Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein) | Oireachtas source

I move:

"That Dáil Éireann: notes that:

— mental health is an issue of vital concern to the nation in general and should be of special concern to policy-makers and legislators in particular;

— mental health services must be designed and delivered to aid the recovery of the individual;

— a person-centred approach is vital to the achievement of the best results; and

— the 2013 Annual Report of the Mental Health Commission, published on 25th June, 2014, has highlighted many of the key issues and requirements for action by Government; affirms:

— its continuing commitment to the implementation in full of A Vision for Change;

— its commendation of the work of the Mental Health Commission;

— its support for the work of the National Office for Suicide Prevention;

— its appreciation of those non-Governmental organisations, national, regional and local who actively promote positive mental health and seek to reduce the incidence of suicide and self-harm;

— its commitment to eliminate the stigma in relation to mental illness; and

— that the mental health of each citizen and of the nation as a whole is a positive resource that contributes to our general social, cultural and economic well-being; and calls on the Government to:

— ensure a consistent high standard of care and support for all requiring access to mental health services;

— provide for independent monitoring of the roll-out and progress towards full implementation of A Vision for Change;

— commit to an annual allocation of €35 million for the development of community mental health teams and to make good any shortfall in any given year in the subsequent year's allocation;

— properly resource mental health services across the board, including the provision of appropriate and adequate staffing and with a key focus always on recovery;

— promote awareness of the unacceptability of certain practices and continue to discourage their use e.g. the application of electroconvulsive therapy on detained persons against their will;

— end the practice of admitting children to adult psychiatric units;

— progress relevant legislative undertakings including completing the ongoing review of the Mental Health Act 2001 and to bring the Assisted Decision-Making (Capacity) Bill 2013 through Committee and remaining stages;

— require the Health Research Board to again carry out a national survey of psychological well-being and distress, last carried out in 2005-2006, and to continue to conduct such a survey at regular two or three yearly intervals;

— ensure a cross-Departmental response to the risk of suicide and self-harm, including from the Departments of Health, Education and Skills, Children and Youth Affairs and Environment, Community and Local Government;

— provide the necessary resources to establish and sustain a 24/7 crisis support service for people experiencing severe mental or emotional distress, to operate in conjunction with the local Community Mental Health Teams;

— arrange for greater co-ordination of all existing suicide prevention initiatives across all sectors and groups working in the area;

— ensure the prioritisation of address of the mental health needs of marginalised communities;

— guarantee that the new National Strategic Framework for Suicide Prevention will place mental health awareness among children and young people at the top of its programme; and

— provide an appropriate accessible alternative to general Accident and Emergency department presentation to victims of self-harm."

Molaim an rún ar son Teachtaí Dála Shinn Féin, rún tábhachtach atá dírithe ar sláinte intinne agus tá sé mar aidhm aige an Rialtas, an tOireachtas agus an pobal i gcoitinne a spreagadh chun go mbeidh sláinte intinne mar fhíor-thosaíocht againn.

We in Sinn Féin have chosen to return to the theme of mental health and suicide prevention for our final Private Members' time debate in advance of the Dáil summer recess. We think it is vital to focus again on these fundamental aspects of public health in Ireland. These issues are of vital concern to the nation in general and should be of special concern to us as policy-makers and legislators.

The motion is timely in that it comes immediately in the wake of the latest annual report of the Mental Health Commission. Some of the findings of the report are alarming. The report of the Mental Health Commission shows that only 44% of psychiatric hospitals and mental health facilities are compliant with staffing level regulations. The report also makes clear that since 2007, staffing in mental health services has been reduced by the implementation of recruitment embargoes and employment moratoriums.

The authors of the report pull no punches when they state that such policies are endangering the delivery of confident and responsive community-based services as envisaged in A Vision for Change, the Government's mental health strategy. It is also of huge concern that the commission reports that children are still being admitted to adult units. There were 91 such admissions in 2013, which represented 22.3% of all child admissions that year. These are some of the highlights of the report to which I will return in a moment.

In most cases motions such as this, tabled in Opposition Private Members' Time, come in the form of indictments of Government failures, and in most, cases, deservedly so. There is more than ample material to take such an approach. However, in this case we have taken a different approach, recognising where progress has been made and encouraging, prompting and pushing for improvement and progress at all times. This is the outlook of the Oireachtas all-party mental health group and one we are continuing in this debate.

It was all the more disappointing therefore to find this afternoon that the Government had decided to table an amendment to this motion. It is my earnest wish that we not only continue but that we build on the spirit of interparty co-operation and working together on these issues, and I will therefore proceed with the all-party approach that I have intended from the outset. I appeal to all Deputies to support our motion as tabled. I also appeal to the Minister of State, Deputy White, on behalf of his colleague, the Minister of State with responsibility for mental health, Deputy Kathleen Lynch, to whom I send good wishes this evening as she is hospitalised and will not be able to participate or attend over these days. We will identify both the positives and the negatives, and endeavour to be constructive.

Fundamental change in the care of mental illness has been undertaken. Guided by A Vision for Change, it is a very significant, but, regrettably to date, a long-term project. It requires maximum support to ensure that it proceeds apace and that it is not allowed to stall as has happened too often in recent years. That is very much the purpose of this motion and this debate. It is to give a further push to a stalled process and to refocus on the needs and rights of those who use our mental health services.

The Mental Health Commission report acknowledges that there have been "significant improvements in many areas of patient care" since the passage of the Mental Health Act 2001 and the subsequent establishment of the commission. It is positive that, as the commission states, there is considerable commitment to the policy of A Vision for Change. However, the reality is also that the policy is being implemented unevenly and inconsistently across the country, and the commission identifies the requirement for innovative actions to be supported and reinforced by strong corporate governance at national level. This requirement hopefully will be fully addressed following the welcome appointment in 2013 of the director of mental health services and the creation of the national mental health service management team.

As our motion states there needs to be independent monitoring of the roll-out and progress towards full implementation of A Vision for Change. Regarding the focus on recovery there are two sides to the coin. The commission finds that the concept of recovery, where services are designed to assist in a person's recovery rather than to manage his or her illness, is now well understood. It welcomes the continuing development of the systematic initiative "Advancing Recovery in Ireland" by the HSE.

It is also the case, however, that implementation is uneven. The report points to "a serious deficiency in the development and provision of recovery-oriented mental health services". It identifies the absence of psychology, social work, occupational and other multidisciplinary team members. It calls for a change in attitudes and behaviours and for training in recovery competencies.

As our motion states, mental health services must be designed and delivered to aid the recovery of the individual and a person-centred approach is vital to the achievement of the best results. It is people who deliver mental health services. Visions, plans, systems are nothing without dedicated trained personnel to implement them. Adequate staffing is the biggest deficit in our mental health services.

To recognise the positives first, it is positive that 652 staff have been appointed in community mental health teams in the past two years. As the NGO, Mental Health Reform, states, this has the potential to transform the type of mental health care people receive to a more holistic approach, since the new appointments are resulting in more input from a range of disciplines including psychology, social work and occupational therapy. However, as the Mental Health Commission reports, the input of the latter professionals is still too limited. The commission's findings on staff levels and the adverse effects of the recruitment embargo is the most worrying aspect of its report. I have already noted its finding that only 44% of psychiatric hospitals and mental health facilities are compliant with staffing level regulations. It goes further and states:

Since 2007, staffing in mental health services has been reduced by the implementation of recruitment embargoes and employment moratoriums... The medium and long term effect of such policies is to endanger the delivery of confident and responsive community-based services as envisaged in A Vision for Change.

At the end of December 2013 the overall staffing level for community mental health teams was still about 25% less than recommended in A Vision for Change.

Unquestionably, this points to the need for continued and enhanced investment. I cannot emphasise enough the importance of that part of the motion which addresses staffing. Sinn Féin calls on the Government to commit to an annual allocation of €35 million for the development of community mental health teams, to make good in the subsequent year’s allocation any shortfall in any given year and to resource mental health services properly across the board, including the provision of appropriate and adequate staffing and with a key focus always on recovery. This is the outcome all Members seek and they must have a shared determination in this Oireachtas to achieve it.

I will now address some other key elements of the motion. The Government must promote awareness of the unacceptability of certain practices and must continue to discourage their use. The prime example is the application of electroconvulsive therapy, ECT, on detained persons against their will. The Mental Health Commission report expresses continuing concern at this practice. In 2011, a code of practice under the Mental Health Act 2001 came into effect and stated “no child under 18 years is to be admitted to an adult unit in an approved centre from 1^stDecember 2011”. Although this was only to be breached in exceptional circumstances, in 2013 there were 91 such admissions. While this was a decrease on 2012, it is still not acceptable and the practice needs to end. Relevant legislative undertakings should be progressed, including completing the ongoing review of the Mental Health Act 2001 and to bring the Assisted Decision-Making (Capacity) Bill 2013 through Committee and Remaining Stages. The last survey of psychological well-being and distress was carried out in 2005 and 2006 and Sinn Féin believes it is time for the Health Research Board to carry out another such survey and to proceed to do the same at regular two or three yearly intervals.

All Members are conscious of the continuing toll of suicide and self-harm, especially but by no means exclusively among young people. The work of the National Office for Suicide Prevention is to be highly commended. Members need to ensure a cross-departmental response to the risk of suicide and self-harm, including from the Departments of Health, Education and Skills, Children and Youth Affairs and the Environment, Community and Local Government. It is crucial that a 24-7 crisis support service for people experiencing severe mental or emotional distress is put in place and is properly resourced and sustained. It frankly is an insult to expect that such emergency support can be provided on an office hours or even part-time basis.

The following quotes from public meetings organised by Mental Health Reform speak for themselves. They are the views and the expressed opinion of service users in this respect. The first is, "We need a system to bypass A&E ... Admissions in A&E are not working - it comes up time and time again - waiting around". Another user stated "Last time I was in A&E I was there for hours and started getting paranoid that people were talking about me". A third stated:

They need to change the environment [of accident and emergency] to make it more friendly for people in distress. All it does is compound their difficulties.

The final quote is, "When you are sick with a mental health difficulty, you can’t wait until 8 or 9 in the morning for a doctor to show up or for a certain place to open". An alternative to general accident and emergency presentation for those who self-harm and a 24-7 crisis support service in conjunction with local community mental health teams are what is required, in line with A Vision for Change. There also must be greater co-ordination of all existing suicide prevention initiatives across all sectors and groups working in the area.

Marginalised communities often have more acute and more particular mental health needs. Indeed, the treatment of some sectors of society by this State is undoubtedly damaging the mental health of many individuals. I need only cite the disgraceful conditions - the Minister of State has heard this issue referred to in this Chamber many times - in which people are detained in so-called direct provision centres. This, I believe, is creating a legacy of mental and physical illness, especially for the children held in these centres, in some instances for many years. The Government must guarantee that the new national strategic framework for suicide prevention will place mental health awareness among children and young people at the top of its programme.

I pay tribute to the work of Mental Health Reform, which has been of invaluable support to the Oireachtas cross-party mental health group. I thank in particular Dr. Shari McDaid and Ms Lara Kelly. I also acknowledge the work of Amnesty International, which previously provided secretarial support to the cross-party group. I also pay tribute to my colleague Members of the aforementioned all-party group. Each party participates in common pursuit of good outcomes and improved services right across this area. Sinn Féin's motion also commends the work of the Mental Health Commission, the National Office for Suicide Prevention and those non-governmental organisations, national, regional and local, that actively promote positive mental health and seek to reduce the incidence of suicide and self-harm. The funding supports of those organisations need to be restored at the very least. The reduction in core funding year on year since 2009 has placed serious pressure on their work, while demand on their services certainly is increasing. At this point, I will take the opportunity to acknowledge the presence in the Gallery of a small number of people from those organisations. I believe Members will be joined by an even larger body in the course of the debate tomorrow evening.

Much has been done in recent years to educate our society about mental health. Tribute should be paid above all to those who have experienced mental illness and who have used that experience to help right the wrongs in a society which for decades stigmatised, criminalised and institutionalised those with mental illness. Hopefully, those attitudes and practices have receded into the past. However, much more remains to be done. We must see the mental health of each citizen and of the nation as a whole as a positive resource that contributes to our general social, cultural and economic well-being.

I will conclude by quoting from the World Health Organization, which in 2007 stated:

Mental health is an indivisible part of public health and significantly affects countries and their human, social and economic capital. Mental health is not merely the absence of mental disorders or symptoms but also a resource supporting overall well-being and productivity. Positive mental health is a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and can contribute to his or her community.

In my last few words, I wish to express my hope that in the course of the Minister of State's contribution this evening, he will signal that Members will conclude this debate tomorrow night with one voice, una voce, on this most important issue and that Members can collectively and unanimously endorse the motion as tabled.

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