I thank the committee for giving Mental Health Reform this opportunity, which we very much appreciate, to try to put mental health at the heart of the future vision for health care in Ireland. Mental health is a cross-cutting issue that is deeply entrenched in every aspect of Irish society. In 2015, the European Joint Action on Mental Health and Well-being, to which Ireland is a party, stated, "mental health is more crucial today than it has ever been" due in part to its impact on every domain of life. This effect is compounded by the growing recognition of mental health difficulties and, as a consequence, the increasing demand on mental health services that are already under-resourced and overstretched.
Mental health difficulties currently constitute one third of the disease burden in Europe and, according to the World Health Organization, depression is expected to be the largest contributor to disease burden by 2030. The Healthy Ireland survey reports that 9% of the Irish population over the age of 15 has a "probable mental health problem", which equates to approximately 325,000 people on the basis of the 2011 census. Almost 20% of young people aged 19 to 24 and 15% of children aged 11 to 13 in Ireland have had a mental health disorder, according to research conducted by the Royal College of Surgeons in Ireland. According to a survey conducted by the 3Ts organisation, suicide is the leading cause of death in young males, exceeding road traffic accidents and cancer. More recently, new research published by the Economic and Social Research Institute identified the two most common types of work-related illness, one of which is work-related stress, anxiety and depression and stated that stress, anxiety and depression account for 20% of work-related illness.
The costs relating to mental health difficulties in Ireland are significant. There is a strong correlation between physical and mental health difficulties. All together, when the NHS studied this, it stated that the extra physical health care caused by mental health difficulties was estimated to cost the NHS at least £10 billion per annum. Adults aged 18 or older with any type of mental disorder or major depressive episode in the past year are more likely than adults without these conditions to suffer high blood pressure, asthma, diabetes, heart disease and stroke. Regarding health service utilisation, adults with any mental disorder use both emergency departments and hospitals more than those without a mental disorder, leading to higher health care costs. In Ireland, it has been estimated that the overall cost of poor mental health is about 2% of GNP, which we calculate to equate to about €4 billion. To put this in context, the cost of overweight and obesity in Ireland was estimated in 2009 at €1.13 billion, equating to 0.7% of GNP.
One can see the impact of mental health is greater than some health issues that are getting much attention. This evidence suggests the individual and social returns from adequate investment in mental health in Ireland are likely to be "high and sustained", according to the Centre for Economic Performance in England. The main economic costs of mental health difficulties in Ireland have been said to be associated with the labour market as a result of lost employment, absenteeism, lost productivity and premature retirement.
Mental Health Reform strongly recommends that the area of mental health is recognised and afforded appropriate priority within the wider health agenda to reflect its significance in contributing to the burden of disease in Ireland and its impact on other areas of life. Despite the high costs of mental health difficulties to Irish society, resources for mental health services continue to be disproportionately low compared with resources for physical health services. For example, in the most recent budget, announced for 2017, there will be a 3% increase in revenue funding for mental health; the wider increase in revenue funding across the health budget was 7.4%. In the 2016 budget, mental health funding represented just 6.2% of the overall health budget, which is significantly lower than other leading countries and lower than recommended in Irish mental health policy. In both Britain and Canada the proportion of funding for mental health out of the health budget is approximately 13% and in New Zealand it is 11%. This Government’s allocation for next year will do little to address the historical underfunding and decades of neglect of Ireland’s mental health system.
I would like to speak about mental health in primary care. In addition to gaps in mental health services, there continues to be a significant lack of capacity within the primary care sector to provide comprehensive mental health at that level, including early intervention, detection of mental health difficulties and appropriate primary care interventions for adults and children. Such gaps include wide variation in access to mental health support in primary care and the underdevelopment of the role of mental health workers in primary care teams. There is a lack of a comprehensive range of mental health interventions in primary care and this is reflected in the current limitations of counselling in the primary care service, which is only available to people over age 18 who have a medical card and has a maximum of eight sessions. We know that as of the first quarter of 2016, 2,500 clients were waiting for counselling for between three and six months with the counselling and primary care service. That is significant as this is supposed to be an early intervention and quick access service.
I will speak about e-mental health, as there is potential for this to play a significant role. E-mental health is another strand of service delivery that has received little attention in the Irish context and could be considered in the development of our health system. There is potential for e-mental health supports to improve accessibility and affordability of mental health care, reducing the extent of unmet need. This, in effect, could address health inequalities and social exclusion, particularly in times of increased demand and overstretched services. We note, for example, the counselling in primary care service received 17,000 referrals in 2015; however, an estimated 325,000 people over age 15 in Ireland have a probable mental health problem, so we can see there is a significant gap in provision when compared with need.
It is very important to balance investment in the future health services towards prevention and early intervention services, particularly those targetting the mental health of infants, young children and their families. Despite targeted investment by Government in evidence-based programmes to improve outcomes for children and families, such as the area-based childhood initiative, there has been a lack of national direction on mental health in this area and a lack of consistency in incorporating mental health integrally into local early intervention programmes. Prevention needs to include an approach that places the social and emotional health and well-being of infants on a par with that of their physical health. This should be set out in national policy and complemented with the necessary resources.
In 2013, the World Health Organization recommended redirecting mental health spending towards community-based services, including the integration of mental health into maternal and child health, thereby enabling access to better and more cost-effective intervention. We note a recent evaluation of a parenting programme in Ireland indicated that for every €1,463 spent per child, a saving of €4,599 per child was realised. In this context I draw attention to the fact that according to information we recently examined, funding for family resource centres - a community resource that can be a great space for early intervention - was cut between 2008 and 2015 by 38%. The financial impact on wider society by neglecting to invest in early intervention services has been clearly identified, from economic disadvantage to academic underachievement, substance abuse, so-called juvenile delinquency and intergenerational effects, to name but a few. Researchers, clinicians and economists are in strong agreement that adequate investment in this area and a move towards prevention and early intervention, as opposed to crisis care, will lead to long-term economic savings, enhanced social capital and individual better outcomes.
One of the clearest goals must be for mental health to become the business of everybody in government and not just the health system. Overall, Mental Health Reform recommends that the Government adopts a "mental health in all policies" approach. This approach has been defined by the European Framework for Action on Mental Health and Wellbeing as the development of "mental health promotion and prevention and early intervention programmes, through integration of mental health in all policies and multi-sectoral cooperation".
To conclude, I draw attention to our core recommendations. These are that mental health should be prioritised in any future health care vision and integrated with physical health care throughout the health system, that the principles of human rights, autonomy and recovery should underpin all health service delivery, including in mental health, the wider health services and related social and community services and a "mental health in all policies" approach should be adopted to take account of the broad impact of mental health on a range of social and economic policy areas. Additionally, the Government should invest in mental health in primary care to ensure the mental health needs of the population are addressed at the lowest possible level of the mental health system. This should be supported through investment in mental health resources in primary care and implementation of a shared-care approach between primary and secondary mental health services. Furthermore, individuals with long-term mental health needs should be afforded access to free primary health care. That is very important to facilitate recovery and long-term health. Finally, investment in prevention and early intervention services should be put in place to support the mental health of infants, young children and their families.