Dáil debates

Thursday, 26 May 2011

 

Mental Health Services

11:00 am

Photo of Dan NevilleDan Neville (Limerick, Fine Gael)

I thank Amnesty International for its interest in mental health and the programmes, documents and advice it recently provided in its briefing pack for Members of the Oireachtas, which is extremely helpful and well written. The organisation will be 50 years old on Saturday, on which I congratulate it and thank it for the work it has done throughout the world. It has been of great assistance to me and other Members of the Oireachtas who believe mental health is a human rights issue.

Successive Governments have called for fundamental reform of the mental health system. The Planning for the Future report published in 1984 was followed in 2006 by the expert report, A Vision for Change. However, progress on implementing reforms has been painfully slow. A Vision for Change set out a policy framework for the mental health of the whole population. In addition to recognising the importance of mental health promotion and primary care, it called for a person-centred, recovery orientated and holistic approach to mental health services. It also called for a shift from the current system, which is excessively reliant on institutional care and medication, to a system centred on community-based care provided by multidisciplinary mental health teams. These teams would include psychologists, social workers, occupational therapists and service users who would work alongside psychiatrists, mental health nurses, psychotherapists and counsellors. Such services allow people with mental health problems access to the services and supports they choose while continuing to live and participate in their community, as is their right.

Ireland is more reliant on institutional mental health care than any other country in Europe. While there are examples of good practice in certain areas, notably County Monaghan, implementation of the plan to which I referred has been inadequate overall. Services remain widely deficient with few complete multidisciplinary mental health teams in place and limited access to community care for the full range of psychological supports that should be part of a modern mental health service.

In 2009, only one in five staff in the mental health service was working in a community setting. Inpatient facilities remain completely unsuitable, with 15 of the 63 approved inpatient centres dating from the Victorian era or earlier. The Inspector of Mental Health Services has described some of these facilities as entirely unacceptable and inhumane. The position in respect of older people and people with intellectual disabilities is even worse as specialist mental health services in these areas are almost non-existent.

Non-capital expenditure on mental health services was cut radically from €1.1 billion in 2008 to €770 million in 2009. These cuts continue an historical trend in which expenditure on mental health services declined from 13% of the overall health budget in 1986 to only 5.3% in 2010. A Vision for Change recommends that 8.4% of health expenditure should be allocated to improving mental health services. The public sector staffing moratorium has also disproportionately impacted on mental health services which account for just 9% of the health care workforce but for 20% of the 1,500 posts lost as a result of the moratorium last year.

The programme for Government contains a welcome commitment to establish a cross-departmental group to ensure good mental health will be a policy goal across Departments. In addition, under the programme a sum of €35 million will be allocated each year, which will be ring-fenced to introduce the reforms outlined in A Vision for Change. This sum has been ring-fenced because when the former Minister for Health and Children, Mary Harney, allocated funding, it was hived off for other purposes. During the two-year period 2007 and 2008 some €50 million was allocated but only €27 million was spent on what the then Minister wanted the money for. In 2009, when I asked her if she was going to allocate further funds for that purpose, her reply at a Dáil committee was: "Why should I give it to them when they are not going to spend it on what I want them to spend it on?" That has shades of the fair deal scheme.

The commitment given needs to be implemented as a priority by the Government in order that it can build on the good work already done by the Office for Disability and Mental Health which has a cross-departmental remit. The group should include representatives from the following Departments: Health and Children; Education and Skills; Social Protection; Justice and Equality; Defence; the Environment, Community and Local Government; the Arts, Heritage and the Gaeltacht; and Public Expenditure and Reform. The group should outline how responsible Departments will progress the social inclusion recommendations made in A Vision for Change, as well as reporting publicly on progress. It should also ensure mental health issues are adequately reflected in the work of other Government structures such as the national disability strategy and the Office for Social Inclusion.

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