Dan Neville (Limerick, Fine Gael)

I welcome the Bill. It means that if suitably qualified general practitioners, GPs, decide to set up practice they will be able to treat not only private patients but also holders of GP visit cards and full medical cards. There is no limit to the number of contractors who can be involved. The changes are being introduced on foot of a commitment in the EU-IMF programme which dictated the introduction of legislative changes to remove restrictions to trade and competition in sheltered sectors, including eliminating the restrictions on GPs wishing to treat public patients. It was also part of the pre-election pledges made by the Government.

The current restrictions are detrimental to the ability of young, properly qualified GPs to set up a practice and deliver care and services to their community. In many instances in the past the restrictions accounted for whether GPs decided to stay in this country or to emigrate, which was our loss. I recall debating this issue many years ago when I was a member of a health board. I was extremely concerned about the matter.

I wish to raise another concern I have had for some time. There is a need for Dáil reform because Members do not have an opportunity to raise issues of extreme concern. I refer to an article in The Sunday Times by John Mooney entitled "Course to treat eating illnesses lacks weight". This is an issue I have raised previously. In the article he states that a high profile psychotherapist who offers diplomas in the treatment of eating disorders has no official professional accreditation in Ireland and has not obtained any medical or psychological qualifications from a university. I am concerned about unqualified people involved in psychotherapy and counselling at a very delicate level in treating people with serious psychological, psychiatric and emotional difficulties. Serious damage can be done by unqualified people operating in this area.

Mr. Mooney referred to the Eating Disorder Resource Centre of Ireland which offers diploma courses at a cost of up to €3,000. These take eight weekends to complete. It was stated by the centre that it is accredited to the British Psychological Society, but a spokesman for the society stated that it does not recognise any courses offered by this centre. I investigated this issue more than 18 months ago when Bodywhys, the Eating Disorders Association of Ireland, brought it to my attention as a result of its concern. People had contacted Bodywhys in extreme distress following a discussion with somebody who had completed a diploma and was practising and charging for psychological assistance, advice and counselling.

There are no statutory regulations in the State for the registration of psychotherapists and counsellors. There is no State control over them and over what qualifications are held by people practising in these areas. It is dangerous for untrained, unskilled people to probe others' unconscious mind. They are dealing with human vulnerability and serious damage can be done to such delicate people. There is a historical situation in this regard which dates back to the Health and Social Care Professionals Act 2005. That Act provided for registration of persons qualifying in the use of the title of a designated profession for the determination of compliance relating to their fitness to practise. Twelve professions were listed but psychotherapy and counselling were not included.

For more than 12 months, when an agreement was reached between all the relevant psychological and psychotherapeutic groups and counsellors, we have been seeking the introduction of regulation in this area. The Government has stated that it will introduce a Bill in the new year to deal with this area but I understand the Bill will deal with difficulties experienced with the Health and Social Care Professionals Act 2005 rather than the regulation we have been seeking for some time. When the Fine Gael Party was in Opposition, it fully accepted this and last December I introduced a Private Members' Bill to provide for it. This has been a matter of extreme urgency for some time because we are aware of the difficulties experienced in this regard by people who have been damaged by their experience with untrained professionals.

There is another matter I wish to raise which has concerned me greatly for a number of years. It is in the psychiatry area. I and many psychiatric professionals believe that the family has a key role in the recovery of a person who is in crisis or has a psychological or psychiatric problem, including suicidal ideation. However, a large section of the psychiatric profession fails to recognise the benefit of family involvement. Too many professionals refuse to include family members in the recovery plan for their patients. In too many instances psychiatrists refuse to discuss the after-care needs of a patient after discharge from a mental ill health residential service. This refusal to discuss the after-care service on leaving a hospital is unique in the health services. In general medicine, professionals see the family involvement as part of the recovery programme after discharge from hospital.

Too often, I have met families who are stressed owing to a lack of information on the treatment regime that best serves the convalescence of a person coming out of a psychiatric institution. Patient confidentiality is given as the reason. Family members are key to identifying a member in danger of losing his or her life. Too often, however, I receive complaints that the professionals do not listen to families with this experience. Sadly, the family's views may be borne out and in many instances, the person in crisis has taken his or her life. The culture of excluding a family in such a crisis from the recovery programme of a person with a mental health issue must change and the full family must be involved. In the United States, in the event of a person being diagnosed with a psychiatric or psychological difficulty, the family are called and are involved in the recovery plan for that person. Psychiatric treatment must pertain to recovery rather than to containment. I believe mental health to be central in building a healthy, inclusive and productive society. Illnesses such as depression and schizophrenia can be treated successfully for the majority of sufferers, and with early intervention and treatment - early being the operative word - people can live healthy lives fulfilling their individual potential.

In this context, I again raise the issue of the adoption by the Government of the strategy, A Vision for Change, as the basis for the development of mental health services in Ireland. The policy framework as set out in A Vision for Change built upon the recommendations made in the Planning for the Future document of 1984. Moreover, recommendations have been presented in various reports from the 1960s in respect of the development of psychiatric services that have not been acted on over the decades. A Vision for Change was greeted with universal approval as being the best model that was comprehensive and would introduce a world class service to meet the mental health challenges facing our society. However, five years since its announcement, there has been a lack of progress in implementing A Vision for Change as well as an absence of leadership at a national level. I was pleased that during questions to the Taoiseach two or three weeks ago, the Taoiseach again confirmed and reiterated the Government's commitment to ring-fencing €35 million each year during its five-year life towards the implementation of A Vision for Change. Given the pressures on the Exchequer and particularly during recessionary times, it is easy to be concerned regarding areas of vital importance to the health of the people. I again welcome the confirmation by the Taoiseach that the aforementioned €35 million will be ring-fenced for the development of A Vision for Change.

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