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

Gabhaim buíochas le gach Teachta a ghlac páirt sa díospóireacht seo. Tá súil agam go leanfaimid ar aghaidh tar éis na díospóireachta ag obair le chéile agus ag cur sláinte intinne chun cinn sa tír seo.

I thank all the Deputies who have taken part in the debate last night and tonight. I acknowledge also all the groups and individuals who have had an input into the debate, in terms of informing the construction of the motion itself, the contributions we have heard over both evenings, and also the attendance in the Visitors Gallery last night and tonight and the ongoing work of so many of those present with us this evening on the issues of mental health and suicide prevention. I record our thanks to each of them.

I very much welcome the decision of the Minister for Health and the Ministers of State, Deputy Alex White and Deputy Kathleen Lynch, not to proceed with the Government amendment and to accept our motion as tabled. That is a good development. Where consensus can be reached in the Dáil it should be achieved. It is very appropriate that on these issues of mental health and suicide prevention we have achieved consensus over these two evenings.

The basis of the cross-party consensus on mental health is support for A Vision for Change, its principles and its implementation. The Minister in his contribution last night reaffirmed the Government's commitment to that plan and to reform of our mental health services. Of course, that commitment carries no weight unless it is backed up with sufficient resources. In that regard I recommend that the Minister for Finance and the Minister for Public Expenditure and Reform should read the report of this debate and, especially, that they should read the agreed motion carefully. The Minister stated last night that implementation of A Vision for Change has been affected by a number of factors, including constraints in public spending and the moratorium on recruitment. That should be noted by the Cabinet colleagues of the Minister for Health, regardless of who the Minister may be after the reshuffle next week. More resources must be made available and the recruitment embargo must be lifted if A Vision for Change is to be implemented and if existing services in this and other areas of health care are to be maintained, let alone expanded.

The Minister pointed out that the promised €35 million for development of mental health services was delivered in 2012. However, it must be pointed out that in that year the funding was not all used for mental health services. There is a significant question over how much was spent on the area, if at all. The same sum was made available again in 2013 but in 2014 the figure has been reduced to €20 million. The Mental Health Commission in its 2013 report has noted the ministerial commitment to the reinstatement in 2015 of the expected €15 million not forthcoming in 2014. Although the Minister did not restate it last night, I trust that commitment stands. I say to the Minister of State, Deputy White, that we will certainly hold the Government to that commitment.

Much progress has been made in recent years but, as I stated in proposing this motion last night, much, much more remains to be done. The recruitment achieved thus far is welcome but, as was clear from the Minister's outline of the figures and timelines last night, the process is far too slow and every effort needs to be made to accelerate it. An important element of the motion, which I highlighted in my earlier contribution, is to provide an appropriate accessible alternative to general accident and emergency presentation to victims of self-harm. The experience of many people in mental distress in accident and emergency departments is totally unacceptable. The Minister stated last night that if by "appropriate" we mean there is no physical or medical risk, we are on the same page. That is the correct interpretation and, I would add that we mean also that an alternative should be available where and when appropriate. Alternatives must be in place.

We cited the various reactions of people to mental health issues and reform in advance of this debate.

People in accident and emergency departments can be in grave mental distress and this cannot be ignored. It should be added also that this must be seen in the context of the pressing need to address the chronic overcrowding and excessive waiting times in hospital accident and emergency departments that so adversely affect all patients and not only those in distress. Eliminating that scandal must be a Government priority too.

I want to highlight another aspect of mental health that I did not get a chance to include last night due to time constraints and that is the link between eating disorders, mental health, self-harm and suicide. I commend the organisation Bodywhys on the work it has done on this areas. It points out that anorexia has the highest mortality rate of any mental health condition, either through suicide or organ failure, each of which constitutes 50% of fatalities caused by anorexia. Up to 200,000 people in Ireland may be affected by eating disorders, including anorexia nervosa, bulimia nervosa and binge eating disorder. These are complex and serious mental illnesses. A report on mortality in eating disorders found that women with anorexia nervosa face more than 50 times the risk of completed suicide and suicide was determined to be the second most common cause of death in anorexia nervosa cases.

Suicide attempts occur in up to 20% of patients with anorexia nervosa and 35% of patients with bulimia. The mortality rate associated with anorexia is 200 times higher than the suicide rate of females in the general population. As relapse is high and recovery often episodic, the disorder can result in lifelong physical and psychiatric morbidity and risk of suicide. Furthermore, mortality due to eating disorders is likely to be higher where service provision is inadequate. The recent My World survey found clear evidence to link suicidal behaviour and eating pathology. Fear of being overweight was significantly associated with having thoughts that life was not worth living, deliberate self-harm and a suicide attempt. The prevalence of self-harming behaviour among adolescents is especially high in those with eating disorders. Official death certification may underestimate the incidence of suicide associated with this disorder and this, all too sadly, is the case across the board. These findings underscore the severity and health significance of eating disorders.

Bodywhys reports that it is often the first port of call for people affected by eating disorders as the crisis often occurs out of hours. It also points to the lack of regulation of counselling and psychotherapy professionals, which can put those who are vulnerable at severe risk, and the organisation suggests that regulation of this area needs to be progressed. In examining in detail the contributions made to this debate last night and tonight, it is very important that we look at these issues holistically and in the round. This is why I have taken the time to expand into the area of eating disorders, which was otherwise overlooked yesterday and today.

I thank all Deputies for their participation in this mature and sincere debate. Government and Opposition Deputies have contributed, all parties participated and Independent voices have been heard. There is unanimous agreement on this and I look forward to us moving forward on this issue in the same spirit of co-operation. We must vindicate the rights and needs of all who use our mental health services and significantly reduce the level of suicide in the country. We must enhance the mental health of Irish society.

I thank the Minister of State and his colleagues for the wise and welcome decision to allow this motion through unanimously.

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