Dan Neville (Limerick West, Fine Gael)

I welcome the opportunity to speak on the budget provisions. The Minister for Finance announced an additional €25 million for the delivery of psychiatric services under A Vision for Change. This figure will only allow services to be maintained at existing levels, with 7.3% of the total health budget devoted to psychiatric services in 2006. Next year, according to the Minister's figures, 7.2% of the overall budget will be allocated to these services. There is no effective increase in funding at a time when there is greater recognition and understanding of the need to roll back the neglect of decades. If there is a commitment to such action on the part of the Government, it is not evident in this budget.

The Mental Health Commission has stated that "underfunding is reflected in the prevalence of mental disorder and generally negative and stigmatised attitudes towards mental illness". For three or four years, questions to the Minister about the development of the psychiatric service were met with the response that we must await the report of the commission. That report was published last January but we all had a good idea of what it would recommend. The requirements in this area were outlined clearly in 1984 in the Department's Planning for the Future document. All of us were aware of the need for multidisciplinary, community-based psychiatric services and increased provision of child and adolescent psychiatric services. We knew of the negative effects of excessive waiting lists for psychiatric assessment and services, especially in the case of children and adolescents for whom a mild condition could become chronic during the waiting period.

This budget does not meet our expectations and hopes that a corner had been turned. The Government should immediately double the moneys allocated. The standard of patient care in large mental institutions was severely criticised by the Inspector of Mental Health Services in his 2005 report. Many of the wards in mental health institutions have little or no therapeutic activity, multidisciplinary input, regular physical or psychiatric assessments, or care plans for patients. Community residences for former long-stay patients were found by the inspector to be an exercise in relocation rather than part of a rehabilitation programme.

We must urgently address the shortage of psychiatrists, psychotherapists, community nurses, occupational therapists and family therapists to provide for the needs of those who suffer from a psychiatric condition. Approximately 5% of people over 65 years of age suffer from some form of dementia, and a further 15% to 20% suffer other mental problems such as depression and anxiety. People with intellectual disabilities have a higher than average risk of developing a mental illness. Only two units are approved for inpatient care; the other units in which patients receive care are not subject to inspection and are outside the legal framework that protects patients' rights.

We are all aware of what happened at Leas Cross nursing home. There must be an effective system of inspection of those facilities where people with intellectual disabilities receive inpatient care. We must be confident the service they receive complements their dignity. People with mental health difficulties sometimes find themselves homeless and their problems then become more chronic. It is unacceptable that psychiatric patients are being discharged from hospital onto the streets. There is an urgent need for a hostel-type step-down facility from psychiatric institutions. Local authorities should be obliged to provide for the housing needs of such persons.

Child and adolescent psychiatric services account for only 5% to 10% of spending on mental health services but cater for 23% of the population. This under-investment has resulted in a service that is at best sporadic and at worst non-existent. The key to dealing with psychiatric conditions is to have a large input into the development of child and adolescent psychiatric services. Early intervention, experts claim, gives a 90% chance of a full recovery. A delay in intervention makes a condition chronic, with over 70% recidivism where people return to psychiatric hospital on a regular basis. Early intervention is crucial in that fewer people will be in need of care in their adult lives and, as such, that will have a knock-on effect on adult psychiatric services.

It will also have an effect on suicide rates. Up to 80% of people who take their own lives suffer from a psychiatric condition. In excess of 200,000 children have a mental or behavioural problem at any one time, with one in ten having a disabling problem. More than 1,900 children under the age of 18 years sought addiction treatment in Dublin, which amounted to 20% of all new attendances. Suicide accounts for 30% of all deaths for the 15 to 24 years age group. In 2004, 11,200 adolescents presented at accident and emergency departments after causing self-harm. Approximately, 5,330 children and adolescents have autism spectrum disorder. Eating disorders are rising every year. Will the Minister for Health and Children examine funding in this area? While it may not have been dealt with in last Monday's "Prime Time" programme, the levels of death from suicide and other disorders are the highest of all psychiatric conditions.

Last year the National Office for Suicide Prevention received funding of €1.2 million. There was no statement in the budget for next year's funding. In Scotland, where inroads have been made into reducing suicides, its suicide prevention office receives an annual budget of Stg£10 million. In the context of the amount of moneys flowing into the Exchequer, it is not unreasonable that the National Office for Suicide Prevention be allocated €10 million.

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