John Dolan (Independent) | Oireachtas source

I apologise for not being able to be here sooner.

If I touch on something that was dealt with earlier, the witnesses may give me short shrift and need not go through it again. I have some generic questions. Can the witnesses name one or two critical issues, areas or services that are outside the health services and that have a significant impact on the people about whom they are concerned? On prevention, which Dr. McDaid just mentioned, we have the analogy that it is better to prevent people falling into a river than to be trying to pull them all out in time. Are we spending too much effort on trying to save people, as it were, and not enough on keeping them well most of the time? I am not suggesting that resources be taken from one and given to the other.

I also have a couple of questions for the Mental Health Commission. It was great to see the executive summary it provided with the bullet points. The summary states that there are some good things happening. It also sets out six areas, forensically but briefly, where there are serious issues. It states that "basic and fundamental aspects of care and treatment in regulated health services continue to be lacking", that there is "lingering complacency around restrictive practices", and that a large number of specialist community health teams remain without regulatory oversight. It cites a lack of rehabilitation supports for people with enduring mental health services; the whole issue of the physical health needs of people with enduring mental health needs; and the provision of child mental health services in the community. I want to focus on the second last item. What is the interaction in respect of general health, disability and other conditions? How might that be dealt with differently? The drugs thing was almost a parallel issue in terms of trying to slice and dice people.

The Mental Health Commission is the regulator of mental health services. It is also there to protect the interests of people admitted and detained under the 2001 Act, which is quite a critical and long overdue provision. It is, dare I say, therefore locked into people who are in services or who are on the cusp of being so. We have heard it set out eloquently by Senator Colm Burke. What has the commission to say about people who are not in services and should be?

Turning to Mental Health Reform, it sets out three major issues in the first page of its presentation, governance, accountability and protracted delays in reform of the 2001 Act. We hope we do not have to wait as long as from 1945 to 2001 to get the next Act and get things moved on. Reference was also made to implementation of the national mental health policy. I refer to the United Convention on the Rights of Persons with Disabilities. Will the witnesses comment briefly on what it requires, what Ireland has said it is going to do and how this relates to A Vision for Change and the Mental Health Act? The second page of Mental Health Reform's presentation states "the Irish mental health system suffers from a severe lack of capacity in the face of increased demand which has pushed the mental health services to breaking point". What is actually meant by that? When is that going to happen if something does not change?