John Halligan (Waterford, Independent)

I wish to share time with Deputies Daly, Boyd Barrett, Catherine Murphy, Joan Collins and Tom Fleming.

Two years ago, when I was Mayor of Waterford city, a huge conference took place on the subject of taking the stigma out of mental health, which was attended by about 500 people from all parts of Ireland. There were some stunning statistics, which have been alluded to over the course of today's and last night's debate, regarding the number of people who have presented with mental health problems in Ireland - between 350,000 and 400,000. There is also an unknown number who do not present themselves for treatment. I acknowledge that this has already been brought to the attention of the Dáil by a number of people.

Tonight I want to concentrate on the latest report from the independent monitoring group for A Vision for Change, which criticised, among other things, a disappointing lack of progress in specialist services for substance abuse problems. These services, according to the IMG, have not received the priority and urgent attention they require. The group mentioned the importance of dual diagnosis in the effective treatment of addiction, which cannot be overstated, because at least half of people with addiction problems have coinciding mental health problems which often go undiagnosed and untreated.

What I and the IMG cannot understand is why, given the commitment in the programme for Government to ring-fence €35 million annually from within the health budget to develop community mental health teams and services, we still have no community-based mental health service similar to the community-based drugs initiatives, CBDIs, which cater for those with addiction issues. CBDI workers are not psychologists or psychiatrists; they are not trained or equipped to deal with the complexity of mental health issues. Yet, at the moment, 50% of those who present to the service with addiction concerns also have mental health problems, so it does not make sense that we do not have a similar community-based initiative for mental health problems. This is what is urgently required: community-based mental health services that work in tandem with the local drugs projects to offer people access to psychological and social services for mental health treatment, not just biological and medical interventions.

Not only are community mental health services more accessible to people living with severe mental disabilities, they are also more effective in taking care of their needs compared with mental hospitals, as has been stated by many previous speakers. The strengths of CBDIs are that they are community-based, community-driven, and less sterile than a hospital environment. They are informal yet confidential and they offer a holistic approach. Taking all this into consideration, the Government should rethink its strategy on community-based programmes. It is also important that people can go through the service at a first point of contact and then be referred, if required, back to the community service for support. This would remove the stigma, as has been mentioned by many people, that is associated with attending psychiatric treatment wards. Furthermore, psychiatric wards are not always the correct environment for those with mental health issues, as it may not be appropriate for them to mix, for example, with those who are going through the detoxification process. What CBDI workers are telling me is that because of the lack of mental health services within the community, a significant number of people with mental health issues are using illegal drugs to self-medicate. That is something the Government should examine.

Unfortunately, I do not have enough time to address a number of other issues. As a member of Amnesty International, I thank that organisation for highlighting many mental health issues in Ireland over the last number of years. I also want to pay tribute to the Minister of State, Deputy Kathleen Lynch, who I know from personal conversations is determined to push forward projects in the area of mental health. However, I am disappointed, based on the report from the monitoring group of A Vision for Change, that we have not established community-based programmes on the ground similar to the drugs initiatives.

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