Helen McEntee (Meath East, Fine Gael) | Oireachtas source

I move amendment No. 1:

To delete all words after “Dáil Éireann” and substitute the following:

"notes:— in line with the Programme for a Partnership Government, the Government acknowledges 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;

— the critical importance of prioritising mental health policy and service development;

— the need to increase the mental health budget annually during the lifetime of the Government, building on the substantial additional funding provided for mental health services between 2012 and 2016; and

— the need to further develop crisis and 24/7 responses, building on the investment to date in Acute Units and in supports at community level;

recognises that the Government is committed to:— continuing to implement A Vision for Change, in a manner which recognises geographical accessibility, in the spirit of both the Programme for a Partnership Government and the Confidence and Supply Arrangement;

— increasing the mental health budget annually during the lifetime of the Government building on the substantial additional funding provided for mental health services between 2012 and 2016;

— completing an evidence-based expert review of the current status of implementation in Ireland and of international best practice in the area of mental health;

— establishing an oversight committee within three months, to oversee the development of a new policy for mental health based on the outcome of the expert review; and

— directing the Health Service Executive to develop a multi-annual approach to the development of mental health services."

I welcome this debate as a chance to restate the Government's commitment to further develop and improve mental health services in Ireland. I have met voluntary, public and private organisations. Unfortunately, I have personal experience of losing a loved one to suicide. I do not think any one person in this Chamber is any more committed to this issue than the next person. We are unanimous on the need to work together to tackle this issue. I welcome the timely manner of this motion, given that next Monday, 10 October, is world suicide prevention day. I am conscious that many organisations and groups are holding events throughout the country. I thank all of those who are making an effort. In my own county, mental health week is being marked by those who are trying to reduce the stigma and to get people talking and raise conversations.

The Government recognises that we cannot afford to be complacent about mental health. That is why the Programme for Partnership Government includes a clear commitment to undertake to increase the mental health budget annually to try to build capacity in existing services and develop new services. Since 2012, an additional €115 million has been put into our mental health services. That equates to 1,150 new posts. The funding for suicide prevention has increased almost fourfold, from €3.7 million to €11.5 million in 2015. I think this reflects a deliberate decision to try to tackle this issue. Each suicide is one suicide too many. We need to continue to try to bring the figures down. Funding for mental health will continue to increase this year from last year's figure of €785 million to €826 million this year. That is an increase of 5.2%. While I agree that this is not half enough, I suggest that there has probably been more investment in mental health services in the past five years than there was in the previous ten years. This continued investment underscores the fact that this Government is focusing on the modernisation of our mental health services, in line with A Vision for Change, and is aiming to develop mental health policies and services that are, above all, person-centred and recovery-based. I think that is particularly important because for a long time, our services focused on treatment without considering the possibility that people might recover and go on to live, work and have happy and healthy lives in their communities.

It is obvious that financial commitment is not enough in isolation. It must be directed towards what is needed to effect real change. That is why the Government is committed to updating the policy set out in A Vision for Change. This process has commenced with an evidence-based expert review, which is focusing on the progress that has been made in implementing A Vision for Change and is reviewing the current delivery of services in Ireland. This report will take account of international best practice and will inform the next steps in the development of our policy, having regard to human rights, health and well-being. The tender for this review was awarded recently. The report will provide a solid evidence base to determine the policy direction for the revision of A Vision for Change and provide a basis for further service development in this area to help to shape future policy. When A Vision for Change was launched in 2006, it highlighted many areas where attention needed to be increased. A Vision for Change was undoubtedly affected by a number of factors in recent years, including the changed economic context, the constraints on public spending and, most important, the moratorium on recruitment, which probably had the greatest effect. Recent years have seen investment in this area prioritised and significant reforms made.

One suggestion in A Vision for Change was the provision of State-wide 24/7 crisis intervention adult mental health cover. Services are provided to those in need of urgent care. I agree that they are not perfect and we need to continue to improve them. The interlinked components across the services include community mental health teams, which we have been building on. I acknowledge that not all of these teams are full. The staff of these teams are working to the best of their ability. They are able to respond to crises during normal working hours. These teams have established pathways of contact for existing patients, while other individuals can be referred through their GPs. All of the mental health teams keep slots for urgent referrals and emergency cases, for example when people are acutely suicidal or severely depressed. An individual in crisis may present to an emergency department outside of normal working hours. The mental health division has now ensured that all level 4 hospitals have a liaison psychiatric service available on the site of the acute hospital. This service provides prompt assessments in emergency departments. Most level 3 hospitals now have a service in place or one planned. Recruitment is taking place for the planned services. Where a liaison service is not in place, the local service has an alternative arrangement whereby the person is assessed by a liaison nurse, or else the on-duty consultant provides that advice.

While I acknowledge that dual diagnosis is a problem, a clinical programme is being established and worked on. We have appointed a national clinical lead in that area. I hope we will develop that, particularly in our accident and emergency units, as a means of providing additional support. Another example of this is the national clinical programme for the assessment and management of self-harm in emergency departments, which began in 2014. We often speak about suicide, but self-harm is actually an equal if not a greater problem throughout the country. The national clinical programme has trained and deployed 25 senior mental health nurses at clinical nurse specialist level to emergency departments around the country. This facilitates an onsite, rapid response to those who have self-harmed or are suicidal. It supplements and works with the liaison psychiatry services to provide a bespoke response to those who are suicidal or have self-harmed.

There are other measures to note, such as consultant psychiatrists being on call outside normal working hours. This is another example of a service that has been affected by a lack of staff and the moratorium on recruitments. The consultants who are working in this area, together with the psychiatric registrars or senior house officers on duty in acute hospitals, provide an urgent crisis response to people who present to emergency departments. In line with the focus of A Vision for Change on early intervention and community-based resources, approximately half the areas in this country offer a contact point for existing patients within the mental health service seven days a week. This is provided for existing patients who are thought to require additional follow-up, particularly on Saturdays and Sundays when there are no clinics operating.

5 o’clock

It is important that we ensure we get the seven day services working as best we can. The 24/7 services need to be our priority and our goal but we need to ensure we can provide a seven day service as well.

The motion specifically mentions crisis houses as an alternative to inpatient care. When discussing this topic we must bear in mind the fact that while A Vision for Change recommends the provision of crisis houses on a population basis, it does not detail the model of care or the specific role or functions of such facilities. Currently, the HSE mental health division is concentrating on the development of a seven day service focused around day hospital and home supports as a priority. It is crucial to match the needs of our population with the services that benefit them most. This approach is in line with the resources currently available to the HSE.

We need to look forward. We must acknowledge that we have a duty to prioritise where and how our services are delivered at present to ensure the provision of safe and evidence-based interventions. However, a good deal of progress has been made. Advances have been made through the implementation of A Vision for Change, including the closure of the vast majority of old institutions, the expansion of community services and funding of specialist areas. I acknowledge the need for continued attention and monitoring to help to ensure that we meet the needs. The review of the implementation of A vision for Change will assist this process, especially in light of the fact that many of the recommendations made in 2006 are based on the 2002 census, when we had a population of 3.9 million. We now have a population of 4.8 million.

We should focus on what is positive as well. Investment in mental health services in recent years has resulted in an increase in the number of staffing levels for adult, child and adolescent community mental health teams. It has helped in the development of specialist services, including those relating to forensics, eating disorders and mental health of those with intellectual disability. Additional investment has also helped us to commit to building a liaison psychiatry service to help develop community mental health services.

Recent data on admission rates from the Health Research Board show a decrease of 20% even though we have had an increase in people seeking services. However, I agree with the comments of Deputies in the sense that we need to continue to see these numbers decrease. In particular we need to focus on the recovery model. Earlier, I emphasised the need for people to understand that they can recover within their communities. This is vital to prevent their relapsing or coming back to hospital with the same problems.

Finally, I am keen to discuss the area of prevention. The programme for partnership Government states that we will establish a youth mental health task force. The task force has been set out. Often we discuss services but until we actually address the area of prevention we will be simply chasing our tails and always playing catch-up. The task force is asking simple questions. How can we align services at national level? How can we align community interaction at a local level? How can we get these strands working together in the best way to help build resilience within our younger people and to ensure they are equipped for everyday life? This would ensure we do not see the same numbers of people needing to or seeking to access these services. Until we deal with these questions, we will always have problems.

While I very much welcome the candid discussion on this critical issue, I call on Deputies to maintain sight of our common goal - ensuring that the mental health needs of our nation are best served. I look forward to the remainder of the debate and everything my colleagues raise today.

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