Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I begin by thanking Deputy Mark Ward for bringing attention to the topic of mental health. The importance of supporting good mental health and well-being has been recognised for some years now and never more than during the current pandemic. The onset of Covid-19 has presented enormous challenges for people's mental health and the Government has responded rapidly by putting additional services and supports in place.

The Government acknowledges the positive intention of this Bill and does not intend to oppose it. Many Deputies will be aware that a very similar Bill was brought forward by a colleague in the last Dáil, Deputy James Browne, who is now a Minister of State. I distinctly remember speaking on and supporting that legislation.

The stated aims of the Bill are to offer hope for better mental health care by ensuring that vulnerable persons with mental illness are cared for efficiently, when needed and on parity of esteem with physical health and to compel a change in attitudes towards mental health at the highest level of policy making and governance. Its main provision obliges the Minister for Health to continue the promotion of a comprehensive health service designed to secure improvements in physical and mental health and in the prevention, diagnosis and treatment of physical and mental illness .

An equal standing within the healthcare system for mental health and physical health is something that we strive for every day. The interdependencies between physical and mental health are well recognised. WHO research suggests that key risk factors for poor physical health and reduced life expectancy are more prevalent among people living with a mental health difficulty than among the general population. For example, people with schizophrenia are more than twice as likely to develop type 2 diabetes when compared to the general population. The incidence of respiratory and cardiovascular disease is also higher among those with a serious mental health condition. Equally, there is a higher incidence of conditions such as anxiety and depression among those suffering from long-term chronic physical health conditions such as asthma and arthritis. The need for a whole-person approach to achieving the highest possible standards of physical and mental health and well-being has been recognised in formulating our mental health policy, as is the need to support the wider psychological aspects of physical health challenges.

While the Government does not oppose this legislation, I have some observations to make on the Bill as proposed. I am offering these with the benefit of having some knowledge of a similar Bill introduced in the previous Dáil. The aims of the Bill are broad. It does not offer any guidance on what parity of esteem would look like in practice. Given the vast spectrum of conditions that influence both physical and mental health, it is silent on what esteem for mental health should be compared to when assessing parity. It does not include specific provisions for how parity of esteem would be achieved, implemented or measured. The Bill's provisions appear different to the narrative in the explanatory memorandum. As currently constructed, it is aspirational but unclear on what it would accomplish in concrete terms.

I urge Deputy Ward to consider these observations in the interest of developing a precise and specific Bill that is easily understood in practical terms. Without that precision, its implications are difficult to predict, and consequently will not be possible to quantify from a financial perspective. I believe this is where the last Bill fell down. I say all of this from a position of experience and in the spirit of the collegiality on matters of mental health that this House has traditionally enjoyed across all parties and none.

I remind the House that the WHO defines health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". This is an all-encompassing view of health. It acknowledges that the determinants of health are multifaceted and does not recommend prioritising any one aspect above another.

The Health Act 2004 provides that the HSE shall use the resources available to it in the most beneficial, effective and efficient manner to improve, promote and protect the health and welfare of the public. It also states that the HSE shall manage and shall deliver, or arrange to be delivered on its behalf, health and personal social services. It further states that the HSE shall integrate the delivery of health and personal social services. Deputy Ward's Bill seeks to oblige the Minister for Health to "continue" the promotion of a comprehensive health service designed to secure improvements in physical and mental health. I acknowledge the important role that legislation plays, as Members of this House will know. However, when it comes to health, treatment and services are what we look to for healing.

Funding for mental health services is a priority for the Government. Budget 2021 saw the continued commitment to mental health with increased funding of €50 million, bringing the annual budget to €1.076 billion. This represents an increase of over €365 million or 51% since 2012. The Government is committed to continuing to increase funding as circumstances allow. The Department of Health and the HSE are currently finalising the 2021 HSE service plan, which will be published shortly.

I am confident that this will give a balance of new mental health developments across age ranges and sectors of the population. It will also cover the full spectrum of mental health, from mental health promotion and early intervention to acute and forensic inpatient care. It will also ensure that greater attention is given to improved links between mental health and other services.

With regard to policy, we recently published a new refreshed national policy, Sharing the Vision: A Mental Health Policy for Everyone. The Sharing the Vision policy does not replace that of A Vision for Change but instead updates our approach in the light of evolving and future needs. The implementation of Sharing the Vision is obviously critical to its success and this is a core objective for me as Minister of State. Last month, I announced the establishment of the new national implementation and monitoring committee framework that will drive implementation of the policy. An independent chair for the committee, Mr. John Saunders, has been appointed and selection of the membership is currently under way. Over the 10-year lifespan of Sharing the Vision, the committee will be integral to maintaining the momentum necessary to make the policy a reality and to hold stakeholders to account. Implementation will also be progressed through planned additional investment for the sector under the annual budgets and agreement of HSE annual service plans.

It is important that the implementation of Sharing the Vision is a collaborative process. I intend that the committee and its associated specialist groups will be fully representative and will include strong service user, service provider and non-statutory sector participation.

As the debate here this evening is about mental health legislation, I will take the opportunity to update the House on progress on the review of the Mental Health Act 2001. The Department is currently finalising heads of a Bill to significantly amend and update mental health legislation, taking into account the 165 recommendations of the expert group review, which was partly informed by a public consultation, a comprehensive submission by the Mental Health Commission and Ireland's domestic and international commitments such as those under the Assisted Decision-Making (Capacity) Act 2015 and the UN Convention on the Rights of Persons with Disabilities. The provisions of the Mental Health (Amendment) Act 2018 are also being incorporated into the draft heads of Bill.

There are over 100 sections in the draft heads. The Department has included detailed information under each head to allow for expert input from the Mental Health Commission and the HSE to be provided prior to publication. This will allow the Department the opportunity to address any concerns as early in the process as possible. The draft heads of Bill propose to extensively amend and update existing mental health legislation, moving from what has been described as a paternalistic approach in existing statute to a more person-centred, human rights-based approach. The Department had hoped to submit these heads for legal advice by the end of 2020, however, the Department is currently awaiting further input from the HSE, which is expected in early December, and plans to consider the HSE's submission and finalise the draft heads prior to submission for internal legal advice and to the Office of the Attorney General, as required, in early 2021.

A new part of the Act related to children is being advanced separately, and the Department has approached the HSE, the commission, the Ombudsman for Children and the College of Psychiatrists of Ireland for their expert opinions on the draft heads.

I thank Deputy Ward for introducing his Bill. Work is required to ensure that the final Bill is legally robust, specific and implementable. I hope I have given some useful input on how the Bill might evolve and look forward to hearing the remaining contributions here this evening.

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