Catherine Connolly (Galway West, Independent) | Oireachtas source

I always preface my remarks by saying the Minister of State inherited the situation. In that context, I welcome this opportunity, although like another speaker said, I do not know whether the word "welcome" is appropriate in relation to what I am about to say. I will start with the statement of the chairperson of the Mental Health Commission, John Saunders, who said: "The current Covid-19 pandemic has highlighted in stark terms the need for a modern, well-staffed, holistic community-based mental health service." That was on the publication of the 2019 annual report of the commission, which was published midway through 2020, and we are waiting on the updated annual report. I will refer to some of that report.

I am someone who has a privileged background in my working career. I foolishly thought that things were improving in the 1980s with the publication of Planning for the Future in 1984. That was followed by A Vision for Change, which was followed by Sharing the Vision. The independent panel, which the Minister of State has worked hard to set up, will be the measuring stick of how serious this Government is about mental health.

I thank Sinn Féin for using its Private Members' time for this issue and I welcome this opportunity, although I despair of the words used. Like Deputy Verona Murphy, I cannot say how many times I have spoken on mental health since 2016. First, we were trying to ascertain where A Vision for Change was at and then we were told there was an update review of the literature. When it was done, it was done quickly and effectively by the professionals who did it but it took forever to make that decision. Then A Vision for Change came along. All the time, the implementation body was gone, although the Government is in the process of re-establishing it. We should not need to talk about mental health in this Chamber. There should be a policy and legislation and they should be implemented. That is why we had an independent panel monitoring body to take it out of our hands and come back with reports to us. We should be discussing the reports of that independent monitoring body, not discussing the Minister of State's speech in which she is obliged to say what the Government is spending, which is not detailed in context. We should be looking at the reports of the independent monitoring body. That is the step I would like to see taken in the future.

It is truly upsetting to read this report. I will take a pen picture of what the Mental Health Commission found when it looked at the 65 approved centres. There are also lots of centres that are not approved so somebody might deal with that and outline what the Government's plans are in that regard. While the commission's staff can go into those facilities, they cannot make them change or comply with the recommendations. That is a serious gap. We can look at the number of deaths of people using mental health services alone. Unfortunately, we are all familiar with the revolving door in emergency departments and the distress it is causing. I am from Galway and, unfortunately, we have a suicide patrol watch, which I pay tribute to. That is where we are in Galway with helicopters in the sky and we all tremble and say a prayer if we believe and if we do not believe we say something else. In that context, in 2019, some 563 people died. That was the number of deaths of people who were using the mental health services. Some 166 deaths related to approved centres and 397 deaths related to community mental health services. Of those, 168 were suspected suicides of people who were attending the mental health services.

I mention the context of the report that has been mentioned by a number of Deputies on child mental health cases due to excessive medication doses and I will come to that in a minute. I am looking at the report of Dr. Susan Finnerty, inspector of mental health services at the Mental Health Commission, and it is worth looking at. It is not an onerous chapter in the sense of the number of pages in it but it captures is what I would love to hear from a Government and a Minister when they come in to talk to us. The report poses the question: "What did we find?". It goes on to answer: "We found a number of issues of concern" when the 65 approved centres were inspected. It states that they found "poor quality in monitoring the physical health of residents" and mentions "the impact of staffing shortages". That absence of staff has been mentioned by many. The report mentions "the failure to provide all residents with a meaningful individual care plan." Something as basic as an individual care plan was missing, which Mr. Saunders has pointed out should be the blueprint of care. The figure for something as basic as that was a 52% non-compliance rate but I am subject to correction. I might have that figure wrong but it was an extremely high non-compliance rate.

What is also worrying is the level of compliance generally and again the Mental Health Commission is fair. It does not zone in on one particular criterion but it takes an overall approach. Some of the percentage compliance rates in 2009 were 56%, 57% and 59%. In Galway, quite shockingly, there was 70% compliance. I would expect 95%, 96% or 97% compliance. The Galway centre is a brand new one, relatively speaking. Dr. Finnerty and Mr. Saunders stated:

The patient’s individual care plan should be ... the blueprint for their care pathway. It should be viewed as the patient's care plan, not the clinician's.

Then they go onto physical care for persons with severe mental illness, stating: "It remains a fact that in the 21st century people with a mental illness will die between 15-20 years earlier than their peers in the general community, in many cases due to preventable physical illnesses."

They further state that the system has:

...lost sight of the ‘whole’ patient and the need to consider both mental and physical factors in the genesis and continuation of mental illness ... While not unique to mental illness, there is a now well documented association between the use of antipsychotics... and the development of metabolic syndrome. It is estimated that over a third of patients with schizophrenia will develop metabolic syndrome with detrimental effect on their health and life span.

It goes on and on.

In my remaining two minutes I will deal with one specific issue relating to the review. Urgent clarification is needed on the review of the excessive medication doses for children. The question is whether that applies in the west of Ireland, in Galway. What are the implications throughout the country?

The Mental Health Commission refers to parity of esteem for mental health. We have not even gone near to having parity of esteem. When the Minister of State comes into the House in the future, I would like her to address that. I know she inherited the situation, but the blueprint is there from all the documents. There was nothing wrong with A Vision for Change. The time span was from 2006 to 2016; the date was out of date but nothing else was. It was visionary. As I have said before, it set out all the problems and inadequacies on the ground, and what we needed. Successive governments delayed on that. Not alone did they delay, but they abolished the independent monitoring panel. The Minister of State has inherited that. She has an opportunity to say this is out of her hands and that she will be guided by the independent monitoring body regarding the progress or lack of progress.

Instead of that, successive governments have delayed, and we got the ridiculous update of literature which could have been done in parallel with the implementation of it. All the time on the ground the services have been creaking at the seams. I say that reluctantly. I am a positive person. I come from a wonderful city. I also come from a city where there is a revolving door in respect of mental health. The report identified that services are operating over capacity. There is overcrowding, lack of privacy and so many other defects. Why is this? It is simply that we have failed to treat it with a parity of esteem. We do not have appropriate staff on the ground. We have made too much use of medication as a way of dealing with issues, as appears to be confirmed in the report in today's Irish Independent.

I do not wish to stand up here again and speak on mental health to outline my opinion or anecdotes on the ground. I want to see the implementation of what is now the policy document, Sharing the Vision. I want to see updated reports on how far we are progressing with that and what we need to be doing. That is where my energy and the energy of other Deputies should be directed.

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