Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I thank the Deputies from the Regional Independent Group for tabling this motion. Supporting positive mental health and well-being is a priority for me and the Government and is particularly important during the current pandemic. Covid has presented significant challenges for people’s mental health, including increased stress, anxiety and fear. This has been exacerbated by experiences of isolation, bereavement and loss of income and work among many others. We have responded rapidly by reconfiguring existing services and putting additional services and supports in place.

I say at the outset that the Government does not oppose this motion, as it is broadly in line with the Government’s policy objectives for mental health. It also highlights a number of actions the Government has already significantly progressed. However, I am not convinced that the motion accurately reflects the Government's progress to date in improving mental health services and its commitment to continue to enhance services.

Accordingly, I welcome the opportunity to emphasise the priority given by the Government to mental health and our commitment to the continued development of all aspects of mental health services across a broad continuum from mental health promotion and early intervention to acute and specialist services. I also draw attention to the significant measures put in place to address the particular mental health challenges posed by Covid-19.

Furthermore, I reaffirm our commitment to the implementation of Sharing the Vision, the national mental health policy, in line with the programme for Government and Sláintecare and to Connecting for Life, the national suicide-reduction strategy through its extension for another four years until 2024.

The Government has invested significantly in the enhancement of mental health services. Budget 2021 allocation for mental health, of €1.076 billion, is an increase of €50 million over 2020. Of the additional €50 million for 2021, €23 million will be used to commence implementation of many of the short-term recommendations set out in Sharing the Vision. This will fund an additional 153 staff to enhance community mental health teams, including CAMHS; clinical care programmes, including in the area of dual diagnosis; bereavement counselling; and crisis resolution. There is also €15 million for Covid measures, including the provision of extra mental health beds, as required.

Deputy Canney asked about CAMHS. I am very concerned that 2,200 people are on the CAMHS waiting list. These are all vulnerable children under 18. Those figures are similar to last year's. Owing to my concern, of the new posts for 2021, 29 whole-time equivalents will be specifically for CAMHS.

Many local mental health services are also implementing innovative practices such as the introduction of a community assessment hub in Cork which provides direct access to mental health assessment and support seven days a week, reducing the need for people to present to emergency departments. This is a really innovative practice that has been put in place in Cork and is keeping many people out of emergency departments. Appropriate clinical people in the hub can point people in the right direction.

We do not yet fully understand the impact of Covid-19 on mental health and the subsequent demand on services. However, the HSE already has a range of proactive responses for any increase in service need, including online and other telehealth psychosocial supports. The Department and HSE continue to plan for any surge in demand as it arises.

This is the case, for example, with MyMind, which is a HSE partner NGO providing online counselling sessions. Additional funding of €2.2 million has been provided for 2020 to ensure that we can meet this increased demand through MyMind and a number of other providers. This funding will help to strengthen and expand psychosocial and telehealth services, such as the national crisis text line, to augment existing services and to support a transition to online and telephone support where face-to-face services cannot be provided safely.

In addition, as part of the HSE’s psychosocial response to Covid, counselling supports are available to staff impacted by the pandemic. Local support structures are also in place in each community healthcare organisation, CHO. These supports are also available to section 38 and 39 workers.

Awareness-raising campaigns which promote existing mental health services have been launched, including through national and local radio campaigns, to assist people in finding appropriate supports where needed.

This is a significant investment by any standard and the programme for Government gives a clear commitment to continue investment in mental health services as resources allow. More specifically, mental health remains a core aspect of the Government’s response to Covid-19. It is important to note that specialist mental health services have continued to operate at 85% to 90% of pre-Covid levels, although there has inevitably been some impact on referrals to specialist services which are being monitored.

In recent years, we have witnessed a major shift in our society’s willingness to discuss and address mental health issues. It is now recognised that there is no health without mental health. Furthermore, the many determinants of mental health must be appropriately addressed if we are to improve the mental health outcomes of Ireland’s population and build strong, healthy and resilient communities.

This change is reflected in Sharing the Vision and Connecting for Life. Both advocate a cross-departmental, whole-of-Government approach to delivering these policies. Sharing the Vision, published earlier this year, sets out a progressive shift in mental health service delivery from volume of supports provided to outcomes achieved for people using the services. In line with Sláintecare, it promotes enhanced access to services; person-centred care, taking account of the needs of particular groups; and flexible and community-based service provision, reducing the need for hospital admission while still providing inpatient care, where required.

I recently established a national implementation and monitoring committee, NIMC, to oversee the implementation of the Sharing the Vision policy over its ten-year life cycle. The NIMC structure will involve a broad base of state bodies, NGO service providers and service user representatives to ensure that a whole-of-government and indeed, a whole-of-society, approach is adopted in its implementation. The steering committee will hold its inaugural meeting on Friday morning of this week. The committee will be supported by specialist groups that will provide expertise to progress recommendations relating to areas such as Travellers’ mental health and the transition from CAMHS to adult services. Implementation will also be progressed through planned additional investment under annual budgets and agreed HSE service plans. The new programme for Government recommends that we examine the reinstatement of a national director in mental health to ensure the new policy is driven in the HSE. I am keen to explore this issue with the HSE in the coming months. I will also seek an undertaking from the executive that mental health staff will only be redeployed for Covid work in extreme circumstances.

While mental health care should be provided at the lowest level, not all mental health issues can be dealt with in the community. Inpatient and residential care has, and will continue to have, an important role. The new 170-bed hospital complex in Portrane will replace the Central Mental Hospital, Dundrum with a modernised national forensic mental health service. The new facility includes a 130-bed forensic hospital, due to open in early 2021, a ten-bed forensic child and adolescent unit and a 30-bed intensive care rehabilitation unit. This represents a major step forward in the care and treatment of people who require such care. I am moving legislation in the Dáil tomorrow to allow for the opening of the new service and I hope that everyone in the House will support this action. The Department of Health is also nearing completion of an extensive overhaul of the Mental Health Act 2001. The revised legislation will improve protection for the rights of mental health service users, including provision for consent to treatment for 16 and 17-year-olds. The draft heads of this legislation are expected to be finalised in early 2021.

The Government and mental health services have been particularly active in response to the pressures placed on people’s mental health due to Covid-19. At an early stage of the pandemic, HSE community mental health services moved rapidly, in compliance with public health guidelines, to provide in-person specialist services where it was safe and possible to do so for both staff and service users, and to augment this, with expanded telehealth services, to continue to provide mental health supports. To ensure oversight of the performance of mental health services in responding to Covid-19, the Department of Health worked with the Mental Health Commission and the HSE - which is important to note - to develop a risk management framework for residential facilities, identify and address structural and operational issues and track and contain infections within residential and acute units. The framework reports regularly, and infection rates in our facilities have remained low overall. The establishment of a tripartite group, with the Department, HSE and the commission, will help to monitor our service-wide response to the pandemic and to identify any potential issues as early as possible.

I ask that we maintain sight of our common goal of ensuring that the mental health needs of the nation are served in the most effective manner. I am, with the Government and the Minister for Health, fully committed to the continued development of high-quality, person-centred and human rights-based mental health services for all children, young people and adults. I welcome open and positive discussion on this important area, and I look forward to suggestions and constructive comments from the floor.

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