Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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In the earlier part of my contribution last night, I referred to recent decisions which do not augur well for the delivery of mental health care in this State. The Health Service Executive, HSE, is now charging mental health patients in the greater Dublin area for their medication which, up to now, was free of charge. Under a scheme which was initially established by the former Eastern Health Board, all mental health patients received free psychiatric medication, including both medical card and non-medical card patients. This has now ceased with non-medical card patients paying full costs up to the drugs payment scheme threshold of €120 per month.

As I have stated before, this is a backward step and the Minister for Health, Deputy Reilly, should intervene to reverse it. It is an anomaly that such a scheme would apply to just one region in the State. Patients, however, should not simply be cut off in this summary fashion, in some cases after many years of dependence on this scheme. Many may go without essential medication as a result. My colleagues in Sinn Féin and I have been contacted by extremely concerned people directly affected by this. I am sure other Members, across all parties, have been contacted also. The scheme should remain in place pending a thorough review of supports for mental health patients across the State.

In reply to a parliamentary question from me on this matter, the Minister of State at the Department of Health, Deputy Shortall, stated in 2009 the HSE decided to bring the arrangements for the supply of medicines to patients attending mental health outpatient clinics in the greater Dublin area into line with those operating in the rest of the country. While this may be the case, it came as a bolt from the blue to those in the Dublin and mid-Leinster area who lost access to this scheme from 1 November 2011. They were simply not prepared for it.

The Minister of State also stated in her reply that people affected by these changes who cannot, without undue hardship, arrange for the provision of medical services for themselves and their dependants may be entitled to a medical card. In the assessment process, the HSE will take into account medical costs incurred by an individual or a family, including the cost of medication.

This is no different from their entitlement in any case. If the Government will not reverse this change, will it at least, when assessing people's eligibility for a medical card, take into account the nature of their illness and the fact that, having benefited from a scheme in some cases for year, they are now forced back on their own resources?

In December 2009, I asked the then Minister for Health and Children, Mary Harney, what measures would be undertaken to ensure the roll-out of A Vision for Change. It is interesting to compare the answer given then with the proposed amendment to this motion in the name of the Minister for Health, Deputy Reilly. The previous Minister stated the HSE mental health capital programme would be funded from the proceeds of sales of former psychiatric institutions. At that time, the proceeds of those sales amounted to €42 million according to the Minister. Perhaps the Minister of State responding could indicate the current figure and if all of the proceeds will be ring-fenced for community-based facilities. It is not clear if that is the case from the Government's amendment.

Last night, the Minister of State, Deputy Kathleen Lynch, stated there are 61 child and 124 adult community mental health teams working across the State, not all of which are fully staffed, which constitute the backbone of A Vision for Change project. If they are not fully staffed, they are then not fully working. The Minister of State said each team must have representation from several core areas including psychiatry, psychology, social work, occupational and other therapy and mental health nursing. She intends 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.

I welcome this statement as well as her stated intention last night that the recruitment moratorium will be breached to provide an additional 450 posts to implement A Vision for Change. I hope the Minister for Finance and the Minister for Public Expenditure and Reform have signed off on this.

I agree with the June 2011 TASC report, Eliminating Health Inequalities, which stated that while the programme for Government brings a much-needed renewed focus on mental health, the ring fencing of €35 million annually will do little more than extend existing pilot initiatives or support new initiatives on a pilot basis. Sinn Féin has set out a more ambitious programme which includes developing health services on an all-Ireland basis, progressing from increased co-operation to integration of services on the island; improving accountability and transparency in planning and financing mental health service reform; modernising mental health legislation in line with the UN Convention on the Rights of Persons with Disabilities; promoting cross-departmental action to combat social exclusion, prejudice and discrimination against people with mental health problems; ring-fencing 12% of the annual Department of Health budget for mental health services in line with World Health Organisation recommendations; developing and promoting suicide prevention strategies; and ensuring provision of required child and adolescent community-based mental health services and ending the wholly inappropriate placement of children in adult inpatient facilities.

The reference to asylum seekers and refugees in the motion is welcome. Research carried out by consultant psychiatrists Dr. Niall Crumlish and Dr. Pat Bracken, presented last year to the Oireachtas Joint Committee on Health and Children, demonstrated alarmingly high levels of mental ill-health among persons seeking asylum. Some of this can be traced to the inhumane treatment they receive during the asylum process. Comprehensive reform of this system must be a central element of any effort to improve the mental health of this vulnerable population.

I support the demand for change to section 59 of the 2001 Mental Health Act. This proposes to ban the use of electroconvulsive therapy, ECT, on patients without their consent. It is not acceptable this highly controversial and medically questionable procedure which impinges fundamentally on patents' rights should be imposed on patients without their consent but on the say-so of two psychiatrists. Many people have been damaged by the use of these procedures in the past. They emanate from a time when people with mental illness were treated like criminals and subject to incarceration, often in horrific conditions, and to medical experimentation. Care of people with mental illness has been transformed for the better but these procedures remain. It is long past time to deal with this issue. ECT is among the issues addressed very comprehensively by Amnesty International in its review of the Mental Health Act 2001. I commend Amnesty's recommendations to the Government.

The Government itself in its programme for Government made a commitment to review the Mental Health Act 2001 in consultation with service-users, carers and other stakeholders and to introduce a mental capacity Bill in line with the UN Convention on the Rights of Persons with Disabilities. Those commitments are welcome. It is our responsibility to ensure they are delivered upon.

The closure of St. Brigid's Home, Crooksling, Brittas, County Dublin, will affect 89 patients with various degrees of dementia, 67 of whom are high dependency. While it has been signalled that Hollybrook community nursing unit, Inchicore, and other sites will take a number of these patients, many are still uncertain of their futures, which is a real concern to them and their families. The Minister of State, Deputy Kathleen Lynch, gave an undertaking that she would facilitate a meeting with HSE and departmental decision-makers for representatives of the residents at Crooksling. This still has not happened weeks after the Minister of State gave her commitment in the House. Will the Minister of State, Deputy Sherlock, raise this matter with his colleague, the Minister of State, Deputy Kathleen Lynch, who I know to be a sincere voice in this House, to come back to me on this eagerly sought meeting?

I urge the Government to withdraw its amendment and to support the motion as tabled by Deputy Maureen O'Sullivan and the Independent Members of the Technical Group.

Colm Keaveney (Galway East, Labour)
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I thank some of the Members opposite for their contribution on this motion. Members on all sides of the House have strong shared concerns in this area. It is also a shared concern that the one in four people is affected by mental health issues. There go I but for the grace of God. It is important that this Dáil takes whatever action is necessary to deliver critically important services within the community.

I support and applaud the Minister's commitment with regard to the policy in the programme for Government. It is the intention of this Government to break the perception that mental health services can only be delivered within an institutional environment of care. We must tackle that but we must also ensure that we adequately resource the delivery of community based services and try to break from the perception that the only quality delivery can be done through the State agencies or the Health Service Executive.

We must acknowledge the great work done by the voluntary and community sector in that regard. I refer in particular to Outhouse, a lesbian, gay, bisexual and transgender community resource centre based in Dublin whose primary objective is to ensure that it can support clients of services with mental health issues. Outhouse is a front-line service provider which provides a safe space where people can get information, support, organise and build capacity to act. It is often the first point of contact for LGBT service users to find a safe space where they can talk about their concerns regarding emotional isolation, coming out, homelessness, alcohol and substance misuse and abuse, self-harm and suicide. When I refer to community it is that type of model that we must extend above and beyond our effort to address the scourge and the great stealer that we know as mental health illness.

The current work as indicated to me in my discussions with representatives of Outhouse today involves a minimum investment on behalf of the State where often life-saving services can be delivered through volunteers and peers who can provide support and deliver a front-line service to what we would consider are marginalised people within our society.

I welcome the great work of organisations such as Outhouse which refers its work across the sector in terms of the Garda gay liaison officers, the Public Interest Law Alliance, the HSE social inclusion and HSE mental health nurses within the community. We must endeavour to work with and support those type of partnerships to ensure we deliver modern public services that deal with the emergence of mental health issues within that community. There are great demands to ensure we increase resources to this community because the reality is that Irish society must deal with the stigma of mental health issues and the mental health issues associated with the lesbian, gay, bisexual and transgender community.

In future I would like to see organisations dedicated to mental health supported under the provisions of the proposed Government legislation. In that regard there is a commitment in the programme for Government to retain and ring-fence spending under A Vision for Change, which provides for an additional ring-fenced €35 million annually from within the health service budget. That is important in terms of sending out the signal that in austere times this Government is serious about debunking the notion that we do not wear the issue of mental health on our sleeves. We are proud to associate ourselves with this issue. It is not an issue we want to sweep under the carpet but one in which we want to invest to deliver critically important services to vulnerable people in society.

I welcome the opportunity to speak on the motion. It is important for us as a Government to listen to what the Opposition has to say in this regard because there are some valid proposals in this area to which we must give serious consideration.

Gerald Nash (Louth, Labour)
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I very much welcome the opportunity to contribute to this debate. This is not the first time we have discussed this issue in the House in recent months but I welcome this debate on the importance of mental health and ensuring the resources are in place to help those with mental health issues across the country.

For far too long mental health issues were swept under the carpet and talked about in hushed and sometimes ignorant terms, if they were talked about at all. President Bill Clinton spoke on the subject at length on occasion and once stated that mental illness is nothing to be ashamed of but stigma and bias shame us all. This is an issue that does affect us all.

The most common and familiar manifestation of mental illness is depression. Severe depression can cause paralysis not just of the soul but of the body as well. Those who share their lives with victims of depression are also under incredible strain. It is frightening to see one's loved ones suffering from depression or other forms of mental illness. There can be a feeling of helplessness and of no longer being able to reach or recognise the person one loves.

My involvement and that of other Deputies across the north east is with the Save our Sons and Daughters, Sosad Ireland, organisation with which my colleague, Deputy Doherty, would be familiar. It has brought home to me the urgent need to provide community based services and a community based approach to mental health in general. It is essential that a strong and positive mental health policy should support not just the patients but also provide the families of patients with the knowledge and tools they need to help their loved ones. The best way to do that is through primary care both through our health service but also by working with organisations such as Sosad Ireland, Aware, the Samaritans and so on.

We all agree that our current support system is far from perfect but many positive steps have been taken in recent years. As Deputy Ó Caoláin stated, the era of hiding away or, worse, locking away patients is thankfully on its way out. The vast majority of mental illness problems can and should be treated by primary care. Hospital admission should be reserved for acute cases of severe illness. A total of 90%of mental health problems are now treated at primary care level and the number of involuntary admissions to hospitals has decreased by over 30% in the past five years. That is a credit to the changed conversation we have led in this country around mental health issues, and a change in attitudes also. The recommendations outlined in A Vision for Change continue to be implemented as a series of speakers stated and the Government has committed to ring-fencing €35 million annually to develop the type of community health teams and services that are vitally needed across the country.

It is important also that we remind ourselves of the true aim of health care, which can be often lost on people. The World Health Organisation states that health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. We sometimes lose sight of that particular focus. Too often we focus on the illness and not on the well-being. With mental health issues, as with all health issues, prevention is much better than cure. That is particularly relevant in the case of youth mental health services. I am glad to see the HSE is continuing to support and is seeking to expand initiatives targeted at young people such as the Jigsaw programme with which many Deputies will be familiar. Our end target must be to make that programme and others like it available across the country.

I am pleased that our recently elected President, Michael D. Higgins, has prioritised this area. One of the first initiatives he intends to take is to have a presidential seminar, a national discussion, about what it means to be young in Ireland today and I am sure mental health will provide a focus for that particular discussion.

This country's new approach to mental health is a win-win for everybody. A healthy society is a productive society. Critics will quote statistics marking a reduction in percentage spend on mental health while sometimes conveniently ignoring the successful replacement of outmoded, anachronistic and hugely expensive hospital care with the more effective primary and community based care and interventions we have seen in more recent years.

Our services are far from perfect but I am proud to be part of a Government that is committed to making real improvements in this area, and continues to do so. I am also very proud to be working alongside a Minister of the calibre of the Minister of State, Deputy Lynch, who gets the mental health issue and has encouraged us all to take it on, break down the barriers and speak openly and freely about mental health in our society. This is not the first time we have discussed this issue in the House and I commend the Technical Group for bringing it forward previously. We spoke about it at length in recent months and I hope we continue to do so.

Regina Doherty (Meath East, Fine Gael)
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I thank the Technical Group for bringing forward this motion because the more we talk about it and the more normal we make it as a condition the more acceptable it will be for ordinary people outside this House to talk about it and accept it.

On that basis I want to talk about stigma. While one could discuss many topics related to mental health, stigma is particularly important because it lies at the root of the problem. The word "stigma" in this context refers to the use of negative labels to identify people. The stigma around mental health problems has its roots in fear and misunderstanding. Many people hold negative opinions of people with mental health problems because they rely on myths, misconceptions and stories they were told when they were younger. When I was child I often heard it said that my nanny, God rest her, was suffering with her nerves. Years later when I thought about what my nanny went through, it became obvious that her problems were widely ignored and the solution was to label them as suffering with her nerves.

I read a recent study entitled, Public Attitudes Towards Mental Health Problems, which showed that stigma was one of the most persistent barriers to understanding mental health problems and the importance of mental health. I was curious about the medical meaning of the word "stigma" and when I looked it up I found it defined as "a cluster of negative attitudes and beliefs that motivate the general public to fear, reject, avoid, and discriminate against people with mental illnesses". Stigma leads to low self-esteem, isolation and hopelessness and deters sufferers from seeking care and in some cases from even wanting it because their sense of hopelessness is so great. It results in people with mental health problems internalising public attitudes and become so embarrassed or ashamed that they will often conceal their symptoms and fail to seek treatment.

Three core issues arose from the study on social stigma, the first of which is a lack of knowledge and ignorance. People in general have little understanding of mental health problems and much of the information they have is factually incorrect. I adhere to the view that a picture paints a thousand words. There is no substitution for real people telling real stories. Messages with a Government or departmental spin are largely ignored whereas real people, even relatively famous people, with real stories have a much greater impact. I refer to the recent case of Carol Hunt, a well-known journalist, whose open and honest comments on the issue resonated with me and many of friends.

The second core issue to emerge from the study was negative attitudes or prejudice. Anxiety, fear and a desire to avoid people with mental health problems are common feelings. People do not want to sit down and discuss their innermost feelings, the fuzzy things they wish to avoid. People with mental health difficulties expect a certain reaction from people. It is human nature, therefore, that they will prefer to conceal the difficulties they are experiencing rather than face rejection or hostile behaviour from their peers.

The final core point to emerge from the study was discrimination. People with mental health difficulties must enjoy the same basic rights as everyone else, on an equal basis and without discrimination. Treating people with mental health problems differently can result in social exclusion and the denial of rights in areas such as housing, employment and education. It, therefore, creates disadvantage. Only Government policy and action can change minds and perceptions.

The See Change programme is Ireland's national partnership to reduce stigma and challenge the discrimination associated with mental health problems. Started by the previous Government in 2010, See Change continues to be Government policy and we will work with the 35 organisations in the See Change alliance which have banded together to promote responsible marketing of the programme's message. The alliance works together to bring about positive change in public attitudes and behaviour towards people with mental health problems.

For some people, the stigma and discrimination associated with a significant mental health problem is almost as difficult to manage as the experience of being unwell. It is vital that we provide an effective stigma reduction programme, one which incorporates all agencies and types of media and has the potential to bring about real change in the attitudes of normal people towards mental health problems. While tackling the stigma associated with mental health problems will not be achieved overnight, the positive support of the See Change programme will and must effect change in society. We must provide a real and positive transformation in how mental health problems are perceived.

Jerry Buttimer (Cork South Central, Fine Gael)
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I compliment Deputy Maureen O'Sullivan and the Minister of State, Deputy Kathleen Lynch, on the speeches they made last night. Those who have not read them should do so. As both the Minister of State and Deputy O'Sullivan pointed out, mental health has become the Cinderella of the health system. We believed the publication of A Vision for Change would deliver a new era, a new dawn and a new beginning and that all would be well as community based supports would be introduced and the gargantuan, horrific asylum approach to mental health services would end. Unfortunately, our hopes have not been realised.

I am confident the Minister of State, Deputy Lynch, will not walk away from the challenge of bringing about change and reform in the mental health service. The benchmark of the Government will be whether it delivers in the area of mental health. I say this having spent my entire life involved with people with intellectual disabilities. Relatives and friends of mine have suffered from mental health problems. I also worked as a porter in Cork University Hospital. I have had the pleasure of seeing people recover and of meeting past pupils who had suffered from mental health problems and had the courage to say they were in trouble and needed help and proceeded to make a determined effort to recover. Other friends did not make a recovery and did not complete the journey to a better place. Unfortunately, some of them are no longer with us while others are up to their eyes in medication. Over-prescribing and over-medication of patients are profound difficulties in the mental health system.

Given the importance of maintaining a cross-party approach to mental health services, it is regrettable that the House will divide on the motion. If we are honest, this issue affects every one of us, whether at home, in our extended family or in our local community. This is about the future and the Government leading, advocating and delivering a better mental health service. Well-being is important and one's sense of well-being is affected by simple matters such as the sun shining or television programmes such as the news. Deputy Regina Doherty spoke at length about stigma. While we have made strides in eroding the stigma associated with mental health, we must do much more in this regard. We need to change mindsets.

I welcome the Government's policy on developing primary care and related infrastructure. The capital investment programme provides for the development of a new central mental hospital. In addition, ten beds will be allocated for people with intellectual disability and the problem of children and adolescent mental health care will be tackled for the first time. Four regional centres for mental health services will also be established. Thanks to the Minister of State, Deputy Kathleen Lynch, the capital funding envelope has mental health services at its core.

I plead with the Minister of State, Deputy Sean Sherlock, to ensure the mental health intellectual rehabilitation unit for the south is located in Cork. It is imperative that the GF ward in Cork University Hospital is demolished and rebuilt. It is the only part of HSE south which has not been developed or modernised notwithstanding the great work done by staff on the ward. I hope the delivery of mental health services in the south will be transformed in 2012 with the development of a new GF ward.

Marcella Corcoran Kennedy (Laois-Offaly, Fine Gael)
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I welcome the opportunity to speak on this important issue. It is appropriate that Parliament should discuss an issue which would have been swept under the carpet not many years ago. In former times the outcome for unfortunate patients could be appalling. Among other things, they could be locked up in an institution or at home or, at best, branded as odd and avoided not only by neighbours and friends but also by family members.

Thankfully we now have become a more informed society and accept that we will all experience some form of poor mental health at some stage in our lives. Informing ourselves and our children of the signs and symptoms of depression and the fact that help is available is crucial to dealing with the issue. Nowadays, we can access mental health services in many settings, and the old taboos about depression are being slowly broken down.

I would like to focus my remarks this evening on youth suicide. As a young child and teenager living near a river, I became aware of suicide as two adults took their own lives in different years. I must admit that suicide was not something that I thought a lot about since then, but in recent years the increase in suicide in Offaly, especially among our youths, has brought the issue into sharp focus. It primarily occurs among young men, but young women too now appear to be resorting to death by suicide. What are the reasons for this drastic step? It is a challenge for society to deal with this. There must be a growing feeling of hopelessness which is leading to increasing levels of alcohol and drug abuse, anti-social behaviour, homelessness, mental health problems and suicide.

There are now many organisations out there which support young people in particular. Headstrong, SpunOut and other organisations are doing exemplary work in attempting to support youth mental health by enabling them to access systems and supports where needed. The Jigsaw programme was designed by Headstrong and it is a wonderful programme that works on capacity building and in partnership with communities to support young people's positive mental health. Communities from all over Ireland are availing of this wonderful project, and I am delighted that Offaly has been included in an expansion announced recently by the HSE. We must be as proactive as possible in developing and supporting better services to support our young people.

Seventy five per cent of mental health difficulties emerge before the age of 24. It is a long time since I was 24, but I can remember the feelings of being somebody of that age trying to find herself. This is a critical period in a person's development and if we can identify issues as they emerge, then if we intervene at an early stage, we can prevent people from suffering a lifetime of pain.

The extension of the Jigsaw service means that young people will get help earlier and prevent unnecessary potentially very serious problems for them in their day to day lives. It is a challenging subject and we need to innovate and come forward with novel and effective solutions. The existing Jigsaw projects demonstrate that it is possible to reduce the stigma associated with mental health, remove barriers and design a service that works for young people by listening carefully to their ideas and react to their feedback. This is the type of service that should be rolled out across the country.

I would like to refer to an excellent project carried out recently in Offaly to address mental health. It was called "Let's talk about mental health" and it was carried on in collaboration between the HSE, the county council and the community forum. There was a week of events across the county, in libraries and community halls, in which mental health issues were discussed. It culminated in a wonderful family celebration on the final day, which was a great end to what was a difficult week when people talked about their experiences. It should be experienced in other counties across the country. I am sure an evaluation of the impact of that week will be carried out, and it should be referred to in future.

Jack Wall (Kildare South, Labour)
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I thank Deputy Maureen O'Sullivan for putting forward this motion. I remember vividly the high walls around St. Dympna's Hospital in Carlow so that nobody could see in or out, as well as the stigma attached to those who were signed in. It was a regular comment to make in those days that a family had "signed in" their loved ones. The torment associated with a public display of the fact that a family was not in a position to care for their loved ones was something they had to endure in their own community. As somebody who worked in the vicinity of St. Dympna's Hospital, I can remember seeing the tractor going to the farm every day, and all those unfortunate people piled on the back of it going out to do a day's work, before going back home in the evening. There was such dejection among those unfortunate people. Many of them had been forgotten by their loved ones, while others were signed in for whatever reason, but were never given the opportunity to play an active role in their community.

This stigma still exists to some extent. I am concerned about what I see in my constituency, where we have low support and high support community accommodation. In many instances, there is no link up with those people. There is nobody available to ask them to come to the cinema or a game. We often talk about community, but I wonder if we are involved with those in the community who are crying out for help in so many different ways.

Some of these unfortunate people come into our clinics, and we have to give them the time to ensure that they feel wanted. As elected representatives, we should lead the charge on involvement. This debate should highlight the word "involvement". We should not forget about them, irrespective of where they are. We should not just talk about Age Action and all the other wonderful groups, but we should work with them. Deputy O'Sullivan has brought forward a motion on this issue, but it should not be raised just once every term. It should go back to the health committee and back in here again, if we feel that the actions are not being taken.

I fully support what the Minister of State, Deputy Lynch has been doing. It is an ongoing problem in families. I remember socialising on one occasion and I met a famous singer. I started talking to him and he told me that he was in a difficult time. I asked why that was the case. It was in early July and the weather was good, but he said that his problem was that he would become manic depressive in a few weeks. He was worried - in July - whether he would have a happy Christmas and if he could not get that out of his system, he would be depressed for the rest of the year. It was hard to believe that this one question could put that man in such a position.

These are the challenges that face us. We have a problem. We should work with it and ensure that organisations with a community base should widen their involvement and include people who have suffered from their time in mental institutions, but who have since moved on. We should help them to move to the next stage.

John Halligan (Waterford, Independent)
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I wish to share time with Deputies Daly, Boyd Barrett, Catherine Murphy, Joan Collins and Tom Fleming.

Two years ago, when I was Mayor of Waterford city, a huge conference took place on the subject of taking the stigma out of mental health, which was attended by about 500 people from all parts of Ireland. There were some stunning statistics, which have been alluded to over the course of today's and last night's debate, regarding the number of people who have presented with mental health problems in Ireland - between 350,000 and 400,000. There is also an unknown number who do not present themselves for treatment. I acknowledge that this has already been brought to the attention of the Dáil by a number of people.

Tonight I want to concentrate on the latest report from the independent monitoring group for A Vision for Change, which criticised, among other things, a disappointing lack of progress in specialist services for substance abuse problems. These services, according to the IMG, have not received the priority and urgent attention they require. The group mentioned the importance of dual diagnosis in the effective treatment of addiction, which cannot be overstated, because at least half of people with addiction problems have coinciding mental health problems which often go undiagnosed and untreated.

What I and the IMG cannot understand is why, given the commitment in the programme for Government to ring-fence €35 million annually from within the health budget to develop community mental health teams and services, we still have no community-based mental health service similar to the community-based drugs initiatives, CBDIs, which cater for those with addiction issues. CBDI workers are not psychologists or psychiatrists; they are not trained or equipped to deal with the complexity of mental health issues. Yet, at the moment, 50% of those who present to the service with addiction concerns also have mental health problems, so it does not make sense that we do not have a similar community-based initiative for mental health problems. This is what is urgently required: community-based mental health services that work in tandem with the local drugs projects to offer people access to psychological and social services for mental health treatment, not just biological and medical interventions.

Not only are community mental health services more accessible to people living with severe mental disabilities, they are also more effective in taking care of their needs compared with mental hospitals, as has been stated by many previous speakers. The strengths of CBDIs are that they are community-based, community-driven, and less sterile than a hospital environment. They are informal yet confidential and they offer a holistic approach. Taking all this into consideration, the Government should rethink its strategy on community-based programmes. It is also important that people can go through the service at a first point of contact and then be referred, if required, back to the community service for support. This would remove the stigma, as has been mentioned by many people, that is associated with attending psychiatric treatment wards. Furthermore, psychiatric wards are not always the correct environment for those with mental health issues, as it may not be appropriate for them to mix, for example, with those who are going through the detoxification process. What CBDI workers are telling me is that because of the lack of mental health services within the community, a significant number of people with mental health issues are using illegal drugs to self-medicate. That is something the Government should examine.

Unfortunately, I do not have enough time to address a number of other issues. As a member of Amnesty International, I thank that organisation for highlighting many mental health issues in Ireland over the last number of years. I also want to pay tribute to the Minister of State, Deputy Kathleen Lynch, who I know from personal conversations is determined to push forward projects in the area of mental health. However, I am disappointed, based on the report from the monitoring group of A Vision for Change, that we have not established community-based programmes on the ground similar to the drugs initiatives.

Clare Daly (Dublin North, Socialist Party)
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There are many issues about which we can make the criticism that there is a lot of talk and not enough action. Ironically, the area of mental health is one in which there is not enough talk, although that does not mean there is enough action. It is one important area in which talking is a positive thing as it allows issues to be aired. It is important that we are having this debate because of the points made about the stigma that still surrounds the issue of mental health. As a shop steward in a previous job for many years, I represented people who were out of work sick, and never once did a doctor write on the certificate that mental health issues were involved. There were always other reasons put forward for the person's absence because of the fear of stereotyping. One of the messages from this debate is that there is nothing embarrassing whatsoever about mental health problems; they are perfectly normal. At least one in four people will experience such problems at some stage, and they can be dealt with. We were laughing here at the number of Deputies who said they had friends with these problems; we were thinking that maybe they were not actually friends at all. I have no problem in saying that I myself have suffered from depression. I have taken medication for depression on occasion; I have dealt with it, and now I am grand. Many other people in Irish society are the same.

It is important that we talk about these issues, in the House and outside it, but this is not enough. The talking must be backed up with action. I do not think it is good enough that A Vision for Change has been lying on the shelf for five years even when it must be admitted it is not that visionary in its approach. It was a repeat of a policy that was already in place, Planning for the Future, which was not that radical. It was concerned with the provision of treatment and care for people primarily in the communities they come from so that they would not have to be locked up and institutionalised. However, the resources were not provided to back up that policy and make it a reality.

It is appalling that these policy changes were not implemented during the boom. It is important to stress the need to protect the funding - €35 million - for community health teams and so on but given the stresses being experienced by people due to the recession, there needs to be more to respond to the crisis. The current economic situation is putting major pressure on people mentally and emotionally and contributing to mental health problems.

We cannot see the issue in isolation. It is clear that more staff are needed to deal with it. We cannot divorce this issue from the public sector recruitment embargo, which needs to be addressed, because decisions are being made without taking into account the views of staff at the front line. They are concerned that the resources will not be available to adequately run the new units that are being promised but they are not being listened to. It is not just lip service that we need. We need action and investment. It is impossible to deal with this issue while the public sector recruitment embargo remains in place.

I would like to step back and consider how society as a whole deals with the issue of mental health and the role of psychiatric drugs. Serious issues are currently being debated, including whether psychiatric medications alter the long-term course of mental health disorders for the better or for the worse. Do they increase the possibility that a person will be able to function well, or that he or she will end up with a disability? Could it be the case that a person with a mild disorder has a bad reaction to an initial drug which puts him or her on the path to long-term disability?

We must be careful in this regard, because research from the United States shows that mental illness disability rates have doubled since 1987 and increased sixfold since 1955, while psychiatric drug use greatly increased in the 1950s and 1960s and has skyrocketed since 1987, when Prozac was introduced. These pharmaceutical companies make billions of dollars, and anti-psychotic drugs are far and away the biggest money-spinners. Evidence suggests they are useful for short-term treatment but in the long term they can increase problems. There are worrying trends, in particular of children being prescribed such medication and this is something we must attend to. We must determine who controls health and who decides on these things. Is this being done in the interests of the big multinational corporations to earn a profit or is it being done for the benefit of the individual and for society as a whole? We must examine the role of transparency in decision-making in this regard and we must seek to enable people to make decisions for themselves. People should be able to make an informed choice about all of the treatments available. There is a role for drugs, for counselling and for other supports. People should get the entire package and should be informed not only of the short-term impacts, but also of the long-term impacts.

Michael Kitt (Galway East, Fianna Fail)
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Four of your colleagues have yet to speak. I call Deputy Boyd Barrett.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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I commend Deputy Maureen O'Sullivan on putting forward this motion. This could not be a bigger issue. One quarter of the population are affected at some time by mental health issues. We have all been touched by it. I have been touched by the impact of it as have people close to me. Let us consider the link, although not inevitable, to depression and alcohol-related abuse, both of which have been seriously on the rise in recent years. It is important that we address this because it has been a significant problem and, as Deputy Daly has suggested, it has been growing for the past 20 or 30 years but it has dramatically worsened in the past few years.

Without getting into a complex analysis of these difficult issues. it is clear that there is some causal link between unemployment, economic dislocation, poverty and mental health issues. In addition there has been a rise in the levels of suicide, alcohol abuse, other drug abuse and so on. While I have no wish to rehearse the economic debates we have in here every day of the week, this matter cannot be dealt with seriously and no commitment to deal with this issue can be taken seriously unless we address such issues as unemployment urgently. If there are 300,000 or 400,000 people in the country with no hope of work then this problem will get worse. The levels of depression will rise, the rates of suicide will increase, drug and alcohol abuse will get worse and all the costs of all of these problems will get worse as well.

Although we have these problems, we know they can be helped by the provision of mental health services. However, this State is failing to make a priority of the provision of these services. We all acknowledge we should do so but in reality we are not doing it. Some 5% of the health budget in the State goes on mental health services as against a budget of 12% in Northern Ireland and an average of 8% throughout Europe.

A Vision for Change was not a bad document. Nor was it a brilliant document or the last word on this issue but even this document has not been implemented. Some 60% of child psychiatry teams continue to await the funds and the staffing they need. Child mental health protection is of particular importance since it is preventative and it will prevent greater costs and more damage in the long term. School counselling services are practically non-existent and school principals regularly tell parents that there is a quota of only two children per year per school to be seen by the National Educational Psychological Service, NEPS. Up to three quarters of all mental health problems begin between the ages of 12 and 25 years. However, the roll-out of jigsaw walk-in centres for adolescents and young adults is painfully slow with only five centres open at present. There are no functioning child psychiatry teams for children with severe intellectual disabilities, as promised by the A Vision for Change document.

I put it to the Minister that under any universal health insurance, mental health will not be prioritised because it is not a profit-making area. This is the case in such places as the United States. Mental health treatment is manpower-heavy and, therefore, a recruitment embargo disproportionately hits the delivery of mental health services because of its reliance on manpower. The cuts in staffing levels will force more people into dependence on drugs which, as Deputy Daly correctly stated, represents a concerning way to deal with the problem. To deal with the problem effectively, we need more psycho-social interventions, social workers, occupational therapists, psychotherapists and so on. I appeal to the Government to take this issue seriously. The Government acknowledges that we must deal with the issue. I emphasise my disbelief at the fact that the Government has amended the motion. Given all that those in Government have said, I do not understand why they are playing politics with this motion when there is nothing controversial in it and many speakers on the Government side have endorsed it.

Catherine Murphy (Kildare North, Independent)
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I wish to draw attention to the amendment and express my dissatisfaction that the amendment does not specifically deal with the area of addiction. One cannot deal properly with mental health issues without dealing with the area of addiction. The Minister of State, Deputy Shortall, criticised the HSE for withdrawing services today. It should be a matter of real concern that there is no connection between the HSE and the Minister of State's Department in respect of these services at a time when we are being told that heroin addiction is on the rise.

Today, I invited to the House a group which has previously met some of the County Kildare Deputies. The group is based in Kildare. It is made up of a fantastic group of people who are all in recovery from addiction. Some of them are back in education having returned after being addicted for a long time. They are keen to ensure that they play a positive role in assisting others, especially in County Kildare. I am referring to the Addiction Services Kildare Users Forum. One of the most revealing things they produced was a map of the services in Kildare. They placed four stars on the map around the county signifying where the services are provided. There were two level 2 doctors and a detox unit in Athy. Most people from Kildare are obliged to travel to Dublin for these services. I realise no community is queueing up to get addiction services within their community and the issue must be handled sensitively but there is a real and practical issue to be addressed. In a county such as Kildare with 209,000 people, including west Wicklow, there are inadequate services at the point where people can easily access them.

One must be very determined to deal with an addiction problem and if it is not made reasonably easy then the opportunity can be lost. For example, today I heard about a couple who must travel every day from Athy to Pearse Street. They take the journey in turns because they are on a methadone programme. That is simply not sustainable. However, they have come forward with some practical proposals which I hope to bring to the Minister. These are small changes which would not be particularly expensive to implement. I hope there will be a positive response to such situations because treatment is not simply a matter of dealing with an addict. One must deal with his or her family and friends and one must also deal with a reduction in health services and crime and prison services. Sometimes it is a matter of putting in place simple things to make it easy for people to deal with addiction and this can have a large influence not only for the individual, but for the community. I was hugely impressed with the group but its members, as volunteers and recovering addicts, want to play a positive role in their community in assisting other people. We have to resource such people. If they are coming forward to do such work we should be going out of our way to assist them.

Some decades ago Tony Gregory outlined, during recessionary times, the terrible problems in the north inner city of Dublin. They have spread because there was not a timely and appropriate response. We can see how the problem has escalated and is much more difficult to contain. When positive things come forward, particularly from people like the group to which I refer, there must be a positive response.

Joan Collins (Dublin South Central, People Before Profit Alliance)
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There are many failings in our health system and those in the area of mental health are appalling. It is an historic issue for the nation. The treatment of people with mental health problems illustrates an appalling failure by the State, comparable to its failure to protect children. I get a shiver down my spine when I hear Government Ministers talk about protecting the most vulnerable in society when the records and facts are there. The most vulnerable, namely children and the mentally ill, have been abandoned by the State over the past decades.

An unequal society, alongside an unequal health service, does not make for a healthy society. The rate of hospitalisation for mental illness among unskilled workers is six times that of higher professional groups and ten times that of employers or managers. Those figures come from the health inequality on the island of Ireland 2007 report. The poorer layers of society suffer more from mental illness.

The programme of austerity has hit the poorest sections of society hardest. It will increase inequality and add to the stress, worry, poor diet and low self-esteem which are key factors in causing mental health problems. At the same time that cuts are affecting mental health services people, only 9% of staff in HSE work in the area of mental health yet it is has experienced 50% of staff cuts. It is a Cinderella syndrome which has to be discussed in the open.

The Government claims there has been significant progress in the implementation of the 2006 strategy, A Vision for Change, stressing particularly improved child and adolescent health services. That jars with two facts. There are 200 children in adult inpatient units. Assessment waiting lists for children and adolescents rose by 14% this year.

I have found the experience of older men and women availing of public psychiatric services is also appalling. I know of a person who had psychiatric counselling with a different person each month. The person came into contact with young people in the system and there was no continuity of care. Older people found it difficult to talk to young men or women who do not have the experience to assist them.

Dependency on tablets such as Prozac creates other problems such as impotence and can affect mental health and self-esteem. We have to seriously examine those areas. Community based mental health services must be in place, linked to the national understanding of mental health.

I welcome the fact the Government benches welcome the motion, that €35 million has been ring-fenced and that clinical care programmes will continue. More austerity is being implemented by the IMF and EU, through the Government. There is more joblessness and more people are stressed out by the mortgage crisis and possible evictions and dealing with all the problems associated with that. There will be more stress, inequality and depression. Mental health problems will need to be reviewed, not just in terms of policy but to determine what the needs of our society will be the next number of years.

Tom Fleming (Kerry South, Independent)
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I will illustrate the situation at a local level in my constituency of Kerry South which mirrors the national situation. There is a continuing exodus of nursing staff from Kerry mental health services which has resulted in the loss of over 50 nursing posts over the past three years. There are a further 30 retirements expected before the end of February 2012.

This will leave the service chronically understaffed and even more dependent on overtime to deliver what is becoming an often basic and fractured mental health service for the people of Kerry. If the recruitment of nursing staff is not commenced before 2012 many parts of the service will have to be closed or abandoned as there will not be enough nurses to sustain even the most basic services in many areas.

At a national level, more than 1,500 psychiatric nursing posts have been lost from 2009-11. This is disproportionate to the reduction in staff numbers in disciplines throughout the public service. The resulting reduction in the budget for mental health services has seen expenditure fall from €800 million in 2006 to €700 million in 2011. As a percentage of the overall health budget expenditure on mental health has fallen from 8.5% in 1980 and 1990 to 4.9% today.

In comparison, Northern Ireland spends 11% of its health budget on mental health, well in line with WHO recommendations which advocate that 12% of a nation's health budget be spent on mental health services. In monetary terms for every euro spent on mental health in the Republic, €2.30 is spent in Northern Ireland. The Republic's current percentage spend of 4.9% on mental health puts it firmly in the third world league.

To further illustrate the point, the Irish mental health service have been described by the human rights organisation, Amnesty International, as a service under siege and compared it to the Gaza Strip. Overtime is currently being used throughout Kerry mental health services in an effort to staff the various wards and units. If the amount of money spent on overtime was instead diverted to the recruitment of nursing staff it would pay for 23 first year nurses with money to spare.

The spending of money on staff recruitment rather than overtime and agency staff as the first option would offer better value for money to the service and the country. It is obvious that the current recruitment ban on the direct employment of psychiatric nurses by the HSE is costing more and is therefore counter-productive. To alleviate the current chronic shortage of psychiatric nurses I propose the extension of the timeframe for the implementation of the revised pension lump sum calculations based on the public service pay cuts. It would stem the rush to retire before 29 February 2012 and allow for a more controlled and orderly departure of staff nearing retirement.

If the moratorium on the recruitment of psychiatric prices was lifted 1,000 psychiatric nurses could be recruited by the HSE on a cost-neutral basis. The implementation of these proposals would have an immediate positive impact on mental health services at a local level in Kerry and nationally.

I thank the Minister for his reply to a parliamentary question I tabled. I asked him to provide capital funding for the replacement facilities to be put in place to complete the necessary closure of St. Finan's Hospital in Killarney. I ask him to pay special attention to it. The commitment he gave that the money will be made available sounds positive. I expect him to honour the commitment.

James Reilly (Dublin North, Fine Gael)
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I am delighted to have an opportunity to address the important issue of mental health provision in the State. I thank Deputy Maureen O'Sullivan and the Technical Group for putting forward the motion on Private Members' business. This subject is obviously close to the hearts of many Members and the contributions last night and again this evening have been both extensive and impressive. Another feature of the debate which cheers me is the strong cross-party support for A Vision for Change and the many efforts of this Government to put renewed impetus into the implementation of that policy.

Our counter-motion and the Minister of State, Deputy Kathleen Lynch's, contribution last night summarise the Government position on this issue. As the Minister of State pointed out, A Vision for Changewas widely welcomed on its publication in 2006 as a progressive, evidence-based and realistic document which offered a new model of service delivery for mental health that was patient-centred, flexible and community-based. Since then, a great deal of progress has been made in closing many of the old psychiatric hospitals and providing modern acute inpatient as well as community-based facilities and services.

We must ensure that we fast-track the remainder of the strategy set out in A Vision for Change. To do this we will have to provide more and better mental health services via primary care and in the community. There must be a cultural shift away from the overly medical model of the past to an all-embracing therapeutic and person-centred service that is focused on recovery. This will include an increased focus on the provision of counselling services. In this regard, it is my intention to introduce a system for regulating the provision of counselling.

A point that has been made numerous times but bears repeating is that one in four of us will experience some mental health problem in our lifetime. The message is clear; we must mind our mental health every bit as much, if not more than, our physical well-being. The Government has demonstrated its commitment to mental health from the start, with the programme for Government including several commitments in this regard. These include the ring fencing of €35 million annually from within the health budget to develop community mental health teams and services. We are also committed to ensuring patients can access mental health services such as psychologists and counsellors in the primary care setting. Early, appropriate and effective intervention is our key message.

My Department and the Health Service Executive are locked into a process of identifying specific aspects of A Vision for Change and Reach Out which we can target in order to apply resources in a planned, proactive fashion in the next three years. I have asked for timelines, detailed costs, structures and identifiable responsible persons in order to prioritise and drive the necessary change. I will not accept "cannot" or "will not" as an answer. This is too important. It is my intention that the issue of a directorate of mental health services, as referred to in the debate last night, will be dealt with in this context. I am also anticipating recommendations in the area of clinical care programmes across the spectrum of care pathways, including dedicated services to deal with complex psychological conditions such as eating disorders which are all too common and have devastating effects on individuals and their families.

The Minister of State, Deputy Kathleen Lynch, set out our position on the staffing of the child and adult community mental health teams. These teams must include expertise from all the core disciplines of psychiatry, psychology, social work, occupational and other therapies as well as mental health nursing. It must be primarily a people-based, multidisciplinary provision.

Many mental health issues surface first in our early years. We must ensure such difficulties do not catch hold of and destroy the lives and potential of young people. The HSE provides a range of services across primary care, specialist child and adolescent mental health services, health promotion and suicide prevention services which support young people's mental health. I am particularly pleased with specific initiatives in this area such as the Jigsaw programme, which was designed by Headstrong and its panel of youth advisers and is an evidence-based, integrated model designed to strengthen a community's capacity to support young people's mental health. The most powerful comment I can make on the project is that it works. Jigsawis up and running in five counties and an additional €1 million in innovation funding was allocated to Headstrong in 2011 to support the expansion of Jigsaw to a further six areas. Further initiatives aimed at addressing young people's mental health include the National Office for Suicide Prevention's public education campaign, centred around the platforms of "Your mental health" and "Let someone know", which is specifically targeted at a younger audience. Both of these campaigns are critically important in getting the right messages out there.

The Government's commitment to mental health is reflected in our capital plan, which includes approval for funding to build a new central mental hospital. One of the Members opposite mentioned the vulnerable in society. Our commitment to the national paediatric hospital addresses the needs of children, who comprise a particularly vulnerable group.

Under the primary care strategy, primary care teams in each of the primary care centres will include specialist personnel to deal with mental health issues. By offering these services in a primary care team setting, we can help to remove the stigma associated with mental health problems. People with mental health concerns will be dealt with in the same way as anybody with any other health issue. They will walk in the same door and share the same services. That has already happened in some locations, such as Mallow.

Another aspect of the Government's work in this area is the ongoing review of the Mental Health Act 2001. We recently established a steering group, with representatives from my Department, the HSE and the Mental Health Commission, to oversee the review. The terms of reference for the review include examination of the general operation of the Act since commencement. Importantly, the group is also tasked with reviewing whether A Vision for Change could or should be underpinned by legislation. The group must also consider the provisions of the UN Convention on the Rights of Persons with Disabilities. The public consultation phase of the review has been completed. More than 90 submissions were received, with some 25 or more of those coming from individual service users or their carers. The steering group is now conducting a series of meetings with key stakeholder groups. I look forward to an interim report on all of these matters by the end of this year. We hope to have the review completed by mid-2012.

I thank all Members who contributed to this important debate. I assure the House again of this Government's firm commitment to the reform and modernisation of our services in line with A Vision for Change.

Mick Wallace (Wexford, Independent)
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There seems to be a broad consensus that mental health provision deserves special attention and should not be neglected. The Minister's speech and that of the Minister of State, Deputy Kathleen Lynch, set out the Government's position quite clearly. The Minister of State observed:

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.

She went on to stress that mental health must become part of the primary care infrastructure. She stated:

Early intervention in a wrap-around system involving community, friends and low level counselling and psychology is what is required.

Both the Minister and the Minister of State spoke about the importance of changing social attitudes and behaviours and stressing that mental illness is not a lifelong condition. We all accept that society must learn to treat people with mental health problems as fully fledged members of society with a contribution to make, rather than seeing them as burdens. The burden of financial debt and, in many cases, unemployment is an additional strain on people. The current recession increases pressure on those already struggling with mental health problems and may lead to problems for people who did not previously experience difficulties with their mental health. Deprivation, poverty and unemployment are linked to mental health, and the economic problems the country is facing create a difficult situation for many people.

Barnardos has pointed out that despite the Government's commitment to continuing the strategy set out in A Vision for Change, its implementation has been slow and is likely to decline further. It points to recent reductions in mental health spending to just 5% of the overall health budget compared with an internationally recommended figure of 12%. Barnardos also observed that we still have cases where children are placed in adult psychiatric facilities at a vulnerable time in their young lives. I am sure the Minister will agree that is not a satisfactory situation.

There is broad agreement as to how we proceed from here in regard to mental health provision, but the challenge is to ensure the HSE succeeds in delivering community-based mental health care. The policy of moving to a community health care service has been around for a while, but successive Governments have done little to implement it. There must be an obligation on the HSE to deliver community health care services. Colm O'Gorman and Karol Balfe of Amnesty International Ireland have stated:

A progressive framework for mental health services is set out in A Vision for Change and this was widely endorsed and welcomed by stakeholders and people with mental health problems. Community mental health services can provide the specialised supports which mean that individuals with severe or chronic mental health problems can recover while living in their community. They also provide a wide range of supports that would not have been the case in traditional psychiatric hospitals. The Government should ensure that this policy is delivered by enacting legislation to ensure it happens. Legislation will demonstrate that we are serious about reform. It should require the health services to ensure a move from an over-reliance on inpatient care to comprehensive and community-based multidisciplinary services. The need for a new approach to accountability for implementation of A Vision for Change is clear. This can be achieved by: introducing a statutory obligation on the HSE to publish an appropriate implementation plan for A Vision for Change and to provide comprehensive and community-based mental health services in line with that plan to the maximum of available resources; and introducing statutory measures to require greater transparency and accountability from the HSE for expenditure on mental health through detailed annual reporting. The statutory obligation should stipulate the level of detail to be included in such a plan including measurable targets, milestones, outcomes and indicators as well as clear timeframes and details of the funding, human resources and infrastructure needed for implementation, and giving statutory powers to the Mental Health Commission to regulate, approve and inspect community mental health teams.

Luke Flanagan (Roscommon-South Leitrim, Independent)
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Obviously I think this is an excellent motion as I would not have signed my name to it otherwise. Many interesting things have been said and this is what I have to say about it. There is no doubting that there have been many improvements in our approach to the issue of mental health in the past half century or so. An elderly relative of mine informed me - I was shocked when I first heard it - that in the 1950s they witnessed a man with mental illness being loaded onto a boat to Liverpool in what was, in effect, a cage. I have also heard stories that in the 1940s people with mental illness were housed on straw in some mental hospitals and hosed down in a communal fashion in order to wash them. One could only conclude that if one was not suffering from a mental illness before one went into a mental institute then one certainly would be afterwards.

The town I come from had up until the mid-1990s a mental hospital called St. Patrick's and known as St. Pat's. It was the last place on the planet that anyone would have wanted to end up. In fact it was used as a threat and term of abuse to suggest that one might "end up there" as the saying goes. In 1988 a few years before it closed my father was given the contract by the health board to replace the wooden steps on one of the stairwells. I was given the job by my father of being the gofer. At 16 I finally got to see what was behind the walls of St. Pat's. While not being anywhere near as bad as I had heard from the 1940s, it was nonetheless bleak. I always remember one particularly striking thing and that was seeing men and women leaning against a wall and rocking back and over for hours on end.

It was so bleak that when my father had finished the job it left an indelible mark on me that lasts to this day. As a result, my biggest fear of suffering from a mental illness would not be the illness itself but the fear of having to engage with the services. The hospital appeared to be arranged in such a way that the higher up the floors one was then the more ill one was classified. The hospital was closed in 1996 whereupon many of the residents were moved out into the community and others who were not suitable placed in other institutions such as Ballinasloe. When they tried to move people into the community, some people, including neighbours of mine, objected because they were scared of them, but fortunately not anymore.

The hospital was replaced with a prison. I was, under protest, an inmate at that prison on two occasions for a short time. While the name of the institution had changed much had remained the same. The place was as bleak as ever in fact slightly more so. On many occasions I came across people who were obviously mentally ill. I met one man who was leaning against a wall and rocked back and over manically similar to what I had seen in the same building when it was a mental hospital. The question is as follows. When the State decided to close the hospitals did it make adequate resources available for the people who were formerly housed at the institution? A report done by the Irish Journal of Psychological Medicine found that 60% of females and 35% of males have suffered some form of psychological illness. So even though we had officially moved away from a particular type of institution for treating people with mental illness, many have just ended up being treated in the same way as always except we now call them criminals.

One of the main reasons I feared mental institutions so much is because at a very young age I suffered from depression. I spent evenings when I was younger when all I was capable of doing was staring into the fire for hours on end. At the time it was considered preposterous by a great many people that one could suffer from depression as a young person. I remember a nun in my school saying: "What are you on about? Don't be daft." The irony of it all. Another fear I had of the institutions was that I had heard people had been put in there for being different. As a child and to this very day I could justifiably be described as an eccentric so this added further to my fears.

It was not until I was 23 years of age that I tried to deal with my mental health issues. I went into my GP in Galway and told the doctor in question how I was finding life a struggle. I told the doctor that I had motivational problems - by the way I was not smoking cannabis at the time - and that no matter what I did I found life to be struggle. I had even contemplated suicide. Deputy Clare Daly laughed at me earlier when I told her that only reason I did not commit suicide was that I did not have the motivation to do it, which is bad. The doctor in question unfortunately knew nothing about me. They never asked me about my diet. They never asked me if I did any exercise. They never asked me how I spent my days. In fact all I was asked was whether I would like to take Prozac. I was given a prescription and told to come back in a couple of weeks. Fortunately I never took the tablets. I am not saying that is the answer, but for me it was. However, the idea that I would have to take tablets inspired me to find another solution. I immediately took up exercise by running five miles per day and changed to a diet which meant that I was getting everything that was essential to a body working well. As the saying goes, a healthy body leads to a healthy mind. That has certainly been the case for me. From listening to some people in the mental health profession one would think that all has changed since I went looking for help in the mid-1990s. However, from talking to people in my constituency clinic over the past eight years it is quite clear that people are still being offered tablets as a first rather than as a last resort. This is something which must change. I do not know how many times I have heard of people being given tranquillisers in order to deal with grief. How can one grieve when up to one's eyeballs in drugs? Surely it should be normal to be hysterical after losing a loved one.

Ultimately prevention is better than cure and from an economic point of view it is infinitely cheaper. An individual can only do so much in order to prevent mental illness. A responsibility also rests with the State and society. We must develop a society which does not treat people like a cog in an economic machine. We must look at ways in which the inevitable stress of life can be minimised. However, at the moment we are going in the opposite directions. Bullying has become an acceptable way to progress in life. This should come as no surprise as the very idea of capitalism is based on the survival of the fittest - in other words the crushing of the weak.

One of the most popular shows on television at the moment is "X-Factor". This show is based on demeaning people. It deliberately sets out to expose, in the most public way possible, performers' imperfections upon which a crowd of people savage them by booing them. There is also "The Apprentice" with Bill Cullen, the entrepreneur as he keeps calling himself, where bullying is just par for the course and the person who can put up with his bullying the best ends up getting a job. We have the same thing on "Dragons' Den" where people's ideas are trashed and the more demeaning the dragon is the better. Imagine if that went on in the schoolyard. It would not be allowed. However, it is inevitable that this philosophy on life will be taken up by children in the playground as well as by budding entrepreneurs who see this as the only way to succeed. If such a philosophy is allowed to pervade, it is inevitable that we will live in a more stressful society and as a result end up with extensive mental health problems.

Obsession with body image is something which is causing major problems in mental health. While this used to be more particular to women, it is now spreading to men. I pity any young woman who has to live in this environment whereby if she is not a size zero then she is a failure. Magazines such as Heat etc. are exceptionally damaging to the mental health of this generation. They publish close-ups of women's legs taken by the low-life paparazzi that are done in such a way as to highlight cellulite. I ask Deputies to remember that cellulite is bad. It is a modern symbol of failure unlike in the past where it was sign that one was not afraid to eat one's dinner. This inevitably leads to insecurities in women which make them feel somewhat inferior. In many cases it leads to mental illness. There is also the issue of financial stress, which I will not get a chance to discuss.

Our latest end of pipe solution to dealing with mental health issues in Ireland is A Vision for Change, a document first published in 2006.

Its goal was to make mental health services in Ireland person-centred, recovery-orientated, holistic, community-based, multi-disciplinary and population-based. While these are laudable goals they require extra resources. When the document was first published it was stated that for the strategy to be implemented 2,000 extra staff would need to be employed. This has not happened. The health service has instead taken on thousands of new administrative staff. Not only have extra staff not been recruited but staff are currently being let go and not replaced. I am told that locally in Roscommon one-third of staff will have left the service by next March.

I have heard the Minister of State, Deputy Lynch, talk about this issue. She appears to speak with genuine compassion and concern. The ball is now in her court. We need to treat the issue of mental illness seriously. We need to treat it with the urgency with which one treats a cancer patient or a person with a heart problem. We need, by the end of her term as Minister of State, for people to be able to genuinely open up about mental issues without feeling shame or, more important, without being made feel shame. As things stand, that is not the case. I implore the Government to do something about this.

The Technical Group has decided, in order that this issue be depoliticised, that there is no need to vote on this motion. It is too important an issue to be made a political football of. The only thing that needs a kicking here is our old attitudes to mental illness.