Tim O'Malley (Limerick East, Progressive Democrats)

I thank Deputy Neville for raising this matter.

I welcome the publication of A Vision for Change, which outlines an exciting vision of the future for mental health services and sets out a framework for action to achieve it over the next seven to ten years. The report has been accepted by Government as the basis for the future development of mental health policy.

I established the expert group on mental health policy in August 2003 in recognition of the need to review long-standing policy in this area and to formulate a blueprint for a modern, comprehensive, world class service to meet the mental health challenges facing our society.

The group's report is the first comprehensive review of mental health policy since Planning for the Future was published in 1984. The expert group was chaired by Professor Joyce O'Connor, President of the National College of Ireland, and consisted of 18 widely experienced people drawn from a range of backgrounds within the mental health services.

Wide-ranging consultation took place throughout the country in the development of this policy, drawing on the experience, perspectives and ideas of key stakeholders, interested agencies and concerned individuals. The findings from the consultation process provide a very clear indication of service users' views on the current state of the mental health services and how they should be developed in the future.

The report proposes a holistic view of mental illness and recommends an integrated multidisciplinary approach to addressing the biological, psychological and social factors that contribute to mental health problems. It proposes a person-centred treatment approach which addresses each of these elements through an integrated care plan, reflecting best practice, and agreed with service users and their carers. Special emphasis is given to the need to involve service users, their families and carers at every level of service provision. Interventions should be aimed at maximising recovery from mental illness and building on the resources of service users themselves and within their immediate social networks to allow them to achieve meaningful integration and participation in community life. A Vision for Change recommends that specialist expertise should be provided by community mental health teams — expanded multidisciplinary teams of clinicians who work together to serve the needs of service users across their lifespan. The community mental health teams should serve defined populations and age groups and operate from community-based mental health centres in specific sectors throughout reconfigured mental health catchments areas. These teams should assume responsibility for self-governance and be accountable to all their stakeholders, especially service users, their families and carers. Some of these community mental health teams should be established on a regional or national basis to address the complex mental health needs of specific categories of people who are few in number but who require particular expertise.

A Vision for Change envisions an active, flexible and community-based mental health service where the need for hospital admission will be greatly reduced. This policy will require substantial funding and it is recommended in the report that steps be taken to bring about the closure of all psychiatric hospitals and to re-invest the resources released by these closures in the mental health service.

The closure of large mental hospitals and the move to modern units attached to general hospitals, together with the expansion of community services, has been Government policy since the publication of Planning for the Future in 1984. A number of large psychiatric hospitals around the country have already been closed, including Our Lady's in Cork, St. Patrick's in Castlerea, St. Columba's in Sligo, St. Mary's in Castlebar and Our Lady's in Ennis. The re-organisation of services following these closures resulted in more community facilities, new acute psychiatric units in some cases and an overall improvement for service users, their families and carers. The remaining stand-alone psychiatric hospitals cater in the main for long-stay patients, many of whom are over 65 years of age.

The report recommends that a programme of capital and non-capital investment in mental health services adjusted in line with inflation should be implemented in a phased way over the next seven to ten years, in parallel with the proposed reorganisation of mental health services. The proposed new workforce will comprise more than 11,000 staff throughout the service. Allowing for the assimilation of all existing posts, the expert group has estimated that a total of 1,803 new posts across the service, together with a total non-capital investment of €151 million per annum in addition to existing funding are required.

Due to the current non-availability of certain health professionals, investment will be required on an incremental basis, resulting in a proposed non-capital investment of an additional €21.6 million each year for the next seven years. An additional €25 million has been allocated to the HSE for mental health services in 2006 and it is hoped to continue this level of investment in the coming years.

Significant capital investment is also required to provide and equip the proposed new mental health infrastructure. The report estimates that €796 million will be required. There are, however, substantial capital assets in the existing psychiatric hospital buildings and lands which could be released to fund the capital investment required.

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