Thomas Pringle (Donegal, Independent) | Oireachtas source

Unfortunately Ireland has a dark and disturbing history when it comes to the mass institutionalisation of people with mental health problems. It is only in recent history that the State has begun a broad shift away from this model of care. However, according to the Mental Health Commission, the law in its current form is still outdated and outmoded and is not based on a progressive rights-based approach to mental health care. The commission's most recent report highlights significant governance and management deficits within mental health services. Other concerns relate to hygiene and maintenance levels, levels of compliance, the use of physical restraint of young people, seclusion, and 70% of approved centres registered with the Mental Health Commission remaining dirty and poorly maintained.

On upgrading legislation, it is vital that there be reform soon. Advocates have continued to call for legislation to be published no later than the end of this year. Irish legislation is still without key aspects. Specific guiding principles for children are not in the 2001 Act. Individuals do not yet have a statutory right to individual care or recovery plans. Voluntary patients still do not have basic rights to information or advocacy. While those aged 16 and 17 can consent to or refuse physical healthcare decisions, this right does not apply to mental healthcare decisions. Most poignantly in the context of this debate, involuntary patients do not have the right to have their advance wishes about treatment respected, leading every year to the detention of between 2,000 and 2,500 people against their will in psychiatric facilities where they can be forcibly injected with medication, physically restrained by staff and locked in isolation. It is clear that despite reforms made in recent years, the State retains a disproportionate amount of power over individuals with mental health issues. The use of control and coercion must be examined as a matter of urgency.

The Mental Health Commission has repeatedly called for serious attention to be paid to the human rights of mental health service users in terms of capacity and consent to treatment. The main obstacle to greater reform is the fact that State funding has been in crisis, largely due to decades of chronic underinvestment and the inability to recruit and retain staff providing the care. If we decide on everything based on money, we will have serious problems and have them continuously. Waiting lists are long and demeaning. The longer people have to wait to receive mental healthcare, the more problems they face. The commission's annual report also revealed that 84 children were admitted to adult mental health centres in 2018. This is absolutely unacceptable over 13 years after A Vision for Change was published.

Furthermore, the number on the waiting list for child and adult mental health services in Donegal is at an all-time high, with no sign of it dissipating. This is due to inadequate staffing levels. Some are waiting more than a year to be assessed, and that is before they get into the system to receive proper care. We should be at a stage where 24-7 child and adult mental health services are in full effect and fully resourced but we are far from that reality. The current services are not meeting the needs of young people and their families. They have been shockingly underfunded for quite some time. The failure to recruit and retain staff is hampering efforts also, yet the Government does not seem to be doing anything to address this crisis.

Let us not forget the young people in third level education. Record numbers of third level students are receiving counselling for mental health problems, such as anxiety. However, the number of counsellors per student, one for every 2,600, is very low by comparison with the recommended ratio agreed by the International Association of Counselling Services, which states there should be one councillor for 1,000 to 1,500 students. This means students often end up waiting for weeks before they can gain access to a counsellor. The latest figures show waiting times vary, between seven and 40 working days, depending on individual colleges.

One reason for the dire state of our mental health services is ideological. The Government does not believe in the right to healthcare based on need rather than ability to pay. That is the crux of the problem. Instead, the Government continues to invest in a two-tier health system that consistently undermines public services. Despite this, the Government continues to support the structure as opposed to winding it down, and staff are moving away from public care to private care.

It took over a decade for Ireland to ratify the UN Convention on the Rights of Persons with Disabilities. I hope it is not taking another decade to reform our mental health services so the human rights of all those with mental health issues can be protected. The Minister of State must address this on a human rights basis, focusing on the right to treatment and not the cost of treatment. That is the only way to sort this out once and for all. I would love to hear in the Dáil the actual cost of having a health service that is fit for purpose rather than one that meets the arbitrary budgetary figures picked every year for it. That would be refreshing in itself.

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