Cork academic points to ways mental health services in Ireland can be improved

While the quality of mental health care varies globally, several countries have established robust systems, each with unique features contributing to better mental-health care.
The state of mental health services in Ireland is much-debated.
When you compare the services here to other countries’, it could be argued ours could be better. We need to learn from best practice elsewhere.
A scan across Europe shows what other countries do well in mental health services, and also identifies potential opportunities for Ireland.
While the quality of mental health care varies globally, several countries have established robust systems, each with unique features.
Finland is often cited as one of the best. Their system regards mental health as an essential part of overall healthcare, with mental health services integrated in to primary care.
The Finnish strategy focuses on the importance of prevention, early intervention, and improved accessibility to services. Its government has launched projects to address specific issues, like suicide prevention and youth mental health.
Another country that is well-regarded for its mental health services is Sweden, which provides a highly accessible mental health care system, with strong integration between primary healthcare providers and specialists.
Anti-stigma campaigns
Sweden also has strong anti-stigma campaigns, and they country puts a great importance on awareness and education.
Closer to home, in the United Kingdom, the National Health Service (NHS) provides free or low-cost mental health care, including counselling, therapy, and psychiatric services.
The UK also has been actively working on mental health awareness, with initiatives from public health bodies and national campaigns, such as ‘Time to Change’, aimed specifically at reducing stigma around mental health.
James O’Mahony, lecturer in cognitive behaviour therapy and programme director of the MSc in cognitive behavioural psychotherapy in University College Cork (UCC), describes to The Echo what the UK is doing in comparison to Ireland.
Major gap
“So, one major gap is that they’ve got a service called Improving Access to Psychological Therapies (IAPT),” Mr O’Mahony said.
“Really, it’s a service where people in primary care are offered psychological intervention.
“Either what’s called low-intensity psychological intervention or high intensity.
“The high intensity, then, is cognitive behavioral therapy and they get offered that by referral from their GP,” said Mr O’Mahony.
“We have a version of that in Ireland, called counselling and primary care, that the HSE implemented a number of years ago.
“But there’s difficulties in terms of that service, at the moment, being only available to people who have medical cards and it is not available to people who do not have medical cards.
“The difficulty there is that there are a lot of people who don’t meet the threshold to have a medical card, but they also don’t have the means to pay for private therapy, which is also another issue,”
he added.
“Then, there’s other issues just around that. With IAPT in the UK, it is all cognitive behavioral therapy-based, predominantly.
“If you look at the National Institute of Care guidelines, for a lot of psychological difficulties, like panic disorder, generalised anxiety, depression and trauma, the first line intervention and psychological intervention is cognitive behavioural therapy. But we don’t have a service like IAPT in Ireland at all.”
Australia
Australia’s mental-health system is well developed, with a focus on a comprehensive model of care. Services include GPs, psychologists, psychiatrists, and other mental health professionals.
Mr O’Mahony said that the Australian system performs well.
“I’ve never worked in Australia, and I would know the Irish mental health services more in depth. But what it appears from Australia is that they have greater access to resources, in terms of the human resources.
“So, they seem to have greater access to physicians, to nurses, to social workers, psychologists, and so, therefore, then, by virtue of the fact that they have greater access to these resources, they can provide the services they more effectively,” said Mr O’Mahony.
“There isn’t an over-reliance for a smaller number of people to give more, which leads to burn-out, and which leads to people leaving the health service.
“So that seems to be done better in Australia.
“Then, people will stay more, because, you see, I suppose it’s a kind of a vicious circle in Ireland, really, in the sense that if you’ve not got enough people, then what’s happening is that they end up doing more work. So, they’re under more pressure.”
Multi-pronged approach
As to what he would like to see improved in Irish mental health services over the next five to 10 years, Mr O’Mahony hopes for a multi-pronged approach.
“There’s a number of things,” Mr O’Mahony says.
“I think, first of all, there needs to be further development, in terms of the primary care mental health services.
“I think, if there was some kind of model that is similar to the Improving Access to Psychological Therapies that is rolled out across the UK, I think that would be really useful, in terms of preventative treatment and trying to get people treated early in order for that to happen.
“Obviously, that would have to be resourced.
“I think preventative care, in terms of improved access to psychological therapies, needs to be rolled out. I think there needs to be greater scope for private providers.
“There are some people who can pay and who will pay. I am not saying that they should have to pay, but there are some people who can pay and will pay, so that should be facilitated, then, where possible, as well.
“What ends up happening, then, is that helps to lower the waiting list for access to the public mental health services.”
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