Willie Penrose (Longford-Westmeath, Labour) | Oireachtas source

I extend the apologies of my colleague, Deputy Kelly, who cannot be here to speak on this motion. I compliment Deputy James Browne and the committee for producing this comprehensive and focused report. It is an invaluable contribution to this important area. As Deputy Browne said, it is a very important and vital first step towards addressing an area that has long been neglected and overlooked. It was often looked at as a Cinderella area in terms of budgeting. I recall my colleague, the former Minister of State, Ms Kathleen Lynch, having to fight extremely hard to maintain the €35 million that was earmarked for the area some years ago. She fought to the bitter end and held on to that funding.

On behalf of the Labour Party I genuinely welcome the publication of the interim report of the Joint Committee on the Future of Mental Health Care. We are at a critical juncture as we seek to ensure the full implementation of A Vision for Change. The aim of the Joint Committee on the Future of Mental Health Care is to engage with all relevant stakeholders and to achieve cross-party agreement on the implementation of a single long-term vision for mental health care and the direction of mental health policy in Ireland. We recognise that the Department of Health is simultaneously conducting a review of A Vision for Change, which in my view requires significant repair and refurbishment, with renewed focus and new objectives.

To put the matters in context, we are struggling with a situation whereby children are waiting 15 months to see a psychologist and 2,500 young people are awaiting access to public mental health services more generally. We have a crisis in the provision of child and adolescent mental health services, where patients are placed on lengthy waiting lists because of the serious lack of immediate counselling available. This is an important issue. Recently I discussed mental health with teachers, who informed me that due to an increase in mental health issues emerging in our schools at both primary and secondary level, for example social media addiction, suicidal ideation and the rise of suicide in young people, there is a need for professionally trained school counsellors or psychotherapists. The Government in the UK and Northern Ireland is investing serious sums to make sure that a counsellor is placed in every school. Counsellors are extremely important. They deal with young people who are having suicidal thoughts or who talk about contemplating dying by suicide. It is very likely that we would have a significant decrease in serious mental health issues among young people if we had those services available. It would be a positive, preventative measure to invest in accessible mental health services in schools rather than having to invest in intervention at a later time.

The recent survey carried out by Jigsaw and Headstrong, the My World survey, illustrates that young people need one good adult who they can go to for support or consult at various times. While in schools our teachers have provided that one good adult down through the years, all too often our teachers are stretched and do not have the time or resources to support our pupils in the way they would like to and in the necessary way. It is time to listen to the principals and teachers in our schools. They say that there is a huge need for school counsellors or psychotherapists in each and every school in the country. We should be positive and proactive in that regard.

We spend approximately €910 million annually on mental health services. That only equates to 6% of the total health budget, and in my view it is totally insufficient. It is approximately half of what is required. In other countries 12% to 14% is the norm. We are starting from a very low base. A more radical approach is undoubtedly required. Indeed, the committee has remarked that the most startling service area in which the gaps in provision are felt is in child and adolescent mental health service, CAMHS. The committee views the mental health of children as being particularly important, therefore it is clearly incumbent on the State to ensure a responsive and meaningful service to children, to be provided as soon as they experience any mental health difficulty. Unfortunately, currently this is far from being realised. This is a reflection of particularly low clinical staffing figures in CAMHS. It is disturbing to note the number of young people with mental health issues who have been referred to adult facilities. I have experience of that situation: it is something that has to be addressed in the 21st century.

The Irish Medical Organisation, IMO, told the committee that its GPs described the situation in CAMHS as heart-sinking. There is a direct link between over-long waiting times in the area with staff shortages, the relatively low level of child and adolescent psychiatrists and the general shortage of front-line resources as a result of an unacceptably high number of children on the CAMHS waiting list. The waiting times are too long. It is clear that solving the recruitment and retention crisis with health care professionals is going to be absolutely vital and pivotal to building a fair, equitable and available mental health service for all.

We have arrived at an ironic scenario whereby we have a significant number of medical schools, among the highest per head of population of any other country in the western world, and are near the top of the scale in terms of the number of doctors we export and import. It is a truly remarkable and baffling situation. We have to examine seriously why our graduates are choosing to go overseas. We are all aware of why that is the case and we have to try and address that. We are beginning to examine it now. A re-examination of career progression and training opportunities for healthcare graduate is going to be a cornerstone in re-imagining the mental healthcare system that we want to see in Ireland.

I certainly hope that Deputy Browne and his colleagues continue with the excellent work they have done in this area.

We need to move to a space where mental health is treated on a par with physical health. A motion in that regard was debated in the House last week. I think it was a British doctor, Martin McShane who, in 2014, succinctly described the issue of parity of esteem for mental health when he said:

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 stops 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 [what Dr. McShane says next is interesting]: 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.

I think that encapsulates where matters stand. If an NHS director is saying that in a jurisdiction where the authorities invest more, it is certainly a portent of how we have to raise our ambitions.

I wish to comment on the reference the committee has made to early intervention. Early intervention in psychiatric care is absolutely critical to reducing the severity cf conditions, especially in the areas of depression and bipolar disorder. However, the principle is effective right across the board. The committee's recommendation of providing a psychiatric nurse for initial assessment is a welcome first step. This would serve to reduce waiting lists by filtering the people being directly referred to CAMHS and adult services without prior screening. Collaboration on a temporary basis between public and private psychiatric teams would also assist in achieving the goal of early intervention as a more rounded approach is devised.

In order for the aims of the committee to be successfully accomplished, we need to ensure that the stakeholder input outlined by Deputy Browne is continuously focused on and not just paid lip service. Real and tangible recognition must be given. I was concerned to read in the report that the HSE was unable to provide a breakdown of mental health spending by service area at the committee meeting on 22 November 2017. This is just one example of a number of issues raised by the members of the committee. The HSE and the Department of Health need to act prudently in terms of supplying the necessary information to assist the work being carried out. If they cannot do that, how can they plan for the future and bring about improvements?

I am not a member of the committee. Like Deputy Neville, I genuinely hope that a standing committee of the House will be established to deal with this issue. That would be an important step. There is not a family in this country that has not been touched. I spent eight years suffering from panic attacks. Indeed, I was brought out of this House on a stretcher on three occasions and taken to St. James's Hospital. It was a fairly sobering experience. A particular event triggered it and, as a result, I spent eight years suffering, almost crashing a car on one occasion. This is a significant problem. It affects everyone. The people we speak to may well be suffering and they may be doing so in silence, which is the worst of all worlds.

I look forward to seeing the final report when it is published later in the year. Mental health reform is long overdue. I am optimistic that with the help of colleagues here, and with a degree of goodwill, foresight, co-operation and strategic thinking, we can achieve a world-class service that our people expect and deserve. In that context, I again congratulate all the people involved in preparing this report. I hope that it leads to a significant improvement for all the service users in this area.

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