It didn’t take the Covid-19 pandemic for anyone to recognise that rural Ireland is facing particular challenges when it comes to mental ill health.

However, the situation is escalating, and think-tank Social Justice Ireland has told Agriland that as we leave one crisis, we will enter another: a mental health crisis, due to the stress the pandemic has placed on people.

Michelle Murphy, Social Justice Ireland research and policy analyst has said she would hope the government is aware of the scale of challenges ahead when it comes to tackling mental ill health post-pandemic – and that we’ll see come Budget 2022 time what sort of coordinated response there is.

Over €1 billion in Budget 2021 for mental health

In June 2020, the national mental health policy: ‘Sharing the Vision – A Mental Health Policy for Everyone’ was published, aiming to “enhance the provision of mental health services” during the period from 2020 to 2030.

As part of Budget 2021, Minister of State with responsibility for older people and mental health Mary Butler announced an allocation of more than €1 billion for mental health services, an increase of €50 million on the previous year’s budget.

€15 million of this funding was allocated to addressing additional challenges posed by Covid-19. Last year, an additional €2.2 million was also allocated to develop telehealth and psychosocial responses to Covid-19.

The Department of Health confirmed to Agriland that currently, it does not yet “fully understand the impact of Covid-19 on mental health and any subsequent demand on services”, but that along with the HSE, it continues to plan “for any surge in demand as it rises”.

However, many say that they are seeing the impacts in their own communities.

A ‘multidisciplinary approach’ is needed

“The pandemic has highlighted the continuing underinvestment in our mental health services,” TD for Cork South West Holly Cairns said.

“The World Health Organization [WHO] recommends that each state spends 12% of its health budget on mental health care; in Ireland it is less than 7%.

“In response to Covid, we need not only to put in place the necessary staffing and infrastructure over the long-term, but we also need a temporary investment to deal with the current surge in mental health concerns.”

Now that increasing numbers of older people and healthcare professionals are vaccinated, there needs to be safe ways for them to interact “as soon as possible”, deputy Cairns, who is the Social Democrats’ spokesperson on social justice and rural development, said.

“A multidisciplinary approach needs to be at the centre of this response,” she continued.

“Increases in depression and anxiety are strongly related to declines in activity – this is a crucial factor in the wellbeing of older adults – as well as sleep quality and cognitive functioning.

“Geriatric psychiatrists, psychiatric nurses and psychologists can drive medical treatments, but we also need occupational therapists, physiotherapists and other therapists to help provide holistic care.”

Overreliance on charities

Claire Kerrane, Sinn Féin TD for Roscommon-Galway and party spokesperson on social protection and rural development also feels that is there is not “enough action” being taken.

“I think the fact that governments have relied on the likes of Pieta House for so long and, obviously they are hugely successful in their own right, but I think there is a sense there [in government] that ‘well, an organisation is dealing with that and we’ll provide a bit of funding here and there’,” the deputy said.

“I think we shouldn’t be depending on charities when it comes to issues that are so important – I mean these are life or death issues in some instances.

“Charities should be there to supplement and complement public services that are there, are accessible and are free at the point of delivery.”

An immediate priority, according to the deputy, is seeing the rollout of 24/7 intervention services for those struggling with mental ill health across the state “at community level, as much as possible”.

“We have that situation where people, out of hours, literally have no option but to turn up to A&E and we know that is not the place for them.”

Mental health services to suit communities

Michelle Murphy of Social Justice Ireland is in agreement.

“If someone has depression, that will not change come 5:00p.m on Friday until Monday,” Murphy said.

“As a state, we now need to look at how we can bring services to people rather than always making people travel to the services.

“There’s opportunities now to look at how we might deliver services in a way that’s fit for modern society; in a way that suits people and their communities, rather than suiting the service itself.

“We need to look at how we combine our infrastructure.

“If we want the transition of getting people out of their cars [for the environment], then we have to think about why people in rural areas have to travel three times longer than someone in a town just to get to most everyday services.

“How are we going to bring the services to them? For example, is it going to be a mobile clinic that comes to an area every fortnight? Do we look at remote working hubs as a public space that can provide the room where someone can come and provide a service in a community once a week?

“It costs money to provide services, there’s no two ways about it. Rural areas have a deficit of services.

“But, what the research shows is that it doesn’t actually cost you a huge amount of money to invest in rural communities, yet the return is significant.

“If you’re not going to put in the investment, then this problem is only simply going to grow and it’s going to cost you in other areas.”

Murphy said that a while a lot of money went into the health system to deal with Covid-19, “which was incredibly welcome”, the state must look at “what sort of resourcing is needed for the services that are now required”.

Ireland has been on ‘a long journey’

As a member of a government party, Green Party spokesperson on social protection Marc Ó Cathasaigh said he feels that the recent financial allocations for mental health are adequate, but that it is important this type of funding is maintained.

The Waterford TD said that a lot of the funding relates “to that idea of moving mental health out of a clinical setting and back out into communities”.

“I think we have yet to see that come through because Covid has dominated so much of what we’ve had to do as a government, but I do think the political will and the funding is now in place to begin thinking about mental health in a new way,” he added.

Thinking back over the last 10 years, the deputy said that Ireland has been on “a very long journey” when it comes to actually speaking about mental health.

A primary school teacher before being elected, the deputy met with students ahead of this year’s Leaving Certificate exams, resulting in him being “amazed” with their vocabulary around mental health, and their “ability to discuss it in a way I certainly wouldn’t have been able to when I was 18”.

“We tend to focus on ill health, I think we do this with both physical and mental health – we talk about illness,” he said.

“By building resilience into our communities and building resilience into our young people and discussing mental health, that allows us to really promote mental health as opposed to just tackling mental illness.

“We need to get over some of our remaining hang-ups around talk therapy and for it to be destigmatised – for it to be accepted that as part of any person’s health journey throughout their lives, they’re going to hit points where their physical, emotional and mental health needs to be attended to.”