MENTAL HEALTH IS often seen as the Cinderella of health – the overlooked sibling.
Over many decades, the development of Ireland’s mental health system has been slow, falling well behind the rest of the health service.
There has been an historic underinvestment in the system which has resulted in slow development of some specific services as well as patchy provision across the country.
Year after year, mental health funding announced on Budget Day has not taken into account some basic principles that are taken for granted in other areas of the health service.
No funding for rising costs
The cost of maintaining existing services in mental health rises each year. This is not surprising – staff are on pay scales, different numbers of agency staff are required each year to cover vacancies, some services might have more clients some years than others.
Yet before 2016, the Government gave no money to recognise the rising cost of “existing levels of services” each year.
This money has had to come from somewhere, and it usually comes from so-called “development funding” – the money supposed to be used to develop new mental health services each year, in line with national mental health policy.
Between 2012 and 2019, the HSE has said that almost 20%, or €50m of the €265m, of development funding set aside for the development of mental health services was used for this purpose – to fill the gaps in existing services left unfunded by Government.
As a result, many services have gone underdeveloped. Eating disorder services are a prime example.
Eating disorders affect up to 5% of the population at some point in their lives, and anorexia nervosa has the highest mortality rate of all of mental health conditions. People can and do recover from eating disorders, but early intervention is a key factor in long-lasting sustained recovery.
With good quality services, eating disorders are both preventable and treatable, allowing for people to regain control over their lives and work towards their own personal recovery. In line with Sláintecare, the objective for the development of services is to provide the right care, to the right patient, at the right time and for the right cost.
Budget allocated but not spent
For eating disorder services, development money supports the implementation of new services across the country, including those in areas outside of Dublin and Cork where services have typically been underdeveloped.
In 2018, €1.5m was allocated for the development of eating disorder services across Ireland. However, according to the HSE, just €137,000 of this money was spent.
The remaining approx. €1.4m, in agreement with the Department of Health, was used to prop up other areas of the mental health services that the Government did not fund.
In 2019, a further €1.6m was allocated to the development of eating disorder services.
However in November 2019, nearly a full year after it was promised, the HSE said that this funding was being held by the Department of Health “and so in effect this will not become available to [mental health] until Jan 2020”.
This suggests that little or no new money for the development of services for eating disorders was made available to the HSE in 2019.
In Budget 2020, no new development funding was allocated by the Government to progress many areas of our mental health services that so sorely needed it, including eating disorder services.
Though the HSE did say that there were plans to progress a number of posts in 2020 for eating disorder services, they have also acknowledged that these plans will likely be impacted by COVID-19.
There is a pattern of underinvestment in our mental health services – one step forward, two steps back.
Services should not fall victim
While eating disorders services in Ireland are progressing, and it should be acknowledged that where these services are in place they do excellent work – the problem that must be addressed is that services such as these should be and could have been much further along the road than they are, if sustained investment was made.
Over many years, Ireland has faced huge increases in demand for mental health services. More and more people are coming forward for help and support – we have encouraged them to do this!
However, when people do come forward, services need to be there to support them.
In the context of Covid-19, when people face levels of isolation, loneliness and distress rarely seen before, investment in mental health services has never been more important.
In Budget 2021, the Government must ensure that services like those for people with eating disorders do not continue to fall victim to a systemic failure to adequately invest.
Fiona Coyle is the CEO of the Mental Health Reform, the leading national coalition on mental health in Ireland.
If you need to speak to someone, contact:
SILENT TREATMENT Investigation
Do you want to know if people with eating disorders are being failed by the public health system?
The Noteworthy team want to do an in-depth investigation into the progress of the national clinical programme for eating disorders and what is causing delays in its implementation.
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