Mental Health Services

Dáil Éireann Debate, Tuesday - 20 October 2020

Tuesday, 20 October 2020

Ceisteanna (726)

Mark Ward

Ceist:

726. Deputy Mark Ward asked the Minister for Health the recommendations in Sharing the Vision that will be financed by the €23 million allocated for this purpose in budget 2021. [31567/20]

Freagraí scríofa

Minister of State at the Department of Health

Budget 2021 saw an additional €50 million allocated to Mental Health Services, bringing the total 2021 mental health budget to €1,076 billion, which is the biggest mental health budget noted. This signifies the Government’s continued commitment to mental health and the priority it deserves in these unsettling times.

€23 million has been allocated for implementing the short-term recommendations of Sharing the Vision in 2021. This includes the provision of additional beds; enhancing mental health teams including CAMHS hubs/teams, adult crisis resolution teams; expansion of the clinical and dialectical behavioural therapy programmes; peer support workers and the IPS employment and training initiative.

€15 million will assist with the challenges arising from Covid-19. The number of step-down beds will be increased and extra resources will be provided for community mental health teams. Reconfiguration of mental health facilities will also take place, in line with Mental Health Commission recommendations.

The remaining €12 million of the additional €50 million additional mental health funding for 2021 will help to cover the rising cost of existing service provision, including placements for those patients whose needs cannot be met within the public mental health system.

Sharing the Vision was launched in June 2020. The policy promotes equitable access to quality, safe mental health care for all citizens. Service users and their families, carers and supporters will have timely access to evidence-informed mental health services. Tailored measures will be put in place to ensure that individuals with complex mental health difficulties can avail of services across the State without discrimination. This builds on the intent of A Vision for Change and Sláintecare and is expected to be implemented as part of a ten-year plan.

Sharing the Vision recognises and plans for the increasing need for mental health services and demand for more holistic person-centred responses. The ten-year plan addresses population needs through a focus on the requirements of individuals. It promises early intervention, with a focus on prevention and positive mental health promotion. This focus advocates a mental health system that works in partnership with service users and their families to deliver a range of integrated services and supports.

The attached breakdown indicates in more detail the service priorities for 2021 and aligns those priorities to the recommendations contained in Sharing the Vision.

Sharing the Vision Recommendations for Budget 2020/2021

Initiative	Description	Recommendation
Additional Mental Health beds	This initiative is to increase number of step-down beds available in the community due to the reduction in capacity as a result of COVID-19.	38, 46, 50
Enhanced Mental Health community teams	Sharing the Vision states that the cornerstone of service delivery in secondary care will continue to be the multi-disciplinary Community Mental Health Teams (CMHTs). Funding will be provided to provide additional staff for community teams.	13, 17, 20, 25, 26, 28, 30, 32, 33, 34
CAMHS Hubs/Teams	StV encourages access to evidence based digital health interventions. Tele-psychiatry models can provide 24-hour psychiatry consultations to service users of all ages who can access supports from a variety of locations such as primary care centres, GP practices and VCS services. Funding will replicate existing models to provide remote access to tele-psychiatry interventions.	2, 31
Adult Crisis Resolution Services	Crisis Resolution (CR) offers after-hours and urgent mental health assistance. This funding will enhance Crisis Resolution Services within Adult Mental Health Service by increasing home-based Crisis Resolution Teams and piloting Crisis Cafes nationally to provide intensive, time-limited support with 7/7 access and connection to other care providers/GP to support recovery and prevent hospital utilisation.	24, 40
Clinical Programmes - Dual Diagnosis teams	Access to primary care addiction services and existing mental health supports when there is a co-existing mental health/addiction problem remains complicated. Specialist Dual Diagnosis teams will offer those with moderate to severe Dual Diagnosis addiction and mental health interventions based on individual need.	57
Clinical Programmes - Early intervention programme	The HSE National Clinical Programme for Early Intervention in Psychosis has the potential to transform the lives of people with emerging or first-episode psychosis. Multi-disciplinary training in behavioural family therapy and specialist cognitive behavioural therapy (CBT) for patients with psychosis will increase positive outcomes.	20, 53
Clinical Programmes - MHID	As described in AVFC, mental health and intellectual disability (MHID) teams should be developed to provide population-wide coverage and ensure fair and equal access to mental healthcare for people of all ages with an intellectual disability (ID). This funding will support the ongoing development of specialist, multi-disciplinary, community MHID services for adults and children providing an effective response to moderate to severe mental illness, deliver quality care and promote recovery.	50
IPS workers	Individual Placement and Support (IPS) is an evidence-based approach to helping people with acute mental health challenges enter the labour force. It is internationally accepted to be the most effective approach to supporting people with significant mental health challenges to gain access to mainstream employment and to helping them to progress on their recovery journey. Funding to mainstream this positively evaluated project is proposed.	71
Peer support workers	The further deployment of Lived experience in peer support roles as part of local CMHT’s and services to enhance recovery outcomes for individuals and families and to increase the recovery orientation of services in line with ‘Sharing the Vision’ and the ‘Framework for Recovery in Mental Health’. This initiative proposes to expand peer support working on adult teams, enhance support services for families, and develop recovery focused services within CAMHS.	15, 21, 39
Bereavement co-ordinators CfL	Sharing the Vision recognises that major life events can be compounded by significant additional pressures that contribute to poor mental health. It is important to ensure that during and following Covid-19, supports are in place for those who have lost loved ones through suicide. This funding will ensure that those bereaved by suicide will have access to information resources, supports and counselling.	15, 21, 39
Clonmel Crisis house	The need for alternatives to hospital admission featured in Sharing the Vision as a major priority. Funding a crisis house offers individuals experiencing acute mental health difficulties access to a service that acts as gatekeeper to hospital beds by ensuring that every individual referred for in-patient admission receives a comprehensive inter-disciplinary assessment before a decision is made about admission to an inpatient unit in a hospital.	24, 40
DBT	The further development of access to talk therapies is promoted in Sharing the Vision. Several online supports have been piloted in the past number of years and have proven to be effective interventions especially during the pandemic. Dialectical Behaviour therapy is an evidence-based treatment option that holds the most evidence for the efficacy and effectiveness in terms of treatment for borderline personality disorder. Access to additional DBT is in line with StV priorities.	Talk Therapies Various
Sharing the vision - setting up structures	To ensure ongoing operational implementation of recommendations contained in Sharing the Vision on a day-to-day basis, it is proposed that the HSE establish a structure to assist the NIMC in driving implementation of the policy. This work will require administrative support to assist the NIMC and the various sub-committees with their work.	76, 99

In addition, the establishment of a National Implementation and Monitoring Committee (NIMC) to oversee implementation of the policy was recently approved by Cabinet and announced by Minister Butler. The Committee will be mandated to drive reconfiguration, monitor progress against outcomes and deliver on the commitments made in this policy. Planning for the establishment of the NIMC and associated implementation structures is underway.