Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I thank the House for allowing us time today to discuss the very important issue of mental health during and beyond Covid-19. I welcome the opportunity to restate my own and the Government’s commitment to the continued development and enhancement of mental health services and supports, from mental health promotion, prevention and early intervention to acute and specialist services.

The pandemic has been very challenging, and some people are finding it more difficult than others. Financial and employment worries have caused anxiety and the disease itself has caused significant stress. This has been exacerbated, in many cases, by isolation and bereavement. While the Government’s overall focus is on reducing Covid numbers and ensuring the safe and effective roll-out of the vaccine, our citizens’ mental health needs, particularly for those already vulnerable to or with existing mental health difficulties, remain a priority.

At the outset, both the Department of Health and HSE mental health services put in place, in the safest environment possible for staff and service users, a range of proactive responses to provide for any rise in service need. Our approach to Covid-19 risk mitigation and infection control in mental health services has been systematic and structured.

Residential services were quickly identified as the highest risk areas for staff and service users. The Department tasked the Mental Health Commission with developing a risk control and monitoring framework for residential mental health facilities to identify and address infection risks.The commission collected Covid data and reported weekly to the Department and the HSE on the suitability of premises, preparedness, training and equipment levels. From this process, many facilities were reconfigured to single rooms to reduce the risk of cross-infection and into possible Covid and non-Covid areas. In addition, staff training, personal protective equipment, PPE, provision and testing were implemented to recommended levels. As a result, HSE residential mental health services have continued throughout the pandemic. There has been reduced capacity in some settings to ensure staff and service user safety, and there have been some outbreaks, but the protocols and procedures in place have reduced the impact of these as much as possible.

In this current episode, case numbers in mental health facilities have started to reduce, in line with national figures. Although suspected and confirmed staff and resident cases are still too high, HSE mental health services have worked tirelessly with public health to mitigate the spread of the virus. A tripartite oversight group, comprising representatives from the Department, HSE mental health services and the Mental Health Commission, was established to monitor outbreak control. It continues to monitor and identify issues and risks, find potential solutions and follow up as appropriate.

With respect to vaccine roll-out, the HSE has undertaken to prioritise vaccination of those over 65 years in residential settings, including mental health facilities. The majority of the 46 units with residents over 65 years have now received the first dose of the vaccine.

At this point, I would like to remember the 28 people who have died due to Covid while resident in a mental health centre. I believe that, without the work on outbreak control, the situation could have been much worse in our residential services, and I commend the dedication of staff, the HSE, the commission, the Department and families of residents who all worked to keep infection rates down and our people as safe as possible.

The Department also introduced two pieces of emergency legislation to protect staff and people in hospital for mental health treatment. The first allowed mental health tribunals, which review involuntary detentions, to be held remotely and with one person if staff pressure led to unavailability. Luckily, these measures have not been required so far. The second provided for patients to be transferred temporarily from the Central Mental Hospital in Dundrum to the new Portrane facility to allow for a Covid isolation facility in Dundrum during the second quarter of 2020. Those involved have since moved on to other accommodation in line with their care and treatment plans.

Community mental health teams continue to provide services following rapid reconfiguration and with adaptations in place to protect service users and staff. Significant supports are in place and telehealth services are fully established, with online psychosocial supports now embedded in service provision. Seven-day telehealth services include yourmentalhealth.ie,the information line 1800 111 888, the crisis textline 50808 and NGO partners’ online supports.

It must be noted that availability of staff has been a significant issue throughout the pandemic. Mirroring national services, most cases of Covid-19 have been among staff and this has added pressure to our mental health services.

While we do not yet fully understand the impact of Covid-19 on mental health and any subsequent demand on services, it is acknowledged that there have been increased presentations in certain areas, especially in first episode psychosis and eating disorders. I am particularly concerned about the rise in eating disorders among girls and young women.

I have met numerous times with the HSE regarding the mental health national clinical programmes and launched models of care on mental health and intellectual disability and ADHD in recent weeks. The programmes and models of care will facilitate significant service improvements and will ensure consistent delivery of high-quality mental health services that can be replicated nationally.

I am pleased to say that the 2021 budget allocation will enable continued development of the programmes, including the national clinical programmes for early intervention in psychosis and eating disorders. Funding to enhance eating disorder services will be allocated this year for the recruitment of staff to enhance and establish specialist teams in addition to capital works. I am fully committed to ensuring that this money is spent in full and translates into real improvements in service provision for people with eating disorders.

The HSE psychosocial framework, published in January this year, acknowledges the pandemic’s impact on mental health in all areas of society. It aims to mitigate longer term effects and sustainably support the mental health and psychosocial well-being of both the public and healthcare workers through targeted actions.

We need to maintain psychosocial supports to protect the mental health and well-being of all our citizens. This year, 2020, saw the Government provide €1.1 million for a mental health promotion and well-being campaign and a further €1.1 million for a psychosocial campaign. This funding sought to address potential demand from the public, front-line health professionals and people with new or existing mild to moderate mental health issues.

Online counselling supports have been developed and include those provided through NGO partners such as MyMind, Turn2Me and Jigsaw. As an example, MyMind delivered nearly 10,000 free online appointments in 2020.

While the numbers of people accessing yourmentalhealth.ieand NGO partners’ websites seeking information and supports have increased in some instances, there is still some unused capacity in this area. The Department and the HSE continue to plan for any surge in demand as it arises.

Currently, data show no evidence of a significant increase in self-harm presentations to emergency departments. It is too early to speculate on suicide figures, which the Central Statistics Office, CSO, reports each June following coroners' verdicts. However, early international evidence indicates no increase in suicide, with a decrease in self harm-suicide attempts earlier in the pandemic. However, these findings should be interpreted cautiously as we await more up-to-date analysis.

Implementation of Sharing the Vision is proceeding and the national implementation and monitoring committee, which I established late last year, is meeting monthly. The committee will drive reconfiguration of mental health services, monitor progress against outcomes and begin delivering the commitments in Sharing the Vision. The policy is closely aligned with Sláintecare’s vision of the right care in the right place at the right time. It aims to create easier access to multidisciplinary, user-centred supports in primary care, focusing on early intervention.

Of the additional €50 million secured as part of budget 2021, €23 million is allocated to commencing implementation of many of Sharing the Vision’s short-term recommendations. Fifteen million euro will assist with Covid-19 challenges. There will be more step-down beds and extra resources for community mental health teams as well as reconfiguration of facilities, in line with Mental Health Commission recommendations. There will also be a focus on enhancing digital mental health supports and increasing additional capacity in private sector approved centres.

In addition to this significant investment, the national forensic mental health service will be relocated this year from Dundrum to Portrane. This follows the passing of legislation which I brought through the Oireachtas before Christmas. In that regard, I would like to thank all the Deputies for their support.

The review of the 2001 Mental Health Act, which has involved many stakeholders over quite a few years, is concluding and the heads of the new Bill will be ready to publish very soon.

I acknowledge the tremendous efforts and sacrifices our citizens have made to follow public health advice and mitigate the spread of Covid-19. I encourage everyone to link with the Government's well-being campaigns, including Keep Well, which my colleague, the Minister of State, Deputy Feighan, will speak on now, to promote physical and mental well-being in the safest possible ways.

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