Dan Neville (Limerick West, Fine Gael)

I intend to discuss the recommendations of the report of the expert group on mental health policy, A Vision for Change. I thank the Ceann Comhairle for allowing me the opportunity to debate this important report and welcome the participation of my colleague, the Minister of State at the Department of Health and Children, Deputy Tim O'Malley.

A comparison between these latest recommendations and the 1984 report on psychiatric services, Planning for the Future, reveals little progress and raises questions about our attitudes towards improving the treatment of mentally ill people. It is depressing that a report dating from more than 20 years ago contains so many of the recommendations made by the most recent expert group. While this does not undermine the validity of those recommendations, it reveals how little progress we have made in terms of the way we treat the mentally ill. All this time, we have been promising to care for this most vulnerable group in their communities but progress has been painfully slow. How many other sectors in these modern and fast-paced times measure milestones in decades rather than years?

The Government proposes that its new plan will be effected incrementally over ten years, with funding from the sale of 15 mental hospitals to provide the necessary structures at community level. Why should the desperate need of the mental health sector depend on its ability to raise its own finances? Other areas of need are not treated in that way. By all means, let the Government raise money where possible from the sale of institutions but why should vital recommendations wait until this is complete before they are implemented when the money could be made available immediately?

It is a poor reflection on our society that our economy is in rude health, yet we still fail to act on behalf of the mentally ill. The disappointing proposal to increase the percentage of the health spend for mental health services from 6.98% to 8.24%, which the Minister of State has endorsed, compares unfavourably with other countries. For example, the comparable spend in England is 12% and is 18% in Scotland. For that matter, the recommendation falls far short of Ireland's mental health spend in 1997, which was 11% of total health expenditure.

There are inescapable doubts about the ability and commitment of the Government to deliver on the changes that the mental health sector so desperately needs. After knowing for 20 years the essential requirements of the mental health service, I have little confidence that the recommendations of this report will be implemented by this Government. I want to know how many sales have been completed since last March, when the Minister of State announced the sale of mental health service property to facilitate expenditure on psychiatric care.

It is unacceptable that there is a serious dearth of suitable community-based facilities for the delivery of high quality care. This not only applies to community mental health centres but also to day and hospital accommodation and community residences. Specialised mental health services are lacking and the neglect of young and old people with difficulties and of those with intellectual disabilities reflects badly on the Government.

Outpatient services for those suffering from mental or emotional illnesses are not being determined by need but by available resources. An integrated model of care should be introduced to address the broad needs of service users, including biological, psychological and social aspects of presenting disorders. Emotional aspects of mental disorder have been neglected, as has the disruption this can cause to sufferers' social and occupational functions. We did not need this report to inform us that there is a major scarcity of psychological therapists dealing with mental illness and the re-establishment of healthy supportive relationships. Some 22 years after the publication of the report, Planning for the Future, there are serious shortcomings in existing services for people with severe and enduring mental illness. At present, there are only five specialist rehabilitation teams in the country, none of which has the full range and number of staff required. Only two rehabilitation community mental health therapy centres have sufficient staffing.

For many years, I have witnessed the exclusion by the psychiatric service of families involved in the recovery and care for loved ones. The family of people with severe mental illnesses carry significant burdens of care but this goes unrecognised. There is a need to provide families and carers with support, information and, when needed, accessible help. The instant response by specialists to more than 90% of queries on the conditions of loved ones is that the matter is confidential and cannot be discussed with families. This contrasts with other areas, where the involvement of families and loved ones is welcomed by specialists.

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