Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)

In the earlier part of my contribution last night, I referred to recent decisions which do not augur well for the delivery of mental health care in this State. The Health Service Executive, HSE, is now charging mental health patients in the greater Dublin area for their medication which, up to now, was free of charge. Under a scheme which was initially established by the former Eastern Health Board, all mental health patients received free psychiatric medication, including both medical card and non-medical card patients. This has now ceased with non-medical card patients paying full costs up to the drugs payment scheme threshold of €120 per month.

As I have stated before, this is a backward step and the Minister for Health, Deputy Reilly, should intervene to reverse it. It is an anomaly that such a scheme would apply to just one region in the State. Patients, however, should not simply be cut off in this summary fashion, in some cases after many years of dependence on this scheme. Many may go without essential medication as a result. My colleagues in Sinn Féin and I have been contacted by extremely concerned people directly affected by this. I am sure other Members, across all parties, have been contacted also. The scheme should remain in place pending a thorough review of supports for mental health patients across the State.

In reply to a parliamentary question from me on this matter, the Minister of State at the Department of Health, Deputy Shortall, stated in 2009 the HSE decided to bring the arrangements for the supply of medicines to patients attending mental health outpatient clinics in the greater Dublin area into line with those operating in the rest of the country. While this may be the case, it came as a bolt from the blue to those in the Dublin and mid-Leinster area who lost access to this scheme from 1 November 2011. They were simply not prepared for it.

The Minister of State also stated in her reply that people affected by these changes who cannot, without undue hardship, arrange for the provision of medical services for themselves and their dependants may be entitled to a medical card. In the assessment process, the HSE will take into account medical costs incurred by an individual or a family, including the cost of medication.

This is no different from their entitlement in any case. If the Government will not reverse this change, will it at least, when assessing people's eligibility for a medical card, take into account the nature of their illness and the fact that, having benefited from a scheme in some cases for year, they are now forced back on their own resources?

In December 2009, I asked the then Minister for Health and Children, Mary Harney, what measures would be undertaken to ensure the roll-out of A Vision for Change. It is interesting to compare the answer given then with the proposed amendment to this motion in the name of the Minister for Health, Deputy Reilly. The previous Minister stated the HSE mental health capital programme would be funded from the proceeds of sales of former psychiatric institutions. At that time, the proceeds of those sales amounted to €42 million according to the Minister. Perhaps the Minister of State responding could indicate the current figure and if all of the proceeds will be ring-fenced for community-based facilities. It is not clear if that is the case from the Government's amendment.

Last night, the Minister of State, Deputy Kathleen Lynch, stated there are 61 child and 124 adult community mental health teams working across the State, not all of which are fully staffed, which constitute the backbone of A Vision for Change project. If they are not fully staffed, they are then not fully working. The Minister of State said each team must have representation from several core areas including psychiatry, psychology, social work, occupational and other therapy and mental health nursing. She intends 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.

I welcome this statement as well as her stated intention last night that the recruitment moratorium will be breached to provide an additional 450 posts to implement A Vision for Change. I hope the Minister for Finance and the Minister for Public Expenditure and Reform have signed off on this.

I agree with the June 2011 TASC report, Eliminating Health Inequalities, which stated that while the programme for Government brings a much-needed renewed focus on mental health, the ring fencing of €35 million annually will do little more than extend existing pilot initiatives or support new initiatives on a pilot basis. Sinn Féin has set out a more ambitious programme which includes developing health services on an all-Ireland basis, progressing from increased co-operation to integration of services on the island; improving accountability and transparency in planning and financing mental health service reform; modernising mental health legislation in line with the UN Convention on the Rights of Persons with Disabilities; promoting cross-departmental action to combat social exclusion, prejudice and discrimination against people with mental health problems; ring-fencing 12% of the annual Department of Health budget for mental health services in line with World Health Organisation recommendations; developing and promoting suicide prevention strategies; and ensuring provision of required child and adolescent community-based mental health services and ending the wholly inappropriate placement of children in adult inpatient facilities.

The reference to asylum seekers and refugees in the motion is welcome. Research carried out by consultant psychiatrists Dr. Niall Crumlish and Dr. Pat Bracken, presented last year to the Oireachtas Joint Committee on Health and Children, demonstrated alarmingly high levels of mental ill-health among persons seeking asylum. Some of this can be traced to the inhumane treatment they receive during the asylum process. Comprehensive reform of this system must be a central element of any effort to improve the mental health of this vulnerable population.

I support the demand for change to section 59 of the 2001 Mental Health Act. This proposes to ban the use of electroconvulsive therapy, ECT, on patients without their consent. It is not acceptable this highly controversial and medically questionable procedure which impinges fundamentally on patents' rights should be imposed on patients without their consent but on the say-so of two psychiatrists. Many people have been damaged by the use of these procedures in the past. They emanate from a time when people with mental illness were treated like criminals and subject to incarceration, often in horrific conditions, and to medical experimentation. Care of people with mental illness has been transformed for the better but these procedures remain. It is long past time to deal with this issue. ECT is among the issues addressed very comprehensively by Amnesty International in its review of the Mental Health Act 2001. I commend Amnesty's recommendations to the Government.

The Government itself in its programme for Government made a commitment to review the Mental Health Act 2001 in consultation with service-users, carers and other stakeholders and to introduce a mental capacity Bill in line with the UN Convention on the Rights of Persons with Disabilities. Those commitments are welcome. It is our responsibility to ensure they are delivered upon.

The closure of St. Brigid's Home, Crooksling, Brittas, County Dublin, will affect 89 patients with various degrees of dementia, 67 of whom are high dependency. While it has been signalled that Hollybrook community nursing unit, Inchicore, and other sites will take a number of these patients, many are still uncertain of their futures, which is a real concern to them and their families. The Minister of State, Deputy Kathleen Lynch, gave an undertaking that she would facilitate a meeting with HSE and departmental decision-makers for representatives of the residents at Crooksling. This still has not happened weeks after the Minister of State gave her commitment in the House. Will the Minister of State, Deputy Sherlock, raise this matter with his colleague, the Minister of State, Deputy Kathleen Lynch, who I know to be a sincere voice in this House, to come back to me on this eagerly sought meeting?

I urge the Government to withdraw its amendment and to support the motion as tabled by Deputy Maureen O'Sullivan and the Independent Members of the Technical Group.

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