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

One of the most gratifying developments in the past decade in challenging prejudice and stigma has been the improved attitudes in society towards mental health. We should not be complacent, however, as there is much left to be done, but we should acknowledge the significant improvements we have seen in challenging stigma and delivering improved treatments. Where people with mental health problems were once hidden away behind high walls, with other groups of stigmatised persons such as single mothers and their children, our society has now firmly and rightly rejected that approach in the context of the word "care". We have, in the past 20 years, faced up to much of the darkness of our past, which included industrial schools, laundries and mother and baby homes. When it came to some of those past abuses, the State was able to share the blame with other bodies such as the Catholic Church or it managed to disguise its own failures behind those of others. However, in terms of the sheer numbers involved, the abuses perpetrated within the mental health system dwarfed everything else. On the human rights abuses that occurred in the old asylums, the entire blame lies squarely and solely with the State. That past has yet to be investigated and acknowledged and an apology has yet to be given to victims.

Among the factors that played a part in my choice to join Fianna Fáil was the excellent work done by that party in government from 2000 onwards in improving mental health services and moving the approach to treatment away from an institutional model towards a recovery-based one. The two key achievements of Fianna Fáil during that time in mental health policy were implementation of the Mental Health Act 2001 and the reforms set out in A Vision for Change which, as the Minister of State indicated, will be ten years old next year. While both are now in need of review, they represented a significant change of mindset ain how we approached the issue of mental health.

A Vision for Change was published in 2006. It laid out a ten-year strategy for the reform of mental health services and signalled a new approach to the delivery of services to users. Significant progress was made between 2006 and 2011 in advancing that vision and providing the investment required to ensure its success. In 2011 Fine Gael and the Labour Party promised in their programme for Government to press on with the development of community mental health teams and ring-fence funding for that purpose. They have failed to honour these commitments. Not one cent of the €35 million allocated for the development of community mental health teams in 2015 has been spent. Vulnerable people in desperate need have been left to cope by themselves. As well as being a complete neglect of duty, this situation places a massive strain on the families and friends of those most in need of help. Only 24% of mental health posts approved last year were filled by 31 March this year. Delays in hiring within the year where posts are promised have been a consistent feature under the Government.

For the Health Service Executive to claim the only reason there are enormous gaps in front-line mental health services is it has been unable to find suitable staff is inexcusable. The notion that it has been actively seeking to recruit front-line staff within the timeframes of A Vision for Change does not ring true. In reality, there has been a deliberate and sneaky slowdown in the recruitment of promised community mental health service staff. The HSE’s own 2014 national service plan outlined strategically plans to delay the recruitment of mental health service staff until the latter half of the year to save money. The plan specifically stated certain recruitment initiatives, including the appointment of community mental health workers, would be “specifically targeted towards the latter half of 2014 to allow ... savings to be utilised on specific services on a timing delayed basis". That was a political and deliberate decision by the Government to ensure staff would not be recruited in this area. As a result, the funding that had been ring-fenced for the recruitment of specialised community health teams under A Vision for Change remained unspent. There are now 1,000 fewer filled mental health posts than when the Government took office in 2011, this at a time when the greatest public health crisis of our generation requires an investment focused on mental health. The implications of failing to recruit the promised community health teams are grave. We cannot continue to allow a situation to continue where someone in severe difficulty has nowhere to go. The Minister of State needs to explain the failure with respect to the allocation in last year's budget, as 76% of promised front-line posts remained unfilled. The Government has failed to deliver a functioning mental health service, despite prioritising other sectors. Units such as St. Brigid’s in Ballinasloe have been closed and not replaced with community mental health teams. As a result, major backlogs are developing in the system. The real aim of the closure of units such as St. Brigid’s has more to do with cost savings achieved than with the development of community structures. In the past two years there was a €70 million underspend in the national mental health budget. This money has been moved from the mental health sector to other parts of the health service for political and electoral reasons.

There are many other serious issues within mental health services, but I want to highlight two as critical. First, there is the continuing practice of placing children in adult wards. This is an abuse of the rights of children and leaves us in contravention of our international commitments to human rights. The other issue is the recent notable and significant increase in the incidence of electroconvulsive therapy being administered against the expressed and clear will of individuals. This practice also needs to end. It is welcome that the Minister of State has outlined that progress will be made in December in amending legislation to address this issue.

Mental health issues continue to have a devastating impact on our society. The Ireland we want to build must commit itself to an all-out effort to help people and reduce the number of cases of self-harm and suicide. In doing this we can learn from initiatives that have already worked well. Since the Road Safety Authority was established, it has helped to halve the number of deaths on the roads. That means that the lives of more than 200 people a year have been saved. It is time to do the same in the field of mental health.

Accordingly, Fianna Fáil proposes the establishment of a national mental health authority to be charged with adopting an agency approach to lead the promotion of positive attitudes to mental health, while reducing the incidence of self-harm and suicide. One key feature of this idea is challenging political interference with the mental health budget whereby it has been stolen, as I referred to. The authority would provide for a definite ring-fenced approach to funding mental health services and prevent moneys from being pulled from mental health services to shore up other parts of the health service. The establishment of the authority would mean that a vote of the Dáil would be needed to alter the budget for the proposed mental health authority, ensuring full accountability. The authority would be a separate body from the HSE, with its own director general. It would remain under the authority of the Department of Health, working in co-operation with the HSE through a range of mutual service-level agreements. I look forward to making the argument for the establishment of the authority in the forthcoming general election and ensuring mental health will feature as one of the key topics of debate in the context of our vision for the future for mental health services, as well as the continuing effort to reduce any remaining stigma with regard to it. Stigma is a great stealer of innocent human lives.

I acknowledge and welcome the commitment given by the Oireachtas to facilitate this debate on this important policy area.

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