Ms Linda Thorpe:

I thank the committee for the invitation to be here today.

As regards the questions that were posed by the members, from a mental health perspective there is quite a lot of good going on - I want to recognise that for starters - but, I suppose, to coin a phrase, there is a lot still to be done.

I agree with Deputy Ó Cuív that the inter-generational structure is important. The Government must be mindful of the fact that younger people and not so young people are moving away from their families of origin and it is creating a vacuum with people left in silos to be minded by neighbours, friends and people coming back. There is a lack of dignity being shown to and respect for older people. It might not be only an age issue. Some people are old at 50 and some are not old at 90. It is a matter of restoring due respect for older people for their wisdom and that they have worked and contributed to the country that young people now are enjoying the benefits of. They have paid their taxes. They have made the country what it is. Such recognition is sadly lacking. Maybe it is something the committee could look at.

As regards child care issues that Deputy Ó Cuív mentioned, I know plenty of families that are caring for their grandchildren.

This indicates that people who care for their grandchildren, particularly those from a lower economic group, suffer greater instance of depression, and it has a knock-on effect in mental health services.

Going back to what Mr. Moran was saying about transport, not only older people but those with disadvantage, particularly with mental health issues, find it difficult, particularly in rural areas, to access services such as appointments and clinics. This has a knock-on effect where maybe they do not attend clinics, their mental health suffers and they go back into departments of psychiatry and there is an extra expense on the Government. It is a domino effect. It keeps increasing Government expenditure at another end.

Deputy Danny Healy-Rae spoke about A Vision for Change, which is now ten years old. It dates from 2006. It is for review this year. While it is nearly the Bible of how mental health services move forward within urban and rural communities, and a lot of good work has been done, it needs to be reviewed with regard to how crisis intervention teams are established, how people have access to those teams, where they are well established and where they are not, and it needs to be looked at in a global way.

As regards Kerry, I refer to Kerry Mental Health Association. Ms Bourke outlined that we work through 92 mental health associations. We have a vibrant one in Kerry. It has a huge housing facility that is seen as a model of best practice. There is quite a lot going on in the Kerry area. I note Deputy Danny Healy-Rae brought up some of the services that are not working well there, but that is one of them that is working well.

I am sure Ms Bourke has more to add to this. There are facilities within the State. For instance, Inishowen has a facility under the auspices of Mental Health Ireland that works well. There is Áras Folláin and Gateway, here, in Dublin, supporting people with long-term and enduring mental health problems, some of whom are elderly but, certainly, who are disadvantaged. We need to support that. For very little funding people can be well supported.

Other services include the green prescription or social prescribing, which was piloted in the north west where a lot of elderly people went to their GP three or four times a week and they were taking up space. In an initiative between the HSE, the GPs and either the partnership or FÁS at the time, they employed somebody to lead walking groups and social interaction groups. That has proved beneficial, also for very little funding. It is a model that might be looked at.

The senior social initiative of the GAA works well, as do men's sheds and women's sheds. There is also a suicide crisis assessment nurse, SCAN, where people will present to their GP with suicidal ideation and they will, within 24 hours, have a nurse to come out and assess them to see what level of care, if any, they need at that moment in time. It is proving that people of whatever age, and certainly the disadvantaged, are not being admitted to departments of psychiatry and they can access care in the community. There is also a self-harm intervention programme, SHIP. It was piloted in the south east where people who are self-harming have an intervention programme and they have access to six weeks' counselling, which is good.

As regards primary care, the centres are not well established in a lot of areas. In the south east, we have pockets that are well established, but it needs to be looked at and rolled out so that people can go to the one-stop shop.

Befriending for the elderly and in mental health services is beneficial as well where people have a one to one. With the elderly, such as my own father, who is 85 and, thank God, has a home help for a couple of hours a week, it is about the connection. It is the fact that a human being goes in and that he sees somebody. His home help has been going in since my late mother died and I could not say how beneficial it is, if only for the social connection. For mental health, to be connected to somebody and to see somebody, through families, through members of the communities and through home helps, is the most important aspect.

I would recommend putting funding into transport and home help and growing services that exist locally. Deputy Michael Collins made the point about the local. If the home help changes every day, there is no rapport and people do not have trust. People need to have that trust, particularly if they are vulnerable. That is where we need to be at.