Dáil debates

Tuesday, 31 May 2016

Mental Health Services: Statements (Resumed)


5:45 pm

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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The Government is in possession. Deputy Heydon, who is the next speaker, is sharing with Deputy Hildegarde Naughton.

Photo of Martin HeydonMartin Heydon (Kildare South, Fine Gael)
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I begin by congratulating the Minister of State, Deputy Helen McEntee , on her elevation to the new position of Minister of State with responsibility for mental health and older people. It is an area that the Minister of State has a huge commitment to and a passion for, and I look forward to working with her to help in our necessary improvement of mental health service provision.

Mental health issues affect all categories of citizen - male and female, young and old, urban or rural. There are no exceptions. However, today I want to focus on young people, specifically those living in County Kildare. Kildare has one of the largest populations of young people in the country and the majority of correspondence that I have received from constituents whom I have engaged with on this issue has come from younger members of the community who feel passionately about this issue who either have been affected themselves or had close family members or friends affected by mental health issues.

I believe much of the increased media coverage and discussion about mental health in recent years has been driven by young people who have suffered themselves or know friends or family members who have, and who, therefore, want to speak out about it. For too long mental health issues were not discussed or acknowledged in Ireland even though they have always existed. Bringing the discussion out in the open is one of the first key steps in helping to address these critical issues.

There are 77,832 persons between the ages of zero and 24 years in County Kildare, accounting for more than one third of the population. As I mentioned, this is one of the highest rates in the country and is also considerably higher than the eastern and midlands average. Research carried out by the Children and Young People's Services Committee found that current service levels in Kildare are not sufficient to meet the needs of the 77,832 young people in the county. However, Kildare has also one of the lowest funded youth services in the country, including those for mental health issues. That same report also highlighted that funding from the Department of Children and Youth Affairs in Kildare in 2011 was €13.55 per young person. This was the third lowest per capitaallocation in the State. Kildare also has one of the lowest funded mental health services per head of population, and this just is not good enough.

We have the Lakeview mental health facility in Naas, which is over 25 years old. It is a 29 bed unit that is in real need of significant capital investment. Lakeview, I understand, is constantly at in excess of 100% occupancy. We also have ten beds in Portlaiose taking an overflow of Kildare patients and in addition, in more recent times, we have had to go and use services in Tallaght as well. This has a significant knock-on impact on support services.

We also do not have enough high support hostel places as step-down facilities from Lakeview, meaning patients struggle to transition from the service following their time at Lakeview. I understand that a proposed investment plan has been submitted for consideration to the Department of Health and I would expect a decision to be taken on this as soon as possible to boost existing services in the county. This investment will be our attempt in Kildare to catch up with the rest of the country. Sometimes I feel that we in Kildare suffer from a presumption of wealth and our close proximity to Dublin. When it comes to mental health services, I believe that perception has damaged us in terms of investment. That must change.

I was surprised to see in the statistics provided by Mental Health Reform that 75% of mental health difficulties arise before the age of 25. That statistic is frightening, but backs up the need for services for our young people.

Credit is due to the many organisations providing services, in Kildare and nationally. From the great Samaritans to Pieta House, we have wonderful voluntary elements that are playing their part in providing the support needed to people when they reach out. We also have pilot programmes that need to be extended. Mojo is one such programme in Kildare town. This is a pilot project for men over 18 funded by the National Office of Suicide Prevention, NOSP, which has been very successful to date. While there is a commitment to continue the programme in 2017, the funding available through NOSP is limited and its future cannot be guaranteed. I call on the Minister of State to ensure that Mojo and programmes like it which are serving a real need in the community are continued through the allocation of increased funding.

The child and adolescent mental health service, CAMHS, in Kildare is simply not fit for purpose.

I have dealt with too many cases in which the need was not met by the service required. While changes are afoot to move services into the primary care centre in Kildare town, there seems to be an issue regarding funding from the primary care element. I will take it up with officials in the Department of Health to address the deficiency. While we have a very fine building that can help to improve the CAMHS facilities, they have not moved yet. We need it to happen very quickly.

I have dealt with cases of children as young as 11 years expressing suicidal ideation and needing to go to Pieta House, given that the services in the CAMHS in Kildare could not assist them. It is not good enough. While funding for mental health services was increased by 16% under the previous Government, more is required after decades of neglect. We need to get mental health funding up to 12% of the health budget in order to be in line with our international colleagues.

There is much more that I would like to say about the status of A Vision for Change. Mental health is a major issue which permeates many facets of society. We must improve how we deliver mental health services. If we do, it will go a long way toward dealing with many other issues. Continued investment in services is critical and I will use my voice to fight for it as long as I remain a Member of the House and beyond.

5:55 pm

Photo of Hildegarde NaughtonHildegarde Naughton (Galway West, Fine Gael)
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Mental health and an awareness of it should be included in the national curriculum for schools. The Young People's Mental Health Advisory Group which is part of the National Health Service, NHS, clinical research network recently recommended this in the United Kingdom. We should do the same here. The rationale is that prevention is better than cure and that if problems present in later years, they can be dealt with more effectively. Others have mentioned the stigma attached to mental health as a first obstacle. What better way to tackle this than in early education about mental health while young people are still learning?

The NHS indicates that to have maximum access to young people, it is best done through schools. School is also where many young people start to experience mental health problems first. We have had some advances in educating young people about their mental health. MindOut and the Jigsaw mental health project are services that have been very successful. Youth Work Ireland has been offering an excellent service for young people with mental health difficulties across the country. They take up the slack in the State system and prevent even more people from joining waiting lists. However, a more sustained and school based approach is warranted.

A host of international, peer-reviewed literature on the subject suggests a multi-level, school based intervention on adolescents' emotional well being is effective. The Oireachtas Library and Research Service also produced a very good spotlight document on promoting mental health in schools. It suggests mental health, rather than being seen as a problem, should be seen as something which requires maintenance and protection. I could not agree more. It is not a problem to be solved but part of who we are, like a limb or an organ.

Some mental health difficulties are lifelong. While there may be no cure, in the majority of cases there are ways to enable people to live their lives. It is ongoing and we should not think it is in any way a problem. Our discussions should be about ways to enable people who suffer from mental health difficulties to lead the most fulfilling lives possible. We should be concentrating on promoting physical fitness, exercise and a balanced diet, on developing our mental health awareness and knowledge and on ongoing support and treatment, where necessary.

I will make a point which I picked up from a recent social media post and talking to people. Some people, when they hear that a friend or acquaintance is taking anti-depressants to treat depression or anxiety, have a tendency to be critical of the use of anti-depressants. The point was made that some people benefited enormously by taking them. I recently spoke to a person who was infuriated by the suggestion the use of medication was something to be criticised. While the person would prefer not to be taking it, it enables them to avail of non-medical treatments. Medication is often taken as part of an holistic treatment for anxiety or depression which may involve exercise and cognitive behavioural therapy.

There is no golden rule. People's mental health issues are complex and multifaceted and require knowledge and understanding. That brings me back to my original point. Where better to impart that knowledge and understanding than in school? The research indicates that mental health promotion programmes are effective in equipping people with the necessary skills to avoid or deal with mental health difficulties. There are great benefits to be had from school-based programmes. They include positive effects on behaviour, social and emotional skills, the ability to learn and achieve academically and increased levels of problem solving in social settings.

The World Health Organization estimates that 20% of children and adolescents worldwide experience mental health problems. The OECD reports that 4.5% of Europe's population suffer from depression, with an associated cost of more than €118 billion. In Ireland the cost of poor mental health was estimated to be 2% of GDP, or €2 billion, two years before the economic crisis struck in 2008. Major costs are associated with poor mental health. While there would be a cost involved in placing mental health in the education system curriculum, it is very much warranted, both practically and financially. It would be the right thing to do.

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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Deputies Frank O'Rourke, Eamon Scanlon and Niamh Smyth are sharing time.

Photo of Frank O'RourkeFrank O'Rourke (Kildare North, Fianna Fail)
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I extend warm congratulations to the Minister of State, Deputy Helen McEntee, and wish her all the best in her new role. She will be a good Minister of State with responsibility for mental health services and older people.

It is ten years since A Vision for Change, the report of the expert group on mental health policy, established by the then Minister of State with responsibility for mental health and disability services, former Deputy Tim O'Malley. The foreword states, "Each citizen should have access to local, specialised and comprehensive mental health service provision that is of the highest standard". This should be our objective as we set about trying to secure resources for mental health services.

Let us consider the cost of mental health problems to society. Mental illness causes both social and financial damage. The Mental Health Commission estimates that the cost of dealing with poor mental health is 2% of GNP. The mental health of the population of Ireland is an essential foundation for economic and social recovery. More than 450,000 people in Ireland experience depression at any one time. This represents one in ten of the population. People with a mental health disability are nine times more likely to be outside the labour force.

Spending on the delivery of mental health supports is scandalously low. According to the College of Psychiatrists of Ireland, annual expenditure on mental health services is 6.2%, which is extremely low when compared to the figure in countries such as the United Kingdom where it is 12% and Canada and New Zealand where it is 11%. A Vision for Change proposed annual expenditure of 8.24%. The low level of expenditure on mental health services must be addressed and we must start the process in the next budget.

The number of suicides in Ireland has remained high, with between 495 and 554 deaths per year from 2009 to 2012. When a focused set of policies, backed by adequate resources and supported by Government policies and State organisations, was put in place to deal with road deaths, we reduced the significant number road deaths that used to occur on the road network. We must give mental health the priority it deserves to enable us to deal with the number of suicides in Ireland.

In its 2016 budget submission the College of Psychiatrists of Ireland put forward a number of positive proposals to assist in developing a policy platform for mental health services. One proposal concerned the provision of community based mental health teams for patients of all ages on a 24/7 basis nationally. It stated this must be a priority if inroads were to be made in dealing with the continued morbidity and mortality due to suicide, self-harm, chronic mental illness and alcohol and substance abuse. It also proposed a nationwide recruitment of recommended professionals to fully resource the teams, giving people in need co-ordinated, professional support where and when they needed it. A Vision for Change delineates the types and numbers of mental health professionals who should be involved in mental health teams in each area nationally. The College of Psychiatrists of Ireland also proposed multi-annual funding, beginning with a five-year rolling incremental budget, increasing to a minimum 12% of GDP.

I acknowledge the work of many advocates in this area and give special mention to Dr. John Hillery, director of communications and public education at the College of Psychiatrists of Ireland, who is passionate about advocating for people with mental health challenges. In my constituency, Kildare North, I see the benefits of having a day care psychiatric service in Kilcock. Users of this service contacted me recently when it was threatened by cutbacks. I was delighted that it was maintained, but I saw the distress and anxiety caused by the threatened cutbacks to the people using the service and the benefits they derived from it.

Photo of Eamon ScanlonEamon Scanlon (Sligo-Leitrim, Fianna Fail)
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I welcome the opportunity to contribute to the debate on mental health. It is a privilege to be given the opportunity to contribute on behalf of my constituents, with a view to highlighting areas where there are significant opportunities for improvement. I extend my good wishes to the new Minister of State with responsibility for mental health services, Deputy Helen McEntee, and wish her well in her post. I also extend my good wishes to the Minister for Health, Deputy Simon Harris.

Mental health is the most critical health issue facing young people in Ireland. Up to one in four students experiences psychological problems at any given time.

For some the cause may be a psychiatric illness while for others it is bullying, a problem at home or difficulties coming to terms with their body image or sexual orientation. We are not doing nearly enough to help our young people to cope with such problems as is evidenced by the fact that Ireland's youth suicide rate is now the fourth highest in Europe.

As part of the agreement to support a minority Government, Fianna Fáil made it a critical point that the strategy, A Vision for Change, would be implemented fully and the party expects that to happen. Fianna Fáil's recommendations are based on the core principles of early intervention, stigma reduction, peer support, accessible community-based care and giving young people a voice in politics that affect them. I agree with the WHO's statement that mental health is an issue which even the poorest society must afford to promote, to protect and to invest in.

Every young person goes through tough times. It is estimated that at any one time one in five of them are experiencing psychological difficulties. Some Irish studies suggest that the number in this country may be as high as one in four, which equates to six or seven students in an average school class.

Organisations such as Amnesty International, See Change, GROW, Alive2Thrive and STOP thrive in my constituency of Sligo-Leitrim and have done excellent work in reducing the stigma associated with mental illness. However, serious stigma remains and it presents a significant barrier to improving mental health. Studies have found that six in ten Irish adults would not want people to know if they were experiencing mental health problems. We must challenge this stigma and normalise the discussion of mental health issues for our young people. They must know that they are not alone in experiencing mental health difficulties. We must ensure that young people with mental health disorders to not face discrimination. Despite the high prevalence of mental health problems among Irish young people, we are optimistic that the situation can be improved if the Government acts decisively. In 1990, Australia's suicide rates were near what they are in Ireland today. However, following significant investment by the Australian Government in mental health reform, coupled with an increase in public awareness about mental health problems and the importance of getting help early, Australia saw a 55% reduction in its suicides rates in less than ten years.

I would like to know how much funding will be invested in mental service services in my constituency of Sligo-Leitrim, south Donegal and west Cavan. I call on the Minister to place mental health on an equal footing with physical health. We must implement A vision for Change, that is, to 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.

6:05 pm

Photo of Niamh SmythNiamh Smyth (Cavan-Monaghan, Fianna Fail)
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I congratulate the Deputy McEntee on her appointment as Minister of State and I am sure she will do a wonderful job.

I welcome the opportunity to speak on the important issue of mental health services. For far too long mental health services have suffered because of the outgoing Government's failure to allocate the resources necessary to ensure a functioning health service. Despite promising to protect funding for mental health services, Fine Gael and the Labour Party delayed funding allocations and instead diverted money to other areas when crises emerged. It is claimed in the HSE 2016 service plan that €35 million has been set aside for mental health services. However, that plan fails to outline where and when the money would be spent and it merely contains vague references to further specific initiatives.

Mental health issues are bordering on a national emergency. It is disgraceful that voluntary organisations and charities are funding essential services which should be provided by the State. We need to properly fund our mental health services and to stop this practice of raiding the budget every time there is a shortfall in other areas. Mental health services need to be acknowledged as being one of the most important sections of the health care service. We need to start prioritising mental health and this new Government cannot continue to ignore the significant challenges that need to be addressed in the mental health sector. It must begin by securing a workable budget that is properly ring-fenced to ensure that the services are enhanced and improved.

As a priority, we need to engage in and fully appreciate the role that the arts have to play in this important issue. The arts initiative in mental health, which is already happening in some parts of the country, has the potential to embrace a range of arts practices occurring in primary health care settings, which bring together the skills and priorities of both health and arts professionals. This approach will promote health and wellbeing by improving the quality and cultural access into health care settings. The arts initiative in mental health can involve all art forms and can incorporate a variety of approaches. By engaging the arts with mental health services, we can facilitate mental health service users to participate fully in the cultural life of their community. We can challenge the stigma faced by service users and we can enhance the health care work environment and promote the value of the arts within the health care service.

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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The next speakers are Deputies Ellis and Tóibín who I believe are sharing a ten minute timeslot.

Photo of Dessie EllisDessie Ellis (Dublin North West, Sinn Fein)
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There is a very broad consensus in this House and across the State that mental health is a very serious issue that requires immediate attention. It is our job to take that consensus and build a coherent and focused plan to ensure that the changes which need to happen are identified and tackled in the coming months. Mental health is an issue which affects nearly every family and people in every walk of life. It is particularly important that we discuss this issue now as no doubt budget preparations are already under way. Money is not a silver bullet that will solve all the problems in this area but it is clear that our mental health services and our mental health care professionals have been chronically underfunded for decades. The clearest evidence of this is that ten years on from the publication of A Vision for Change many of its recommendations are either completely unfulfilled or partially complete. Lip service has been paid to the delivery of true community-based care and institutions were closed or downsized but the replacement services have not met demand.

The Mental Health Reform group, made up of large number of bodies actively involved in care provision, advocacy and health promotion, estimates that a yearly budget of €973 million is required to properly deliver the services and care needed to meet the demand being place on the system. That is nearly €150 million more than what has been pledged for 2016 even before we consider the shameful proposal to reallocate €12 million earmarked for mental health for other purposes.

The list of crucial items yet to be delivered due to a lack of funding goes on and on. Staffing levels are 23% less than recommended. Only 2.8% of the recommended posts in mental health and intellectual disability adult services have been created. We do not have a 24-hour crisis support service in place, which leaves people in serious distress outside office hours with little access to care. In some cases people in crisis may have to travel hundreds of kilometres back and forth to different services in order to potentially get a bed in an acute unit. This is what is required of somebody who is already incredibly vulnerable and in such a hopeless state.

Accident and emergency departments, which are already packed to capacity with general medical emergencies, are having to deal with people in mental health crisis who have nowhere else to go. Many of these, after waiting for an extended period of time, have been told there is no place for them and to leave the accident and emergency department. Recently we have seen a spate of tragedies where people who left accident an emergency department in crisis subsequently took their lives. On the north side of Dublin two brothers in the space of weeks reported to an accident and emergency department with no resolution, and left vulnerable and in crisis. One brother took his life and the other brother was found having attempted to hang himself. The Minister has said that those who leave an accident and emergency department due a waiting times are gambling with their health but it is the State that is gambling with the lives of people who may be suicidal and are being forced to wait in this manner, in crowded, noisy and chaotic waiting rooms.

The full roll-out of suicide crisis assessment nurse would cost less than €400,000 but it has yet to be completed. These nurses need to be on hand to ensure no person in crisis leaves hospital without assessment and the appropriate care. We also need a focused response to the very common problem of what is called dual diagnosis, where someone with a mental health problem also has a substance abuse problem. Many people in desperate situations turn to substance abuse and our services must be able to address this without passing people from pillar to post looking for appropriate care.

I wish to praise the excellent work of voluntary and community bodies such as Finglas Suicide Network, Pieta House, the Mental Health Reform group and many others who have done so much to raise these issues and to provide crucial on the ground services. Initiatives such as the recent Walk of Hope in Tolka Valley in Finglas, organised by local people, is one many. It was a magnificent initiative to raise awareness of mental health problems.

It is the responsibility of the State and we must live up to that challenge. We cannot shirk responsibility by relying on the dedication of members of the public who pledge their time so generously. We also need to treat our nurses and junior doctors better. They are not volunteers but are professionals who deserve fair remuneration and decent conditions. We can provide a service which truly delivers care where it is needed but we need to recognise that this costs money and needs real dedication. If we are willing to prioritise mental health care, we will succeed. That is a political choice. Past Governments chose to ignore the issue and that cannot be allowed to happen again.

6:15 pm

Photo of Peadar TóibínPeadar Tóibín (Meath West, Sinn Fein)
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Ar dtús, ba mhaith liom gach rath a ghuí ar an Aire Stáit nua, Teachta Helen McEntee. Is mór an onóir di é a bheith ina hAire agus tá a fhios agam go mbeadh a hathair iontach bródúil aisti inniu.

I have three issues to raise with the Minister of State. My colleague, Deputy Ellis, has spoken very well about the macro issue in Ireland and I want to look specifically at some of the localised, micro issues with regard to mental health. I am the chair of the campaign to save Navan Hospital which held a meeting last Thursday night to discuss the closure of the 24/7 psychiatric unit in Navan. There is deep unease within the campaign about the closure of that unit. We understand there will be clinical and accommodation benefits and advantages to the new Drogheda unit but there is significant concern that there is not enough capacity within the region. One of the major difficulties is that despite having one of the highest levels of mental illness in Europe, Ireland has fewer adult psychiatric beds than most other European countries. There has been a sharp drop in the number of those beds in the five years of the Fine Gael Government. The closure of Navan and the move to Drogheda will only reduce the number of beds available in our region. We are also concerned that it will be difficult for people who live in places like Oldcastle, Kells, Athboy and Trim to get to Drogheda. Indeed, family and friends are very important to the support of persons receiving treatment but they will not be there because the public transport links to Drogheda are simply not good enough. On top of this, there are concerns that the Drogheda building to house the new unit has not been signed off as of yet and that the pathway for patients has not been properly created. Patients admitted to Navan's accident and emergency unit are an example. We have just heard the difficulties patients have had when admitted to accident and emergency of not getting to see the specialists with psychiatric experience that they need.

Due to health cuts, Meath has 33% less money for mental health services and this is going to be something which is very important for the Minister of State over the next five years. For every individual in County Meath, there is €104 spending on mental health services. That compares to a State average of €150 per person. This is not unique. Across a whole range of socio-economic areas, Meath is at the bottom of the funding list. That is because we have had a massive growth in population in the 1990s and the last decade. There are 80,000 new people living in the county but there has not been a major increase in funding to deal with that. That underfunding has a real human impact. I can give one example. There is a growing number of patients with schizophrenia in Meath who are being prescribed a drug called Clozaril to ameliorate their symptoms. This drug is usually prescribed at the end of a person's treatment - in other words, when all the other drugs and treatments have failed. It is a very strong, dangerous drug but in most cases, it allows patients to be able to live full and normal lives. However, the danger of the drug means there is a necessity for a specialised nurse to administer it. Due to cuts by the Minister of State's Government and the lack of funding in County Meath, there is no second nurse. The only nurse who is there is at complete capacity.

When I put the question to the HSE as to why it would not fund another person, it said it did not have the funding to do so. It cannot be clearer than that. This is a fool's errand. Patients who do not get the service in County Meath face extreme difficulties on a humanitarian level, as do their families, but some are then forced to spend their time in the 24/7 psychiatric units the Government is closing. There are three or four more patients being prescribed the drug every month. The cost of the patient receiving the drug and living a full life compared to the cost of keeping a patient in a 24/7 psychiatric unit is not comparable. It is a fool's errand. The lack of funding for a second specialised nurse is actually costing the Government more. I hope that in the next five years, the Minister of State will pay attention to that underfunding element we have in County Meath and ensure very quickly that we have a specialised nurse available in the county to administer this drug. I also hope she will stop the closure of the 25/7 psychiatric unit in Navan.

Photo of Alan FarrellAlan Farrell (Dublin Fingal, Fine Gael)
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I congratulate Deputy Helen McEntee on her appointment as a Minister of State to tackle a very important subject and an issue which has not really received the required political attention over the last number of decades. It is important to note that we now have a dedicated ministerial appointee with responsibility for this portfolio.

I will start by addressing an issue which in certain circles remains a taboo and something which is not discussed openly. That is regrettable. If we are overweight, we exercise and if we need to improve our knowledge, we study. However, when it comes to the most important muscle in our body, we do not exercise it. We do not speak about it and we are not really given the opportunity to be heard and yet that can often be the antidote to depression. It can help even those who might not like to classify themselves as depressed but might say they are feeling low. This relates to one in four of us statistically but everyone in certain professions finds this is a subject that arises from time to time. It is important for us to recognise the importance of being able to talk and be heard and to ensure that the State provides a service which can cater to all of those in need of support, whether through resources and physical buildings or the personnel to support the general public.

I am glad to see that there is a focus on mental health services in the programme for Government. I remember debating this in the Chamber and I was in the Chair at one time listening to various Members discussing mental health prior to the formation of the programme for Government. It is important to see that focus on the subject in the programme and its result in the appointment of a Minister of State with responsibility for the area. I am pleased to see this approach being taken in the programme for Government, particularly with the acknowledgement that the budget for mental health will be increased on an annual basis. We must work tirelessly to progress and implement A Vision for Change, which is ten years old this year. I am sure the Minister of State will do just that.

Education allows people to disassociate mental health issues or depression from the taboo status it has had in society heretofore. As such, the introduction of a junior certificate subject in this area is very important. Education is the key to a vast majority of issues across Irish society. If we can provide school children with the opportunity to articulate issues in what is a very pressurised environment for them in terms of bullying and physical concerns about appearance and so on, that will be positive. It is important to provide a broad base for our school children to come through the education system with the tools necessary to tackle issues that might arise with their own mental health as they grow older. We always come under pressure. The last ten years or so have been incredibly problematic for families the length and breadth of this country, whether as a result of unemployment, mortgage distress or other issues like that.

Not a day goes by that my office does not speak with individuals who, despite so many years having passed, are still under severe pressure, be it from small personal debts, issues relating to their family homes or so on. The stress that this can cause for families can shove a wedge between couples and mortgage holders, resulting in the collapse of marriages and partnerships. Several Departments can provide support, but the most important is the Department of Health, which is tasked with an added emphasis on providing mental health services.

The new junior certificate subject will be accompanied by the establishment of a national youth task force on mental health, which will target how best to promote awareness among young people across the board. As outlined in the programme for Government, we will conduct an evidence-based expert review of the status of Ireland's implementation of international best practice in terms of mental health. We are a small country of just over 4 million people and, while we have proven for many decades to be world leaders in innovation at Government level, we must learn and be informed by international best practice. The best way to improve our health services, particularly mental health services, in this way is for our Minister, Ministers or Oireachtas committees to investigate and speak with representatives of various nations at health service or parliamentary level. It is a positive that we are utilising this option and conducting an evidence-based review. We must increase awareness of mental health in every community so that we might promote a discussion and remove the stigma that, unfortunately, continues to apply in Irish society to mental health issues.

I apologise for having missed the previous Deputy's contribution on the provision of acute services, but the development of the national forensic mental hospital in Portrane is a positive step. It provides a 21st century state-of-the-art facility almost in the heart of Dublin that caters for those who require 24-hour care, outpatient services etc. While the facility on the south side of Dublin is good, it is bursting at the seams and does not provide all of the requisite services. Centralising services will be important, although some issues arise in the constituency, as is always the case with such developments. The HSE's broad approach in its delivery of this facility is to be welcomed.

The mental health budget has increased year on year from €711 million in 2012 to €826.6 million in 2016. While this includes a lay-over from last year, there were reasons to do with the recruitment process for that €35 million being held back. The new Dáil arithmetic means that we must all work together if we are to do anything. The recruitment process to put experts where they are required must be prioritised, which I am sure the Minister of State, Deputy McEntee, will do in the coming months. The development of the national forensic mental hospital in Portrane is important in the move towards a patient-centred approach.

I am sure that every Deputy knows someone who has faced mental health difficulties. We have all heard from constituents who have been impacted by such difficulties. It is important on this subject that the Dáil arrives at suggestions. I presume that this matter will go before the Oireachtas health committee, once it has been formed, for the purpose of debate and informing it of examples from which we can extract and implement best practice. It is up to us all to make a positive contribution to what is an important subject.

6:25 pm

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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I call Deputies Eugene Murphy, Fleming and Rabbitte, who are sharing ten minutes with three minutes and 20 seconds each.

Photo of Eugene MurphyEugene Murphy (Roscommon-Galway, Fianna Fail)
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We had better get going because time is short. Like other Deputies, I wish the Minister of State, Deputy McEntee, every success in her portfolio. She will leave no stone unturned in dealing with this issue. She will have the co-operation of all Members in tackling what is a problem for society. Every Deputy knows the situation and has seen the stress, heartbreak and puzzlement of children, aunts, uncles, mothers, fathers, brothers and sisters as they try to grapple with their families' tragedies.

We have heard all of the statistics, for example, the 11,000 people presenting at accident and emergency departments last year after self-harming, and about budget cutbacks, but I will not dwell on the latter. I want to move forward and try to rectify funding cuts or improve the service so that no one is left without help. Too often, people in my locality present at a hospital but cannot be looked after. This is not the staff's fault. Rather, it is because there is no money to provide the service. This aspect of community services is important.

I wish to refer to my constituency. The Minister of State will know a bit about it. Jigsaw, the mental health counselling service for young people, closed in County Roscommon last February because it could not recruit a clinical co-ordinator. The good news is that the service will re-open shortly, but only on a limited basis and without a full staff complement. The people in charge at Headstrong promised us that a full-time clinical co-ordinator would be put in place, but that will not happen. These services are important. Jigsaw provided a vital service for young people in Roscommon, with free counselling for people aged between 15 and 25 years of age. It was temporarily closed in February due to problems with recruiting clinical staff to deliver an important one-to-one service for young people. Despite four attempts, the most recent of which occurred this month, Headstrong was unable to fill the clinical roles needed to establish a full service for Roscommon. Now, the service will only re-open on a limited basis.

I want people to take note of my next few lines. In the past three years, 409 young people accessed Jigsaw's services in County Roscommon, including 96 in the past year. Jigsaw is an important service for Roscommon and everywhere else it operates. Ours was a good service. I hope that the Minister of State can do something to reinstate a full service so that young people can be looked after.

Photo of Seán FlemingSeán Fleming (Laois, Fianna Fail)
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I welcome the opportunity to contribute on what is not a debate, but a discussion on mental health. I congratulate the Minister of State, Deputy McEntee, on her appointment and my Fianna Fáil colleague, Deputy Browne, on his appointment as mental health spokesperson during the life of this Dáil. I hope that substantial progress is made.

When I think about mental health, I think about the people. I am an accountant, but this is one debate that is not about statistics and numbers. Although we could cite them today, we would be missing the point. This issue is about the hundreds of thousands of people who are suffering as we speak. People will have been surprised by our interest in this debate since it commenced a couple of weeks ago. There is not a Deputy who has not been asked by many constituents about whether he or she has contributed, or will contribute, on this debate. A large, silent group of people are watching what is happening in the Chamber. They hear talk of other issues, but these are the ones that matter to them because they are suffering in silence.

6 o’clock

It means many people suffering from mental health issues are not living their lives to their full potential. Their families are not either because there is an impact on them and their communities.

The first point we have to accept is that there is no easy answer; it is a journey and there will always be a long journey to go. We all talk about how people should be more open. Men should be much more open. More often than not, the funerals of those who have committed suicide in my area are of men. Sometimes it is women. It is saddest when it is a young person. One feels he or she must have been in a very dark space when he or she felt there was no way out or way ahead. This requires understanding, not judgment. It is very easy for people to be judgmental and say, given an individual's circumstances, he or she should be better off than others. However, there is no accounting for what happens people's brains.

Many people suffer from financial or emotional stress. There is more stress in the rat race of modern-day life than there used to be. Often, there are no answers when it is all said and done. This is why I say people will be on an ongoing journey. The more we talk about mental illness here, the more we will increase its priority in the national debate and political agenda. That, in itself, will lead to additional funding. It is easy to allocate an extra €10 million here or there for various services but there should be greater understanding among people as to what is actually involved. We need to accept that the mental health service has been the Cinderella service of the health services. If this debate achieves nothing but an increase in the profile of the need to deal with mental illness, it will have done everybody who suffers from mental illness a lot of good. They will know they are not alone.

6:35 pm

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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I wish the Minister of State, Deputy Helen McEntee, all the best in the future. I will continue on from where Deputy Fleming left off. It is a journey.

When we speak of mental health, it has many connotations. It is a broad ranging and far-reaching concept and crosses every boundary, including age, gender and status. It defies adequate coverage by me in my two minutes and 49 seconds here this evening.

It would be wrong of me to start without saying I did not agree with the sidelining of the €12 million from mental health services when I first entered the Dáil a number of weeks ago. I felt it was very wrong, as did many Members. Let us hope for a more positive working relationship right across the Chamber so we can deliver to all, young and old, across the country. Protesting groups, such as the Union of Students in Ireland and Mental Health Reform, are indicative of the sectors in which the cuts are having a direct impact. These include the young, the elderly, adolescents and those going through university, the adults of tomorrow. Also included are young families, the highly qualified unemployed, the poorly paid, those in JobBridge, the homeless, the evicted, the indebted, the new poor, the casualties of the Celtic tiger, the marginalised and the disempowered of society. In the words of Dr. Harry Barry, there is no joined-up thinking and the disconnect between government and reality is alarming while the crisis of suicide is escalating.

As Front Bench spokesperson on children and youth affairs, I want a bottom-up approach and early intervention. I want us to start with the children. This is where it all begins. If we work with CAMHS, start out in the community and the preschool service, get relevant people into the schools and support the parents and teachers, we will actually be cutting out the problem from our queueing systems in hospitals.

In 2014 in east Galway, from where I come, we lost St. Brigid's. There was an outcry over its loss. We channelled all the people with mental health issues into University Hospital Galway where there is a 250-bed unit bursting at the seams. It cannot cater for this. There are people presenting at the accident and emergency unit in University Hospital Galway with psychiatric needs but it is not the right environment for them. Having gone that far into Galway city centre, they will already have sat for an hour in traffic. If one has come to Galway from Coose, which is on the boundary between counties Galway and Clare, or Portumna, which is on the border between counties Galway and Tipperary, or where Deputy Eugene Murphy is from, off down in the bowels of Roscommon, one will have been in the car for two hours, and one might be on medication. We have to think of the person driving the ill person. The latter are probably undergoing psychosis or having hallucinations. They sit praying to get to their destination. When the patient arrives at University Hospital Galway, he or she must then sit in a queue in the hope of gaining access to a bed.

What really frustrates me - I did not realise this until a number of weeks ago - is that neither department talks to the other. The rooms in the psychiatric part do not feed into the overall governance.

My last point is on youth. The standard operational procedure issued to CAMHS last June clearly set out that it is not the role of CAMHS to make recommendations that determine the provision of specific educational supports or resources as that is the responsibility of the Department and the National Educational Psychological Service. I want the Minister of State to find out why two Departments are making the decision? Children have to be assessed twice. This is clogging up the whole system and it is really frustrating to parents.

Photo of Brendan GriffinBrendan Griffin (Kerry, Fine Gael)
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It is very positive that we have been having this discussion. I listened quite intently to many of the contributions. Some excellent proposals have been made by Members throughout the Chamber. I know the Minister of State will take the very best of them and all the positive ones on board and implement them. I congratulate her on her recent appointment and wish her the very best in her new role. I am sure she will do an excellent job. Mental illness is an area she feels very strongly about. I speak for every Deputy in saying any assistance on this issue we can give will be forthcoming. The Minister of State's role is very important.

Given the shocking figures on suicide and people presenting with mental health difficulties and the fact that modern communications technology and media can expose everybody to global events at the touch of a button on a telephone in the privacy of one's own home, very often when alone, I feel there is growth in anxiety. Perhaps with the exception of people at the front line in war zones or those in extraordinary circumstances, people are now being exposed to types of phenomena to which they may never have been exposed in the past. This is being treated as ordinary but I believe it is extraordinary, particularly for young people, very impressionable people and vulnerable people who are seeing all sorts of unspeakable violence and tragedy unfolding before them through social and various other media. It is a cog in a wheel but not something we should overlook either. The growth in anxiety levels is partly attributable to daily exposure to material people were not exposed to previously. It is just a cog in the wheel but it is a factor. In the future, as we try to tackle some aspects of the problem, we should consider this.

Unfortunately, there have been a number of very tragic suicides in Kerry in recent days and weeks. It seems to keep happening despite all the efforts made by so many people. Families and friends of suicide victims ask what more they could do, or what can be done. The State should certainly ensure that absolutely nobody slips through the net, that everybody experiencing a crisis has help and that there is no reason for someone not to receive help.

We must address crisis welfare to ensure those who are experiencing a crisis do not face problems caused by a lack of finance or restrictions to access. A person transferred to an accident and emergency unit after a road traffic collision will receive the best possible treatment irrespective of his or her financial circumstances, whereas people experiencing a mental health crisis must often join a waiting list for treatment when they present at a hospital. That is not good enough. People presenting in a crisis must be treated similarly to those who experience trauma in a road traffic collision. If such treatment is not available on the spot, the State must provide the funding needed to allow the individual in question to access treatment or assistance. This would not cost the world and would be supported by all sides in the House. Access to assistance must be provided.

On maternal health, I recently attended a meeting in Tralee organised by the Nurture charity. I urge the Minister of State, Deputy Helen McEntee, to meet representatives of the group as it provides a fantastic service. One of the issues raised at the meeting was the lack of accreditation for counselling services. This issue must be addressed.

Counselling services should become part of the culture of the workplace. Given the stressful nature of employment, the provision of workplace counselling services should become the norm rather than the exception.

We must take a ground-up approach to mental health, which means people should not wait for the State to do everything. This process must be driven by every citizen, starting at primary level. Children in primary school should learn about mental health in the same way as they learn about toothache or looking after themselves through sport. It should be a mainstream, ordinary part of the curriculum.

6:45 pm

Photo of John Paul PhelanJohn Paul Phelan (Carlow-Kilkenny, Fine Gael)
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I thank Deputy Griffin for sharing time. I congratulate the Minister of State, Deputy Helen McEntee, on her appointment to a very important position. I hope the Government will give her the resources necessary to tackle, in so far as she can, the issues that arise in the mental health area. As these are many and varied, I will not dwell on them in great detail other than to mention a couple of important issues.

Speaking as someone who spent six unhappy months as a mathematics teacher, I believe the Government must reinvest in guidance counselling at second level. In its first year in office, the previous Government's decision to integrate guidance counselling hours in overall school hours resulted in a significant reduction in the number of guidance hours available in secondary schools. As the economy improves and more investment is made in education, particularly in second level, the issue of guidance hours should be tackled first. While this issue does not fall directly within the remit of the Minister of State, I hope she will be in a position to influence the Minister for Education and Skills and ensure action is taken on the matter. As Deputy Griffin outlined, people in every walk of life face many pressures. Young people, in particular, are under pressure caused by unrealistic expectations, social media and so forth. For this reason, the cuts in guidance counselling must be reversed as soon as possible.

The statements people make on social media never cease to amaze me. People would never dream of making the same comment to one's face or if one was willing to answer them back. I took a leaf out of the Acting Chairman, Deputy Durkan's book by answering back on social media. It is amazing that some people who hide behind anonymity are not used to people they target answering back. Some people will call politicians every name under the sun because they believe it is fine to abuse us. While I accept that social media, as with all other media, cannot and should not be censored, an element of personal responsibility must attach to the statements people make on social media. While I do not know how this issue can be addressed, I note the House has not yet had a proper discussion of the issue.

I grew up in a household in which mental health was always discussed. In the past ten or 15 years, the stigma attached to speaking about mental health has been declined, although it has not yet been eliminated. Nowadays, people feel they can speak about issues that remained unspoken previously. An uncle of mine who lived with my family spent most of his life in a psychiatric hospital where he should never have been placed. Thankfully, this no longer occurs for the most part because families and the institutions of the State are much more aware of mental health issues and must more able and better resourced to deal with them. A job of work remains to be done, however, and I hope the Minister of State, as the face of mental health in government, will ensure it continues.

Photo of Mick WallaceMick Wallace (Wexford, Independent)
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Two weeks ago, I held a public meeting in Wexford to discuss the state of mental health services in the county. Ten groups were in attendance, namely, Good2Talk, the Collective Sensory Group, Cycle Against Suicide, New Me, New Ross, the campaign for Wexford's acute mental health service, Creacon Lodge wellness centre, Eolas Soiléir, Cura, See Change and the Cornmarket Project. These groups, among others, pick up the slack when the Health Service Executive is lacking but receive very little credit for doing so and next to nothing in the way of funding. The meeting heard from people who are going through or had been through the mental health system, others who could not access services and others who wanted to break free from HSE services.

There is a crisis surrounding mental health and mental health services, and nowhere is this crisis worse than in Wexford. Sadly, it is directly connected to neoliberal Government policy and the rise in inequality it has caused. Figures released last month by the charity, Mind, revealed that 46% of people with mental health problems in the United Kingdom had considered taking their lives or attempted to do so as a result of social factors such as debt and welfare difficulties. The austerity programme of the past seven years has taken its toll on the collective well-being, in particular in the area of mental health. One of the most maddening aspects of these years was observing cuts being made to mental health services just when support and resources were needed most.

Children and teenagers are being failed most. Even from a purely economic perspective, this is a disastrous position. Many studies, most recently a study carried out by the Centre for Mental Health in the United Kingdom, have shown that there is a serious economic case to be made for improving prevention and early intervention services. Money is much better spent reshaping services for children and young people and on community based alternatives than on inpatient crisis care in general. Sending patients far from home to access acute care when they are in crisis is expensive and bad for the patient, his or her family and his or her recovery. Despite this, only ten inpatient beds are available for those aged under 18 years in the entire south of the country. These are all located in the Eist Linn centre in Cork. Let us imagine the case of a teenager who survives an attempted suicide in Wexford and desperately needs around-the-clock supervision. If he or she is lucky enough to get a bed, it will mean travelling more than 200 km. That can hardly be described as humane.

The meeting the other week, which lasted for four and a half hours, was a very troubling experience. A number of issues stood out and were raised repeatedly during the discussion. Most important was the intense dissatisfaction with the complete absence of 24-hour acute mental health services in County Wexford. It is not a coincidence that the most recent figures from the Central Statistics Office show that Wexford has the highest suicide rate in the country. The rate doubled in 2011, one year after all acute beds in the mental health service were moved to Waterford.

People in Wexford are ending their lives because the Government has made the reckless and absurd decision that the best time to provide emergency mental health services is from 9 a.m. to 5 p.m. from Monday to Friday. The logic of that decision does not bear thinking about when we think about the times people are likely to come under pressure.

I was also struck at the meeting by the fact that nobody advocated or had anything positive to say about the medicalised model of mental health care that is promoted by the HSE. This brings us to the crux of the matter. We want better acute services but we do not approve of how these services tend to medicate rather than resolve issues and trauma. However, matters are so bad at this point that we are glossing over that concern while we call for just basic service provision. We got rid of a place that was not fit for purpose, St. Senan's, and were told that as planned under A Vision for Change, great care through community provisions would be made available. Sadly, that has not happened.

In a recent response from the HSE to a parliamentary question about the numbers of people currently prescribed anti-depressant medication by the health service, it revealed that as of 2015, there were 249,900 people on eight different versions of anti-depressant medication. This quarter of a million people comprises only those on State supported medication.

Some of the listed drugs are widely known in the scientific community to be dangerous. Seroxat was declared safe by a 2001 study and was marketed by GlaxoSmithKline as safe and effective for children and adolescents for the treatment of depression, although company executives were aware that studies had shown that the drug was no better than a placebo and caused thought disturbance and suicidal behaviour in a significant number of young people. After a ten year struggle by concerned scientists and researchers to get to the truth, the 2001 study was reanalysed and rebutted last September. However, GlaxoSmithKline refuses to retract it. Why are almost 10,000 people in Ireland still being prescribed this drug by the HSE, although we know it is unsafe? For ten years, GlaxoSmithKline intentionally deceived the public about its findings and made a killing while it knew it was killing children.

Sertraline, manufactured by Pfizer, is the second most widely prescribed anti-depressant in Ireland. It also has a woeful track record. The first study of the drug took place in Leeds University in 1983 and all the subjects who took it reported apprehension, insomnia, movement disorders and tremors. Pfizer pulled the study and yet here we are 33 years later handing it out to 42,585 people.

There are many alternatives to this top-down medicalised model of care, even for the most debilitating of mental health problems. For example, in western Lapland in Finland, there has been a state endorsed programme called Open Dialogue in place for the past 25 to 30 years. In the 1980s, western Lapland had the worst incidence of so-called schizophrenia in Europe. Now it has the best documented outcomes in the western world. Today, 75% of those experiencing psychosis have returned to work or study within two years and only approximately 20% are still taking anti-psychotic medication and a two year follow up.

The Open Dialogue approach ensures the person having the crisis is empowered and has the final word about how his or her care proceeds. Everyone involved in the crisis is invited to meet and discuss how to deal with the issue. The family, friends, care professionals, police, people who have been affected by the person and people who have affected the person are all invited to sit and discuss the best way to advance the well-being of the person in need. The Open Dialogue representative is only there to facilitate the discussion, not to judge or have an opinion about what should happen to the individual. At the centre of this process is a foundation built on respect for the individual and his or her autonomy. That alone marks a massive step forward for the person's sense of self worth and healing process.

It is frightening how much needs to change about how we provide care in this area. The Government's only solid plan so far is to remove ring-fenced funding from it. I already mentioned the group It's Good2Talk. Before the election, I saw a picture showing a huge cheque for €130,000 being awarded to that group. That was a political stroke for certain politicians. However, as of two week's ago, the group has not seen a penny of that money and has been led to believe that, for one reason or another, it will only get some of it. Will the Minister of State find out for me whether this group will get the money it was told it will get?

We are all very much aware of the problems all around the country in regard to mental health and I am sure anybody who knocked on doors during the election got it by the bucketful. Sadly, for a number of years now we have also got neoliberal government by the bucketful. This has led to significant difficulties and challenges for many people. It has also led to mental health issues for many people. Now, here we are taking funding, which was supposedly ring-fenced, from an area that is already under-funded. How in God's name can we proceed with that cut? The suggestion was made that professionals could not be found for jobs to be covered by that funding. If that is the case, the money should be put into some other mental health area. We all know there is a huge need for extra funding for mental health care all over the country, not just in Wexford. I am aware the fact we have more than 20% unemployment in Wexford is one of the reasons we now have the highest suicide rate in the country but that is not disconnected from the issue of the provision of services. The Government needs to put more money into mental health care.

6:55 pm

Photo of Bobby AylwardBobby Aylward (Carlow-Kilkenny, Fianna Fail)
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I am delighted to have the opportunity to speak on one of the most pressing issues of our time, mental health. Like many Deputies, I had to make a number of requests for speaking time on this issue, which gives an indication of the impact of mental health problems in every constituency. Depression, anxiety and other such conditions do not discriminate but affect people of all ages and backgrounds at any stage in their lives. Addressing this issue is a huge challenge for our new Minister for Health and I wish him and the Minister of State well in that respect.

I recently met with the Kilkenny consumer panel on mental health services, a voluntary group of service users, family members and staff working in partnership to improve local mental health services. They are extremely concerned that the mental health budget has been raided to the tune of €12 million. We all understand there are great pressures on the health services in this country but I cannot overstate my view strongly enough that mental health services should not be subject to any diminution of funding.

The mental health situation in this country is reaching epidemic levels and we need investment, as opposed to cuts, to improve staffing levels, the provision of services and the quality of care available in all parts of the country. Service users, their families and friends and those who continue to suffer in silence need to see investment in psychiatry and psychology health professionals. They need sustained and meaningful engagement between the Department of Health and groups such as the Kilkenny consumer panel to identify the best ways to help those who suffer the most and those who suffer in silence. People who come forward and speak openly about their experience with mental health problems are to be commended for doing so as they inspire hope for those who remain silent. However, it is those who suffer in silence who are most at risk of allowing a mental health problem to fester and manifest itself through real physical harm, such as suicide. The Kilkenny consumer panel recently wrote to the Minister expressing its legitimate concerns. I have a copy of that correspondence for the Minister if he or the Minister of State would like to see it following this debate.

Groups such as Men's Sheds have saved countless lives and must be supported further. I met with the group's CEO, Mr. Barry Sheridan, recently and he explained to me that it has a budget shortfall of €200,000 per year. This is a lifesaving network that is attended by more than 10,000 men per week in 300 communities in Ireland. Mr. Sheridan explained to me that the group receives three or four requests for new sheds to be set up every week. This means there are three or four communities coming forward every week seeking help from Men's Sheds because of the demand for effective mental health services that work in their towns or villages.

The HSE must provide avenues of funding to groups such as Men's Sheds but I dare say that their work is being undervalued. Increased investment could go a long way in such organisations and, ultimately, save lives.

Will the Minister of State address the clear and apparent problems we are having with recruitment? What action is she undertaking to find out why psychiatry and psychology graduates are choosing not to enter our mental health service and what provisions are being pursued to ensure that such posts are filled in the future?

Fianna Fáil is committed to reviewing what still remains to be achieved under A Vision for Change and it wants to see an updated plan for 2016-2026. A Vision for Change was brought in for the 2007-2011 period by the former Minister of State, John Moloney, who had forward thinking ideas about mental health. We all know about what were the old mental homes and we know of the importance of getting people out and integrated into the community. That was what A Vision for Change was about and it needs to be pursued by this Government. We need to properly fund our mental health services as current funding is insufficient to deliver the staffing levels envisaged by A Vision for Change.

7:05 pm

Photo of Margaret Murphy O'MahonyMargaret Murphy O'Mahony (Cork South West, Fianna Fail)
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I congratulate the Minister of State, Deputy McEntee, on her new position as Minister of State with responsibility for mental health and I know she will do a great job. I wish her well in her new important role and I guarantee my support in anything she endeavours to do to raise awareness of, and the importance of, good mental health. I thank Deputy Aylward for sharing his time with me. I have been waiting a long time for this slot, which shows the importance of the issue.

Peace of mind is a natural condition and is available to everyone. Good mental health strengthens and supports our ability to have healthy relationships, make good life choices, maintain physical health and well-being, handle the natural ups and downs of life and discover our potential and grow toward it. Businesses benefit when employees have good mental health. Mental health is associated with higher productivity, better performance, more consistent attendance and a reduction in workplace accidents. It is imperative that businesses provide workplace support for people who are going through a hard time in their lives.

Early intervention is extremely important in the whole area of mental health. If a person is feeling down, it is imperative that there are services and supports available to help prevent their feelings from escalating and becoming unbearable. The whole notion that it is okay not to be okay needs to get out there more. In general, we are very quick to discuss and seek help for physical conditions and problems but very slow to speak of or seek help if we are feeling down or feeling vulnerable.

There needs to be more helplines available and maybe an idea would be to increase the number of age appropriate helplines. The important thing is that people feel encouraged to use these lines. We need to engage and implement a robust strategy to ensure that every man, woman and child in Ireland feels thought of, cared for, safe and well.

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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I now call on Deputies John Lahart and Dara Calleary, who are sharing ten minutes. Deputy Clare Daly was scheduled to come in before the two Deputies but was not in the House.

Photo of Clare DalyClare Daly (Dublin Fingal, Independent)
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I have just left the business meeting.

Photo of John LahartJohn Lahart (Dublin South West, Fianna Fail)
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I have no problem giving way to the Deputy.

Photo of Clare DalyClare Daly (Dublin Fingal, Independent)
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The Deputies may finish their ten minutes if they wish.

Photo of Dara CallearyDara Calleary (Mayo, Fianna Fail)
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No, Deputy Daly may speak.

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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Then I call on Deputy Clare Daly. We will make allowances for the business committee.

Photo of Clare DalyClare Daly (Dublin Fingal, Independent)
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I thank the Deputies and the Acting Chairman. The number of people who want to speak and the fact we are debating who goes first are indicative of the seriousness with which the public and Deputies across the House take the issue. When the debate started, there was a big outcry on social media that we were not in the Chamber and were not interested in speaking but that reflects the lack of public knowledge about how this House works. It is normal for people not to be in the Chamber during part of a debate. It also showed that people wanted to engage with and to watch this Parliament for once because we were discussing an issue of critical importance.

Mental health is hugely important. During the nominations for Taoiseach, I read out a letter from a woman in my own constituency whose family had been very much affected by this issue. Her family ran into financial difficulties around mortgage repayments, resulting in relationship breakdown, and she was unable to access mental health services in her area. Ultimately, the woman died through suicide and the family was left with many unanswered questions. After I read the letter out, the amount of feedback I received really showed how much this issue had affected so many people. It touched people and people saw in it something of their own circumstances, or those of their sister, family and so on.

The link between austerity and mental health issues cannot be ignored as the two things are intrinsically linked. So many people are now experiencing these issues that one cannot divorce it from what is happening. We have seen an undermining of the social fabric like never before. We have seen an undermining of the concept of public services and a greater emphasis on individualism, which is contributing to isolation and is very unhealthy for people. Psychologists Against Austerity have called neoliberalism "poisonous public policy". It is fairly obvious when one thinks about the unspeakable pressure people have come under as a result of their situations; they are perfectly predictable and natural reactions to what they are faced with. If one takes away people's security of employment and housing and leave them to drown in debt while taking away their social protection and removing community supports, it is no surprise they suffer and that their mental health suffers. One in five suicides worldwide is linked to unemployment and job insecurity and huge numbers of suicides are linked to depression and anxiety as a result of not being able to access a job. In this context, cutting mental health services is like closing oncology departments after a nuclear disaster. It is the last thing one should do.

The fact that the mental health budget has been even touched is absolutely scandalous and is the wrong answer to the issue. Actions speak louder than words. The first day Deputy Enda Kenny was elected as Taoiseach he spoke about the need to teach young people resilience and said that they and their families could access the services they need. Resilience has a particular meaning in mental health services but to hear the Taoiseach say that, when the actions of the last Government have actually contributed to poor mental health, is not acceptable. There were cuts to mental health budgets to the tune of almost €214 million, or 21%, between 2009 and 2015. There is a link and those in power have to take responsibility for that. People could infer from the Taoiseach's remarks that they would have to put up with whatever was thrown at them.

The facts as they relate to Ireland show that we are performing very poorly. Ireland has the fourth highest rate of suicide in Europe among young people aged between 15 and 19. Almost one fifth of people aged between 19 and 24 have experienced some type of mental health problem and 75% of mental health difficulties arise before the age of 25, so that age cohort must be our starting demographic. Young people in society need our help the most. The Taoiseach directed them to the services but sometimes the services are not there. Sometimes they are, of course, and I praise the great initiatives that have been taken, such as the Jigsaw programme in second level schools where young people engage in peer mental health tutoring with their school colleagues.

It has been shown scientifically that if young people talk and open up to other young people - perhaps those who are a little older than themselves and might be perceived as cool kids in the way younger teenagers look up to older teenagers - they take in much more from such peer mentoring than they would from adult mentoring. The programmes being run in our second level schools are absolutely worth their weight in gold. They encourage young people to talk and open up. They emphasise that there is no such thing as a small problem or a problem that cannot be shared. This service is an asset that needs to be developed.

Pumping people up on anti-depressants is not the best way to deal with these issues. People often need counselling. They need to talk and listen. In many cases, people do not have the money for such services because they are privately run. It can cost between €60 and €100 an hour to continue with counselling. Those who cannot afford private services have to wait for months to access the services provided by the public system, which do not extend beyond a maximum of eight sessions. We cannot have a health service like that. It is letting people down and costing lives. That is why any discussion on mental health must be linked with economic policies. Neoliberal economics is directly at odds with the idea of good mental health.

I do not have time to speak about the fragmentation of mental health services, as evidenced by the presence of different providers. Instead, I will focus on the issue of mental health in prisons. The Jesuit Centre for Justice and Faith, which made an excellent presentation to us this morning, has released a report about young people in prisons and the dangers of solitary confinement. All of the empirical evidence shows that a significant proportion of those who end up in prison have mental health problems. People with such problems are disproportionately represented in our prison system. We have not managed to find a proper system of interim care between the old institutional model that prevailed in years gone by and the care in the community model that exists now. There is a gap there.

Many people end up in our prisons because they are responding to behaviour, trauma or crises that happened earlier in their lives, when their mental health issues were not dealt with. It is enormously expensive to keep some someone in a prison. The best way to deal with someone who has mental health problems does not involve putting him or her into an environment where, at best, he or she will be locked up in their cells with one or two other prisoners for 17 hours a day. Some people can be in solitary confinement or lock-up scenarios for 23 hours a day. These are the mechanisms that drive people to mental health problems. Clearly, such an approach does not help people to sort out their problems. At this morning's meeting, Fr. Peter McVerry and others suggested that the services in our prisons should not be equal to what is in the community - they should be better than what is in the community. That might sound a bit mad but there is a need to re-tilt the balance. One of reasons some people end up offending and getting involved with our criminal justice system is that they have not been given the supports they need. Once they are linked in with the system, we should be going over to help them sort out their problems. This area needs huge consideration, particularly in light of the correlation between young people and offending and the prevalence of mental health issues among young people.

Everybody in this House has a genuine desire to tackle these issues. This is one of the biggest problems facing Irish society. We have to back up our approach to it with the empirical studies showing that economics feeds into mental health difficulties. A different type of tack needs to be taken from an economic perspective if we are to deal with this issue.

7:15 pm

Photo of John LahartJohn Lahart (Dublin South West, Fianna Fail)
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I would like to share time with Deputy Calleary.

Photo of Alan FarrellAlan Farrell (Dublin Fingal, Fine Gael)
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Is that agreed? Agreed.

Photo of John LahartJohn Lahart (Dublin South West, Fianna Fail)
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I am pleased to have an opportunity to speak on this issue. I am not sure whether it is good to draw a dichotomy between health and mental health. I know we need to accentuate the whole mental health argument in order to raise awareness of it but at the end of the day, it is all about health. I think we will have reached a successful point when people regard their mental health as an essential component of their overall health and well-being. I hope we will reach a day when we do not need to talk about mental health as opposed to physical health.

The demand for speaking time during the debate on mental health reflects well on this Parliament. Like some of my colleagues, I am getting to contribute to this discussion at the third attempt. My slot is quite short. There has been a rich tapestry of contributions from Deputies on all sides of the House. Everyone has had something unique to contribute to the debate. I know the Minister of State, Deputy McEntee, will take that on board. Her task is to parse what has been suggested and come up with a cohesive policy.

Many of my colleagues will know that there was a positive protest on the street outside the Dáil in recent weeks. As I was walking back in through the gates of Leinster House that day, I heard someone call my name. It turned out to be an 18 year old student from my constituency who had taken a half-day from school to be here. The person in question had walked to Kildare Street because they wanted particular issues to be raised. When I stopped at a petrol station in Rathfarnham on my way home that evening, I ended up engaging in two conversations with constituents on the whole topic of mental health, which was quite live at the time. All of this shows that this is a big issue. The Minister of State does not need me to tell her that.

I would like to focus on a couple of issues during my brief comments. I am not making a political argument when I mention that the establishment of a national mental health authority was included in Fianna Fáil's manifesto for the recent general election. I suggest that a national mental health authority, filled with experts from across the wide range of mental health fields, is badly needed to co-ordinate the entire public policy approach to mental health and to give mental health a central position in national dialogue, policy and development. A national mental health authority could ensure every Department and Government decision is mental health-proofed. We have never done that before. Other kinds of proofing take place when decisions are made by the Government but we need to engage in mental health-proofing to improve awareness of the downstream effects of Government and Department decisions on mental health.

We need to look at the crude figures for investment in mental health and in structures supporting mental health from a cost-benefit perspective. It has been proven in other jurisdictions, including Australia and New Zealand, that such investment results in a reduction in health premiums in line with the reduction in the cost of mental health difficulties to health insurers. I am bringing the debate down to the brass tacks of figures. We also need to start a more coherent and developed national mental health conversation. The recent appointments to the Seanad indicate that my party is taking seriously the need for such a conversation.

Many people of all ages are not aware that their mental health can suffer in times of stress, crisis and loss. This is a big issue that needs to be addressed. Having worked in this field for a number of years, I am aware that this aspect of the matter can come as a surprise to many people. Many of my clients were really taken aback by how they were responding to previous traumas or crises. Many people are not aware that it is perfectly natural to feel bad or down - or "abnormal", as my colleague said - in the teeth of or the aftermath of a crisis or loss. Many people are not aware that when we suffer loss or trauma, the body holds onto it and finds some kind of way of letting that loss or trauma go. How could we be aware that it is okay to feel sad, down, angry, frustrated, anxious, hopeless or depressed when our national stereotype involves suffering in silence? We need to break that kind of stereotype.

I have much more to say on this issue but time has run away with me. I will finish with a sentence that is known across the psychological field: "Lack of expression leads to depression". We are still on statements but action will be needed at some point. I look forward to seeing what the Minister of State proposes out of the fruits of these statements.

Photo of Dara CallearyDara Calleary (Mayo, Fianna Fail)
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Guím gach rath ar an mbeirt Aire Stáit nua. Tá jab an-tábhachtach le déanamh ag an mbeirt acu. Guím gach beannacht orthu. When one lives in a town that has a river running through it, the sound of the search and recovery chopper coming over the town brings fear into every house. The closer one lives to the river, the more clearly one can see the Air Corps crew of the chopper as they fly over the river, with the heat-seeker going up the river, looking for somebody who has sadly ended his or her life.

There are other ways to look for people but that is the most public way. It is the one thing that frightens people who live along a river. We all need to work collectively to bring an end to that. The figure of 554 people who ended their lives through suicide has to come down. My party has proposed the establishment of an authority similar to the Road Safety Authority with ring-fenced funding so that civil servants do not get to play with the budget to suit their needs and we do not have a repeat of the €12 million reallocation incident a few weeks ago.

As a country, we need to collectively change our mindset. Deputies John Lahart and Margaret Murphy O'Mahony touched on the fact that this issue is one for all of us. Our mental health is as important as our physical health and in the same way we treat our physical health, we must treat our mental health. I believe young people are leading the way on this and I really want to acknowledge the work that young people did to initiate the Mindspace project in Mayo. It was a team of volunteers, led by Breda Ruane from the Mayo Education and Training Board, which involved young teenagers in transition year from around the county, who put the legwork in to create Mindspace in Mayo. It is a kind of recreation of the Jigsaw project in Galway, which does fantastic work. We need to invest in the Child and Adolescent Mental Health Services, CAMHS, and in the rolling out of the CAMHS model across the country. More importantly, we need to roll it out consistently. Geography should not dictate what level of service, what access to service or what speed of service one gets. There should be a consistent model of CAMHS across the country.

Similarly, that is why restoring guidance counselling is so important in secondary schools. There is a generation that has a notion of guidance counselling as being the career guidance teacher we all spoke to. It is a much broader and more holistic concept than that. It is the person in the school who identifies and works with young people who are going through issues and it is in school that one is more prone to such issues. A proper, functioning guidance counsellor in place will start to work with people who come under mental health pressure at school from an early age. It is important to get them into the service at an early age. As we all know, early intervention is absolutely crucial.

Why do we still force people to go through the old accident and emergency system to get emergency mental health cover? One does not want to be in the accident and emergency department. If one is under physical pressure, one has to be. However, if one is under mental pressure or mental stress, it is the last place one needs to be. We need to roll out a system of proper 24-hour emergency mental health care around the country. Again, geography should not dictate service or access. As long as we push people through the accident and emergency system, many will leave it, not go through it and, as a result, will not have that recovery experience or receive the kind of coverage that we have. An issue that was raised in the last Dáil by the health committee was that we, as public representatives, and our staff need training on how to deal with constituents who come to us.

I fully agree with Deputies Mick Wallace and Clare Daly that we have stirred up a major problem in this country. If we think we have problems now with our mental health, the events in family homes across the country in the past eight or nine years will store up a further avalanche of problems, unless we decide to invest properly in people from an early age and decide to take this seriously. Geography should not dictate what service one gets, whether one goes private or public, or whether one can recover from an incident quicker than otherwise. As Deputy Lahart said, we are all only one incident away from a mental health crisis. Nobody is immune to it. We need to embrace it and work at it as a country, as public representatives and ultimately, as a Government.

7:25 pm

Photo of Alan FarrellAlan Farrell (Dublin Fingal, Fine Gael)
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Deputy Aindrias Moynihan has ten minutes. I will have to interrupt him at 7 p.m.

Photo of Aindrias MoynihanAindrias Moynihan (Cork North West, Fianna Fail)
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Ar an gcéad dul síos, ba mhaith liom comhghairdeas a ghabháil leis an Aire agus le Deputy Helen McEntee and Deputy Marcella Corcoran Kennedy, atá anois mar Airí Stáit. Guím gach rath orthu le sin. I wish them every success in their positions and I congratulate them on their recent appointments.

When the people of this country reach out for help, it is critical that they are able to find good quality services and supports. We are more than a decade on from A Vision for Change, which was commissioned by the then Minister for Health in response to a widespread need for improved mental health services. It identified the critical structural, human and financial resources required. Sadly, the early momentum and progress that was achieved at that stage by A Vision for Change was not maintained. Things have slipped back over recent years. That happened during a time of increased demand for mental health supports. The consequences of increased demand alongside the slip back led to much larger increases in waiting lists for children and adolescents and people seeking emergency treatment.

For example, the figures in Cork are astounding. According to HSE figures, there were 537 children waiting to be seen by child and adolescent community mental health services at the end of last year. Alarmingly, 115 of those children and young people had been waiting for more than 12 months. It is very easy to dehumanise it but behind all of those figures there are real people suffering in isolation who are very distressed and very distraught individuals. In many cases, the families around them are suffering the same way.

I wish to acknowledge the huge community initiatives such as the Darkness Into Light movement and Cycle Against Suicide. These are predominantly driven by younger people who are bringing people together, increasing awareness, fundraising, talking about the issue, raising the profile and making people realise that it is okay to feel the way that they do.

Unfortunately, we are still 3,000 staff short of what was recommended in A Vision for Change. That needs to be dealt with to ease pressure and to tackle the waiting lists. What is needed is an enhanced focus and resources for mental health services. Mental health should be taken as seriously as physical health in terms of the development of State resources. We need to see the establishment of a national mental health authority to ensure that there is a single organisation tasked with the co-ordination of mental health services. We need a full review of what is still left to be achieved in the strategy and a revamp of the plan to get it back on track. We also need the reinstatement of an implementation review group which will issue regular reports on the progress being made to deliver the strategy. The people and the resources need to be put in place and not siphoned off to other areas as we unfortunately saw a number of weeks back.

The challenge is not isolated to the health services. Previous speakers identified the education system where we saw the removal of the ex-quota guidance counsellor. Unfortunately, that had a knock on effect in schools around the country. Guidance counsellors were able to offer many services aside from talking to people, accessing services and so on. It was done in a way that if a student who was distressed wanted to go and use the service, nobody really knew whether he or she was going in to inquire about the CAO, career guidance or some other distressing issue he or she had. That was a big loss in schools. If schools had been able to maintain the service, the focus would have been shifted in the service's restricted time and CAO and career guidance would have trumped guidance counselling. This service was lost at a time when young vulnerable people were at a particularly tough time in their lives. We need to see the reinstatement of that guidance counselling service in schools to be able to support people at that critical time. I know it was a significant part of my party's discussions during Government formation earlier this year. It is something that is key and we need to see it delivered on.

The provision of mental health services must be a priority for Government. Far too many people have been suffering from mental health issues in isolation and are not receiving the help and support they need from the State at the right time.