James Browne (Wexford, Fianna Fail) | Oireachtas source

I congratulate the Minister on his appointment. I welcome the proposal to establish an all-party committee to devise a cross-party agreement on a long-term vision for health care and health policy. Fianna Fáil will support the motion which seeks to build a cross-party consensus on health. We believe in a publicly funded and delivered health care service that emphasises patient care above structures. We are also committed to making primary care the bedrock of the health system. For too long, the country's health care system has been based on fire-fighting. We welcome the intention to agree a strategic plan to address these issues. The current health system is neither fish nor fowl. It is neither public nor private. We often hear about the two-tier health system, but we know that there are many more tiers. There are separate tiers for medical card holders, GP-only card holders and the working poor who are not entitled to any kind of medical card or support, even though they cannot afford private health care. It is important that this new committee is not used as an excuse for inaction by the Department of Health. There are many obvious, acute and immediate failings in the system.

Discrimination in service provision based on one's address is particularly insidious. I will talk about the area I know. Wexford psychiatric services are tied in with the services in Waterford. A person in Wexford who has an acute psychiatric event is not allowed to go to the emergency department in Waterford, even though he or she is living in the Waterford-Wexford area. He or she has to go to the emergency department in Wexford. If this happens out-of-hours, the person in question will be seen by a triage nurse who will contact the service in Waterford by telephone. If a psychiatrist in Waterford can be contacted, an assessment will be made over the telephone. If the person is refused at this point, he or she will be sent home after spending three, four or five hours in the Wexford emergency department. If he or she is accepted, he or she will have to travel to the emergency department in Waterford and spend another three, four or five hours waiting to be seen by a psychiatrist. That psychiatrist will have to make a decision on the basis of whether the person's case deserves to be prioritised over those of others who need to be admitted, rather than on the basis of whether he or she needs to be admitted. If he or she is not admitted, he or she will be sent back home into the care of his or her family if he or she is lucky enough to have family to take care of him or her. Otherwise, he or she will just be cut loose.

The admission of children to adult psychiatric units needs to be dealt with immediately. The Mental Health Commission's reports on approved centres were released a few days ago. The commission reported that nine children had been admitted to an adult centre at St. Luke's Hospital in Kilkenny and were, therefore, placed at high risk. According to the report, "the approved centre was deemed non-compliant as there was no evidence of required Children First training or any other relevant training for all staff". This centre "was not suitable for the admission of children", but they were admitted nonetheless. As far as I know, this was not the first time the centre in question was deemed to be insufficient. We are continuing to admit children to high-risk facilities. I accept that the parents of these children signed consent forms, but I suggest they did so out of desperation and under duress.

I would like to speak about some other issues that have been highlighted in the reports on mental health approved centres. Some hospitals have no toilet rolls. Others have no shower facilities, or have facilities that are covered in mould. All of these issues could be addressed quickly and readily without the need for a committee to report. The lack of services for children with disabilities is another such issue. There is a shocking lack of the availability of services for children who need speech and language therapy. A significant part of mental health suffering is related to connectedness - people need to feel a connection to those who love them. If they feel isolated, it can develop into mental health problems.

Many young children cannot access the speech and language therapy they need to enable them to communicate. I am talking about children who might have other issues. If they could develop their speech and language facilities, at least they could communicate with their parents and families. The same parents have to fight for everything. People have to wait up to two years for needs assessments. They might have to wait another two years after that to access inadequate services. Bizarrely, they are the lucky ones. There are many conditions the HSE simply refuses to recognise. It seems to have a policy on health conditions that are treated with medicinal creams. Children with rare conditions such as ichthyosis need significant care and support from their parents. Many children and adults need to have medicinal creams applied to them three or four times a day. In some cases, they have to sleep in bandages. People in such circumstances have to go back to their GPs and the HSE every three months to beg for medical cards. It seems that they are deemed eligible for short-term medical cards only. DNA testing can be used to identify the conditions to which I refer. It is easy to prove that someone has one of these conditions which cannot be cured. Across the water in England, people with these conditions receive all the services they require as if they had any other medical condition. We are refusing to recognise them in the same way. Ultimately, any health system must be rights-based and have regard to availability and need while taking account of ability to pay.

I would like to speak about the role of the proposed committee in the area of mental health. Fianna Fáil believes any attempt to devise cross-party agreement on a single long-term vision for health care and the direction of health policy in Ireland must prioritise mental health and well-being. Our vision is built on five key principles. First, public policy ought to ensure people with mental health problems are included in society and enabled and assisted to play their part in it. Second, the recovery model of mental health care is the most appropriate in terms of the well-being of individuals and enhancing their ability to defend themselves as citizens of the country. Third, mental health should be taken as seriously as physical health in the deployment of resources and other areas such as health and safety and planning. Fourth, there should be an emphasis on early intervention and early action. Most mental health conditions are readily treatable if there is early intervention.

Even when they reach crisis point, as I have outlined earlier, the supports are not there.

Fifth, mental health policy must be mainstreamed across society in order to promote mental health well-being and to lessen the risks to mental health. There has already been a ten-year plan for mental health that had cross-party support but it has not been fully implemented. As we all know, that plan was A Vision for Change. Its time is nearly up but it needs to be fully implemented while a review is carried out as to what to do for the next ten years. It needs to be integrated into the overall health policy. Ultimately, we need to reach a point where mental health is not distinguished from health and is treated with the same respect.

Over the last number of years, community care teams have not delivered on the partnership approach and have instead moved the services that were provided in the hospital out into the community in a "ward in the community" approach, with treatments still being primarily limited to classic psychiatric-led treatments. Mental health policy is in need of a reboot in 2016. Fianna Fáil believes that Government should carry out a full review of what is still left to be achieved and commit to the reinstatement of a plan to achieve that in the period 2016-26, taking into account any deficiencies identified in A Vision for Changeby a review group. The Government needs to ensure that the critical feature of that review will be the holding of a mental health summit of all key stakeholders and must direct the review group to consider placing particular attention on the need to stress non-medical approaches to dealing with mental health issues, including talk therapies such as cognitive behavioural therapy.

The Government must ensure that the recovery model's ethos is placed at the centre of mental health policy as expressed in the policy document that will follow and build on from A Vision for Change. It must re-establish the implementation review group to issue regular reports on the progress in delivering the 2016 to 2026 plan. A Vision for Change envisioned a partnership model between health professionals and service users that would have an equality of respect at the heart of its approach. This has not been followed through, with a regression from initial progress in that respect. Service users need to be put at the centre of any future programme. Access for 24-7 crisis supports for all ages needs to be delivered irrespective of geography.

My central point is that mental health must be a fundamental part of this new committee that is put together and not simply shunted to the side.

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