Brendan Ryan (Dublin Fingal, Labour) | Oireachtas source

I commend Deputy James Browne for his work on this Bill and express the support of the Labour Party for it. Ireland, and indeed the world, has come a long way in respect of mental health but a lot remains to be done.

It is poignant that we are discussing Second Stage of the Bill at this point, given that the Darkness Into Light event run by Pieta House takes place on 12 May, a little over a week from now. I imagine Members across the House will join me in praising this fantastic initiative which aims to raise awareness and funds for people suffering from mental illness. I encourage people to take part, if possible. I shout out to some of my friends, including Mick Matthews, Jackie Morrison and those involved in the Skerries Cycle Against Suicide group.

The intention of the Bill is to place mental health on a par with physical health. It is an important Bill which, if enacted, will bring Ireland further into line with international best practice in medicine. I hope it will be enacted soon.

Our goal should always be to treat a patient with a mental health issue with the same compassion and clinical excellence we would expect for someone with a physical health issue.

I am keen to reference some examples from overseas related to mental health parity or parity of esteem, as it is also known. In the United Kingdom the then NHS director for people with long-term conditions, Dr. Martin McShane, succinctly put the issue of parity of esteem for mental health on the table in 2014. He stated:

To me parity of esteem means tackling mental health issues with the same energy and priority as we have tackled physical illness.

It is about changing the experience for people who require help with mental health problems.

It is about putting funding, commissioning and training on a par with physical health services.

And parity of esteem is about tackling and ending the stigma and prejudice within the NHS which stop people with serious mental health problems getting treated with the same vigour as if they had a physical illness such as, say, diabetes.

That stigma can be demonstrated like this: if you fall down and break your hip, an ambulance will be with you in eight minutes to give emergency care at the scene before taking you to A&E. If, however, you suffer an acute psychotic episode in the street, you are just as likely to be attended by a police car and taken to a cell.

We must end the stigma associated so often with mental health. We must raise awareness of the importance of mental health care and recognise the inadequacies of how we have regarded mental health in the past. This means raising awareness within the NHS itself. And we must create parity for mental health care in reality – rather than just issuing rhetoric and paying lip service to it.

On 2 February 2011 the British Government published a 109 page report entitled, No health without mental health – a cross-government mental health outcomes strategy for people of all ages. The comprehensive document listed key achievements required to bring the NHS up to date in mental health care. The report references the fact that there are many interdependencies between physical and mental health. In principle, this is a departure from prior thinking, which suggested mental health was a separate and distinct area never truly considered to be on a par with physical health. The NHS mandate 2014 to 2015 directly states the objective of the NHS is to put mental health on a par with physical health. That is what the Bill also seeks to achieve.

In 2009 Harvard Medical School published an article entitled, Benefitting from mental health parity. The article referred to the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act 2008 which came into law in the United States on 1 of October in that year. Prior to enactment patients suffering from bi-polar disorder and schizophrenia were liable to vast costs. Many insurance plans now fully cover these illnesses.

The importance of the Mental Health Parity Bill 2017 is the proposed establishment of a legal commitment to have equal and due regard for psychiatric patients when provision is being made for improvements in the health service. In Ireland today we bear witness to children waiting 15 months to see a psychologist and, more generally, a total of 2,500 young people awaiting access to public mental health services. There is a crisis in the provision of child and adolescent mental health services. General practitioners are referring patients to a waiting list because there is a serious lack of immediate counselling services available. This, in turn, has a knock-on effect on the clinical outcome for these patients. A striking example arises in cases of moderate to severe depression, in which a combination of medication and psychotherapy is recognised as the optimum treatment. Owing to the lack of psychotherapists, a shortage of cognitive behavioural therapy specialists, an inability to fill vacancies for adult and child psychiatrists, as well as the shortage of other mental health care specialists, patients are often left solely on anti-depressant medication without the additional counselling intervention that has been proved to be beneficial in tackling the underlying issue. I am dealing with a mother who is at her wits' end because her son is being left on anti-depressant medication and nothing beyond. It is frustrating and unacceptable.

It is important to note that currently private health insurance cover has a focus on inpatient psychiatric care as opposed to care on an outpatient or community basis. For example, there is full cover available for inpatients in a psychiatric hospital up to 100 days per calendar year. There is a separate arrangement for people suffering from substance abuse. Often such persons are covered for 91 days in a five-year period. Depending on the insurance plan, patients who see mental health teams on an outpatient basis receive limited cover for outpatient expenses. For example, if an initial consultation fee to see a psychiatrist is €180, the patient may receive a refund of €60. Naturally, the crisis in child and adolescent mental health services is masked by this dependence on private care. If we are serious about seeing parity between physical and mental health, we need to drastically improve out-of-hospital mental health care servoces. Inpatient care is, by its nature, unsuitable to deal with all cases of psychiatric distress. Research into outcomes for patients strongly favours community-based care to treat certain classes of depression and other less serious psychiatric illnesses. We have heard much over the years about a shift towards care in the community. With the further development of primary care centres, I am hopeful psychiatric care will become integral to everyday medicine at a local level.

I alluded to the shortage of adult and child and adolescent psychiatrists and the fact that the HSE regularly advertised posts that were not filled. To tackle waiting times, we need to be more proactive in staff recruitment and retention. I could develop the point further, but I will leave it at that. I thank Deputy James Browne and look forward to serious engagement on the issue and enactment of the Bill.

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