Barry Andrews (Dún Laoghaire, Fianna Fail)

I am glad of the opportunity to raise this matter. The east coast catchment has the unhappy distinction of being the mental health service area with the lowest funding in the State. The reason is partly historical, in that most counties had their own psychiatric hospitals and, when these were closed and replaced by better community-based facilities, funding was provided to compensate for the loss of county hospitals. However, because Dún Laoghaire never had a county hospital, it had nothing to bring to the bargaining table. As a result, it lies at the bottom of the league table of funding according to figures provided by the HSE. We need to acknowledge that significant problems exist in terms of funding for this area.

The recently published report, A Vision for Change, details a comprehensive model mental health service provision in Ireland. The report describes a framework for building and fostering positive mental health across the entire community and for providing accessible community-based specialist services for those suffering with mental illness.

In Dún Laoghaire, when a national pilot project, DETECT, was established, a mere 10% of the necessary funds was provided by the HSE, with the balance coming from Order of St. John of God. The project, which was rolled out last month, tries to reduce the duration of untreated psychosis because people with an established psychosis are 25 times more likely to commit suicide than the general population. This highlights the importance of early detection. As it is an established fact that psychosis is treatable, the earlier the detection, the better.

This issue particularly affects areas of disadvantage and identifiable social and economic problems. The lack of services within the Dún Laoghaire area affects people on low incomes more than those with private insurance. The need for a multidisciplinary response to diagnoses of psychosis is not always met in such circumstance. Sufferers are seen by psychiatrists but have little or no access to community psychiatric nurses, social welfare officers or occupational therapists.

A false economy is created by balancing the cost of hospitalisation for sufferers of mental illness against the much lower cost of setting up a system of early detection. DETECT has impressed me with the type of service it intends to provide. The people involved in the project made a presentation at Cluain Mhuire last month, in which they demonstrated their knowledge of best international practice and their plans to reduce the incidence and duration of psychosis.

There is a perception among the providers of mental health care that the service is grossly under-resourced, both in financial terms and in the range of staffing and physical resources required to provide a quality service. The serious funding crisis that exists may be illustrated as follows. In 1984, 13% of total health expenditure went towards mental health but this figure decreased to 10% in 1994 and to 7.3% in 2004. While the overall pie has grown larger, the lack of resources for this area is apparent.

In the past, mental health budgets were funded on the basis of historical budgets and existing service pressure. In the future, this funding will follow existing population trends and needs, if the recommendations of the report, A Vision for Change, are implemented. The report draws into focus the uneven distribution of funding and human resources throughout the country. The recommendations have been made and the ideas are there. We need substantial extra funding to finance these policies. An urgent programme of capital and non-capital investment in mental health services adjusted in line with inflation should be introduced in line with the reorganisation of the mental health services.

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