Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I thank all of the Deputies for some useful inputs today. The Minister outlined the comprehensive supports the Government has put in place to mitigate the impact of Covid-19 on the economy and society. He also outlined the Government's national Covid-19 vaccination strategy. I can assure the House that the Government is fully committed to supporting people during this challenging time and I would like to set out in particular some of the important measures that have been put in place to protect the elderly, vulnerable groups and those experiencing loneliness, mental health difficulties and social isolation.

Covid-19 has presented significant challenges for people's mental health, as many individuals have experienced increased stress, anxiety fear or panic. Supporting positive mental health and well-being is a priority for Government and me, particularly during the current pandemic.

We have responded rapidly by reconfiguring existing services and putting additional services and supports in place. HSE community services moved rapidly to provide in-person specialist services, where it was safe to do so, and to augment this with expanded telehealth services, so as to continue to provide mental health supports to the greatest extent possible.

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 to develop a risk management framework for residential facilities to identify structural and operational issues and address them, and to track and contain infections within residential and acute units. The framework reports regularly and infection rates in our facilities have remained low overall. In addition, the Department of the Taoiseach has established a cross-Government group to support vulnerable persons. Departments with lead policy responsibility are represented on this oversight group, including the Department of Health. Vulnerable groups, such as mental health service users, have been disproportionately affected by Covid-19 and there is a continued need to co-ordinate cross-Government support to these groups of people.

The Government has invested significantly in the enhancement of mental health services and the budget now stands at €1.076 billion. The increase of €50 million secured in the budget will fund an additional 153 staff in enhancing community mental health teams, including CAMHS with 29 new staff. It will also fund clinical care programmes, including in the areas of dual diagnosis, bereavement counselling, employment supports and crisis resolution. Some €15 million will be allocated to Covid measures, including the provision of extra mental health beds as required. At regional and local levels, many mental health services have responded throughout the pandemic by implementing innovative practices such as the introduction of a community assessment hub in Cork. This hub provides direct access to mental health assessment and support seven days a week, reducing the need for people to present to emergency departments.

We do not yet fully understand the impact of Covid-19 on mental health and the subsequent demand on services. The HSE already has a range of proactive responses for any rise in mental health service need, including online and other telehealth psychosocial supports. The Department and the 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 increased levels of online counselling sessions throughout the pandemic. It provides counselling in 15 different languages. Additional funding of €2.2 million has been provided for 2020 to ensure we can meet increased demand through MyMind and a number of other providers.

Awareness-raising campaigns that promote existing mental health services have been launched, including through national and local radio campaigns and through the dissemination of leaflets to schools across the country to assist children, young people and adults in finding appropriate supports where needed. In addition, as part of the HSE’s psychosocial response to Covid-19, counselling supports are available to staff impacted by the pandemic. Local support structures are in place in each CHO and these supports are also available to section 38 and 39 workers. The programme for Government gives a clear commitment to continue investment in mental health services, as resources allow. 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 between 85% and 90% of pre-Covid levels.

Many comments were made today about older people, and rightly so. Older people living in nursing homes are among those who have been most adversely affected by Covid-19. Residents are vulnerable because of their age, underlying medical conditions, the extent of their requirement for direct care involving close physical contact and the nature of living in congregated settings. The many challenges arising from the management of Covid-19 in nursing homes are identified in the Covid-19 Nursing Home Expert Panel: Examination of Measures to 2021 report, which was published in August 2020. The expert panel’s report includes 86 recommendations in total and there is a robust oversight structure in place to ensure their implementation. The oversight team reports regularly to me as the Minister of State with responsibility for mental health and older people. Some highlights of early key progress include the extension of the temporary assistance payment scheme, TAPS, until June 2021, with up to €92 million available in 2020 and up to €42 million available in 2021. We also have enhanced public health measures, including the provision of staff accommodation when required; support to nursing homes through 23 HSE Covid-19 response teams; provision of PPE free of charge to nursing homes; and serial testing of all nursing home staff on a fortnightly basis.

Earlier this month, updated visiting guidance for long-term residential care settings came into effect. This new guidance outlines an updated definition of "critical and compassionate circumstances", which provides that, subject to risk assessment in each case, people living in nursing homes may receive up to one visit by one person per week under levels 3 and 4 of the framework and up to one visit by one person per two weeks under level 5. It also notes that every practical effort should be made to accommodate an additional visit on compassionate grounds during the period of a major cultural or religious festival or celebration of particular significance to the resident, such as the Christmas and new year period. People have been very upset about the fact that they have not been able to see their loved ones, but 32 nursing homes have open clusters of Covid and in the past seven days a further five nursing homes have developed Covid clusters. Unfortunately, while we are doing very well as a country we cannot take our eye off the ball as regards nursing homes. We have to be very vigilant to support our older and more vulnerable people. However, it is important to note that around half of our nursing homes remained Covid-19 free this year and many nursing homes that experienced a Covid-19 outbreak managed very well.

As Minister of State with responsibility for mental health and older people, I welcome the prioritisation of older people under the vaccination strategy as they have been the most affected by the pandemic. I encourage everyone who is in a position to do so to avail of the vaccine as early as he or she can. This is such an important step on our way back to normal life. I will be working, through my officials and the HSE, towards the reopening of day services in the new year. However, we must remember that this is just the first step and until enough people are vaccinated we must still remember to follow all the infection prevention and control advice to ensure that services that are operating can continue to do so in a safe way.

Covid-19 has also highlighted the vulnerability of people who are in homelessness and in addiction. They are a group of people with complex health needs. The HSE has established the Covid-19 Dublin homeless response team and has appointed a HSE clinical lead. The team co-ordinates the response to the virus for the homeless population across the whole of the Dublin Region Homeless Executive area. Socially excluded groups in congregated settings received priority action in terms of detection, case management and contact tracing. A fast-track flexible approach was used for complex cases in these communities. The HSE produced Covid-19 guidelines for homeless and vulnerable groups and this provides general advice about preventing the spread of Covid-19 in homeless settings and other vulnerable group settings, including direct provision. In Dublin, more than 1,000 additional beds were provided and 400 additional beds were put in place in other local authorities nationally.

Looking to the future, the Government has taken significant steps in response to Covid and, as I have outlined, this includes vulnerable people, older persons, and people with mental health difficulties. The Government's response is reflected in the countermotion the Minister has put forward and I commend it to the House.

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