A PRESCRIPTION FOR CHANGE
5. Mental Health
Fairer, safer and more efficient healthcare
HEALTH PLAN HOMEPAGE
UNIVERSAL HEALTH AND SOCIAL CARE
LOCAL HEALTH AND SOCIAL CARE SERVICES
HOSPITAL REFORM
MENTAL HEALTH
DELIVERING ON RIGHTS FOR DISABLED PEOPLE
STRATEGIC IMPROVEMENT PROGRAMMES
AGING AND OLDER PERSONS CARE
TACKLING ADDICTION, EMPOWERING RECOVERY
SAFE STAFFING FOR SAFER HEALTHCARE
ACCOUNTABILITY AND REFORM
OTHER KEY INFORMATION
Mental Health
Current Expenditure: €250 million
Sinn Féin’s Mental Health Action Plan would transform how we deliver mental health services across the country. It sets out our absolute commitment to delivering widespread and significant change and a fresh start in mental health care. Sinn Féin would ensure that access to services is based on need and not where you live or your ability to pay privately. Our plan is based on fairness, access to high quality local services, early intervention, prevention, and suicide reduction. We would ensure parity of esteem between mental and physical health, and that mental health is seen as an all of government priority.
Sinn Féin’s €250 million, 5-year Mental Health Action Plan is the biggest proposed investment in mental health in the history of the State. This is equivalent to three times the level of new development funding for mental health in the five budgets under Fine Gael and Fianna Fáil. This represents a core funding increase of 20% for new services only, before counting funding for future requirements to maintain the same level of service accounting for demographic changes, inflation, and other cost pressures. We acknowledge the 10% funding target as an ambition, but we do not use this as a benchmark in the context of runaway spending. There is the additional challenge of workforce availability. Additional funding will be needed over the next decade as well as a rebalancing of spending within the existing health budget.
We would develop universal access to community-based therapy, counselling, and support, alongside addressing the crisis in emergency, urgent, and acute services. We want better care and outcomes for children and young people up to the age of 25, an end to the cliff edge faced by many young adults, and to break down barriers that disadvantage disabled people.
Sinn Féin’s plan would move away from decades of crisis management and underinvestment to community-based, proactive care. This would be backed up by multi-annual funding, long-term planning, and workforce planning. Fianna Fáil and Fine Gael have paid lip service to mental health and wellbeing but have failed to deliver on the promises of Vision for Change and Sharing the Vision. The result is that mental health services are in a state of emergency. Funding has been stagnant, reform has been stalled, and waiting lists have reached crisis point.
The community and voluntary sector provides vital services for people that otherwise would not be seen in the public system. The sector is essential for providing cost-effective, wide-reaching community services. Our priority is to develop public services and we would work with core service partners to develop an efficient, sustainable mental health ecosystem.
Investment in mental health and wellbeing is a no-brainer. The social and economic benefits of a healthy and happy society are numerous. The impact on young people’s development, and our own growth as we age, cannot be overstated.
Mental Health Reform
The Mental Health Act, 2001 is outdated and there have been calls for reform since 2015. Government have delayed the publishing of this Bill until July 2024, leaving little time for it to progress through the Houses of the Oireachtas. Sinn Féin in Government would prioritise the reform of the Mental Health Act to ensure robust and comprehensive person-centric mental health legislation that will protect the rights of people with mental health difficulties in the decades ahead.
In advance of the passage and enactment of the full reform Bill, we would pass urgent legislation to regulate CAMHS and ban any routine admission of children to adult inpatient psychiatric wards in the interim.
Sinn Féin Will:
Reform the Mental Health Act
Legislate to regulate CAMHS and the admission of children into adult psychiatric wards in the interim
Primary Care, Counselling, and Wellbeing
Primary care should be the first port of call for people who are experiencing periods of mental health difficulties, and the vast majority of mental health or psychosocial needs can be met through community services.
Primary care psychology waiting lists have more than doubled since this Government took office in 2020, from 10,466 to 21,707. Over 19,000 of these are under the age of 18. There are no counselling services for children in primary care.
Sinn Féin would deliver an accessible mental health service which is rooted in local communities. We would build up primary care wellbeing, counselling, psychotherapy services and fund equitable, universal access. We would ensure consistent relationships between GP medical services, core community partners such as Jigsaw, and secondary and acute care services.
Sinn Féin Will:
Deliver universal counselling in primary care
Fund statewide access to Jigsaw and integrated mental health and wellbeing community services
Child and Youth Mental Health
Youth mental health services are at breaking point. Waiting lists for Child and Adolescent Mental Health Services are up by 80% since this Government took office, with the number waiting over a year up 140%. Early intervention is key to reducing the chance of lifelong ill-health, but that chance is passing young people by. 75% of mental health conditions are established by the age of 25, but young people aged 18-25 are not specifically targeted for early intervention.
To develop a robust and practical policy for improving youth mental health services, Sinn Féin engaged with key stakeholders in Ireland and internationally, facilitated by Orygen, the leading Australian centre of excellence in youth mental health. We published this policy, Priorities for Change in Child and Youth Mental Health, in full in 2023.
We are proposing to develop child and youth mental health and wellbeing services which provides care for young people up to the age of 25 before transitioning to general adult services. This service would be multi-disciplinary and integrated across care sectors, with strong links to relevant mainstream and disability services. Part of this expansion would include state-wide coverage of Jigsaw’s dynamic services, as well as the full complement of HSE services including community-teams, inpatient places, intellectual disability teams, and specialist early intervention in psychosis services.
A major shortfall in the current system is the cliff-edge for people at the age of 18. Young people with moderate to severe mental ill-health are discharged to adult services (GAMHS) at 18 years of age. This is contrary to international best practice and evidence which indicates that mental health services for young people should span the period from 0 to 12 and 12 to 25 years of age. In most cases recently reviewed by the Mental Health Commission, there is no transition or handover support happening for people aging into adult services. This would be resolved in the long term by a 0-to-25 Child and Youth Mental Health Service. In the interim, we would mandate a six-month transition period for young people moving from CAMHS to GAMHS.
The Mental Health Commission has recommended that community CAMHS be regulated under the Mental Health Act, 2001, to give oversight to the Commission and the statutory powers to implement change. Sinn Féin has introduced legislation to do this, and we would include this in legislation to reform the Mental Health Act, 2001.
Sinn Féin Will:
Deliver a new Child and Youth Mental Health Service framework to replace CAMHS and provide integrated early intervention services for children and young people to the age of 25
Mandate a six-month transition period for young people moving from CAMHS to GAMHS
Expand access to Jigsaw and primary care mental health services to deliver equitable access across the state, and deliver universal counselling in primary care
Deliver 47 additional community CAMHS teams, 17 CAMHS-ID teams, 41 inpatient CAMHS beds, and 20 Early Intervention in Psychosis teams
Reform the Mental Health Act to include the regulation of community CAMHS
Clinical Improvement Programmes for Mental Health
There are four HSE National Clinical Programmes in Mental Health: Eating Disorders, Self-Harm and Suicide Reduction, Early Intervention in Psychosis, and ADHD in Adults. People in need cannot access these services in much of the country because they do not exist. People cannot be referred to another catchment area, leading to a postcode lottery.
Eating disorders have the highest mortality rate of any mental health difficulty. However, there are only 3 public adult inpatient eating disorder beds in the state, all located in one catchment area. People in need of emergency care are often admitted to A&E due to the lack of alternatives. The self-harm and suicide reduction programme is only available in 26/29 emergency departments in the state. Only 5 Early Intervention in Psychosis teams have been established, out of 25, and 4 Adult ADHD teams are still needed.
Sinn Féin Will:
Provide multi-annual funding certainty to these clinical programmes,
Fund 20 additional eating disorder inpatient beds and community-based services
Full Emergency Department rollout of the Self Harm and Suicide Reduction programme and embed across primary care and everyday clinical practice
Fund the medium-term development of all EIP and ADHD teams, integrated with child and youth, and adult mental health services as appropriate
Loneliness, Isolation, and Inclusion
Many people experience loneliness and isolation at different stages in their lives. Most of us were impacted by the Covid-19 pandemic, and we are all challenged as we become a more and-more technology dependent society. People with physical and psychosocial disabilities, people from minority backgrounds, and older people can face particular isolation. Sinn Féin would fund an action plan to support inclusion and wellbeing, supporting those most at risk of isolation.
Sinn Féin Will:
Develop and implement an Action Plan to Combat Loneliness and Isolation
Embed mental health and wellbeing in community services for minority groups, marginalised people, and older people
No Wrong Door
People who present for help for dual diagnosis often fall between the gaps that exist in addiction and mental health services. An addiction may lead to the onset of mental health difficulties or a mental health difficulty can lead to people using substances as a coping mechanism. Sinn Féin would urgently implement a fit-for-purpose model of care for people presenting with dual diagnosis as laid out in Sharing the Vision. Mark Ward TD and Thomas Gould TD introduced the Dual Diagnosis: No Wrong Door Bill. This bill will ensure that no matter what door the person knocks on for help for addiction and mental health difficulties, that they are treated with dignity. A joint care plan between addiction and mental health services needs to be developed to make sure people get the care they need, when they need it and where they need it. There can be No Wrong Door for dual diagnosis treatment.
Keltoi, a trauma-informed, state-run residential facility treating addiction and mental health dual diagnosis was closed in March 2020 during Covid Restrictions and has not re-opened since. The HSE has a comprehensive, credible plan to reopen Keltoi as a dual diagnosis Centre of Excellence, but this has not been funded by the Government. Sinn Féin would re-open this vital rehabilitation service to help people to fully recover from dual diagnosis and to learn new coping skills.
Similar challenges face people who are neurodiverse or who have physical disabilities when accessing mental health services. Sinn Féin would embed clear and accountable care pathways to deliver access to mainstream and specialist services as appropriate.
Sinn Féin Will:
Legislate to obligate any Government to uphold No Wrong Door policies,
Support health and social care services to implement No Wrong Door policies
Re-opening of Keltoi, the residential dual diagnosis facility,
Ensure joined care planning between services and appropriate training for inclusion
Crisis Intervention
Mental health difficulties do not just occur between the hours of 9-5, Monday to Friday. A&E is often not the most appropriate place for people in a crisis.
Sinn Féin would develop a mix of 24/7, community-based multidisciplinary services to provide rapid assessment and varying degrees of support to people who are in a mental health crisis. Access to services from call lines to Crisis Resolution Teams is essential. There is a role for new Solace or Crisis Cafés within the community.
When a person is a danger to themselves or others, crisis de-escalation teams can be deployed to assist the Gardaí where necessary and appropriate. These teams would comprise of mental health professionals and a paramedic. These can make the most appropriate interventions and referrals where necessary. A pilot programme in Limerick has been promised for the previous two years but has not been delivered. We have seen the successes of this service where a pilot was rolled out in Belfast.
Sinn Féin Will:
Develop regional crisis resolution and de-escalation teams
Fund 2 WTE Consultant Liaison Psychiatrists at every Emergency Department
Fund Suicide Crisis Assessment Nurses in Emergency Departments and in Primary Care in line with the National Clinical Programme on Self Harm and Suicide Reduction
Roll out Crisis Cafés in every city
Support access to urgent mental health support and advice
Perinatal Mental Health Care
There is currently no dedicated mother and baby perinatal mental health unit on the island of Ireland. This means that mothers who need to be admitted for inpatient care are separated from their newborns. Sinn Féin would provide funding to advance the Mother and Baby Perinatal Mental Health Unit at Elm Park, which will host the new National Maternity Hospital. This would be an all-island service for all those who need it.
Sinn Féin Will:
Develop all-island mother and baby perinatal mental health unit
Workforce Development and Professional Regulation
Ambitious plans cannot be delivered without equally ambitious workforce planning. Government after Government has expected mental health professionals to appear out of thin air. Sinn Féin would deliver a new, multi-annual approach to workforce planning. We would ensure joined up thinking across Further and Higher Education and Health.
We would place an obligation on the HSE to work with students in their final years to ensure timely entry to the workforce. The HSE spent €35 million training approximately 150 clinical psychologists between 2017 and 2021 and not a single one of these were given a job at the end of their training despite the huge demand for psychologists across the health service.
Professional regulation of allied health and social care professionals remains an ongoing saga. Regulation of Counsellors and Psychotherapists began in 2018 and has yet to be completed. Professional regulation is essential to protect patients and professionals and guarantee the highest quality of care. This process must be supported so that certainty can be given to professionals and people seeking supports. Sinn Féin would also fund trainee counselling and educational psychologists in line with their trainee clinical psychologist colleagues.
Sinn Féin Will:
Implement a multi-annual strategic workforce plan across the health service and higher education institutes to address short-, medium-, and long-term workforce challenges
Advance professional regulation with CORU
Fund all trainee counselling and educational psychology positions in line with their clinical counterparts
Review regional and national leadership structures for mental health.
A Prescription for Change - Sinn Féin's Healthcare Plan
Sinn Féin has the plan, vision, and determination to deal with the big challenges in healthcare. Our plan sets out in detail how we will deliver better access to healthcare when you need it, improve access to a GP when you need one, and end the crisis in our Emergency Departments.
Our plan will transform your experience of our health service and to deliver fairer, safer and more efficient healthcare.
