Dáil debates

Thursday, 29 April 2021

Covid-19, Mental Health and Older People: Statements


10:00 am

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail) | Oireachtas source

I thank Members for another opportunity today to update the House on developments in the areas of mental health and older people.

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. Surveys have shown an increased number of people reporting symptoms of stress, anxiety and depression during the pandemic.

Many people are experiencing emotional difficulties, including boredom, sadness and loneliness. In anticipation of this, and early in the pandemic, a range of psychosocial responses was introduced, including self-help supports, which promote positive physical and mental health. The Keep Well campaign provides practical advice, empowering individuals to maintain and improve their overall well-being.

Digital initiatives were rapidly enhanced to enable services to meet not only current demand but new and emerging need. Technology has aided the provision of seven-day tele-mental health supports, including YourMentalHealth.ie, the information line 1800 111 888, the crisis text line 50808 and NGO online supports. These include 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 and there is capacity for upsurges in demand.

The HSE already has a range of proactive responses for any increase in service need, including online and other telehealth and psychosocial supports. The HSE’s psychosocial framework, published in January 2021, recognises the impact of Covid on mental health and provides for five key levels of support, from mental health promotion to specialist services. The framework provides a co-ordinated, consistent and collaborative approach to the provision of mental health services and supports during and beyond the pandemic.

HSE mental health services have continued to operate throughout the Covid-19 pandemic. Early in the pandemic, the HSE moved rapidly, under public health guidelines, to deliver 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, community and acute, are operating at between 85% and 90% of pre-pandemic levels. While referral rates are below normal, the level of appointments offered and waiting times to access community services have remained consistent with previous years. This is despite adaptations to service delivery due to the considerable challenges posed by Covid.

There is no doubt that this shows the ongoing dedication of mental health staff to ensuring service continuity. I express my sincere thanks to all those working across the services for their hard work and dedication during what has been an incredibly challenging and difficult time.

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. Some €13.65 million has been allocated for this specific purpose.

Underlining the Government’s commitment to mental health, budget 2021 saw an increase of €50 million, bringing the total mental health budget to over 1.1 billion. This is the largest budget on record. Furthermore, it does not take account of additional funding allocated to mental health in other areas of the health system or through other Departments such as justice, education and social protection.

Of the additional funding for 2021, €23 million is for implementation of many of the short-term recommendations of Sharing the Vision - A Mental Health Policy for Everyone. This will fund 153 new staff in community mental health services, including 29 posts 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 last week.

I have also secured the availability of €3.94 million for the national clinical programme on eating disorders this year. This will fund the establishment of three new specialist eating disorder teams and complete the three existing teams. I am aware of the increase in numbers and acuity of people presenting with eating disorders and I am fully committed to ensuring this funding is invested in full in 2021 and that we also see a continuation of the funding until we have all 16 teams in post.

I am also actively working with the Department and the HSE to develop a targeted initiative to significantly reduce the number of children and young people under 18 waiting more than 12 months for psychology in primary care. To supplement this, an additional €150 million is being provided for the enhanced community care programme, which will include recruitment of over 2,000 front-line primary care staff, to support a new community health network model.

It would be remiss of me not to provide some assurances about the range of processes that have been put in place to review the care received by children and young people who attended south Kerry CAMHS between 2016 and 2020. In light of concerns raised about the care given in some cases, the HSE will review the details of a very large number of young people, 1,500, who engaged with the service during this time. A CAMHS consultant has been in direct contact with all young persons or their families where concerns have been raised to date, and this process will continue as the review is undertaken. As the team reviews cases and files, any urgent issues will be dealt with immediately.

It is expected that the look-back review process will take in the region of 16 weeks. The HSE will share the findings and recommendations once the process is completed. A helpline has been put in place until 30 April. However, demand has been low. I am keeping this matter under close review in consultation, as appropriate, with other relevant areas in the Department and the HSE.

While a range of post-pandemic mental health and psychosocial challenges are likely to arise, a negative mental health outcome for our population from the pandemic is avoidable if we respond to the challenge in a cohesive manner. As Minister of State with responsibility for mental health, I assure the House of my full dedication to addressing the challenges that this represents.

The pandemic has posed the biggest challenges for those most at risk, including our older people. We recognise that there is still a long road ahead. However, there is much cause for us to feel optimistic. The Government will continue to make every effort to ensure the vaccine roll-out is successful so that we can all look forward to the restrictions being lifted as we move into summer.

Administration of the vaccine is well advanced as the programme continues to prioritise those who are most at risk of severe illness and death from Covid-19. The positive impact of the vaccine roll-out to date has been significant.

Between January and last week, there had been a 98% reduction in cases among healthcare workers, a 99% reduction of incidence in those aged over 85 and a 100% reduction in the incidence in nursing homes. For the third week in a row, there have been no cases associated with outbreaks in nursing homes.

In recognition of the positive impact of the vaccine across nursing homes, new guidance on visiting will come into effect on 4 May allowing residents to receive four visits every week.

Work to progress the implementation of the expert panel report will continue as it provides an important framework for the ongoing response to Covid-19 and longer term reform. The availability of supports to all nursing homes continues, including financial assistance, staff accommodation, personal protective equipment, PPE, serial testing and HSE Covid-19 response teams, where needed.

A dedicated system has been established to ensure all those awaiting a vaccination at home will be contacted in the coming days. This has been ongoing all week. The National Ambulance Service has been working hard to process referrals received for the programme. It is currently undertaking approximately 400 appointments per week. Over 3,500 referrals have been received as part of the housebound programme. To date, there have been 1,800 first doses and 500 second doses of vaccine administered. Of the more than 3,500 people referred, not all may be deemed suitable for a vaccine on assessment. I reassure those who are still awaiting a vaccination that the HSE will make direct contact with them and will administer the vaccine within a three-week period. This is week one. Of note, there has been considerable progress on the vaccine roll-out among the over-70s, with more than 95% of this age cohort having received a first dose of the vaccine.

This year, an additional €150 million has been provided to deliver on the Government's commitment to increase home care hours. This includes €17 million to progress the development of a statutory scheme for the financing and regulation of home support services. This brings the total investment in home support, including winter funding, to €666.5 million in 2021.

I am pleased to advise the House that, on 27 April, the Government approved the drafting of a general scheme and heads of a Bill to establish a licensing framework for publicly funded, for-profit and not-for-profit home support providers. As part of the wider reform of the model of service delivery for home support, the Department is finalising business cases with the HSE on the key enablers of the statutory scheme.

A key priority for me currently is the resumption of day care services, and I will continue to engage with senior officials within the Department and HSE to ensure that as many services as possible can reopen as soon as it is safe. The HSE is focused on delivering on this priority, and a dedicated focus group is in place to drive and oversee a plan to resume these services as soon as possible.

The nursing homes support scheme continues to deliver affordable and accessible nursing home care for citizens with long-term care needs. Notwithstanding this, the programme for Government commits to introducing an amendment to the scheme to cap the financial assessment of family-owned and family-operated farms or businesses at three years when calculating the means to pay for nursing home care.

A finalised draft of the Bill has now been signed by the Attorney General and I expect to bring the Bill to the Cabinet for approval next week. I hope it will be before the House in four to six weeks.

A range of initiatives and resources is available through the Understand Together campaign to ensure that people living with dementia stay safe, well and connected. Primary care teams are referring people with dementia to community supports such as the local authority community response forums and the Alzheimer Society of Ireland dementia adviser service. I am particularly pleased that additional funding for 2021 will ensure the recruitment of 11 new dementia advisers, bringing the expected total to 29 by the end of this year. In line with the national dementia strategy, €5 million has been allocated to support those with dementia this year, with a focus on six key initiatives. A minimum of 5% of the 5 million home support hours for this year are allocated for people with dementia. Taking into account the increased investment in the dementia adviser service and the national dementia strategy, this brings the total investment in dementia services to €12.9 million this year.

I am fully committed to further enhancing mental health and older people's services and look forward to Members' contributions today on these important areas of work.


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