Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

I welcome the holding of this debate and the opportunity to describe some of the developments in mental health services overseen by the outgoing Government. I am making this statement on behalf of the Government as the Minister of State responsible for mental health services, Ms Kathleen Lynch, is not permitted to speak in the Chamber as she is, regrettably, no longer a Member of the House.

Promoting positive mental health and well-being is important to us all. During the period of office of the outgoing Government there was wide consensus in both Houses and the community at large in support of the programme, A Vision for Change. I hope that remains the case in this House and that the incoming Government will commit to it.

Despite claims to the contrary, the outgoing Government consistently increased investment in mental health services, while the HSE has been steadily implementing change on the ground. Reform of mental health services has been accompanied by much needed additional investment. Reform requires new approaches to enhance the capacity of the services to deliver new models and realise a common vision. It ranges from overcoming staff recruitment and retention issues to rebalancing services at local level between hospital and community-based care services.

The genuine implementation difficulties we face on the ground in some areas which have often been acknowledged in the past do not relate primarily to a lack of funding. It is far more a question of change management, modernising practice and driving implementation.

Since 2012 the outgoing Government has provided additional funding earmarked for mental health services. In 2012, in its first budget, the mental health budget was €711 million. This year it is €827 million, an increase of €116 million, or 16%, over the period. In the same period the HSE's budget has increased by 11.2%. Therefore, the proportion of the overall health spend allocated to mental health services has increased, both in cash and percentage terms, under the Fine Gael-Labour Party coalition. Clearly, the mental health sector has benefited more than other parts of the health service from spending increases under the outgoing Government. The numbers do not lie. Overall, approximately 1,550 new posts have been approved for mental health services since 2012, although some existing posts have also been lost in that dime owing to retirements and normal attrition.

The HSE service plan 2016 provides for mental health services funding to increase from €775 million to €827 million this year. These figures are available for verification in the plan. This represents an increase of €52 million, or 6.7%. The figure is made up of €617 million for existing services and €35 million for the development of new services. Of the additional €52 million, €32 million was secured by me in difficult budget negotiations last October. A further €20 million was secured by the Minister of State in tense bilateral negotiations with the Minister for Public Expenditure and Reform, Deputy Brendan Howlin, and the Tánaiste's office on budget day. Overall, I thought it was a good few days' work by the two of us at the time. While I have read a somewhat different account since, one need only look at the numbers, specifically the difference between the Health Estimate on budget day and the Revised Estimates Volume, REV, in December, for verification. Deputies who have been in the House previously will know that the budget books are printed overnight and presented to the Cabinet and the Dáil the next day and changes made on budget day or subsequently are not shown until the REV is published.

While an extra 6.7% is provided for mental health services this year, it is worth noting the increase for the promotion of health and well-being is 6.2%; for primary care services, 2.7%; for disability services, 4.5%; for the ambulance service, 5.1% and the fair deal scheme, 3.9%. The budget for acute hospitals is actually being reduced by 2%. Therefore, mental health services account for the largest increase in percentage terms of any service area in 2016.

The House will understand my surprise when I heard a mental health advocate saying acute hospitals did so much better than mental health in the 2016 service plan. If money is anything to go by, this is patently not the case. Overall, the net increase in the health budget voted for 2016 is €300 million. Just over €200 million is required for pay restoration, increased demand and the full year cost of new programmes introduced during 2015. This leaves some €97 million earmarked for new developments as part of the HSE's 2016 service plan, with over one third of it earmarked for mental health. Again, this is more than any other service area. As happens every year for new developments, the HSE must put an implementation plan in place for these programmes before funding is released. This can give rise to one-off savings as the full year cost of a new programme does not arise if it does not come in on 1 January.

There have been some comments on the timing of various investments and spending in 2016 which gave rise to some money being transferred to services for the elderly, specifically home care packages and community beds. I put the correct position on this matter on the record of the House last week. As I have said previously, there is nothing to be gained from setting one part of the health service against another part. Since I became Minister for Health, I have been clear that I believe that, allied to reform and enhanced efficiencies, more money needs to be invested in health. In the two health budgets I negotiated, a health budget increase after seven years of decline or stagnation. The budget increased from €12.113 billion at the start of 2014 to €13.6 billion for 2016, an increase of just short of €1.5 billion, or 12.4%, over two budgets, before any Supplementary Estimates.

While mental health services are of great importance, so are services for the elderly, paediatrics, cancer care, primary care, ambulance services, disability, public health, maternity services and hospitals. Some Members will call for mental health to be prioritised. While I understand the sentiment, it means little without saying what service area it should be prioritised over and why. Which of the areas I mentioned are less important, and why?

Members may wish to be aware of how the additional money for mental health will be spent in 2016. This includes additional funding to implement Connecting for Life, the new suicide prevention strategy; the transfer of some patients from the forensic mental health services to the community, which is more appropriate; investment in high observation units in acute mental health settings; the improvement of 24-7 services through additional liaison psychiatrists and psychiatric nurses; new clinical programmes for dual diagnosis and adults with ADHD; provision of additional clinical space in community services; and more funds for clinical programmes directed at eating disorders, self-harm presentations in emergency departments and early intervention in psychosis. This is all outlined in the 2016 service plan.

These developments are in addition to other important developments that occurred under the term of the outgoing Government. These include the development of the counselling in primary care service, CIPC, for adults over 18 years who have are medical cards; greater awareness of fostering mental health promotion in society through campaigns such as the Talk campaign and The Little Things; and the publication, last year, of the Expert Review Group Report on the Mental Health Act 2001; and the new suicide reduction strategy, Connecting for Life. The outgoing Government reduced the child and adolescent mental health services, CAMHS, waiting lists for those waiting over 12 months and commenced, at long last, the enabling works for new National Forensic Hospital in Portrane, to replace the Victorian institution in Dundrum, the Central Mental Hospital. Other developments that occurred during the term of the outgoing Government include the better development of counselling services across primary and secondary care, including early intervention at primary care level, and five new Jigsaw youth mental health services planned for Cork, Dublin and Limerick; the development of perinatal mental health services, which was much neglected by previous Governments, in line with the new maternity strategy; and the doubling of the budget for the National Office for Suicide Prevention.

In the past year, there has been a particular focus on reducing waiting lists and waiting times for CAMHS. The number waiting 12 months or more at the end of December 2014 was 405, a reduction of 55% over 12 months, or 60% compared to April 2015, when the CAMHS waiting list initiative focusing on those waiting 12 months or more was commenced by the Minister of State, former Deputy Kathleen Lynch.

The HSE's annual target for admission of children to CAMHS units, rather than adult units, is 95%. An admission rate to age-appropriate units of 80% was achieved in December of last year, representing a significant improvement from 55% in January 2015. When such admissions occur, they usually involve older teenagers who are admitted to adult wards with the consent of their parents. An additional eight CAMHS beds were added with the opening of Linn Dara in early December 2015, thereby increasing the total number of CAMHS beds to 66.

Mental health legislation is an important area because it provides for the necessary safeguards and protections on which people rely when the State needs to use its power to detain someone because he or she is suffering from a severe mental illness. The outgoing Government amended the existing legislation for the administration of electroconvulsive therapy and the administration of medicine after three months. These important amendments will ensure involuntary patients with capacity can no longer be given ECT or medicine against their will. The outgoing Government also gave approval to the drafting of a general scheme of a Bill to reflect all the other recommendations of the expert group that was set up to review the Mental Health Act. I hope the new Government will follow through on this.

Discussions are under way within the Department of Health concerning the parameters for a review of the Vision for Change strategy. My view is that any new mental health policy should be broad and should not deal with mental illness only. It should recognise the importance of health and wellness, positive mental health and resilience and the wider social influences on this area and should have regard to the evidence of national and international best practice. I look forward to hearing the contributions of Members and their suggestions for positive change in the future under the new Government.

See this speech in context