Mental Health in Ireland

Mental health is critical to individual well-being, as well as for social and economic participation and it is an increasingly important concern in both Ireland and Northern Ireland. The pandemic has had significant impacts, which are likely to be a long-lasting, on mental health issues for many different groups in society.

A NESC Secretariat Report ‘A Shared Island Perspective on Mental Health’ argues that the pandemic has shown that there is scope for development, and much value to be found, in increased cross-border co-operation. It highlights that many aspects of mental health services and promotion are well-suited to cross-border working. These include the provision of on-line supports, mental health promotion, and training and education. Both jurisdictions have recently published mental health policies and there is potential for greater collaboration on shared concerns, building on existing cooperation on health across the border.

The report gives an overview of the policy landscape North and South. It highlights examples of areas where co-operation already exists, often led by the community and voluntary sector. 

Main findings:

• The pandemic has increased the pressure on mental health services that were already strained. There is a consensus that additional efforts and resources will be needed to address the increased demand for mental health services as a result of the pandemic, and also to catch up in some areas where services were cut back as a result of lockdowns and restrictions.
• There is a well-documented shortage of some health professionals, particularly in specialised areas, and this is a factor in mental health services both north and south.
• There have been increased efforts from both the Irish Government and the Northern Ireland Executive to promote and support mental health services in the last couple of years.
• In Ireland, a new policy for mental health was published last year, and some extra funding was also provided to strengthen mental health supports in the context of the pandemic.
• Northern Ireland’s first mental health strategy and funding plan was published in early 2021. This was preceded by a mental health action plan and the creation of a new role, a Mental Health Champion for Northern Ireland.
• The legacy of the Troubles still has a significant impact on mental health in Northern Ireland, and mental health issues are most prevalent in deprived areas and in areas affected by the violence – a clear example of health inequality. The social determinants of health – such as income, education and employment status7– play a big part in mental health, and this is particularly pronounced in Northern Ireland as a result of the conflict.
• There is evidence of good collaboration in the mental health area between public, community, and voluntary stakeholders on an all-island or north-south basis. Some of this co-operation happens through network approaches, in areas such as suicide prevention, but also through more formal structures on an operational level.

The paper also recommends a number of the topics which would be suitable for further consideration, including:

• possible benefits from enhancing the level and range of settings for cross-border engagement between the two administrations, and in professional and clinical terms, on mental health co-operation;
• how to ensure consistent funding and subsequent mainstreaming of successful cross-border and all-island projects;
• the possible role of a Mental Health Champion in Ireland, building on the experience in Northern Ireland;
• improved and more standardised data collection on mental health, as a tool for comparing policy outcomes, and to help share learning and information;
• how to build on and use the growth in online supports as a tool in cross-border co-operation;
• whether scope exists for more policy co-operation, and, given the public health aspect, whether there is potential for more co-operation around prevention and early intervention.

Mental Health in Europe

Mental health is critical to individual well-being, as well as for social and economic participation and yet it is estimated that more than one in six people across EU countries had a mental health issue (in 2016), equivalent to about 84 million people[1].  The connection between disadvantage and ill health when the social determinants of health (such as housing, income, childcare support, education and so on) are not met is well documented. This is also true in respect of mental health issues. So, for example, people in the lowest income group are more than two times more likely to report chronic depression than those in the highest income group across the EU[2].

Looking at the situation across Europe, it is reported that the COVID‑19 pandemic has increased the risk of development of various mental health conditions, particularly amongst young people and people in lower-income groups[3]. The COVID‑19 crisis has had a marked impact on the mental health of both people with pre-existing mental health conditions and the general population; it has also added further stress to mental health services and compounded issues of access to them[4].

Mental Health in Ireland

The estimated prevalence of mental health disorders is relatively high in Ireland compared with other European countries yet spending on mental health is relatively low[5].  In 2019, the Inspector of Mental Health highlighted the continued lack of development of mental health rehabilitation services (rehabilitation in this context meaning an approach to recovery from mental illness that maximizes quality of life and social inclusion). One example relates to recommendations from A Vision for Change (2006) to develop 48 rehabilitation teams, whereas there were then (in 2019) only 23 poorly staffed teams[6]. That report also considers it to be ‘imperative’ that funding is made available to implement a Model of Care for the provision of rehabilitation mental health services, rather than simply providing highly supported residential care.

Young people and mental health

In 2006, A Vision for Change (revised as per Census 2011 data) recommended the establishment of 129 specialist Child and Adolescent Mental Health (or CAMHs) teams. That strategy was replaced in 2020 by Sharing the Vision. Though A Vision for Change was due for full implementation by 2016, there have been problems with implementation and many gaps remain in both the primary care and in the specialised Child and Adolescent Mental Health Services (CAMHS) systems. There are 73 CAMHS teams in place at present.   Waiting lists for CAMHS can be significant.  There were 2,112 children and young people awaiting supports from CAMHS in 2020. Of these one in ten were waiting for treatment for 12 months or more and one in three were waiting for six months or more.

A 2021 report from Unicef on child well-being in rich countries found that Ireland's overall ranking for child wellbeing outcomes is 12^th out of the 41 countries studied[7]. Our ranking for child mental health is poor, at 26th; our ranking for physical health is in the mid-range at 17th; and our ranking for academic and social skills is relatively high at 6th. This indicates that while a focus on education has yielded benefits, there is a significant detriment to our children's mental and physical health which must be addressed.

Areas of concern in mental health:

There is a need for effective community services including effective outreach and follow-up programmes for people who have been in-patients in institutions upon their discharge into the wider community. These should provide:

• sheltered housing (high, medium and low supported housing);
• monitoring of medication;
• retraining and rehabilitation; and
• assistance with integration into community.

In the development of mental health teams there should be a particular focus on people with an intellectual disability and other potentially vulnerable groups, including children, homeless people, prisoners, Travellers, asylum seekers, refugees and other minority groups. People in these and related categories have a right to a specialist service to provide for their often complex needs. A great deal remains to be done before this right could be acknowledged as having been recognised and honoured in the healthcare system.  Research and development in all areas of mental health are needed to ensure a quality service is delivered. Providing good mental health services is a necessary investment in the future wellbeing of the country. Public awareness-raising should continue, to ensure a clearer understanding of mental illness so that the rights of those with mental illness are recognised. Funding has been allocated in recent budgets for mental health services. Social Justice Ireland welcomed these allocations. However, progress in implementation has continued to be slow related partly to recruitment difficulties.  It is important that structural challenges in relation to training, recruiting and retaining specialised and appropriately qualified staff are addressed in a timely manner.

Policy Priorities for consideration

• Ensure that announced budgetary allocations are valid, realistic and transparent and that they take existing commitments into account.
• Complete the roll-out of the Community Health Networks across the country and thus increase the availability and quality of Primary Care and Social Care services.
• Properly resource and develop mental health services, and facilitate campaigns giving greater attention to the issue of suicide.
• Work towards full universal healthcare for all. Ensure new system structures are fit for purpose and publish detailed evidence of how new decisions taken will meet healthcare goals.
• Enhance the process of planning and investment so that the healthcare system can cope with the increase and diversity in population and the ageing of the population projected for the next few decades.
• Ensure that structural and systematic reform of the health system reflects key principles aimed at achieving high performance, person-centred quality of care and value for money in the health service.

 

[1] OECD/European Union (2018), Health at a Glance: Europe 2018: State of Health in the EU Cycle, OECD Publishing, Paris. https://doi.org/10.1787/health_glance_eur-2018-en

[2] OECD/European Union (2018), Health at a Glance: Europe 2018: State of Health in the EU Cycle, OECD Publishing, Paris. https://doi.org/10.1787/health_glance_eur-2018-en

[3] OECD/European Union (2020), Health at a Glance: Europe 2020: State of Health in the EU Cycle, OECD Publishing, Paris, https://doi.org/10.1787/82129230-en.

[4] OECD/European Union (2020), Health at a Glance: Europe 2020: State of Health in the EU Cycle, OECD Publishing, Paris, https://doi.org/10.1787/82129230-en.

[5] OECD/EU (2018), Health at a Glance: Europe 2018: State of Health in the EU Cycle, OECD Publishing, Paris. https://doi.org/10.1787/health_glance_eur-2018-en

[6] Finnerty, S. (2019) Rehabilitation and Recovery Mental Health Services in Ireland 2018/2019. Dublin: Mental Health Commission

[7] UNICEF Innocenti Report Card Series, Worlds of Influence: Understanding What Shapes Child Well-being in Rich Countries,