Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I thank Members for the opportunity to update the House further on mental health services during and post-Covid-19. At the outset, it is important to acknowledge that although we are, hopefully, past the worst of the pandemic, we are not out of the woods yet. When we talk about mental health post-Covid-19, therefore, we should acknowledge that the impact of Covid-19 will be felt for some time to come. It is also important for me to acknowledge the significant impact the cyberattack on the HSE has had, including on mental health services. I have remained in close contact with the HSE and I know how hard the staff are working to overcome the existing challenges. I commend all the staff working across the country on their unwavering commitment in continuing to provide vital mental health services.

I have regularly been here to update Members on mental health service provision. Delivery and development of such services are underpinned by our policies in this area, namely, Sharing the Vision, and, for suicide reduction, Connecting for Life. Our approach to the continued enhancement of mental health services is also reflected in the HSE national service plan 2021 and in specific commitments under the programme for Government. Our national policies set out recommendations to improve the mental health outcomes of our population. All these together represent the broad framework through which we are moving forward, addressing challenges, implementing policies and developing an integrated response to mental health.

Covid-19 has undoubtedly caused considerable upset and disruption to people’s lives, and while we do not yet fully understand the extent this will have on people’s mental health, it is acknowledged that a range of post-pandemic mental health and psychosocial challenges are likely to arise. These may persist for months or years, and will likely be compounded by economic impacts. The Government’s overall focus is on keeping Covid-19 case numbers down and reopening our society and economy while ensuring the safe and effective rolling out of the vaccines. However, the mental health needs of our people remain a priority, particularly for those already vulnerable to or experiencing mental health difficulties. Stress, anxiety and low mood have become part of many people’s lives. Many of us, at some stage, have experienced emotional difficulties, including grief, sadness and loneliness.

In response to the pandemic, the broad range of mental health services and supports provided by the HSE, and its partner organisations, were significantly expanded to address the additional demand created by Covid-19. A range of psychosocial responses were introduced, including self-help supports, which promote positive physical and mental health. The Keep Well campaign continues to provide practical advice and empower people to maintain and improve their overall well-being. Digital mental health initiatives were rapidly enhanced to enable services to meet not only current demand, but new and emerging needs. It has enabled us to continue providing much-needed supports where face-to-face service delivery was not possible. This includes video consultations and signposting to online counselling, self-help initiatives and other supports. Face-to-face assessments continue to be provided where remote assessment is not possible or appropriate.

We have also expanded our telephone and texting supports. E-mental health is now embedded and enables us to offer a blended, more up-to-date mental health service offering to meet evolving demands and circumstances. Digital mental health has aided provision of seven-day tele-mental health supports, including yourmentalhealth.ie, the information line 1800 111 888, the crisis textline 50808 and NGO online supports. These include one-to-one counselling and group and peer supports delivered, for example, through MyMind, Turn2Me and Silvercloud. MyMind provides free online counselling, in 15 languages, to people in communities nationwide. It delivers 4,000 counselling and psychotherapy appointments each month, supported by HSE and Sláintecare funding, which has been further extended to September 2021. As online activity has increased, we have increased capacity to allow for an upsurge in demand.

Early in the pandemic, the HSE moved rapidly, under public health guidelines, to continue community mental health services to the greatest extent possible, with enhanced digital mental health models adopted for service user and staff safety. Face-to-face supports continue where necessary and high-support residential placements have continued. Overall, specialist mental health services, in both community and acute settings, have operated at 85% to 90% of pre-pandemic levels.

Vaccination of mental health staff and individuals in long-term residential mental health care, who consented, is complete. In addition, vaccination of people with mental health difficulties in the community who fall under cohort 4, that is those at very high risk, is complete. Individuals with mental health difficulties who fall under cohort 7, that is those at high risk, continues to be rolled out.

While referral rates were initially below normal, the level of appointments offered and waiting times to access all community mental health services have remained consistent with previous years. This is despite adaptations to service delivery due to the considerable challenges posed by Covid. In anticipation of a requirement for increased mental health hospital beds, the HSE has worked with private hospitals on additional acute and longer-term beds to free up public capacity. Dedicated funding of €13.65 million has been allocated for this purpose.

As restrictions are easing and we move into summer, HSE mental health services have planned and are prepared for expected levels of service demands. The HSE psychosocial framework forms part of this, both now and into the future. The framework builds on existing psychosocial supports and provides a co-ordinated, consistent and collaborative approach to mental health service delivery at national, regional and local levels. It recognises the impact of Covid on mental health in all areas of society and aims to mitigate longer term effects while sustainably supporting the psychosocial well-being of both the public and healthcare workers during and beyond the pandemic.

The HSE social prescribing initiative is an additional route to providing psychosocial and practical support. In over 30 locations across the country, partners are offering social prescribing opportunities through many local community activities to support people to improve their overall health and well-being. Just last week, I announced the phased reopening of day care centres for older people which will have a considerable impact on promoting the mental health of this group of people. A total of 101 day centres are expected to reopen by the week of 5 July. More centres will resume later in July and August, with any remaining services that require adaptation works reopening before the end of the year. Funding will be made available for centres that require adaptation works.

Youth mental health is a critical issue and I assure the House that this continues to be a priority area for me and the Government. The pandemic has been hard on our children and young people. Schooling has been affected and physical, social and mental health difficulties are becoming more apparent. There are currently 13 Jigsaw sites nationally, with the fourteenth due to open to referrals in Thurles this July. As a national organisation, with increased capacity across its online supports, the services of Jigsaw can now be accessed from anywhere in the country. It offers much needed advice and early intervention to our young people and their families.

Underlining the Government’s commitment to mental health, budget 2021 saw an increase of €50 million bringing the total budget to over €1.1 billion. This 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. The new funding allocated this year will allow for implementation of many of the short-term recommendations of Sharing the Vision. It will fund 153 new staff in community mental health services, including 29 posts for CAMHS teams and tele-health hubs, bereavement counselling, employment supports and crisis resolution teams. Work is progressing in each of these areas. Similarly, service improvements are being achieved through investment in the national clinical mental health programmes and models of care, such as perinatal, talking therapies and specialist mental health of intellectual disability services. I am happy to report that recruitment is progressing successfully for many of the specialist posts. These programmes and models of care facilitate significant milestones in improving access to and enhancing the quality of mental health supports, ultimately seeking better outcomes for people using our services.

I am very aware of the increase in numbers and acuity of people presenting with eating disorders, particularly since the start of the pandemic. I am fully committed to ensuring that the €3.94 million I secured for the national clinical programme on eating disorders is fully invested in 2021. This will allow for the completion of the three existing specialist teams and the establishment of three new teams. Significant work on the recruitment of these specialist posts is progressing.

We have achieved much in recent years, through new developments and improvements to existing services. Our national policy, Sharing the Vision,will guide and enable us to enhance provision of mental health services and supports across a broad continuum, from mental health promotion, prevention and early intervention to acute and specialist service delivery. To drive implementation of Sharing the Vision, I established the national implementation monitoring committee. In addition, the HSE implementation group held its first meeting in May. A review of mental health inpatient bed capacity will be completed this year through the work of the committee.

It is acknowledged that there are aspects of mental health services that require improvement. However, I remind the House of the enormous amount of work being undertaken to improve our mental health services. The National Forensic Mental Health Service will relocate to a new purpose-built facility in Portrane and is scheduled to open in the next month or so, subject to ongoing challenges associated with the recent cyberattack on the HSE. This is a major step forward in providing a world class service to the highest international standards of quality and excellence and to greater numbers of people who need this care.

The Mental Health Act 2001 is undergoing a major overhaul and heads of Bill will be brought to Government for approval before the summer recess. The draft legislation will​ give effect to the recommendations of the expert group on allowing 16 and 17 year olds to consent to mental health treatment; the regulation of mental health community residences and services; the involvement of family members and advocates in a person's care, with the individual’s consent; the introduction of a set of guiding principles for the care and treatment of people in mental health services; and enhancements to the right to care plans and information for all people receiving inpatient care.

Our services continue to work closely with the Mental Health Commission to improve further inpatient residential settings. Covid-19 has further impressed upon us the need for single en-suite bedrooms and the importance of infection prevention and control. The HSE has been upgrading facilities, where feasible, to improve residential environments, creating more private, personalised and dignified settings.

Enhanced 24-hour crisis services have been called for. Sharing the Vision makes recommendations for the enhancement of crisis resolution supports, including the provision of out of hours and urgent mental health assistance, building on services already in place. This is a critical area of service development to which I am fully committed. The continued development of tele-psychiatry and tele-health solutions, which are already provided through the 24-hour crisis text line and tele-hubs such as CAMHS Connect in the west of the country, are also recommended. Further funding is secured for CAMHS Connect this year, along with other identified sites.

A sum of €1.4 million has been allocated for the continued development of the Castlerea hub in 2021. The hub includes CAMHS Connect and a CAMHS day hospital. The release of funding is imminent and local services have approval to proceed with developments this year. In 2020 approximately €400,000 was spent on refurbishment and €400,000 on staffing. Continued investment and implementation of the national clinical programme for the assessment and management of patients presenting to emergency departments following self-harm will also be provided for.

As we face continued challenges from the pandemic and its impacts on mental health and well-being, it is important for us to recognise that the majority of people will be able to manage many of the difficulties that they may experience in the short-to-medium term through low-level supports. However, some will experience distress over a longer period after the immediate crisis has passed and a minority will require more specialist input. To address this, we will continue to provide sustained psychosocial responses to effectively manage the overall well-being, resilience and mental health of our population.

I wish to repeat my thanks to the House for keeping us focused on our citizens' mental health and well-being during and post Covid, and for reminding us of the first class service everyone deserves, and for which we continue to strive to deliver. I also want to thank again the many front-line workers, healthcare workers and voluntary partners, whose tireless dedication and commitment have helped us reach where we are today, on the cusp of reopening our society and economy.

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 preventable if we respond to the challenge in a cohesive manner.

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