I thank the committee for the invitation to address it today. I am pleased to join the committee on behalf of Mental Health Ireland.
There is no health without mental health, as in the UN declaration. In recent decades we have seen the use of the term "mental health" expand well beyond its original and previous connotation of mental illness and psychiatry. Irish people now apply the term across a much broader range of life experiences, including overwhelming stresses, life adjustments and well-being issues. It is used in a less stigmatised way today. Mental health services have been through a period of extraordinary change and reform over recent years, but significant concerns relating to service access and capacity persist. We have experienced a pendular swing from the 1980s when it was largely a bed-based service to having now the lowest bed-to-population ratio in Europe, approximately half the European rate. This has been quite challenging for everybody involved. Such a model can only really be contemplated if there is very robust and strong investment in community-based mental health services. This has not been our experience to date.
As a country, we have experienced radical social change over the past two decades, with lifestyle changes, different constructs in families and work patterns, demographic and social changes, greater diversity and new expectations. In fact, personal satisfaction and well-being are now considered the new determinants of success. The term "mental health" attempts to encompass a broad sweep of human experiences, from life satisfaction, well-being, stress and distress to mental illness through to full psychiatric illnesses. To date, we have looked to an under-resourced psychiatric model to extend itself to respond to the full spectrum of these needs. This is neither an appropriate nor sustainable model. We must step back and apply the right solutions in the right context for the right person at the right moment.
The recently published Sharing the Vision: a Mental Health Policy for Everyone proposes that we address the needs of the whole population, and this is the sensible approach in providing properly resourced, more responsive services for people with the most significant mental health needs. The WHO recommends that every state should dedicate 12% of its health budget to mental health spending. In Ireland, it is less that 7%. That is going to be a stark reality that will be difficult to avoid no matter how we approach this conversation. Despite the extraordinary commitment of staff working in the services, it is unrealistic to expect that they can deliver the full range of services when they have less than 60% of the resourcing that is recommended. Our mental health services are imaginative each day, but they cannot be imaginary. We must be plain and honest with each other in that regard.
The additional pressures associated with the Covid-19 pandemic have uncloaked underlying tensions and some of the fragility that people live with daily. We have had strained social bonds, overstretched families, people living in insecure housing, precarious employment, long commutes, inadequate childcare provision, drug and alcohol misuse and financial uncertainty. These additional stressors have opened up fractures in many instances. Supporting mental health can be difficult at the best of times, and these certainly are not the best of times. A healthy society seeks to address proactively many of these concerns. Chronic stress corrodes not just physical but also mental health. At a societal level, it can instil division, hostility and cynicism, eroding the quality of life for all citizens. The uncertainty of Covid-19 has overwhelmed many, and the crushing effects of isolation have been very difficult to bear, especially for those already dealing with loneliness.
We know that loneliness is a particularly damaging phenomenon at individual and societal levels.
At Mental Health Ireland we have two primary roles, promoting positive mental health and well-being across whole populations and supporting individuals in their journey towards recovery. We do this in a variety of ways. We work with our network of volunteers and staff and with peers, peer educators and recovery colleges right across the Republic of Ireland. We work very closely with the HSE mental health services and a range of partners within the mental health sector and in other sectors.
This Saturday is World Mental Health Day. The theme is Mental Health for All: Greater Investment, Greater Access. It is really important that our new national policy perfectly echoes this sentiment and calls for additional investment. It does not mean more of the same. It seeks to advance a different, more hopeful and inclusive agenda, hence its title, Sharing the Vision: A Mental Health Policy for Everyone. This new policy is a comprehensive and impressive declaration of intent, but it must be more than that. Unless it is backed with investment, the momentum and enthusiasm for implementation will very quickly be lost. It must be monitored via political oversight as well as through the structures described in the policy itself. There is a huge risk that it could disappear without trace unless we monitor it very closely.
Mental Health Ireland and our colleagues in Mental Health Reform and other agencies would certainly welcome the establishment of a special mental health subcommittee of the Oireachtas Committee on Health. This would really help to focus on, capture and celebrate the progress as we fulfil the objectives of this policy in its full implementation.
We know that Irish people are concerned about mental health, and not in a self-serving or selfish way. There is a genuine concern for ensuring that all citizens are treated fairly, equally, effectively and respectfully. This has to be more than just a faint hope. We frequently hear the words "mental health" being bandied about. There is sometimes a lot of chatter in this space. We need to follow through with action. People who use services and their families have been disappointed before. Now they want to be seen, heard and listened to. Talk is cheap but talking therapies are not. We need to respond to this in a credible way.
When promoting positive mental health and well-being, Mental Health Ireland pursues three strategies, namely, strengthening the individual, strengthening communities and removing barriers to good health. Our work is supported by the HSE and very generous public donations. There has been an enormous groundswell of people who want to become involved, contribute and be active in this area. We welcome people who wish to do that as volunteers.
Research shows that investment in the mental health of our population does not just raise quality of life for individuals. It builds better communities, promotes independence and brings economic benefits too. The London School of Economics suggests that there may be an eightfold return on each euro of investment. We have been very economically successful in many ways, but our burgeoning economy is of little value unless all of the people benefit from, enjoy and share in that success. We cannot return to slavish routines, stressed and unsustainable lifestyles and inequality. We can do better, and as a community and society, we can make very active decisions which will promote mental health for all of our citizens.
In the past seven months, we have witnessed the best that Irish people can bring, pulling together, protecting one and other and reawakening community bonds. If we can retain some of that spirit, we can do really well. The challenge of Covid-19 has reminded us that personal health and well-being is not a solo pursuit. It is a shared exercise built on cohesion, collective effort and mutual respect across all life stages.
Providing high-quality uninterrupted community-based mental health care is a challenge, particularly in the context of Covid-19. Many services have had to be reduced. We really believe that these are essential services. We need to create more innovative and adept workarounds so that people who genuinely depend on these services are not left behind. We must overcome the challenge of providing continuous community-based services and supports in the context of Covid-19. We also know that peers and family members want to contribute. More than half of our organisation's staff are people with lived experience who want to share their unique insight, contribute to understanding and assist other people on their journey to recovery. This is a much more hopeful message than those of the past.
However, we also know that Irish mental health services are patchy and unevenly resourced. There are significant differences in spend per capita between one county and another, or indeed between one community healthcare organisation, CHO, and another. We must ensure that every citizen has his or her right to recovery fully realised in every county of our country. Uneven investment has restricted timely access in some parts of the country and discouraged innovation and modernisation in others. It seems an unusual thing to say, but an abundance of resources has caused services to become stuck. The weight of resources is causing inertia. Services' agility in moving forward and accepting better and more modern practice has sometimes been limited. We need even distribution of the available resources. We know they will never be adequate, but let us at least be fair.
We also know that timely access to service is critical. Delayed interventions risk lives and miss opportunities for recovery. When someone is acutely unwell and needs to see a psychiatrist, psychiatric nurse, occupational therapist, social worker or psychologist, no substitute will do. We also know that the new policy opens up new opportunities to welcome new talents and skill sets. A much more diverse workforce could include new skills in the areas of employment, supported housing, education, training, life skills and community integration. In the past, we were inclined to look to health professions to fulfil all of these functions. We need to use our health professions in a more targeted and deliberate way. Sharing the Vision invites us to do that.
We have also learned from international colleagues. I spent two hours last night talking to colleagues in the US, Canada, Australia, New Zealand, the UK and Sweden. They spoke about the corrosive effects of what are described as "diseases of despair". For example, for three consecutive years, life expectancy has decreased in the US for the first time in history. The loss of life expectancy has been attributed to poor mental health phenomena, often manifested as drug and alcohol use, obesity and suicide. These are eroding the huge gains that have been made in healthcare in recent years. We cannot allow our country to go down that path. We must learn from the experiences of others to avoid this.
Our new mental health policy is a very confident statement.