James Browne (Wexford, Fianna Fail) | Oireachtas source

I am sharing my time with Deputy Robert Troy. We have five minutes each. By agreement, we will share the remaining two minutes with Deputy Michael Fitzmaurice.

I welcome the opportunity to discuss mental health in the Chamber. The promotion of mental health and well-being in addition to the provision of services for those suffering or affected by mental illness must be a priority for us all. I welcome the many mental health spokespeople and family members in the Gallery today.

Mental health issues continue to inflict immense damage on our community. Depression, anxiety, addiction and self-harm are profound and great problems in our society and have been for a long time. No family is untouched by mental health issues. For example, we know from an Irish Creamery Milk Supplier Association survey that 51% of farmers have been directly affected by suicide. That is only one section of our society. I have no doubt this is reflected throughout every section of Irish society.

We have successfully confronted dangerous challenges like this before, when people said it could not be done, for example tackling road traffic accidents. We need a similar national platform to address mental health issues.

Suicide is preventable. It was said earlier that it was okay not to be okay and that it was okay to say as much as well. A breakdown in services and access to specialist treatment is all too often a common feature, as attested by the brave families who have told their stories in recent times. More and more, families are stepping out to tell their stories. Our mental health services are under-funded and under-resourced. Disarmingly, the service a person receives can be totally dependent on the county he lives in. A type of post-code lottery applies. We are all too aware of this in my county of Wexford, where the population is ostensibly under the care of Wexford and Waterford mental health services. However, when people present with mental health issues in Wexford they suffer discrimination in terms of a lack of availability of specialist assessment. They are assessed by a triage nurse over the telephone whereas those in Waterford get specialist treatment in person. This highlights the inadequacies, differences and inconsistencies from county to county throughout the country.

Since my appointment as the Fianna Fáil spokesperson on mental health I have had the opportunity to discuss the issues around mental health and access to services with leaders in the field of medicine, practitioners, nurses, other providers, volunteers, sufferers and family members. They have provided me with the necessary information to advance the cause of mental health.

One of the big issues facing patients with mental health problems is that they are seen in overcrowded emergency departments with little or no privacy or confidentiality. They have to wait excessive periods to be seen and they are exposed to constant noise, light and stimulation. Emergency departments should have a designated safe psychiatric area, away from the main emergency department to allow people to get confidential treatment. I will read out extracts from an e-mail sent to me by a lady who came in to my clinic two weeks ago. This lady is available to meet the Minister of State provided her identity is kept secret. She has given me permission to read these extracts. She said:

I took an overdose of paracetamol in an attempted suicide. For about half an hour I felt very dizzy and nauseous. My nose dried up. I could barely breathe and my heart was pounding through my chest. I felt like I was going to be sick but could not get sick, nor could I fall asleep. In fact, my mind was never more alert and was racing faster and faster. I took the overdose thinking I would die fast. But I did not. And I could not take the pain in my chest and stomach any longer, so I went to CareDoc and I was advised to go to Wexford accident and emergency, where I went.

Eventually she was seen in Wexford accident and emergency department and admitted to a six-bed ward. In the morning she woke up in the six-bed ward. She goes on to say:

I was very uneasy about this as I was extremely upset and dealing with a lot of anxiety after an attempted suicide. To have to fix yourself up and not look as if you have been crying all morning as quietly as you can so people can't hear you is very distressing for someone in my situation. Shortly after breakfast the doctors done their rounds. You could pretty much hear what they were saying to each patient as they went around, not exactly everything, but I could still tell you what was wrong with each patient in the room that day. This meant they would hear that I had taken an overdose and this really panicked me.

Eventually she was released from hospital. She was given a referral letter to give to her general practitioner. She told me she never had any contact from the GP. Two days later, she received a bill from the hospital for an overnight stay. It was another two weeks before she got a date for a referral, two months down the line, for psychological services. The bill came first.

I do not hold the Minister of State personally responsible for that individual situation. I realise the Minister of State can relate to that story. However, we must take steps to address these gaps. These are not extremely costly gaps to address either. It simply requires arrangements in hospitals whereby there are proper referral systems. Again, I do not hold the staff in the hospital responsible - they are stressed all the way out the door - but there are simple things we can do. Sometimes we have to get away from the idea of big strategies and reorganisation of the health system. We need to start looking at the simple things that can be done to alleviate people's problems, because these problems have serious consequences.

I want to address the situation with regard to children in particular. In Ireland, one in four of the population is under 18 years of age. Yet, at the end of 2015 the HSE had a total of 600.95 whole time equivalent staff working in children and adolescent mental health services, some 51.6% of the staffing levels recommended in A Vision for Change.

This is insufficient for our mental health services and must be addressed as a matter of urgency. We know that the inadequacy of current provision can have serious knock-on effects. For example, the Mental Health Commission reported earlier this year that the lack of provision of emergency assessment by a CAMHS team in respect of children presenting at emergency departments and adult units is one of the factors contributing to the continuing high number of admissions of children to adult units. The practice of admitting children to adult psychiatric units is one we all want to see end. The provision of a 24-hour emergency CAMHS service in all community health care organisations, CHOs, and the proper resourcing of CAMHS community services is fundamental to achieving this. It will not, however, be possible with such a low staff complement. We need a child-centred approach, the availability of direct access to seven day a week crisis intervention mental health services with outside office hours and specialist telephone support in every catchment area. That is only for a start. Ten years after the publication of A Vision for Change, we have only 75% of the staff required and in the CAMHS only 51%.

Today, I followed up on a situation that I raised during the summer involving a girl who was aged three and a half years when an aunt she was very close to died. She was a lively girl but went into a state of depression afterwards. During the summer, I pointed out that she had been on a waiting list to be seen for 18 months. Last week, she got a letter from the psychological service informing her that it does not cover bereavement. It took 18 months to get a rejection. Yesterday we met Hospice Ireland which told us about the importance of mental health support in end of life situations. It is unbelievable that bereavement does not merit mental health supports. If that is the case, it should be covered. The child turned five a week ago. It is ridiculous that she had to wait 18 months to be told that the service did not cover her.

In the 1980s, approximately 12% to 13% of the health budget was spent on mental health but that figure is now barely over 6%. I am told but I do not know if it is true, the Minister of State might be able to confirm it, that the dedicated section for mental health funding in the HSE will be subsumed into a broader budgetary process. I read that simply as meaning that the HSE is fed up with people in here pointing out that while money is allocated to it for mental health in the budget it is not being spent. This will make it almost impossible to track where mental health spending is going. Will the Minister of State confirm that is the case? We have to track the funding for mental health services.

There is a confidence and supply agreement between Fianna Fáil and Fine Gael to facilitate a Fine Gael minority Government. The preamble to one of the terms in the agreement states that the confidence and supply votes are dependent on the full implementation of the policy principles attached to this document, appendix 1. One of the terms within appendix 1 refers to full implementation of A Vision for Change in the area of mental health. It does not say "prioritise", "facilitate" or "look at" but "implement". I am somewhat concerned by some of the things I am hearing from the Department of Public Expenditure and Reform in the last day or two that suggest mental health services are not being taken seriously when it comes to funding. It is the little things that bring down governments. I am very concerned that the Minister for Public Expenditure and Reform, Deputy Donohoe, and the Department see mental health services as a little thing.

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