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Promoting mental health and wellbeing- coping with chronic underfunding of mental health services

News item

Monday 15 Sep 2014

“Counselling psychology:  Contributing to Mental Health & Well-being” – A one day conference celebrating 25 years of counselling psychology training in Ireland.

Good afternoon.  It is a real pleasure to be invited to speak to you today about mental health and well-being in  Irish society, and how we should promote it.  In my short speech I will briefly look at what is happening at EU level, and then describe the type of service I believe would help to support a culture whereby people are allowed to care and speak openly about their mental health.

Promoting mental health is a complex proposition, dealing with the individual and their needs, and dealing with the chronic underfunding of mental health services.  For the bottom line is that mental health is not only the responsibility of the individual it is the collective responsibility of wider society and government.

Services have to be looked at in a political context.  It is my strongest belief that society should be measured by how we treat the most vulnerable among us – and the policies we pursue at national and European level effect people’s lives emotionally.  Constant fear of insolvency, fear for the future, and not having enough money to care for your family contributes to an environment where emotional pain can predominate, leading to long term mental distress.

As a member of the European Parliament, our work is of course at EU level.  And mental health is an EU wide concern.  Mental disorders are now described as the common ‘diseases’ of the 21st century in Europe. Every third adult in Europe will experience mental health problems within the course of a year. Psychological distress is the main cause of the approximately 58,000 suicides per year in Europe, resulting in more fatalities than road accidents.

The UN Convention on the Rights of Persons with Disabilities, which is redefining international understandings of society’s approaches towards mental health, as well as other areas, has important implications for policy. It is explicit in that States must put systems in place that allow people’s ‘will and preferences’ to be followed insofar as is possible, rather than corralling people into one form of treatment without the ability to express their preference for an alternative treatment method.

If we accept the UN Convention on the Rights of Persons with Disabilities, then EU and national policymakers must ensure that people living with mental illness have the services and care they need.    EU Policy on mental health is approached from the perspective of the consumer (in our case the patient); and the free movement of goods and services, innovation and job creation.

The European Commission’s website lays out the underlying premise for EU policy, and I quote: “Apart from the obvious benefits for individuals, good mental health is increasingly important for economic growth and social development in Europe. All of these are key EU policy goals”.

The EU has adopted a European Pact for Mental Health and Well Being – that identifies five priority areas:  the prevention of depression and suicide, mental health in youth and education, mental health in the workplace, mental health of older people, and combatting stigma and social exclusion.  Earlier this year the European Parliament adopted a very detailed resolution on mental health and called on the European Commission to keep proposals for a European strategy on mental health and wellbeing as a long-term objective.

These documents and resolutions show that awareness and understanding of the important of mental health is there, but the lack of action proves that the political to fund and prioritise mental health is lacking.

What type of service do people want?  Research shows that psychotherapy is the method of choice for treatment for the majority of psychological problems; or at least an indispensable part of any overall treatment plan. Yet despite this, the use of psychotherapy is still not easily accessible. In a European comparison the use of psychiatric drugs dominated, although they are rejected by many patients because of their side-effects and, as in the case of major depression, should only be prescribed in combination with psychotherapy.

I believe that to support a cultural change and tackle stigma we need strong political commitment to facilitate easy access to a primary care model that offers talk therapy where people live and work, rather than the current predominantly medical approach.  Offering talk therapy in a variety of settings – designed for different needs – could provide the first critical step in changing the Irish culture of introversion surrounding emotional pain.  We need to be where people feel comfortable.

A truly multi-disciplinary community service is something that many in the sector have been calling for; it’s what is outlined in A Vision For Change but has simply failed to materialise on the ground despite this policy being in place since 2006. By simply enforcing this policy many feel that this would be a start in the move away from the medical model that is currently in place and help re-orientate the culture surrounding mental health to being that of recovery focused and person centred.

Last year I co-hosted a conference in the University of Limerick, in association with the Network for Psychotherapeutic Care in Europe (NPCE).  The conference was titled ‘De-medicalising primary mental health care: Can we afford to, can we afford not to? The conference proposed a collaborative effort, to follow best practice and be informed by the evidence in order to provide a high quality primary care mental health service.  The conference proposed that we make ordinary and common practice, to seek direct professional help for emotional problems.  To bring talk therapy into the public consciousness in a way that is open and acceptable to health professionals, government and the wider public.

In Ireland we have many localised voluntary community services providing support and help for young people, for people with addictions and so on.  But these organisations do not receive secure funding support from the state – and exist through fundraising and short term grants from government.  The model I believe as best suited to providing good quality primary care, would allow existing existing community services to fit into an overall primary care model within what is known as stepped care.

Within this stepped care model, existing community based services would be better co-ordinated, accredited and integrated in this system.  These services will come together with a profession that is willing to work together, but completely depends on political will to make it happen.   The main problem, as I said earlier, is the historical under funding of mental health services.  The austerity programme being endured for the last four years in Ireland, has allowed even further cuts to these services, and those most affected by mental health issues, those who suffer social disadvantage, are those who are not able to afford help.

To conclude, promoting mental health and well-being involves government addressing the causes of social deprivation and isolation, and the chronic underfunding of the service.

Then we, as a society, relentlessly challenging and talking about stigma – while our profession works together to provide a service that is easily available, and suits a wide section of society.

Nessa Childers MEP – Key-note Speech 12 September 2014 – The Mansion House, Dublin.