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

According to the most recent statistics available for suicide in the State, 459 persons - 368 males and 91 females - took their own lives in 2014. During the same period there were 62 undetermined deaths which in the North and other countries would be normally counted as suicides. At the same time, around 300 citizens in the North die each year by suicide. It is generally accepted that the real figure for suicides is higher and that as many as 1,000 citizens die across the island each year by suicide.

The human cost for families and communities is devastating. The reality is that all sections and generations of our society are affected, from the very young to the very old, in rural and urban areas alike. Mental health is traditionally an area in which Ireland has performed badly. While society has started to deal with the issue in a more open way, mental health remains a taboo subject for many and mental health care has been poorly provided for. While there have been attempts to reconfigure health spending and ensure mental health care is prioritised, we see funds earmarked for mental health services spent in other areas.

Preventive and early intervention mental health care remains underfunded. One in seven adults in Ireland, 644,000 people, has experienced a mental health difficulty in the past year. Despite a perceived openness about mental health, the number of suicides has remained high, with between 495 and 554 deaths per year between 2009 and 2012. Lack of staff in the sector is a major problem. Despite a greater need for mental health services, there are 1,200 fewer mental health staff now than there were in 2006. A report in June 2015 highlighted an 11% decrease in posts since 2008, despite 1,200 being promised. Between 2008 and 2015, there was a loss of over 1,000 mental health staff and staffing levels were only 77% of the recommended level in A Vision for Change.

The situation is more severe in child and adolescent mental health services, with just over half of the staff required in post. There have been considerable staff losses in mental health nursing, with a reduction of 1,063 nurses between March 2009 and September 2014. Around the clock mental health services for adults in acute mental distress are still lacking across considerable parts of the State. The overall budget is insufficient also.

Nine years on from the publication of the strategy, just 6% of the total health budget goes to mental health services, compared to 7.2% in 2006 and far short of the 10% target. In 2015 the figure is predicted to be only 6.5%. In 2014 there was a €15 million shortfall in funds due to be ring-fenced for community based mental health and suicide prevention services. There were also delays in spending the €35 million promised in budget 2013. In fact, in practically every year of this Dáil term the Government has not even spent the amount to which it has publicly committed.

We need to see a modern bio-psycho-social model of care available locally across the disciplines, with a focus on primary care, counselling and 24/7 access to emergency supports. We also need to address the issues of housing, employment and discrimination in line with proposals made by Mental Health Reform, on some of which I will touch. The proposals contained in the overarching framework document for the sector, A Vision for Change, are sound, but they have never been fully introduced and so-called ring-fenced funding has, in some cases, not materialised. A Vision for Changewas published in January 2006 and originally supposed to be reviewed after seven years, but that is only now occurring. Sinn Féin believes A Vision for Change still needs to be implemented. Additional funding should be provided and directed towards community mental health services.

Ireland’s new strategy for suicide prevention, Connecting for Life, needs to be incorporated. It sets a target to reduce the incidence of suicide and self-harm by 10% in the next five years, based on WHO targets. A continuation of the roll-out of suicide crisis assessment nurses is needed. These nurses liaise with GPs where there are concerns about patients who may be suicidal. The data available for the impact these nurses have had to date are very encouraging. However, only 24 of the 35 nurses approved for the programme have been recruited, which is unfortunate. The full initial complement must be recruited and deployed as a matter of extreme urgency.

Greater support must also be extended to people with mental health issues to access housing. Recent housing lists showed a need for just over 1,000 places for those with mental health difficulties. There was a 36% increase in admissions of homeless people to psychiatric units between 2006 and 2013. We need increased supports to access appropriate housing to aid integration and recovery.

In January 2015, 429 children were waiting more than one year to be seen by the Child and Adolescent Mental Health Service, CAMHS. That figure has improved, as the Minister of State recorded, but we need to focus on early intervention. There has been investment in child and adolescent mental health teams but just half of what was recommended in A Vision for Change and far from enough to meet the 50% increase in demand for the service. By the end of 2014, there were 63 partially complete community CAMHS teams in place, but in A Vision for Change77 teams were recommended.

On crisis supports, more than nine years after publication of A Vision for Change, mental health services are still not uniformly providing the basic model of care that includes 24/7 crisis intervention and home based and assertive outreach treatment, with crisis houses as the norm in all areas. The HSE reports that in nine of 17 mental health areas there is weekend cover for existing mental health service users across the entire catchment area, while in the remaining eight areas they are partially in place. A clear framework for collaboration and referral between mental health services is lacking. This issue must be addressed.

People with mental health difficulties, like other forms of disability, disproportionately experience unemployment which can, in turn, exacerbate their health difficulties. Sinn Féin supports the expansion of Employment First supports, whereby a person’s work preferences and skills are assessed quickly after coming into contact with mental health providers, a suitable placement in the workforce is identified and appropriate supports are offered within the work environment. Mental Health Reform is leading a pilot project,Integrated Employment and Mental Health Support, in which four EmployAbility companies are participating. The Department of Health provided €250,000 to allow each of the companies to employ an additional job coach for the two year period. The pilot project is based on a British Individual Placement and Support, IPS, model of supported employment. It espouses an employment first approach in which a person's vocational skills and work preferences are assessed quickly after coming into contact with mental health services. Being job-ready is not a requirement; rather a suitable setting in the workforce is found and support is provided to develop skills within the work environment. A report for the British Department of Work and Pensions found that for every £1 invested in IPS, there was an expected saving to the Exchequer of £1.51.

Primary care services should also play a central role in supporting those suffering from mental health difficulties. Many find it very difficult to access help when needed, while some cannot afford to make use of private counsellors. The Counselling in Primary Care, CIPC, service is an early intervention programme that provides medical card holders with mild to moderate mental health difficulties with access to a limited number of sessions. It is imperative that this service capacity is increased in order that those on low wages who often find it very difficult to access such care are looked after appropriately.

See this speech in context