Mick Wallace (Wexford, Independent)

There seems to be a broad consensus that mental health provision deserves special attention and should not be neglected. The Minister's speech and that of the Minister of State, Deputy Kathleen Lynch, set out the Government's position quite clearly. The Minister of State observed:

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.

She went on to stress that mental health must become part of the primary care infrastructure. She stated:

Early intervention in a wrap-around system involving community, friends and low level counselling and psychology is what is required.

Both the Minister and the Minister of State spoke about the importance of changing social attitudes and behaviours and stressing that mental illness is not a lifelong condition. We all accept that society must learn to treat people with mental health problems as fully fledged members of society with a contribution to make, rather than seeing them as burdens. The burden of financial debt and, in many cases, unemployment is an additional strain on people. The current recession increases pressure on those already struggling with mental health problems and may lead to problems for people who did not previously experience difficulties with their mental health. Deprivation, poverty and unemployment are linked to mental health, and the economic problems the country is facing create a difficult situation for many people.

Barnardos has pointed out that despite the Government's commitment to continuing the strategy set out in A Vision for Change, its implementation has been slow and is likely to decline further. It points to recent reductions in mental health spending to just 5% of the overall health budget compared with an internationally recommended figure of 12%. Barnardos also observed that we still have cases where children are placed in adult psychiatric facilities at a vulnerable time in their young lives. I am sure the Minister will agree that is not a satisfactory situation.

There is broad agreement as to how we proceed from here in regard to mental health provision, but the challenge is to ensure the HSE succeeds in delivering community-based mental health care. The policy of moving to a community health care service has been around for a while, but successive Governments have done little to implement it. There must be an obligation on the HSE to deliver community health care services. Colm O'Gorman and Karol Balfe of Amnesty International Ireland have stated:

A progressive framework for mental health services is set out in A Vision for Change and this was widely endorsed and welcomed by stakeholders and people with mental health problems. Community mental health services can provide the specialised supports which mean that individuals with severe or chronic mental health problems can recover while living in their community. They also provide a wide range of supports that would not have been the case in traditional psychiatric hospitals. The Government should ensure that this policy is delivered by enacting legislation to ensure it happens. Legislation will demonstrate that we are serious about reform. It should require the health services to ensure a move from an over-reliance on inpatient care to comprehensive and community-based multidisciplinary services. The need for a new approach to accountability for implementation of A Vision for Change is clear. This can be achieved by: introducing a statutory obligation on the HSE to publish an appropriate implementation plan for A Vision for Change and to provide comprehensive and community-based mental health services in line with that plan to the maximum of available resources; and introducing statutory measures to require greater transparency and accountability from the HSE for expenditure on mental health through detailed annual reporting. The statutory obligation should stipulate the level of detail to be included in such a plan including measurable targets, milestones, outcomes and indicators as well as clear timeframes and details of the funding, human resources and infrastructure needed for implementation, and giving statutory powers to the Mental Health Commission to regulate, approve and inspect community mental health teams.

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