Colm Keaveney (Galway East, Fianna Fail) | Oireachtas source

Fianna Fáil remains deeply committed to the full implementation of A Vision for Change. It is the policy for the future of mental health services. I am, however, very concerned that progress on implementing A Vision for Change has been slowing down just when we most need a functioning mental health service. I deplore the fact that the programme for Government commitment of an annual ring-fenced €35 million fund for community health services was broken in budget 2014 when the funding was reduced to €20 million. Media reports the weekend after that budget indicated that just before the press conference to announce details of the health budget, the Minister of State at the Department of Health, with responsibility for mental health, Deputy Kathleen Lynch, complained bitterly and colourfully about being kept in the dark about the budget. The Minister said this funding will be restored in 2015. Can he confirm today that €50 million in funding will be provided in budget 2015 and ring-fenced?

This cut, and the deliberate policy of delaying hiring of critically important community health staff until close to the end of the calendar year has damaged the health of those who need us most. The recent annual report from the Mental Health Commission warns that the progress made over recent years in improving mental health services in Ireland is in danger of coming to a standstill. In the opinion of the chairman of the commission, Mr. John Saunders, "While some service providers are making progress toward providing a truly modern mental health care service there are many others that are struggling. There are many contributing factors including resource constraints". There is also an unwillingness on behalf of the Department to provide support. For instance, while more than 90% of approved centres comply fully in areas such as insurance, certificate of registration, hazard analysis and critical control point, HACCP, and health and safety requirements, only 60% are compliant with regulations relating to care plans and other staffing matters.

Mr. Saunders added, "There is potential to make more progress but the resource constraints and in some cases reluctance to change are making progress more difficult". This is critically important. A Vision for Change is being implemented unevenly and inconsistently across the country and there is a requirement on the Minister and the Department to be more innovative in their actions to support this, reinforced by strong corporate governance in the roll-out of a such an important national plan.

The emphasis on resource constraints is noteworthy, given that the Government cut its commitment by €15 million in last year's budget. The Mental Health Commission also expressed concern regarding a number of specific areas of service provision which impinge on human rights. In principle, for example, it is accepted that each user of mental health services is entitled to have an individualised care plan, designed to assist his or her recovery.

The commission estimates that just 60% of approved centres implement appropriate individualised care plans. The extent of the continued usage of seclusion and physical restraint is unacceptable. It is worth noting that of the nine conditions attached to each of the approved centres in 2013, four relate to non-compliance with care planning, two relate to the use of seclusion and restraint, one relates to transfer, one relates to staffing levels and one relates to unsuitable sleeping accommodation.

The presence of children in adult units remains a scandal. The Mental Health Commission report states that "in relation to younger service users, there is still a most unsatisfactory situation whereby children are being admitted to adult units". There were 91 children admitted to adult wards in the single calendar year of 2013. A themed report from the child and adolescent mental health services on the issue of the admission of children to adult units in 2013 was also published last week. The report highlights that A Vision for Change recommended that mental health inpatient services for children up to the age of 18 should be provided by dedicated adolescent mental health units. Despite this, some 91 admissions of children to adult units took place in 2013, with 60% of these children remaining in adult units for periods in excess of three days and 21% of them remaining there for more than ten days. When all notifications to the Mental Health Commission of child admissions to adult units were examined, it was found that in 64% of cases, such admissions were made on the basis that no child and adolescent mental health service beds were available on the date of the child's admission. However, an analysis of vacancies within child and adolescent mental health service units showed that there were significant vacancies in the various unit locations and administrative supports. It seems that on some occasions, children were admitted to adult units simply because there was no infrastructure for child and adolescent mental health services in the community.

Criticisms of the Minister and HSE management have been made by front-line staff and patient representatives in Roscommon, Galway, north Dublin and, most recently, Carlow, Kilkenny and south Tipperary. According to a HSE report released last weekend, mental health services in Roscommon and Galway are being run in accordance with an outdated model that is 30 years old. I want the Minister to be aware that when he makes a parallel with the Cavan model, he should look at the number of admissions relative to both of those administrative areas. An expert panel appointed by the HSE concluded that services in the west will operate under the new national planning guidelines for the future, with the out-of-date plan from 1984, which was agreed by front-line staff at the time, being shelved. The expert report into mental health services in the west describes an "astonishingly large" number of hostels, day centres, sheltered workshops and other supportive community structures. The experts suggest that such services have become the focus of all treatment. They are criticised as inflexible and expensive compared to using teams to treat people at home, as recommended by experts and dictated in A Vision for Change.

There is a huge willingness among the staff to whom I have spoken to address these problems and to move to the new model provided for in A Vision for Change. Their fear is that the community resources they currently have will simply not be transferred in conjunction with the move from the traditional system to the A Vision for Change system. The local experience of what has occurred since the closure of the state-of-the-art €3.2 million ligature-free unit at St. Brigid's Hospital in Ballinasloe has confirmed the worst of their fears. The unit in question was never opened. The promised community services in some parts of Galway and Roscommon have proven to be largely fictitious. Vulnerable people have been left to depend on a hopelessly inadequate, dilapidated and substandard psychiatric unit that is attached to the end of an acute unit. The people in question, who need help and support, have to admit themselves through an accident and emergency unit, which is a significant no-no. They have to go through an acute service to be triaged to a psychiatric unit at the other end of the campus.

We learned in June that a group of consultant psychiatrists in Carlow-Kilkenny have withdrawn their confidence in the clinical management of the mental health service there because they believe it is unsafe. Nine doctors wrote to the Minister of State with responsibility for mental health to express "serious concerns" about local services in light of nine fatalities that had tragically taken place in the local community. In a letter they sent to the Minister of State, Deputy Kathleen Lynch, last month, the doctors repeatedly questioned the safety of the governance of the service and said they felt "devalued" and "ignored" in their attempts to raise concerns about the HSE. As in Galway and Roscommon, the medical professionals who dared to speak out in Carlow-Kilkenny found themselves isolated, dismissed, ignored and ultimately ostracised. Those who criticise the Minister are regularly accused of acting in bad faith and wanting to go back to the institutional care model. They are subjected to intimidation by their managers. Their arguments are ultimately dismissed by the Minister.

I have experience of engaging with medical professionals who are deeply committed to securing the best outcomes for patients who are worried about the state of these services and the lack of resources. The Mental Health Commission has highlighted the need for ongoing independent monitoring of the A Vision for Change implementation body. The commission has said that since the dissolution of the second independent monitoring group in June 2012, there has been no independent monitoring of the implementation of any policy provided for within A Vision for Change. I have already called on the Minister to confirm that €15 million that is to be provided in budget 2015 will be ring-fenced. I am also calling on him to re-establish the independent group that monitors the implementation of A Vision for Change.

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