Pat Buckley (Cork East, Sinn Fein) | Oireachtas source

I thank the witnesses for coming in today. I welcome that they have talked about moving away from a medical model. I firmly believe that is right. The witnesses have all touched on the issue of funding. I believe that a number of years ago around €10 million was going into psychological services and therapies and whatever, and over €400 million was being spent on medicines. There was definitely an issue with that.

I want to touch on two issues. One is that of advocacy, which plays a huge part. I do not think there is enough publicity around it. From personal experience over the years, when somebody is in crisis - I suppose this is a cliché but we are a very reactive society rather than a proactive one - we panic, and families do the same. As the witnesses mentioned, gardaí are then unfortunately the first to be called. Again, we are reactive in that. It is very traumatic for the patient or individual involved, and it escalates the problem. Each and every one of us sees such incidents every day. Mental health issues are going to get even worse coming out of the pandemic and given what is happening at the moment. Many people are going to be very disturbed and unwell, given the events in Ukraine as well.

Looking at the Irish model, advocacy would be my number one priority. I agree with the witnesses that members of the public complain. However, it is about trying to get the model into legislation to make it part of the pot. As I said, there should be no competition between psychology services and the clinical lead. All services should be part of a team, but it does not seem to be that way. That is what makes it very frustrating. I had the honour of sitting on the Joint Oireachtas Committee on the Future of Mental Health Care a number of years ago. It was a cross-party committee and members signed off on an agreement eventually. It may not have been perfect, but it was moving in the right direction. I am back here listening to the witnesses today. I actually wrote down the following question. Even if the Bill passes in its entirety, with 99.9% of what people advocated for, how confident are the witnesses that it will actually be enforced? I am saying nothing now. I am using the word "enforced" because somebody is going to have to be accountable and take responsibility for it. If this Bill is passed in its entirety, who is going to enforce it?

There are also issues with how services will be staffed, because there will be multidisciplinary teams. In a few committee meetings it has been mentioned that if there was a premier league of CAMHS teams, there would probably be three matches a year, out of a total of 25 teams. That is a fact, because the teams are not resourced. There could be 11 players on one team, seven on another and nine on a different team. When I hear about this whole-time equivalent, it drives me mad.

I also want to touch on the issue of early intervention and community services. That is why I asked the witnesses about whether they have confidence in this Bill. The Chairman will be very aware of what I am about to raise. At present, in my area there is a mental healthcare centre that has long-term respite and short-term respite beds. It is in the community. The majority of its residents are long-term patients. They are totally integrated into the town. In my opinion, because the building is not suitable, the HSE has decided that it is easier to shut the whole lot down and move all these people out. We are being told that we will not need these services again. That is why I asked the witnesses about how confident they will be if the Bill is passed. We have a centre with a model that has worked for years. It serves a huge population and there is a wonderful team of staff in it.

Yet, because of failings within the HSE, which did not maintain the building, it is easier for it to shut down services. Mentally, it is still systemic within society that if people try to change something, there is resistance to it. Regardless of whether or not something is working, people have no power to say that something is inappropriate, is against European law or is a human rights issue.

First, if this Bill were passed in its entirety, and even if it were perfect, how confident are the witnesses that it would be actually enforced? Second, I am very interested in the independent complaints mechanism. As was said, most people in these scenarios do not have a voice and do not realise what their rights are. Restraint was mentioned. Should there be a separate paragraph on that stating the rules to be followed, what must be done first and that there must be an independent group that can assist the patient and the family? Nobody knows what is going on. There is the over-reliance on medication as a form of sedation or restraint. We are talking about all these issues but the first thing we will hear when we leave this room is that we have a problem with recruitment and retention. I am a firm believer that we have one of the best educational systems in the world. The Irish people are very empathetic and passionate about what jobs they go into. The majority of these people went into these jobs because they wanted to do something and to make a difference in society.

I wish to ask about getting proper funding. The witnesses all mentioned funding, funding, funding. I remember that in 2018, I think, we asked the CHOs how much was spent on mental health services. It was over €1 billion, yet they could not tell us where they spent it. Then what happened? They shut down the Owenacurra centre when we wanted accountability. That was handy. I will not dwell on that too much.

I am very interested in the model of early intervention community services. That works and is being supported yet there are failings from one entity to another. How can they be made responsible and accountable for their failings so patients do not suffer? I go back to my first question. If the Bill were passed in its entirety tomorrow, would the witnesses have confidence in it actually being pushed forward?