Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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The next speaker is Deputy Josepha Madigan. She is listed to share time with Deputy Michael D'Arcy. Is that agreed? Agreed.

Josepha Madigan (Dublin Rathdown, Fine Gael)
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I am delighted to speak on mental health. I wished to speak on the issue on the previous occasion when such a debate was held in the House but, unfortunately, I had a foot injury. Mental health is a great concern for all of us. Our society has become more complex, our purpose less clear and the route our lives will take, less certain. The strain of the multitude of tasks we perform on a daily basis and the ever-increasing fast pace of the world we live in can place greater stress on all of us. Depression and mental illness can transform the beauty of a bright and beautiful May day such as today and a world with promise into a place of dread and worthlessness. Those days, when life has to be endured and where it all seems like a pointless crawl towards old age, are a burden many with depression and mental illness face on a daily basis. Even those of us with good mental health know painful times, days where life seems to be without meaning and pain and disappointment are very present. Those times, however, give us an opportunity to show empathy with those who suffer with bad mental health.

Understandably, there has been much focus on the mental health budget in recent times. Since 2012, we have provided for continued spending on mental health. We must remember that the national debt, which increased from €47 billion in 2007 to €189 billion in 2011, the year Fianna Fáil and the Green Party left Government, is a reality with which mental health funding strategists will have to grapple for decades. I want to be part of a Government that will be able to better resource mental health in the years ahead. We are doing that incrementally. The gross non-capital mental health budget has increased from €711 million in 2012 to €791 million in 2016.

While there is and always will be much work to do in the field of mental health, one also should take stock of the improvements that have been made in this vital area. The era of large, fully operational industrial-sized psychiatric hospitals in places such as Ballinasloe and Portrane is gone. If one remembers the year 1963, when President Kennedy visited Ireland, more than 19,000 people, or 0.7% of the national population, were in psychiatric institutions, more than half of whom had a diagnosis of schizophrenia. The transition of St. Brendan's psychiatric hospital at Grangegorman from a dreary hidden complex with more than 2,000 patients at its peak to what is now a vibrant new campus for the Dublin Institute of Technology reflects our commitment to change. There was a time, not so long ago, when depression and mental illness were shameful hidden taboo subjects, but this no longer is the case. Even though society has become more complex, it also, quite rightly, has become less judgmental of people. The Mental Health Act 2001 puts on a statutory footing the rights of users of psychiatric hospitals and sets out clearly their right to a decent standard of care in their best interests and with a view to reviewing involuntary detention. Ireland has moved into a new era of mental health and, with this Act, psychiatric patients are better protected, with a robust charter of rights.

As a people, we must reach out to our brothers and sisters in their despair while acknowledging their pain and showing solidarity. As a mediator and family lawyer, I have seen how depression can engulf a family, particularly one-parent families with mental health concerns, and children are particularly vulnerable in such circumstances. Funding for the child and adolescent mental health services, CAMHS, is a priority. I am happy to note there have been improvements in this vital area for young people who are affected by mental illness. The number of people waiting more than 12 months for treatment from December 2014 to April 2015 has decreased by 60% under the CAMHS waiting list initiative. Moreover, an additional eight CAMHS beds were added with the opening of the Linn Dara facility in December 2015, which increases the number of CAMHS beds to 66. While these are modest achievements, they were made at a time of unparalleled economic adjustment. This is an acute area in which improvements will be made, and the urgency of doing this must be informed by the suicide rate in Ireland among 15 to 19-year-olds, which, frighteningly, is the fourth highest among 31 European countries surveyed. This must be taken into account.

The new programme for Government sets out an ambitious strategy on mental health and the Government is committed to meeting the recommendations set out in the strategy A Vision for Change. As Members are aware, this strategy sets out wide-ranging recommendations, including improved communications for continuity of care, referral protocols, direct access to diagnostic facilities, discharge plans, integrated pathways and shared care arrangements. Since early 2015, clinical nurse specialists in psychiatry have started work in emergency departments to provide a rapid response to those who present with self-harm.

Bernard Durkan (Kildare North, Fine Gael)
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Is the Deputy sharing time?

Josepha Madigan (Dublin Rathdown, Fine Gael)
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I am unsure whether Deputy D'Arcy is in the Chamber.

Bernard Durkan (Kildare North, Fine Gael)
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Deputy D'Arcy is present.

Josepha Madigan (Dublin Rathdown, Fine Gael)
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As he is, I will conclude. Suffice it to say that those who speak out on mental health must be commended. They show how illness cuts across all sections of society, and I assure Members I will do all I can to ensure continued investment in the mental health of all.

Michael D'Arcy (Wexford, Fine Gael)
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In common with everybody else, I note that the pressure on budgets in respect of the mental health services has had a huge impact. In 2007, on the basis of implementing A Vision for Change, all Oireachtas Members from County Wexford were the first to agree to close what was the old system, namely, St. Senan's Hospital, which went back to the Victorian tradition of institutionalising people. The services were placed within the community and throughout the county. Carn House, Tara House, Summerhill, Ard Aobhinn and Maryville House have provided good services and, based on my interaction with clients, staff and those who are providing the services, people can only say good things about it. There is an area where is inadequacy - namely, in respect of acute admissions. On the basis of A Vision for Change, it was agreed within County Wexford that there would be admissions in Newcastle, County Wicklow, for people from north County Wexford and in a facility at Waterford General Hospital for those in south County Wexford. I and some other colleagues who stood in the general election gave an undertaking to do all we could to ensure there would be an acute admission facility in County Wexford, where it is required. County Wexford is one of the largest counties and a need exists there which must be met.

However, the area in which major pressures exist is in respect of child and adolescent mental health services, CAMHS. These are new pressures in new areas in which the services are merely catching up. Social media are having a hugely negative impact on some children and adolescents, and much research is required in this regard to try to ascertain the impact it is having. I commend the voluntary associations within my county, such as Talk to Tom and It's Good 2 Talk, to name just two, as well as others. A national group, Cycle Against Suicide, should be commended on bringing awareness to the issue of mental health and bringing into the open that it is not the stigma it once was. We used to call St. Senan's Hospital in Enniscorthy "the Redbrick," which only had a negative connotation about what would happen when one went to that hospital. However, I do not believe we are discussing mental health issues with children sufficiently early. I read research last week about social media and the amount of time children spend in front of a screen or a tablet of some nature.

I wish to touch on the issue of CAMHS in County Wexford, where the accommodation is completely inadequate. The HSE is renting facilities in Enniscorthy and has some facilities in Slaney House. However, there is nothing in Gorey town or district and nothing in the town and district of New Ross. Moreover, there is no out-of-hours service for CAMHS in the county, and it appears to be nearly impossible to recruit a CAMHS consultant psychiatrist. There are three vacant posts in Counties Wexford and Waterford. There is an issue in this regard and Members might as well face up to it. I spoke to a consultant last week who complained about his net pay, rather than his gross pay, because he was paying tax at a rate of 58% between USC, the pension levy and everything else. He told me he would be there for a little while but would leave because he did not intend to pay tax at a rate of 58%. Unfortunately, too many children and adolescents are paying the price because it is not possible to recruit. This is a problem that exists across the entire health service. In addition, I refer to the services for those with complex needs. In the past, these complex needs were served by locking up such people. That is not the answer.

While I would like to speak for longer, my time is up and I do not wish to eat into the time of the next speaker. However, Members should have a mental health debate on the complex needs of a small minority. We should be more detailed and more structured in this regard.

Bernard Durkan (Kildare North, Fine Gael)
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I now call on Deputy James Browne, after whom the next speaker from Fianna Fáil will take the following slot.

James Browne (Wexford, Fianna Fail)
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On average, two people per day are taking their own lives at present. This means two families and two groups of friends are devastated on a daily basis, and these are merely the deaths one can be certain are suicides. The issue of mental health and mental well-being affects everybody, including children, young people and the elderly, and it affects people in towns, rural areas and cities. In making mental health a front-bench portfolio, Deputy Micheál Martin and Fianna Fáil are setting out clearly the priority this issue is for our party. As part of the agreement to support the minority Government, Fianna Fáil made it a critical point that the strategy, A Vision for Change, would be implemented fully, and the party expects this to happen. This means placing in our community the necessary supports to provide effective early interventions, support networks and a recovery model for those suffering from mental health issues.

One must treat the head and the heart with equal respect. A person who presents with a broken arm is not turned away, and someone who has the courage to speak out about his or her mental health should be given equally urgent care. To date, the Health Service Executive has been practising what effectively is graveside medicine in respect of mental health, and this must end. People with mental health issues are being treated inhumanely and families are suffering when simple early intervention could allow people to live full and amazing lives.

We need to see a community recovery model that allows people who suffer from mental health issues to receive treatment among their own in order that they can retain a sense of connectedness to their community.

In this time of modern communications we have never had as many close and personal friends. Some people have up to 4,000 or 5,000 close and personal friends on their Facebook pages, yet the daily interaction between people has almost been lost. For a farmer living in rural Ireland today, his hardware store has probably gone, along with the garda station, post office and school. The postman leaves letters in a green box at the end of the laneway and even the milk collector tends to come in the middle of the night. Farmers can go days without making contact with anybody.

Ten, 20 or 30 years ago, when young people were growing up the only people they were trying to compete with were those in their classroom. Now, however, they are trying to compete with others across the world because they can see what everybody is up to on Facebook.

We need to increase awareness of mental health problems and end the stigma concerning them to allow and encourage people to break their silence on the issue. That means giving people the confidence that if they break their silence they will get the supports they need within the community.

I support the closure, underA Vision for Change, of those old institutions. In the 1948 to 1949 period, almost one in 50 people was in an institution, but thankfully those days are long behind us. Part of the quid pro quofor closing those institutions was a buy-in by service users who were promised that community care would be there for those requiring mental health treatment. That has not been delivered, however, nor anything close to it. Much of that care work has been supplemented by voluntary groups, such as Cycle Against Suicide, Talk to Tom and others, but they need co-ordinated support at national level.

Suicide is now the leading cause of death among young people. In 2013-14, suicide among women increased by 14.7%. That was mostly women in their 20s, yet we lack research on how to prevent suicide. Only a few weeks ago, the then Minister for Health, Deputy Varadkar, performed liposuction on the €35 million additional moneys provided for the mental health budget. He took €12 million out when more funding is needed. That was reprehensible.

The other day a young mother rang me to say that her almost five year old child who had experienced trauma has been awaiting an assessment for nearly two years. When some young people finally receive an assessment they are told that they are too old and no longer meet the criteria for treatment. They are then put onto other waiting lists and such people are constantly being shuffled around.

I urge the new Minister, Deputy Harris, to treat mental health as a crisis. He should establish a national mental health authority, similar in format to the Road Safety Authority. When road traffic deaths were increasing annually, we set up that authority which is independent of the Government. It was allowed to challenge the Government on policy setting and implementation. We need a similar body to tackle the prevailing mental health crisis.

I also urge the Minister to take on the vortex of inertia in the HSE, although I realise that will not be easy. I have dealt with the HSE and there are many good people in it, but there also seems to be a lot of paper shuffling and a lack of responsibility there. People suffering with mental health issues do not want any more tea and sympathy. Last Friday, Mr. Vincent Browne from Cycle Against Suicide told a public meeting on mental health in Wexford that they do not need any more mothering and apple pie.

The cause of mental health has been advanced to the point where it is being publicly discussed. Everybody supports more care for mental health, but they need funding and action. If the Minister takes action we will support him because he has a tough job on his hands. He must treat mental health as a priority and put it on an equal footing with physical health. If he fails, however, we will be relentless in our criticism. It will be the duty of every Fianna Fáil Oireachtas Member, including myself as spokesperson on mental health, to raise that issue. When Deputy Thomas Byrne from Meath speaks on education, he will raise mental health. When Deputy McConalogue speaks on agriculture, he will also raise mental health issues. When our spokesperson on disabilities, Deputy Murphy O'Mahony, contributes to debates, she will also raise mental health, as will Senator Catherine Ardagh, our party leader in the Seanad.

Mental health will no longer reside in the shadows, nor should it. We will be at the forefront of keeping it as a priority issue in this Chamber. I therefore call on the Minister to place mental health on an equal footing with physical health. He must fully implement A Vision for Change and develop a follow-on programme. A Vision for Change is now ten years old, but a follow-on programme should not be used as an excuse to park that policy which needs to be fully implemented. We also need to establish a policy group owned by the service users. It should not be a top-down policy, dictated to those with needs, but rather a policy that involves talking to people on the ground.

I ask the Minister to restore the €12 million cut in funding and ensure the money is spent. We have had endless announcements of mental health funding, but it is always left unspent and is then used elsewhere.

The Minister should institute a programme of awareness and coping skills in our schools. Young people today are increasingly facing stresses that previous generations did not have to cope with. In their teenage years, however, they may face their first serious moment without having developed natural coping skills.

I again urge the Minister to establish a national mental health authority, similar to the Road Safety Authority, which is independent of the Government. Such an authority could assess and challenge Government policy, thus ensuring mental health resources are delivered.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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I wish to share time with Deputy Jonathan O'Brien.

Bernard Durkan (Kildare North, Fine Gael)
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Is that agreed? Agreed.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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It is true to say that a lot of progress has been made in raising public awareness and understanding of mental health, emotional well-being, suicide and other self-harm. It would be foolish, however, to think for a second that all the stigma and fear surrounding these issues have been overcome.

Public representatives must be part of an open dialogue in partnership with the communities we represent. That compassionate conversation must honestly begin to tackle prejudice, fear and isolation. Massive credit is due to the many brave individuals who have experienced mental health or emotional well-being issues, including suicide, personally or in their own families. Through their own drive, passion and initiative they have founded a plethora of local community organisations throughout the country. They have been key to opening the door for others, letting people know that they have somewhere to turn and are not alone. Such initiatives go against the old, hard-chaw, pull yourself together attitude that may have typified earlier responses to people in mental or emotional crises.

We must recognise that we all have a part to play in this. It is an issue that concerns every Deputy, Senator and citizen. We need to bring that conversation to communities in towns and villages throughout the country. Our goal must be to end stigma, discrimination and isolation.

Mental health and emotional difficulties respect no boundaries of class or colour. They are as likely to affect one individual or family as the next.

It is not unusual at all for somebody to experience a mental illness. It is even more common for people to experience emotional ill health and pressure and, sadly, for many people, suicide and self-harm loom large. We can all make a difference. I commend the Minister of State, Deputy McEntee, on her appointment and she has a particular role to play.

Let us not make any bones about it. It is not that we are facing into a crisis in our mental and emotional health; we are in the middle of a crisis. All the statistics, which I will not recite, tell us that. We have heard them many times in the House. In a crisis situation, crisis responses are required. The challenge for the Government and the system is not only to say the right things and lead that compassionate conversation, but it is also about resources. To put it a little crudely, it is about the system putting its money where its mouth is. A fraction of Government budgets is spent on suicide prevention. If the moneys dedicated to road safety and accident prevention measures, worthy as they are, are weighed against the amount dedicated to suicide prevention, it tells a story, which is that the system does not yet understand or prioritise the issue in the way it should and it must.

I refer to CAMHS, in particular. All of us know there is a crisis in these services and all of us know about the waiting lists and the desperation of families across the State trying to access them. That needs to be sorted out. A Vision for Change is ten years old and it is being reviewed but it has not been fully implemented. Let us vow and give a commitment collectively that we will not allow another year, five years or ten years to pass without this commonly agreed strategy being implemented and properly resourced. The staffing crisis in the services is most dramatically underscored by the fact that the Psychiatric Nurses Association has a ballot for industrial action up to including strike action. This is not because they do not care about their service users. On the contrary, this is a response to what they correctly call "the staffing crisis in the mental health services". That is where it sits. Human desperation and all the pressures we are familiar with and that speak to our common humanity have people reaching out for help and finding in so many instances that it is not there. We, as politicians, the Government and the Minister of State need to ensure resources are provided and the €12 million that was to be ring-fenced from the health budget is reinstated, drawn down and spent on these essential services.

Jonathan O'Brien (Cork North Central, Sinn Fein)
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I also congratulate the Minister of State on her appointment. I do not have much time but I could speak for an hour on this issue. I am glad the three Ministers in the Department are present because one of the issues I have come across is that of dual diagnosis where somebody has a mental health issue and an addiction and how they are dealt with. There is no single solution. Everyone has to be treated on a case-by-case basis. It is important to remember that everybody's mental health is different and their needs and responses will be different.

Deputy McDonald referred to the issue of stigma. Great work has been done on this, particularly when it comes to self-harm, suicidal ideation and depression, but a major taboo is still associated with many other mental illnesses such as schizophrenia, post-traumatic stress disorder and personality disorders. We do not have the same focus on breaking down this stigma. A great deal of work, therefore, remains to be done on the issue.

We are encouraging people to be more open when it comes to speaking about mental health but if they suffering from depression, anxiety or another mental health illness, their first port of call in most cases is their local GP. I am frustrated that it is not mandatory for GPs to do basic courses to enable them to deal with people who may have suicidal ideation such as SafeTALK, or the ASIST programmes. It is also not mandatory for gardaí. These professionals, who are on the front line dealing with people when they first seek help, therefore, do not have the basic skills to deal with them. In many cases, the response from some GPs is to medicate but that is not always the solution. Medication may be part of a solution but every individual is different. Many of the individuals who end up in therapy find cognitive behavioural therapy, CBT, and talk therapy helpful and, therefore, sometimes a combination of medication and therapy is needed. Something that could be done instantly at a low cost is to encourage doctors and members of front-line services to engage in programmes such as SafeTALK and ASIST to give them the basic skills to deal with people in order that they do not always instantly reach for a prescription, which is counterproductive.

We have not got our head around understanding how to treat mental health. I read a number of WHO reports from 2015. One report states: "Mental health can negatively be affected by low income. Those who cannot afford private therapies or care are the most at risk of crisis which exacerbates the issues at hand." While income does not discriminate against whether someone has a mental illness, it is a factor in accessing services. The report also states: "An environment that respects and protects basic civil, political, socioeconomic and cultural rights is fundamental to mental health promotion." We need to take that on board as a State because we have citizens whose cultural rights have not been recognised and others whose socio-economic and political rights are not on the same footing as everyone else. Equality, income and socio-economic issues and the societal and public health response to them are all critical in helping to address this. While money is important, it will not in itself solve this.

Jan O'Sullivan (Limerick City, Labour)
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I also congratulate the three Ministers on their appointments. I welcome the opportunity to contribute to the debate. I refer to the €12 million that was to be assigned to the mental health budget this year. This was bravely and hard fought for by my friend and colleague, Ms Kathleen Lynch, the former Minister of State. That money cannot be allowed to fall back into the black hole of general health spending. It is a relatively minuscule amount in the context of the overall spending on health but it is very important for people whose mental health is fragile. I urge the Government to put that money back into the mental health budget.

Since the beginning of the drive to ring-fence money for the development of mental health services in 2012 under Ms Lynch's passionate and determined stewardship, the money has been used to fund support for community organisations working on suicide prevention, education of GPs on suicide prevention, a primary care counselling service, access to psychology and psychotherapy services, additional beds for CAMHS, clinical nurse specialists to respond to those who present with self-harm in accident and emergency departments, a national clinical programme for eating disorders, training in behavioural family therapy and the roll-out of Jigsaw, a particularly positive development that has been mentioned on previous occasions when this issue has been debated in the House.

I had the opportunity to visit Jigsaw in Galway a few years ago. Funding was provided under this ring-fenced money to roll out Jigsaw, a young person-friendly service, in two areas in Dublin, two areas in Cork and one in Limerick. Jigsaw is a service that young people can walk into. I know from visiting the Galway centre several years ago that it has given young people the opportunity to have a place they feel they can go to when they are concerned about mental health issues. I spoke about community organisations being funded. Much of this has gone into youth services. Limerick Youth Service was recently allocated funding for its youth mental health programmes.

I have read out a list of areas where this ring-fenced funding was used in the past number of years. It is simply unacceptable that this progress in such a crucial area of the health service should be halted in any way. I ask the Ministers who are here today to give a commitment that this money will be restored. If it is not, there will be a sense that people are being let down, that services for vulnerable people have been underfunded for a long time under successive Governments and that the mental health area has been very much neglected. The signals will be wrong and the practical services that are being provided with this money will be underfunded.

Of the €12 million that was to be used this year, €5 million was to be used to recruit up to 100 psychologists and counsellors to develop psychological services for those under 18 in primary care. We must not fail to deliver this service. An analysis of the waiting list for acute mental health services for children and adolescents demonstrated that at least 20% of those waiting did not need an acute psychiatric service. A psychological or psychotherapy service would have been more appropriate but was not always available. Deputy Jonathan O'Brien made some points a few minutes ago about ensuring that the services that are available are the ones that are most appropriate. In many cases, these services are cheaper to deliver than some of the traditional services that are available, or unavailable in some cases because people cannot access them. It is important that we focus on this funding and that it continues in future years because the area has been very under-resourced and one-dimensional in the sense that a person sees a psychiatrist and everything flows from that whereas people sometimes need something that is more talk-based, more based in their community and more accessible to them. We cannot afford to go back on the progress that has been made.

I looked at the section on mental health in the programme for a partnership Government. While it takes up a few pages and refers to the Government being committed to meeting the recommendations in A Vision for Change, which is welcome, it is quite vague. Reference is made to reviews that will advise on certain things. I would like to see more specific commitments and I hope the new Minister will be able to work on ensuring that there are more specific and deliverable developments in this area. There is quite a lot of knowledge around what needs to be done but what we really need is implementation. While there are many good general aspirations in the programme for a partnership Government, many of them are less specific than most people would like.

I will refer briefly to education, an area in which I worked, and the importance of a positive culture that supports people's mental health and ensuring that bullying does not happen because that very often affects people's mental health in a very negative way. Schools are required to have anti-bullying policies. Much work is being done with organisations like BelongTo in respect of homophobic, transphobic and Internet bullying. In terms of a culture of nourishing people, inclusion and care in schools and society in general, there has been far more talk about mental health in a positive sense. This is very good and we need to continue doing that. However, there are still areas where people feel they are being singled out as being different and, therefore, when they have an issue, they find it very difficult to talk about it and feel they are still part of the organisation, community or school. We need to ensure that we continue with that work.

There is a commitment in the reform programme to making well-being a compulsory subject for the junior cycle by 2017. I look forward to seeing that implemented because well-being as a subject is about the whole person and physical and mental well-being. It encompasses many areas but if we can embed it in our young people along with a sense of responsibility for themselves and those around them, we will have a far more positive culture in which people feel that if they have mental health issues, they can engage very early on with somebody who can help them. This would be so much more positive than waiting until people have acute issues.

There are a number of other areas. We need to see far more linking of education, health and community services. I again urge that this ring-fenced funding be restored to the mental health budget and that we continue to ring fence funding for mental health developments because this is such a crucial area for so many people who still feel that their issues are not being responded to. Ireland is becoming economically strong and we need to ensure it is socially strong and that people who are not having their needs met can have them met.

Michael Harty (Clare, Independent)
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I extend my good wishes to the new Minister of State with responsibility for mental health, Deputy McEntee, and the new Minister, Deputy Harris. I wish them the best of luck in their new portfolios.

The mental health service remains the Cinderella of the health service. The recent removal of €12 million from the mental health budget indicated the manner and esteem in which mental health services were held by the previous Government. The new Government must urgently return this funding in a manner that allows it to be spent in a practical and effective way on front-line services. That figure of €12 million could have been spent on many other areas and in many other ways. Examples include school educational programmes and concentrating on early intervention, the sourcing of counselling and other therapies from the private sector where no public services are available, providing 24-hour crisis intervention services for acute health problems and supporting voluntary agencies like Pieta House and the many other organisations that provide essential support services such as the William Winder Rainbow Foundation for suicide prevention in my county of Clare. Recent Ministers of State have had to fight hard to prevent the same siphoning off of funds that had been allocated to mental health services. I hope the current Minister of State will not have to fight the same battle.

As mental illness may not have the external signs that one would associate with physical illness, it can be more easily missed and overlooked. A high proportion of consultations in general practice have a mental health component, which may be the entire reason for or a significant component of the consultation.

A high proportion of mental health issues are dealt with within general practice, yet those who need further assessment and treatment find it difficult to access specialist services and therapies due to a shortage of front-line staff. Thank goodness that our old institutional model of care has been dismantled and replaced with a much more progressive model where treatment is delivered in specialist inpatient units that aim to return patients to their communities as soon as it is safe to do so for continuing care and follow-up. However, these services need to be resourced properly and our community multidisciplinary teams are not being completely staffed.

In my catchment area, there has not been a psychologist in place for the past four years. There is no cognitive behavioural therapy, yet many patients require this service. There is just a half-time equivalent occupational therapist. For one staff member to be taken on, two staff members need to leave the service, and since last week we have an additional embargo on new recruitment for already depleted staff levels. There are problems in recruiting and replacing consultant staff. The reduction in new consultants' pay by 30% significantly reduced the number of applicants for vacant posts. Prior to this poorly thought out pay reduction, there could be ten to 12 applicants for a vacant post. Now, one is lucky if there is any applicant and even luckier if anyone accepts a post, yet €12 million earmarked for new staff has been taken out of the mental health budget and a new embargo on recruitment has been imposed. Where is the logic in that? It can only have one result and that is certain future reductions in front-line services and poorer outcomes for patients.

Across Europe, 12% of the health budget is spent on mental health services, yet in Ireland it is less than 8%, which is one third short of the European average. Mental health budgets are promised to be ring-fenced, yet they rarely are. Inpatient beds in acute mental health units are in short supply and the demand outstrips the bed numbers. These units are always at capacity and it is illegal to exceed their maximum number. There is pressure consequently to discharge patients sooner than planned and, when discharged, community disciplinary teams are not in place to monitor and assess their recovery. Furthermore, the failure to resource these teams adequately is leading to unnecessary readmissions to the acute units. As we know, mental health problems are not confined to social class, income or age. Child and adolescent mental health services are not properly resourced. Those aged between 16 and 18 have nowhere to go. Child and adolescent services say they are too old for their service and adult services say they are too young. As a result, they are dependent on the kindness of strangers to look after them, when they require urgent care.

There is also a lack of resources in old age psychiatry. Dementia services suffer from a lack of home help and home care packages and there is great difficulty in sourcing these. I understand there is to be a further reduction in home care packages. Dedicated dementia units are required to cater for a subgroup of patients who have specific needs and are not suitable for general psychiatric wards. Quite often there is an inappropriate mixture of elderly patients who suffer from mild dementia and those who have advanced dementia and challenging behaviours, which is quite unacceptable.

Ireland has a high rate of male suicide due to social and economic pressure. Farmers who were encouraged to invest in their farms are now, due to falling prices, under pressure from their banks to sell their stock and assets to pay their debts. Housing problems, homelessness and mortgage difficulties are also causing serious mental health problems. There is a crisis of hope in our society as austerity has had a serious effect on mental health and the economic recovery is patchy and creating divisions in our society.

Adolescents and young adults are subject to social pressures. They are expected to be high performers and high achievers. They are expected to conform to unhealthy media driven and peer driven body image. They suffer from a lack of jobs and opportunities, rising rents and a lack of housing, and drug abuse is a huge problem. Cluster suicides are all too common. There were seven suicides in the midlands recently in a short period, and death by suicide is now far more common than death due to road traffic accidents, yet no area of the country is immune from suicide and it is suffering from an increased response to despondency.

The organisation of our mental health services is driven by a bureaucratic management rather than clinical management. There is minimal clinical input from those delivering the service and this does not make common sense. It hinders the delivery of good patient outcomes and there is a disconnect between management and the front-line staff who deliver the service. The entire management structure of our mental health services needs to be reviewed with a view to putting the patient first and focusing on giving clinicians a critical say in how their services are delivered. A Vision for Change, published in 2006, which was to deliver a comprehensive active, flexible and community-based mental health service has not been fully implemented. Even though it was not a perfect document, if it had been delivered on, patients would be much better served.

It is essential that the Government fully implements A Vision for Change. It is essential it provides 24-hour crisis intervention, extends its counselling services, develops child and adolescent services, ends the inappropriate admission of children to adult wards, develops mental health supports for those who are homeless and develops a national dementia strategy.

Jim Daly (Cork South West, Fine Gael)
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It is heartening to see, contrary to some of the popular opinion that has been expressed, that there has been enormous interest across the House on this debate. It is very welcome. The last time statements were made on it, I was unable to get a slot such was the popularity and interest of Members in wanting to be part of trying to find a solution to this problem and to be part of the debate around it.

When we take a very narrow focus of toing and froing with the Government on who spent more, who cut more and all of this kind of thing, we are missing a lot of the fundamental point. We are also doing a further disservice because we are abdicating our own and society's responsibilities. We are all citizens - brothers, sister, mothers, fathers, sons, daughters, neighbours, friends, work colleagues and students - and we all have a role to play in mental health. We should focus the debate less on resources and a narrow definition of percentages.

I have to take issue with the previous speaker, Deputy Michael Harty, on percentages. When one compares Ireland's mental health budget as a percentage of the overall budget, the reason for the disparity is because of the amount of money we spend on drugs which is far in excess of the amount spent by many other countries across the EU. That distorts the percentage so it is an unfair comparison to say it is 8% versus 12%, which is the European norm. Any independent analysis would find that we spend more per capitaon mental health. I do not want to enter into that debate. In 2015, we spent something like €826 million on mental health, which was up from €711 million in 2012. That is a 16% increase in the mental health budget versus an 11% increase in the overall health budget. If we enter into those debates, we are missing many of the broader factors and I would like to broaden out the debate and look specifically at our collective responsibility and role in addressing the issues facing mental health because it is an increasing challenge, particularly for young people. I will hone in specifically on the education side of things in my contribution.

I was speaking to a number of experts recently and I asked some consultants if there had been a serious increase in the incidence of mental health issues and what they would attribute it to. Very interestingly, they informed me that while there has been a significant increase in the presentations of issues surrounding mental health, the physiological element to it is not increasing noticeably. Incidences of things like bipolar, schizophrenia and those sort of issues have not increased but the basic coping skills and coping mechanisms that people have to try to deal with matters are causing more and more problems. There are obviously a variety of reasons and we need to move the debate on to that. What is happening in society that is causing so many of our young people to feel that they cannot cope with the stresses and tests of everyday life? Trying to protect people from those stresses and tests is easier said than done.

Moving to the education system, I have always advocated that we can play a vital and productive role in this area. I have advocated also for the broadening of mental health awareness among teachers and pupils of schools. Much of that can be done by way of debate, awareness and people watching out for each other. I have always advocated the enabling of teachers in that regard.

When people think of mental health, they think of a crisis. They think, "Oh my God, I am not equipped to deal with this". I taught in both primary and secondary schools but mental health is about encouraging people to ask, "How are you? Are you doing okay? How are you feeling today?". Those are the initial steps that must be introduced in primary school and all of us must have a part in reaching out to each other and trying to promote that awareness in terms of the whole area of mental health. There are amazing resources for anybody in the education system who wants them, including the Iris the Dragonbooks. I have read some interesting books for young children that deal head-on with many of the issues around the challenges in the area of mental health.

Unfortunately, in the past 30 or 40 years our education system has become driven by points, attainment, competitiveness, and having to serve the needs of industry, commerce and so on. It is about playing its part in a successful economic society, but our education system is failing us if we are ignoring the cohort of people who are struggling at the expense of the commodification of education that has emerged in terms of grinds schools and so on. There is an inherent lack of understanding that, as a society, we must encourage a broadening of our education system to ensure that the dignity of every child is respected within the education system and that we must develop, promote, enhance and encourage their physical, mental, spiritual and emotional well-being to allow them reach their potential, whatever it may be. That is a challenge for all of us to take on board. I refer to teachers in particular because any of us who have children know how much they adore their teachers. In my day we were not so fond of our teachers but they are the most trusted people who are in daily contact with our children, whether they are in primary or secondary school. There is enormous potential in that regard and we should invest resources in upskilling those teachers. They are a caring and compassionate profession who want to be involved in this area but we must resource them and put the necessary supports in place to ensure teachers can recognise problems and, where it is more serious, refer for further help.

I always felt the term "mental health" was a difficult one for people of my generation and older. Heretofore, there was a stigma associated with the word "mental" in terms of being locked up away from society. Thankfully, younger people do not have the same view of that term.

I would like to see more co-operation among Departments. The Department of Health is represented here for these statements on mental health but I would like to see the Departments of Education and Skills, Children and Youth Affairs in particular, and even Social Protection, coming together to identify and address some of these issues. Many of the issues and challenges I have identified can be addressed by taking simple steps. It does not have to involve massive change. Much of it is cultural, particularly in our schools because it is our young people who are affected. I spoke recently with a psychologist who told me that many adults are presenting now for counselling to deal with issues, most of which can be traced back to their early development years. It is in their early years that people fail to cope with issues, and they present for therapies much later in life. If our school setting was more open, with a more holistic approach taken and everyone embracing their responsibility, and this is not about divesting responsibility from parents onto schools but about everybody being aware, caring and embracing this challenge, we would have much more success.

Bernard Durkan (Kildare North, Fine Gael)
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I call Deputy Fiona O'Loughlin. Is the Deputy sharing time?

Fiona O'Loughlin (Kildare South, Fianna Fail)
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I am sharing with Deputy MacSharry who has been sent a message to come to the Chamber.

There is no doubt that modern life is very challenging. Bills pile up, homes are repossessed and jobs are lost. More hours are spent in cars stuck on bottleneck roads. Children are spending more time separated from their parents and families. People are time starved, with less capacity for leisure and community activities, and all of that leads to mental health pressures.

The proper care for those in need and the erosion of stigma about those people in need and who are suffering must be prioritised. Stigma is one of the most damaging factors undermining personal well-being and mental health. The stigmatised person is marginalised, devalued and rejected, and the greatest tragedy of all is that stigma keeps people from seeking help.

Our minds are our most treasured possessions, and yet the most fragile of all we possess. In recent years there has been a considerable growth in the number of voluntary organisations which are addressing suicide or mental health related issues. The wonderful work of the Samaritans, Pieta House and Console on a national level must be acknowledged and applauded.

We have more community recognition, initiatives and supports than at any time in the past. I see at first hand in Kildare the incredible work that Jim Brady and Hope D do in organising help and support for those in need of urgent counselling. I must also pay tribute to Peter Hussey, one of my personal heroes in life, who has established a group called Crooked House in Newbridge, which essentially helps young people, and particularly young people at risk, to develop the necessary coping skills to deal with all that life throws at them. Through theatre, drama and improvisation I have seen hundreds of young people in Crooked House deal with subjects as diverse as suicide, sexuality, depression, voting, civic participation and teenage pregnancies. The work of Crooked House has been acknowledged on a European level but, sadly, not in Ireland in terms of funding. I invite every Member of the House to come to Newbridge to see the incredible work it does.

Every one of us has a role to play in giving shape to a nation that cares for the mental well-being of all its citizens. It is welcome to see so many people in the public eye who come forward to share openly their stories about their own mental health struggles. That naturally will have a positive effect on removing the stigma associated with mental health issues. However, the test will be the extent to which we have nurtured a culture in society in which people in distress are encouraged not to feel any less of a human being or any less worthy of help, and to realise that mental health can be recovered after it has been lost; a culture in which we do not feel embarrassed about our own, or a family member’s, mental health, and it all starts with each of us and our own prejudices, ideas and actions.

I find it shocking and horrendously disappointing to every citizen who has been impacted by mental illness that money from the mental health budget has been diverted into the general health budget. My home town and county has been rocked by deaths due to mental illness and shortfalls in treatment for mental health. Just over three years ago the small town of Rathangan, with a population of 2,000, suffered five suicides of young men within a few weeks. I will never forget the sense of tragedy and overwhelming grief that pervaded our town for a long time and that has truly never left, but there was a strong community response and through our community, local youth club, Scooters, Hope D and the Health Service Executive, measures were put in place to help others.

During a short period of time early this year, five men died by suicide in Newbridge. There was hardly a person in the town not deeply affected by that epidemic. Kildare has the lowest funding for mental health and young people than any other county in the country.

The HSE has stated that one in four of us will experience some mental health problems in our lifetime. Mental health issues continue to silently inflict immense damage on our country. The undercurrent of depression, anxiety and addiction is a profoundly ingrained problem for society. No family is untouched by some form of mental health issue.

Our society is struggling to compensate for the shortcomings of a regime that will not take a holistic approach to funding mental health in a manner that treats every citizen equally. Under-resourced guidance counsellors at all levels of the education system understand the importance of mental health services for teenagers and young adults. They get it. Voluntary organisations, youth clubs and sports clubs have identified young people at risk and are doing their best to help. They get it.

The big issues currently facing our society are inextricably linked. I refer to housing, health and crime. Very recently, a principal of a second level school in Newbridge confided in me that one of the main problems facing children in her school was the threat of being without a roof over their heads.

Mental health is a major issue.

I would love to speak to many areas but I cannot do so in five minutes. Treatment delayed is treatment denied, leaving those in need in crisis.

Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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I wish the Ministers of State well in their roles. I am delighted for them and their families and I am sure it is a great honour for them. All I can say to begin with is that I hope they are not treated with the same contempt as their predecessors responsible for this area. I never doubted their commitment and the former Minister of State, Ms Kathleen Lynch, was a fantastic person and very focused on the job at hand. Sadly, the cupboard was always raided and the money was never available that it was thought would be available. It seems that is the way this Administration is starting too, with a diversion of €12 million and rumours of other money going away. As a nation, we have continued to pay lip service to mental health. It seems everybody agrees with the content of A Vision for Change, which started in 2006, but as of today less than 40% of it has been implemented. There are rumours that psychiatric nurses are preparing for strike action because of the lack of supporting numbers.

I know many colleagues have dealt with all the different aspects of mental health but suicide prevention is of most interest to me. Everybody in this House, the Seanad and wider society has an interest in this issue. The only thing missing is our making a penetrative impact by resourcing the plans we have and the strategies developed by experts. They can begin to peel back the blindfold on the phenomenon of loss of life through suicide. It is a battle we are continuing to lose and which we refuse to face. For example, we know the equivalent number of people in two planes crashing - 600 people - are affected. That is the population of an entire village wiped out. If it happened in another country, the United Nations would send in troops and Concern would call for additional investment. As Irish society always does, we would dig deep to support the cause, yet we have done nothing.

We have developed a great strategy, Connecting for Life, and the Minister of State and I discussed it on Vincent Browne's show. I do not doubt the brilliant innovations in that and I recognise some stuff from the paper I wrote on the matter. This is not about credit or anything like it but rather the implementation of that plan. The money is just not being made available to it so the question is whether we are serious about wanting to save lives. What is needed, in effect, is a national authority. One regularly hears a comparison being made with the National Roads Authority, and, at the peak of its work, it spent in the region of €200,000 per fatality to deal with the problem of road deaths. The most spent in this country so far in trying to deal with loss of life through suicide, in a similar comparison, was €6,000 per fatality. That does not equate to the kind of commitment indicated by the rhetoric of these houses following a high-profile suicide or that of a child and so on. It does not equate to the kind of commitment we ought to have.

There was a tragic murder this morning and if a suicide was treated like that or as in another country, we would throw money at the issue. We simply just do not care. There are broader mental health issues throughout the country, in Sligo and Leitrim, south Donegal and west Cavan, which I represent. Does the Minister of State know how long it takes to see a child psychologist in those areas? Does she know how difficult it is when a 17-year-old with difficulties turns 18? Those people get thrown under the bus because they are out of the system. We say, "Sorry, you can join the queue over there and we will get to you when we can". There is an issue in that regard.

In the context of the murder this morning in Dublin, what we have at the top of the Garda is the same as what we have at the top of the Health Service Executive. There is a senior crew and everything they say is laundered through a public relations agency to make it sound good. All of us know through our constituencies - the towns, cities and rural communities in which we live throughout the country - when we speak to any health care professional that they are worked to the bone. The resources are not there and what resources there are might be spent in the wrong place. Perhaps they are caught in administration; at least that is what we all love to think. Morale, as in the Garda, is at an all-time low in this area. Health care professionals engaged in the mental health services, particularly those in suicide prevention, are not getting the support or resources they need.

With suicide prevention, there should be one authority and appropriate resourcing to implement Connecting for Life and the many good parts within it. That means there should be more resource officers in every community. We do not need an organisation in every townland associated with suicide prevention. All the actions should be determined by the National Office for Suicide Prevention or a single national authority. It should not be buried in the bowels of the HSE, subservient to the budgetary constraints that it has on an ongoing basis.

Donnchadh Ó Laoghaire (Cork South Central, Sinn Fein)
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I wish to share time with Deputy Funchion. Ba mhaith liom comhghairdeas a rá leis an dá Aire Stáit atá anseo agus ar ceapadh le déanaí.

I will speak to the nature of the overall discussion around mental health in recent years. Recently, depression has become somewhat synonymous with sadness or a prolonged sense of sadness. I fear we are beginning to draw closer to a place where mental illness is almost synonymous with depression or anxiety. Social media has presented us with an opportunity to share our thoughts with the world, whether it is a light-hearted joke or opening up about our personal struggles. Tá na meáin shóisialta tar éis an tslí ina roinnimid eolas faoinar saol pearsanta a athrú go hiomlán agus i slí a bhíonn tionchar aige ar an tslí ina smaoinimid go léir ar ábhair tromchúiseacha ar nós sláinte meabhrach.

Due to the stigma that surrounds mental health, people tend to open up in a way that is protective of themselves and their immediate family. Combined with a simplistic analysis by elements of the media, sometimes this dynamic can result in a somewhat simplistic view of what may be a very complex situation. Conversation and public discourse has become somewhat generalised. We then overlook the greater topic on a whole, as this somewhat simplistic version is presented as a microcosm of what is a significantly more complex topic. This takes nothing away from those who choose to tell their story, for whom it makes a big difference in dealing with their own issues, which takes significant bravery. Ba chóir an gníomh sin a mholadh sa tslí go cuireann sé chun cinn caint mar slí chun cabhair a lorg.

Talking, however, is not always the answer. There are many cases where talking will go a long way in helping deal with the issue. Alternatively, there are also many illnesses or conditions where talking will not resolve the issue or where it is only part of the solution. This is a place to which we must take the discourse. With mental illness, the conversation is relatively new to many people and us, and as a result the conversation has yet to begin to develop. Mar reachtóirí, tá freagracht orainn a chinntiú nach dtógann an proiséas seo na blianta, sa tslí nach dtiteann daoine tríd na bearnaí.

Ms Fiona Kennedy, a blogger and journalist who regularly writes on mental health issues, put it much better than I could begin to articulate in two separate articles in broadsheet.ieand The Irish Timesin the past month. She speaks of her own experience with borderline personality disorder, coupled with bouts of depression, and how she has become fed up by the constant media hype and sanitisation of mental health and its portrayal within sections of the media. She made a valid point in how we view mental illness and the use of the term mental illness being a condition in and of itself, rather than getting into the intricacies of the diverse complexities that the umbrella term represents. It is a valid point of concern.

She went further to look at the term "physical illness", how it is never deemed to be a sufficient diagnosis and that it covers such a broad spectrum. She stated:

We have come up with a way of talking about mental illness that separates it from physical illness, and I believe this is making it far more complicated than it should be. For starters, there is the fact that we are using the term "mental illness" in the first place. We would never say "I have a physical illness". We would say "I have the flu’. Why should any of the many and varying mental health conditions that people live with be treated any differently?

She continued:

We want mental illness to have parity with physical illness, but at the same time, we are setting it apart. The two go hand in hand and should not be separated. When we are physically unwell, it is difficult to have a positive and upbeat outlook. When we are mentally unwell, it is very difficult to physically do the things that we know will help. One feeds into the other, one cannot exist without the other.

Is tuairimí tabhachtacha iad seo agus is dóigh liom gur chóir don Rialtas iad a thógaint san áireamh. In the same way that we should aim not only to deal with physical illness, but to promote physical health promotion, whether that is exercise or good food in our schools, we should aim to promote good mental health.

In the past I have used the services of a counsellor and would do so again in the future.

I see that as no more remarkable or noteworthy than getting a check-up from a GP. The public should have greater access to counselling and psychiatrists through the public system-----

Bernard Durkan (Kildare North, Fine Gael)
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There are five minutes left in the slot.

Donnchadh Ó Laoghaire (Cork South Central, Sinn Fein)
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----- and not to have to wait perhaps a year for treatment, as a young person in my constituency has recently informed me they will have to wait, despite knowing from a private practitioner what specific treatment is required. The fact that someone is not in what might be described as a crisis situation does not mean the situation can or should wait.

Properly funded public treatment is ultimately the answer. However, in the interim, we can and should find other ways of encouraging people to look after their mental health. For example, tax can be claimed back for a whole variety of procedures and treatments, from dentistry to laser eye surgery. Why not for counselling or psychiatric treatment for the general population, or for any of the many treatments that may assist in safeguarding good mental health? This is not ideal, but could be an interim measure. I emphasise that they are interim measures because ultimately these treatments should be provided through the public system and in that context the recent €12 million cut was deeply disappointing and harmful.

Bernard Durkan (Kildare North, Fine Gael)
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There are four minutes left.

Donnchadh Ó Laoghaire (Cork South Central, Sinn Fein)
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However, this proposal can be undertaken quickly, and at limited cost, and in the context of significant demand and need, it should be considered.

Kathleen Funchion (Carlow-Kilkenny, Sinn Fein)
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I wish the Minister of State all the best in her new role. I want to focus on two areas. The first relates to mental health among our children and young people. We all know there has been a significant increase in the number of children and young people suffering in relation to mental health, particularly with anxiety and depression. I commend the role that the Child and Adolescent Mental Health Service, CAMHS, carries out. However, it is drastically underfunded and understaffed. Just over half of the required staff are operating in the child and adolescent mental health services at present and it is not uncommon for children and adolescents to wait in excess of a year to be seen. In my own constituency, I was dealing with someone recently who is 16 years old and is facing an 18-month wait. The parents were in contact with me - I know many people will have this type of story - because they are so worried about their son, who will not come out of his room, and they are faced with 18 months of not knowing what exactly is wrong and how they can help him. We cannot stress that enough in respect of young people.

Sinn Féin wants to see an increase in the number of CAMHS teams throughout the country and to ensure that they are staffed and funded properly. It cannot be stressed enough how crucial early intervention is for a child or young person presenting with a difficulty, whether it be depression, self-harm or an anxiety disorder. There have been cuts to guidance counselling in school. Cuts in 2012 have resulted in a 51% reduction in the one-on-one counselling available for children and adolescents. Again, this can often be a first port of call for young people experiencing mental health difficulties. I urge the Minister to restore the funding in this sector. It would cost €14.7 million to restore the 700 posts in this field.

All of this leads to the old saying that prevention is better than cure. When we look at our young people, we do need to look at our education system as well. There are many schools that have access to play therapy for young children, particularly those at primary school level, but unfortunately not all schools have access to this service. It is usually linked to schools that are dealing with the school completion programme and that are in disadvantaged areas. That is one service we need to look at expanding. It costs very little and play therapy can be instrumental in helping a young child at primary school level deal with anxiety in particular. That is something we are seeing more and more of on a daily basis with young children and if it is not dealt with, it develops into this major obstacle for a child and can impact on their education and how they perform in school, on their relationships with friends and family and on their social life. It has such a knock-on effect on everything and it goes back to the argument that prevention is better than cure. We talk a lot about mental health nowadays, but that is one area that gets overlooked. The CAMHS runs a very good service, but I do not think they access play therapy for younger children, and that is something we need to look at in respect of the education system.

My last point relates to the suicide crisis assessment nurses. These nurses liaise with GPs where there are concerns about patients who may be suicidal, but only 24 of the 35 nurses approved for this programme have been recruited. I urge the Minister of State to go ahead with the job of recruiting the rest of these nurses, because it is key when somebody is in crisis that they have access to the services and do not have to wait. That is the big problem we all see on a daily basis with people who come to us: they have to wait and unfortunately they cannot afford to wait. For many people when they are going through a difficult time, if they finally make that decision to reach out to a GP or whoever it might be and they do not get the service, they then decide there is no point and it has a knock-on effect. I urge the Minister of State to ensure correct and adequate funding goes into these services because we cannot just be talking about it - we really have to see action on these points.

Tony McLoughlin (Sligo-Leitrim, Fine Gael)
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I wish to begin my contribution to this mental health debate today by highlighting what I believe to be a very important goal for this Chamber to achieve over the course of the Thirty-second Dáil, namely, to ensure that the general public is better able to understand the workings of this Chamber in the future. I say this with regard to the controversy that unfolded around this mental health debate on 5 May, and to the fallout on social media over the supposed poor attendance and lack of interest in the topic. At this stage, I would also like to congratulate our new Ministers of State, Deputies Helen McEntee and Catherine Byrne, who are with us this evening, and the Minister, Deputy Simon Harris. I am not sure whether the Acting Chairman is aware, but what sprung to prominence was a split second snapshot from a three-hour debate where ten or so Deputies were in this Chamber. It was then inaccurately and, in my opinion, maliciously portrayed simplistically online as if only there were only that number of Deputies in Ireland who cared about this issue. This was hurtful to those Deputies who had sought to speak on that day but could not do so, due to the time constraints involved in the three-hour debate. No matter the issue, 158 Deputies could not speak in the time period given. As Members may be aware, I later read via TheJournal.ie, that over the course of this debate 39 Deputies contributed to the debate and 27 others were present in the Chamber. These are the true facts.

The Acting Chairman may be aware that the main cause of the recent public anger surrounding mental health funding is due to the reports on the supposed cut of funding in the mental health budget by the then Minister for Health, Deputy Leo Varadkar, in 2016. However, when one takes the time to look at the figures involved it becomes very clear that this claim could not be any further from the truth. To his credit, the Minister, Deputy Varadkar, had, since his first budget in the Department of Health in 2012, fought for and overseen increases to both the mental health budget and the overall health budget in general.

For example, in 2012, the national mental health budget was €711 million. In 2016, it had increased to €827 million. This is an increase of 16%. Since 2013, the Minister, Deputy Varadkar, had increased spending in the mental health budget at a higher percentage than any other service in the HSE budget, including vital areas such as the ambulance service, the fair deal scheme, cancer care and vaccinations. This is a very important aspect to understand, so I will repeat it: he increased funding in the mental health budget every year since he was appointed Minister and at a higher percentage than any other service in the HSE. To say otherwise is wrong and should be challenged with the facts involved.

However, unfortunately this type of factual information is not as popular or as shareable online. This is the world we now live in and which we as public representatives must rise to meet. The real difficulties for mental health services came during the period between 2008 and 2012, when the mental health budget was reduced substantially, like all other areas of the health service. This was hard to accept for many and even more difficult to implement and endure. However, we all know the reasons for this happening. They lie with the bad management of the economy, the financial crash that followed and the loss of our economic sovereignty.

As we are now in a strong period of positive economic growth once again, we can continue to increase the mental health budget. In terms of mental health spending locally in my constituency of Sligo-Leitrim, while there are always difficulties with mental health services, such as staff recruitment and service amalgamations, I believe we can now look forward to increased funding for local services. In Sligo-Leitrim, funding has increased by over €1.6 million since 2013. However, I now want to see this returned to pre-crash levels. In 2016, it is expected that the HSE will spend €23.6 million on mental health in Sligo-Leitrim.

In 2006, we spent €26.5 million locally and I want to see more services and staff employed in the sector locally and for the budget to allow this. We need to see a continual increase in funding for the mental health area. I am confident, however, that reforms, new staffing appointments and management changes are all aspects which will also have a beneficial effect.

Our mental health is very fragile, sensitive and open to fluctuation, which is normal. Being able to talk to someone about our problems is key. We need to break the stigma and illuminate the point that it is okay to feel down and unhappy; this is part of life. I believe that campaigns such as the HSE's Little Things campaign are very important. Websites and online resources such as Joe.iedeserve credit for promoting mental health awareness and advice to large audiences. I hope the State will continue to improve the overall services on offer and I look forward to this happening.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I call Deputy Shane Cassells who will be sharing time with Deputy Declan Breathnach.

Shane Cassells (Meath West, Fianna Fail)
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I welcome the opportunity to speak on mental health. I congratulate my fellow royal county colleague, the Minister of State with responsibility for mental health and older people, Deputy Helen McEntee, on her appointment to ministerial ranks. We may share different political backgrounds but we both had famous uncles who soldiered on the great Meath teams of the 1980s so myself and my family are particularly pleased for her.

I acknowledge the work of the cross-party committee from the previous Dáil which recently staged a very successful and informative launch in Leinster House of the green ribbon campaign and the See Change movement. The contributions by Deputies Ó Caoláin, Troy, Doherty and O'Sullivan were all insightful but more importantly they were all positive. The people who spoke at the launch all spoke positively about mental health well-being and that was very insightful. The guest speakers on the day who addressed their own past problems spoke about the importance of having somebody who will listen and somebody simply caring. Most strikingly, they spoke about the issues around resources and the need for support services because there are times when just kind words are not enough and the services of professionally trained people are required.

Last week, a young lady from Trim contacted me. She has suffered from agoraphobia for the past 15 years and it has become so bad in the past few years that she cannot leave her apartment. She wrote to complain about the lack of help available for herself and others with the illness. She attends mental health services in Trim. She had an appointment in early May for which she had to take Xanax in order to attend. She is allowed only ten tablets a month since the medication is addictive and she hates having to take them. She can only go as far as her neighbour's house without having to take Xanax. At her appointment, she was told that the service would not send someone out to her apartment to help her because it was thought this would enable her. She was told she should go to see a therapist in Trim but she would not be allowed to take that particular medication. The problem is that this person cannot get to the appointments without taking Xanax and even when she does take it, she finds it difficult. She suffers from panic attacks and depression and she is reaching out; she wants to be helped but the system is working against her.

At the beginning of this debate I heard Deputy Josepha Madigan speak about the psychiatric services in the State and say that there are now some top class facilities available. However, in my own county we are on the cusp of losing our 24-7 acute psychiatric unit facility and having it downgraded to a Monday to Friday service which would open during office hours. That is not how real life works but that is what is being proposed with the potential implementation of this measure in July. At the beginning of May, I tabled a parliamentary question to the previous Minister on this matter and I still have not received a response. What does this say of the HSE in how it treats this Dáil with contempt and no regard whatsoever? More importantly, what does it say about how the HSE treats patients in Meath upon whom this decision will impact? Our Lady's Hospital in Navan, as the Minister is very well aware, is under threat across a number of areas in the services it provides and the Save Navan Hospital campaign has done fantastic work in protecting these services. I acknowledge the presence of Deputy Tóibín in the Chamber who is the chairman of that campaign and I also acknowledge the exceptional work of Dr. Ruairí Hanley on that campaign. However, the proposed downgrading of the acute psychiatric facility needs to be addressed. It deserves and demands an immediate response and I hope the Minister of State will address it in the House this evening. I sincerely hope that as a Meath woman she will intervene to attain the 24-7 facility and I hope that having three Ministers in Meath will carry some weight in fighting this decision.

I spoke yesterday with Christopher Rennicks, the chairman of the Meath River Rescue service. It is a voluntary organisation which is over 20 years' old. It has, unfortunately, seen its services required more and more in recent times. We do not want to see these services more in demand. We do not want a scenario where a person presents in Navan outside of office hours and finds acute psychiatric facilities are not available. There is little point in Deputies making speeches in this Dáil Chamber about mental health if there is no commitment to the resources required. I am appealing to the Minister, on behalf of the hospital campaign, and more importantly on behalf of the patients who use the facility, to interject and to ensure the retention of that facility on a 24-7 basis.

Declan Breathnach (Louth, Fianna Fail)
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I appreciate the opportunity to speak on this mental health debate and I too congratulate both Ministers of State on their elevation. According to the HSE, one in four of us will have mental health problems at some stage in our lifetimes. Putting that into perspective, at least 39 Members of this House and four of the 16 Cabinet Ministers will experience mental health problems at some stage. Outside this House, we all engage with family, friends and neighbours who too often suffer in silence with what in their view is an inadequacy in their own make-up when the real problem is an inadequacy in the provision of resources to help them. In the past, mental health was too often dealt with in cold, monetary and statistical terms. Now is the time that we in this House and beyond need to see this as a collective, surmountable issue and target a warm, sustainable, national solution to help those suffering with mental health issues.

The Fianna Fáil Party supports the creation of a mental health authority to provide focus through an organisation with the treatment of mental ill health and distress and the promotion of positive mental health as its sole focus. There needs to be definitive ring fencing of funding for mental health services. That means an end to pulling the rug from under these services to shore up other health services. The World Health Organization recommends that a total of 10% of the total health budget needs to be set as a target and ring-fenced. The mental health authority could also help with focusing on tackling homelessness among those with mental health issues.

The Fianna Fáil Party believes the Government should carry out a full review to see what has and has not been achieved with a view to ensuring that targets are met over the next ten years. The Government should hold a mental health summit with all key stakeholders. A renewed respect for stakeholders' input is critical to rebuilding trust with this sector. The review group should consider placing particular attention on the need for non-medical approaches to dealing with mental health issues. It should also ensure that the recovery model ethos is placed at the centre of mental health policy as expressed in the policy document that will follow on from A Vision For Change. We also need to re-establish the implementation review group that would issue regular updates on progress and delivery of the plan. Finally, there is a need to establish a service user representative body to ensure a quality of respect to all those who are involved across the spectrum of service users and providers.

Stephen Donnelly (Wicklow, Social Democrats)
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I congratulate the Minister of State on her appointment; it is a great honour I am sure and a great responsibility. I wish her every luck in the coming months and years.

I welcome the opportunity to speak on mental health today and I acknowledge the importance the Chamber has placed on the topic. It has received several hours of debate with much input.

Based on my past five years in this House, we disagree, as we should, on many issues. However, mental health seems to be one of those ones where there is much agreement on what the challenges are, how important mental health is and what needs to be done about it.

In preparing my speech today, I did what probably many Deputies did; I looked at the mental health reform figures. I have seen them before and I have used them before in this Chamber, yet they absolutely shocked me. They have been repeated - I have listened to much of the debate - and they are worth repeating again. In Ireland today, almost one in ten adults is experiencing a mental health disorder, one in seven has experienced a mental health difficulty in the past year and, by the age of 25, one in five of us has experienced some form of mental health difficulty. These figures have been stated by many Deputies over the past few days. I have seen them before and I have used them before, yet, when I pulled out my notes to prepare for today, I was again shocked at how prevalent and damaging this is. It means that probably every one of us - certainly the majority of us - is either dealing with a serious mental health issue or have friends and family doing so.

I would like to focus on youth mental health, which is an area in particular need of intervention, although the entire mental health service needs help. Again, a figure that floored me today, which I have seen before, is that we have the fourth highest rate of teen suicide in Europe. We have problems in Ireland, but we are a modern, reasonably progressive and wealthy nation. That we have the fourth highest rate of teen suicide shocked me when I saw that figure today. More than one in five young adults have indicated that they have engaged in self-harm. As I have heard other Deputies reference, a recent study of LGBT young people found that one in five has attempted suicide, one in four has self-harmed and one in three has thought seriously of ending his or her life in the past year.

Youth mental health workers that I speak to in Wicklow tell me that morale is so low in the system, from psychiatrists to psychiatric nurses, that they are finding it hard, where funding has been provided, to fill the posts. I was particularly taken by one psychiatrist I spoke to a few months ago. She works outside Dublin in the commuter belt. She said that youth mental health services are so difficult to access where she is that the GPs in the area are writing letters for young people stating they are at imminent risk of suicide and telling them to present at emergency departments in Dublin. They are using that as the pathway to accessing youth mental health services.

I do not mean that to score any political points. I do not think any one of us would want that for anyone. However, this goes to the heart of the matter. I have heard several Fine Gael Party Deputies speak about some of the funding improvements and hiring that has occurred. While that may be going on, and may it continue, we must acknowledge just how desperate the situation is right now. This is not something that needs a little more money or a few more staff. This is a system in crisis and we are failing our young people. If it is true, and I have no reason to believe the psychiatrist I spoke to was misleading me, then this is a crisis and it needs to be dealt with as a crisis.

I would like to acknowledge several welcome pieces in the programme for Government. Increasing the mental health budget year on year is very welcome. Fully implementing A Vision for Change post-review is welcome. I was delighted to see a reference to ensuring support in crisis and I guess that is part of the example I have just given of young people presenting in accident and emergency departments. Sufficiently staffing our primary care centres with mental health professionals, psychiatrists and psychiatric nurses is also very welcome. However, the programme for Government is lacking. It is not the place for the programme for Government, but what is not in it and what we need and I imagine what the Minister of State will be dealing with right now is a timeline for implementation, with allocated budgets. As she knows, we need 1,000 psychiatric nurses by the end of the year and we know that the Psychiatric Nurses Association, in light of low morale, is balloting for action. My understanding is we need to double the number of consultant psychiatrists as well, which is what the professionals have advocated.

A Vision for Change is a great document and a great plan, but it is ten years old and was written in a very different socio-economic environment. While the programme for Government calls for an update and an expert review, which is absolutely the right call, we have to start seeing some timelines. I heard nothing but support for five years for A Vision for Change in this Chamber during the last Dáil. However, there is nothing to hold any Government or us, the Parliament, to account. We need goals, timelines, deliverables and allocated budgets.

If we are serious about addressing and improving mental health, we must have an honest conversation about funding. We know that Ireland spends less on mental health services, preventative care and community care than comparable countries and we are experiencing difficulties in all three of those areas. Since 2011, the number of psychiatric beds per head of population has halved, so this is serious stuff. We know that as a percentage of our health budget we spend 6% on mental health. Our closest neighbours spend 10%. These are not marginal changes. These are big things that need to be addressed.

There is a need for reform in youth mental health. We need to move from the two-stage model we have, which is a paediatric-adult model, to a three-stage model, which is a paediatric-youth-adult model. We have to provide a user-friendly and welcoming entry mechanism for young people. We cannot have young people presenting at accident and emergency departments except in the most extreme emergency. To have them going in and sitting on a plastic chair at a formica table in the local community or health centre is not the right way for us to be welcoming in young people who have mental health issues. We need a welcoming service. What we have at the moment is a very siloed service which kicks into action when things get quite bad. Obviously, we need more prevention, and I know this is something the Minister of State is interested in. We need more prevention, but we need a much more holistic and joined-up service as well.

We need these reforms, but we must have the money, which is why the tax base has to be protected. It is so that we can both reform and invest in these critical services. The reality is that we have the fourth highest rate of teen suicide in Europe and one of the lowest levels of taxation on labour. These are OECD figures and not Social Democrats propaganda. That is the reality and that is what we are dealing with. We desperately need investment in mental health and in youth mental health services and we already have one of the lowest levels of tax on labour in the OECD. Here is the question for all of us. I believe we all agree on the importance of mental health. I do not hear people try to score political points very often on this debate. We all agree with the need for reform and new funding. Therefore, this will come down to what we believe is more important: investment in mental health services and youth mental health services or further tax cuts. That is the choice. That is the choice that will be put to this House in October.

I will finish by reiterating that I wish the Minister of State the very best. She has a very difficult and hugely important job. The Social Democrats and I have every intention of engaging in a constructive way. We may end up disagreeing on how much money is required, with us looking for more, but I wish her the very best over the coming months and years in this role.