Dan Neville (Limerick West, Fine Gael)
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I thank the Ceann Comhairle for allowing me to raise this issue. I plead for the life of Emer Carroll and many others like her who are suicidal and who have been discharged from hospital because of a lack of facilities to deal with them. I also wish to highlight the broader issue of the neglect of those who are suicidal.

Emer suffers from an eating disorder and now weighs just six stone. She has made seven suicide attempts and feels her life is worth nothing. She wants assistance. She has stated:

I want help, I don't want to be like this anymore. But because I am not eating, my brain is just telling me I don't want to live anymore and that I have no worth. I don't want to hurt my family, but I feel so bad that my brain just tells me they'd be better off if I was dead. And the fact I feel like this is not helped by the lack of treatment that is available to me. They told me they were discharging me from Tallaght because they do not have the facilities to treat eating disorders.

Funding has been made available in Tallaght Hospital by the National Office for Suicide Prevention for a suicide prevention nurse. Although the money is available, the Health Service Executive prevented the hospital from taking on a nurse because of the embargo on staff recruitment. This is nothing to do with controlling the overspend by the Health Service Executive. The money is available, yet the Health Service Executive is allowing a person like Emer Carroll to probably die because it will not allow the recruitment of a suicide prevention nurse.

Emer's father said that as far as he is concerned, this is tantamount to murder. I will not comment on that other than to say it is a sign of how upset the family is about the issue. This is similar to the experience of so many families around the country. I speak with people every week who are put under unbelievable pressure because members of their families who are suicidal are not getting the services they require. Many of them have attended funerals that could have been prevented if the recommendations of the various reports were implemented, including last year's report of the joint Oireachtas committee that has been totally ignored.

I was informed today by the Minister of State at the Department of Health and Children, Deputy Devins, that we are spending only 7.7% of the total health budget on mental health services, yet one in four people suffer from a psychiatric illness that will require intervention at some stage in life.

I do not expect any great answer on this matter from the Minister of State, Deputy Hoctor, because I have not received any in the 18 years I have spent campaigning on this issue. I urge her to think of Emer Carroll who suffers from anorexia nervosa, who has attempted to take her life seven times, who went for help to Tallaght Hospital only to be told the facilities were not available to help her because the Health Service Executive prevented the resources being expended for bureaucratic reasons.

I have a copy of Healthmatters, a Health Service Executive publication. It contains 36 pages of information but only one small article is devoted to mental health.

John O'Donoghue (Kerry South, Ceann Comhairle)
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The Deputy is aware we cannot have illustrations in the House.

Dan Neville (Limerick West, Fine Gael)
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I beg your pardon. One small column is devoted to a report on a mental health conference in a 36 page publication. That is indicative of the attitude of the Health Service Executive and the Minister towards psychiatric services.

Máire Hoctor (Tipperary North, Fianna Fail)
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I am replying to this matter on behalf of my colleague, the Minister for Health and Children, Deputy Harney. I thank Deputy Neville for raising this matter. However, I do not consider it appropriate to comment on the clinical management of this individual case. All of us wish the young woman involved well and we want her to be treated with great sensitivity.

I wish to deal with the general issues. The decision to suspend recruitment temporarily was taken as part of a financial break-even plan developed by the Health Service Executive national management team to ensure it remained within its Vote for 2007. The Health Service Executive must be able to manage within the resources made available to it by the Government and voted by the Dáil. Operating within budget and making the best use of the available resources should be a key priority for any organisation. Reforming our health system is not just about extra funding and extra posts; it is about ensuring that the extra money which has already been invested by the Government on behalf of the people is being used wisely and efficiently.

Approximately 130,000 people are employed in the delivery of public health and personal social services, the vast majority of whom provide direct service to patients and clients. The current pause in recruitment must be viewed in this context. It is a temporary measure put in place by the HSE to operate within budget which is reviewed every month and is monitored by the HSE on a week-by-week basis.

There are some limited, critical or exceptional circumstances where appointment of staff may be necessary in frontline services. A small group has been established with representatives of the national employment monitoring unit, the National Hospitals Office, primary community, continuing care and other directorates, to evaluate, monitor and approve requests for derogation from the general recruitment pause. This group meets every week. To date, 340 essential posts in frontline and stand-alone critical areas have been exempted from the employment pause.

The provision of mental health services is underpinned by the comprehensive policy framework outlined in A Vision for Change, the report of the expert group on mental health policy and Reach Out, the national strategy for action on suicide prevention. The current level of expenditure on mental health is unprecedented, having trebled since 1997. This year approximately €1 billion will be spent on specialist mental health services. It is important to bear in mind that approximately 90% of public mental health services are provided at primary care level, which is not captured in the €1 billion.

A Vision for Change was adopted by the Government in January 2006 as the basis for the development of mental health services for the next seven to ten years. This policy envisions an active, flexible and community-based mental health service where the need for hospital admission will be greatly reduced. Reach Out was published in September 2005 and represents Government policy on suicide prevention. Additional funding of €3.05 million was provided in 2006 and 2007, which brings the total funding available to support suicide prevention initiatives in 2007 to €8 million.

The €1 billion expenditure on mental health services generally is also of benefit to persons who may be suicidal. This substantial support for suicide prevention must be taken into account when considering the availability of individual posts. I have been informed that the Health Service Executive's National Office for Suicide Prevention has provided funding to Tallaght Hospital for the recruitment of a suicide prevention nurse. While this post is currently affected by the recruitment pause, it will be kept under review by the Health Service Executive as part of the monitoring process to which I have referred.

Other important supports are already in place to help people who may be suicidal. For example, funding has been provided in 2007 to complete the availability of self-harm services in accident and emergency departments. Self-harm services are in place in the vast majority of accident and emergency departments whereby, in addition to receiving medical care, people presenting with deliberate self-harm also receive a psycho-social assessment following which they are admitted to the treating hospital, a psychiatric hospital or discharged.

Another positive initiative is a national mental health awareness campaign which was launched earlier this month by my colleague the Minister of State, Deputy Devins. The main aim of the campaign is to influence public attitudes to mental health. It is specifically designed to alter negative attitudes and promote positive attitudes and a greater understanding of mental health.

Thankfully, the level of discussion and openness on mental health issues, including suicide and self-harm, has increased significantly in recent years. However, we need to ensure public discussion and media coverage of suicide and deliberate self-harm remain measured, well informed and sensitive to the needs and well-being of psychologically vulnerable and distressed individuals in society. In particular, we need to continue to work as a society to create a culture and environment where people in psychological distress will feel they can seek help from family, friends and health professionals. The Government is committed to the provision of quality care in the area of mental health.