Maureen O'Sullivan (Dublin Central, Independent)
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Gabhaim buíochas don Teach agus ba mhaith liom a rá go bhfuil áthas orm go bhfuil an t-ábhar seo á phlé againn inniu. Tá sé riachtanach go gcoimeádfaidh muid an t-ábhar seo, cúrsaí sláinte intinne, os ar gcomhair amach anseo. We know the plan for community-oriented multidisciplinary mental-health teams that will allow people to access treatment without hospitalisation, but it is not moving as efficiently as it should. Apart from the human advantages, there are also significant economic advantages. The money for mental health services has not always gone into mental health services, where we know it is needed.

There is a need for a system that would track the activities of community-based mental health services and funding. I draw the attention of the House to the report, published on 1 February, of the UN Special Rapporteur on Torture and other Cruel, Inhuman or Degrading Treatment or Punishment, Mr. Juan Mendez, which looks at abuses in health care settings that may cross the threshold of mistreatment and be a form of torture or cruel and degrading treatment. In looking at mental health legislation within the UN Convention on the Rights of Persons with Disabilities and UN Committee on the Rights of Persons with Disabilities, Mr. Mendez established that community living with support is no longer a favourable policy development but an internationally recognised right.

Community mental health services are not an established right in Ireland. While this was first proposed in 1984 and again in A Vision for Change in 2006, we are still awaiting the move from residential and institutional care to community care. While the policy in this regard has been in place for more than 30 years, it has not been the practice. I support the call by Amnesty International for legislation in this area to provide that health authorities are duty-bound to account for and ultimately deliver community mental health services. Mr. Mendez also calls in his report for legal provisions to be revised, which provisions currently permit detention on mental health grounds in mental health facilities and allow coercive interventions and treatments in mental health settings, without the free and informed consent of the person concerned. The report also calls for a ban on forced and non-consensual medical interventions for persons with disabilities, be that psycho-surgery, electric shock treatment, mind altering drugs, restraint or solitary confinement. I would like to know where we stand on these matters.

Another issue of concern is the status of the appointment of the director for mental health services and whether that person will have budgetary control and an implementation plan for delivery of A Vision for Change. I have previously tabled parliamentary questions to the Minister, Deputy Reilly, and Minister of State, Deputy Lynch, on staffing issues. Between March 2009 and December 2012, there was a 12.1% decrease in staff numbers in mental health services. We do not want a recurrence in 2013 of the delays which occurred in 2012. There must be visible accounting in terms of what is happening in terms of funding and staffing for mental health services.

Brian Hayes (Dublin South West, Fine Gael)
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I apologise on behalf of the Minister, Deputy Reilly, and Minister of State, Deputy Lynch, for their not being in the House to respond to this important issue raised by Deputy O'Sullivan.

In line with the agreed programme for Government, the Government has prioritised the reform of our mental health services and is committed in particular to the delivery of more and better quality care in the community, as envisaged in A Vision for Change. Deputy O'Sullivan referred to the 1984 document, which I recall because I was a student at that time and did a special report on it. That report focused on the move to a community model. I recall distinctly well the context of the report at that stage. Implementation of the recommendations of the report has been slower than originally expected owing to a number of factors, including the changed economic context, constraints on public expenditure and the moratorium on recruitment. However, with regard to residential services, a great deal of progress has been made with the accelerated closure of old psychiatric hospitals and their replacement with bespoke new facilities such as the Phoenix Care Centre which was recently opened in St. Brendan's, Grangegorman. Beyond new capital developments, progress also encompasses shorter episodes of inpatient care and involvement of users in all relevant aspects of mental health policy and services. One of the most fundamental changes in recent years, as the Deputy will be aware, has been that people within the mental health service now have advocates who argue for their requirements, in terms of services, locally. This is happening across mental health service provision in this country and has given an additional voice to people who need help.

A Vision for Change recommended that a modern mental health service is best delivered in the community. The Deputy will be aware that a special allocation of €35 million was provided in 2012 for mental health services to strengthen community mental health teams in adult and children's mental health services; provide an additional 414 full-time posts to enhance suicide prevention measures; initiate psychological and counselling services in primary care, specifically for people with mental health problems; and advance relocation of mental health service users from institutional care to independent living arrangements. Full utilisation of the 2012 funding, together with a further €35 million for the new service put in place for 2013, represents an extra €70 million, with more than 800 associated mental health posts to improve and reform services. Recruitment of 307 of the additional 410 posts approved in 2012 has been completed. The HSE aims to fill the remaining posts by end March 2013. I hope to be able to report progress in this regard over the next few weeks.

Under the national implementation framework for the National Housing Strategy 2011-2016 for people with a disability and mental health issues, initial funding of €1 million has been made available by the Department to support the commencement in 2013 of the transitioning of people from existing settings to independent mainstream options. The renewed investment in mental health also facilitates the full implementation of the clinical programmes in this area and will drive service delivery and consistency, with a major emphasis on early intervention and improved collaborations within the primary care system to ensure the provision of a 21st century mental health service in Ireland. Ireland has a strong human rights record. The protection of such rights is central to our domestic and foreign policies. The practical fulfilment of this objective is of paramount importance, including proper reflection in evolving policies and settings across a wide range of our health and personal social services.

Deputy O'Sullivan referred to the most recent report of the Special Rapporteur, Mr. Mendez. There are significant findings in that report in terms of the setting that is now chosen for the majority of people in this country with mental health issues. I understand that the Department is studying the report in detail and will issue its considered view on it in due course.

Maureen O'Sullivan (Dublin Central, Independent)
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I take heart from the fact that the Department is studying Mr. Mendez's report and will issue its findings on it. It is, however, difficult to accept much of what the Minister of State had to say about budget cuts and the moratorium on recruitment given the issue of mental health has not suddenly appeared on our agenda. This issue has not been a priority for any of the parties, including Fine Gael, Fianna Fáil and the Labour Party, in Government since 1984, although it has become a priority in recent times.

What was promised in 2012 did not materialise. The fear in the mental health setting is that the same will happen in 2013. The point that must be made is that political will alone has not worked when it comes to the provision of mental health services. A different approach is now needed, which could be provided by way of enactment of legislation to provide that the HSE is obliged to account for progress in this area and for the production of regular transparent reports in this regard, including to this House. It is important also there is development of mental health services for people with an intellectual disability. I ask that these proposals be taken on board. As they are included in the report, I presume the HSE will respond to them.

Spending on community mental health has been static at 27%. Spending on residential care has been consistently 58%. I acknowledge the opening of the Phoenix Care Centre, which I attended. I was disturbed by the attention of the media on that occasion to the Minister, Deputy Reilly, and Minister of State, Deputy Lynch, being stuck in a lift rather than on that amazing facility. The opening of that facility presented an opportunity to look at the whole area of mental health in a much more progressive manner rather than on the mishap in the lift.

Brian Hayes (Dublin South West, Fine Gael)
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I do not disagree at all with what the Deputy said and there is much common sense in it because we should focus on the merits of the issue rather than frivolities or otherwise of people getting stuck in lifts. There is a message in this for the media and those who pander to them with simplistic commentary rather than detailed policy work. The Deputy is right to say that even with the cutbacks there has been a renewed commitment on funding on the part of the Government, and the Minister of State, Deputy Lynch, in particular has taken a huge interest in this area. Fair is fair and in circumstances where cuts have occurred a special allocation of an additional €35 million was made last year. Our commitment was to have an additional 414 places. As of now, 307 of these are in place and a commitment has been given that the great majority of the remaining number will be in place in a matter of weeks. I understand the 2013 budget also contains a commitment that an additional €35 million would be put in place to allow these additional posts to be filled.

Even in very difficult times when budgets are being cut this is an area where budgets are expanding because we recognise there has been a real deficit in the number of trained personnel working in the area. I expect, because of the notes I have in front of me, these people will be in place by March this year. This will represent an increase of €70 million over the past two years and an additional 800 posts over a longer period of time. Slowly but surely we are beginning to recognise the need for proper mental health services, as the Deputy has rightly said. Even in difficult times we can still do this. I am sure the Deputy and others will encourage the Minister to get even bigger budgets and have a larger number of supporting personnel. As the Deputy rightly pointed out, there is an issue with regard to how developments in this area will have a practical impact throughout the HSE service and this is something of which we need to be very mindful. We should not have doctrinaire ideological views on something if evidence shows a better system, or at least a more flexible system, needs to be put in place. We need to be mindful of this and change policy accordingly.