Safely emerging from the Covid-19 crisis demands that we reimagine the structure of our day to day lives. How we access mental healthcare is no exception. Following the unified calls from opposition parties last week, the government has approved ‘Sharing the Vision – a Mental Health Policy for Everyone’, for the period 2020-2030. This plan for the future delivery of mental health services was first published in 2006, titled ‘A Vision for Change’, and advised a move towards providing mental health facilities on a primary care level. The report advocates that the entire population should have access to a multidisciplinary team of mental health professionals in their local communities. The government unfortunately never provided the necessary funding to achieve this, and Irish mental health services currently operate on wholly inadequate staffing levels.
As of 2019, there were more than 2,400 positions not filled in the mental health service, while child and adolescent mental health services (CAMHS) were operating on just over half of the required capacity. Despite this, the government has shown no sense of urgency to tackle this chronic under-resourcing, as Ireland spends a low proportion of the overall healthcare budget in comparison to other European countries.
Early reports of what the updated ‘Sharing the Vision – a Mental Health Policy for Everyone’ document contains have indicated that more focus will be placed on online mental health services. A move towards online supports may provide a welcome relief for those living in mental healthcare blackspots. Access to support services in Ireland is determined by a geographical lottery, with some regions suffering from severe understaffing in psychological and psychiatric services. Often those seeking treatment have to travel far outside of their home counties to access primary care services. Having a wide-ranging set of online resources would go a long way towards ensuring an equitable regional distribution of healthcare resources.
John Farrelly, the Chief Executive of the Mental Health Commission, has called for the publication of the report to be delayed until a new government can “take ownership of the strategy”. However, Mental Health Reform, which represents over 60 organisations and charities nationwide has taken an opposing view. Their CEO Fiona Coyle aired the view that the document should be published immediately so it can be reflected in programme for government negotiations and specific funding commitments can be made. Coyle also called for the formation of a group to oversee the implementation of the strategy.
The government has been heavily criticised in recent years for over-reliance on charities such as Pieta House and Jigsaw to deliver essential services and not building up capacity in the public Mental Health System. Only 6% of the annual healthcare budget is dedicated to mental health, significantly less than the 8.24% recommended in a Vision for Change, and the proposed 10% in the Sláintecare report.
A bigger role for online mental health services should be welcomed with caution. The American Psychological Association explains that while remote counselling services delivered online can provide an increased degree of flexibility both for patients and staff, research does not conclusively indicate that stand-alone therapy online or via texting is equally effective for patients in every situation. A briefing document on eMental Health services published by Mental Health Reform in 2019 also highlighted that online resources are an effective tool for engaging with hard-to-reach groups, by providing individuals with a broader range of options for delivery of mental healthcare. While extending the range of services for providing counselling and therapy services is welcome, a flexible approach must be adopted allowing clinicians and patients to engage with services in the way they find most appropriate and effective. Properly implementing the updated policy requires that additional finances be provided by the government in order to meet the growing demand for mental health services. Online resources must be used to enhance the current system and not as a cost-cutting exercise.
UCD students face many of the same challenges in accessing on campus counselling. There was one counsellor for every 2,340 students in UCD as of 2019, far from the ratio that the PHCEI (Psychological Counsellors in Higher Education) describe as international best practise of 1 counsellor to 1,000-1,500 students. While students can also access useful online resources such as Silvercloud online CBT courses, phone support from Niteline, and the USI mental health text line, none of these facilities should be used as a substitute for a well-resourced counselling service. Despite the best efforts of staff, due to sustained underfunding of the Student Health and Counselling service, students are faced with long waiting lists and often cannot be accommodated for on-campus counselling. UCD is currently spending more on business class flights for staff than on the health and wellbeing of their 30,000 students. This is not a tenable position for a public institution to hold.
Students can’t be expected to take University Management at their word when they claim to prioritise student welfare, because their track record says otherwise. There is no excuse for cutting €25k from the campus counselling service despite a €35 million budget surplus for the university the previous year. If UCD wishes to provide a fully functional student support service, a drastic overhaul of current policies is needed. This starts with a comprehensive and fully costed plan for hiring the required number of staff and investing in innovative online resources. Put simply, UCD needs our own ‘Vision for Change’.
Ruairí Power – UCD Students’ Union Welfare Officer