August 7, 2009

The State is failing to deliver on its promises to young people who suffer from mental health problems, writes PAUL GILLIGAN .


FEW CAN argue that as a society we are taking the mental health of our young people seriously.

We are not delivering on the promises and commitments we have made to young people who suffer from mental health problems and many believe that we are not living up to our constitutional obligations to “cherish all of the children of the nation equally”.

A Vision for Change is the national policy framework which currently guides the provision and development of child and adolescent mental health services in Ireland and, when launching the strategy in January 2006, the Government committed substantial funding to enable the radical restructuring and enhancement of these services.

Despite this commitment, development of child and adolescent services has not progressed in line with expectations.

The Expert Group on Mental Health Policy established to independently monitor implementation of the Vision for Change strategy expressed concern in its most recent report produced in April that, three years into implementation, a comprehensive implementation plan is still not in place and that progress is slow.

This view is supported by those working on the frontline of mental healthcare.

A Vision for Change recommends the establishment of 71 child and adolescent mental health teams but fewer than 50 have been established to date and not all of these have the full complement of staff.

Only a small number of these teams provide mental health services to the full 0-18 age group and some teams have waiting lists of more than 75 children and adolescents.

Of the 100 inpatient beds recommended in the strategy, fewer than 30 are currently available. The result is that children and adolescents continue to be admitted to adult psychiatric units or to be sent to Britain for treatment.

In Towards 2016 , the Government pledged to develop 300 primary care teams by the end of 2008, but to date nothing like this number has been established. In the teams that have been developed, there is a recognised shortage of mental health therapists such as counsellors, social workers and psychologists.

The lack of services is having a major impact not just on young people’s lives but on Irish society. More young people are committing suicide than should be, more young people are abusing alcohol and drugs than should be and more young people are carrying mental health difficulties into their adult lives than should be.

Families are being unnecessarily traumatised and the primary care, education and justice services are being left to pick up the pieces. Every time a young person commits a serious drug or alcohol-related crime, or an act of self-harm, we have to ask ourselves,could this have been prevented by a good mental health service?

For those young people who experience acute mental illness and are lucky enough to receive treatment, the situation is often not much better. Imagine what it is like to be one of four or five teenagers in an adult mental health facility or being sent to a different country to receive treatment.

Imagine how difficult it is for the parents of these young people trying to support their son or daughter through such a process.

Why have the required services not been established? The economic argument for investment is beyond dispute. It is recognised in most other developed countries that investment in children’s services saves the State money in the long term.

With good child and adolescent mental health services, fewer children become involved in the criminal justice system, fewer families break down and young people experiencing mental health problems can go on to live emotionally healthy lives.

It should not be necessary to justify expenditure on child mental health on economic grounds. The moral, social justice and social capital arguments are the most compelling.

Investing in the welfare of those who suffer from mental health difficulties, particularly children, is an essential component of any mature, socially just society.

Of course, tough decisions have to be made about how we allocate resources. However, it is simply unacceptable that we would deprive the most vulnerable, those who society has an obligation to nurture, of essential resources.

In a mature society, investing in social capital is an imperative. The Report of the Commission to Inquire into Child Abuse gives us a stark illustration of what can happen when as a society we fail to honour our obligations to the most vulnerable. Financially compensating the victims of institutional abuse is not enough.

We need to start reassessing our societal responsibilities and reprioritising investment in social capital.

Many frontline workers believe the fault lies with the HSE and its inability to project-manage new developments. Others believe it is a result of years of poor strategic and manpower planning.

While this might be overly critical, there is little doubt that there is a reluctance to actually spend the money allocated and that, either through a lack of planning or a revised financial perspective, the intended services cannot be delivered on.

How can an inpatient unit be built in Cork and yet there is no funding to staff the unit?

There is now a real concern that because of the economic downturn, spending on children and adolescents is no longer considered a priority.

The economic downturn and poor strategic planning do not explain all of the problems. The biggest difficulty lies with growing disempowerment and disillusionment.

There are deeply held insecurities about what we can actually do for the young people suffering from serious mental health problems. We are afraid, we don’t have faith that the system can or wishes to distinguish young people who have mental health problems from those who engage in anti-social behaviour or from those who are experiencing trauma and abuse.

We are not confident that the services to meet these different needs will be established. We don’t know what works and what doesn’t with these young people. We worry that if we fully engage in this work we will be left by the system to burn out or fail.

This insecurity leads us to run from the most challenging area of work, engaging at a treatment and therapeutic level with young people who have significant mental health problems. We prefer to talk about prevention initiatives which, of course, have significant long-term benefits but do little to help those young people who need help right now.

We engage in extensive planning, policy formation, architectural design and training but pause once the time comes to start engaging with the neediest young people. The conversations around treatment for these young people always centre on how difficult the work is; how inpatient units can become so dysfunctional that they have to be closed down for periods and how working in such units will inevitably result in burn-out.

As chief executive of an independent mental health service provider which has recently established a new adolescent service, I believe a new mindset is needed. The training, commitment and dedication of mental health professionals, particularly those working with young people, are second to none.

We need to remind ourselves of what we can achieve. These young people not only deserve the best services we can provide but they also deserve our optimism, dedication and commitment to helping them confront the many challenges they face.

These young people also require us to be their advocates because they are not in a position to advocate for themselves. We need to commit ourselves to ensuring the promised services are established in a fully funct
ional and constructive manner.

We need to resolve our concerns about providing such services and commit to doing our best and learning from our mistakes to ensure these young people are given a fair chance.

Paul Gilligan is chief executive of St Patrick’s University Hospital, Dublin

This article appears in the print edition of the Irish Times