Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I thank those who have given us this opportunity to debate this important issue. Every time it is debated in the House, we call for additional resources, for the implementation in full of A Vision for Change and for strong commitments to be put in place to ensure a positive resource is available to people who suffer with mental health issues. Too often, we use such debates as an opportunity to continue to engage in political argy-bargy. The bottom line is that when we strip that away and instead look at the harsh reality of life for people in our society who have anxiety, depression, eating disorders or other mental illnesses, it is clear that the system is simply not able to cope as we would like, as the Minister would like and as society demands.

A Vision for Change was a visionary document. It laid out a pathway for how we should fund mental health services over the years ahead. More importantly, it set out how we, as a society, should deal with the issue of mental health. It said we should become more open, take people out of institutions and offer people pathways for accessing services to ensure they can fulfil their lives. I believe that over many years, we have collectively failed to address the core principle of pathways of care and assistance to full wellness over a period of time. We still have huge deficiencies in key areas. I refer, for example, to child and adolescent mental health services, access to child psychologists and assessments for child psychology. It is simply unacceptable that children are facing these and other challenges in our schools and in our society. I accept that some improvements have been made in certain key areas of assessment but we are going backwards in other areas. We cannot allow this to affect vulnerable children who need support and assistance. More importantly, they need assessments so that we can ascertain what supports they need. We have to accept that we have fundamentally failed them.

Our schools are unable to cope because the supports and services available in the education system have been diminished and there are long waiting lists for assessments by child psychologists. The system that is in place to cater for teenagers and adolescents is quite chaotic. The Minister spoke about the consent of parents when admissions take place. Of course the parents have to consent because if they do not, there is no other place for their children. That is the reality of life. They consent to the admission of young adolescents to adult wards because it is the last port of call. I have come across some harrowing cases. Staff have informed me of frightful cases involving the admission of adolescents to wards when that was not in the best interests of those young people or of society at large. The manner in which people are being forced in these types of circumstances is fundamentally flawed.

The Minister talked about budgets and repeated twice what he had identified as good news in the context of what he had achieved as Minister for Health. However, what he forgot to mention in terms of the 16% increase for mental health services and the 11% increase in the HSE's overall budget was that they were coming from a very low base. The number of whole-time equivalents working in mental health services is 9,316, which is only 75% of the number outlined as being required in A Vision for Change. There has been much reference in recent years to a difficulty in recruiting professionals into this area, but that excuse has been ongoing for some time. We are, however, running out of excuses. Tonight there will be a child sitting at the end of his or her bed looking at a jagged piece of glass or a knife contemplating whether he should harm himself or herself. Somebody somewhere in Ireland tonight will consider ending his or her life. These things are happening. The bottom line is that this area needs to be prioritised and in a manner that has not been done previously.

The Minister of State, Ms Kathleen Lynch, who was a constituency colleague of mine having lost her seat in the recent general election is responsible for mental health services, but it is easy to apportion blame. The bottom line is that the HSE service plan dictates where funding is allocated year-in and year-out. The record of the HSE, in its pillage and plunder of the mental health budget, is appalling. This has been happening consistently since 2011. It is important when we speak about ring-fenced funding that funding be ring-fenced for that specific purpose. The HSE service plan for this year outlines the funding for certain services and supports and further specific initiatives, but it does not specify what the "further specific initiatives" are. When one strips away the HSE plan for mental health services, it is short in detail. It is certainly short in aspirations but, more importantly, it is short in terms of the commitment to provide resources. There is not sufficient detail which allows me to believe there is a genuine commitment to address the fundamental shortages in mental health services. As I said, this is evidenced by the absence of any detail in the HSE service plan for this year. I have no doubt that it will be raided again this year, as it was last year and in previous years. The Minister can dress up the figures any way he likes, but day-in and day-out across the country people are suffering, either in silence or a very public way, and we cannot give them assistance.

The Minister spoke about primary and community care settings and stated these areas had received more funding than acute hospital settings. We all commend the provision of additional resources for community and primary care settings. The Minister is a medical professional. Anybody who has spoken to general practitioners the length and breadth of the country is aware of the huge pressures they are under. Consultation times have been shortened such that it is no longer possible for GPs to hold 40-minute consultations with a vulnerable adult or child. The first port of call is a general practitioner, but general practitioners no longer have the resources to cater for the demands being placed on them. The provision of free health care for the under-sixes is a case in point. There is no doubt that vulnerable children are not being dealt with as effectively and efficiently as they should be because other children who may not need treatment by a general practitioner are taking up the their time. These are the realities of life. Universal free GP care for everybody is a noble calling. However, to utilise limited resources to fund such a scheme is to put people with no health needs ahead of those who genuinely and urgently need health care. This is happening today in surgeries across the country and will happen tomorrow until such time as health service provision is reprioritised.

We should, of course, prioritise those who are vulnerable and need help over those who are not and do not need help. The universality that has been championed in the Chamber by many Deputies does mean one thing: where there is a limited financial budget, resources will be cut to those who need it most. In the area of health, and mental health in particular, I believe we are prioritising the wrong areas in the current format in which we structure and fund our health services.

I believe the establishment of a mental health authority is important. It is something that we need to accept. If we look back at how we dealt with the issue of road safety and the carnage on our roads over a number of years, we established the Road Safety Authority, RSA. It had a statutory function. It was able to challenge Government policy. It was not afraid to say what was required and what was needed to address the carnage on our roads. It identified the lack of Garda resources and the flaws in our legislation. Governments responded because the RSA was unafraid to challenge the Government of the day. We need a statutorily-based mental health authority independent of Government which can challenge, request and direct. Until we have an agency that is not fearful of its political master and not afraid of the HSE when it diverts money and scarce resources from people who genuinely need support, funding will always be taken to areas that are more politically palatable.

There are many people suffering in silence. They live in dark shadows in our society because we are simply incapable of collectively shining a light on them. We do not resource or allow them to access services in a timely and meaningful fashion. While the Minister may laud the fact that there have been increases in the mental health budget, the bottom line is that the 16% increase he talks about is coming from a very low base. A Vision for Change, though it was a visionary document, has much in it that is yet to be fulfilled. That is down to the lack of resources, priority and commitment.

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