Kathleen Lynch (Cork North Central, Labour)

Approximately one in four of us will experience mental health problems in our lifetime. Above anything else, this tells us we must mind our mental health. The State has an obligation to its citizens to mind them and ensure, in as far as it is possible, they are enabled to attain the highest possible quality of life. The way in which mental health is treated is about how we live our lives.

The 2011 budget provided special consideration for the mental health and disability sectors and sought to ensure a reduction of 1.8% in the 2011 allocation for these sectors. This relatively low reduction, when compared with other sectors of health, recognised that mental health and disability services are provided to vulnerable groups. Approximately €920 million was provided for mental health services in 2011. Some 90% of public mental health services are provided at primary care level and expenditure on these services is not captured in the €920 million figure.

An earlier contributor referred to the lack of access to primary health care services. If one has emotional difficulties or one's mental health is not as it should be, this should not preclude one from accessing normal health services. Mental health services and the teams required must become part of the primary care infrastructure. The interconnectedness we are trying to introduce in the health service will be very important. If one visits one's general practitioner because one is having a mental health or emotional difficulty, the GP's first port of call should not be an acute unit or a prescription but a referral to the counsellor or psychiatric nurse working in the adjacent room. The psychiatrist is the last person one needs to see. While psychiatrists are extraordinary people, they only need to treat about 5% of the population. Early intervention in a wrap-around system involving community, friends and low level counselling and psychology is what is required.

The Department has requested the Health Service Executive to prepare an implementation plan which will identify specific areas of A Vision for Change and reach-out that can be progressed over the next three years, with timelines, detailed cost structures and identifiable persons responsible for driving the change. Until now, we knew what we had to do and where it needed to be done. Deputies are correct that services are patchy, with excellent services available in some areas and no services available in others. We must identify needs and who is responsible for delivering on them. The difficulty until now has been identifying who is responsible for driving change.

There are 61 child and 124 adult community mental health teams working throughout the country, not all of which are fully staffed. These constitute the backbone of our A Vision for Change project. Each team must have representation from a number of core areas, including psychiatry, psychology, social work, occupational and other therapy and mental health nursing. It is intended that the HSE implementation plan will include a strategy for restoring the multidisciplinary composition of the community teams to appropriate levels to deliver the required services in their respective areas.

A Vision for Change provides detail on what is needed and what population will be dealt with. John McCarthy, whom I met last night, is correct that one size does not fit all. Some people will need six sessions of treatment, while others may need services for two years. However, everyone must realise that recovery is possible. Above all else, the notion that a mental health problem is a lifelong condition must be dispensed with because it is not true. I meet people daily who have recovered and made enormous progress in their lives.

Excessive prescribing occurs across the health system. One of the problems in the mental health system is that prescriptions are sometimes not reviewed for as long as ten years. In some cases, the effects of medication become so embedded that they are greater than the effects of the condition the medication is supposed to treat. We must do something about this problem.

The national stigma reduction campaign, See Change, was launched in April 2010 and continues this year with the aim of positively changing social attitudes and behaviour, inspiring people to challenge their beliefs about mental illness and be more open in their attitude and behaviour, and encouraging people in distress to seek help. Deputy Maureen O'Sullivan is correct. Which one of us would have the courage to state that he or she had a breakdown at 16 years and does not remember anything about the following four years? We know what would be the reaction of others. People who have emotional distress or mental health issues are not foolish. They know exactly what the reaction will be, and we have got to stop that. See Change, Make a Ripple and Reach Out are useful in respect of the technological advances we can make for young people. These people are the key. Most mental illness occurs in adolescence. That is when it first presents. Where are those people? They are online. They are looking to new technologies and Reach Out and Make a Ripple are the areas where we will find those people and connect to them. We have to be careful because the Internet sometimes is not a safe place. We must ensure that those programmes are safe and monitored, but it is there that we will reach our young people. Jigsaw and Headstrong also represent all the things we need.

Even though we are in a deep dark hole with the IMF and have no funding, we managed last week for the first time in years to pull the Central Mental Hospital across the line. The Central Mental Hospital will not just be one building. It will consist of three units. The first is the Central Mental Hospital itself. The second will be a specific ten bed unit for people with intellectual disability who have difficulties and who we are sending abroad because we cannot manage them. We will also have a child and adolescent unit, which will deal with children who we are again sending abroad because we cannot manage. There will be four regional centres, where people currently in the Central Mental Hospital can be managed nearer their own homes.

We have people in jail who have severe mental illness and who should be in a more appropriate setting, and we cannot take them out because we do not have the room. In all of this awfulness to do with the lack of resources, the Government has recognised that this is a key part of the puzzle if we are to solve it. We are going to solve it and the money has been set aside for it. We are making progress with the €35 million per annum for three years promised in the programme for Government. It is all about the multidisciplinary teams.

The moratorium disproportionately affects the psychiatric services for a very good reason. People who work in the psychiatric services are, on average, older than people in the rest of the health service and they can retire earlier. With the tough job they do and with the service they provide, who can blame them for taking that opportunity? I know I cannot blame them. In order to put A Vision for Change in place, we will need an additional 450 posts and we need to breach the moratorium to do that. The last Government breached the moratorium on two separate occasions for psychiatric nursing posts and it should be commended for that. If we keep saying that we are going to do things differently, then we have to appreciate what has gone before as well. That Government did breach the moratorium and we will do so as well. The 450 posts will not be put in place over one year, because the people we need probably are not available in that one year and they have other commitments, but it will be over a three year period.

We need to be very serious about what we do for psychiatric services, our emotional well being and our mental health. I do not think that there is any disagreement on this. I acknowledge fully that the Opposition is as committed to this programme as the Government. The contributions tonight prove that more than anything else. However, I am conscious of the need to keep pushing, not to allow it to slide off the agenda as it has in the past. Some day, if I can present to Barry Desmond a combined version of Planning for the Future and A Vision for Change, I will be very happy. I commend the amendment to the motion.

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