Liam Quaide (Cork East, Social Democrats)

I thank the Minister of State for being here. I commend Deputy Roche on his heartfelt and powerful testimony. I thank him for sharing it with us.

In response to the mental health allocations in the budget, I want to be constructive and fair. I welcome the crisis support cafés that were announced, the focus on suicide prevention and the increase in CAMHS inpatient bed capacity. However, it is also important to state that the Sláintecare report recommended that at least 10% of the overall health budget be spent on mental health. This year's allocation of almost €1.6 billion represents only 5.8% of the overall health budget. Last year's budget allocation for mental health was 5.7% of the overall health spend, so the Government is moving towards that 10% at a snail's pace.

Meanwhile, many people who are desperately in need of multidisciplinary intervention in secondary and tertiary mental health services will have to continue to wait extended periods because of the recruitment restrictions still in place under the pay and numbers strategy. The latter has resulted in the decommissioning of an as of yet unknown number of essential community mental health and inpatient posts, which, in turn, as resulted in an unsustainable clinical burden being placed on existing team members. Anecdotally, I know of many posts that have been vaporised by the pay and numbers strategy. The HSE's responses to previous parliamentary questions, one of which I received only a short time ago, involve seeking more clarity with follow-up questions to me only to obfuscate the details further. Until we get beyond the pay and numbers strategy, we cannot really get serious about resourcing our mental health services and that is the case from primary care up to intensive mental health support for people with the most serious and urgent mental health difficulties.

Two days on from the publication of the budget, transparency in reporting is a long way off. We need to see a more detailed breakdown of the mental health allocation to analyse it properly. We need to know, for example, how many inpatient beds for people with life threatening eating disorders will be provided. We currently have three of the 23 beds recommended in the model of care. We need to know how many residential placements will be funded for the vulnerable cohort of people who have an intellectual disability and co-existing mental health difficulties.

It is extremely disappointing that no capital funding appears to have been committed in this budget to a perinatal mental health mother and baby unit, despite the fact that it was identified as a priority in a model of care that is now more than eight years old. Dr. Suzanne Crowe, president of the Irish Medical Council, wrote in The Irish Independent on Tuesday of the additional suffering caused to mothers with severe postnatal mental health difficulties who are separated from their babies.

This is an acutely sensitive and consequential time for both mother and baby and it is essential that both be supported, along with the mother's partner where that applies, in a therapeutic environment. I say consequential because we know from research and clinical experience that the early stages of attachment are crucial to later mental health and development. The crude medicalised psychiatric wards that mothers with severe post-natal mental health difficulties are currently referred to are likely in many cases to actually deepen their distress further and run the risk of disrupting those early bonds with their babies.

I know from patients and colleagues that those characteristics of many inpatient wards have worsened in recent years as those services have come under more pressure a result of fewer staff being on site and the increasing demand on services. Dr. Crowe states in her editorial that nearly nine years on from the publication of the model of care, no such unit has been built. She said this inertia is unfathomable. Yet there are plans to build other types of facilities, including a 50-bed centralised residential service for adults with severe and enduring mental health difficulties on a hospital site in Glanmire, County Cork at a projected capital cost of €64 million. If this goes ahead the residents will be starkly dislocated from anything resembling community living, living on the grounds of a hospital, and the proposal would be at odds with every mental health policy that has been written since Planning for the Future in the mid-1980s as well as being in breach of the UN Convention on the Rights of Persons with Disabilities. This is a retrograde proposal with no precedent as a new development in recent decades which will send mental health rehabilitation and recovery services into the dark ages where we removed people with mental health difficulties from society. I look forward to further details on the breakdown of the mental health allocations on the budget.

I also want to raise an issue of major concern to psychotherapists and one of great public interest regarding the regulation of their discipline by CORU. The Irish Council for Psychotherapy represents over 2,100 psychotherapists across ten professional organisations. It has raised six critical objections to what is being proposed under this CORU framework and has submitted a detailed policy proposal on that to the Minister for Health, Deputy Carroll MacNeill.

My own background is in psychology. I have the greatest of respect for psychotherapists and I believe there is much about their training that my discipline could learn from and strive to emulate. A core part of psychotherapy training is that the trainee would have mandatory psychotherapy for themselves. The ICP is extremely concerned about the removal of a mandatory personal therapy requirement for trainees under CORU’s proposals. Psychotherapy at its essence is a deep human engagement, often necessarily over a sustained period of time that requires humility, self awareness and constant reflection on the part of the therapist, what the Neville Symington called the core of one person meeting the core of another. It is recognised within the broad field of psychotherapy and psychology that it is essential to face one’s own areas of vulnerability, shame and aggression and become aware of one’s own psychological blind spots before attempting to help a client to do so. Removing this requirement amounts to stripping away part of the essence of psychotherapy and it should be reversed. The ICP is also deeply concerned about the absence of close clinical supervision requirements, no minimum duration for training programmes, a reduction in required clinical practice hours from 500 to 200 and a failure to distinguish psychotherapy from more brief psychological interventions. These proposals by CORU amount to a disregard for European standards jeopardising employment mobility across the EU for psychotherapists and undermining public safety. I urge the Minister, Deputy Carroll MacNeill, to engage with the Irish Council for Psychotherapy as a matter of urgency and to intervene with CORU on this matter.

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