John McGuinness (Carlow-Kilkenny, Fianna Fail) | Oireachtas source

I pay tribute to Deputy James Browne on the interest he has shown in this area since his election to this House. I am also aware of the Minister of State's support for change in this area. I served with the father of Deputy Neville who is sitting beside him. Dan Neville also had great interest in this matter at a time when it was not being talked about and he brought great attention to it in the course of debates in this House. He focused on the need for change and I compliment him on doing that.

This report is very timely. Members have put a huge amount of work into it and it needs to be considered fully by the HSE. The implementation of a lot of the things in the report may cost money but it will save lives and will give better quality of life to the family and social network of the individual concerned.

Mention has been made of A Vision for Change from 2006. Unfortunately, that policy change was not followed through with the appropriate sums of money that were required. All over the country there are huge gaps in the service that is delivered at community level. This is further damaging the health of those who are out in the community but have very little support. I meet them regularly in Kilkenny and Carlow and I am sure there are Deputies in this House who also engage with the services in terms of how clients and patients are supported. The time has come for a significant move to be made in the context of funding. We need to examine where A Vision for Change is at. Demand on services is great but the service is simply not there for some people. I have witnessed individuals in distress and deeply depressed and upset over something that has happened in their lives but who cannot access the service. Someone in such a high level of distress needs immediate attention and care but they are told they cannot see a counsellor for six months.

I do not share Deputy Wallace's view on medication but neither am I in favour of the overuse of medication. A balance has to be struck. A lot of mental health issues are being faced by people because they do not have the service. In Kilkenny, the Teac Tom voluntary service is funded by people shaking buckets. It deals with referrals from the HSE as well as other referrals from GPs, or just people who turn up to request immediate support. They can deliver immediate access to a counsellor for an individual but the HSE cannot do it. The HSE tells us there is a wait of several months for such a service but the HSE refers people in distress to Teac Tom. When Teac Tom sought funding from the HSE, however, it was told there was no money in the budget, yet the HSE itself uses the service. Something has to be done to bring private operators, which are delivering a decent service, under the HSE or to allow them to work with the HSE. Their service is far more flexible than what the HSE can offer and maybe it is now time to fund them adequately so that they can pick up the slack when the HSE cannot deliver.

I have spoken to families of persons in distress who have been referred on to hospitals in Dublin but who stay there for the best part of three months. The only thing they get is medication. If it is difficult for them at some point during the day, they are given more medication. Families have taken family members out of such hospitals for fear of the high use of medication where it is not appropriate. I have seen the same patients engage with the community services, as limited as they are, and with the likes of Teac Tom and, over time, they gradually get themselves back to better health.

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However, they do not receive the support or access they need in a timely fashion. Many are being moved away from an institutionalised setting, which is fine and is a good idea, but I am concerned that the necessary services are not in place and that they are being substituted by private businesses. I do not know how long the HSE can afford that, but that model needs to be examined in the context of the individuals who are living in community settings, trying to establish a life for themselves but not having the supports they need. I refer, in particular, to young people who are on the autistic spectrum. In terms of being cared for in the community, what plan has the HSE to assist those who are teenagers now but who will become young adults and then adults or those who might be left behind after their parents have died? I do not see the services being developed at the speed necessary to keep up with all those changes. It is a great concern that schools and so on that are funded are now working to capacity. There is no capacity in the system and there is a lack of professionalism within it. There is a lack of future planning for those on the autism spectrum, to whom I specifically refer. I find that quite shocking.

In the context of this interim report, one would imagine that a modern health service would be constantly planning for the next phase. For example, we should look back over the previous two or three years and then establish the plan for the following two or three years, bearing in mind the changes in modern medicine and treatments, including talk therapy and so on. I acknowledge the desire of the professionals in this area to do better and to go the extra mile for their patients, but it seems the HSE and the Department of Health, whichever it is, are incapable of establishing a programme with a review provision every three years. I find that difficult to understand, particularly in the area of mental health. I would say there is not a person in the House who has not been touched in some way, shape or form by the experiences of a person who has mental health issues.

The final point I make relates to our understanding of mental health. One does not know on seeing a person in this House or anywhere else in the workplace whether he or she may have a mental health issue. We have little tolerance of mental health and those with mental health issues in the context of our work in this House. We should have more understanding of the fact that within any workplace there are people with mental health issues who are trying to cope on a day-to-day basis. We need to be far more open in terms of how we deal with each other, be it here or anywhere else, because of the fact that it is deemed to be a weakness if one was to admit that one had a mental health issue. We have to get over that. As public representatives, we should be to the fore in ensuring that is the case. I commend the members of the committee on the work they have done.

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