Dan Neville (Limerick West, Fine Gael)
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I intend to discuss the recommendations of the report of the expert group on mental health policy, A Vision for Change. I thank the Ceann Comhairle for allowing me the opportunity to debate this important report and welcome the participation of my colleague, the Minister of State at the Department of Health and Children, Deputy Tim O'Malley.

A comparison between these latest recommendations and the 1984 report on psychiatric services, Planning for the Future, reveals little progress and raises questions about our attitudes towards improving the treatment of mentally ill people. It is depressing that a report dating from more than 20 years ago contains so many of the recommendations made by the most recent expert group. While this does not undermine the validity of those recommendations, it reveals how little progress we have made in terms of the way we treat the mentally ill. All this time, we have been promising to care for this most vulnerable group in their communities but progress has been painfully slow. How many other sectors in these modern and fast-paced times measure milestones in decades rather than years?

The Government proposes that its new plan will be effected incrementally over ten years, with funding from the sale of 15 mental hospitals to provide the necessary structures at community level. Why should the desperate need of the mental health sector depend on its ability to raise its own finances? Other areas of need are not treated in that way. By all means, let the Government raise money where possible from the sale of institutions but why should vital recommendations wait until this is complete before they are implemented when the money could be made available immediately?

It is a poor reflection on our society that our economy is in rude health, yet we still fail to act on behalf of the mentally ill. The disappointing proposal to increase the percentage of the health spend for mental health services from 6.98% to 8.24%, which the Minister of State has endorsed, compares unfavourably with other countries. For example, the comparable spend in England is 12% and is 18% in Scotland. For that matter, the recommendation falls far short of Ireland's mental health spend in 1997, which was 11% of total health expenditure.

There are inescapable doubts about the ability and commitment of the Government to deliver on the changes that the mental health sector so desperately needs. After knowing for 20 years the essential requirements of the mental health service, I have little confidence that the recommendations of this report will be implemented by this Government. I want to know how many sales have been completed since last March, when the Minister of State announced the sale of mental health service property to facilitate expenditure on psychiatric care.

It is unacceptable that there is a serious dearth of suitable community-based facilities for the delivery of high quality care. This not only applies to community mental health centres but also to day and hospital accommodation and community residences. Specialised mental health services are lacking and the neglect of young and old people with difficulties and of those with intellectual disabilities reflects badly on the Government.

Outpatient services for those suffering from mental or emotional illnesses are not being determined by need but by available resources. An integrated model of care should be introduced to address the broad needs of service users, including biological, psychological and social aspects of presenting disorders. Emotional aspects of mental disorder have been neglected, as has the disruption this can cause to sufferers' social and occupational functions. We did not need this report to inform us that there is a major scarcity of psychological therapists dealing with mental illness and the re-establishment of healthy supportive relationships. Some 22 years after the publication of the report, Planning for the Future, there are serious shortcomings in existing services for people with severe and enduring mental illness. At present, there are only five specialist rehabilitation teams in the country, none of which has the full range and number of staff required. Only two rehabilitation community mental health therapy centres have sufficient staffing.

For many years, I have witnessed the exclusion by the psychiatric service of families involved in the recovery and care for loved ones. The family of people with severe mental illnesses carry significant burdens of care but this goes unrecognised. There is a need to provide families and carers with support, information and, when needed, accessible help. The instant response by specialists to more than 90% of queries on the conditions of loved ones is that the matter is confidential and cannot be discussed with families. This contrasts with other areas, where the involvement of families and loved ones is welcomed by specialists.

Tim O'Malley (Limerick East, Progressive Democrats)
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I thank Deputy Neville for raising this matter.

I welcome the publication of A Vision for Change, which outlines an exciting vision of the future for mental health services and sets out a framework for action to achieve it over the next seven to ten years. The report has been accepted by Government as the basis for the future development of mental health policy.

I established the expert group on mental health policy in August 2003 in recognition of the need to review long-standing policy in this area and to formulate a blueprint for a modern, comprehensive, world class service to meet the mental health challenges facing our society.

The group's report is the first comprehensive review of mental health policy since Planning for the Future was published in 1984. The expert group was chaired by Professor Joyce O'Connor, President of the National College of Ireland, and consisted of 18 widely experienced people drawn from a range of backgrounds within the mental health services.

Wide-ranging consultation took place throughout the country in the development of this policy, drawing on the experience, perspectives and ideas of key stakeholders, interested agencies and concerned individuals. The findings from the consultation process provide a very clear indication of service users' views on the current state of the mental health services and how they should be developed in the future.

The report proposes a holistic view of mental illness and recommends an integrated multidisciplinary approach to addressing the biological, psychological and social factors that contribute to mental health problems. It proposes a person-centred treatment approach which addresses each of these elements through an integrated care plan, reflecting best practice, and agreed with service users and their carers. Special emphasis is given to the need to involve service users, their families and carers at every level of service provision. Interventions should be aimed at maximising recovery from mental illness and building on the resources of service users themselves and within their immediate social networks to allow them to achieve meaningful integration and participation in community life. A Vision for Change recommends that specialist expertise should be provided by community mental health teams — expanded multidisciplinary teams of clinicians who work together to serve the needs of service users across their lifespan. The community mental health teams should serve defined populations and age groups and operate from community-based mental health centres in specific sectors throughout reconfigured mental health catchments areas. These teams should assume responsibility for self-governance and be accountable to all their stakeholders, especially service users, their families and carers. Some of these community mental health teams should be established on a regional or national basis to address the complex mental health needs of specific categories of people who are few in number but who require particular expertise.

A Vision for Change envisions an active, flexible and community-based mental health service where the need for hospital admission will be greatly reduced. This policy will require substantial funding and it is recommended in the report that steps be taken to bring about the closure of all psychiatric hospitals and to re-invest the resources released by these closures in the mental health service.

The closure of large mental hospitals and the move to modern units attached to general hospitals, together with the expansion of community services, has been Government policy since the publication of Planning for the Future in 1984. A number of large psychiatric hospitals around the country have already been closed, including Our Lady's in Cork, St. Patrick's in Castlerea, St. Columba's in Sligo, St. Mary's in Castlebar and Our Lady's in Ennis. The re-organisation of services following these closures resulted in more community facilities, new acute psychiatric units in some cases and an overall improvement for service users, their families and carers. The remaining stand-alone psychiatric hospitals cater in the main for long-stay patients, many of whom are over 65 years of age.

The report recommends that a programme of capital and non-capital investment in mental health services adjusted in line with inflation should be implemented in a phased way over the next seven to ten years, in parallel with the proposed reorganisation of mental health services. The proposed new workforce will comprise more than 11,000 staff throughout the service. Allowing for the assimilation of all existing posts, the expert group has estimated that a total of 1,803 new posts across the service, together with a total non-capital investment of €151 million per annum in addition to existing funding are required.

Due to the current non-availability of certain health professionals, investment will be required on an incremental basis, resulting in a proposed non-capital investment of an additional €21.6 million each year for the next seven years. An additional €25 million has been allocated to the HSE for mental health services in 2006 and it is hoped to continue this level of investment in the coming years.

Significant capital investment is also required to provide and equip the proposed new mental health infrastructure. The report estimates that €796 million will be required. There are, however, substantial capital assets in the existing psychiatric hospital buildings and lands which could be released to fund the capital investment required.