Dáil debates

Tuesday, 8 December 2015

Mental Health (Amendment) Bill 2008 [Seanad]: Second Stage


7:05 pm

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

Over many years, I have called on this Government and its predecessors to promote awareness of the unacceptability of certain practices in mental health care and to urge that the use of such practices be discouraged. One such practice is the application of electro-convulsive therapy, ECT, on detained persons against their will. That is a very important point. Under the Mental Health Act 2001, the consent of the patient must be received before ECT treatment, which involves sending an electrical current through the brain via electrodes applied to the scalp, can be used. If a patient decides not to consent to ECT treatment, that decision can be overridden if two psychiatrists believe this treatment is in their best interests. Therefore, a patient who is capable of giving or withholding informed consent can be forced to take ECT treatment against his or her will.

Mental health organisations have been actively campaigning against such a practice for many years and their stance was vindicated following a report by the Mental Health Commission who expressed their continuing concern at this practice.

This Bill comes on the back of the review carried out by the expert group on the Mental Health Act 2001 and will see the word "unwilling" removed. It will no longer be possible to administer the controversial therapy to a person who has capacity and does not consent to the treatment. Despite its short length, this Bill is of significant importance and my party and I are happy to support its swift passage through these Houses.

Given the time, I will reflect on a number of other areas. Less than three weeks ago, we had statements on developments in mental health services. I believe that the allocation of time to such a topic is most important in order to establish where we are at and, indeed, how far we have to go in terms of where we want to bring these services. It is imperative that we all work together to push for improvements and progress at all times. This has demonstrated itself in this Chamber and in the Oireachtas all-party mental health group. It is my hope that we not only continue but build on the spirit of interparty co-operation and working together on these issues post the upcoming general election.

There is no doubt that there has been fundamental change in the care regime available to patients with a mental illness over this past decade. The review of the

Mental Health Act 2001 was a key step in the provision of revised and more appropriate mental health legislation in this country. Aside from its recommendations in relation to ECT, it contained a number of proposals to strengthen patients' rights, placed a greater emphasis on children's services and supported the extension of responsibility to community mental health teams, something Sinn Féin has advocated for a long time.

A Vision for Change is a very significant but, regrettably to date, a very long-term project. It requires maximum support to ensure that it proceeds apace and that it is not allowed to stall again, as has happened too often in recent years. I believe that there is commitment to the policy objectives contained in A Vision for Change across the political spectrum represented in this Chamber. However, apart from its slow pace, the reality is that the policy is being implemented unevenly and inconsistently across the country.

Mental health is an area in which successive governments have struggled to provide an adequate level of service. This is despite the fact that 644,000 people, one in seven adults, have experienced a mental health difficulty in the past year. The number of suicides has remained high, with between 495 and 554 deaths per year from 2009-2012. The human cost of this on families and on communities is devastating, a point I have made recently but which I make no apology for repeating. The reality is that all sections and all generations of our society are affected, from the very young to the very old, in rural and urban areas alike. The funding allocated to mental health is insufficient. The overarching framework document for this sector, A Vision for Change, proposed a mental health funding target of 10% of the overall health budget. While there have been attempts made to reconfigure health spending in order to afford mental health greater priority, we continue to see funds which have been earmarked for mental health diverted to other areas. Nine years on from the publication of the strategy, just 6% of the total health budget went to mental health in 2014 compared to 7.2% in 2006. In 2015, it is predicted to account for just 6.5%. To reach the budget target of 10% would require an estimated increase of €400 million in its annual allocation.

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. 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. In child and adolescent mental health services, the situation is more severe with just over half of the staff required in post. In terms of crisis supports, more than nine years after the 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. A clear framework for collaboration and referral between mental health services is lacking and this must be addressed.

Sinn Féin believes that 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. This sets a target to reduce suicide and self-harm by 10% over the next five years, based on WHO targets. A continuation of the roll-out of suicide crisis assessment nurses, SCANs, is needed. These nurses liaise with GPs where there are concerns about patients who may be suicidal. SCAN deployment has resulted in significantly better outcomes for patients than traditional mental health services and they may result in lower costs. Only 24 of the 35 nurses approved for this programme have been recruited and this is unfortunate.

In January 2015, some 429 children were waiting more than a year to be seen by CAMHS. We need to focus on early intervention. There has been investment in child and adolescent mental health teams but just half that which was recommended in A Vision for Change and not 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 while A Vision for Change had recommended 77 teams. Sinn Féin recognises the merits of the proposed suicide prevention authority and is favourably disposed to the establishment of such an overarching body on an all-Ireland basis to lead the way and set the standards for all who are involved in suicide prevention initiatives.

I reiterate and stress my support, and that of my colleagues, for this Bill. This is a progressive step forward and its importance cannot be underestimated. I commend the Minister on pushing ahead and ensuring that it progresses while we still have the opportunity, here today. We are on the right path but so much more needs to be done. I believe that some of the suggestions I have put forward today have the potential to deliver to the greatest extent possible for all those who, from time to time, may require mental health services, treatment or care. Furthermore, I ask the Minister to ensure that the heads of the legislation needed to give effect to the other recommendations of the expert group on the review of the Mental Health Act are published as soon as possible, bringing the long-awaited reform of Ireland's mental health services to fruition.


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