Rosemary Smyth EPSO Meeting

Dublin September 2014

Presentation AimIntroduction to Ireland & some features of

the recession

Overview of Mental Health Commission Publication

“ The human cost of the economic crisis: A review of the evidence on economic

adversity and mental health”

Ireland Population

The Recession – Some FeaturesSwift and dramatic decline: negative growth,

high unemployment, high national debt, banking crisis

Personal debt levels much higher than ever before

Personal debt combined with dramatic reductions in property and investment values

Group of people who have never experienced economic adversity before

Perceived effect of the recession more marked in Ireland due to the rapid and steep decline from a period of unprecedented growth - living standards increased by 1/3 in 10 years.

Inflation & Unemployment Rate

Public DebtBefore 2007 the levels of Irish public debt were

low and declining.As a consequence of the very deep recession

which began in 2008, combined with significant levels of public money injected into the Irish banking system in 2009, 2010 and 2011, the level of public debt soared.

National debt increased from 20 % of GDP in 2007 to 84 % of GDP in 2012,

The general government debt increased from 25 % of GDP in 2007 to 117 % of GDP in 2012.

National Debt

Annual GDP Growth

Health ExpenditureFollowing rapid increases during the

first part of this ten year period, a decrease of 11% in total public health expenditure has taken place since 2009.

Capital expenditure, which accounts for only 3% of total expenditure, was 32% lower in 2012 than in 2003 and 41% lower than in 2008.

Mental Health Budget A Vision for Change (Government Policy on mental health)

was published in 2006, if fully implemented the mental health budget would be expected to account for 8.24% of overall on-going health spending.

Spending decreased from 7.2% in 2006 to 5.2% in 2012 - averaged 6.11% of overall health spending.

As a percentage of overall health spend, the budget for mental health has always been lower than recommended for a developed country.

In the UK, mental health is 12% of the health budget. The overall amount of funding for mental health services has

dropped from €937 million in 2006 to €733 million in 2013. Before the recession in Ireland, the percentage was down to

7%, and since the recession has reduced to nearer 5%.

Mental Health Commission The Mental Health Commission (MHC) is

an independent statutory body.

The principal functions of the Commission are:to promote, encourage and foster the

establishment and maintenance of high standards and good practices in the delivery of mental health services;

to protect the rights of individuals who are involuntarily admitted.

BackgroundThe Commission was concerned about the impact

of the current economic situation on the mental health of the wider population and on those with pre-existing mental health conditions in particular

The Commission was also concerned about the resultant impact on the mental health services

The Commission wished to propose helpful, pragmatic actions that could be easily implemented and which may help alleviate some mental distress and difficulties

A review of evidence was undertaken and a workshop convened

Who is affected?People with pre-existing mental health

difficulties:Most are already ‘at the margins’ in terms of high

unemployment and high debt levels – 1 in 4 with mental health difficulties is in debt (English study)

Features of specific mental health difficulties can lead to/exacerbate debt

Stigma attaching to mental illness leads to a reluctance to engage with financial institutions

The rest of the population:Many with no experience of dealing with financial hardship

and hence few coping skills In the general population, 50% of those in debt have a

mental health difficulty compared to 14% of those with no debts

Mental health & public healthDo not wish to ‘medicalise’ financial,

social and economic problems – no need to bring large numbers of people into specialist mental health services

The most effective actions are those which will change the social circumstances of those affected – long term solution

Workshop focused on actions that can occur in the short term and are ‘resource neutral’

However... impact on mental health services At time of increased demand, mental

health services (along with other health services) face cuts

‘Hidden’ cuts – no staff replacement – 10% of psychiatric nursing staff left the mental health services in 2009

Funds attaching to staff who leave are also lost permanently

Poverty, unemployment & mental health

Strong inter-relationship between the three: Poverty in itself related to psychological

distress (particularly deprivation of basic necessities)

Unemployment related to psychological distress

Poverty and unemployment obviously related but have cumulative effects on mental health

Many people with mental health difficulties are unemployed and reliant on social welfare

Debt/economic hardship & mental health

Debt and mental health difficulties related – 1 in 2 adults in debt has a mental health difficulty

Debt can have indirect effects on household psychological wellbeing over time as it impacts on parental depression, conflict-based family relationships and potential mental health problems among children

Childhood adversityStrong evidence that the presence of factors

which adversely affect mental health in childhood can have significant and long-term impacts on the child in many life domains

Economic adversity or poverty is one such factor which has a strong association with mental health problems in childhood

In adolescents, awareness of financial difficulties in their families has a negative impact on their mental health

SuicideRelationship between economic

adversity/recession and suicidePeople who are unemployed are two to

three times more likely to die by suicide than people in employment

The suicide rate in Ireland increased from 424 in 2008 to 527 in 2009, an increase of 24%

Consequences for the wider ‘mental health system’

Community level – increased calls to Samaritans, increased demand on variety of community support organisations

Primary care level – increase in allocation of medical cards – increased workload on GPs and primary care system, increased prescription of drugs

Increase in self-harm leads to increased admissions to psychiatric units, general increased demand on mental health services

Proposed actions:Health and social care sector Financial services sectorWithin and across sectorsActions by government

Health and social care practitioners do not need to become ‘financial experts’ and financial sector employees do not need to become ‘mental health experts’

Health and social care sectorC – consider debt as a possible underlying

factor in ill health – physical or medicalA – ask about debt – the person may be too

embarrassed to bring it upR – refer consenting clients to a money adviserE – engage with financial advisers

Share information and create tools to do this – Debt and Mental health Evidence Form (England)

Financial sectorRecognise the existence of consumers with

mental health difficulties and define best practice in dealing with such consumers – progress here already

Become ‘mental health aware’ Be informed of sources of referral for people

in distressSupport staff who have to deal with

unaccustomed situations

Government policyImproving the practice of financial services:

Mortgage Arrears and Personal Debt Expert GroupFinancial Regulator consultation on the Consumer Protection

Code – proposal to include concept of ‘vulnerable consumer’

Longer-term actions:Actions to support employers to keep people with mental

health difficulties in workTake long-term view on health cuts/investmentAction on the recommendations of the Report of the Mortgage

Arrears and Personal Debt Expert Group

Public Health & Wider SocietyMany of factors contributing to mental health

problems occur within a much broader context than health

Therefore actions within a public health or & wider societal context was recognised.

Actions identified in the workshop:–Training, communication and resources

TrainingWho?

Frontline line workers Financial services Charities/voluntary agencies Government agencies

What?Mental Health Awareness – MABSASIST - Teachers, Gardaí, youth workers,

volunteers, family friendsSafe talk - workshop - National Suicide Office

CommunicationThe need for improved communication across

sectorsTraining central to improving awareness and

equipping staff with appropriate and helpful communication skills.

The development of Arrears Support Units in financial institutions (January 2011) provided a locus for expertise and training within banks.

Establish secondment schemes Financial Regulator allow third party to engage

with a lender on behalf of vulnerable person.

Resources Information/Leaflets examples:

Look after your mental health in tough economic times. Managing your mental health

A Revised Consumer Protection Code from the Financial Regulator A published Code of Conduct on Mortgage Arrears (CCMA), a

statutory code of the Central Bank. Mortgage Arrears Resolution Process (MARP) established within

lending institutions for dealing with customers in arrears and pre-arrears.

Lending institutions are required to establish an Arrears Support Unit to assess arrears and pre-arrears cases.

The Irish Banking Federation and MABS have developed a joint

Consumer Guide to Dealing with Mortgage Repayment Difficulties.

Available @ www.mhcirl.ie

Thank youwww.mhcirl.ie