Maureen O'Sullivan (Dublin Central, Independent)
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I move:

"That Dáil Éireann:

noting:

— that one in four Irish persons will experience a mental health issue at some point in their lives;

— that good mental health is an integral component of general health and well-being and recognising the importance for all citizens to achieve and maintain optimum mental health;

— that mental health worryingly represents just 9% of the Health Service Executive, HSE, work force yet accounts for 20% of the loss of posts in 2010;

— the disturbing increase in drug induced psychosis of recent years;

— the significant collaborative work of the document, A Vision for Change, the commitments contained in the strategy and its placing of the service user at the centre of the mental health services;

— that funding for mental health has dropped from 13% of the health budget in 1986 to just 5% in 2010, while A Vision for Change target is 8.4%;

— that Community Mental Health Teams, CMHTs, are understaffed;

— that adult CMHTs have 50% of the required clinical psychologists, 60% of the required social workers and 50% of the required occupational therapists;

— that child and adolescent teams have 41% of the total staffing required under A Vision for Change;

— that the independent monitoring group for A Vision for Change reports that it "is alarmed and concerned at the complete lack of progress in the Psychiatry of Old Age, Intellectual Disability, Liaison Psychiatry, Eating Disorder, Recovery and Rehabilitation, Co-morbid Substance Abuse and Mental Illness, Neuropsychiatry and Borderline Personality disorder [services]";

— that properly and adequately resourced community services are crucial in helping people recover from mental health issues and so prevent hospitalisation;

— that there are mental health difficulties amongst individuals with drug addiction issues, known as dual diagnosis; and

— that there has been a disappointing lack of progress on implementing plans in the area of mental health as set out in the Government Programme for National Recovery;

while welcoming that there have been examples of positive change in the area of intellectual disability with the recent announcements by the Government on the development of the national mental health service and the appointment of executive clinical directors with responsibility for the mental health of people with intellectual disability, yielding positive outcomes in certain parts of the country, accepts that:

— access to mental health services for people with intellectual disability, ID, remains extremely difficult;

— the approved centre for people with ID at Stewarts Hospital has been closed, therefore there is currently no publicly funded specialist approved centre for people with ID in the country; and

— this closure has resulted in a situation whereby, for a small number of people, the HSE must now, on an ad hoc basis, fund private sector agency places which are not being inspected adequately; and

calls for:

— funding for mental health services proportionate to its prevalence and role in overall individual and societal well-being;

— the ring-fencing of €35 million annually from within the mental health budget to develop community mental health teams and services as outlined in both A Vision for Change and the programme for Government;

— a commitment that the overall mental health staffing be maintained and funding for posts preserved at the level of budget 2011;

— provision of adequate capital funding in 2012 to continue the closure of psychiatric hospitals and the transfer of service users to appropriate community-based programmes and accommodation;

— a commitment that the overall mental health budget service staffing level be maintained and funding for posts preserved at the level of budget 2011;

— a commitment to the psychological and social aspects of mental health treatment as well as the biological and medical interventions;

— the deletion of paragraph (b) of section 59 of the Mental Health Act 2001;

— the design of mental health facilities to be aesthetically pleasing, taking account of international best practice;

— a commitment that the first clinical encounter focus on the client and that the voice of the service user be respected and at the centre of the recovery plan;

— the reduction, and eventual elimination, of the use of stereotypical language in relation to mental health with a commitment to reduce and remove stigma;

— a statement from the Mental Health Commission and the Health Information and Quality Authority to state immediately what portions of ID services each agency should inspect in order to remove the vacuum that remains around quality development;

— the continuation of the current training in nursing with the specific skills basis for those who will work in the areas of mental health and intellectual disability;

— the commitment to the International Declaration on Youth Mental Health;

— recognition of mental health for asylum seekers and refugees;

— increased provision of immediate access to mental health series and quality psychotherapeutic supports for drug users and no further cuts for those projects and programmes in communities working with those suffering from addiction; and

— appropriate services for those with mental health issues in our prisons.

I would like to share time with Deputies Seamus Healy, Thomas Pringle and Stephen Donnelly.

Jack Wall (Kildare South, Labour)
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Is that agreed? Agreed.

Maureen O'Sullivan (Dublin Central, Independent)
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The first question I would like to ask is what is mental health. Many people consider it is a question of somebody with a mental illness. We know that one in four people will develop a mental issue at some point in their lives. I think mental health has to do with all aspects of our lives. Sometimes it is more important than our physical health. We know what we should do to look after our physical health, even if we do not always do it. We know why we should take exercise, what kind of food we should eat and how much sleep we should get. We know to avoid alcohol, cigarettes and drugs. Do we pay the same attention to our mental health as we pay to our physical health in order to ensure personal optimal mental health? I believe both are linked. Things that help our physical health will also help our mental health.

More strategies and programmes in areas like meditation, yoga and mindfulness are needed to ensure we look after our mental health. We need to look at the importance of self-esteem, real communication, positive relationships and relaxation. It is possible for someone who is physically unwell to be well mentally. Some good articles in a recent health supplement in The Irish Times drew attention to various aspects of mental health. We need more of that. I would like to emphasise that we should not create an illness out of normal distress. We all suffer bereavement. Grief is natural. There are stages in the grieving process we have to go through. There has been an alarming increase in the use of anti-depressants and medication by people in such circumstances. We should allow the grieving process to take its natural course and acknowledge the need for space and time of the person who is grieving. He or she should be listened to in an empathic way.

Children can be bold. They have high energy. They can present with challenging behaviour. They will not do as they are told. Some parents have difficulties with them. We can be very quick to put a label on such children and prescribe drugs to them. Naturally, there are times when we all suffer from depression. We use the word "depression", which comes in various degrees, when we feel down. There is a propensity for anti-depressants to be used in such circumstances. I welcome the guidelines on the management of depression in primary care that have been drawn up by the College of Psychiatry of Ireland and the Irish College of General Practitioners. There are various procedures for dealing with mild depression, and moderate to severe depression. The colleges use terms like "watchful waiting", "psychological intervention", "social support" and "exercise programme". Depression and anxiety are common mental illnesses in older people. The independent monitoring group has recognised the lack of progress in the psychiatry of old age.

Depression needs to be treated. There are various treatments. I do not want us to drift further into the "pill for every ill" syndrome. The 2010 medication report of the mental health services referred to the overuse of medication in inpatient services. It reported that 57% of inpatients are being prescribed benzodiazepines. In one psychiatric unit, benzodiazepines were prescribed to 97% of patients. The question of community care arises in this context. Too many Victorian-era psychiatric hospitals are still open. We cannot close them if that means leaving their clients exposed. We need multidisciplinary care teams in the community, as set out in A Vision for Change. Just 20% of community mental health teams have the full range of disciplines that are recommended in A Vision for Change. Just 12% of teams have them on a full-time basis. Staffing is another major issue. We do not have required number of psychologists, occupational therapists or social workers.

According to the Mental Health Commission - we knew it anyway - recessions are times of high stress. Unemployment, debt and poverty have a significant impact on mental health. The chair of the commission has said that "economic difficulty leads Government to postpone necessary investment in mental health services in recessionary times". The irony is that at a time of increasing stress and strain, there are fewer resources. The Celtic tiger contributed to mental ill health. Our President spoke out on this issue on Friday when he referred to "individualism" that is closer to an "egotism based on purely material considerations".

Mental health is the Cinderella of the health service. It is not the Government's fault that it does not get the proportion of funding it needs - it is the fault of every Government since the foundation of the State. The Cinderella within that Cinderella is the area of intellectual disability. The motion before the House acknowledges and welcomes the positive appointment of executive clinical directors with responsibility for the mental health of people with intellectual disabilities. The gaps are disturbing, however. The motion refers to the approved centre at Stewarts Hospital in that context. I acknowledge the work of St. Michael's House and other services that are flexible, creative, resourceful and inventive in developing new and cost-effective ways of delivering services and dealing with cuts to date.

The service user has to be at the centre of the recovery process. I support the call for the first clinical encounter to focus on the client. If the client is not in the sort of space to make a decision, which can happen, he or she will be entitled to dignity and respect. There is a need for peer advocacy. Mental health advocates want the forthcoming legislation to ensure that those who could make a decision with the assistance and support of an advocate are given the opportunity to do so before a guardianship is considered as a last resort. There is some good international practice in this regard. I am in favour of the inclusion in the legislation of supported decision-making and independent advocacy. The frameworks that will specify how the systems work will also be a priority.

I could stand up here and say I have cancer, angina, a broken leg, diabetes or arthritis. It would be different and difficult for me to stand up here and say I have had a breakdown, I am an addict, I have an eating disorder, I have trouble with my nerves or I am an alcoholic. We do not say such things. Instead, we hide them. That brings an added pressure. We have to be comfortable in being as open about mental illness as we are about physical illness. There are examples of absolutely horrible expressions that are used to describe those with mental health issues. Such labels have to be challenged.

The Minister of State, Deputy Kathleen Lynch, and I are both familiar with Mr. John McCarthy, who is a proud member of the Mad Pride community. He established Mad Pride Ireland. He has spoken about the normality of madness. He deplores the way society has been allowed to think the mad community is dangerous and to be feared. For Mr. McCarthy and others, madness is an everyday occurrence that affects everyone and can be dealt with in an open and loving way with no fear. Mr. McCarthy and others are particularly critical of the "one size fits all" approach to treatment. I believe the pharmaceutical industry needs strict ethical and moral boundaries. I acknowledge those people who have spoken out about the high use of seclusion and restraint, particularly those who were over-medicated and forgotten about in institutions. It is important to note that the Mental Health Commission has reported on the uneven use of seclusion and restraint across the country.

I would like to speak about this country's suicide statistics. It is difficult to get accurate statistics, for obvious reasons. Of the 486 people who are known to have died by suicide in 2010, some 386 were men and 100 were women. This 4:1 ratio is replicated in other parts of the world. It comes back to the question of stereotyping. The ideal man is supposed to be a strong individual who does not show his vulnerability and is able to solve his own problems. It is not seen as masculine or macho to share problems or discuss feelings. Male suicide has to be targeted. A Scottish campaign, Choose Life, which was run with the Scottish Football Association, reduced the male suicide rate by 15%. The slogan used in a campaign involving US war veterans, among whom asking for help is not considered to be very manly, is "it takes the courage and strength of a warrior to ask for help".

The cross-party group on mental health in the Oireachtas has introduced SafeTalk training for staff. I acknowledge the ASIST training that takes place. We have to delete paragraph (b) of section 59 of the Mental Health Act 2001. Under the current mental health laws, ECT can be used on a patient who is unwilling or unable to give consent as long as it is approved by two consultant psychiatrists. There are grave reservations about this because of the diverse evidence on it. It is used as a method of torture in certain countries.

We know about the disproportionate loss of staff in the mental health services. In our motion, we mention the need to continue the current nursing training, with particular skills being taught to those working with intellectual disability and to psychiatric nurses. We are aware that funding decreased from 13% of the health budget in 1986 to 5% of the budget in 2010. The target in A Vision for Change is 8.4%. The assistant director general of the World Health Organisation has made the point that Governments tend to spend most of their scarce mental health resources on long-term care in psychiatric hospitals. That is a worldwide phenomenon. This money needs to be invested at primary care level to reach more people and address the problems at an earlier stage. Prevention is vital and it goes back to more focus on, and more awareness of, our mental health. The home, school and society have a role to play. We must celebrate difference and not be afraid of it.

We must acknowledge the work of groups like the Samaritans, Bodywhys, Aware, Jigsaw, AA, NA and Headstrong. The Departments must also take on A Vision for Change, whether the Department of Jobs, Enterprise and Innovation, the Department of Social Protection, the Department of the Environment, Community and Local Government in regard to housing issues, the Department of Arts, Heritage and the Gaeltacht or the Department of Tourism, Culture and Sport.

People in prison, people who are homeless, people with addiction issues and refugees and asylum seekers all have very particular mental health issues. I was at something earlier at which the point was made that as the numbers in our psychiatric institutions go down, the numbers in our prisons go up. That is pretty frightening.

I acknowledge the amendment. I find Private Members' business frustrating because we are all on the same wavelength on this issue and I acknowledge what is in the amendment and the work of the Minister of State, Deputy Kathleen Lynch, and of the former Minister of State in the previous Government, John Moloney.

If I go into an accident and emergency department with a broken leg or chest pains, I might have to wait a few hours but I will be dealt with. Where do I go if I have a mental health issue? I could be waiting and waiting.

Stephen Donnelly (Wicklow, Independent)
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I am not an expert on mental health so in preparation for the motion, I spoke to mental health professionals on the medical side, the clinical therapeutic side and the complementary therapy side. I also spoke to people involved in community-based care and in hospital-based care and I have had input from constituents in Wicklow, both from those involved in community-based provision and those who have had experience of mental health service provision over the years.

Broadly speaking, I have heard four things from all groups which are very much reflected in the programme for Government and in many of the things I have heard. First, mental health services in Ireland do not receive the attention and resources they need and deserve. Second, the approach to mental health in Ireland to date has been overly focused on medical treatment and in spite of some great local successes, service provision has not advanced as quickly as it needs to and should have by now. Third, the existing service provision is highly variable and the level of service provision for mental health depends to a huge degree on where one happens to live in the country. Fourth, there are steps which this new Government can take immediately to have a real, significant and quick impact on the provision of mental health services and outcomes across the country.

I would like to speak to those four points. In terms of funding and staffing, it was shocking to find that funding for mental health as a percentage of the total health budget has fallen from 13% in 1986 to 5% in 2010. The recommendation in A Vision for Change is 8.4%. It was truly shocking to see this massive fall off in funding for mental health at a time when, globally, awareness and funding were increasing. Good quality mental health provision is more personnel intensive than many areas but it is massively under-resourced. The figures for community mental health teams really shocked me. I found that adult teams have 50% of the required psychologists, 50% of the required occupational therapists and just 60% of the required social workers. Even worse, the child and adolescent teams have just 41% of the staffing recommended in A Vision for Change. It is absolutely appalling that they must try to provide this service with just 41% of the staffing recommended.

Similarly, we see that mental health services are suffering more from the hiring embargo than other areas. We know that mental represents 9% of the HSE workforce but accounts for 20% of posts lost in the HSE in 2010. There is something very wrong there which might provide a real opportunity for the new Government.

The approach to mental health focuses far too much on medical treatment and service provision is not advancing as well as it should. I do not know about mental health but I have been involved in health care configuration and what I have found is that the principles are exactly the same for modern mental health care. One invests in promotion and prevention and one provides medical, therapeutic and complementary treatments and care in the community wherever possible. One really only brings people into acute hospital care when it is absolutely necessary and right for them, which is something we are not seeing. Certainly, the professionals to whom I spoke said that is not standard in Ireland.

What I found is that in mental health, in particular, increased promotion and prevention and early detection and intervention are critical for our youth population. Some 50% of adults diagnosed with a mental disorder may have developed that disorder by the age of 14, and 75% of those who are diagnosed will have developed that disorder by the age of 24, so it is not like general health which works the other way in that a vast proportion of the intervention comes in older age. What I have heard consistently is that this focus on and intervention in the youth population is not happening as much as in general medicine but here it is like not helping older people in general medicine. It is a huge challenge and opportunity for the new Government.

A Vision for Change was completed in 2006. It was a collaborative process. The medical community seems en masse to have contributed to and bought into it. What I have learned is that many of the medical professionals who contributed to it feel very let down by the lack of implementation. I read that the independent monitoring group reported that it was alarmed and concerned at the complete lack of progress in the psychiatry of old age, intellectual disability, liaison psychiatry, eating disorders, recovery and rehabilitation, comorbid substance abuse, mental illness and so on. Clearly, there are major concerns in terms of the lack of implementation.

We have had some great successes. We have Headstrong which targets youth. I commend the Minister of State on the recent €3 million in funding given to Headstrong. We have seen its Jigsaw programme in a small number of areas begin to reach out, raise awareness and engage in promotion. I understand it lacks clinical therapeutic services, which might be something at which to look. We have the DETECT programme based in Blackrock which targets the adult population. It serves south County Dublin and my constituency of Wicklow. What I like about it is that it has four pillars, namely, mental intervention if necessary, cognitive behavioural therapies, occupational therapy and what I thought was really nice, family education. It does not just target the service user but surrounds them with education and awareness. My understanding is that, unfortunately, it is the only service of its type in the country.

The tunnel project, which has been set up in my constituency of Wicklow, is another example of a wonderful initiative. It is a horticulture-based project which, to date, has provided meaningful occupational therapy to 40 service users. It targets mental health and has the secondary benefit of physical health. There is a lot of small scale success which I hope the Government will look to increase.

The figures in regard to service provision and geography were staggering in terms of the level of inequality. The 2010 Mental Health Commission report shows huge variations in the staffing targets being met and in the per capita spend for the super catchment areas. For example, Carlow-Kilkenny has reached 96% of its staffing targets under A Vision for Change but south Dublin and Wicklow have only reached 50% of the target which is the lowest in the country. Similarly, Dublin north shows a per capita spend on mental health of €268 while Galway west receives just €96. There is extraordinary inequality in the system.

While I am on the subject and as a representative for Wicklow and east Carlow, I note for the Minister of State that my constituency regularly comes in at the bottom or close to it in terms of hospice and acute care. I have been quite shocked by the fact that it comes very close to the bottom in many areas.

What can we do? I acknowledge the Government's commitment to this in the programme for Government and in recent activity such as giving Headstrong some badly needed funding to scale up its activities. What are the issues? The issues are that there is very little money for anything at the moment, the extraordinarily slow progress in implementing A Vision for Change and the huge inequality.

I would like to suggest a few ideas to the Minister of State. First, we must move from 5% of the total health budget given over to mental health services to 8.4%, as recommended in A Vision for Change. Such an increase, nearly 50%, would be very welcome. I support the Minister's commitment to ring-fence €35 million annually for the provision of community mental health teams. I call on the Government, however, to fulfil immediately the staffing targets as set out in A Vision for Change or at least put in place a clear plan with targets and timelines on how they can be achieved. It is obvious we are miles behind in this regard.

Will the Government provide adequate capital funding for the continued closure of the old psychiatric hospitals and the transfer of those service users to community-based programmes and accommodation? Investment must also be made in ensuring community-based care is located in appropriate facilities. I understand many of the new facilities are dilapidated church halls and so forth, inappropriate for anyone using a health system. Many of them do not have general health facilities which means blood pressure tests and various other scans cannot be carried out, many of which are necessary for mental health patients on particular medications.

The national roll-out of early intervention for psychosis services, such as DETECT and other holistic programmes, would be very welcome. I would also welcome staff training for medical staff in emergency and accident departments and GP practices who could triage, increase awareness, intervene in cases of alcohol dependency and so forth. Will the Minister of State ensure those with mental health difficulties have access to general medicine which they currently do not?

Séamus Healy (Tipperary South, Workers and Unemployed Action Group)
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Mental health services continue to be the Cinderella of the health system. As other Members pointed out, the amount of overall health funding given over to mental health services has reduced considerably from 13% several years ago to 5% in 2010. A Vision for Change recommended the figure should stand at 8.4%. Mental health services have lost significant numbers of staff owing to early retirement schemes and recruitment moratoriums. While mental health staff comprised only 9% of the total health services complement, they have been reduced by 20%. It can be argued provisions for this area have actually worsened over the past 20 years. If mental health services are to be given the priority and its service users given community-based treatment, the financial and staffing resources must be increased. Services and staffing levels cannot be maintained on current funding.

A Vision for Change is an integrated package of measures to provide community-based and inpatient mental health services for users. While the policy was first announced in 2006, little progress has been made in implementing it since then. In those areas where progress has been made, a welcome culture change has been introduced in mental health services with a move to community-based services away from the medical led model. There is no doubt community services, provided by home-based teams and day hospitals, are the future of mental health service provision. This can only be developed if proper funding, resources and staff are made available.

Access to these services by service users and their families is vital. Recovery for many service users would be difficult unless they had the full support of their families and friends. Providing such services in a local setting goes a long way in doing so.

I disagree with the Government's policy of cherry-picking elements of A Vision for Change by providing reduced services, resources and staffing. In recent weeks a home-based team was put in place in south Tipperary. A Vision for Change recommended such a team would comprise a team leader, a consultant psychiatrist, a non-consultant hospital doctor, several nurses along with allied health professionals such as occupational therapists and social workers. The team in south Tipperary has neither a team leader, a non-consultant hospital doctor on call or any other health professional. A Vision for Change cannot be implemented in such a fashion.

Any community-based service must include vital inpatient acute services for the small number of patients who may require them.

Mattie McGrath (Tipperary South, Independent)
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Hear, hear.

Séamus Healy (Tipperary South, Workers and Unemployed Action Group)
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In line with A Vision for Change, such acute services must be provided locally. Service users in south Tipperary have been seeking a meeting with the Minister of State, Deputy Kathleen Lynch, for some time. Will she inform us when it will take place?

I also ask the Minister to indicate when the Shanker report on St. Michael's acute unit in South Tipperary General Hospital will be published. My Oireachtas Member colleagues and I were told in March of this year that it would be published within a month. It was not. I raised the matter again at a meeting of the Joint Committee on Health and Children in July of this year. I have correspondence from a senior national director of the Health Service Executive who told me it would be published on 23 July. It still has not been published. I met senior HSE personnel yesterday in south Tipperary and again asked if it has been published but it has not and we have not been given a date for the publication of the report. I ask the Minister to tell us when replying when that report will be published.

I accept the A Vision for Change policy and that community based services are the future of the mental health services but I am adamant that the small number of inpatient acute beds that are necessary under A Vision for Change should be provided locally in St. Michael's acute unit in South Tipperary General Hospital.

Thomas Pringle (Donegal South West, Independent)
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I welcome the opportunity to speak on this important Technical Group motion on mental health services. As we all are aware, one in four of us will experience problems with our mental health. It is part and parcel of being human and living our lives in today's climate. No one should ever be ashamed to seek help and no one should ever have to suffer in silence.

Too many lives have been lost in our country due to inadequate mental health services and the lack of out of hours cover for people who are in desperate need. People who are experiencing problems with their mental health need availability to services 24 hours a day, seven days a week. These people do not have a collective voice and are in a very vulnerable situation.

A Vision For Change was adopted as policy four years ago and given the slow pace of reform there is a risk that with any more significant delays as a policy it will be rendered out of date or unimplementable as the original end date of 2012 for its implementation draws closer. A Vision for Change is widely accepted by everybody involved in mental health services as being very positive, if only it was implemented. The lack of progress to date does not reflect the commitment or expectations of stakeholders, clinical staff or health service management who want to see the full implementation of A Vision for Change.

I take the opportunity to praise the staff of Donegal County Council who assisted me during the summer with a number of cases of people with severe mental health difficulties. They went above and beyond in that regard. They did not adopt a bureaucratic attitude but one of wanting to help and ensure those people could be safe and have accommodation that would ease some of their burden.

A Vision for Change proposes a holistic view of mental health and recommends an integrated, multidisciplinary approach to addressing the biological, psychological and social factors that contribute to mental health problems. It proposes a person-centred treatment approach which addresses each of these elements through an integrated care plan and reflecting best practice.

Special emphasis should be given to the need to involve service users and their families and carers at every level of service provision. Interventions should be aimed at maximising recovery and building on the resources available to service users and within their immediate social networks to allow them achieve meaningful integration and participation in community life.

The non-capital expenditure on mental health services in 2009 was €770 million. That was in comparison to €1.1 billion in 2008. Spending on mental health has dropped from 13% of the overall budget in 1986, as outlined by previous speakers, to 6.4% in 2009 and 5.3% in 2010. A Vision for Change recommends that the rate reach 8.4%, which is still a low level of commitment compared to international standards. The equivalent rate is 12% in England and 18% in Scotland, with other European countries allocating over 20% of their total health spend on mental health services and support.

The staff moratorium has disproportionately impacted on mental health services. Mental health represents just 9% of the health care workforce but accounted for 20% of the 1,500 posts lost due to the moratorium. That situation must be reversed if we are to have any meaningful progress in regard to assisting people with mental health difficulties.

In our society attitudes around mental health lead to stigmatisation, discrimination and social exclusion for those with mental health issues. Those attitudes and behaviour towards the issue of mental health have a direct impact on the experiences of those with difficulties. It impacts on their lives at home, at work and potentially in many social contexts. It is vitally important that we encourage people to seek help at an early stage and remove that stigma. The people who avail of counselling services should be able to say that with pride rather than try to keep it hidden from their neighbours so that they do not feel there is anything substantially wrong with them.

What has been lacking in mental health services also is advocacy and groups who support and advocate for change. I welcome the See Change campaign that has been taking place, which is very important. The Mental Health Commission and Amnesty International have also been campaigning for mental health reform. That is positive and should lead to real change because all of us who are politicians respond to pressure from groups. In many cases the crying baby gets fed first. It is important that we have strong advocates in the community who are monitoring everything being done and highlighting to us at all times that people are not getting the delivery of services they need.

If we compare it to the Disability Act and the disability strategy we can see how organised the disability groups are in that area. They are constantly lobbying and highlighting to us what is needed and we must get to that stage within mental health also. I welcome the move by any groups that will highlight the lack of progress and encourage us to keep working to ensure that progress is made on mental health priorities within society.

I hope this debate can contribute to highlighting the issues and encourage people to come together and work towards change by pushing the political groups and the health services to ensure we have real change and real implementation of A Vision for Change. I am aware the Minister of State is keen to ensure that happens and will work towards making it happen but we would all welcome having those groups pushing us along the road as well, which would make for a more inclusive programme.

Michael Kitt (Galway East, Fianna Fail)
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I call the Minister of State, Deputy Kathleen Lynch, who I understand is sharing time with the Minister of State, Deputy Shane McEntee.

Kathleen Lynch (Cork North Central, Labour)
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I move amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following:

"notes that:

— good mental health is an integral component of general health and well-being and recognises the importance for all citizens to achieve and maintain optimum mental health; and

— about one in four people will experience some mental health problems in their lifetime;

welcomes the:

— significant progress which has been achieved to date in the implementation of the 2006 strategy on mental health outlined in 'A Vision for Change' including, in particular, improved child and adolescent mental health services, fewer involuntary admissions and the involvement of service users in all aspects of mental health policy,service planning and delivery; and

— recent announcement on capital allocations for the health sector which includes the replacement of the Central Mental Hospital, the development of a 10-bed Intellectual Disability Forensic Mental Health Unit, a 10-bed Child and Adolescent Forensic Mental Health Unit as well as four regional Intensive Care Rehabilitation Units in line with the recommendations of 'A Vision for Change', to enable the delivery of a modern National Forensic Mental Health Service; and

acknowledges that:

— this Government has further prioritised the reform of the mental health service, in line with 'A Vision for Change', in the Programme for Government, which provides for the ring-fencing of €35 million annually from within the health budget to develop community mental health services and to ensure early access to more appropriate services for adults and children;

— the Health Service Executive (HSE) is currently working closely with the Department of Health to finalise a development plan to ensure mental health services are targeted where they are most needed with service user involvement in a system which will be heavily recovery focussed;

— the plan, when completed, will identify specific recommendations of 'A Vision for Change' that can be progressed over the next three years, with timelines, detailed costs, structures and identifiable person(s) responsible for driving the change and that issues related to staffing levels and the impact on this service of the moratorium on filling posts in the public sector will be examined in this context;

— the plan will include provision for clinical care programmes especially in the areas of complex psychological conditions such as eating disorders, common mental health problems and early intervention in psychosis;

— the HSE will continue in its Capital Plan for 2012 and future years to provide for the phased closure of older psychiatric hospitals and investment in more community based facilities;

— the Department of Health is already developing a proposal with the HSE and the Health Information and Quality Authority (HIQA) for the commencement of the provisions of the Health Act 2007 in relation to the regulation, registration and inspection by HIQA of residential services for people with disabilities; and

— the Department of Health has commenced the promised review of the Mental Health

Act 2001 which is planned to be completed by June 2012."

I wish to share time.

Michael Kitt (Galway East, Fianna Fail)
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There are 20 minutes available.

Kathleen Lynch (Cork North Central, Labour)
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I thank the Technical Group, the Independents and the various people who contributed to the debate on the motion because as the previous speaker said, we need advocates in society to speak about our mental health or our emotional well-being. It is important that we recognise our emotional well-being, and it is not just about different groups or people speaking themselves. It is us speaking as well, which is very important because we deem ourselves to be the representatives of the people and as most contributors said, one in four of us will experience emotional difficulties at some point in our lives. We must speak for them as well.

There is no doubt that mental health has been the Cinderella of the health service and that there have been shortcomings in terms of the delivery of service. I met Barry Desmond at Dublin Castle the other night and he said he had heard I had got his old job to which I replied, "Yes, and I think everyone else's as well". When I saw this motion had been tabled I checked it out because it deals with an issue that was very close to me. I still have a copy of Barry Desmond's Planning for the Future, which was published in 1984. Planning for the Future and A Vision for Change are quite similar. It is not that we do not know what needs to be done, we do. The stigma that has been attached to the issue of emotional well-being and good mental health is such that we have not spoken out or been free with our comments. I am accustomed to citing the words of Barbara Brennan who stood up in front of 600 people and said: "I am Barbara and I am bipolar." When none of us reacted to her statement she asked whether we would find it peculiar if she had stood up and said: "I am Barbara and I am chest infection." We would have found it peculiar had she done so.

The manner in which we judge people who have emotional difficulties or whose mental health is not great at certain points is a problem. We need to keep saying this. I speak aloud about this issue as often as possible because that is the only way to get a reaction. We used to talk about cancer by placing our hands over mouths and saying someone had the "big C" or "the other thing". We did so because we did not understand the disease and were not aware that early detection and proper intervention could cure it. We understand this now and we must reach a similar understanding in terms of mental health. We must keep talking about the issue which is not alien but part of us.

My predecessors, including Mr. John Moloney, Mr. Tim O'Malley and Mr. Barry Desmond, knew what the issue was. As Deputy Pringle stated, it is very much about society. I speak to people about different issues and I am often asked how one gets elected. The great progress that has been in society has not come from this House. Although we eventually legislated in certain areas, the progress was made by groups outside who pushed us to introduce the relevant legislation. This is a societal issue which no Government can address on its own. My predecessor, Mr. John Moloney, was as committed to A Vision for Change as I am. Sometimes, however, the time is not right. I believe this is the right time.

A Vision for Change was widely welcomed when it was first introduced. Everyone agreed it was the way forward, as they did in respect of the Planning for the Future strategy. Although implementation has been slower than expected, significant progress has been made in closing the old, traditional psychiatric hospitals and providing more acute inpatient facilities. The closures include up to 12 such institutions such as the famous St. Ita's and St. Brendan's hospitals in Dublin as well as smaller hospitals in every region. Where the hospital has not been closed, at a minimum it will not accept new admissions. We must be conscious that institutions become home for those who have been in them long-term. It is important, therefore, to be careful about how we move such people on. In that regard, I recognise that all the contributions have been sensitive and well researched.

Peter Mathews (Dublin South, Fine Gael)
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Hear, hear.

Kathleen Lynch (Cork North Central, Labour)
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Approximately one in four of us will experience mental health problems in our lifetime. Above anything else, this tells us we must mind our mental health. The State has an obligation to its citizens to mind them and ensure, in as far as it is possible, they are enabled to attain the highest possible quality of life. The way in which mental health is treated is about how we live our lives.

The 2011 budget provided special consideration for the mental health and disability sectors and sought to ensure a reduction of 1.8% in the 2011 allocation for these sectors. This relatively low reduction, when compared with other sectors of health, recognised that mental health and disability services are provided to vulnerable groups. Approximately €920 million was provided for mental health services in 2011. Some 90% of public mental health services are provided at primary care level and expenditure on these services is not captured in the €920 million figure.

An earlier contributor referred to the lack of access to primary health care services. If one has emotional difficulties or one's mental health is not as it should be, this should not preclude one from accessing normal health services. Mental health services and the teams required must become part of the primary care infrastructure. The interconnectedness we are trying to introduce in the health service will be very important. If one visits one's general practitioner because one is having a mental health or emotional difficulty, the GP's first port of call should not be an acute unit or a prescription but a referral to the counsellor or psychiatric nurse working in the adjacent room. The psychiatrist is the last person one needs to see. While psychiatrists are extraordinary people, they only need to treat about 5% of the population. Early intervention in a wrap-around system involving community, friends and low level counselling and psychology is what is required.

The Department has requested the Health Service Executive to prepare an implementation plan which will identify specific areas of A Vision for Change and reach-out that can be progressed over the next three years, with timelines, detailed cost structures and identifiable persons responsible for driving the change. Until now, we knew what we had to do and where it needed to be done. Deputies are correct that services are patchy, with excellent services available in some areas and no services available in others. We must identify needs and who is responsible for delivering on them. The difficulty until now has been identifying who is responsible for driving change.

There are 61 child and 124 adult community mental health teams working throughout the country, not all of which are fully staffed. These constitute the backbone of our A Vision for Change project. Each team must have representation from a number of core areas, including psychiatry, psychology, social work, occupational and other therapy and mental health nursing. It is intended that the HSE implementation plan will include a strategy for restoring the multidisciplinary composition of the community teams to appropriate levels to deliver the required services in their respective areas.

A Vision for Change provides detail on what is needed and what population will be dealt with. John McCarthy, whom I met last night, is correct that one size does not fit all. Some people will need six sessions of treatment, while others may need services for two years. However, everyone must realise that recovery is possible. Above all else, the notion that a mental health problem is a lifelong condition must be dispensed with because it is not true. I meet people daily who have recovered and made enormous progress in their lives.

Excessive prescribing occurs across the health system. One of the problems in the mental health system is that prescriptions are sometimes not reviewed for as long as ten years. In some cases, the effects of medication become so embedded that they are greater than the effects of the condition the medication is supposed to treat. We must do something about this problem.

The national stigma reduction campaign, See Change, was launched in April 2010 and continues this year with the aim of positively changing social attitudes and behaviour, inspiring people to challenge their beliefs about mental illness and be more open in their attitude and behaviour, and encouraging people in distress to seek help. Deputy Maureen O'Sullivan is correct. Which one of us would have the courage to state that he or she had a breakdown at 16 years and does not remember anything about the following four years? We know what would be the reaction of others. People who have emotional distress or mental health issues are not foolish. They know exactly what the reaction will be, and we have got to stop that. See Change, Make a Ripple and Reach Out are useful in respect of the technological advances we can make for young people. These people are the key. Most mental illness occurs in adolescence. That is when it first presents. Where are those people? They are online. They are looking to new technologies and Reach Out and Make a Ripple are the areas where we will find those people and connect to them. We have to be careful because the Internet sometimes is not a safe place. We must ensure that those programmes are safe and monitored, but it is there that we will reach our young people. Jigsaw and Headstrong also represent all the things we need.

Even though we are in a deep dark hole with the IMF and have no funding, we managed last week for the first time in years to pull the Central Mental Hospital across the line. The Central Mental Hospital will not just be one building. It will consist of three units. The first is the Central Mental Hospital itself. The second will be a specific ten bed unit for people with intellectual disability who have difficulties and who we are sending abroad because we cannot manage them. We will also have a child and adolescent unit, which will deal with children who we are again sending abroad because we cannot manage. There will be four regional centres, where people currently in the Central Mental Hospital can be managed nearer their own homes.

We have people in jail who have severe mental illness and who should be in a more appropriate setting, and we cannot take them out because we do not have the room. In all of this awfulness to do with the lack of resources, the Government has recognised that this is a key part of the puzzle if we are to solve it. We are going to solve it and the money has been set aside for it. We are making progress with the €35 million per annum for three years promised in the programme for Government. It is all about the multidisciplinary teams.

The moratorium disproportionately affects the psychiatric services for a very good reason. People who work in the psychiatric services are, on average, older than people in the rest of the health service and they can retire earlier. With the tough job they do and with the service they provide, who can blame them for taking that opportunity? I know I cannot blame them. In order to put A Vision for Change in place, we will need an additional 450 posts and we need to breach the moratorium to do that. The last Government breached the moratorium on two separate occasions for psychiatric nursing posts and it should be commended for that. If we keep saying that we are going to do things differently, then we have to appreciate what has gone before as well. That Government did breach the moratorium and we will do so as well. The 450 posts will not be put in place over one year, because the people we need probably are not available in that one year and they have other commitments, but it will be over a three year period.

We need to be very serious about what we do for psychiatric services, our emotional well being and our mental health. I do not think that there is any disagreement on this. I acknowledge fully that the Opposition is as committed to this programme as the Government. The contributions tonight prove that more than anything else. However, I am conscious of the need to keep pushing, not to allow it to slide off the agenda as it has in the past. Some day, if I can present to Barry Desmond a combined version of Planning for the Future and A Vision for Change, I will be very happy. I commend the amendment to the motion.

Shane McEntee (Meath East, Fine Gael)
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I thank the Minister of State for the opportunity to speak on this issue. She has covered every point on this major problem. Coming up to Christmas, it is always a hard time for people with problems.

I would like to deal specifically with one issue. I have been involved with it for a number of years following a knock on a door in Ashbourne, where I met a lady called Joan Barry, whose daughter was suffering from an eating disorder. I was able to relate to her as someone close to me had a daughter in the same position a few years before who was as close to dying as possible, but point blank refused to allow her to go into St. Patrick's Hospital or an institution where she would be force fed. In the end, he discovered a place called the Marino Therapy Centre in Dublin, where his daughter was dealt with on a one-to-one basis with no medical treatment. Her emotions were dissolved and while I cannot go into it, I can say that it worked very well. His daughter is now qualified in the medical profession.

Following that knock on the door and the encounter with Joan Barry, I got involved with her and she formed an organisation for parents of children across the country, who come every month to Dublin to talk about their situation. They have to drive their daughters and sons to places like the Marino Therapy Centre, where they can get one-to-one intervention that is so successful. Through friends of mine and friends of Joan Barry, funds were raised in order to help parents and girls. There is a great number of young people across the country tonight suffering from this, but it is hidden. They hide it from their parents and from themselves until they are extremely weak. Some of them have died and some will continue to die if we do not change our ways.

The Minister of State said we need a mental health unit in four or five regions across the country. I pay tribute to her predecessor as Minister of State, the former Deputy John Moloney. I had several meetings with him and he was very aware of the issue. Now is the time to change. We have got to stand up to the old systems and introduce the new systems. The VHI and other organisations have to be in a position to fund families whose children are in this situation. I know one family from Sligo who spent €180,000 on their daughter just to keep her alive. I know of another family in my area who have spent every last penny on their daughter, and eventually the HSE got her into a facility in Dublin. It was the first time in six years that the girl had seen the light of day and things were going right, but due to lack of funding, the HSE withdrew its services halfway through her treatment programme, and came back with a programme to send her into an institution. I am not going to say that is shameful, but we cannot be afraid to implement these changes.

I challenge the people in our hospitals who are afraid to move with the times. I challenge them openly on this. I am not a doctor, but I have seen family after family go through this. There are girls out there - and boys - in this city who are close to death, but we will not recognise new ways in which this can be treated. To ask someone to wait for six months or 12 months is a sin. Treatment must be given now. The money that is being put aside for three years must be used now. All Deputies, including those from the Technical Group, know there is not a parish in Ireland that does not have two or three people suffering from this - both boys and girls, but mostly young girls. It clicks in at 12 or 13 years of age for no known reason. Nobody can say exactly why it happens, but it must be dealt with. As the Minister of State rightly said, we need units across the country - only four or five are required - which have two or three people who are qualified to deal with young people at an early age. They might need four sessions, as the Minister said, or they might need six, or ten, or five a week - but it works, and when it is over, they can return to a normal life. That is what modern medicine can do.

I read today about the Queen's hidden cousins. I do not know if that is related to what we are discussing. I was wondering what the newspapers were talking about, but it appears the Queen had two cousins who were locked away, and we are only hearing about this now. This country, no matter what they say, has moved on so much. There is nobody who has a brain that is not challenged at some stage. Everybody's brain is challenged at some stage in their life, and sometimes one needs help or needs to talk. Even the fact that we are talking about this here tonight is good. Deputies do not know how much it means to people out there to know this debate is going on and that somebody cares.

The challenge of mental health services must be dealt with. There are too many people who are unwilling to face up to it. I am delighted to participate in this discussion. I will not say any more; I will ask somebody else to take it up. Minister after Minister has highlighted this area, but there always comes a time to make a move. I have no doubt that everybody in this House knows this is going on. We must put each issue into its own box. The area of mental health services needs funding; it must be separate from everything else. I cannot say it better than Deputy Lynch said it.

I am homing in on the issue of anorexia because, as a Deputy, one gets involved with parents who do not know where to turn. They meet at a hotel near the airport just to know how to get through the next day. There are people who get up at five o'clock in the morning, sometimes five mornings a week, to bring their families to Dublin, where we have just one or two centres, to deal with their problem. I am not condemning the HSE, because I know that in some cases it steps in and pays for half the sessions, which are private and cost €60 to €80 per session. It means a lot that the HSE will step in and pay for ten sessions. In some cases it will put up more. However, this must happen right across the board. These units must be set up. Four of them will do, including one for people in the south, so that parents know what to do. I cannot say it enough: if a parent has a problem or is worried about a daughter or son, he or she should lift up the phone. Not a week goes by without my talking to some of these girls. We did a deal that at some stage this would happen.

This happens to some girls as young as 13; it clicks in, for reasons unknown to them and their families. In some cases, families are lucky; in other cases, it goes on until the age of 19 or 20 or even older, and when this happens, a lot of harm is done. There are married women out there of 29 or 30 who have had their children but are still suffering from anorexia. However, it is something that can be dealt with without going into a hospital.

I pay tribute to our ex-Minister for Health and Children, Mary Harney. In one case I was dealing with, two members of the same family were suffering from anorexia. One girl had already passed away and another sister was in the same situation. Things had gone so far when, by accident, through former Deputy Noel Grealish, I was introduced to the Minister's secretary. This girl got the funding to go to England for treatment. It was an awful lot of money - I could not believe it. We were talking about well over €30,000. The Minister made sure that girl was looked after.

Michael Kitt (Galway East, Fianna Fail)
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Sorry, Deputy; I think Deputy Mathews wants a few minutes.

Shane McEntee (Meath East, Fine Gael)
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I would just like to highlight this issue. I am delighted we got the chance to talk about it.

Peter Mathews (Dublin South, Fine Gael)
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I just want to say to everybody here tonight a hugely warm thank you for their superb contributions. It is a privilege to be part of this House when I hear the quality, the passion and the authenticity of every contribution tonight. It makes me proud to be an Irishman because, as the Minister pointed out, here, in the hall and buildings where legislation is discussed in Bills and passed into law, I heard authenticity - the hearts and the minds of the legislators empathising with the great pain and suffering that can be hidden for so long and bottled up in the hearts and minds of people who are hurting. One in four - that is a really stark figure. Out of this Chamber alone, that is 45 people. That is an awful lot.

I do not want to dwell on this in a sombre or sad way. I would like to say thank you. Tonight's contributions were powerful, and no matter how low the money is in the kitty, the issue of mental health services is definitely a priority. This resonates with what our new President, Michael D. Higgins, said on the day of his inauguration, last Friday, which was a tremendous day of gracious generosity by the two figureheads of our country - the Taoiseach, with his gracious introduction, and our new President, who graciously accepted his responsibilities in service. Let me say what a wonderful contribution everybody has made. I thank them for it and I hope the people of the country hear it because it would do them good.

Billy Kelleher (Cork North Central, Fianna Fail)
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I wish to share time with Deputies McConalogue and Browne.

We welcome the opportunity to speak on the issue of mental health in this Chamber. Many positive things have happened over the last couple of years, particularly the acknowledgement of society that this is an issue that must be dealt with and that we need to open up and talk about it more. We will have debates and disagree on certain issues with regard to the treatment of mental health problems and the development of therapies, but in the broader context, we still need a cultural change in how we view mental health and how we deal with it as individuals and collectively as a society, including medical professionals.

There is now a strong acknowledgement that A Vision for Change is the blueprint for our approach. It is the programme we have all bought into in considering how to deal with the challenges in our society. However, because there is such a collective buy-in to A Vision for Change, one could be concerned that it would slip down the political agenda, although I know the Minister of State's commitment to it is very strong. Because we are all in agreement on the need to deal with these challenges for individuals who suffer from mental health issues and on the need for investment in programmes to deal not only with individuals but with society at large, the larger issue can drift off the agenda. For that reason, this motion gives us an opportunity to ensure that A Vision for Change is seen as a document to be upheld and supported, and, more importantly, that we actually act upon what is contained in it. Clearly, there is an implementation plan and the next issue is for it to be published. Some of the soundings from the Department and the HSE give cause for concern. Will the directorate for mental health oversee the full implementation of A Vision for Change? Where is it and when will those involved be appointed? This will be a key indication of the Government's commitment to A Vision for Change. Until we see the directorate in place, a strong commitment in terms of finance and a prioritisation by the Government, then A Vision for Change is simply a document as opposed to a living, breathing manifestation of what we all agree upon in the Chamber and elsewhere in terms of dealing with mental health.

Recent years have seen great changes. Senator Averil Power raised an issue recently in the Seanad. I call on the Minister of State to consider the case of Lois Bridges clinic in Sutton which treats eating disorders. Its work has been recommended by the Mental Health Commission and I wish to make a strong plea on behalf of the clinic. I realise Senator Power has raised the matter on several occasions in the Seanad. I urge the Minister of State to do whatever she can to ensure funding and to provide the support necessary to deal with such disorders, which are in a knock-on effect from the challenges and pressures that exist as well as the changes in society.

Broadly speaking, mental health is an issue with many facets. We can deal with it in isolation as individuals whereby we drift further into the darkness or we can light up as stated in A Vision for Change and we can embrace and acknowledge the difficulties individuals have and we can ensure they can have the confidence and support in the medical services and in society at large such that they can come forward and get the best treatment. In this regard the Government is following on from the work of previous Governments in the primary care setting since it is where front line services are delivered.

Mental health affects one in four of us at some stage in our lives, an alarming statistic which shows the importance of ensuring that we deal with it upfront in the community setting and in the context of primary care units. There must be access to councillors and psychologists and general practitioners. We must address this area. Sometimes there is excessive prescribing of certain medicines for treatment of mental health but there should be a strong emphasis on training and retraining of general practitioners since they are the front line care providers in the primary care setting that has been established and rolled out in recent years and which is being continued under this Government.

All of these reasons highlight the importance of the matter but it is more important that we encourage the Minister and the Government so that they ensure A Vision for Change becomes a living document. Only when it becomes a living document will it make an impact on people's lives and only then will it save people's lives.

John Browne (Wexford, Fianna Fail)
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I welcome this debate in the House. As Deputy Mathews stated, it is good that everyone is keen to ensure that mental health services in the country are improved dramatically in the coming years. I am old enough to remember St. Senan's Hospital in Enniscorthy and when the walls surrounded the hospital. At one stage we took down the walls. Then, in recent years and against my express wishes, the then Minister of State, John Moloney, closed down St. Senan's Hospital in Enniscorthy. I hope at some stage in the future when the finances get better there will be an admissions unit in County Wexford again. At present, patients from north and south Wexford must go to Waterford. As the Minister of State is aware, the hospital in Waterford is overcrowded and patients are unable to stay as long as they would wish. At the same time, it is important that people are looked after in their own communities and areas and CARN House in Enniscorthy continues to carry out this work.

It is important that funding for suicide prevention is ring-fenced because suicide is a major problem in many counties throughout the country. There is a significant problem with suicide my county. Some tremendous organisations have been set up such as Touched by Suicide and Let's Work Together to Prevent Suicide and many other organisations. They do not seek a vast amount of money but they are looking for support and help and a small amount of money to ensure they can continue to provide services to the people. I realise an additional €1 million was provided but we must red-circle this money for 2012 to ensure funds are available in the area of suicide prevention.

Last week the Minister, Deputy Howlin, the Minister of State, Deputy Kehoe, and I held meetings with groups in County Wexford. We are lucky in the sense that a local priest, Fr. Scallan, has set up many community workshops in Wexford, including St. Patrick's Special School in Enniscorthy and St. Aidan's Daycare Centre in Gorey. He used to say that he would set up projects but he would let someone else worry about paying for them. That was then and this is now. Those involved are concerned that there will be cuts in the HSE allocation of 3.6% in 2012. This will mean a drop of €1 million in disability services in Wexford and this will mean either cutting back on posts or reducing services. There was a 1.8% cut last year and the organisations were able to live with that. They have pointed out that they could live with a 1.8% cut this year. There are workshops in St. Aidan's Day Care Centre and at the Windmill Therapeutic Training Unit. The Minister of State will be interested to learn that they are proposing shared services and the idea of working together, in conjunction with each other and in harmony with each other and, where they can share services, they are prepared to do so. This could save a certain amount of money as well.

It is important that the House continues to debate mental health issues. Mental health is a serious issue and mental health problems are serious issues throughout the country. We cannot close our eyes to what is happening. We must provide the services and have the required backup services and support. I realise the Minister of State has a deep interest in this area and I call on her not to forget the admissions unit which we need in County Wexford in the coming year or so.

Charlie McConalogue (Donegal North East, Fianna Fail)
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I commend the Technical Group on bringing forward this important motion tonight and on ensuring that mental health issues get the time and the prioritisation in the Parliament that they deserve to ensure we continue to implement the A Vision for Change document and to continue the progress made in recent times. Undoubtedly, a great deal remains to be done.

It is often said that the mark or character of an individual or a person is determined by how they treat people who are more vulnerable than them and the same can be said of a society. Let us consider our record since independence in Ireland. As a society and a country we have left a lot to be desired in terms of how we treated the weaker and more vulnerable. This ranges from those who were physically or mentally disabled to children. Issues arise with regard to the record of how we have ensured they have been protected throughout the years. This also applies to vulnerable people such as single mothers and, not least, those with mental health concerns. The State has been grossly inadequate in providing services to ensure people with mental health concerns get the treatment they need and the hence the ability to make a quick and a full recovery.

I wish to focus on child and adolescent mental health services. These form a key component of the services we must continue to provide. Studies have shown that one in ten children and adolescents will suffer from mental health disorders severe enough to cause impairment. The same studies show that experiencing such mental health difficulties in childhood and adolescence is a key indicator of mental health issues later in life. The expansion of child and adolescent mental health services is a key component of A Vision for Change. A key characteristic of that is setting up child mental health service teams which can draw on multidisciplinary people in order to take comprehensive and complex assessment and treatment approaches. In addition, they can provide packages of care where more than one professional intervention is required in order to meet the needs of young people.

Child and adolescent community based services are poorly staffed and only 41% of the staffing recommended under A Vision for Change is currently in place. The moratorium on public sector recruitment has hit mental health services very severely and disproportionately. I know from the comments of the Minister of State that she is keenly aware this must not be allowed to continue and the moratorium will be lifted. In her comments she mentioned the need for 450 posts under A Vision for Change. I recall reference being made to 300 posts. I ask for clarification on the difference.

In my home area of Donegal I have seen first-hand the change in mental health services. An old facility, St. Conal's mental health facility which used to house hundreds of people, was closed recently. In the past six weeks the Minister of State opened a new mental health unit. I acknowledge the effort and contribution of the former Minister of State, John Moloney, in ensuring the unit was built. I acknowledge the comments of the Minister of State, Deputy Lynch, and the Minister of State, Deputy McEntee, on the efforts made by previous Ministers, while at the same time recognising the vast amount of work that remains to be done.

The development of services in my area is a good example of where we have come from and where we need to go. A former hospital housed hundreds of patients who lived there for many years. We now have a unit with a capacity of 30 or 40 beds, which is sufficient to deal with inpatient-----

Kathleen Lynch (Cork North Central, Labour)
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Short stays.

Charlie McConalogue (Donegal North East, Fianna Fail)
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-----numbers within the county. We are moving into community mental health care.

I am aware of a gentleman in his 80s who passed away recently. He entered a mental health care home over 60 years ago and spent his entire life there, from his late teenage years until his death. It is a legacy we have to address and ensure is never repeated. We are going a long way towards doing that but a lot remains to be done.

The appointment of a specific director who can take on and monitor responsibility is key. If a job of work needs to be done somebody needs to be in place on the Civil Service side to complement the fact that a Minister is responsible for it.

I commend the motion to the House and thank the Technical Group for highlighting the issue.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Cuirim fáilte mhór roimh an rún seo agus molaim an Teachta Maureen O'Sullivan agus an grúpa teicniúil as an rún a chur os comhair na Dála. Is ceart é cúram sláinte, sláinte intinne san áireamh a déantar dearmad air go minic. Leis an rún cuimsitheach seo tá clár soiléir leagtha amach don Rialtas agus molaim dó glacadh leis an gclár sin agus é a chur i bhfeidhm.

I commend this comprehensive and progressive motion, in the name of Deputy Maureen O'Sullivan and the members of the Technical Group, to the House. It is timely, coming as it does within weeks of the budget. It could be a budget which will see mental health again relegated as the poor relation of the health care system but we hope that is not the case. There are alternatives, as we outlined to the Minister of State and her predecessors time after time, and there is a better way. The motion sets out a programme on mental health for the Government to follow. I join strongly with the earlier voices in urging the Government to adopt the motion and continue the programme as outlined.

World Mental Health Day took place on 10 October. A unique event took place here, the first in my experience as a Dáil Deputy, when the cross-party Oireachtas group on mental health launched the first ever cross-party pre-budget submission. I am a co-convenor of the group, which also includes Deputies Maureen O'Sullivan, Dara Calleary and Simon Harris and Senator Susan O'Keeffe. It was a very positive development that the group, representing all of the component parts of the political parties and Independents in the Houses of the Oireachtas and having only been set up soon after the establishment of the 31st Dáil, made its first pre-budget submission. It is a major step forward. I pay tribute to the advocacy group Mental Health Reform, which has encouraged and facilitated the establishment of the all-party group and thank Natalie Buhl for her dedicated support.

The group has made very clear that at its core it has the conviction that now more than ever, in a time of economic recession, we need to prioritise mental health. In light of this, the group made straightforward budgetary recommendations which I wish to put on the record of the House. First, in line with the programme for Government, the implementation of A Vision for Change must continue. Second, funding for mental health must be held at the budget 2011 level. The funding attached to any mental health posts lost in 2012 must be preserved and used for the recruitment of multidisciplinary community-based mental health staff. Third, the ring-fencing of €35 million annually from within the health budget to develop community mental health teams and services, as outlined in A Vision for Change, must occur in order to ensure early access to more appropriate services for adults and children and to improve comprehensive community-based mental health services which are linked to primary care.

These are very straightforward proposals and I hope the strength of the appeal behind the co-signatories to the pre-budget submission will ensure their wishes are reflected when budget 2012 is laid before the House. The cross-party group has highlighted the fact that mental health difficulties cost the Irish economy approximately 2% of GNP annually and most of the costs occur in the labour market as a result of lost employment, absenteeism, lost productivity and premature retirement. Some 25% of people on illness benefit and almost 20% of people on disability allowance have a mental health difficulty as their primary health problem.

The record of successive Governments in dealing with mental health has been far from glowing, to say the least. Much progress was made in recent years but it must be continued if the promise of A Vision for Change is to be realised. It is a good and positive development that we at least have unanimity across the House on the relevance and importance of a vision for change and it is something we can all work towards together.

However, decisions over the past year do not augur well and not only since the new Government took office. In my constituency the removal of the acute inpatient mental health care admissions unit in St. Davnet's Hospital in Monaghan was deplorable. I raised the issue in the Dáil over a year ago and strongly objected to the transfer of the admissions unit from the hospital, which arguably was and still is the better facility and location. It is certainly superior to the alternative now in use. People are now directed to the basement area of Cavan General Hospital. I visited the unit and felt discomforted descending into the basement. As I said to the predecessors of the Minister of State, it is not suitable for people with severe mental health issues.

The former Minister of State, John Moloney, to his credit admitted to me in this Chamber, sitting where the Minister of State, Deputy Lynch is now, that the basement services are clearly not adequate or proper, yet it is the location where acute inpatient mental health care is provided in Cavan and Monaghan for those who seek those services.

While I acknowledge community mental health teams continue to provide services at St. Davnet's, the question must be asked for how long. There is no comfort in what is a prime example of spin, such as the statement from the HSE which announced the closure of acute inpatient services at St. Davnet's. It was reported in local media that the campus would not close. It is a lovely place for a walk but that is not what we are looking for when we seek access to mental health services.

The Dáil adjourned at 9.01 p.m. until 10.30 a.m. on Wednesday, 16 November 2011.