Professor Brendan Kelly:

The Senator referred to a grim picture in her comments and there is a lot of grimness in the picture. I want to bring a note of positivity and optimism that change is possible. We have seen this large de-institutionalisation occurring in the field of psychiatry and in the dismantling of the large mental hospitals. Some 30% of people admitted to psychiatric hospitals are discharged within a week, 70% are discharged within a month and 95% are discharged within three months. Change is possible, therefore. There are difficulties with the community services that are in place to replace the institutions. The Senator asked about co-working in the mental health services and housing and primary care are key parts of that. Deputy Tully asked about the unique identifier and that would help significantly with that. Primary care is a structure that already exists and there is enormous opportunity there. There is a counselling and primary care service, where anyone with a medical card attending a GP can access low threshold psychological care such as counselling. Unfortunately that is not open to people who do not have medical cards, nor is it open to people under the age of 18 years, and there is a waiting time. That would be one accessible way that mental healthcare could be provided; through expansion and improvement of an existing initiative rather than trying to invent something new. There has been this big de-institutionalisation but the community structures need some work.

On the housing front, the mental health service operates community residences with smaller numbers of people in them and the Office of the Inspector of Mental Health Services reports that in 2018 there were 119 community residences, often housing small numbers of people with enduring mental health problems who would, in another era, have been in a psychiatric hospital for all o their lives. The inspector is good at keeping an eye on them and at ensuring that institutional practices do not emerge within community residences because in the mental health setting we have become aware of how old practices can creep back in. It is another possibility and solution now that the institutions are gone and the main problem is not protection from over-exuberant care but accessing the system in the first place.

The Senator mentioned intellectual disability and mental illness. There is a mental illness in intellectual disability service but those services are mostly resourced to see people with moderate or severe intellectual disability who develop mental health problems, not people with mild intellectual disability who develop mental health problems. It is fair to say there is a general agreement that those services need to be resourced to take on that wider brief so that people with mild intellectual disability and whatever mental health problems they might have get a dedicated service, similar to if they had moderate intellectual disability.