THE MENTAL HEALTH PANDEMIC

• Published date: 23 January 2021

"We're anticipating this," says one of the report's co-authors, Dr Karen O'Connor, a psychiatrist and the national clinical lead for early intervention in psychosis. "I don't want to overstate it, but it's based on the numbers that we're getting out of our early intervention and psychosocial services."

The mental health system as it stands isn't resourced to deal with a crisis, largely because it's already in one. There are 2,000 children and young people waiting for Child and Adolescent Mental Health Services (CAHMS) in Ireland, and 10,000 people waiting for primary care psychology, the majority of whom are also children.

"This means a GP felt [the person] needed to speak to a psychologist," says Ray Burke, senior communications and advocacy officer with Mental Health Reform. "And then they just went on to this massive waiting list. A huge concern across the sector is that, while they're waiting, things get worse."

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In response to a recent query on social media, I received more than 60 messages from people who told me about their experiences or those of close relatives while navigating the public mental healthcare system. Many spoke of meeting kind mental- health professionals who helped them, but most also described system failures that left them feeling distressed and alone and, often, not sick enough to deserve help.

They wrote about being on waiting lists for mental health services and overworked staff who treated them like they were filling in a "checklist". Overall, they described a system that often waits until a mental- health issue becomes a mental health emergency before engaging fully.

Here are just four of the responses:

1. "I was referred to the hospital ... I was self-harming and my doctor was afraid I would take my own life. The staff there said my case wasn't severe enough for them to help me, and they sent me home with advice to go to Pieta House or the university's counselling services."

2. "I think the system of rotating doctors is completely incompatible with mental- health services. To begin the process of opening up with a new point of contact every six months is lunacy … And you are unfortunately very reliant on personalities … Do you gel with your assigned psychiatrist? ... Are you high-priority or is your misery less severe?"

3. "I was convinced I was starting to have a psychotic episode and I did everything they tell you … [I contacted the HSE funded text service] 50808 who told me to contact the Caredoc or 999 … I called 999 who told me to come into the hospital where my usual psychiatrist was on call. She proceeded to tell me I need to learn coping mechanisms … and that they couldn't do anything because I'm not suicidal and sent me home. Since then I've had nurses calling and doing the checklist shit with me every day or so, but they don't seem to have any plan to stop me feeling this way."

4. "My main takeaway from the system is that once you're relatively stable, they don't care about helping you get better." l l l

We often assume when discussing system failures that the solution lies in new ideas. But the consensus from the mental health professionals and advocates I spoke to for this article is that we have all the good ideas we could ever need in mental health plans like Planning for the Future (1984), A Vision for Change (2006) and Sharing the Vision (2020).

This last report aspires to a community-based "recovery" model in which there are clearly defined "stepped care" pathways: from social and family supports; to primary care; to well-staffed specialist mental health services in the community; to specialist residential services.

It promotes early intervention, the involvement of service users and family members in planning their own care, and takes account of societal issues like prejudice, inadequate...