Dan Neville (Limerick, Fine Gael) | Oireachtas source

I welcome the opportunity to contribute to the debate on this motion. I have been aware for many years of Deputy Ó Caoláin's interest in this area and his contributions to the debate. This is a difficult issue which affects 25% of the population at some stage in their lives. They are affected by something that has been neglected not only over the decades but also the centuries in terms of services for those who suffer from problems of mental ill-health. While improvements have been made in recent years, we are coming from a low base.

A Vision for Change was a very good document but the commitment to implementing it has not been convincing. While the Government has invested an additional €90 million in mental health over the last three budgets, I am disappointed with the roll-out of that money by the HSE. In the first year it was allocated, recruitment did not commence until the October. I do not know if anyone had been recruited by the end of that year. What happened to the €35 million that was allocated? According to 2012 figures, there were 395 out of 414 posts, or 96%, which is fair enough. In 2013, €35 million was allocated for 477 posts but only 326 of these posts have been rolled out. Very little of the €20 million provided last year has been rolled out in respect of the additional 250 to 280 posts that were to be created. These posts were very important because they were in community based mental health services and were intended to establish teams of practitioners rather than having an individual professional deal with cases. The posts were for psychiatrists, psychologists, occupational therapists, family therapists and nurses. A care and recovery plan was to be developed in the community. We have one of the highest rates of in-patient care for mental illness in Europe because of a lack of community based care.

The Government announced that it would allocate this money when it came into office. The first thing the HSE should have done was to make plans for its expenditure. When the money rolled in, it should have been ready to publish advertisements rather than wait until May of the first year and then start recruiting in October.

I will speak to issues with A Vision for Change. There is a need for the strategy to be recovery-oriented, with an absolute need for willingness by professionals to involve service users, or patients. There may be a debate about how to refer to these people but I am certainly a patient of my GP. There is still much reluctance by professionals to engage with service users and families in a recovery plan. Family carers are often excluded from a care plan and not consulted or informed. Their role should be recognised, as if a person goes to a consultant because a parent, wife or child has a serious illness, there would be discussion of aftercare and what happens when a patient returns home. If a person has had a heart attack, for example, there would be discussion of how much exercise he or she should have and what other treatment should take place. If such issues are discussed, why would there not be something similar for mental health issues? I am not painting all psychiatrists in this light and some of them are very good. I am only talking about a minority. That aspect of A Vision for Change should be considered, and there may be a battle to have the professions open up. There is another issue with individual care plans, as there is a reluctance in some areas to implement them for inpatients. Only 60% of institutions have individual care plans for the recovery of service users or the person attending for medical intervention.

There is another issue, which we raised last week and which is contained in the motion as well. It is completely unacceptable that children are in adult psychiatric units, and the matter has been flagged by the World Health Organization and recognised throughout all the institutions. Every professional would say it is not in the interests of the recovery and well-being of children, or those under 18, to be in these units. Some children under ten years old are in adult units, and they may be sharing it with people ranging from 20 years old to 90 years old with various conditions. Children should not be in that position.

See this speech in context