Maureen O'Sullivan (Dublin Central, Independent)

The first question I would like to ask is what is mental health. Many people consider it is a question of somebody with a mental illness. We know that one in four people will develop a mental issue at some point in their lives. I think mental health has to do with all aspects of our lives. Sometimes it is more important than our physical health. We know what we should do to look after our physical health, even if we do not always do it. We know why we should take exercise, what kind of food we should eat and how much sleep we should get. We know to avoid alcohol, cigarettes and drugs. Do we pay the same attention to our mental health as we pay to our physical health in order to ensure personal optimal mental health? I believe both are linked. Things that help our physical health will also help our mental health.

More strategies and programmes in areas like meditation, yoga and mindfulness are needed to ensure we look after our mental health. We need to look at the importance of self-esteem, real communication, positive relationships and relaxation. It is possible for someone who is physically unwell to be well mentally. Some good articles in a recent health supplement in The Irish Times drew attention to various aspects of mental health. We need more of that. I would like to emphasise that we should not create an illness out of normal distress. We all suffer bereavement. Grief is natural. There are stages in the grieving process we have to go through. There has been an alarming increase in the use of anti-depressants and medication by people in such circumstances. We should allow the grieving process to take its natural course and acknowledge the need for space and time of the person who is grieving. He or she should be listened to in an empathic way.

Children can be bold. They have high energy. They can present with challenging behaviour. They will not do as they are told. Some parents have difficulties with them. We can be very quick to put a label on such children and prescribe drugs to them. Naturally, there are times when we all suffer from depression. We use the word "depression", which comes in various degrees, when we feel down. There is a propensity for anti-depressants to be used in such circumstances. I welcome the guidelines on the management of depression in primary care that have been drawn up by the College of Psychiatry of Ireland and the Irish College of General Practitioners. There are various procedures for dealing with mild depression, and moderate to severe depression. The colleges use terms like "watchful waiting", "psychological intervention", "social support" and "exercise programme". Depression and anxiety are common mental illnesses in older people. The independent monitoring group has recognised the lack of progress in the psychiatry of old age.

Depression needs to be treated. There are various treatments. I do not want us to drift further into the "pill for every ill" syndrome. The 2010 medication report of the mental health services referred to the overuse of medication in inpatient services. It reported that 57% of inpatients are being prescribed benzodiazepines. In one psychiatric unit, benzodiazepines were prescribed to 97% of patients. The question of community care arises in this context. Too many Victorian-era psychiatric hospitals are still open. We cannot close them if that means leaving their clients exposed. We need multidisciplinary care teams in the community, as set out in A Vision for Change. Just 20% of community mental health teams have the full range of disciplines that are recommended in A Vision for Change. Just 12% of teams have them on a full-time basis. Staffing is another major issue. We do not have required number of psychologists, occupational therapists or social workers.

According to the Mental Health Commission - we knew it anyway - recessions are times of high stress. Unemployment, debt and poverty have a significant impact on mental health. The chair of the commission has said that "economic difficulty leads Government to postpone necessary investment in mental health services in recessionary times". The irony is that at a time of increasing stress and strain, there are fewer resources. The Celtic tiger contributed to mental ill health. Our President spoke out on this issue on Friday when he referred to "individualism" that is closer to an "egotism based on purely material considerations".

Mental health is the Cinderella of the health service. It is not the Government's fault that it does not get the proportion of funding it needs - it is the fault of every Government since the foundation of the State. The Cinderella within that Cinderella is the area of intellectual disability. The motion before the House acknowledges and welcomes the positive appointment of executive clinical directors with responsibility for the mental health of people with intellectual disabilities. The gaps are disturbing, however. The motion refers to the approved centre at Stewarts Hospital in that context. I acknowledge the work of St. Michael's House and other services that are flexible, creative, resourceful and inventive in developing new and cost-effective ways of delivering services and dealing with cuts to date.

The service user has to be at the centre of the recovery process. I support the call for the first clinical encounter to focus on the client. If the client is not in the sort of space to make a decision, which can happen, he or she will be entitled to dignity and respect. There is a need for peer advocacy. Mental health advocates want the forthcoming legislation to ensure that those who could make a decision with the assistance and support of an advocate are given the opportunity to do so before a guardianship is considered as a last resort. There is some good international practice in this regard. I am in favour of the inclusion in the legislation of supported decision-making and independent advocacy. The frameworks that will specify how the systems work will also be a priority.

I could stand up here and say I have cancer, angina, a broken leg, diabetes or arthritis. It would be different and difficult for me to stand up here and say I have had a breakdown, I am an addict, I have an eating disorder, I have trouble with my nerves or I am an alcoholic. We do not say such things. Instead, we hide them. That brings an added pressure. We have to be comfortable in being as open about mental illness as we are about physical illness. There are examples of absolutely horrible expressions that are used to describe those with mental health issues. Such labels have to be challenged.

The Minister of State, Deputy Kathleen Lynch, and I are both familiar with Mr. John McCarthy, who is a proud member of the Mad Pride community. He established Mad Pride Ireland. He has spoken about the normality of madness. He deplores the way society has been allowed to think the mad community is dangerous and to be feared. For Mr. McCarthy and others, madness is an everyday occurrence that affects everyone and can be dealt with in an open and loving way with no fear. Mr. McCarthy and others are particularly critical of the "one size fits all" approach to treatment. I believe the pharmaceutical industry needs strict ethical and moral boundaries. I acknowledge those people who have spoken out about the high use of seclusion and restraint, particularly those who were over-medicated and forgotten about in institutions. It is important to note that the Mental Health Commission has reported on the uneven use of seclusion and restraint across the country.

I would like to speak about this country's suicide statistics. It is difficult to get accurate statistics, for obvious reasons. Of the 486 people who are known to have died by suicide in 2010, some 386 were men and 100 were women. This 4:1 ratio is replicated in other parts of the world. It comes back to the question of stereotyping. The ideal man is supposed to be a strong individual who does not show his vulnerability and is able to solve his own problems. It is not seen as masculine or macho to share problems or discuss feelings. Male suicide has to be targeted. A Scottish campaign, Choose Life, which was run with the Scottish Football Association, reduced the male suicide rate by 15%. The slogan used in a campaign involving US war veterans, among whom asking for help is not considered to be very manly, is "it takes the courage and strength of a warrior to ask for help".

The cross-party group on mental health in the Oireachtas has introduced SafeTalk training for staff. I acknowledge the ASIST training that takes place. We have to delete paragraph (b) of section 59 of the Mental Health Act 2001. Under the current mental health laws, ECT can be used on a patient who is unwilling or unable to give consent as long as it is approved by two consultant psychiatrists. There are grave reservations about this because of the diverse evidence on it. It is used as a method of torture in certain countries.

We know about the disproportionate loss of staff in the mental health services. In our motion, we mention the need to continue the current nursing training, with particular skills being taught to those working with intellectual disability and to psychiatric nurses. We are aware that funding decreased from 13% of the health budget in 1986 to 5% of the budget in 2010. The target in A Vision for Change is 8.4%. The assistant director general of the World Health Organisation has made the point that Governments tend to spend most of their scarce mental health resources on long-term care in psychiatric hospitals. That is a worldwide phenomenon. This money needs to be invested at primary care level to reach more people and address the problems at an earlier stage. Prevention is vital and it goes back to more focus on, and more awareness of, our mental health. The home, school and society have a role to play. We must celebrate difference and not be afraid of it.

We must acknowledge the work of groups like the Samaritans, Bodywhys, Aware, Jigsaw, AA, NA and Headstrong. The Departments must also take on A Vision for Change, whether the Department of Jobs, Enterprise and Innovation, the Department of Social Protection, the Department of the Environment, Community and Local Government in regard to housing issues, the Department of Arts, Heritage and the Gaeltacht or the Department of Tourism, Culture and Sport.

People in prison, people who are homeless, people with addiction issues and refugees and asylum seekers all have very particular mental health issues. I was at something earlier at which the point was made that as the numbers in our psychiatric institutions go down, the numbers in our prisons go up. That is pretty frightening.

I acknowledge the amendment. I find Private Members' business frustrating because we are all on the same wavelength on this issue and I acknowledge what is in the amendment and the work of the Minister of State, Deputy Kathleen Lynch, and of the former Minister of State in the previous Government, John Moloney.

If I go into an accident and emergency department with a broken leg or chest pains, I might have to wait a few hours but I will be dealt with. Where do I go if I have a mental health issue? I could be waiting and waiting.

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