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

I begin by thanking Deputy Browne for introducing this motion. I welcome today's debate as an opportunity to restate the Government's commitment to our mental health policy and to the continued development and improvement of our mental health services. I am pleased to have this opportunity to speak on the action that has been initiated, and continues to be advanced, on this issue.

In recent years, there have been welcome changes in the area of mental health. We have witnessed a significant shift in our society's willingness to discuss and address mental health issues. It is now recognised that there is no health without mental health. This has been reflected in the Government's approach.

Mental health has been shown to be a priority care programme 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 permitted us to approve about 1,800 new mental health posts over this period. This is a significant investment by any standard and the Programme for a Partnership Government gives a clear commitment to increase our mental health budget annually, as resources allow, in order to expand existing services. Budget 2018 made allowance for an additional €57.5 million for mental health services for 2018. This funding will help us to build on the work commenced in 2017 on the enhancement of community teams for children, adults, later life and mental health intellectual disability services.

A Vision for Change, published in 2006, set out a ten-year policy framework for Ireland's mental health services.

It recommended that interventions should be aimed at maximising recovery from mental illness, building on service user and social network resources to achieve meaningful integration and participation in community life. It was welcomed as a progressive, evidence-based policy document that guided the development of our mental health services towards a new model of service delivery, one which would be service user-centred, flexible and community-based.

A Vision for Change highlighted many areas which were in need of increased attention in the shift from a service with an institutional focus to a community-based service. Implementation of A Vision for Change was undoubtedly affected by a number of factors after 2006, including the changed economic context, public spending constraints and the moratorium on recruitment. However, recent years have seen investment in this area prioritised and significant advances made in the reconfiguration and delivery of services.

In line with A Vision for Change, our focus continues to be on building the capacity of community mental health teams across all areas to facilitate the move from the traditional institution-based model of care to a more patient-centred, flexible and community-based service, where the need for hospital admission is greatly reduced while still providing inpatient care, as appropriate. Progression in other priority areas is also ongoing, such as the continued move towards the delivery of a full 24-7 service, work in the psychiatry of later life, perinatal mental health, ADHD in adults and children and dual diagnosis of those with mental illness and substance misuse.

While much of A Vision for Change remains relevant, its term came to an end in 2016. The Government recognised the need to update the policy in order that we can be assured we are adequately meeting the current mental health needs of Ireland. The establishment of the oversight group was agreed prior to the establishment of the Joint Committee on the Future of Mental Health Care. The commitment to review A Vision for Change policy was referenced in a Private Members' Bill speech on 15 November 2016. In addition, I understand that the review of the A Vision for Change policy is noted in the joint committee's own terms of reference.

With this in mind, the Department published a request for tender in August 2016 for a review and analysis of international evidence and best practice in the development of mental health services, including a review of current delivery of services in Ireland. In September 2016 this external evidence and expert review was commissioned from WRC Consultants as the first step in determining the parameters of a revision of A Vision for Change. This review was completed on 17 February 2017 and provides evidence to inform the policy direction for a revision of A Vision for Change, both in terms of international best practice and the experience of implementing A Vision for Change. An independent chairperson, Hugh Kane, was appointed in July 2017, with oversight group membership finalised in October 2017.

This oversight group is responsible for producing a high-level policy framework which sets out future service priorities. The group is overseeing the development of a refreshed policy for mental health based on the recommendations arising out of the expert review and other documents. The policy review process will also involve consultation with key stakeholders, which is due to take place in the coming weeks. The oversight group is scheduled to have completed its work by December 2018.

Concurrent to the progress of a review of A Vision for Change, on 13 July 2017 the Dáil agreed to establish a new Joint Committee on the Future of Mental Health Care. While all-party agreement exists on A Vision for Change, the committee was established with the aim of achieving cross-party agreement on the implementation of a single, long-term vision for mental health care and direction of mental health policy in Ireland. Upon establishment, through the terms of reference the committee formally recognised that the Department of Health was simultaneously conducting a review of A Vision for Change. The terms of reference also commit the committee to examining the implementation of A Vision for Change, the current integration of delivery of mental health services in Ireland, the availability and accessibility of services and supports and alignment of services and supports, the challenges in the recruitment and retention of skilled personnel and the efficacy of establishing a permanent mental health Oireachtas committee.

To this end, I would like to recognise the substantial amount of work that has been completed thus far by the committee. The first interim report recognises the need for a collaborative working relationship between the Oireachtas committee and the oversight group and I am aware that a copy of the work plan issued to the committee in March of this year. While not the subject of this discussion, I understand there has been recent criticism about the relationship between the oversight group and the committee. It should be noted that both I and the Minister, Deputy Harris, have appeared before the committee, along with the chair of the oversight group, Mr. Kane. The joint committee has expressed concern that the HSE was not in a position to provide detailed financial analysis on how mental health funding was being spent and I welcome the committee's recommendation that proper systems be put in place without delay in order that detailed information can be made available.

Both the Department of Health and the oversight group are committed to obtaining the best possible future for Ireland's mental health care. I know the committee shares this sentiment and vision. It is through working together and supporting each other's work that this outcome will be achieved. Going forward, I hope this is where the focus shall be.

I would ask that today we maintain sight of our common goal of ensuring that the mental health needs of the nation are served in the best manner. The Government continues to be committed to the development of a high quality, person-centred mental health service. I welcome open and positive discussion on this important area and I look forward to the suggestions and constructive comments from the floor.

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