Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I thank Deputy Ward for bringing forth this motion today. I acknowledge the consistent interest of Deputies Ward and Buckley in mental health. This motion provides me with an opportunity to discuss mental health now and beyond Covid-19, to update the Dáil on the work of my Department, the HSE and the voluntary sector in this area, and to put on the record the work happening on the ground. I look forward to addressing many of the issues raised.

During Covid-19, the Government has focused on reducing infection numbers and ensuring a safe and effective vaccine roll-out. However, citizens' mental health needs, especially people at risk of or with existing mental health difficulties, remain a priority. This is demonstrated in the programme for Government and our commitments to developing high-quality, individualised care and supports for all.

In 2019, the mental health budget was 6.3% of HSE funding. The apparent reduction to 5.1% in 2021 arises from the vast increase in Covid resourcing for acute services. The mental health budget has increased by more than €400 million since 2012, from €711 million to in excess of €1.1 billion this year. This figure does not include funding for mental health supports in other areas of the health system or in such Departments as Social Protection, Justice or Education. If anything, the figure underestimates State mental health funding.

Of the €50 million increase in mental health this year, €23 million is for implementation of many of the short-term recommendations of Sharing the Vision. This will fund an additional 153 staff in community mental health services, including 29 new staff for child and adolescent mental health services, CAMHS, teams and telehealth hubs, bereavement counselling, employment supports and crisis resolution teams. It will also fund development of the national clinical programmes and models of care, including the talking therapies model of care, which I launched yesterday. This model of care outlines a collaborative, layered delivery approach as service users commonly move between different service tiers in their healthcare journey. It has been developed in line with clinical evidence and international best practice and in collaboration with service users, family members and service providers, among others.

I particularly welcome this pillar of the model. People who use the services and their families and carers are at the heart of our mental health system and must be empowered to be active partners in the design, development and delivery of mental health services. The model of care will ensure talking therapies are accessible, evidence-based, recovery-oriented, and provide clear pathways for service users, ensuring everyone gets the right support in a timely manner, regardless of their ability to pay or where they live. The introduction of the model of care is a significant milestone in improving access to, and enhancing the quality of mental health supports, ultimately seeking better outcomes for people using our services.

A significant concern for me is the waiting lists for psychology in primary care, especially the waiting list for children and young people, which has been already raised a number of times in the debate. I am actively working with the Department and HSE to develop a targeted initiative to reduce significantly the number of under-18s waiting more than 12 months to access these services. This initiative will supplement the enhanced community care programme, which has an additional €150 million in new development funding for recruitment of more than 2,000 front-line primary care staff to support a new community health network model.

While we do not yet fully understand the effects of Covid-19 on mental health, a range of post-pandemic mental health and psychosocial challenges are likely to arise. These may persist for months or years afterwards, perhaps compounded by economic impacts.

Despite this, a negative mental health outcome for our population from the pandemic is not inevitable, if we respond to the challenge in a cohesive manner.

Launched in January 2021, the HSE's psychosocial framework provides a co-ordinated, consistent and collaborative approach to the provision of mental health services and supports. Building on a range of psychosocial supports introduced last year, the framework provides for five key levels, from mental health promotion to specialist services, during and beyond Covid. Seven-day telehealth services include yourmentalhealth.ie, the information line 1800 111 888, the crisis text line 50808 and NGO online supports. These comprise one-to-one counselling and group and peer supports delivered through MyMind and SilverCloud. MyMind provides free online counselling, in 15 languages, to people in communities nationwide. Online activity has increased since the introduction and enhancement of these services and there is capacity to cater for upsurges in demand. In line with the psychosocial framework, the HSE has a range of proactive responses for potential rises in service need, including online and other telehealth psychosocial supports.

Early in the pandemic, the HSE moved rapidly, under public health guidelines, to continue community mental health services where possible, with digital health models adopted for service user and staff safety. High-support residential placements have continued. Overall, specialist mental health services, both community and acute, are operating at 80% to 90% of pre-Covid levels. While referral rates are below normal, the level of appointments offered in all community services remained consistent with previous years, despite adaptations to service delivery.

With a target of 90%, 91.2% of adult accepted referrals were offered an appointment within 12 weeks in 2020. This compares with 92.9% in 2019. Similarly, with a 98% target, 96.8% of older people were offered an appointment within 12 weeks by psychiatry of later life teams. The community target of child and adolescent mental health services, CAMHS, of offering an appointment within 12 weeks was 78% in 2020. A total of 79.2% of children and young people were offered an appointment within 12 weeks last year, compared with 78.4% in 2019. These data show the ongoing dedication of mental health services to ensuring service continuity, despite the considerable challenges posed by Covid. I thank everybody working in mental health services the length and breadth of the country for the work they do on a daily basis.

To date, all consenting mental health staff and individuals in residential care have been vaccinated. Cohort 4, which includes high-risk mental health service users aged 16 to 64 in the community, is under way. In anticipation of a surge in requirement for mental health hospital beds, the HSE has worked with private hospitals on additional acute and longer-term beds, to free up public capacity. A total of €13.65 million has been allocated for this purpose. Of particular note, and taking account of the increased number and acuity of eating disorder presentations, I have secured the availability of €3.94 million to the national clinical programme for eating disorders this year. This will fund the establishment of three new specialist eating disorder teams and complete the three existing teams. I am fully committed to ensuring this funding is invested in full in 2021 and will continue thereafter.

Since coming to office, I have met many of the key organisations and personnel who deliver services, including HSE corporate staff, community healthcare organisation, CHO, heads of service, clinical leads, healthcare workers, partner NGOs and, importantly, service users and families. Last week, I met each of the nine CHO mental health leads to examine collective challenges, with a particular focus on CAMHS, improving residential standards and Covid-related challenges. These issues, and others we covered, are being addressed through Sharing the Vision, our national mental health policy, and the HSE service plan. Sharing the Vision seeks to enhance services across a broad continuum from mental health promotion, prevention and early intervention to specialist supports. It focuses on outcomes for people using our services, by taking a person-centred approach, and outlines principles of trauma-informed care.

In terms of recent developments, I am delighted that the formal handover of the new 170-bed hospital in Portrane to the national forensic mental health service took place in March.

The HSE is now equipping and commissioning the facility. This is a major step forward in providing a world-class service. Another positive step is the establishment this month of a high-level task force to consider the mental health and addiction challenges for people interacting with the criminal justice system.

I thank the Deputies for raising this motion. I am grateful for the opportunity to clarify how many of the concerns raised are being or will be addressed. This motion is not being opposed and much of the content is welcome. There is no doubt we all seek continued developments across the mental health system, and I am fully committed to working with all Deputies to see this fundamental ambition realised. I thank mental health service staff and those in the community and voluntary sectors for their immense work and dedication in supporting the mental health needs of people living in Ireland during this challenging time.

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