Marc MacSharry (Fianna Fail) | Oireachtas source

I move:

That Seanad Éireann –
notes:- that the mental health policy, A Vision for Change, published in 2006 was a landmark policy in advocating both for closure of the old psychiatric hospitals and continued building up of community-based services as well as cultural change in the form of human rights-based and recovery-orientated services;
- that A Vision for Change was also progressive in taking a whole of population approach to mental health, recognising the importance of improving the mental health of the whole population of Ireland;
- that A Vision for Change recommended the strong participation of users of services and family members at all levels of the mental health service;
- that A Vision for Change recognised the importance that community networks play in the recovery model;
- that it was with the publication of A Vision for Change in 2006 that a recovery-orientated, holistic view of mental health was adopted; and
- that it was envisaged as a ten-year policy, due to be fully implemented by 2016,expresses concern that:- progress on implementing A Vision for Change has been slow;
- the Inspector of Mental Health Services found that mental health services were "stagnant and perhaps have slipped backwards in 2012";
- the Inspector of Mental Health Services also found that most people will be offered a more traditional, medicalised version of mental health treatment rather than the holistic service propounded in A Vision for Change;
- people still regularly must resort to seeking help through A&E when in crisis due to the lack of universal community-based crisis support;
- A Vision for Change stated that 1,800 additional multidisciplinary staff would be needed to fully implement the policy but, despite promises to hire 891 new staff over 2012 and 2013, the total number of staff in the mental health services at the end of December 2013 was five less than in December 2012, and 908 less than the total staffing in September 2009; and
- home treatment is also not provided universally across the country;
- pending the development of an appropriate holistic community-based service, it is contrary to public health that the HSE continue to close any further acute inpatient beds;
- there is a lack of transparency and fairness in the process by which the HSE determined the choice of Roscommon over Ballinasloe for the retention of a 22 acute inpatient bed unit; and
- that there is a shortage of staff and appropriate infrastructure for mental health services notably in the Dublin north-east HSE area,calls on the Government:- to initiate a national programme of reform driven by the National Director of Mental Health;
- to ensure that a new culture is developed within the mental health service that fosters recovery and works in partnership with users of services and their relatives;
- to ensure that the recovery principle should underpin all mental health service delivery in keeping with A Vision for Change;
- to place a stay on the closure of acute inpatient bed units until such time as appropriate holistic community-based services are in place, including St Stephen’s Hospital, Glanmire and Carrig Mór mental health unit, Shanakiel and Toghermore, Tuam;
- to state when the additional 1,800 additional multidisciplinary staff, over the numbers working in the service in 2006, will be provided for;
- to create a plan for the full implementation of A Vision for Change with key timelines and deliverables clearly identified;
- to carry out a full, independent, transparent and fair review of the decision to close the acute inpatient bed unit in St Brigid’s, Ballinasloe; and
- to place a stay on and further bed closures in St. Brigid’s Ballinasloe, pending the outcome of that review.

As always, the Minister of State is welcome to the House to discuss these issues. We did not table the motion lightly. Such motions are sometimes interpreted as highly political or not in the best interests of patient or not in keeping with the configuration of our health services. However, this is different. As I have often said, nobody doubts the Minister of State's commitment to this issue. Sadly, the treatment by the Government of her office, notwithstanding her commitment, is nothing short of disgraceful. Successive governments throughout the history of the State have paid lip-service to our mental health services. None of us could be proud of the evolution of policy up to 2006 but the policy, A Vision for Change, was then agreed and, as she correctly stated on radio this morning, this was signed up to by all Members of both Houses at the time. We passed the eighth anniversary of the report lately and on that night I was promoting my own document on suicide prevention, Actions Speak Louder Than Words.

Sadly, A Vision for Change is failing. It remains a noble aspiration that all of us support. According to John Saunders, chairman of the Mental Health Commission: "What we have are football teams playing with half of their players". I watched Manchester City play Barcelona last night and as that game proved, the best teams can be made to look mediocre. That is what is happening on the ground in the context of our mental health services. Sadly, the fight against loss of life through suicide is being lost hand over fist. The National Office for Suicide Prevention is being starved of resources, is poorly structured and is buried within the bowels of the HSE, subservient to the budgetary demands of the Department and the HSE. Media reports prior to the budget highlighted the Minister of State using stern and colourful language in exchanges with the Minister for Health and the powers that be about the fact that her budget was due to be stripped of €15 million of the mythical €35 million budget that is supposedly ring-fenced every year for mental health services. I do not necessarily want her to confirm this.

This is always the first port of call. The HSE said it would fill the 70% of posts in this area that remain unfilled but recently the HSE stated that it would pick up the pace and employ people. This will get the Government parties through the local elections but the reality is the Government continues to treat the Minister of State with contempt and with no respect whatsoever and despite her commitment, she is unable to do what she knows is correct, which is the speedy implementation of A Vision for Change.

Geologists will have to ascertain the pace of the kind of change required. It was envisioned that it would cost €150 million and be completed in ten years. We are a million miles away from where it should be. As the Minister of State is aware, her Department is being starved of resources.

We are losing the battle with mental health issues such as suicide prevention. There are higher incidences of mental health issues. One in four has a mental health issue; one in 20 will have a suicide ideation. It is okay if one does not need a counsellor in a school, a 24-hour social worker or any other support.

It now seems that in Ballinasloe, as well as certain parts of Cork, acute state-of-the-art services that cost €3 million or more will be stripped back. In the case of Ballinasloe, the service will put into UCHG, University College Hospital Galway, in a department which was condemned by the Mental Health Commission as unfit. Anecdotal evidence suggests two patients at this unit have been sitting on trolleys in one of the busiest accident and emergency departments in the country waiting to be treated.

Is that the vision A Vision for Change promotes? Does this give people dignity and respect at their most needy hour? No, it does not. Why is this? It is because there is no respect for the Minister of State or her office. The Minister for Health, Deputy James Reilly, kicks it around. If he needs €10 million for the health services, he will take it from mental health services. Mental health service provision will be put on the never-never and no one cares who dies from a mental health issue.

The decision on the Ballinasloe service was based on a flawed evaluation. The Minister came up with criteria that suited himself for primary care centres. What criteria were used to shut down this facility which has been described by Dr. O’Grady and the 15 general practitioners in the area as clinically imprudent? I understand the criteria used date back to 2006 which means it could not take cognisance of the up-to-date improved facility and staff complement.

The people of Roscommon have been treated disgracefully by the Government. In an act of political delinquency, signed letters came from the Taoiseach and the Minister promising to keep the accident and emergency department at Roscommon County Hospital. These were not worth the paper they were written on. In the same way, the Minister of State has been given false and mythical commitments by her senior Minister. She is subservient to him because he will not give her the money for her services. There is nothing she can do about it.

Several years ago, the then Minister of State, Deputy Shortall, saw the light. She knew she had a job to do but she could not be expected to do it as she was not given any funding. The facility at Ballinasloe will be shut and moved to a site where haematologists and physiologists using it have described it as beyond capacity. Last week, when the Minister of State was defending the decision to Deputy Colm Keaveney in the other House, the roof at the site was falling down. It is now held up by RSJs, rolled steel joists. Has the Minister of State been in Galway lately? I am listening to the people on the ground telling me this site is beyond capacity. The choice of stuffing this service into Galway is to placate Roscommon for the disgraceful way it was treated. The Government lost Deputy Denis Naughten, one of the best there has been in Leinster House, because of the lies told to the people of Roscommon about their accident and emergency department. The Government must now do something for poor Deputy Frank Feighan who will be cleaned out of it because of the lies told before the election. This is political expediency, as well as a flawed evaluation process which dates back to 2006. The core principle in A Vision for Change is that there would be a consultative process for service users. How many were consulted on these closures? None.

John Saunders and Dr. McDevitt have claimed that the lack of pace in hiring key nursing and other staff is making it impossible for them to run inpatient outlets. A Vision for Change is dead. I will put it to the Minister of State again. Her own senior Minister is treating her like muck. He is making her look stupid because he will not give her the money she needs.

The latest victim to this headless chicken approach to health management and planning is this state-of-the-art unit in Ballinasloe. Excellent services have been provided heretofore and the community is not ready to wind down such services. I am sure some consultant or other will be wheeled out to claim this is the best way forward but the reality is it was a flawed evaluation process. I, along with Deputy Colm Keaveney, have requested it to be published. I know from freedom of information requests that it is impossible to get information from the health service but we will get to the bottom of this.

Closing this service will be a serious mistake by the Government. A Vision for Change is all but dead in the water because the Minister of State is starved of resources. Despite her wish and that of her predecessor as Minister of State, former Deputy John Moloney, who commissioned it, to deliver on it the reality is that it is failing. It is failing because this Government does not give a tuppenny damn about mental health services. The proof is in the pudding. The Minister of State should not take it from me but from John Saunders and Dr. McDevitt, as well as the people from Ballinasloe here tonight who now see the latest innovation in the Government’s headless chicken approach to mental health services.