Ireland currently faces three major challenges. At the moment we are in the whirlwind of the COVID-19 pandemic, and our energies are focussed on saving lives from succumbing to the physical effects of the virus. Soon the economic crisis resulting from social distancing measures will ensue. We have been warned that this is likely to be much worse than the recession that started in 2008, and worse even than the Great Depression in the early 20th century. As an open economy, Ireland will be particularly vulnerable to a worldwide depression, although perhaps better positioned than some in readiness to withstand it, given the strength of the economy before lockdown occurred.
But how well are we prepared to address the follow-on mental distress arising from these two major social events? First, let us look at what we can expect in terms of need for help. A study by researchers at the National Suicide Research Foundation looked at the effects of the last economic crisis on suicide rates. They found that by 2012, Ireland’s male suicide rate was 57% higher than it would have been if the pre-recession trend had continued. Many lives were lost, and we will never know if greater focus on the population’s mental health during and after the recession might have prevented some of those deaths.
Over time, the mental health of children and young people suffered, leading to a 25% spike in demand for child and adolescent mental health services for which the HSE has yet to fully adapt. Despite initiatives to reduce the CAMHS waiting lists, in September of 2019 there were still almost 2,000 children waiting for a first appointment.
Such waiting lists give us a hint of the potential demand, but they relate only to new referrals into the service. It is reasonable to expect that right now, the almost one million people in Ireland already living with a mental health difficulty will be facing extra challenges to staying well. Many of their supports have disappeared over night – the local social club, day centre, vocational training course, volunteer job, library, or other social activity in which they may have nurtured their recovery have all closed up. And on top of that, being socially isolated during a pandemic is likely to have made already high baseline anxiety even worse. Nikki Hayes recently showed this stress when she tweeted, “When people r [sic] joining together and neighbourhoods singing some of us are crumbling managing our depression.“ We mustn’t forget that for those for whom daily life was already a significant challenge to their mental health, this pandemic, the lockdown, and the thoughts of the coming economic crisis could all be magnifying their distress.
There is, then, a well-evidenced risk of a spike in demand for mental health support. How well prepared are our public mental health services for this increased demand? The answer is, not very.
The HSE reported in January of 2020 that it needed €189 million in additional funding to provide the full staffing set out in the national mental health policy A Vision for Change. And that figure does not include additional resources needed for primary care mental health services – the frontline early intervention supports that can stop the escalation of mild to moderate mental health difficulties becoming acute and severe. These primary care mental health supports are also known to be woefully under-resourced, with the Psychological Society of Ireland reporting a waiting list last September of 6,300 children for primary care assessments and 3,345 adults for counselling.
Right now, the HSE is scrambling to try to maintain mental health services during social distancing measures. Yet how can they even provide the most basic online support service when many of their offices don’t even have computers for their therapeutic staff? Shocking, but true.
Thus similar to the under-resourcing in emergency health services prior to the pandemic, mental health services are ill-equipped to cope with the potential increase in mental health need coming their way. The equivalent effort that is now taking place to plan the pandemic response and economic recovery must also be given to the mental health recovery. Ireland’s mental wellbeing must, now, be given the same parity as its physical health and economic strength. This, too, is about saving lives.
Here’s what the Government needs to do:
- Measure on a monthly basis the levels of mental distress and ability to cope. The Department of Health must initiate monthly surveys that measure levels of mental distress, how well people are coping, what their coping mechanisms are, and who is most affected This kind of information is vital for health and social services to be able to plan their response.
- Organise a cross-governmental, cross-society taskforce to develop the country’s mental health recovery plan, with a commitment to publish the plan within six months. The groundwork for such a plan has been laid in the review of the national mental health policy A Vision for Change. This ‘refresh’ was completed at the end of 2019 and is awaiting publication. It should be published immediately to provide the framework for planning the services that will prevent people from developing severe mental health difficulties and help people recover their mental health and wellbeing post-pandemic.
- Commit to the increase in protected funding to implement the mental health recovery plan.
- Rapidly scale-up and implement digital technology in mental healthcare at primary care and secondary care levels. Before the pandemic had occurred, the HSE had been working for several years on piloting online mental health services. A major effort must be put in place now to scale-up these initiatives in order to increase the reach and capacity of services so that anyone who needs an intervention by a mental health professional can get it quickly.
- Embed trauma-informed approaches across public services. Common sense tells us that many people of all ages, from young children to those in their later years, will have experienced personal trauma during the pandemic. In a sense, we all have. But for those children whose families have struggled to cope with isolation, who face sudden economic hardship, the threat of losing their homes, domestic abuse, bereavement, or separation from a loved one who is dying, that personal trauma may be quite profound. Every teacher and school staff member, guard, health professional, social welfare officer, housing officer, and provider of social care needs to know how to respond appropriately to their service users so as not to re-traumatise them.
The Government has a narrow window of opportunity over the next few months to prevent a mental distress crisis and prepare for the mental health need that will arise from this pandemic. There is no time to waste. Government Ministers must demonstrate that there really is no health, and no wealth, without mental health. They must deliver a concrete plan and the resources to make it happen. Lives depend on it.