Dan Neville (Limerick West, Fine Gael)

I welcome the opportunity to contribute to the debate on the budget. Yesterday, I was extremely concerned about the absence of any reference to the delivery of resources for psychiatric services and suicide prevention. A Government commitment to ensuring our psychiatric services are supported or providing the resources required to bring them up to a level of modern efficiency was not mentioned on any occasion or in any supporting document. The fact that, each year, 500 people take their lives was ignored and no commitment was made to support provisions for suicide prevention, research into why it happens or assisting those bereaved by suicide.

The public has no confidence in support services for people who are suicidal. According to a recent survey, only 7% of people stated that if they were in crisis, they would look to an organ of the State for support. Of those surveyed, 50% identified the Samaritans and 22% identified AWARE as services for people in crisis. These are non-governmental organisations. It is of concern that 28% of people stated they were unaware of any services available to people who were suicidal.

This is a serious indictment of the Government's concerns for people who are suicidal, in crisis and in need of support. Immediate investment should be made in psychotherapy and counselling services in all communities and this should be readily available as part of community-based psychiatric teams. We did not hear anything about this yesterday. I am concerned that while lip service is paid occasionally, resources are not supplied at the level required. Ten years ago, up to 10% of the total health budget was applied to psychiatric services. This has been reduced to 7%.

We urgently need greater psychological input in mental health care. In December 1984, a report, Planning for the Future, outlined the urgency required with regard to the input of psychological services in dealing with the treatment of mental illness. Last year, in a submission to the Joint Committee on Health and Children, the Irish College of Psychiatry stated that 83% of psychiatric consultants do not have access to a psychotherapist, 76% do not have access to a family therapist and 33% do not have access to an occupational therapist.

A senior consultant psychiatrist in the public service informed the Oireachtas committee that he has 480 patients with a staff complement of one community nurse, one social worker, two junior doctors, who change every six months, and one third of a psychologist. Mental illness treatment requires more time per patient than such a regime permits. Yesterday, the Minister in his budget ignored this area of urgent concern. The Government has no interest in or commitment to investment in developing mental health services. We urgently require balance of all disciplines involved in treating mental illness.

The Minister of State might state that I argue this on a regular basis. To support what I state and to show it is not only words or that only I say this, I will quote from the most recent report of the Mental Health Commission on this matter. This commission was established by the Government as an independent body:

Mental health services are managed at catchment level by senior management teams (SMTs) which consists in most cases of the clinical director, director of nursing and hospital manager. There were a few exceptions where the senior management teams were multidisciplinary, one example being in the Mayo mental health services. Most senior management teams have no representations from disciplines such as occupational therapy, social work and psychology. While the vast majority of services have signed up to multidisciplinary team working at service delivery this is not reflected at management level. The Inspectorate was unable to obtain any logical reason as to why this was the case, but the apparent resistance to widening the senior management base is surprising. In view of this, the time when service users will be represented at management level seems very distant.

It was suggested in 1984 that service users be involved in management. This report states this seems distant:

Communication and being part of the decision-making process were two areas where there was evidence of failure of management. The majority of senior management teams did not feel that they were part of the decision-making process. There was little evidence of effective catchment management teams. Time after time the Inspectorate was informed by senior management teams of the lack of communication from local health managers. SMTs are rarely integral participants in the planning of mental health services. Many are informed of decisions about their service rather than being part of the decision-making process. Indeed, some senior management teams heard of decisions that were made for their services for the first time from the Inspectorate.

The senior management teams learned of the decisions from the inspectorate inquiring into how they manage when they should have been involved in making those decisions. The report further states:

The difficulties that the Inspectorate had in obtaining information about plans for catchment services mirrored the difficulties that senior management teams had in obtaining information about plans for their own services.

The inspectorate was unable to find out the full case because of the inefficiencies and type of approach taken by the roll-out of our psychiatric services. It is an indictment of the Government that during the past ten years, while lip service was paid to this, nothing has happened and resources have not been allocated. On numerous occasions, particularly over the past five and a half years, we heard in this House about the Government's commitment to multidisciplinary teams. The inspectorate reports that it is not happening:

In the majority of catchment areas, the Inspectorate was left with no clear idea as to the future of the service over the next five years. Therefore it appears that resources will continue to be allocated on an ad hoc basis, with little contribution from the services themselves as to where resources are most needed.

It was quite evident that some senior management teams were not functioning and were not motivated in being part of the planning process. The Inspectorate was surprised at the lethargy demonstrated by some senior management teams which had not sought to have input into decision making. This could be looked on as a measure of the frustration that senior management teams feel about the future of the service and their role within it.

It is an indictment of any service if the management does not operate efficiently, is not in control, does not know what is happening, is not involved in decision-making and is not pivotal to how the service is run. I could quote from the report for half an hour but I have expressed the need for a hands on approach to ensure our mental health services are of concern to the Government and to the Health Service Executive. I cannot get a response regarding why the HIQA report on conditions in our hospitals, which was otherwise quite informative, ignored psychiatric hospitals. The conditions experienced by psychiatric patients should be just as deserving of scrutiny as those of general hospital patients. Did the Government fail to recommend that HIQA should investigate conditions in psychiatric hospitals because it was aware of the Dickensian conditions of some of them?

See this speech in context