bed Capacity Needed
With bed shortages and long waiting lists, the acute hospital system continues to feel the strain. Ireland has the third lowest number of inpatient psychiatric care beds in the EU, at just 32.69 per 100,000 inhabitants – this is half the EU27 average of 73.12 beds per 100,000.
Yet more than 1 in 8 inpatients spend six months or longer in an acute mental health bed, highlighting the lack of a suitable alternative placement for those with severe and enduring mental illness, who often have inappropriately long acute inpatient stays due to the lack of suitable step-down facilities.
Consultants say that the provision of an additional 28 acute psychiatric beds as outlined in the HSE’s National Service Plan 2021, while welcome, will not address the enormous shortfall in our psychiatric bed capacity, which reduced by 68% between 2004 and 2019. They estimate that an immediate increase of at least 300 acute adult psychiatric inpatient beds is required to meet recommended levels.
In light of the pandemic and the challenges of infection control, the fact that the majority of mental health units are in dormitory style format is also a concern. The IHCA recommends a greater number of single occupancy rooms made available to reduce the risk of not just Covid-19, but any viral or contagious infection spreading between vulnerable patients.
Consultant Staffing Crisis
At a time where some Emergency Departments are witnessing 8-fold increases in the number of patients presenting with mental health crises – especially among young people – the IHCA says it is unacceptable that more than 1 in 5 approved Consultant Psychiatry posts are vacant or filled on a temporary basis across the country.
The Association has long pointed to the ongoing salary inequity (applied since 2012) as the root cause of Ireland’s Consultant Psychiatrist recruitment and retention crisis, calling on Minister for Health Stephen Donnelly to deliver on his ‘unambiguous commitment’ to remedy the discrimination against consultants who have taken up contracts since 2012 and for future appointees.
Consultant vacancies are contributing to persistent and damaging waiting lists for treatment which are likely to worsen over the coming months with the impact of the pandemic hitting all areas of the health service, especially mental health.
First signs are already showing increased presentations of patients in crisis at Emergency Departments, which are often chaotic environments and not an appropriate setting for treating those who are acutely mentally unwell for a prolonged period of time.
Commenting on the submission, Prof Anne Doherty, Consultant Liaison Psychiatrist and Chair of the IHCA Psychiatry Committee, said, “the pandemic has completely exposed the cracks across our public hospital system, including in our mental health services. The combination of gaping mental health capacity deficits with significantly increased demand for treatment of mental illnesses impacted by Covid-19 is stretching our acute services to breaking point. It has focused our attention on the urgent need to dedicate specific funding and resources to mental health, anticipating the wider impact of the pandemic on our population.”
“We are at a pivotal moment and decision-making around this Budget is critical. It provides an opportunity to get it right, making a huge difference for our mental health patients. The solution is obvious: we must open the necessary level of beds and recruit the required number of Consultant Psychiatrists – and quickly. Government action now will prevent the current pandemic healthcare crisis drawing out for the rest of the decade and impacting on the nation’s mental health for years to come.”