This Government has prioritised the reform of our mental health services in line with A Vision for Change and is committed in particular to the delivery of more and better quality care in the community. Towards this end, funding of €90 million and some 1,100 posts have been provided since 2012 to develop our community mental health services and suicide prevention resources. The budget for specialist mental health services in 2014 is approximately €766 million which represents approximately 6.2% of the overall frontline health service budget. Approximately 90% of mental health problems are dealt with in primary care and some 30% of people who attend primary care have a mental health problem. Expenditure on these services is not captured in the mental health budget.
A Vision for Change indicates a requirement for 10,647 WTE staff which when adjusted for the 2011 population census is 12,240 WTE staff by 2016. However, given the changed economic circumstances since the publication of Vision in 2006, the Government has decided that the numbers employed across the public service must be reduced in order to meet its fiscal and budgetary targets. The health sector must make its contribution to that reduction. However, the HSE can make staff appointments once it remains within its overall employment ceiling and has the financial resources to do so. The HSE Mental Health Division, in its Service Plan for 2014 commits to the development of an initial workforce plan for 2014 to bring greater certainty around essential replacements and the streamlining of recruitment to allow for more local control and specialisation where appropriate.
While staffing levels in the mental health service have fallen there are positives that must be acknowledged. Many of the staff numbers lost were supporting the excessive numbers of beds which are no longer part of the service user recovery focused, modern, community-based service model for mental health. The overall reduction in numbers has been mitigated due to the priority ring-fenced Programme for Government investments in 2012, 2013 and again in 2014 which has allowed the HSE to begin to re-balance the staff skill mix in mental health to introduce new staff in the historically under represented disciplines recommended in A Vision for Change i.e. psychologists, social workers and occupational therapists.
Recruitment of the additional posts 890 posts approved in 2012 and 2013 is continuing with 95% of the 2012 posts filled as at the end of January 2014 and the recruitment process complete for 51% of the 2013 posts, with a further 20% in the final stages in the recruitment process. These posts continue to come on stream and are targeted to be in place by the end of Quarter 2 of 2014. Decisions on the breakdown of the new 2014 posts (between 250 - 280 posts) will be made following a business case and analysis process which is currently being undertaken in the HSE. This will ensure that the required professional grades are recruited to fill identified service gaps. Active recruitment for these posts will commence in the second Quarter of 2014, with all targeted to be in place by the end of the year.