Catherine Connolly (Galway West, Independent) | Oireachtas source

She might not remember it, but Planning for the Future was the document to change everything in 1984. That was followed by A Vision for Change covering 2006 to 2016. Again, it was brilliant. I had no problems with both documents, but I had a big problem with their implementation. Planning for the Future was to change everything from the mid-eighties onwards to stop institutionalisation, but not to cast people out into the community without care, and that is what really happened. I mentioned A Vision for Change, but nothing changed. It remained a vision, unfortunately.

A very good independent monitoring body, which sat, I think, for two sessions and, in different leaders' speeches since 2016, I highlighted repeatedly that the independent monitoring body did its work so well that it was abolished. It sat for two terms, highlighted what was progressing and what was not progressing and the response of the then Government was to abolish the independent monitoring body. Again, we do not need to hear or see anything wrong. We then got Sharing the Vision after a huge gap and after huge pressure.

I pay tribute to the Minister of State. She has done her work in this regard, but that does not stop me criticising the system and how long it took to move from A Vision for Change to Sharing the Vision. Forgive me if I am cynical and say that all we are doing here is changing language unless we make it a reality. The Minister of State, all the TDs present and I know that, on the ground, there is a big difference between the vision, whether you are sharing it or having a vision and the actual services on the ground. Eventually we got Sharing the Vision, which is going to last until 2030. In her closing reply, the Minister of State might talk about the implementation plan, which runs out this year. It was for 2022 to 2024, so where are we in that regard? Then we had an expert review group. An in-built review was provided for in the original Act and it has taken this long to get the changes again, following the statutory requirement for a five-year review. That group made 165 recommendations.

I raise the subcommittee chaired by Senator Frances Black. I pay tribute to the committee's close scrutiny of the legislation. They have put huge work into it and looked at the use of language, as did Mental Health Reform. Mental Health Reform emphasised the importance of being careful with language and how we deal with it. For example, the term "mental disorder" is included but we do not talk about "physical disorders" and so on. While we have made progress with language, although we are not very good at it as politicians in being consistent, the legislation still retains the "mental disorder" terminology.

The cross-party report recognises the key shift. It also, for the first time, puts an emphasis on challenging the medical model that has dominated in this country from time immemorial when it comes to mental illness. I congratulate the subcommittee, the chair and all those people who took part and made submissions in challenging that very strong narrative which is very difficult to challenge.

Of course, we have signed and ratified the UNCRPD, but we have not signed up to the optional protocol. Again, that is another big gap. The protocol, significantly, will establish an individual complaints mechanism, as well as individual rights, economic, social and cultural rights. The convention requires us to move away from coercion in our legislation, which deprives people of their liberty and their right to make decisions.

Earlier, we discussed freedom of expression and the very specific rights that are enumerated in the Constitution. The previous discussion was in the context of a person's good name and freedom of expression. The same article guarantees the entitlement to liberty, which has often been ignored in terms of involuntary detention. We have committed to a human rights-based system, which I welcome. The Irish Human Rights and Equality Commission says one of the key guiding principles, which is cross-referenced in all three Acts, is the inclusion of the presumption of capacity. Again, of those three Acts, the 2015 Act still has not been fully implemented. We have a serious problem with aligning legislation and filling the gaps. Again, I might be out of date on this but I understand the interaction between the 2015 Act and people who have been involuntarily detained under Part 4 of the Mental Health Act. Those two sections on involuntary detention and capacity have not been aligned either. The Minister of State might correct me if I am wrong, but the post for national director of mental health is still vacant. So we have Sharing the Vision, and Planning for the Future but then we examine what is on the ground and the resources. The inspector of mental health services said the service is "chronically underfunded". In the Mental Health Commission's annual report in 2022, the inspector of mental health services stated:

we have a chronically underfunded mental health service for many years and an inclination [an inclination] for drifting towards providing institutional care for vulnerable groups of people...

Funding allocated [allocation] to mental health has been between 5–6% of Ireland’s total health budget in recent years. [I am quoting directly from the Mental Health Commission.] This is a very low national spend on mental health services when compared internationally ... we are still a long way off from reaching the 10% ... proposed by Slaintecare.

I want to mention physical care. I thank the Mental Health Commission for its work. Dr. Susan Finnerty has repeatedly pointed out a shocking statistic: "It is hard to believe that in the 21st century, someone with a mental illness will typically die between 15 and 20 years earlier than someone without and that mentally ill people continue to suffer unnecessarily with undiagnosed or poorly managed conditions." She goes through all of that in her report. There are premature deaths 15 to 20 years earlier as a result of a failure to look at the physical side of this. She does not quite state the physical problems arising because of medication, but she says the physical problems that are there and are not being treated because the emphasis is on the mental health difficulties and medication. She is clearly highlighting that we need to look at it and it is not being looked at.

Galway got a glowing report from the Mental Health Commission. Notwithstanding the glowing report, the unit in Galway was "over capacity" and there was a shortage of staff. The numbers of occupational therapists were not appropriate to the unit's needs. There were two vacancies and it received a high-risk rating. The numbers were not appropriate and the posts remain vacant. As well as getting a glowing report, my difficulty with this was that the emphasis was put on this to the exclusion of Ballinasloe. It is history now, but bad decisions were made. There was a brand new unit. I recall the psychiatrist, Dr. O'Grady and a small team of committed people on the ground saying not to do this. They did not. A brand new unit that cost millions of euro was not used and the emphasis was put on the acute unit. Only last week, they had no space to take in a patient. Bad decisions were made. I am zoning in on this because of the breakdown of the figures. Forty-nine out of 50 are in there. Fifteen of the 49 were admitted involuntarily. There are two wards of court. When are we going to stop using that, because we have abolished it? We have a process to take away that terminology.

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