CONFERENCE CONDEMS LACK OF PROGRESS IN PROVISION OF CHILD AND ADOLESCENT MENTAL HEALTH SERVICES AND CONTINUED PLACEMENT OF CHILDREN IN ADULT UNITS
The current shortage of nurses in mental health services will only get worse, and services will deteriorate further, unless the current Public Service Pay Commission process results in significant pay measures for nurses, including pay parity with therapy grades the General Secretary of the Psychiatric Nurses Association (PNA) told the union's Annual Delegate Conference meeting in Cavan today ( Thursday 12 th April.)
PNA General Secretary, Peter Hughes said:
‘ The PNA cannot and will not accept anything less than a significant meaningful recommendation by the Public Service Pay Commission to address nurses pay and Conference this morning mandated the union to support a ballot for industrial action, up to and including strike, if those pay measures do no come from the Pay Commission.'
‘Should the Public Service Pay Commission fail to recommend remedial pay measures then the chance for this country to resolve this impending crisis will be lost for a generation with very serious implications for the delivery and development of mental health services and patient care.'
Mr Hughes said a ‘culture of emigration' has developed for graduating Irish nurses, and recruitment and retention into the Irish health services will only be solved by significant increases in nurses pay. He said experts already predict that there is likely to be a significant push to recruit Irish nursing graduates in post Brexit UK and unless there are improvements in nurses pay which close the gap between salaries here and those available to nurses emigrating to UK, Australia and Canada, then the Irish health services will lose another generation of nursing graduates'.
Mr Hughes said the scale of the recruitment crisis facing the mental health services is stark.
‘In December 2016, HSE figures show that there are 885 psychiatric nurses over 55 and 867 nurses between the age of 50-54. Under fast accrual, potentially 885 psychiatric nurses may retire immediately, whilst a further 867 may retire within the next 5 years, this is a total of 1752 which equates to 34.2% of the mental health nursing workforce.'
‘The headcount, as of September 2017 was 4748. These figures would suggest that there are 374 vacancies, however a recent survey of PNA branches suggest vacancies are closer to 500. Services with high levels of vacancies are:
- Tallaght/St Loman's Dublin - 52 vacancies (over 20%)
- St. Joseph's Portrane - 64 vacancies (over 20%)
- Waterford - 26 vacancies (over 19%
- Louth/Meath - 38 vacancies (over 16%)
‘When we factor in the service developments as outlined in Vision for Change, (which have not yet been implemented), there is a requirement for the provision of an additional 1,400 plus nurses.In August 2017, the HSE figures reveal that only 93 new staff were recruited that year despite soaring demand in all areas of the mental health services, and the HSE's own admission that 1963 new posts have to be filled if the level of staffing required in Vision for Change is to be achieved'.
Child and Adolescent Mental Health Services (CAMS)
Addressing the inadequacies and underinvestment in the Child and Adolescent Mental Health Services, Mr Hughes told the Conference that one in seven children being admitted to psychiatric services were being admitted to an inappropriate adult psychiatric unit.
‘For a country that purports again and again to put the best interests of our children first, the Report from the Committee published in October 2017 highlighted some stark facts. According to the United Nations Children's Emergency Report “Building the Future” published last year, when compared to 37 nations in the developed world, Ireland has the fourth highest teenage suicide rate.'
‘We all know too well that the lack of CAMHS beds ultimately leads to the totally unacceptable admission of children to adult admission units and there has been a great deal of media focus on this issue in the past year. In 2016, 68 out of 509 child admissions were admitted to adult psychiatric units. This represents 1 in 7 of all admissions and the indications are, despite all the rhetoric and lip service paid to addressing child and adolescent mental health that these numbers are not reducing.'
‘Failure to address this crisis is not an option and we as a union, representing nurses who deal with the realities of Child and Adolescent Mental Health and the impact it has on parents and families, are determined to have this crisis resolved once and for all.'
Implementation and Review of ‘Vision for Change' Policy
Mr Hughes strongly criticised the lack of PNA involvement on the group currently reviewing the implementation of the Governments ‘Vision for Change' mental health strategy.
‘This review is currently underway but with the voice of the PNA being ignored, we would have to question the make-up of the oversight group. It beggars belief that the voice of psychiatric nurses, the PNA, is not included in the oversight group. Despite being one of the most important stakeholders in the mental health sector, and the fact that we are the only representative organisation to conduct three substantial pieces of research on the implementation, or more accurately, the non-implementation of Vision for Change, we are left outside the door for this crucial review process.'
‘How can this be allowed, unless it directly relates to the fact that we continue to highlight the unpalatable facts about the record on what was to be the roadmap for the future of mental health services in Ireland.'
These include:
- A Reduction in beds of 92% from 1984 to 2016 – from 12,484 beds to 1002.
- During the 11 years of Vision for Change 76% of beds were closed with only 30% of the promised community services provided.
- The percentage of the health budget allocated for mental health has diminished from 14% in 1984 to 6% now.
‘I am calling on Government to ensure in the review of Vision for Change, that the recommendations of 11 years ago are finally delivered on and build on further.'
Non-implementation of the community aspects of Vision for Change
‘The non-implementation of the community aspects of Vision for Change – key pillar of the whole strategy - means NO ICRU's, virtually NO crisis houses, NO crisis teams, inadequately resourced Home-Based and outreach teams. The absence of Community Services has resulted in major issues of concern.
- In the past 10 years there has been an increase from 3% to 8% of the prison population who have a severe and enduring mental illness.
- Due to the failure in the provision of Assertive Outreach Teams and Intensive Care Rehabilitation Units (ICRU's), over 16% of the bed capacity nationally are occupied by service users whose admission has exceeded six months.
- As a consequence of the 76% reduction in beds and the lack of community services there is a huge demand on beds resulting in 120% bed capacity. In practical terms this means that regular admission of service users in, for example, Waterford and Kilkenny who, due to there being no beds, must resort to sleeping on chairs.'
‘For nurses working on the front the question is; ‘Where is the Mental Health Commission in relation to these scandalous circumstances where service managers do not appear to be perturbed by these practices?'
Disbandment of the National Mental Health Directorate
Mr Hughes told the ADC that central to Vision for Change was the establishment of a National Mental Health Division to put in place the administrative and organisational structures to bring about the change required. However this Division has now been disbanded by the HSE.
‘The Mental Health Division was established in the HSE in 2013. Part of its remit was to have operational and financial accountability for all Mental Health Services. Astonishingly five years later the Division has been disbanded. The consequence of this is that the budget allocation will be distributed to the CHO areas and as we have witnessed before funds are transferred between Primary Care, Social Care and Mental Health. Our experience is that Mental Health comes off as the loser in these exchanges.'
‘We have to ask what does this inexplicable decision say about the attitude and regard for Mental Health Services and the priority they are given within policy planning?'
‘By any standards this is this is clearly a retrograde step for the provision of Mental Health and I am calling on the Minister to re-establish a specific Division/Directorate for Mental Health as recommended 52 years ago in the Commission of Inquiry, and reinforced 11 years ago in Vision for Change.'
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