Dáil debates

Tuesday, 7 March 2006

Adjournment Debate.

Mental Health Services.

11:00 pm

Photo of Barry AndrewsBarry Andrews (Dún Laoghaire, Fianna Fail)
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I am glad of the opportunity to raise this matter. The east coast catchment has the unhappy distinction of being the mental health service area with the lowest funding in the State. The reason is partly historical, in that most counties had their own psychiatric hospitals and, when these were closed and replaced by better community-based facilities, funding was provided to compensate for the loss of county hospitals. However, because Dún Laoghaire never had a county hospital, it had nothing to bring to the bargaining table. As a result, it lies at the bottom of the league table of funding according to figures provided by the HSE. We need to acknowledge that significant problems exist in terms of funding for this area.

The recently published report, A Vision for Change, details a comprehensive model mental health service provision in Ireland. The report describes a framework for building and fostering positive mental health across the entire community and for providing accessible community-based specialist services for those suffering with mental illness.

In Dún Laoghaire, when a national pilot project, DETECT, was established, a mere 10% of the necessary funds was provided by the HSE, with the balance coming from Order of St. John of God. The project, which was rolled out last month, tries to reduce the duration of untreated psychosis because people with an established psychosis are 25 times more likely to commit suicide than the general population. This highlights the importance of early detection. As it is an established fact that psychosis is treatable, the earlier the detection, the better.

This issue particularly affects areas of disadvantage and identifiable social and economic problems. The lack of services within the Dún Laoghaire area affects people on low incomes more than those with private insurance. The need for a multidisciplinary response to diagnoses of psychosis is not always met in such circumstance. Sufferers are seen by psychiatrists but have little or no access to community psychiatric nurses, social welfare officers or occupational therapists.

A false economy is created by balancing the cost of hospitalisation for sufferers of mental illness against the much lower cost of setting up a system of early detection. DETECT has impressed me with the type of service it intends to provide. The people involved in the project made a presentation at Cluain Mhuire last month, in which they demonstrated their knowledge of best international practice and their plans to reduce the incidence and duration of psychosis.

There is a perception among the providers of mental health care that the service is grossly under-resourced, both in financial terms and in the range of staffing and physical resources required to provide a quality service. The serious funding crisis that exists may be illustrated as follows. In 1984, 13% of total health expenditure went towards mental health but this figure decreased to 10% in 1994 and to 7.3% in 2004. While the overall pie has grown larger, the lack of resources for this area is apparent.

In the past, mental health budgets were funded on the basis of historical budgets and existing service pressure. In the future, this funding will follow existing population trends and needs, if the recommendations of the report, A Vision for Change, are implemented. The report draws into focus the uneven distribution of funding and human resources throughout the country. The recommendations have been made and the ideas are there. We need substantial extra funding to finance these policies. An urgent programme of capital and non-capital investment in mental health services adjusted in line with inflation should be introduced in line with the reorganisation of the mental health services.

Photo of Brian Lenihan JnrBrian Lenihan Jnr (Dublin West, Fianna Fail)
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I thank Deputy Andrews for raising this matter, which I will take on behalf of my colleague, the Tánaiste.

Our mental health services have undergone significant changes over the past two decades. The move away from institutional care to community care has brought the mental health services generally closer to the service user. The move from hospital-based care to individualised care has empowered users to take a more proactive role in their care and treatment. This has been complemented by the care and treatment provided by multidisciplinary teams in partnership with other health care professionals and voluntary agencies.

These changes have been in line with the model of service provision now recommended by the recently published report of the expert group on mental health policy, A Vision for Change. This report is the first comprehensive review of mental health policy since Planning for the Future was published in 1984. The report has been accepted by the Government as the basis for the future development of mental health policy. It 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. 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 1,800 new posts are required across the services, together with a total non-capital investment of €150 million per annum in addition to existing funding. This programme of investment has already begun with an additional €25 million allocated to the HSE in the Estimates for 2006 for the further development of mental health services.

Significant capital investment will be required to implement the proposals in A Vision for Change regarding the provision of new and replacement facilities for the mental health services. This has been estimated by the expert group to be of the order of €800 million and, as outlined in their report, much of it could be realised from the value of existing hospitals and lands.

The proposals in A Vision for Change will allow for further significant expansion in community services and in specialised services for groups such as children, older people and those with particular needs. The implementation of this policy will be a matter for the Health Service Executive in accordance with the provisions of the Health Act 2004. The national mental health directorate within the HSE is in the process of establishing an implementation group to ensure that the recommendations are realised in a co-ordinated manner.

I am aware the adult mental health service in former community care area 1, now known as the local health office in Dún Laoghaire, has a population of 170,000 and a mental health budget of almost €13 million for 2006. There are 4.5 consultant-led mental health teams operating in the area.

In preparation for the implementation of the Mental Health Act 2001, the Health Service Executive reviewed the number of consultants per capita in the new local health office areas. The review indicated that the local health office in Dún Laoghaire has the lowest number of consultant psychiatrists per capita in the country. In order to begin to address the issue, an additional €550,000 revenue funding will be allocated to the Dún Laoghaire service in 2006, and the intention is to provide additional funding in coming years in order to increase the number of consultant-led teams in line with the national norm.

My colleague, the Minister of State at the Department of Health and Children, Deputy Tim O'Malley, who has special responsibility for mental health, will be seeking the active support of all involved in the mental health services so that together we can bring about the far-reaching improvements contained in A Vision for Change. He will shortly be appointing a group, as recommended in the report, to monitor the implementation of its recommendations.

I would like to stress that A Vision for Change details a comprehensive model of mental health service provision for Ireland. It describes a framework for building and fostering positive mental health across the entire community and for providing accessible, community-based, specialist services for people with mental illness. On that basis, I assure Deputy Andrews that, in line with this policy, the level of mental health service provision throughout the country will be improved and equalised in the coming years.