Dan Neville (Limerick West, Fine Gael)
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I thank the Ceann Comhairle for the opportunity to raise this important issue and welcome my fellow Limerick man, the Minister of State at the Department of Health and Children, Deputy Tim O'Malley, to the House. The Irish Psychiatric Association has published an evaluation of the first 12 months of the national mental health policy, A Vision for Change. Entitled A Vision in Hindsight, its report examines developments since A Vision for Change was launched a year ago to great fanfare as the bible for the development and modernisation of psychiatric services.

The Irish Psychiatric Association has been scathing about the work completed over the past 12 months. Its public relations officer, Siobhán Barry, stated that experience at the coalface has been so disappointing that the enthusiasm felt by service providers 12 months ago has dissipated and been replaced by a feeling of betrayal. After one year, structures should have been established and there is disappointment and dismay at developments. Dr. Éamonn Moloney stated that one third of community-based psychiatric teams, the establishment of which is a key proposal in the new policy, have fewer than 50% of staff. He noted that at the current rate of appointments — 24 posts were filled last year — it will take 25 years to implement the recommendations on staff requirements set out in A Vision for Change. Siobhán Barry described the approach to capital development as "shameful, shabby and shoddy". The national mental health directive, she added, which is cost neutral, has not been implemented.

The Government is not serious about implementing A Vision for Change. A Vision in Hindsight states:

There has been little evidence that the task of implementing A Vision for Change has been seriously tackled by the HSE to date. The HSE Implementation and Expert Advisory Groups took almost 6 months to be established and they have each met only 3 times since. No formal geo-mapping exercise has yet been conducted by the HSE and this would, in our view, be a fundamental task.

Insufficient funding has been allocated to implementing the recommendations of A Vision for Change. A Vision in Hindsight notes that although €26 million was committed nationally to the development of new mental health services in 2006, at the time of commencement of A Vision for Change, the level of funding received by individual services has been small, with none of the services receiving more than €500,000. This funding has been insufficient to create the new multidisciplinary teams the report recommended, and for which it was allocated.

Last week, the Minister of State was unable to provide information I sought in a parliamentary question concerning the percentage of health expenditure allocated for psychiatric services. He indicated the figures were being calculated and would be forwarded to me later this month. The Irish Psychiatric Association has calculated the figure. Its report states:

An unprecedented increase of €1.1bn in the health spend was announced in the 2007 budget — bringing the total to €14 billion. Of that, €800m is allocated to mental health as revenue funding and €25m to new service developments. A Vision for Change advised that implementing their recommendations would require the mental health percentage of the health budget to increase from its previous 6.9% to 8.24% — the meagre increased funding for mental health in 2007 brings that percentage down to below 6%, indicating clearly that we are moving in the opposite direction!

Almost one third of the €25 million development funding the Minister of State committed to mental health services in 2007 has been earmarked for child and adolescent mental health services. More than one fifth of this funding has been committed to contingencies brought about by the commencements, as required by the Government, of the Mental Health Act 2001 and the Criminal Law (Insanity) Act 2006. This leaves little funding to be shared out among disparate areas of need. Only €1.8 million of the money for new services has been allocated to generic adult mental health services in 2007. It is clear from those sums that a continuation of the expanded community services that began in 2006, at the time of the launch of A Vision for Change, has not been incorporated within this year's budgeted programme.

One year after the document's publication, the Irish Psychiatric Association says that at the most senior level little thought appears to have been given to organisational development, financial or otherwise, to enable its implementation. If the funding issue is being debated at all, it is being done in the abstract. The Irish Psychiatric Association states:

The vision is vanishing and with it the opportunity and goodwill to make it possible. Those affected by mental ill health are close to yet another political betrayal. The public service users and carers in our organisation are angered, disappointed and cannot accept this lack of progress. We, together with service users and providers, now demand urgent political and administrative action or, failing that, seek electoral accountability.

Tim O'Malley (Limerick East, Progressive Democrats)
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I thank Deputy Neville for raising this matter on the Adjournment. I am intrigued by his statement that this is an independent report.

Dan Neville (Limerick West, Fine Gael)
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It is not a political report.

Tim O'Malley (Limerick East, Progressive Democrats)
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Not at all. Consultants are never political.

Dan Neville (Limerick West, Fine Gael)
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This is an independent evaluation.

Tim O'Malley (Limerick East, Progressive Democrats)
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I understand what the Deputy is saying.

Dan Neville (Limerick West, Fine Gael)
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It is not my report. I have said much of this in the past in a political context.

Dan Neville (Limerick West, Fine Gael)
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This is not political, it is independent.

Tim O'Malley (Limerick East, Progressive Democrats)
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I suggest to the Deputy that other people have views, as well as the consultants.

The past year has been one of great change within mental health in Ireland with the launch of A Vision for Change, the report of the expert group on mental health policy in January 2006, the full implementation of the Mental Health Act 2001 from 1 November 2006, growing service capacity and additional investment. I assure the Deputy that the Government is committed to the full implementation of A Vision for Change and has accepted the report as the basis for the future development of our mental health services.

Implementation of the individual recommendations of A Vision for Change is a matter primarily for the Health Service Executive. In July 2006, the HSE established an implementation group to ensure that mental health services develop in a synchronised and consistent manner across the country and to guide and resource service managers and clinicians in making the recommendations in A Vision for Change a reality.

Some of the work carried out to date includes informing all relevant stakeholders, including staff, voluntary agencies, service user representatives and media of the recommendations in the report; developing additional capacity in child and adolescent services to reduce the dependency on adult services for this client group; commencing the establishment of 18 additional multi-disciplinary adult psychiatric teams; preparing for eight additional child and adolescent multi-disciplinary psychiatry teams; developing a population based resource allocation model; processing the full economic value of psychiatric hospital buildings and lands for reinvestment in the mental health services; training for 5,300 staff employed in the service; establishing the interim national service users executive, which I launched last week together with a mental health resource pack for use in primary care; and establishing the project team to develop the new Central Mental Hospital.

In March 2006, I appointed an independent monitoring group to monitor progress on the implementation of the recommendations of A Vision for Change. The group will monitor and assess progress on the implementation of all the recommendations, including those which fall under the responsibility of the Health Service Executive, Departments and other relevant agencies. The group is to submit its first annual report in mid-2007.

The chairpersons of the implementation group and the monitoring group will meet in the near future. Following that meeting, the Health Service Executive will publish a progress report and will outline the proposed implementation programme over the ten-year life of A Vision for Change. Both these groups will play an important role in ensuring that the recommendations are implemented in a co-ordinated and timely manner.

The Government has almost trebled expenditure on mental health from €326 million in 1997 to €835 million in 2006. We have already allocated a total of €51 million additional funding for 2006 and 2007 to implement A Vision for Change. This is one third of the total funding estimated by the expert group to implement fully the mental health strategy over seven years.

A Vision for Change outlines a comprehensive model for 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. This Government is committed to the further development of our mental health services throughout the country and to ensuring they will continue to be improved and enhanced in the coming years.