Ms Patricia Bourke:

I thank the Chairman for the invitation to engage in this discussion. Mental Health Ireland is a national voluntary organisation, established in 1966 as the Mental Health Association of Ireland. Mental Health Ireland promotes positive mental health and well-being to individuals and communities through our network of 92 affiliated mental health associations and a team of area development officers who work on a regional basis throughout the country. We deliver awareness-raising initiatives and targeted education services such as the Mind your Mental Health programme. We are committed to providing peer support and recovery initiatives. Áras Folláin peer support centre in Nenagh and Get Together Inishowen are just two examples of grassroots recovery initiatives that are very much in line with A Vision for Change. Mental Health Ireland is engaged in many cross-sectoral partnerships, which is in keeping with our emphasis on a flexibility of approach rather than a one size fits all model. We work with the National Concert Hall, for example, on the Music in Mind programme. Another example is the Woodlands for Health project, on which we work in partnership with Coillte, the Health Service Executive and Wicklow mental health services.

To echo what Mr. Moran said, Ireland is changing rapidly, with huge advances in technology, medicine and communications in recent years. People are struggling to keep up with the speed of modern living and the increasing complexity of family situations. Ethnic minority groups face particular challenges. As we all are aware, the country is facing a housing and homelessness crisis. All of these issues have an impact on people's health. On a global level, country boundaries are becoming virtual and communication via social media is instant. People are expected to be able to multi-task as the norm. The health of individuals, communities and society as a whole is determined by the overall determinants of health, which include physical, social, emotional, mental, sexual and spiritual health, in addition to such factors as childhood experience, financial stability, a sense of security, suitability and security of tenure, and levels of social inclusion and belonging.

With regard to older age, people's experience of aging tends to be health-dependent. While advances in medicine have resulted in life expectancy in Ireland rising by 19.45 years to 84.5 years, advancing age brings, for many, an increased likelihood of diminished health, loss of independence or fear of same and limited mobility. Many older people suffer from bereavement, social isolation and exclusion, and a loss of purpose and usefulness. The World Health Organization noted in 2013 that older people are at significant risk of depression. In addition, many older people are struggling with changed roles. Due to family constraints, large numbers find themselves assuming child care responsibilities in later life. While it is wonderful that life expectancy has increased, we as a society have a responsibility to safeguard the dignity of older people and ensure they have a good quality of life and a sense of purpose, meaning, usefulness and belonging. We need to examine the value we place on our aging population and their life experience. For too many retired people, life is a case of killing time. We must develop intergenerational initiatives that foster learning, understanding and a greater integration between youth and older age. We need to provide ongoing support to enable people to live well and with confidence, security and dignity in their own homes. That is very much in keeping with goals 2 and 3 of the Department of Health's 2013 national positive aging strategy.

We work with a number of disadvantaged groups around the country, including those representing new communities, Travellers, people in direct provision, minority groups, people on lower incomes, carers, the homeless, people with disabilities, the unemployed and people suffering due to addiction and mental illness problems. It is important to emphasise the importance of having a sense of hope, purpose, meaning and belonging, particularly for vulnerable people. In the case of direct provision, people are spending years in the system, unsure of their status and future and without permission no work or engage in pursuits that offer meaningful use of their time. These are profound factors that impact on people's health, including their mental health. There is an absence of even simple things such as a means to cook meals for the family. Together with the loss of cultural connections and the depletion of social and family roles, the impact on people in direct provision cannot be underestimated.

I acknowledge the vast range of services and networks in operation to assist vulnerable people, many of which we work with through various community initiatives. No single agency has all the answers but there is a need for greater joined-up thinking and consistency in regard to the types of services available nationally. The level of service should not be location-dependent. We need a whole-of-population approach to health and recovery and a designated funding stream to support the development and resourcing of peer initiatives in line with a Vision for Change.

We need greater understanding of the interconnectedness of the range of health determinants and their implications for service provision. We need to look at a clear pathways approach from prevention and early intervention through to specialist services, that is people getting into services and also coming back out of them. People tend to get stuck in services that are not necessarily suited for their needs. We need a flexible and creating approach that recognises that one size does not fit all. There is also a need to ensure that the amount of time that people, both individuals and families, spend in homelessness and direct provision is kept to an absolute minimum.

I thank the Chairman and members for their attention and time.