Dan Neville (Limerick West, Fine Gael)

I want to deal with the issue of mental health, which has been ignored as the Cinderella of the general health service. The Minister of State, Deputy Tim O'Malley, said I am always speaking about this matter so I wish to introduce an independent view of the Government's performance since the publication in January 2006 of A Vision for Change, the policy report accepted by the Government. The Irish Psychiatric Association has produced a one-year progress report on the initial report, entitled A Vision in Hindsight. The latter report was launched on 24 January 2007 and the Minister of State should reflect on the views of one of the key groups which delivers psychiatric services. Dr. Siobhán Barry, the public relations officer for the Irish Psychiatric Association has stated that the experience at the coalface over the past 12 months was disappointing. She said the degree of enthusiasm felt by service providers has not been responded to, so there is a feeling of betrayal and disappointment.

After the first year, the Minister should have some structures in place but there is disappointment and dismay at what has occurred. The Government is not serious about doing anything about the health services or introducing the recommendations in A Vision for Change. Dr. Éamonn Moloney has pointed out that one third of community-based psychiatric teams have less than 50% of the staff recommended. At last year's rate of appointments, which amounted to 24 posts, it will take 25 years to introduce the full recommendations of A Vision for Change.

Dr. Barry has said the Government's response to capital development requirements is shameful, shabby and shoddy. The national mental health directive has not been introduced, although it is cost neutral. That indicates the Government's lack of interest in introducing any reform in mental health services. The Government is not serious about change.

The report of the Irish Psychiatric Association says there is little evidence that the task of implementing A Vision for Change has been tackled seriously to date. The HSE implementation and expert advisory groups took almost six months to be established and each met just three times. No formal mapping exercise has yet been conducted by the HSE, although such a task is fundamental in the association's view. Insufficient funding has been provided, according to the Irish Psychiatric Association which states that although €26 million was committed nationally to the development of new mental health services in 2006 at the commencement of A Vision for Change, the level of funding received by individual services has been small with none receiving more than €500,000. This has been insufficient to create the new multidisciplinary teams recommended. In fact, the introduction of such teams was first mooted 22 years ago in a report entitled "Planning for the Future", which was accepted by Government but not implemented.

Last year, I tabled a parliamentary question asking how much was being invested in the psychiatric services as a percentage of the total health service. I was told the figure was 7.3%. That compares to 12% in England and 18% in Scotland. On 1 February, I asked the Minister for the percentage of the budget allocation for psychiatric services compared to the total health budget, but the Minister did not know. She told me the Revised Estimates volume for 2007, which will give a breakdown of spending across these areas, including mental health services, is being compiled. We will not know the answer until 22 February when it is due to be released. While the Minister does not know the relevant figure, the Irish Psychiatric Association could calculate it, and stated:

An unprecedented increase of €1.1bn in the health spend was announced in the 2007 budget — bringing the total to €14 billion. Of that, €800m is allocated to mental health as revenue funding and €25m to new service developments. A Vision for Change advised that implementing their recommendations would require the mental health percentage of the health budget to increase from its previous 6.9% to 8.24% — the meagre increased funding for mental health in 2007 brings that percentage down to below 6%, indicating clearly that we are moving in the opposite direction.

The Irish Psychiatric Association concludes that one year after its publication, A Vision for Change remains a plan. At the most senior organisational level, little thought appears to have been given to organisational development, financial or otherwise, to enable its implementation. The funding issue, if it is being debated at all, is being discussed in the abstract. The financial targets outlined in A Vision for Change will clearly not be met. The Irish Psychiatric Association's latest report states:

We can say with some confidence that on the first anniversary of the publication of the document, and also the year in which our budgetary giveaways have been at a historical high, the relative decrease of the mental health budget is a very bleak indicator for the future.

At its press conference, the Irish Psychiatric Association's representatives stated, "The vision is vanishing and with it the opportunity and goodwill to make it possible. Those affected by mental ill health are close to yet another political betrayal." This is a missed opportunity for the Minister of State, Deputy Tim O'Malley, who is the first incumbent in the newly created junior ministry, to make a credible and enduring contribution to those his office is meant to serve. The public, service users and carers are angered and disappointed. They cannot accept this lack of progress. The IPA, together with service users and providers, is demanding urgent political and administrative action or, failing that, it will seek electoral accountability.

On the first anniversary of the launch of A Vision for Change, the Irish Psychiatric Association published a review of the progress in its implementation but, as I have outlined, no progress is being made.

The Minister of State's colleagues sometimes tell me this is not a political issue and there are no votes in it. I probably agree with that. While getting re-elected is important in order to deliver one's views, politics is also about leadership. It is about taking on major issues of deep public concern, which may not be overtly expressed. The stigma surrounding psychiatric services prevents open debate about their provision. We have asked repeatedly for investment to reduce this stigma. For example, the National Suicide Prevention Office will receive a budget of €1.6 million this year. The National Safety Office, which promotes road safety, has a budget of over €30 million, yet there are more suicides than road deaths. I adhere to the view that investment in promoting road safety is not adequate. Young people in crisis need help. They need to understand that they are suffering from depression. They see no way out of their pain other than to take their lives, but there is no investment or interest in this.

There is a need for leadership in this area. We in Fine Gael and the Labour Party have shown leadership in our first published policy document which, initially, one senior Minister moved to rubbish but then quickly pulled back and accepted it was a good document. Fine Gael and Labour have shown leadership. If there is a change of Government, the parties will have committed themselves to producing a costed policy to change the situation.

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