Simon Harris (Wicklow, Fine Gael)
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I thank the Minister of State, Deputy Kathleen Lynch, for coming to the House for this debate. It is great to have in the House the Minister with direct responsibility for this matter. I raise this issue alongside my colleagues, Deputies Robert Troy and Maureen O'Sullivan, two co-convenors of the cross-party Oireachtas group on mental health. Deputy Ó Caoláin, whose name is also associated with this Topical Issue matter, has asked us to place on record his regret that he cannot be present as he is attending an all-day meeting at Stormont. He wishes to be strongly associated with the matter raised. The other convenor of the cross-party group is Senator Susan O'Keeffe, who is, obviously, a Member of the other House.

That members of all political groupings in both Houses have come together on this issue demonstrates the importance parliamentarians attach to mental health. We are unique in being the only cross-party group with representatives of all political groupings in the Oireachtas which has drawn up and presented to Government a pre-budget submission. The group is pleased with the Government's commitment to provide €35 million in the previous budget for community mental health services.

The cross-party group seeks to achieve three outcomes from this Topical Debate. First, we wish to obtain an update on the status of the €35 million committed in the budget for community mental health services. Second, we wish to obtain from the Minister of State an update on the appointment of a director of mental health. Third, we seek a commitment on the ring-fencing of staff for community mental health teams.

All those involved in politics and society generally are used to mental health being treated as the poor relation of the health service. In the past, money allocated to mental health was siphoned off into different areas of the health service as the year proceeded. While this is clearly not the intention of the Minister, Government or House, we need an assurance that this practice will not occur this year and the commitments provided will be met.

Community-based mental health services are at the core of A Vision of Change. This strategy recommends shifting care from mental health institutions to the community and envisaged specialist services operated by staff with particular expertise in supporting a person's mental health. It seeks to bring together a holistic range of support and staff from a range of specialist disciplines, including clinical psychology, mental health nursing, occupational therapy, psychiatry and social work. There is no doubt that community-based mental health services are the correct approach. There is now a political consensus and compelling economic argument for this model. The Health Service Executive, for example, recently launched a report which showed that the community model of mental health services is the best way to achieve a good quality and cost-effective service. In addition to being the right approach, it is also cost effective.

Robert Troy (Longford-Westmeath, Fianna Fail)
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I add my voice to the sentiments expressed by Deputy Simon Harris. I acknowledge the work done by the previous Government in this regard. The Minister of State's predecessor launched the document, A Vision for Change, and I am pleased the strategy has been adopted and is being acted on.

In the past decade, the number of people resident in psychiatric units has declined by 33%. The special allocation of €35 million towards community mental health services in the 2012 budget was a welcome development. As Deputy Harris noted, we are seeking clarity on precisely where and how the €35 million has been or will be spent. While I do not doubt the Minister of State's commitment to mental health, action is required, including on the recruitment of the 414 professionals promised for community health services, none of whom had been employed as of several weeks ago. This is disappointing considering we are halfway through 2012.

At a time when many people under financial and emotional strain are presenting at general practitioners, it is necessary to have in place appropriate services to which GPs may refer people who are suffering and allow them to receive a proper diagnosis. Many people are engaging in deliberate self-harm, which is an issue that requires a more holistic approach. We must ensure proper professionals such as social workers and psychologists are available in communities to ensure those who require care receive it. I look forward to the Minister of State's reply.

Maureen O'Sullivan (Dublin Central, Independent)
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Reading the programme for Government, I was struck by the following commitment: "We will ring fence €35m annually from within the health budget to develop community mental health teams and services as outlined in A Vision for Change to ensure early access to more appropriate services for adults and children and improved integration with primary care services." Speaking during an excellent debate on a Private Members' motion when many Members spoke from their hearts, the Minister of State noted strong similarities between A Vision for Change and a previous document, Planning for the Future, which was produced in 1984 when Mr. Barry Desmond was the Minister with responsibility for health. It is time to move beyond similarities and implement the programme set out in A Vision for Change.

At the time, the Minister of State herself noted it is not as though we do not know what needs to be done because we do. This is the point behind this Topical Issue. It is from all parties and none because I represent the Technical Group and Independent Members. Its purpose is to ascertain what is happening regarding the €35 million, the director - who will be vital to direct the service - and the ring-fencing of the staff for the community mental health teams. It remains the case that one in four people will have a mental health issue but this is not represented by the budget for mental health, which is still just over 5% of the total. Another interesting statistic is that 50% of adults diagnosed with a mental health disorder may have developed that disorder by the age of 14 and 75% of those so diagnosed will have developed it by the age of 24. The entire point is for early intervention, if for no other reason than from an economic point of view, much more will be saved. Moreover, so doing would prevent those families and individuals from experiencing the distress through which they are going.

Kathleen Lynch (Cork North Central, Labour)
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I thank the four Deputies who added their names to this Topical Issue matter and the three who spoke on it. I am reluctant to read the prepared answer because if I do not know about mental health and what is being done with the aforementioned €35 million by now, I should not be here at all.

To take up Deputy Maureen O'Sullivan's final point, the gap between the publication of Barry Desmond's Planning for the Future report in 1984 and the appearance of the A Vision for Change framework in 2006 is unforgivable. It is a gap through which many people have fallen and is unforgivable. I will revert to this point later because I do not intend for such a gap ever again to exist, which is important. To a great extent, the A Vision for Change framework is a chart or table showing what is needed in community care and one must ensure it is fulfilled and carried forward. The Government's job concerns those posts and teams, as well as deciding what the present Administration will do with the money. In addition, the Government must begin to put in place a particular element to take us into the future beyond A Vision for Change. If the teams are in place, what will they be expected to deliver? I acknowledge I am jumping the gun slightly in this regard but Members must keep this point in mind. The Members who spoke have a particular interest in this subject and I reiterate this must be done.

Heretofore, on foot of a vote for a health budget in this Chamber and the putting in place of such a budget, it was divided up depending on the demographics and the population base and sent down to the four health regions. In the main, it was spent wisely. It was not the job of the Government to do this and those with responsibility to so do took it on and discharged it. However, an entirely different approach was taken in respect of the €35 million. As soon as it was announced, the usual e-mails were received in which people asked for their usual portion of the funds to be sent to them to enable them to decide what to do with it. However, they were informed this was not what was intended. Instead, a gap analysis was sought from them that would indicate where were the needed posts, how many psychologists, social workers and psychiatrists were required, as well as the location of the nursing posts that were required. This process has only been completed in recent weeks and it was only then that I signed off on what was to be delivered.

I listened to Deputy Troy asking where was the €35 million and metaphorically, it is in my back pocket. I still have the money, it still exists and it remains within the Department. However, the aforementioned personnel are now being recruited from existing panels that had been put together over the years and people now are being drawn from them. A difficulty arose in respect of psychologists because as Members will be aware, some panels were not sufficient and ran out of candidates. Consequently, it will be necessary to begin to re-interview in this respect. However, this will not be an issue because there is a sufficient number of qualified people operating in the private sector to do this and they can come over and work for the Government. A particular issue arose in respect of the Dublin mid-Leinster region, where those responsible did exactly what the A Vision for Change framework specified they should do in respect of beds and teams. However, the region then fell below the bar because of the exodus in February and March and it was necessary to convert some of the posts there to nursing staff because nurses are crucial in all this. The HSE has now managed to do that and I am about to sign off on the agreement in that area. Consequently, the four regions will have their teams, of which there will be 90 and the population-base will be 50,000 people per team. The teams will be put in place and this is being done as I speak. I would have loved for it to have been possible to do this last February but as I stated, this would simply have entailed splitting up the budget and sending it out to the regions and this was not considered to be appropriate. The Government is being extremely careful in this regard and this is how it is implementing this process.

There are obvious gaps in respect of things that were not done this year. I have been speaking to those involved and they are happy that these areas will be a matter of priority next year. I refer to old age psychiatry, intellectual disability and forensics. These are the areas that must be prioritised next year but this is not to suggest posts will not be made available next year to increase the size of teams in certain areas. This year, for instance, the Department is establishing 150 new posts in the child and adolescent mental health services, CAMHS, because it was known that a deficit existed in that regard. Those concerned informed the Department of the size of the deficit and of the requirements. As a result, 150 new posts were established and they are very happy with that. Similarly, 250 new posts have been established in respect of adult psychiatry and ten additional posts have been allocated to the national counselling service, which also was a commitment in the programme for Government.

I am very conscious that the budget for mental health services is never what one would wish it to be. However, I am equally convinced that if one spends one's budget well in a directed and particular way, one will get a greater service. I acknowledge I have gone slightly over time and did not mean to so do but I make the point that the gap between Planning for the Future and A Vision for Change must never be allowed to happen again. Consequently, we must start putting in place a group now that will look beyond the A Vision for Change strategy. Now the teams are in place, such a group should consider what they are expected to deliver and what is the service. The A Vision for Change framework was really about the table of requirements. I do not know what will happen next as I simply will be the person who will put in place the team. Hopefully, depending on its expertise and vision regarding what lies beyond A Vision for Change, that team will take it forward. Moreover, the Government is seriously contemplating putting into legislation the obligation to have such ongoing reviews and development.

Bernard Durkan (Kildare North, Fine Gael)
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The Deputies who raised the matter now have one minute each for supplementary questions.

Simon Harris (Wicklow, Fine Gael)
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I thank the Minister of State. Her ability to speak without a script and at such length about her brief demonstrates the passion she has for the area, which is greatly appreciated. I now am much happier that the money is in the Minister of State's metaphorical back pocket, rather than siphoned off to God knows where within the HSE, which is reassuring. The commitment was to spend it in 2012 and if it is spent in that year, the commitment will have been met. I also am happy the reply circulated to Members refers to the legislative plans for the establishment of the directorate of mental health, which will be an important development.

While the Minister of State is in the Chamber, I wish to make one point in respect of the issue of community and education, because I have raised it in another Topical Issue debate previously and the cross-party group has done a lot on it. Moreover, the group had the Oireachtas Library and Research Service produce a report on how mental health is taught in schools. If mental health services are being brought into the community, which is a welcome step, one must tackle the ignorance within our school and education systems when it comes to teaching mental health and adopting a whole-school approach to mental health. There are much better examples but when I have raised this issue with the Minister for Education and Skills and the Ministers of State in that Department, the standard response is everything is all right because the SPHE programme is in place. However, this is not the case. Children are taught from the age of four in junior infants classes about dental health. They are taught about brushing one's teeth daily and not being embarrassed if one has toothache. However, pupils are not spoken to about mental health until they are 15 and then it is done in a highly wishy-washy fashion. Having made that point, I thank the Minister of State for her reply.

Robert Troy (Longford-Westmeath, Fianna Fail)
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I thank the Minister of State for her reply. As she quite correctly stated, the time for talking is over. The A Vision for Change document has been available since 2006 and it is appropriate that action should be taken on it as six years have elapsed. Much work has been done and I cited figures earlier on the number of people who have moved out of institutional care into the community. Nevertheless, while I do not doubt the Minister of State's commitment to the mental health brief, six months have passed since the last budget. While the €35 million is welcome, I note it remains within the Minister of State's back pocket. I would much rather see it being spent in the community.

Many people who are suffering from mental health issues are presenting themselves every day to their local GPs and many others do not know where to go to get the appropriate action. The board of the HSE was abolished with great fanfare last year and still we wait on the direct position to be established for mental health. There is too much of a delay, and while that is not always the responsibility of the Minister of State as things can be tied up in bureaucracy, I urge her to push ahead to deliver the 414 professional places to the community mental health services and to get the money out of her back pocket and into the community.

Maureen O'Sullivan (Dublin Central, Independent)
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There is absolutely no doubting the Minister of State's long-standing commitment to and support for mental health, but it is time we stopped using the future tense on what we will do and use the past tense on what we have done. Would it not make more sense to appoint the director to manage all of these new initiatives? I would also like to call for the nursing course on intellectual disability to be retained. There is a need for those very specific skills required to work with people with intellectual disabilities. I understand there are talks about merging these courses which I think would be harmful.

We cannot talk about mental health without mentioning our late good friend, John McCarthy. When he spoke about the normality of madness, I think we have to push for the normality of the services. If I fall down and break my leg, it is quite normal and I can go to an accident and emergency department. If I have suicidal tendencies, if I feel I am having a breakdown or suffering depression, there is nothing normal about where I will go. Apart from not knowing where to go, there is also a stigma about it. That is a major objective that we must realise.

Kathleen Lynch (Cork North Central, Labour)
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We are developing a whole-school approach for the emotional well-being of young children and how they feel about themselves. It is a different approach and we have to be very careful about it, because we do not want to emphasise that it is a negative thing. It must always be about something very positive and how one feels about oneself and about others. Mr. Tony Bates is developing that for us for secondary schools, but I would rather we started earlier. Children are quite capable of articulating their emotional feelings from a very young age.

In answer to Deputy Troy, we could have spent the money very early on in the year, but my fear was that it would get lost in the usual abyss. We were very careful about that. We would have loved to spend it earlier. We are now spending it in a much more targeted and better way. We will have to change our thinking about how we do things in the future and this is one area in which we have been very careful. There were no problems with the bureaucrats. In fact, they were very helpful in this case.

Deputy O'Sullivan is quite right. The normalisation of mental health as part of the overall health structure is the ultimate aim. We will be able to say next year what we have done, but we also need to ensure we are constantly progressing. We would never say we are finished dealing with cancer or cardiac care and that there will be no more progress. We cannot afford to say that about mental health either. We must be always progressing our thinking, our delivery and how people access services. That kind of focused attention is what will provide us a service that will be as normal as the service provided when somebody breaks a leg.