Eddie Molloy
‘We need action, not broken promises’
IN May of this year, at the launch of St Patrick’s Mental Health Services’ five-year strategy, Minister of State for Mental Health Jim Daly said: “There is no crisis in mental health services, but there are challenges.”
Two weeks later, three psychiatrists in the Child and Adolescent Mental Health Service (CAMHS) in the south-east resigned because they could no longer endure the stress of overwhelming demand and having to work in unsafe conditions.
Shortly afterwards, the president of the College of Psychiatry, Dr John Hillery, resigned and retired from practicing psychiatry in the HSE because the state of the services was “untenable and unsafe”.
He added he experienced “moral distress” when faced with “ethically compromising situations”.
A week ago it was reported that severely mentally ill people are being forced to lie on the floor hallucinating and in distress in Clover Hill Prison because there is no room for them in the Central Mental Hospital.
Then, on July 13 in these pages, consultant psychiatrist Professor Patricia Casey explained why she had resigned. “I could no longer deal with a system that was run by the dysfunctional, visionless behemoth that is the HSE,” she said.
The plight of CAHMS in the south-east is echoed around the country. Mental Health Reform, which has been campaigning for years for improvements in services, stated that staffing levels required to run CAHMS are less than 50pc of the numbers specified in the 2016 official policy statement, ‘A Vision for Change’.
As a result, children with psychological problems are having to wait as long as two years for an appointment and then with little prospect of proper therapies to follow, thereby potentially leading to life-long mental health difficulties and incalculable cost.
So “no crisis”, Minister, just “challenges”. What then would an actual crisis look like?
It would help if ministers and officials would refrain from using the euphemism “challenging” to describe situations that are, in fact, dire and refrain from political promises that are unachievable.
The latest dodgy promise was that Dr Gabriel Scally, the specialist brought in to review the CervicalCheck fiasco, “would be finished by July, though it will be challenging”.
Then, as documents were not forthcoming and the review of smear tests had not yet started, with the result that deadlines were missed and re-set, an exasperated Labour TD Alan Kelly (below) asked, “Who is setting these unrealistic deadlines?” The answer is: primarily, politicians. This kind of spinning has long been a mark of our political culture, from pledges to drain the Shannon to rolling out broadband to rural areas.
It is a pattern of overpromising and underdelivering. The problem is compounded when public servants collude with ministers in maintaining the charade, ostensibly taking responsibility for an outcome that hasn’t a hope in hell of being met.
In their submission to a Department of Public Expenditure and Reform study on accountability in 2014, departmental heads of audit expressed their concern about the pressure placed on public servants to go along with “exaggerated political manifestos” while knowing they are not achievable, either through underfinancing, or absence of enabling legislation, inevitable delays in hiring qualified staff or predictable obstacles in the planning system.
It is unreasonable to hold public servants accountable for not delivering on political promises that both they and their minister knew from the outset were not deliverable, and certainly not in the promised time frame.
Senior public servants are becoming more reluctant to ‘go along to get along’, because they now have to face interrogation in public before Dáil committees.
Officials are often placed in the invidious position of having to give an account of their role and at the same time avoid implicating their minister or line boss in any way.
On one occasion, when he was standing up to leave after a grilling by an Oireachtas committee, Tony O’Brien, then CEO of the HSE, sighed: “In future we will have to be more careful what we take responsibility for.”
Why set yourself up to be punished for an entirely predictable failure of a politically motivated, over-optimistic guarantee that was under-resourced from the outset?
Public criticism and censure is one reason why some senior positions are difficult to fill. Who would want the hassle for themselves and their families?
The integrity of our system of governance relies heavily on public servants ‘speaking truth to power’.
As does the effectiveness of government, because so long as serious problems are glossed over as merely “challenging” and false pledges made about their resolution, then nothing much will be done until there is a true crisis, as there is right now in housing, carbon emissions, water supply, pensions and mental health services – to name but a few.
So ‘no crisis’, Minister, just ‘challenges’. What then would an actual crisis look like?