LACK OF FUNDING, long waiting lists and a disjointed system are the common complaints about Ireland’s mental health services, which critics say poorly serves young people. Now, with demand expected to increase due to the Covid-19 pandemic, there are worries over whether the system can cope.
TheJournal.ie spoke to staff, students and politicians who all shared the concern about whether the system could sustain an anticipated spike in cases and referrals.
Some referred to the situation as akin to waiting for a tsunami, others likened it to a time-bomb.
The months of September and October often see an increase in referrals for mental health as part of the normal cycle. Now with schools set to be transformed by public health guidelines and colleges moving largely online, staff in the sector are preparing for a rising number of issues among students.
While anxiety and stress are to be expected, even less serious mental health issues place burdens on already overstretched services.
Everyone who spoke to TheJournal.ie agreed that the system was under-funded and often inefficient. And while some praised the response of the government and colleges so far, they acknowledged that the next few months would likely bring fresh challenges.
Colleges
The most recent report from the Union of Students of Ireland on mental health found that over 38% of students were suffering from anxiety, while 30% suffer from depression.
There are concerns that the twin effects of the Covid-19 pandemic and the alienation that could come with a largely online experience might see higher rates of stress and drop-out.
Those troubles will then have to be dealt with by an already over-stretched system. Ireland currently has one student counsellor per 2,448 students – the international standard is one per 1,500.
Gertie Raftery, the chair of the Psychological Counsellors in Higher Education Ireland, said the system for college counselling is “under-resourced for what it does”.
“We look after the mental health needs of thousands of young people. We’re the main ones who deal with it,” she says. “Someone in private counselling doesn’t see what we see.
“We’re seeing the full gamut.”
Complaints can often be frustratingly simple, exacerbated now by the pandemic. Small rooms and a lack of space in colleges were problems pre-Covid-19. Now, they’re a major barrier to in-person, socially distanced counselling.
One ongoing issue the sector has is with how €2 million announced last October by Mary Mitchell O’Connor, then Minister of State for Higher Education, for “student mental health and well-being initiatives”, has not materialised.
Counselling services say that they have yet to see the money nearly 12 months later. Officials in the sector believe it’s been provided out to colleges, but no one is sure why counselling services haven’t received it. Raftery says inquiries have been made with the new minister, Simon Harris.
A spokesperson for the Department of Higher Education said that the HEA had provided the €2 million as part of the annual block grant to colleges.
“It is envisaged that the funding would be used for the employment of additional counsellors, provision of additional counselling services, as well as initiatives in the area of mental health training in higher education institutions,” the spokesperson said.
That funding – if it arrives to counsellors – will be used to support an unprecedented array of online supports that have been built up and enhanced in only a few months. Raftery says that change is here to stay.
“We will never go back to all face-to-face. With the new generations, they’re used to working like that.”
The Department for Higher Education said that the Higher Education Authority has provided an extra €2 million this year for colleges to support student mental health, with €3 million also provided by the government to help college services cope with the challenges of Covid-19.
“The HEA will be following up with institutions on this funding allocation as part of the implementation of the soon to be published National Student Mental Health and Suicide Prevention Framework,” the department spokesperson said.
Individual colleges also say they’ve been working to prepare for the coming academic year, with student counselling services already moved online.
TU Dublin employs nine full-time counsellors for nearly 29,000 students. “To meet the extra demand for Counselling during busy periods such as returning to campus this autumn, after what has been a very stressful time for students, we can supplement our team of nine full-time counsellors with sessional counsellors,” a spokesperson said.
But others say the wider problem is structural. Éamonn O’Dochartaigh, a student counsellor in TU Dublin, is worried about a “tsunami” of cases worsened by the difficulties of the pandemic and the uncertainty of the future.
He recalls colleagues working from rooms where staff would be “bumping knees” with a student, while he also worries that too often it’s student counsellers – under-resourced and with an understandably limited range of skills – that are left to pick up the pieces in the face of long public health waiting lists.
For him, the problem with student counselling services – whether they’re funded or not – is that they’re “neither fish nor fowl”.
“It’s money from Department of Education and money from student fees that’s channelled into counselling,” he says. “It needs, ultimately, a hard look at who is really is responsible to meet the mental health needs of two thirds of young people who go to third-level.”
Ultimately, it’s the students who suffer.
“I have accessed supports in the past and I am currently in the process of trying to reach out again to those same supports and whilst there was online supports there was a shortage of in person sessions due to Covid,” one student, who wanted to remain anonymous, said.
Living with other people, I wouldn’t be comfortable speaking online with someone in case someone heard. I am in the process of reaching out to Jigsaw and hopefully getting a face to face session but was told today that it would be months until one became available. Who knows where we’ll be then?
Schools
In recent years, the government has expended significant energy and resources into both researching and promoting “well-being” and positive mental health in secondary schools.
As one report from 2013 stated:
Mental health promotion and the provision of supports for vulnerable students depend on ongoing cooperation between schools and the range of available services and agencies from the education, health and community sectors.
Yet to critics, the system lacks the joined-up approach necessary to care for students. One of the key cogs in the mental health school system is the National Educational Psychological Service, which received an extra €1.25 million at the end of July to hire 17 new staff.
And while psychologists at the service provide support to teachers, critics say the partnership leaves a lot to be desired and is often too reactive with staff rarely ‘on the ground’ in schools.
“The system is not well enough resourced,” says Beatrice Dooley, President of the Institute of Guidance Counsellors. Mental health supports for schools, she says, have long been under stress – but Covid-19 has placed them “under the microscope” in a new way.
One of her main concerns is the referral system, which sees young people with mental health issues generally referred first to GPs. With large waiting lists and a pandemic-induced backlog already a very real concern, there are worries that young people might end up waiting even longer for care.
In August 2019, close to 7,500 children and teenagers were waiting for an appointment with a public health psychologist – a figure that was nearly 20% higher than the previous year.
“We’re going to have an increase of anxiety amongst students and more of them requiring referrals out, so where do we refer these young people to?” Dooley said.
There is an acknowledgement that the government is at least aware of the problem. In July, as part of a €375 million support package for schools, 120 guidance posts were funded.
Dooley has welcomed the decision, but highlights the need for principals to give these posts to qualified, guidance counsellors already in schools and not to opt for cheaper, external providers instead.
For others, there is a sense of the crisis catching up with years of poor planning and provision at every level.
Primary school mental health care, for instance, has long been lacklustre. As one report by Dublin City University academics noted in 2017, “a lack of funding and the absence of a national policy relating to school-based counselling” are major hurdles for principals to overcome.
Work is ongoing. Carmel Halligan, the Youth Mental Health Promotion Manager at Jigsaw, which works with schools to support young people, said that the organisation had seen over 10,000 teachers sign up to complete online courses on mental health awareness.
She believes schools are being “proactive” in preparing for the weeks ahead. She said the organisation had also “developed a series of resources for school leadership, teachers and for students which are designed to normalise conversations about mental health, develop mental health literacy and support help-seeking behaviours”.
Social Democrats TD and the party’s education spokesperson Gary Gannon has raised the wider issue in the Dáil. He tells TheJournal.ie that the problem is a “time bomb” facing the government, which hasn’t yet done enough to support teachers and pupils.
“Every year, normally, secondary schools don’t have the ability to cope with the flux of mental health needs of teenagers and young people. That inevitably falls on career guidance counsellors.
“All of a sudden we release that pressure valve in September and we’ve provided no additional support to schools.”
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