Kathleen Lynch (Cork North Central, Labour) | Oireachtas source

I welcome the opportunity to discuss developments in the mental health services overseen by this Government and to outline my plans for the future.

Promoting positive mental health and well-being in general is obviously important to us all. Mental health, for many reasons and in many respects, is a complex and emotive issue. It is encouraging that, in my time as Minister of State, I have generally found a consensus in both Houses to improve the area of mental health, including implementation of the widely supported policy, A Vision for Change.

This Government has consistently prioritised investment in mental health and the HSE has been steadily implementing change on the ground. While I remain as open as ever to constructive criticism or realistic suggestions, I ask that objectivity and, above all, the best interests of service-users remain paramount today. Reform of mental health services has led to much needed additional investment but it also requires new approaches to enable the capacity of our system, in terms of new delivery models, to realise a common vision. This ranges from overcoming staff recruitment and retention issues to rebalancing services at local level between acute and community-based care in order to achieve the objectives of A Vision for Change.

The implementation difficulties we face on the ground in some areas, which I have often acknowledged in the past, do not relate primarily to a lack of money. As I have indicated on many occasions, it is more a question of change catching up with the funding provided. This Government has provided €125 million ring-fenced funding between 2012 and the end of this year to develop and enhance our mental health services. The aim is to ensure that services are person-centred, user-friendly, responsive to need and recovery orientated. I am pleased that I have secured a further €35 million for 2016 to continue this important work.

To date, a key focus has been additional posts to strengthen community mental health teams for both adults and children. This funding is also being used to enhance specialist community mental health services for older people with a mental illness, those with an intellectual disability and mental illness, the forensic mental health services and suicide prevention initiatives. Some 1,150 new posts have been approved since 2012. Over 90% of the posts approved for 2012 and 2013 are in place and 110 of the 250 posts allocated for 2014 have been filled or are under offer.

Many areas have seen great advances, including those that have embraced the Recovery agenda, the expansion of the forensic services, including the achievement of planning for the new forensic hospital at Portrane, and the ongoing reconfiguration of both adult, and child and adolescent teams countrywide. Other achievements include the development of the counselling in primary care service, CIPC, for adults over 18 years, who are medical card holders; the implementation of national clinical programmes; a greater awareness of fostering mental health promotion in society; publication earlier this year of the expert review group report on the Mental Health Act 2001; and the new suicide prevention strategy, Connecting for Life.

Waiting lists for child and adolescent mental health services is an area of particular interest to me. Last March, I asked the HSE to undertake a detailed validation of the waiting lists with the aim of minimising waiting times and, in particular, reducing the number of those waiting over 12 months. This exercise involved the introduction of a new standard operating procedure for both inpatient and community CAMHS services. I am pleased to note that good progress has been made and that the HSE has given a commitment to eliminate the over 12 month list entirely by the end of this year. In this regard, the latest figures from the HSE indicate a reduction from 479 in March to 214 at the end of September in the over 12 months waiting category, a decrease of 55%. The number of cases waiting over three months has also decreased over the same period. There has also been a significant improvement in the number and range of CAMHS services at community and inpatient level over the past number of years. There are now 58 operational CAMHS beds across four units in Dublin, Galway and Cork. This represents an increase of almost 400% in the number of beds over eight years, from a figure of just 12 beds for the whole country in 2007. Furthermore, an additional eight beds will become available in early December when the new Linn Dara facility opens.

A priority issue for me is address of children and adolescents having, at times, to be admitted to adult acute units. Figures for 2014 indicate that there were 89 admissions of children to adult psychiatric units, with the majority being voluntary and involving parental consent. While these inappropriate admissions have decreased continuously in recent years, from a peak of 247 admissions in 2008, I believe there is still room for improvement.

The Health Service Executive is monitoring carefully all potential admissions to adult units to avoid this as much as possible. However, in some cases, it may be the only available option if an adolescent is to obtain early treatment.

Another topic to which I attach great importance is legislation in the area of mental health. Such legislation provides the necessary safeguards and protections on which people rely if the State uses its power to detain them because they are suffering from a severe mental illness. The report of the expert group set up to review the Mental Health Act 2001 was published in March this year. Government approval has been received for the drafting of a general scheme of a Bill to amend the existing legislation to reflect the recommendations of the expert group. Work is progressing in the Department on these important amendments. In addition, Government approval has been received for an early change to the existing legislation in respect of the use of electroconvulsive therapy, ECT. The effect of this change will be to remove the authority to administer ECT without consent in any circumstance where an involuntary patient is capable of giving consent but is unwilling to do so. The heads of the short Bill relating to ECT have been agreed in recent days with the Attorney General's office and, subject to securing Dáil time for this priority measure, it is my intention to bring it to the Oireachtas in December. Work is ongoing on the heads of the larger amending Bill.

Another important subject I have prioritised during my term of office is the issue of suicide. We are all aware that suicide remains far too prevalent in our society and is a complex problem which requires a multifaceted solution. While there are no easy answers to the problem, we can and must make every effort to reduce the number of lives lost to suicide by ensuring there is co-ordinated partnership among a broad range of Departments, State agencies, non-statutory organisations and, perhaps most importantly, through the involvement of local communities in tackling the issue. Dealing with the current high levels of suicide and deliberate self-harm has been and continues to be a priority for the Government. Earlier this year we launched Connecting for Life, our new strategy to reduce suicide, covering the period 2015 to 2020. The strategy which has an implementation focus on youth mental health sets out a vision in which fewer lives are lost through suicide and communities and individuals are empowered to improve their mental health and well-being. This includes a greater focus on the important issue of support for families and communities in suicide prevention and will involve providing community-based organisations with guidelines, protocols and training in effective suicide prevention.

For those who might ask what good another strategy can achieve, I emphasise that Connecting for Life is much more than a vision. It provides a detailed and clear plan to achieve each of the goals it proposes, with defined actions and a lead agency and key partners in place for each individual objective. The plan will be supported by robust implementation and governance structures, as well as resourcing and communications frameworks. Monitoring and evaluation will be embedded into the implementation process and the National Office for Suicide Prevention has been given a clear role and authority to support implementation of the strategy.

Having noted the progress made in recent years, I take the opportunity to outline to the House my plans and priorities for next year. As I mentioned, a further €35 million is available to us to continue our development work. Next year, in addition to continuing the development of general adult teams and child and adolescent health services, as well as improved 24-7 response and liaison services, priority will be given to the continued development of early intervention and prevention counselling services by HSE mental health and primary care staff, especially for young people. Investment in clinical programmes will continue, including in two new clinical programmes. One of these programmes will deal with ADHD in adults and children, while the other will deal with dual diagnosis of those with a mental illness and substance misuse problems, an issue Deputy Maureen O'Sullivan has raised on numerous occasions in this Chamber. There will be continued development of services in the area of psychiatry of later life and for those with a mental illness and substance misuse problems. An area that has not received the attention it deserves is that of perinatal mental health. Some of the funding secured for 2016 will be used to develop this important service.

A Vision for Change is a progressive, evidence-based strategy. When published in 2006, it provided a comprehensive framework for building and fostering positive mental health across the community and providing accessible, community-based or specialist services for people with a mental illness. It was designed to have a ten-year lifespan, which means that next year will be its final year. Discussions are under way within the Department of Health on the parameters of a review of the strategy. Any new mental health policy should be broader in its scope than just mental illness and recognise the importance of health and well-being, positive mental health and resilience and the wider social influences in that regard. It should also have regard to the evidence of national and international best practice. I hope to be in a position to agree the parameters of a review in the coming weeks.

I assure the House that the Government remains fully committed to mental health and suicide prevention services and the continued development of modern and responsive services in line with A Vision for Change.

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