Jim Daly (Cork South West, Fine Gael) | Oireachtas source

Fáiltím an deis a bheith anseo chun labhairt agus a bheith páirteach san ócáid iontach speisialta seo. I welcome the opportunity to contribute to this important public consultation. We all share a common desire to have the best possible mental health policies and services for children and adolescents nationally, while taking account at the same time of the practical realities involved to effect further improvements.

There is no doubt that mental health remains a priority for the parties, organisations and individuals that have participated in this consultation process. I understand that advances to mental health care in recent years as well as improvements still called for have been highlighted in the presentations and discussions of the committee. I fully appreciate the genuinely held concerns raised here. I assure those present that their considered views will be heard and that I, the Department of Health and the HSE will take heed of the outcome of the work of the committee.

A cornerstone of this Government's overall health policy is to enhance all aspects of mental health care. This is reflected in the programme for Government and is high on my agenda as Minister of State. I wish to take this opportunity to acknowledge the progressive roles played by my various predecessors and, notwithstanding the obvious challenges remaining, to build upon their achievements. Despite severe pressures on our public finances over recent years, steady and measurable progress has been made to develop mental health services. Significant investment has been undertaken thereby allowing a fundamental shift away from a static institutionalised and hidden care system to realising a modern and responsive service. Change is taking place spanning all fronts and across all age groups from enhanced community based care to forensic mental health for children to psychiatry of old age.

A core difficulty we now face is not funding availability per sebut, rather, wider issues surrounding the recruitment and retention of mental health professionals. This can lead to the temporary closure of children and adult mental health services beds, such as occurred recently at Linn Dara in Dublin, especially given the need in such circumstances to balance safety and quality issues against staff availability.

Overcoming staff retention difficulties is obviously core to improving care and access to care. We also need to clearly plan and deliver services in a better way to meet evolving demands and circumstances. This includes better prevention, early intervention and inter-agency approaches in future, thus ensuring the best use of either specialist or wider care resources. We cannot take advances for granted and, therefore, we need to refine policies, legislation and services.

Since 2012, approximately €140 million has been added to the HSE mental health budget, which, this year, totals close to €853 million. This is a significant funding commitment by any standard and the Government intends to increase the mental health budget annually as wider circumstances allow. Core to implementing A Vision for Change has been the approval of over 1,500 new posts since 2012, including those approved for CAMHS. A balance has been struck between acute and community-based care and the pace of change has gradually gathered momentum at local level. In particular, all efforts have been made to ensure that new posts are of the type required to transform our mental health system in the light of increasing and future demands.

The mental health priorities for 2017, as agreed in the HSE service plan, spans much-needed improvement across counselling services, enhanced community mental health teams and improved 24-7 response and liaison services. Work is also ongoing in the areas such as psychiatry of later life, perinatal mental health, attention deficit hyperactivity disorder in adults and children and dual diagnosis of those with mental illness and substances misuse. Again, this reflects many of the issues raised with the committee. The HSE is also addressing other key issues highlighted, such as age-appropriate placements, reducing waiting lists and a more standardised approach to service delivery nationally.

It should be noted that the placement of those under 18 years of age in adult units has reduced considerably over recent years. Where this arises various factors such as geographic location, expected length of stay and age and wishes of the young person and their families all play a role. In addition, the HSE takes special measures to ensure the safety of the young person in such placements.

Other developments designed to relieve system pressures include 60 additional student psychiatric nurse places coming on stream during the period 2016-2017, along with a further 70 to follow in 2017-2018. In addition, the HSE is offering all graduating nurses permanent contracts. In line with a Government commitment to develop early intervention mental health services for those aged under 18 years, approximately €5 million has been allocated to HSE primary care, of which €3.4 million will fund 114 new assistant psychologists. This will enhance response at that level and help to address CAMHS pressures overall.

A significant development in the mental health sphere is the recent commencement of construction by the HSE on the new multimillion national forensic health service capital project at Portrane to replace the Central Mental Hospital at Dundrum. This long-overdue initiative comprises a 130-bed new main hospital along with a new ten-bed forensic CAMHS unit and a new 30-bed intensive care rehabilitation unit. The main development includes ten beds specifically catering for mental health intellectual disability. The new modern complex will greatly transform our forensic mental health services when it opens in early 2020. A new intensive care rehabilitation in particular will be key to alleviating pressure across the wider mental health and judicial care systems.

A priority for me is to progress the work of the national task force on youth mental health established by my predecessor as Minister of State, Deputy McEntee. This is focused on changes to improve communities working together at a local level and services working together at national level. It has been designed to draw on the experience of many quarters to enhance supports for young people and to otherwise promote resilience and emotional well-being. The task force has undertaken a recently completed series of youth consultations and a national consultative forum has convened in June. Many of the participants who have come before the committee had an input in some way to the task force reflecting at least some of the issues raised here. Above all I want the outcome of the task force to be realistically based resulting in real improvements.

Mental health services are obviously shaped by factors beyond pure funding, including prevailing legislation and policy. The recent strategic direction in Ireland has been underpinned by A Vision for Change, complemented on the suicide front by Connecting for Life. I am progressing the context we are focused on today, that is, a review of A Vision for Change, in tandem with changes to the Mental Health Act 2001.

While fundamental principles and approaches will broadly remain unchanged, various aspects of legislation policy and services arguably need to be re-nuanced in light of experience and identified future challenges. In refining policies and services I will advocate strongly for better prevention and early intervention, improved access, more person-centred care and recovery orientation.

Senator Freeman recently introduced the Mental Health (Amendment) Bill 2016, the aim of which is to limit the admissions of children to adult psychiatry units by allowing them to take place only in emergency circumstances. As I said when I spoke on Second Stage of the Bill in the Seanad, the issue is not about whether we need to reduce these admissions but rather about how we go about the change to best effect. A change in legislation certainly has a role to play in this regard and I look forward to working with Senator Freeman and others on exactly how we should frame the terms of such amending legislation. Deputy James Browne has introduced a Bill in the Dáil that seeks to improve the circumstances for children who require inpatient psychiatric treatment. While it is not ideal to amend the same legislation in two Bills at the same time I hope that, with goodwill on all sides, we can reach an accommodation that we can all live with. It is clear that collectively we still face many challenges irrespective of our political grouping or individual view and notwithstanding recent significant progress realised over a relatively short time.

In the interests of one of the most vulnerable groups in our society, the work of this committee is a valuable contribution to the immediate and longer-term priorities required to improve mental health care for young people. As I indicated already, I will give full consideration to the outcome of this process such that we can minimise differences, maximise progress and continue in a responsible and effective way to achieve what needs to be done.