James Browne (Wexford, Fianna Fail) | Oireachtas source

I move: "That the Bill be now read a Second Time."

I am happy to move Fianna Fáil's Mental Health Parity Bill 2017 on Second Stage. This Bill, if enacted, will compel a conceptual shift in attitudes and behaviour towards mental health at the highest level of policymaking and governance within the Department of Health and, consequently, the Health Service Executive, HSE.

Fianna Fáil’s Bill establishes, on a legislative basis, the principle of parity of esteem of our physical and mental healthcare and identifies a legal mechanism for the Minister to compel the implementation of this principle. This Bill, if enacted, will place a legal duty on the Minister for Health to promote health parity and to ensure all organisations within our health system meet parity obligations in regard to mental health.

Ensuring access to timely and appropriate treatment for people with mental health needs on a par with physical health is a major policy concern for the Fianna Fáil Party. The overarching principle of parity of esteem is that of equality. It means, among other points, equality of access to care and treatment, equality of efforts to improve quality of care, and equality of levels of choice of care and treatment. It means the allocation of time, effort and resources on a basis commensurate with need, that mental health has equal status within healthcare education and practice, and that there is equal status in the measurement of health outcomes. It means also that the stigma and prejudice about mental health care and treatment is tackled head on, that there is an understanding, acceptance and execution of the principle that our physical, mental and social health are inextricably intertwined and interdependent, and that there is no health without mental health.

One of the key motivations for bringing forward this Bill now is the downgrading of mental health services within the HSE. A Vision for Change requires the appointment of a mental health directorate, yet the HSE recently abolished the role of the national director of mental health and has reverted to the old system of separating strategy and budget responsibility within mental health services. That did not work in the past and it is difficult to understand why it is believed it will work this time.

The reality is that the relationship of mental health is that of Cinderella to the Department of Health and the HSE. It is ignored for the most part, regarded as something other or lesser, and is the first to be treated badly in difficult circumstances. That is reflected in the fact that for some time now the investment in mental health as a proportion of the health budget has been decreasing. There is ample evidence that if we place mental health on a parity with physical health in our policies and in our healthcare system, we will improve outcomes for mental, physical and social healthcare.

The Government consistently says it has been doing all that it can, but the facts speak for themselves. To provide the Minister with some recent examples, we still have a significant number of children being placed in adult units, some for up to six weeks at a time. Sometimes they are placed in chairs and at other times they are placed in hallways. The recent report from the Mental Health Commission highlighted the fact that it still does not have the powers to regulate community mental health residences, a power that the Health Information and Quality Authority, HIQA, has in respect of similar non-mental health residences. We have patients being kept in prisons due to a lack of space in adult units. We have a chronic problem of mental health issues linked to social media such as cyberbullying and body dysmorphia, yet there is still no appointment of a digital safety commissioner.

We have the revelation that we spend €400 million on psychotropic medicines and only €10 million on community psychology. Our mental health system seems to be geared towards triage and crisis intervention. This is particularly acute in children’s primary care psychology and child and adolescent mental health services, CAMHS. We know that 50% of mental health issues arise before a person turns 14, and 75% arise before they turn 25, yet early intervention for young people is limited, inconsistent and ad hoc. There is clearly a mental health treatment gap with a very significant unmet need in terms of access to care and treatment. That gap must be closed.

It is obvious that the mental health area is underfunded, and not just in real or relative terms. It is also underfunded relative to its potential impact. By that I mean that there is evidence that investment in certain early interventions can save more money than the interventions cost.

As stated earlier, this Bill, if enacted, will establish on a legislative basis the principle of parity of esteem of our physical and mental healthcare and will place a legal duty on a Minister for Health to promote that parity. I implore Members on all sides of the House to support the Bill.

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