Tuesday, 2 July 2019
Mental Health Services Reports: Motion [Private Members]
I thank Deputy Browne for tabling the motion, bringing this issue to the House and giving us an opportunity to discuss and debate it. I thank him for his continued interest, as acknowledged by all of his colleagues present, his professionalism, and the very constructive spirit of co-operation in which he has always approached the issue of mental health. It has been welcomed on this side of the House. I thank all those who spoke on the motion. I always find that debates on mental health issues are non-partisan because people's genuine passions come to the fore and, for the most part, they leave politics at the door, notwithstanding the responsibility of Opposition Deputies to hold the Government to account.
I confirm that the Mental Health Act 2001 went to the Mental Health Commission. That is a very welcome step which is long overdue. The Act finally made that journey, which is a step in the right direction.
Many speakers referred to capacity, beds and issues arising in that regard. Obviously, we will not tolerate governance issues, which are unacceptable. Deputy Rabbitte's comments could have been a template for my closing speech. I could not agree more with everything she said, and she said it very well. We can look at capacity. There is nothing more heartbreaking than to see a parent admitting his or her child to a CAMHS unit. It is devastating to witness and we should try to avoid parents having to do so. Deputy Ó Cuív noted towards the end of his contribution that such admissions are to be avoided at all costs. As he stated, it is far preferable to treat people as outpatients than as inpatients. All Members agree on that.
We want to move to a more proactive space. Thankfully, that is happening in the area of young people. Last year, we introduced 114 assistant psychologists managed by 20 psychologists and overseen by ten advanced nurse practitioners. That addition to the primary care service for young people was aimed to build infrastructure at a lower level to help prevent people having to go to CAMHS. I could have decided to carry out an initiative aimed at reducing CAMHS waiting lists and throw a couple of million euro and additional resources at it, but I pulled back and decided to be more proactive and try to get to people earlier and to get intervention working at a lower level. That is why we introduced those staff.
That is working well and capturing many of these issues earlier. Like any initiative in health worth its salt, it will take time to show real tangible results. Despite this, it has been independently evaluated already by the University of Limerick and it is showing significant decreases in waiting times for primary care psychology services for young people. Of course that will have a knock-on impact on the child and adolescent mental health service list. That is to be welcomed.
In the coming weeks we will have a €3 million community fund. It is a small fund initially but it is the first time we have taken some money away from the HSE on the basis that we want to support some of the wonderful initiatives in place in the community. I will be launching the fund this side of September. I hope that €3 million will grow next year to €5 million and then €10 million. Ultimately, that is a sea change and a move away from the more reactive spending of the HSE towards trying to deal with issues more proactively and recognising the work of community groups. We need to support these groups if they demonstrate their work is proactive and preventative in nature. That €3 million will begin in the coming weeks.
One of the most significant tranches of work we have done in the Department in recent times is the refresh of A Vision for Change. We consulted extensively and widely. It is the single most important job because it will determine the policy long after I am in this position and regardless of whoever occupies this chair afterwards. All of us as stakeholders and vested interests will determine the policy. That will go to Cabinet in September. It will be published subsequently. It will set a new direction for us and will be far more outcome focused than the previous version. A Vision for Change served many good purposes but was of its time, some 13 years ago. It needs to be refreshed in recognition of changes and whatever. In particular it needs to be more outcome focused rather than prescriptive like its predecessor, perhaps.
Reference was made to capacity and the opening of the hospital in Portrane. There is much talk of the children’s hospital. There is much negative commentary, and rightly so, as well as much concern around it. Despite this, under the radar the new forensic central mental hospital that we are building is coming. It is a €170 million project. It is on budget and on time. It is being delivered by the HSE to the credit of those involved. Often those in the HSE do not get credit for what they do right when they do it. We will be getting the keys to that in September or October of this year and it will be open next year. There will be additional capacity of approximately 70 beds there, which is a significant contribution to the overall service.
We had 20,000 acute psychiatric beds in the country in the 1960s. Deputy Healy talked about his parents and their time. It was probably before the 1960s when they were psychiatric nurses. I often wondered about his interest in this area, and his background answered that question. Today there are 1,000 inpatient psychiatric beds. We have come a long way. We do not want to let the stick back into that, as it were. We want to avoid that at all costs. That is why we have to put a focus on this work. That will come under the refresh of A Vision for Change. We have day hospitals to allow people to live in their homes at night but to go into day hospitals to receive the necessary treatment. This treatment does not need to be part of a stay-over service.
Deputy Rabbitte spoke about online services and I was delighted to hear her say it. Today I was in Sligo. Deputy MacSharry is gone now but I was there with my colleague, Deputy McLoughlin. I looked at an online pain clinic. The consultants in the pain clinic in Sligo University Hospital are reaching out to their patients online. Patients do not have to trek into hospital to meet the staff. They do not have to queue up, wait for hours or travel for hours. They can literally pick up their handheld devices and speak to the consultants about managing their pain and prescriptions. If they need a procedure, then obviously they have to come in for it, but the initial assessment is done online. That is very positive and interesting. We have several pilots running in the mental health area as well as psychology and psychiatry. Where there are waiting lists, we are writing to people to ask whether they would like to avail of online psychiatry. I have always said that mental health is an obvious service that can be delivered online. I am delighted that Deputy Rabbitte recognises this. This has been done in Australia and it is the future for us.
I have spoken about signposting. I was two years in the job last week. I have spoken about how we have 1,027 services funded by the HSE throughout the country. It is difficult to know the most appropriate service or where to go. People are clamming up, as it were, and joining the wrong queues, and there are long queues too. If people were signposted more effectively and appropriately, we would avoid much of the queueing system. The website yourmentalhealth.ieis up and running. I appeal to all Deputies to promote it. It is an exceptional website run by the HSE. All a person has to do is put in his or her geography and issue and the website will tell the person the list of services available, whether in person, online, digital or whatever technologies are in place to support it. That is in place.
I am going out to the National Ambulance Service tomorrow morning. A telephone line is to be established. I aim to have it up and running for World Mental Health Day. The line is a one-stop telephone number and it is as recognisable as 999. People can phone in and talk about their issues. An appropriately trained person will be at the other end and will refer the person to the proper service and tell him or her where to go.
Approximately 600 calls per month coming into the National Ambulance Service are mental health related. The service cannot do anything with them. The staff do not know what to do with them. They send out ambulances in many of these cases because that is all they can do, but that is not appropriate. These calls will be captured under this telephone line. Callers will have an appropriate person trained in mental health who will advise them on the service most appropriate for them, explain where it exists geographically and give the details. We have several pilots in psychology and psychiatry.
The substance of the motion relates to the Mental Health Commission. I acknowledge the work done by the commission. I find the body highly constructive. I heard Deputy Noonan speak about the Irish Fiscal Advisory Council one time. He said there is no point in having a dog if it does not bark, as he said in his own inimitable way. It is the same with the Mental Health Commission. We fund it to the tune of €14 million to enable it to challenge the services. I welcome every challenge the commission puts our way. Of course we have to work harder and better for our most vulnerable citizens, some of whom are detained in some of our facilities. They need to have their rights protected. The Mental Health Commission is on their side and we have to support its work and continually challenge the HSE, which is responsible for the delivery of those services. It is not acceptable in any way shape or form that individual care plans are not available for each person or that they are dirty, untidy, unkempt or smelly. That is deplorable and not acceptable on any level whatsoever. I commend the work of the Mental Health Commission. I assure all parties and none in the House that I will continue to support the very important and good work done by the commission.