Thursday, 26 May 2011
Mental Health Services
I thank Amnesty International for its interest in mental health and the programmes, documents and advice it recently provided in its briefing pack for Members of the Oireachtas, which is extremely helpful and well written. The organisation will be 50 years old on Saturday, on which I congratulate it and thank it for the work it has done throughout the world. It has been of great assistance to me and other Members of the Oireachtas who believe mental health is a human rights issue.
Successive Governments have called for fundamental reform of the mental health system. The Planning for the Future report published in 1984 was followed in 2006 by the expert report, A Vision for Change. However, progress on implementing reforms has been painfully slow. A Vision for Change set out a policy framework for the mental health of the whole population. In addition to recognising the importance of mental health promotion and primary care, it called for a person-centred, recovery orientated and holistic approach to mental health services. It also called for a shift from the current system, which is excessively reliant on institutional care and medication, to a system centred on community-based care provided by multidisciplinary mental health teams. These teams would include psychologists, social workers, occupational therapists and service users who would work alongside psychiatrists, mental health nurses, psychotherapists and counsellors. Such services allow people with mental health problems access to the services and supports they choose while continuing to live and participate in their community, as is their right.
Ireland is more reliant on institutional mental health care than any other country in Europe. While there are examples of good practice in certain areas, notably County Monaghan, implementation of the plan to which I referred has been inadequate overall. Services remain widely deficient with few complete multidisciplinary mental health teams in place and limited access to community care for the full range of psychological supports that should be part of a modern mental health service.
In 2009, only one in five staff in the mental health service was working in a community setting. Inpatient facilities remain completely unsuitable, with 15 of the 63 approved inpatient centres dating from the Victorian era or earlier. The Inspector of Mental Health Services has described some of these facilities as entirely unacceptable and inhumane. The position in respect of older people and people with intellectual disabilities is even worse as specialist mental health services in these areas are almost non-existent.
Non-capital expenditure on mental health services was cut radically from €1.1 billion in 2008 to €770 million in 2009. These cuts continue an historical trend in which expenditure on mental health services declined from 13% of the overall health budget in 1986 to only 5.3% in 2010. A Vision for Change recommends that 8.4% of health expenditure should be allocated to improving mental health services. The public sector staffing moratorium has also disproportionately impacted on mental health services which account for just 9% of the health care workforce but for 20% of the 1,500 posts lost as a result of the moratorium last year.
The programme for Government contains a welcome commitment to establish a cross-departmental group to ensure good mental health will be a policy goal across Departments. In addition, under the programme a sum of €35 million will be allocated each year, which will be ring-fenced to introduce the reforms outlined in A Vision for Change. This sum has been ring-fenced because when the former Minister for Health and Children, Mary Harney, allocated funding, it was hived off for other purposes. During the two-year period 2007 and 2008 some €50 million was allocated but only €27 million was spent on what the then Minister wanted the money for. In 2009, when I asked her if she was going to allocate further funds for that purpose, her reply at a Dáil committee was: "Why should I give it to them when they are not going to spend it on what I want them to spend it on?" That has shades of the fair deal scheme.
The commitment given needs to be implemented as a priority by the Government in order that it can build on the good work already done by the Office for Disability and Mental Health which has a cross-departmental remit. The group should include representatives from the following Departments: Health and Children; Education and Skills; Social Protection; Justice and Equality; Defence; the Environment, Community and Local Government; the Arts, Heritage and the Gaeltacht; and Public Expenditure and Reform. The group should outline how responsible Departments will progress the social inclusion recommendations made in A Vision for Change, as well as reporting publicly on progress. It should also ensure mental health issues are adequately reflected in the work of other Government structures such as the national disability strategy and the Office for Social Inclusion.
I thank the Deputy for raising the matter of the implementation of A Vision for Change on the Adjournment.
The Government has prioritised reform of the mental health service in line with A Vision for Change and is committed to reforming our model of health care delivery in order that more and better quality care services are delivered in the community. The Minister of State, Deputy Kathleen Lynch, is committed to this model. As the Minister of State with responsibility for primary care, I subscribe to the principle of moving services, to the greatest extent possible, from the institutional setting to the community.
It is the intention that over time access to modern mental health services in the community will be significantly improved. It is proposed to ring-fence a sum of €35 million annually within the health budget to develop community mental health teams and services to ensure early access to more appropriate services both for adults and children. My colleague, the Minister of State, Deputy Kathleen Lynch, is working with officials in the Department of Health and Children and the HSE to achieve further progress in this regard.
In 2006 A Vision for Change was universally welcomed as a progressive, evidence-based and realistic document which proposed a new model of service delivery that would be patient-centred, flexible and community-based. Progress on implementation has been slower than anticipated when the report was launched. However, it is also important to recognise and acknowledge that in many parts of the country services are pressing ahead with implementation of A Vision for Change. Progress to date includes: a 17% decline in the number of patients resident in psychiatric facilities since 2006; fewer admissions, including involuntary admissions; while the number of patients readmitted to hospital has shown a year on year reduction since 2001. This reduction points to an improvement in community-based services.
The child and adolescent mental health service has seen a significant improvement. There are now 61 multidisciplinary teams in place around the country and further teams will be developed in line with A Vision for Change. In-patient bed capacity for children and adolescents has increased from 12 beds in 2007 to 52 at present. Through the See Change campaign, we are attempting to positively change social attitudes and behaviour in order to encourage people in distress to seek help.
Work on the capital programme is continuing. Acute admissions to St. Brendan's Hospital, Grangegorman, have ceased following the opening of the Pine Unit in Connolly Hospital. During 2011 and 2012 HSE South will complete the process for the closure of St. Senan's Hospital, Enniscorthy, with the implementation of a €16 million capital investment programme. A residential unit is under construction in Clonmel which will allow for the closure of St Luke's Hospital. In addition, work is progressing on the development of a new 60-bed unit at Beaumont Hospital to replace the existing facility at St. Ita's Hospital, Portrane.
Implementing A Vision for Change will involve using existing resources more efficiently and effectively. It will require the reallocation and remodelling of existing resources to move away from the provision of care in institutions to providing it in alternative settings or an individual's own home. We need to be in a position to provide care in the best interests of the individual concerned.
There is no doubt that we are experiencing unprecedented challenges, not just in mental health services but also across every walk of life - challenges that, in turn, may impact on people's mental health. As 90% of mental health needs are dealt with at primary care level, the Government is committed to developing closer links between mental health and primary care services, a key recommendation in A Vision for Change. The focal point of modern mental health services in the community and the development of community-based facilities which house both primary care and mental health professionals will represent a significant step forward for service users and their families. Having a community mental health team in the same building as a primary care team will help to build and cement closer relationships which will benefit everyone, including service users and their families, carers and professionals alike. It has also been shown that people with a severe mental illness have poorer physical health than the general population. Having primary care services available alongside mental health services will ensure the physical health needs of those persons with mental health problems can be dealt with effectively.
I assure the House of the Government's unwavering commitment to improving mental health services and the implementation of A Vision for Change. We will continue to engage closely with the service user movement, one of the most significant reforms to have taken place in mental health services in recent years. We will work tirelessly to change attitudes to mental health, place the service user at the centre and embed the recovery approach in the delivery of mental health services.
I again thank the Deputy for raising this issue. I join him in commending Amnesty International for its outstanding work.