Mary Lou McDonald (Dublin Central, Sinn Fein) | Oireachtas source

I move:

That Dáil Éireann:notes that:

- 2016 marks the 10th anniversary of the publication of the Report of the Expert Group on Mental Health Policy entitled A Vision for Change, which laid out a pathway to progressive, modern and recovery-based mental health care in Ireland;

- despite plans for its complete implementation by 2016, much of the strategy is incomplete and many of its recommendations are still to be implemented;

- the crisis in our mental health service has been exacerbated by the failure to implement A Vision for Changein full;

- the current Programme for Government provides no significant detail on plans for the implementation of the reforms laid down in A Vision for Change; and

- there remains no state-wide 24/7 crisis intervention adult mental health service in this State, a major recommendation of A Vision for Change;

recognises that:

- without a 24/7 crisis intervention adult mental health service, the lives and health of people in mental health distress are being put at great risk;

- it is the responsibility of the State to ensure that those who need crisis mental health supports receive that support in a timely and efficient fashion in line with international best practice;

- 66 per cent of all people who are admitted to an Irish acute mental health unit are readmitted within 12 months and Ireland’s 30 day readmission rate is double that of the United Kingdom; and

- the alarmingly high rate of readmissions for mental health difficulties is due to a lack of outpatient community intervention services which are accessible and flexible; and

resolves that the Government must:

- publish within three months, an implementation plan for a seven-day-a-week adult mental health service in every catchment area to be completed within 12 months;

- open recruiting to employ a full complement of staff to provide a multidisciplinary team for these units which can also operate home visits seven-days-a-week;

- provide immediate funding for, and begin the establishment of, a crisis house in every catchment area as an alternative to in-patient care; and

- publish a detailed implementation plan for the full roll out of 24/7 multidisciplinary crisis intervention adult mental health services in every catchment area within 12 months.

I am pleased to move the motion calling for 24-7 crisis intervention mental health services to be delivered throughout the State. Over recent months I have traversed the country, North and South, meeting representatives of statutory bodies and non-governmental organisations as well as families and citizens who have helped to set up awareness programmes, help groups and local community initiatives to discuss issues around mental health and suicide prevention. Of most importance, I suppose, is that I listened to these people. The motion is very much directed by these ongoing conversations and is a direct consequence of meeting such a wide range of people. It reflects the most immediate concern expressed by all of them at the coalface of these issues, many of whom, I am very pleased to say, join us in the Gallery for the debate.

It is clear from our dialogue that we have much work to do in mental health. I could recite a very lengthy list of what must be done. However, the motion on the provision of 24-7 crisis intervention services reflects the most immediate concern of these groups and individuals. We have very consciously chosen to focus on this. I am aware that every deficiency in a service or euro not allocated to mental health causes distress and damage to those with mental health issues. However, the absence of 24-7 intervention services is the point where lives are lost. Lives have been lost.

We know crises do not occur during set hours and there is no timetable or schedule for a crisis occurring for somebody. By their very nature, crises are unpredictable and unexpected. They do not operate on a nine-to-five basis. As things stand, what may a person do if that person or someone he or she knows or loves is experiencing a serious mental health crisis? There are few options out of hours. The person may go to the Garda and many have done so. The person may go to the accident and emergency department. Many have done this and will continue to do so. Neither of these options remotely offers the appropriate care that is required.

I have mentioned before a young man called Ryan Dempsey. I raised his case in this Chamber. Ryan's case epitomises the absolute and immediate need for 24-7 crisis intervention services. Over six months, he repeatedly presented to accident and emergency services because of suicidal ideation or having self-harmed. He was discharged repeatedly within hours. On his last presentation to an accident and emergency department he self-harmed and, having been left in a ward on his own, he died by suicide. Ryan was not a unique case and others like him require psychological help as well as emotional and social support. This cannot be provided by An Garda Síochána and it certainly cannot be provided in a very busy and stretched accident and emergency department. People are left sitting for hours in an accident and emergency department, waiting for help, when they need immediate and special help in the here and now.

I acknowledge the work of mental health services where they exist but these are only available during office hours, five days per week. After hours service provision is still, sadly and disgracefully, the exception in this State. Our mental health services, as currently configured, are not functioning as required. In 2013, 11,000 people presented to accident and emergency departments having self-harmed. It is shocking that statistics indicate that more than one in five is a repeat attender for self-harm. Most are sent home after a few hours and many receive very little care. It is unlikely they will see follow-up.

We need more than general aspirations. We must be focused and get the ball rolling. We need to implement all of A Vision for Change, as that is clearly what all stakeholders and families, among all of us, wish to see. For today, for the purposes of this debate and motion, we want an agreed position on 24-7 crisis care being made available, with an implementation plan within three months and the services being rolled out over the course of 12 months. That is the essence of our motion.

I again welcome the families in the Gallery. I do not know if Fran Dempsey, Ryan's father, is here but I know there are other family members here. They are most welcome and I look forward to a productive and hopeful debate. I also hope there will be universal support for what is a very specific and focused motion.

See this speech in context