James Browne (Wexford, Fianna Fail) | Oireachtas source

I move:

That Dáil Éireann:

notes:

- the commitment in Appendix 1 of the Confidence and Supply Arrangement for a Fine Gael-led Government to fully implement A Vision for Change in the area of mental health; and

- that the Confidence and Supply Arrangement votes are dependent on the full implementation of the policy principles attached to this document;

further notes that:

- the July 2016 Estimate from the Department of Health indicated that the required resources needed to fully implement A Vision For Change are €177.3 million or €35.4 million per annum over five years;

- in 2017 the funding committed for new developments is just €15 million;

- such an increase would represent only a 1.8 per cent investment in new developments for mental health compared to the 2016 Budget; and

- even including the €9.7 million announced for increased pay rates in mental health services, this represents an increase of just 3 per cent in revenue funding for mental health, much less than the 7.4 per cent increase in revenue spending for the health budget as a whole; and

calls for:

- an urgent review of the Government’s decision to allow just 1.8 percent in additional spending in 2017 for mental health care improvements;

- a multi-annual plan to be published within three months outlining how the commitment in Appendix 1 of the Confidence and Supply Arrangement for a Fine Gael-led Government to fully implement A Vision for Change will be realised;

- any such plan to include a provision that all and any monies allocated to mental health, and that go unspent within a financial year, be carried over to the following year and not be returned to the exchequer and/or expended elsewhere; and

- any successor strategy arising out of a review of A Vision for Change to incorporate this multi-annual plan.

I wish to share time with Deputies Kelleher, Troy, Murphy O'Mahony and Aindrias Moynihan.

I am pleased to move this motion, which seeks an urgent review of the funding allocation to mental health in the recent budget announcement and a detailed plan on how the Government intends to meet its commitments under A Vision for Change. This is the third debate on mental health since the Government was formed. This in itself is welcome and demonstrates an increased awareness of mental health on all sides of the House. It would be difficult to imagine so many debates on mental health occurring even in the recent past. However, we must move beyond debates and towards implementation. Since my appointment I have met, and continue to so do, many individuals, families and groups that have been affected by mental health issues. Their bravery in the face of adversity and frustration at the lack of supports is only too evident. Equally, I have met many members of staff working in mental health services who lack the necessary supports, are over stretched and under appreciated. They feel ignored, forgotten and abandoned, just like the service users.

Fianna Fáil in agreeing to facilitate a minority Government inserted into the confidence and supply agreement a condition that A Vision for Change would be fully implemented within the lifetime of a Government. Appendix 1 of the confidence and supply arrangement commits to implementing fully A Vision for Change. Confidence and supply arrangement votes are dependent on the full implementation of the policies in that document. We agreed to facilitate budgets consistent with the agreed policy principles in the document, which runs over the full term of government of five years. Modern mental health reform began in this Chamber when Deputy Micháel Martin brought forward the Mental Health Act 2001. That Act was the first reform of mental health legislation for more than half a century. The Act radically changed how people with mental health illness were treated. In the decades prior to 2001, mental health attitudes were all too often mired in stigma, prejudice and alienation. Thankfully, they are less so today, but work still needs to be done to continue to challenge attitudes towards mental health. The main objective of the Act was to address the civil and human rights of mentally ill persons while additionally putting in place mechanisms by which the standards of care and treatment in our mental health services could be monitored, inspected and reviewed. In addition, the creation of the Mental Health Commission in April 2002 created an implementation body to ensure that the intention of the Act was fulfilled.

Following on from this reforming Act, A Vision for Change was developed under the then Fianna Fáil Government as a strategy document which sets out the direction for mental health services in Ireland. It describes a framework providing and supporting positive mental health across the entire community and providing accessible, community-based, specialist services for those with mental illness. It had broad support from patient groups and medical professionals and across the political divide. It is based on a recovery model that seeks, where possible, to keep those with mental health problems centred in their communities and to retain their involvement in their family and social circles. While the document may be in need of updating, the principles it was founded on and its fundamentals remain sound. It is ten years since A Vision for Change was published in 2006. Its terms were meant to be implemented by 2016. To date, barely 75% of that vision has been met, but for old age psychiatry, it is 53%; in the area of child and adolescents, it is barely 52%; and for persons with disabilities, it is a shockingly low 19%. It is clear that the more vulnerable you are, the fewer supports you get.

We must arrive at a point where the HSE treats the head and the heart with equal respect: a stage of parity of esteem between mental and physical health. Mental and physical health are fundamentally linked. There are multiple associations between mental health and physical conditions that significantly impact people’s quality of life, demands on health care and other publicly funded services. The World Health Organisation, WHO, defines health as "a state of complete physical, mental and social well being and not merely the absence of disease or infirmity". The WHO states: "There is no health without mental health." Understanding the links between mind and body is the first step in developing strategies to reduce the incidence of co-existing conditions. People with serious mental health conditions are at high risk of experiencing chronic physical conditions. People with chronic physical conditions are at risk of developing poor mental health. A person who presents with a broken arm is not turned away, and someone who has the courage to speak out about his or her mental health should be given equally urgent care. We do not put a limit on the care a person with a physical injury is given. We do not, for example, say to people who have suffered a broken arm that they are only entitled to eight hours of medical care and stop treating them when the plaster of Paris is only half on, but this is done in mental health care when people are limited to eight hours of psychological help.

It is acknowledged that the Minister of State has an incredibly difficult task on her hands, and has only been in her position for a few months, but the task she faces cannot be met if she is not given the necessary resources to implement the change that must be brought about. Responsibility in this regard lies with the line Minister, Deputy Harris, who has failed to fund mental health adequately. However, there is a responsibility on the Minister of State to ensure the senior Minister hears the voices of those suffering from mental health issues and to give a voice to the voiceless. In response to parliamentary questions I tabled during the summer, the Minister stated the required amount to implement A Vision for Change fully is €35.4 million per annum. In budget 2016, the Government announced the provision of €35 million, only subsequently to withhold €12 million. Following the reneging on its promise and due to public and political pressure, the Government was forced into an embarrassing U-turn. In the budget, the Minister for Health pledged to increase funding by €35 million for mental health, a sum that was welcomed only for that sum to ring hollow just a week later when under questioning from Fianna Fáil Deputies during statements on mental health, he confirmed that only €15 million of the announced €35 million was available for spending in this year. This was a spectacular U-turn by the Minister, Deputy Harris. The Government has essentially halved the funding earmarked for mental health services next year. This is despite the fact that there has been significant underfunding and underinvestment in mental health services in recent years. The reason given is there will be a time lag in hiring staff but even if this is the case, there is no reason the differential moneys could not have been spent on one-off programmes this year.

Significant work is needed to bring our mental health services up to standard. This cannot be achieved without adequate funding. Currently, the Government is planning to increase mental health funding by a measly 1.6% in 2017, as opposed to a 7.4% funding increase across the health sector. This clearly shows that mental health services simply are not a priority for this Government. Fianna Fáil remains committed to implementing fully the A Vision for Change road map for mental health services. In that respect, the motion seeks to compel the Government to do that which it appeared it was not prepared to do voluntarily, which is to carry out an urgent review of mental health funding, set out a clear pathway for delivering the outstanding elements of A Vision for Change within the lifetime of this Government, and guarantee the ring-fencing of the mental health budget. I welcome the Government’s intention to support the motion, but we need implementation. The HSE, in particular, seems to suffer from a serious condition - implementation deficit disorder. Let us not have the motion sit on top of a long list of reports that have not been implemented.

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