Dan Neville (Limerick West, Fine Gael)
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I thank the Ceann Comhairle for selecting this item for discussion on the Adjournment.

On 24 January 2006, the expert group on mental health policy established by the Department of Health and Children published a new national mental health policy framework entitled, A Vision for Change. This was subsequently adopted by Government and the Health Service Executive. It proposed significant changes and improvements in mental health services and a true movement of services into the community. It made important recommendations on empowerment, advocacy, peer support, offering a range of therapies, supporting carers and, perhaps most important, recovery from mental illness.

I would like to quote from the Mental Health Commission's 2008 evaluation in this regard.

Regrettably, since the launch of A Vision for Change, there has been little action in its implementation. Two years later, mental health service users and providers are still struggling with an outdated, fragmented and severely under-resourced system. Mental health and related services remain amongst the most neglected areas of Government policy and provision, leading to multiple infringements of human rights of people with or at risk of mental health problems. There remains a widespread unavailability of psychological and social interventions as complements to medication, denying the right to the most appropriate and least restrictive or intrusive treatment. Ireland still has a high rate of hospitalisation for mental health problems, due to limited community-based services, conflicting with the right to treatment in the least restrictive environment. Specialist mental health services, such as services for people with eating disorders or brain injuries, remain generally unavailable outside of Dublin, while access within Dublin remains limited.

In her annual report of 2006, the Inspector of Mental Health Services found mental health provision to be ad hoc in nature, with serious deficiencies in community mental health teams around the country and no teams in mental health services for people with intellectual disability. Basic staffing is unavailable for children's mental health services throughout the country and, waiting lists for children's services remain lengthy. In 2006, 3,000 children and adolescents waited an average of 15 months for assessment and some families waited as long as four years in this regard. In 2007, waiting lists were even longer with 3,598 children waiting for assessment, one third of whom waited more than 12 months.

The reality within mental health services today is that A Vision for Change has not marked a turning point in Government attention to this neglect. While it is the stated aim of the HSE to move to a coherent, transparent and equitable resource allocation model, current funding for mental health services remains inadequate and inequitable. A Vision for Change is explicit that a minimum of an additional €25 million is required annually for a six year period to allow implementation of the mental health service expansion and improvement objectives.

I received several letters from the HSE in response to parliamentary questions requesting information regarding the €25 million allocation. I was informed on several occasions that €25 million had been allocated to this area in 2006 and 2007. However, on 9 January 2008, the HSE in response to a freedom of information request from the Mental Health Alliance stated that 57% of the developments funded in 2006 had been put in place at an annual cost of €17 million and 40% or €10 million of the funding provided in 2007 had been put in place. Of the €51 million we were told had been allocated, only €27 million was spent implementing changes. The HSE response stated that the balance of the funding from 2006 and 2007 had been time delayed to address core deficits in existing mental health services thus ensuring that the HSE met its obligations to deliver services within the Vote. This response makes it abundantly clear that almost half of the funding allocated for implementation of A Vision for Change has been spent in other areas.

Not one extra shilling has been provided in 2008 towards implementation of the recommendations contained in A Vision for Change. The funding has been cut and A Vision for Change has been abandoned by Government. The commitment to provide €25 million annually for a six year period was never met.

Michael Kitt (Galway East, Fianna Fail)
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I am taking this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney, and I thank Deputy Neville for raising it.

A Vision for Change, the report of the expert group on mental health policy, which was launched in January 2006, contains some 200 recommendations. The report has been accepted by Government as the basis for the future development of mental health services. The estimated additional cost of implementing the recommendations of the report is €150 million over a seven to ten year timeframe. A total of €51.2 million has been allocated since 2006 for the development of mental health services in line with the report.

Dan Neville (Limerick West, Fine Gael)
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That is spent.

Michael Kitt (Galway East, Fianna Fail)
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However, implementation of A Vision for Change is dependent to a much greater extent on the remodelling of existing resources than on new additional funding. Additional investment must be phased in parallel with the reorganisation of mental health services and resources.

In the context of ever-rising demands for health resources, mental health expenditure should be closely monitored to ensure services demonstrate both effectiveness and efficiency. Before any further additional funding is provided it is essential that the HSE is in a position to demonstrate that money allocated for mental health services is efficiently used and that the substantial changes in the organisation and delivery of mental health services envisaged in A Vision for Change are progressed.

Under the Health Act 2004, the Health Service Executive is obliged to operate within its overall Vote. It took steps to meet this objective in 2007 by delaying some of its planned developments, including developments in mental health services. Some of these developments will proceed in 2008. These include the provision of eight additional consultant child psychiatry teams; the provision of 18 additional beds for children and adolescents at St. Anne's, Galway, St. Vincent's, Fairview and St. Stephen's Hospital, Cork, to increase the bed complement from the current provision of 12 to 30 during 2008; and the construction of two 20 bed units for children and adolescents in Cork and Galway. Construction on these units is expected to commence in 2008 and be completed in 2009.

An independent monitoring group was established to monitor and assess progress in implementing the recommendations set out in A Vision for Change. The monitoring group's first annual report was published in May 2007. The report acknowledges the progress made but expressed concern about the lack of a systematic approach to implementation of the report and the lack of clarity in responsibility for implementation in the HSE.

The Government's decision to establish the Office for Disability and Mental Health reflects its commitment to developing a more coherent and integrated response to the needs of people with disabilities and mental health problems. The office will support the Minister of State with responsibility for disability and mental health and facilitate cross-agency and cross-departmental work and deliver real benefits to clients and service users into the future. It will bring a new impetus to the implementation of A Vision for Change working in partnership with the HSE and other stakeholders to achieve implementation of agreed targets.

The Health Service Executive recently approved its implementation plan which sets out six key priorities for 2008 and 2009. Following concerns raised by the Office for Disability and Mental Health regarding the need for a longer-term focus, the HSE has undertaken to prepare a more comprehensive plan before the end of this year.

I assure the House of the Government's commitment to the development of mental health services in line with the recommendations in A Vision for Change.