Michael Harty (Clare, Independent) | Oireachtas source

I thank Deputy Browne and Senator Freeman, who pushed for this committee to be established. Fianna Fáil and Fine Gael came together last year and formed the committee, which was a visionary act. I am Chairman of the health committee and there is no way that committee could devote the amount of time the Committee on the Future of Mental Health Care can give to this subject. It is a wide-ranging subject and having a stand-alone committee for it is a good idea. The Government should consider continuing the committee beyond its one year remit.

To take up the theme of implementation mentioned by Deputy Gino Kenny, that is my fear about reports. A wonderful report can be produced but its implementation, the final leg of the cycle for implementing change, does not happen. We are beginning to see that with the Sláintecare report. It has been languishing for almost a year and given the evidence we saw this morning, it could be substantially longer before the Government gives a response to it. We have also seen the difficulties with A Vision for Change. It is now ten or 12 years since A Vision for Change was produced yet many of its recommendations have still not been implemented. We must guard against having wonderful reports and then failing to follow through on them.

With regard to mental health, we should speak about mental well-being, as Deputy Lahart said, rather than mental illness. We must build up resilience in our society, particularly in children. Talking about mental health issues and mental well-being in both primary and secondary school will be very important. It is much better to prevent the development of mental health issues before they become so difficult that people must seek help. We should be talking about prevention and self-help to prevent the development of mental problems.

Generally, primary care is the first port of call when mental health issues arise and the majority of cases can be dealt with in primary care. However, there must be access to other services, not necessarily psychiatric services but talk therapies, counselling, social workers and support workers, who should be part of a community mental health team. We have community mental health teams but, unfortunately, those teams are not fully populated. There might be no psychologist, counsellor or social worker and these are important members of a team to contribute to the care of a patient. Medication should be a last, rather than a first, resort. I agree that we tend to over-medicate patients. A contributory factor to that is that patients do not have access to talk therapies and the other supports that should be available to support them. While I would not go as far as Deputy Wallace in his comments, we certainly tend to rely on medication because the support services are not available. It is not that we are over-prescribing for the sake of it. The difficulty is that we cannot get access to the other social services that are required to help people's mental well-being.

There is a lack of 24-7 crisis intervention services. Many people end up in out-of-hours GP services, which soak up much of the pressure. However, some people also end up in accident and emergency departments and unless there is a dedicated psychiatric or mental health service in those departments, the patients get lost. It certainly is not the appropriate place for them. We must examine our 24-7 services and consider helping the general practitioners who are providing out-of-hours services to access support out of hours, and not have people ending up in inappropriate areas such as emergency departments.

The report states that only 56% of the child and adolescent mental health services are fully manned by the various disciplines that are required to deliver such services. That is a damning indictment of the system. Again, it goes back to the failure to implement A Vision for Change. At the other end of the spectrum are the old age psychiatry teams. Only 60% of those teams are fully manned. Again, that is an indictment. If people cannot access the proper professionals it leads to inappropriate treatment for patients.

There is also a lack of integration between primary care and secondary care. I have already referred to counselling. We are also facing a decline in the number of GPs. General practice is suffering greatly at present. There is great difficulty in recruiting and retaining GPs. In addition, the age profile of GPs means that many of them are due to retire over the next ten years. Once that layer of access to treatment diminishes patients will end up in secondary care, most likely inappropriately. Many of the community psychiatric teams are undermanned as well. In some of the community healthcare organisation areas, only 47% of the staff required to man the community psychiatric teams is available. In other areas it is 94%. There is a geographical lottery in that regard.

We must also examine the issue of dual diagnosis of mental health illness along with addiction to opiate drugs, benzodiazepines or alcohol. That is a huge problem. In urban areas, particularly Dublin, if somebody has an addiction problem the psychiatric services do not wish to know, while if one has a psychiatric problem the addiction services do not wish to know. There is a lack of integration and interlinking between those services, which is a huge problem. Another problem is the division of the city. There can be different access to different services on the north side and the south side of the Liffey. People with a dual diagnosis and, indeed, a triple diagnosis where a physical illness is compounding the problem, are very difficult to treat. Emphasis must be placed on that.

I should also refer to alcohol. It is a huge depressant. People in Ireland have a very unhealthy relationship with alcohol. Alcohol precipitates and is part of many of the problems people encounter with their mental health.

Mental health is not just an issue for the Department of Health. It crosses Departments. While it is the responsibility of the Department of Health, the Departments of Housing, Planning and Local Government, Education and Skills and Employment Affairs and Social Protection have a role to play in dealing with people who have a mental health issue.

I will finish by referring to recruitment. There are huge recruitment issues not only in mental health services but across the health system.

This comes down to a number of factors, among them the working conditions under which people are expected to work, quite often because the teams are understaffed and many members of the community teams are missing. The pressure on those teams increases, which makes working conditions very difficult. Quite often they are overwhelmed with the number of patients they are expected to look after, which puts immense pressure on them. This also affects their mental health because they are also subject to the pressures of everyday life. Once the amount of work they have to deliver exceeds what they can comfortably do, they suffer from mental health problems. This puts them off continuing in the service and this is the difficulty - that staff may be recruited but, because of the conditions under which they must work, they cannot be retained. Ireland has become simultaneously one of the greatest exporters of doctors and nurses and the greatest importer of doctors and nurses. Now that our graduates have left the country, we are trawling the world to try to replace them. This comes down to the conditions under which people must work. We have an issue currently with mandatory reporting. There must be mandatory accountability in our health services, whereby people must perform and deliver and management must live up to the expectations of delivering a proper service.

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