Stephen Donnelly (Wicklow, Independent)

I am not an expert on mental health so in preparation for the motion, I spoke to mental health professionals on the medical side, the clinical therapeutic side and the complementary therapy side. I also spoke to people involved in community-based care and in hospital-based care and I have had input from constituents in Wicklow, both from those involved in community-based provision and those who have had experience of mental health service provision over the years.

Broadly speaking, I have heard four things from all groups which are very much reflected in the programme for Government and in many of the things I have heard. First, mental health services in Ireland do not receive the attention and resources they need and deserve. Second, the approach to mental health in Ireland to date has been overly focused on medical treatment and in spite of some great local successes, service provision has not advanced as quickly as it needs to and should have by now. Third, the existing service provision is highly variable and the level of service provision for mental health depends to a huge degree on where one happens to live in the country. Fourth, there are steps which this new Government can take immediately to have a real, significant and quick impact on the provision of mental health services and outcomes across the country.

I would like to speak to those four points. In terms of funding and staffing, it was shocking to find that funding for mental health as a percentage of the total health budget has fallen from 13% in 1986 to 5% in 2010. The recommendation in A Vision for Change is 8.4%. It was truly shocking to see this massive fall off in funding for mental health at a time when, globally, awareness and funding were increasing. Good quality mental health provision is more personnel intensive than many areas but it is massively under-resourced. The figures for community mental health teams really shocked me. I found that adult teams have 50% of the required psychologists, 50% of the required occupational therapists and just 60% of the required social workers. Even worse, the child and adolescent teams have just 41% of the staffing recommended in A Vision for Change. It is absolutely appalling that they must try to provide this service with just 41% of the staffing recommended.

Similarly, we see that mental health services are suffering more from the hiring embargo than other areas. We know that mental represents 9% of the HSE workforce but accounts for 20% of posts lost in the HSE in 2010. There is something very wrong there which might provide a real opportunity for the new Government.

The approach to mental health focuses far too much on medical treatment and service provision is not advancing as well as it should. I do not know about mental health but I have been involved in health care configuration and what I have found is that the principles are exactly the same for modern mental health care. One invests in promotion and prevention and one provides medical, therapeutic and complementary treatments and care in the community wherever possible. One really only brings people into acute hospital care when it is absolutely necessary and right for them, which is something we are not seeing. Certainly, the professionals to whom I spoke said that is not standard in Ireland.

What I found is that in mental health, in particular, increased promotion and prevention and early detection and intervention are critical for our youth population. Some 50% of adults diagnosed with a mental disorder may have developed that disorder by the age of 14, and 75% of those who are diagnosed will have developed that disorder by the age of 24, so it is not like general health which works the other way in that a vast proportion of the intervention comes in older age. What I have heard consistently is that this focus on and intervention in the youth population is not happening as much as in general medicine but here it is like not helping older people in general medicine. It is a huge challenge and opportunity for the new Government.

A Vision for Change was completed in 2006. It was a collaborative process. The medical community seems en masse to have contributed to and bought into it. What I have learned is that many of the medical professionals who contributed to it feel very let down by the lack of implementation. I read that the independent monitoring group reported that it was alarmed and concerned at the complete lack of progress in the psychiatry of old age, intellectual disability, liaison psychiatry, eating disorders, recovery and rehabilitation, comorbid substance abuse, mental illness and so on. Clearly, there are major concerns in terms of the lack of implementation.

We have had some great successes. We have Headstrong which targets youth. I commend the Minister of State on the recent €3 million in funding given to Headstrong. We have seen its Jigsaw programme in a small number of areas begin to reach out, raise awareness and engage in promotion. I understand it lacks clinical therapeutic services, which might be something at which to look. We have the DETECT programme based in Blackrock which targets the adult population. It serves south County Dublin and my constituency of Wicklow. What I like about it is that it has four pillars, namely, mental intervention if necessary, cognitive behavioural therapies, occupational therapy and what I thought was really nice, family education. It does not just target the service user but surrounds them with education and awareness. My understanding is that, unfortunately, it is the only service of its type in the country.

The tunnel project, which has been set up in my constituency of Wicklow, is another example of a wonderful initiative. It is a horticulture-based project which, to date, has provided meaningful occupational therapy to 40 service users. It targets mental health and has the secondary benefit of physical health. There is a lot of small scale success which I hope the Government will look to increase.

The figures in regard to service provision and geography were staggering in terms of the level of inequality. The 2010 Mental Health Commission report shows huge variations in the staffing targets being met and in the per capita spend for the super catchment areas. For example, Carlow-Kilkenny has reached 96% of its staffing targets under A Vision for Change but south Dublin and Wicklow have only reached 50% of the target which is the lowest in the country. Similarly, Dublin north shows a per capita spend on mental health of €268 while Galway west receives just €96. There is extraordinary inequality in the system.

While I am on the subject and as a representative for Wicklow and east Carlow, I note for the Minister of State that my constituency regularly comes in at the bottom or close to it in terms of hospice and acute care. I have been quite shocked by the fact that it comes very close to the bottom in many areas.

What can we do? I acknowledge the Government's commitment to this in the programme for Government and in recent activity such as giving Headstrong some badly needed funding to scale up its activities. What are the issues? The issues are that there is very little money for anything at the moment, the extraordinarily slow progress in implementing A Vision for Change and the huge inequality.

I would like to suggest a few ideas to the Minister of State. First, we must move from 5% of the total health budget given over to mental health services to 8.4%, as recommended in A Vision for Change. Such an increase, nearly 50%, would be very welcome. I support the Minister's commitment to ring-fence €35 million annually for the provision of community mental health teams. I call on the Government, however, to fulfil immediately the staffing targets as set out in A Vision for Change or at least put in place a clear plan with targets and timelines on how they can be achieved. It is obvious we are miles behind in this regard.

Will the Government provide adequate capital funding for the continued closure of the old psychiatric hospitals and the transfer of those service users to community-based programmes and accommodation? Investment must also be made in ensuring community-based care is located in appropriate facilities. I understand many of the new facilities are dilapidated church halls and so forth, inappropriate for anyone using a health system. Many of them do not have general health facilities which means blood pressure tests and various other scans cannot be carried out, many of which are necessary for mental health patients on particular medications.

The national roll-out of early intervention for psychosis services, such as DETECT and other holistic programmes, would be very welcome. I would also welcome staff training for medical staff in emergency and accident departments and GP practices who could triage, increase awareness, intervene in cases of alcohol dependency and so forth. Will the Minister of State ensure those with mental health difficulties have access to general medicine which they currently do not?

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