Martin Daly warns of crisis in mental health services
Martin Daly, a TD and GP, spoke in the Dáil about the status of mental health services and argued that, despite increased funding and new policy measures, significant gaps remain. He urged the minister and the government to target funding effectively and to expand community and inpatient capacity, staffing, and clear assessment pathways.
Mental health funding has increased by almost 40% to £1.5 billion since 2020, but Daly said services now receive a smaller share of the health budget than three decades ago at about 6% - well below the UK's 9%. He warned that the long-term decline in proportional funding has made timely, accessible care harder to provide as demand rises.
Daly described acute pressure in his constituency, citing Roscommon Acute Unit where 24 acute beds exist and eight are occupied by people ready for discharge for lack of appropriate community accommodation. He said GP referrals for adult and child and adolescent psychiatry are being returned without assessment or recommended pathways, leaving patients and GPs without second opinions or access to timely care.
He highlighted gaps in pathways for neurosensory disorders and ADHD and welcomed the minister's statement on establishing that service. Daly also raised concern that eating disorder hubs have not been fully rolled out, welcomed a planned expansion to 14 units, and urged that the additional units be made fully operational without delay.
Daly noted a shortfall in inpatient capacity - about 24 beds per 100,000 compared with a European average of 75 per 100,000 - and said staffing shortages in psychiatric services undermine prevention and early intervention. He argued that promised reinvestment from institutional to community care has not matched need, contributing to long inpatient stays, high readmission rates and inadequate community supports.
While acknowledging the expansion of National Clinical Programmes for Specialist Mental Health Services and roll-out of self-harm and suicide-related services in emergency departments, Daly insisted those services must be properly resourced and extended into local communities. He called for decisive action on targeting funding, increasing capacity and staffing, and improving assessment pathways to make care accessible and effective for patients and families.
Funding and national share
Mental health funding has increased by almost 40% to £1.5 billion since 2020, but Daly said services now receive a smaller share of the health budget than three decades ago at about 6% - well below the UK's 9%. He warned that the long-term decline in proportional funding has made timely, accessible care harder to provide as demand rises.
Local capacity pressures in Roscommon Galway
Daly described acute pressure in his constituency, citing Roscommon Acute Unit where 24 acute beds exist and eight are occupied by people ready for discharge for lack of appropriate community accommodation. He said GP referrals for adult and child and adolescent psychiatry are being returned without assessment or recommended pathways, leaving patients and GPs without second opinions or access to timely care.
Service gaps for children, neurodiversity and eating disorders
He highlighted gaps in pathways for neurosensory disorders and ADHD and welcomed the minister's statement on establishing that service. Daly also raised concern that eating disorder hubs have not been fully rolled out, welcomed a planned expansion to 14 units, and urged that the additional units be made fully operational without delay.
Inpatient levels, staffing and community reinvestment
Daly noted a shortfall in inpatient capacity - about 24 beds per 100,000 compared with a European average of 75 per 100,000 - and said staffing shortages in psychiatric services undermine prevention and early intervention. He argued that promised reinvestment from institutional to community care has not matched need, contributing to long inpatient stays, high readmission rates and inadequate community supports.
Acknowledgement of policy steps and remaining demands
While acknowledging the expansion of National Clinical Programmes for Specialist Mental Health Services and roll-out of self-harm and suicide-related services in emergency departments, Daly insisted those services must be properly resourced and extended into local communities. He called for decisive action on targeting funding, increasing capacity and staffing, and improving assessment pathways to make care accessible and effective for patients and families.
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Transcript
I've been banished up to the corner. Minister Butler, fellow deputies, I'm grateful for the opportunity to speak as a TD and a GP about the issue of deep concern to my constituents in Ruscommon Galway and indeed to people across the country, the status of our mental health services. Whilst I fully acknowledge the very significant personal commitment of you, Minister Butler, and this government have shown in prioritising mental health care, delivering and sharing the vision and connecting for life strategies, introducing the new mental health bill and the additional funding of almost 40% to £1.5 billion since 2020, it is clear significant challenges remain. And we must be honest about the gaps in the system and take decisive action to address them. Mental health professional GPs and families on the front line are raising serious concerns. Mental health services now receive a smaller proportion of the health budget than it did over three decades ago at just 6% now. It is significantly lower than the UK's spend of 9%. This long-term decline in proportional funding has made it increasingly difficult to provide timely and accessible care, even as demand continues to rise. Even then, Minister, the government must ensure that current funding is effectively targeted. We do not have enough community or inpatient capacity. In Roscommon Acute Unit, there are 24 acute beds. Eight of those are taken by people ready for discharge for the want of appropriate accommodation in the community. Some of those are in beds for years rather than months. In my constituency, Roscommon Galway, care has become increasingly inaccessible. GP referrals, both adult and child and adolescent psychiatry referrals, are returned without actual assessment or a recommended pathway. In no other part of the health service is an experienced GP's referral for a second opinion bounced back without assessment. Acute and chronic services are overstretched, and patients in crisis are struggling to get the care they need. We cannot ignore the impact of modern lifestyle factors on mental health. Social media is contributing to rising levels of anxiety, depression and low self-esteem, particularly amongst younger people. Children and adults until now who have had mental health issues associated with neurosensory disorders or ADHD have had no adequate pathways for assessment and treatment. I welcome your statement on the establishment of that service. Increasing prevalence of substance abuse is leading to increased anxiety, depressive disorders and psychosis. Our services must be resourced not only to treat those in crisis, but also to provide early intervention and prevention strategies. Eating disordered hubs have either not been rolled out or inadequately rolled out, denying young people, especially young women, timely intervention in a disease that has such a high morbidity and mortality, causing untold misery to sufferers and their families. I welcome your statement of the expansion to 14 units. I hope they are fully operational and that the additional two units will be established forthwith. Capacity is the issue. There are not enough inpatient beds, meaning that people in severe distress often cannot be admitted. We have approximately 24 beds per 100,000. The European average is 75 per 100,000. We have moved away from institutional inpatient care to the community, but there is always a need for inpatient treatment for people. The stark reality remains you need to be exceptionally ill to get into hospital. Staffing shortages across psychiatric services continue to place immense strain on the system. In the community, we do not have enough fully resourced multidisciplinary teams to provide early intervention. Without adequate staffing, prevention becomes impossible and more people end up in crisis. Minister, I know this government is committed to improving mental health care. The expansion of the National Clinical Programmes for Specialist Mental Health Services is a welcome development, and I acknowledge the significant efforts to roll out self-harm and suicide-related services across all emergency departments. However, we must ensure that these services are properly staffed and extended into the communities where they are equally needed. When we moved from the institutional care model for mental health services, we promised people reinvestment into community psychiatric services. It was never going to be less expensive, but just a more appropriate, humane delivery of care in people's own communities. The investment has not happened as intended. We see a third of patients in inpatient beds there for more than 12 months, and high rates of readmission. That reflects a failing community sector. We must have capacity in the community sector, whether it is supported, living or robust community support for people in their own homes. Minister, I know that you and this government share my commitment to improving mental health services. We have taken important steps, but we must continue to listen to the concerns of patients, family and mental health refreshments. That by working together, we can deliver a system that is truly accessible, effective and responsive to all the needs of our constituents. Thank you. Thank you.