Progress in mental health strategy implementation, but staffing deficits must be addressed

The lead feature in this issue of the Medical Independent focuses on the implementation of the national mental health strategy, Sharing the Vision.

The latest implementation progress report on the strategy (May 2026) shows that most recommendations are on schedule.

While a number of recommendations are experiencing ‘minor delivery issues’ and three are ‘paused’, the fact most are either ‘on track’ or ‘completed’ is good news.

But the report highlights what has been an issue for mental health services for some time – adequate staffing.

The mental health workforce increased by 46 whole-time equivalents over the period December 2023 to February 2026. While this might seem positive, increases in medical and student nurse categories offset decreases in other staff categories.

The report points out that while mental health services have been effective in filling new development posts, the recruitment and resourcing landscape of the broader health service remains challenging.

“Services are experiencing a range of social, environmental, and service developments that are significantly increasing the demand for a qualified healthcare workforce, while simultaneously managing a tightening of the supply of this workforce in local and international markets,” the report states.

Sharing the Vision requires that community teams be resourced based on population-need to potentially include dietitians, peer support workers, outreach workers, job coaches, and others in addition to the current core disciplines.

“However, there has not yet been significant progress achieved in the area of skills mix or in developing a different approach to staffing mental health teams,” according to the report.

Earlier this year, Consultant Psychiatrist Prof Matthew Sadlier highlighted the difficulty of staffing community teams in child and adolescent mental health services (CAMHS).

Prof Sadlier was responding to the report and lookback review into the standards of care provided by CAMHS in north Kerry.

The report found significant deficiencies in care across a range of areas.

“At the heart of this issue are poor governance and under-resourcing of mental health services – none of the teams in north Kerry was staffed at appropriate levels, denying patients the high-quality standard of care they needed,” according to Prof Sadlier, who is now the IMO President.

“The system is set up to fail, as geographically isolated community-based services have always had difficulties with staff recruitment and retention, which leads to poor outcomes for patients.”

The progress report notes that work continues within the HSE Recruitment, Reform, and Resourcing Programme to increase capability and capacity across services.

It highlights the “considerable work” that has been conducted in the marketing of “difficult-to-fill” consultant posts, in addition to other recruitment initiatives.

The next iteration of the Programme’s resourcing strategy is currently being co-designed with the six health regions.

The significance of the new regional structure is referred to in the report. Yet the exact impact regionalisation will have on mental health services is uncertain.

“Health regions have significant autonomy to determine how to prioritise resources to meet population health needs,” according to the report.

While it states this “may lead to other areas of the health service being prioritised over mental health”, it also presents potential opportunities to improve services.

Whether the health regions retain this autonomy to allocate funding in the wake of the recent overspending controversy, however, remains to be seen.

Also, despite increased investment in recent years, as the College of Psychiatrists of Ireland has repeatedly said, the proportion of funding devoted to mental health in the overall health budget still falls below what is required.

There are plenty of positives in the latest progress report. But without more funding, the long waiting lists and staff shortages that beset mental health services will continue.