No Vision for Change in Mental Health Services
The shocking story of the HSE and it's misappropriation of Mental Health Funding.
By Sara Burke
The HSE is “misappropriating funds allocated to develop mental health services”, while government is stripping mental health services of their main assets – buildings and land. This is according to groups working in mental health.
The current mental health policy is outlined in a document ‘A Vision for Change', published in January 2006. The Government committed itself to an additional €25 million expenditure annually to fund new mental health services over a seven to 10 year period.
‘A Vision for Change' proposes significant changes and improvements in mental health services, with increased reliance on community services. The policy states that finances acquired from the sale of mental health lands should be reinvested in developing community mental health services.
An extra €25 million was allocated annually to fund new developments outlined in ‘A Vision for Change' in 2006 and 2007. But, according to Freedom of Information documents obtained by the Irish Mental Health Coalition, just €27 million of the promised €50 million was spent on developing new services, while the remainder was used to “shore up budgetary overspends” by the HSE in mental health services. In other words the specific commitment made by the government in ‘A Vision for Change' was broken right away – €50m was not spent on the new services, slightly more than half was spent.
But the position is even worse for 2008. The HSE Service Plan for 2008 shows that no additional funds at all have been allocated in 2008. The promise of an extra €25m has been abandoned.
The Irish Mental Health Coalition, a coalition of NGOs working in mental health, held a press conference on 23 January 2008, the second anniversary of the publication of ‘A Vision for Change', to highlight underfunding of mental health services and the redirecting of money intended for new service developments.
At the press briefing, the Irish Mental Health Coalition highlighted other areas committed to in ‘A Vision for Change' which have not been acted upon in the two years since its publication. These include: the abandonment of the promised National Directorate for Mental Health which was central to overseeing progress in mental health services; the fact that mental health catchment areas are not yet finalised – people working in mental health services are not sure of how many people and what areas they are responsible for; and the continued understaffing of mental health services. The Independent Monitoring Group set up to oversee ‘A Vision for Change' said there was “an unacceptable delay between allocation of resources and recruitment of staff” in 2007.
John Saunders of Schizophrenia Ireland, said that 76 out of the 78 community mental health teams are “totally understaffed”. Psychiatrist Justin Brophy said “the recruitment embargo introduced by the HSE for the last four months of 2007 impacted like a torpedo on already bleak landscape of inadequate and under resourced community mental health teams”.
A ‘Vision for Change' promised the publication of an implementation plan. This has not been published by the HSE two years after its publication.
Even Mary Harney, Minister for Health and Children, criticised the HSE 2008 Service plan. She said “it falls short” of developments that could reasonably be expected in mental health.
Central to the achievement of the high standards and comprehensive mental health services set out in ‘A Vision for Change' is the transfer of resources in mental health from institutional care to comprehensive community and day care.
The Irish Psychiatric Association (IPA) also marked the second anniversary of ‘A Vision for Change' with the publication of a report entitled ‘The Lie of the Land'. This report examines the disposal of assets associated with mental hospitals and finds that there is “widespread asset stripping of buildings and land”.
Dermot Walsh, co-author of the report and ex-inspector of mental hospitals said, “'A Vision for Change' is posited on the capital that would derive from existing mental health buildings and lands; this has not happened and I am fearful that it will not happen”.
Chapter 17 of ‘A Vision for Change' clearly states that there are “substantial resources… tied up in institutions and the release of these could form a significant part of the investment required in funding the new model of care”.
The ‘Lie of the Land' report states “there is systematic shredding of assets… with both lands and buildings in mental health services either being given away or being sold for under the market cost without any benefit to mental health services…The political system is clearly complicit in this process, either directly or more often, by silence and
indifference”.
‘Lie of the Land' details the loss and diversion of a range of assets from mental health services, including St Ita's and St Brendan's hospitals.
For 40 years government policy has stipulated that the money acquired from the sale of lands which house old psychiatric units should be reinvested in mental health services.
St Brendan's hospital sits on 73 acres in north city Dublin. According to ‘The Lie of the Land', St Brendan's hospital was “understood to have been agreed to be sold to the Dublin Institute of Technology in 1998 although no monies were ever handed over nor has the precise sum for this sale ever been disclosed”.
The entire 73 acres on St Brendan's is now being developed by the Grangegorman Development Agency. According to Siobhan Barry, PRO for the IPA, the Grangegorman Development Act, 2005, indicates that 10 per cent (seven acres) may be used for ‘health' purposes although psychiatric services are not specified among many health services listed for inclusion on the site.
The IPA report says that clinicians working in “St Brendan's hospital hope that 130 beds for psychiatric service use will be developed on site”. However, “there is no legislative basis to ensure this… and there is no explicit statement to indicate that modern psychiatric services will be developed on site nor funded to be developed elsewhere”.
The IPA is unaware of if and how much St Brendan's was ‘sold' for and whether this money will reinvested in mental health service developments as stated in ‘A Vision for Change'.
St Ita's Hospital in Portrane is a vast 200 acre site, which for over 100 years has housed the main psychiatric services for north county Dublin. In its heyday, 2,000 residents lived in Portrane. Today, a couple of hundred live in the residential adult psychiatric services and the intellectually disabled residences.
For decades, archaic conditions in St Ita's have been highlighted in the ‘Report of the Inspector of Mental Hospitals'.
In 2003, that report identified St Ita's as a “black spot” and it was deemed “unacceptable for the care and treatment of patients because of seriously unsatisfactory conditions”.
In December 2003, Bertie Ahern announced that St Ita's would be part of the State lands released for the Affordable Housing Initiative.
For 25 years until 2005, senior clinicians at St Ita's and Beaumont hospital planned the transfer of acute psychiatric services for the entire north county Dublin area from Portrane to Beaumont. Plans for the new acute psychiatric unit in Beaumont were put out to tender in 2005 when the government granted funding approval.
In June 2005, Mary Harney announced the plan to co-locate private hospitals on the grounds of public hospitals. The site earmarked for the acute psychiatric unit in Beaumont is now the site for the co-located private for-profit hospital. Staff in St Ita's and in other north county Dublin psychiatric services have not been informed of where the new acute unit will be located.
It is unclear what will happen to the acute psychiatric services planned to service north county Dublin in Beaumont or the “unacceptable” services currently being operated in St Ita's Portrane.