Michael Harty (Clare, Independent) | Oireachtas source

I extend my good wishes to the new Minister of State with responsibility for mental health, Deputy McEntee, and the new Minister, Deputy Harris. I wish them the best of luck in their new portfolios.

The mental health service remains the Cinderella of the health service. The recent removal of €12 million from the mental health budget indicated the manner and esteem in which mental health services were held by the previous Government. The new Government must urgently return this funding in a manner that allows it to be spent in a practical and effective way on front-line services. That figure of €12 million could have been spent on many other areas and in many other ways. Examples include school educational programmes and concentrating on early intervention, the sourcing of counselling and other therapies from the private sector where no public services are available, providing 24-hour crisis intervention services for acute health problems and supporting voluntary agencies like Pieta House and the many other organisations that provide essential support services such as the William Winder Rainbow Foundation for suicide prevention in my county of Clare. Recent Ministers of State have had to fight hard to prevent the same siphoning off of funds that had been allocated to mental health services. I hope the current Minister of State will not have to fight the same battle.

As mental illness may not have the external signs that one would associate with physical illness, it can be more easily missed and overlooked. A high proportion of consultations in general practice have a mental health component, which may be the entire reason for or a significant component of the consultation.

A high proportion of mental health issues are dealt with within general practice, yet those who need further assessment and treatment find it difficult to access specialist services and therapies due to a shortage of front-line staff. Thank goodness that our old institutional model of care has been dismantled and replaced with a much more progressive model where treatment is delivered in specialist inpatient units that aim to return patients to their communities as soon as it is safe to do so for continuing care and follow-up. However, these services need to be resourced properly and our community multidisciplinary teams are not being completely staffed.

In my catchment area, there has not been a psychologist in place for the past four years. There is no cognitive behavioural therapy, yet many patients require this service. There is just a half-time equivalent occupational therapist. For one staff member to be taken on, two staff members need to leave the service, and since last week we have an additional embargo on new recruitment for already depleted staff levels. There are problems in recruiting and replacing consultant staff. The reduction in new consultants' pay by 30% significantly reduced the number of applicants for vacant posts. Prior to this poorly thought out pay reduction, there could be ten to 12 applicants for a vacant post. Now, one is lucky if there is any applicant and even luckier if anyone accepts a post, yet €12 million earmarked for new staff has been taken out of the mental health budget and a new embargo on recruitment has been imposed. Where is the logic in that? It can only have one result and that is certain future reductions in front-line services and poorer outcomes for patients.

Across Europe, 12% of the health budget is spent on mental health services, yet in Ireland it is less than 8%, which is one third short of the European average. Mental health budgets are promised to be ring-fenced, yet they rarely are. Inpatient beds in acute mental health units are in short supply and the demand outstrips the bed numbers. These units are always at capacity and it is illegal to exceed their maximum number. There is pressure consequently to discharge patients sooner than planned and, when discharged, community disciplinary teams are not in place to monitor and assess their recovery. Furthermore, the failure to resource these teams adequately is leading to unnecessary readmissions to the acute units. As we know, mental health problems are not confined to social class, income or age. Child and adolescent mental health services are not properly resourced. Those aged between 16 and 18 have nowhere to go. Child and adolescent services say they are too old for their service and adult services say they are too young. As a result, they are dependent on the kindness of strangers to look after them, when they require urgent care.

There is also a lack of resources in old age psychiatry. Dementia services suffer from a lack of home help and home care packages and there is great difficulty in sourcing these. I understand there is to be a further reduction in home care packages. Dedicated dementia units are required to cater for a subgroup of patients who have specific needs and are not suitable for general psychiatric wards. Quite often there is an inappropriate mixture of elderly patients who suffer from mild dementia and those who have advanced dementia and challenging behaviours, which is quite unacceptable.

Ireland has a high rate of male suicide due to social and economic pressure. Farmers who were encouraged to invest in their farms are now, due to falling prices, under pressure from their banks to sell their stock and assets to pay their debts. Housing problems, homelessness and mortgage difficulties are also causing serious mental health problems. There is a crisis of hope in our society as austerity has had a serious effect on mental health and the economic recovery is patchy and creating divisions in our society.

Adolescents and young adults are subject to social pressures. They are expected to be high performers and high achievers. They are expected to conform to unhealthy media driven and peer driven body image. They suffer from a lack of jobs and opportunities, rising rents and a lack of housing, and drug abuse is a huge problem. Cluster suicides are all too common. There were seven suicides in the midlands recently in a short period, and death by suicide is now far more common than death due to road traffic accidents, yet no area of the country is immune from suicide and it is suffering from an increased response to despondency.

The organisation of our mental health services is driven by a bureaucratic management rather than clinical management. There is minimal clinical input from those delivering the service and this does not make common sense. It hinders the delivery of good patient outcomes and there is a disconnect between management and the front-line staff who deliver the service. The entire management structure of our mental health services needs to be reviewed with a view to putting the patient first and focusing on giving clinicians a critical say in how their services are delivered. A Vision for Change, published in 2006, which was to deliver a comprehensive active, flexible and community-based mental health service has not been fully implemented. Even though it was not a perfect document, if it had been delivered on, patients would be much better served.

It is essential that the Government fully implements A Vision for Change. It is essential it provides 24-hour crisis intervention, extends its counselling services, develops child and adolescent services, ends the inappropriate admission of children to adult wards, develops mental health supports for those who are homeless and develops a national dementia strategy.

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