Jim Daly (Cork South West, Fine Gael) | Oireachtas source

I fully support the contention that as a Government and as an Oireachtas, we must continue to do everything we can to address the mental health issues faced by many of our citizens. I am sure all Members of the House agree that we must prioritise our work on enhancing mental health and well-being. I acknowledge Deputy Browne’s commitment to maintaining a focus on mental health. I assure Deputies that the Government will continue to promote a comprehensive health service that is designed to secure improvements in the physical and mental health of all our people.

The stated aim of the Mental Health Parity Bill 2017, which is sponsored by Deputy Browne and was published on 26 September 2017, is to place mental health on a par with physical health with a view to securing improvements in physical and mental health and in the prevention, diagnosis and treatment of physical and mental illnesses. The Government does not oppose the Bill in principle. While the maintenance of the equal status enjoyed by mental and physical health in the health care system is a laudable and desirable objective, the Government has some concerns about the legislation that has been proposed. Its aims are general and aspirational in nature and appear to differ from the background to and stated purpose of the Bill as set out in the explanatory memorandum. In its current form, the Bill raises serious questions regarding how we can achieve the aims that have been set out through additional legislation.

The World Health Organization's definition of health, which has not been changed since 1948, provides that health is "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". This broad holistic definition of health recognises the interconnectedness of the various factors that contribute to overall health and does not seek to prioritise any one factor over another. Under the Health Act 2004, the purpose of the HSE is "to use the resources available to it in the most beneficial, effective and efficient manner to improve, promote and protect the health and welfare of the public". The same Act clarifies that the HSE "shall manage and shall deliver, or arrange to be delivered on its behalf, health and personal social services". This makes it clear that mental health is acknowledged as an inherent component of health and health legislation, part of and indivisible from the whole. Deputy Browne's Bill seems to refer to this in its effort to ensure "the Minister for Health shall continue the promotion of a comprehensive health service designed to secure improvements in physical and mental health".

Legislation must be clear and specific and should be, to the greatest extent possible, easily understood. The inclusion of policy aspirations in legislation is not generally regarded as good practice. The implications of such an approach can be difficult to predict. The possibility of unforeseen and potentially negative unintended outcomes must be borne in mind. It may be easy from a policy point of view to understand putting mental health services on a par with physical health, but what does that mean when it is put on a statutory footing? How do we determine in precise legal terms whether a service delivered for an individual in one context can be equated with another service delivered for another person in a different context? Does the existing legislative text not already imply that all health, both mental and physical, should already be delivered on an equal basis? If so, how is that to be measured?

In the limited time available to it, the Department of Health has not identified a model in other jurisdictions for legislating for mental health parity. The British Secretary of State for Health and Social Care has a legal duty to secure improvements in the physical and mental health of the people and in the prevention, diagnosis and treatment of physical and mental illness. It is not clear that the concept of parity could be given a legal basis and, even if it could, that it could be operationalised in light of the vast spectrum of illnesses that influence both physical and mental health.

Another of the stated aims of the Bill is to compel the integration of mental health services with physical health services. This is already legislated for in the Health Act 2004, which states that the HSE shall "integrate the delivery of health and personal social services". Over the last decade, there has been a move away from the traditional psychiatric hospital model to treatment in specialist units associated with acute hospitals. Ultimately, there should be a focus on achieving the best outcomes for people who are suffering from mental illnesses. I have concerns about whether a prescriptive legislative approach is an appropriate method of achieving that focus.

The draft Bill has not yet been discussed with Deputy Browne. Along with officials from my Department, I intend to meet the Deputy to discuss the aspirations of the draft Bill with a view to establishing whether and how an amended wording might be considered. We need to consider whether the stated aims of this Bill can be achieved by legislation, or are already being implemented more effectively through existing health policy. I will expand on the implementation of various initiatives in mental health shortly. While the importance of legislation cannot be overstated, laws in and of themselves do not heal people - only treatment and services can do that.

The Deputy hopes this Bill will result in mental health issues informing the highest level of policy making and governance. I assure him that mental health is and will remain a priority for the Government. Since 2012, approximately €200 million, or 28%, has been added to the HSE mental health budget, which now totals over €910 million. This extra funding has allowed us to approve approximately 1,800 new mental health posts over this period. Funding has been provided to recruit 114 assistant psychologists and 20 psychologists in primary care and 111 of those assistant psychologists have now been recruited. In addition, funding has been provided to increase the number of undergraduate psychiatric nurses by 130 per year. This will bring the total number of psychiatric nurses graduating each year to 400 by 2021.

A comparative positioning of Ireland internationally suggests that the percentage resource allocation today is close to the median level across EU member states. The Government is committed to increasing funding as circumstances allow. Of course there are challenges in agreeing what does and does not constitute mental health spending. If the percentage spend on mental health is to be increased, it may mean reducing the spend elsewhere in the health budget or increasing allocations to mental health far more than increases in all other areas over a fixed period of time. If the percentage of the overall budget assigned to mental health is to be ring-fenced, it opens the possibility for applications to ring-fence funding for other specific areas of care, such as cancer and maternity services.

As I have said, significant work is required to establish fully how robust legislation can be drafted that achieves the stated goals of this Bill while avoiding unforeseen and undesirable outcomes. This will be the focus of my officials' work in the immediate future. On the basis of these further discussions that will take place, the Government does not intend to oppose Deputy Browne's Bill at this time.

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