Róisín Shortall (Dublin North West, Labour)

I thank the Deputy for raising the matter of the implementation of A Vision for Change on the Adjournment.

The Government has prioritised reform of the mental health service in line with A Vision for Change and is committed to reforming our model of health care delivery in order that more and better quality care services are delivered in the community. The Minister of State, Deputy Kathleen Lynch, is committed to this model. As the Minister of State with responsibility for primary care, I subscribe to the principle of moving services, to the greatest extent possible, from the institutional setting to the community.

It is the intention that over time access to modern mental health services in the community will be significantly improved. It is proposed to ring-fence a sum of €35 million annually within the health budget to develop community mental health teams and services to ensure early access to more appropriate services both for adults and children. My colleague, the Minister of State, Deputy Kathleen Lynch, is working with officials in the Department of Health and Children and the HSE to achieve further progress in this regard.

In 2006 A Vision for Change was universally welcomed as a progressive, evidence-based and realistic document which proposed a new model of service delivery that would be patient-centred, flexible and community-based. Progress on implementation has been slower than anticipated when the report was launched. However, it is also important to recognise and acknowledge that in many parts of the country services are pressing ahead with implementation of A Vision for Change. Progress to date includes: a 17% decline in the number of patients resident in psychiatric facilities since 2006; fewer admissions, including involuntary admissions; while the number of patients readmitted to hospital has shown a year on year reduction since 2001. This reduction points to an improvement in community-based services.

The child and adolescent mental health service has seen a significant improvement. There are now 61 multidisciplinary teams in place around the country and further teams will be developed in line with A Vision for Change. In-patient bed capacity for children and adolescents has increased from 12 beds in 2007 to 52 at present. Through the See Change campaign, we are attempting to positively change social attitudes and behaviour in order to encourage people in distress to seek help.

Work on the capital programme is continuing. Acute admissions to St. Brendan's Hospital, Grangegorman, have ceased following the opening of the Pine Unit in Connolly Hospital. During 2011 and 2012 HSE South will complete the process for the closure of St. Senan's Hospital, Enniscorthy, with the implementation of a €16 million capital investment programme. A residential unit is under construction in Clonmel which will allow for the closure of St Luke's Hospital. In addition, work is progressing on the development of a new 60-bed unit at Beaumont Hospital to replace the existing facility at St. Ita's Hospital, Portrane.

Implementing A Vision for Change will involve using existing resources more efficiently and effectively. It will require the reallocation and remodelling of existing resources to move away from the provision of care in institutions to providing it in alternative settings or an individual's own home. We need to be in a position to provide care in the best interests of the individual concerned.

There is no doubt that we are experiencing unprecedented challenges, not just in mental health services but also across every walk of life - challenges that, in turn, may impact on people's mental health. As 90% of mental health needs are dealt with at primary care level, the Government is committed to developing closer links between mental health and primary care services, a key recommendation in A Vision for Change. The focal point of modern mental health services in the community and the development of community-based facilities which house both primary care and mental health professionals will represent a significant step forward for service users and their families. Having a community mental health team in the same building as a primary care team will help to build and cement closer relationships which will benefit everyone, including service users and their families, carers and professionals alike. It has also been shown that people with a severe mental illness have poorer physical health than the general population. Having primary care services available alongside mental health services will ensure the physical health needs of those persons with mental health problems can be dealt with effectively.

I assure the House of the Government's unwavering commitment to improving mental health services and the implementation of A Vision for Change. We will continue to engage closely with the service user movement, one of the most significant reforms to have taken place in mental health services in recent years. We will work tirelessly to change attitudes to mental health, place the service user at the centre and embed the recovery approach in the delivery of mental health services.

I again thank the Deputy for raising this issue. I join him in commending Amnesty International for its outstanding work.

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