Stephen Donnelly (Wicklow, Social Democrats) | Oireachtas source

I congratulate the Minister of State on her appointment; it is a great honour I am sure and a great responsibility. I wish her every luck in the coming months and years.

I welcome the opportunity to speak on mental health today and I acknowledge the importance the Chamber has placed on the topic. It has received several hours of debate with much input.

Based on my past five years in this House, we disagree, as we should, on many issues. However, mental health seems to be one of those ones where there is much agreement on what the challenges are, how important mental health is and what needs to be done about it.

In preparing my speech today, I did what probably many Deputies did; I looked at the mental health reform figures. I have seen them before and I have used them before in this Chamber, yet they absolutely shocked me. They have been repeated - I have listened to much of the debate - and they are worth repeating again. In Ireland today, almost one in ten adults is experiencing a mental health disorder, one in seven has experienced a mental health difficulty in the past year and, by the age of 25, one in five of us has experienced some form of mental health difficulty. These figures have been stated by many Deputies over the past few days. I have seen them before and I have used them before, yet, when I pulled out my notes to prepare for today, I was again shocked at how prevalent and damaging this is. It means that probably every one of us - certainly the majority of us - is either dealing with a serious mental health issue or have friends and family doing so.

I would like to focus on youth mental health, which is an area in particular need of intervention, although the entire mental health service needs help. Again, a figure that floored me today, which I have seen before, is that we have the fourth highest rate of teen suicide in Europe. We have problems in Ireland, but we are a modern, reasonably progressive and wealthy nation. That we have the fourth highest rate of teen suicide shocked me when I saw that figure today. More than one in five young adults have indicated that they have engaged in self-harm. As I have heard other Deputies reference, a recent study of LGBT young people found that one in five has attempted suicide, one in four has self-harmed and one in three has thought seriously of ending his or her life in the past year.

Youth mental health workers that I speak to in Wicklow tell me that morale is so low in the system, from psychiatrists to psychiatric nurses, that they are finding it hard, where funding has been provided, to fill the posts. I was particularly taken by one psychiatrist I spoke to a few months ago. She works outside Dublin in the commuter belt. She said that youth mental health services are so difficult to access where she is that the GPs in the area are writing letters for young people stating they are at imminent risk of suicide and telling them to present at emergency departments in Dublin. They are using that as the pathway to accessing youth mental health services.

I do not mean that to score any political points. I do not think any one of us would want that for anyone. However, this goes to the heart of the matter. I have heard several Fine Gael Party Deputies speak about some of the funding improvements and hiring that has occurred. While that may be going on, and may it continue, we must acknowledge just how desperate the situation is right now. This is not something that needs a little more money or a few more staff. This is a system in crisis and we are failing our young people. If it is true, and I have no reason to believe the psychiatrist I spoke to was misleading me, then this is a crisis and it needs to be dealt with as a crisis.

I would like to acknowledge several welcome pieces in the programme for Government. Increasing the mental health budget year on year is very welcome. Fully implementing A Vision for Change post-review is welcome. I was delighted to see a reference to ensuring support in crisis and I guess that is part of the example I have just given of young people presenting in accident and emergency departments. Sufficiently staffing our primary care centres with mental health professionals, psychiatrists and psychiatric nurses is also very welcome. However, the programme for Government is lacking. It is not the place for the programme for Government, but what is not in it and what we need and I imagine what the Minister of State will be dealing with right now is a timeline for implementation, with allocated budgets. As she knows, we need 1,000 psychiatric nurses by the end of the year and we know that the Psychiatric Nurses Association, in light of low morale, is balloting for action. My understanding is we need to double the number of consultant psychiatrists as well, which is what the professionals have advocated.

A Vision for Change is a great document and a great plan, but it is ten years old and was written in a very different socio-economic environment. While the programme for Government calls for an update and an expert review, which is absolutely the right call, we have to start seeing some timelines. I heard nothing but support for five years for A Vision for Change in this Chamber during the last Dáil. However, there is nothing to hold any Government or us, the Parliament, to account. We need goals, timelines, deliverables and allocated budgets.

If we are serious about addressing and improving mental health, we must have an honest conversation about funding. We know that Ireland spends less on mental health services, preventative care and community care than comparable countries and we are experiencing difficulties in all three of those areas. Since 2011, the number of psychiatric beds per head of population has halved, so this is serious stuff. We know that as a percentage of our health budget we spend 6% on mental health. Our closest neighbours spend 10%. These are not marginal changes. These are big things that need to be addressed.

There is a need for reform in youth mental health. We need to move from the two-stage model we have, which is a paediatric-adult model, to a three-stage model, which is a paediatric-youth-adult model. We have to provide a user-friendly and welcoming entry mechanism for young people. We cannot have young people presenting at accident and emergency departments except in the most extreme emergency. To have them going in and sitting on a plastic chair at a formica table in the local community or health centre is not the right way for us to be welcoming in young people who have mental health issues. We need a welcoming service. What we have at the moment is a very siloed service which kicks into action when things get quite bad. Obviously, we need more prevention, and I know this is something the Minister of State is interested in. We need more prevention, but we need a much more holistic and joined-up service as well.

We need these reforms, but we must have the money, which is why the tax base has to be protected. It is so that we can both reform and invest in these critical services. The reality is that we have the fourth highest rate of teen suicide in Europe and one of the lowest levels of taxation on labour. These are OECD figures and not Social Democrats propaganda. That is the reality and that is what we are dealing with. We desperately need investment in mental health and in youth mental health services and we already have one of the lowest levels of tax on labour in the OECD. Here is the question for all of us. I believe we all agree on the importance of mental health. I do not hear people try to score political points very often on this debate. We all agree with the need for reform and new funding. Therefore, this will come down to what we believe is more important: investment in mental health services and youth mental health services or further tax cuts. That is the choice. That is the choice that will be put to this House in October.

I will finish by reiterating that I wish the Minister of State the very best. She has a very difficult and hugely important job. The Social Democrats and I have every intention of engaging in a constructive way. We may end up disagreeing on how much money is required, with us looking for more, but I wish her the very best over the coming months and years in this role.

See this speech in context