Dáil debates

Tuesday, 15 November 2016

Mental Health Services Funding: Motion [Private Members]


8:35 pm

Photo of James BrowneJames Browne (Wexford, Fianna Fail)
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I move:

That Dáil Éireann:


- the commitment in Appendix 1 of the Confidence and Supply Arrangement for a Fine Gael-led Government to fully implement A Vision for Change in the area of mental health; and

- that the Confidence and Supply Arrangement votes are dependent on the full implementation of the policy principles attached to this document;

further notes that:

- the July 2016 Estimate from the Department of Health indicated that the required resources needed to fully implement A Vision For Change are €177.3 million or €35.4 million per annum over five years;

- in 2017 the funding committed for new developments is just €15 million;

- such an increase would represent only a 1.8 per cent investment in new developments for mental health compared to the 2016 Budget; and

- even including the €9.7 million announced for increased pay rates in mental health services, this represents an increase of just 3 per cent in revenue funding for mental health, much less than the 7.4 per cent increase in revenue spending for the health budget as a whole; and

calls for:

- an urgent review of the Government’s decision to allow just 1.8 percent in additional spending in 2017 for mental health care improvements;

- a multi-annual plan to be published within three months outlining how the commitment in Appendix 1 of the Confidence and Supply Arrangement for a Fine Gael-led Government to fully implement A Vision for Change will be realised;

- any such plan to include a provision that all and any monies allocated to mental health, and that go unspent within a financial year, be carried over to the following year and not be returned to the exchequer and/or expended elsewhere; and

- any successor strategy arising out of a review of A Vision for Change to incorporate this multi-annual plan.

I wish to share time with Deputies Kelleher, Troy, Murphy O'Mahony and Aindrias Moynihan.

I am pleased to move this motion, which seeks an urgent review of the funding allocation to mental health in the recent budget announcement and a detailed plan on how the Government intends to meet its commitments under A Vision for Change. This is the third debate on mental health since the Government was formed. This in itself is welcome and demonstrates an increased awareness of mental health on all sides of the House. It would be difficult to imagine so many debates on mental health occurring even in the recent past. However, we must move beyond debates and towards implementation. Since my appointment I have met, and continue to so do, many individuals, families and groups that have been affected by mental health issues. Their bravery in the face of adversity and frustration at the lack of supports is only too evident. Equally, I have met many members of staff working in mental health services who lack the necessary supports, are over stretched and under appreciated. They feel ignored, forgotten and abandoned, just like the service users.

Fianna Fáil in agreeing to facilitate a minority Government inserted into the confidence and supply agreement a condition that A Vision for Change would be fully implemented within the lifetime of a Government. Appendix 1 of the confidence and supply arrangement commits to implementing fully A Vision for Change. Confidence and supply arrangement votes are dependent on the full implementation of the policies in that document. We agreed to facilitate budgets consistent with the agreed policy principles in the document, which runs over the full term of government of five years. Modern mental health reform began in this Chamber when Deputy Micháel Martin brought forward the Mental Health Act 2001. That Act was the first reform of mental health legislation for more than half a century. The Act radically changed how people with mental health illness were treated. In the decades prior to 2001, mental health attitudes were all too often mired in stigma, prejudice and alienation. Thankfully, they are less so today, but work still needs to be done to continue to challenge attitudes towards mental health. The main objective of the Act was to address the civil and human rights of mentally ill persons while additionally putting in place mechanisms by which the standards of care and treatment in our mental health services could be monitored, inspected and reviewed. In addition, the creation of the Mental Health Commission in April 2002 created an implementation body to ensure that the intention of the Act was fulfilled.

Following on from this reforming Act, A Vision for Change was developed under the then Fianna Fáil Government as a strategy document which sets out the direction for mental health services in Ireland. It describes a framework providing and supporting positive mental health across the entire community and providing accessible, community-based, specialist services for those with mental illness. It had broad support from patient groups and medical professionals and across the political divide. It is based on a recovery model that seeks, where possible, to keep those with mental health problems centred in their communities and to retain their involvement in their family and social circles. While the document may be in need of updating, the principles it was founded on and its fundamentals remain sound. It is ten years since A Vision for Change was published in 2006. Its terms were meant to be implemented by 2016. To date, barely 75% of that vision has been met, but for old age psychiatry, it is 53%; in the area of child and adolescents, it is barely 52%; and for persons with disabilities, it is a shockingly low 19%. It is clear that the more vulnerable you are, the fewer supports you get.

We must arrive at a point where the HSE treats the head and the heart with equal respect: a stage of parity of esteem between mental and physical health. Mental and physical health are fundamentally linked. There are multiple associations between mental health and physical conditions that significantly impact people’s quality of life, demands on health care and other publicly funded services. The World Health Organisation, WHO, defines health as "a state of complete physical, mental and social well being and not merely the absence of disease or infirmity". The WHO states: "There is no health without mental health." Understanding the links between mind and body is the first step in developing strategies to reduce the incidence of co-existing conditions. People with serious mental health conditions are at high risk of experiencing chronic physical conditions. People with chronic physical conditions are at risk of developing poor mental health. A person who presents with a broken arm is not turned away, and someone who has the courage to speak out about his or her mental health should be given equally urgent care. We do not put a limit on the care a person with a physical injury is given. We do not, for example, say to people who have suffered a broken arm that they are only entitled to eight hours of medical care and stop treating them when the plaster of Paris is only half on, but this is done in mental health care when people are limited to eight hours of psychological help.

It is acknowledged that the Minister of State has an incredibly difficult task on her hands, and has only been in her position for a few months, but the task she faces cannot be met if she is not given the necessary resources to implement the change that must be brought about. Responsibility in this regard lies with the line Minister, Deputy Harris, who has failed to fund mental health adequately. However, there is a responsibility on the Minister of State to ensure the senior Minister hears the voices of those suffering from mental health issues and to give a voice to the voiceless. In response to parliamentary questions I tabled during the summer, the Minister stated the required amount to implement A Vision for Change fully is €35.4 million per annum. In budget 2016, the Government announced the provision of €35 million, only subsequently to withhold €12 million. Following the reneging on its promise and due to public and political pressure, the Government was forced into an embarrassing U-turn. In the budget, the Minister for Health pledged to increase funding by €35 million for mental health, a sum that was welcomed only for that sum to ring hollow just a week later when under questioning from Fianna Fáil Deputies during statements on mental health, he confirmed that only €15 million of the announced €35 million was available for spending in this year. This was a spectacular U-turn by the Minister, Deputy Harris. The Government has essentially halved the funding earmarked for mental health services next year. This is despite the fact that there has been significant underfunding and underinvestment in mental health services in recent years. The reason given is there will be a time lag in hiring staff but even if this is the case, there is no reason the differential moneys could not have been spent on one-off programmes this year.

Significant work is needed to bring our mental health services up to standard. This cannot be achieved without adequate funding. Currently, the Government is planning to increase mental health funding by a measly 1.6% in 2017, as opposed to a 7.4% funding increase across the health sector. This clearly shows that mental health services simply are not a priority for this Government. Fianna Fáil remains committed to implementing fully the A Vision for Change road map for mental health services. In that respect, the motion seeks to compel the Government to do that which it appeared it was not prepared to do voluntarily, which is to carry out an urgent review of mental health funding, set out a clear pathway for delivering the outstanding elements of A Vision for Change within the lifetime of this Government, and guarantee the ring-fencing of the mental health budget. I welcome the Government’s intention to support the motion, but we need implementation. The HSE, in particular, seems to suffer from a serious condition - implementation deficit disorder. Let us not have the motion sit on top of a long list of reports that have not been implemented.

8:45 pm

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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I welcome this opportunity to speak. It is a motion that embodies what we have been saying for a long time on all sides of the House on mental health and the need to implement A Vision for Change. Deputy Browne said we have already had three debates in this Parliament on mental health. It would be a fine thing if we were debating where we will spend the money that had been committed to mental health and A Vision for Change but over the last number of years we are consistently pointing out that insufficient funds are being made available on an annual basis. The €35 million that has been ring fenced for the mental health budget over the last number of years has been consistently pilfered year after year. The spin at every Estimate and every budget is that €35 million will be made available to mental health and the implementation of A Vision for Change. Then we find there is prevarication, delay, a reduction in the budget and excuses are made about the inability to recruit and it is claimed they cannot find the required personnel or clinicians. It is simply not good enough anymore.

The Minister of State is new in her job but the bottom line is it stops with Government decisions and Government policy. The Minister of State has been handed a very bad card in trying to implement and fund a key commitment in the supply and confidence arrangement between Fianna Fáil and the Government. It is critically important that the central tenet of that supply and confidence agreement is acknowledged and A Vision for Change is implemented in full over the lifetime of the Government. That means providing €35 million for the next number of years to make sure we catch up with the deficit that is there currently. If one looks at the figures and statistics with regard to the number of people that have been recruited, over the last six years there has been a 7% increase in recruitment of key personnel as recommended in A Vision for Change. We are still a long way behind what we should be in terms of the numbers. Every aspect of mental health services in this country is underfunded, under-resourced and incapable of delivering the service that is required. When we talk about citizenship and about the need to be inclusive, to embrace people and to allow people to fulfil their opportunities, we need to ensure they are given every assistance.

In the area of child and adolescent mental health services, we clearly have huge problems right across the whole spectrum. The first major mistake made was in the context of withdrawal of career guidance counsellors in our schools. The attack on young people who need access to services is something I find very distasteful. It has been happening consistently. We should have a bit of honesty about the fact that A Vision for Change is the document we are all signed up to. It needs to be supported and bulwarked by financial resources and services and by ensuring that key personnel are put in place. We have consistently heard we cannot find the specialists. The problem is we do not have any plan in place to ensure there is consistent recruitment, training, education and retention of key personnel. That has been a distinct failure in Government policy over the last number of years.

The Government has committed to it in its programme for Government. We are only trying to advise it to implement what it has said itself. We were unsure of the Government's commitment so we insisted it was put into the supply and confidence arrangement to ensure it would be part and parcel of what we are committed to supporting in the context of this Government. We are doing it because for a number of years mental health has been discussed ad infinitumin this Chamber but unfortunately the resourcing and commitment has not been forthcoming from Cabinet. That has been consistent since 2011. If one looks back at the figures on the number of people who were retained in the service, the number of whole-time equivalents, it shows quite clearly there has been an appalling lack of commitment and determination in terms of implementation.

This motion is critically important. The Government still has time to redeem itself by ensuring a strong commitment is shown in 2017 to ensure we can play catch up in terms of the deficiency of services across all levels. We still have a very distasteful circumstance in our public hospitals where people with psychiatric problems and mental illnesses who try to access out of hours services are finding themselves presenting in emergency departments across the country. That is happening to this day. It is wholly unacceptable for those individuals.

The broader issues of pressure in terms of mental health among younger cohorts of people is something we are singularly failing to address in any meaningful way other than with lip service to a certain extent.

I wish the Minister, Deputy Simon Harris, was here to hear but I am sure the Minister of State, Deputy McEntee, will relay to him the concerns of the House with regard to the lack of commitment in view of the fact that €35 million was promised on budget day yet within a week it was confirmed it would be an awful lot less. Overall, a lot of work needs to be done but more importantly there is an opportunity at this late stage to comply with the spirit of the agreement and the programme for Government and, more importantly, to have a meaningful impact on people whose lives depend on the mental health services.

Photo of Margaret Murphy O'MahonyMargaret Murphy O'Mahony (Cork South West, Fianna Fail)
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I am very grateful for the opportunity to speak if only for a couple of minutes. Across the constituency of Cork South-West which I represent, mental health is a huge issue. A recent survey shows that 45% of farming families reported a family member being treated for emotional and mental issues. The numbers among the families of the rest of rural west Cork and towns are also very high. Early intervention, as in anything, is crucial.

The loss of guidance counsellors to schools had a particular impact across west Cork. People have told me that students could go in as if seeking advice on future careers but gain valuable information on mental health. Luckily, mental illness can be treated but unfortunately cash is needed. I cannot emphasise enough that the full committed funding needs to be provided and a plan needs to be formulated for going forward.

I will finish with a quote from Shannon Alder:

Never give up on someone with a mental illness. When the letter "i" is replaced with the letters "we" the word "illness" becomes the word "wellness".

Photo of Aindrias MoynihanAindrias Moynihan (Cork North West, Fianna Fail)
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Implementing A Vision for Change is a key priority for Fianna Fáil. The Government has said it is committed to meeting the recommendations but in order to do that, the funding, or lack thereof, needs to be addressed as a priority. There is currently under-investment in the mental health service and significant work is needed to bring it to a higher standard. It is not going to be achieved without adequate funding. Government is planning to increase mental health funding by 1.6% next year compared to a 7.4% funding increase across the wider health sector. It is a clear indication that mental health services simply are not the priority they should be. Mental health services should not be left as the poor relation. On budget day the Minister for Health announced €35 million for mental health services in 2017. The July 2016 Estimate for the Department of Health outlined that the required resources to implement fully A Vision for Change is €177.3 million or €35 million for each of five years. In the days after the budget the Minister of State outlined that just €15 million of the €35 million allocation would be spent next year. Fianna Fáil is calling for a provision that there would be adequate resource and it would be spent on mental health services. Any moneys that are not spent within that financial year could be carried over into the following year for the benefit of mental health services and for the benefit of communities around the country.

I acknowledge the invaluable work that community based organisations such as Tosnu in Ballincollig and Cunamh in Macroom do by providing key services locally and allowing treatment for people within their own community. It is an invaluable alternative to acute, inpatient treatment.

Service organisations such as Cunamh and Tosnu as well as many others throughout the country are providing lifelines to many families and individuals. They should be supported.

Everyone recognises that there are no quick fixes, but there is a strategy in place, A Vision for Change. To facilitate that strategy, there needs to be long-term planning in mental health services. It is vital that the Government moves away from allocating mental health funds on a year-by-year basis. Instead, the Government should introduce funding measures to ensure mental health services are developed further. There should be a multi-annual investment policy, a long-term investment strategy to ensure that issues will be addressed.

8:55 pm

Photo of Robert TroyRobert Troy (Longford-Westmeath, Fianna Fail)
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I welcome the opportunity to contribute to this important debate. It is disappointing that we are back here debating this issue again. We are debating this issue again because the people on the far side of the House have not lived up to their commitment to an additional €35 million in spending in this area. In fact, only an additional €15 million will be spent. The excuse provided is somehow related to time-sensitive savings. Members will excuse me for stating that no one believes that. That excuse rings hollow to the parents of the children who cannot get access to critical services.

Last month in a similar debate I raised the issue of Good 2 Talk, a service based in Mullingar and Longford. The group was established because the HSE reneged on its commitment to provide affordable counselling services for young people. An undertaking was given that the application for funding of this service would be re-examined. I received a letter stating that the funding would not be forthcoming this year. The €25,000 is critical and necessary. The service was told to apply to the Department of Health national lottery application. I am not aware of the outcome of that application. This is simply not good enough.

Last Friday, I visited the young adult mental health services in Mullingar. The group was set up on a pilot basis by the HSE. It has the potential to do good and I imagine it will. However, it does not have the potential to do good if it is established with insufficient staff. A Vision for Change, a document which is over ten years old now, stated that there should be four clinical psychologists to deal with those under 18 years of age in my region. We have two. We should have two occupational therapists, but we only have one in place now as well as one on maternity leave. Three full-time social workers are on maternity leave as well.

It is time for the platitudes, talk and promises to end. It is time for delivery. Failure to deliver is resulting in people losing their lives.

Photo of Pat GallagherPat Gallagher (Donegal, Fianna Fail)
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Minister of State, I understand the Government slot is for ten minutes. Are you sharing time?

Photo of Helen McEnteeHelen McEntee (Meath East, Fine Gael)
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Yes. I am sharing with Deputy Neville.

This is the third debate we have had on mental health in recent times. I welcome the debate as an opportunity to re-state the Government's commitment to our mental health policy and to the development and improvement of our mental health services.

The Government will not oppose the motion. We agree on the need to maintain the significant progress in this area. We have already given an undertaking in A Programme for a Partnership Government to increase the mental health budget annually to build capacity in existing services as well as developing new services.

Since 2012 an extra €115 million and approximately 1,150 new posts have been allocated for mental health suicide prevention initiatives. This happened during tough economic times for this country and at a time when every other Department had its funding cut. By the end of this year, funding for mental health will increase from the 2015 out-turn of €785 million to a projected budget of €826 million. This includes the return of €12 million, something myself and my colleagues fought hard for this year.

In addition, budget 2017 has provided for additional spending for enhanced services of €35 million on a full-year basis to enable further improvements in a range of areas. The key priorities to be addressed for me in the HSE service plan include youth mental health, further improvements to child and adolescent and adult services as well as older people services and further enhancement of out-of-hours responses for those in need of urgent services. These developments will be outlined in the HSE service plan in the coming days and weeks.

We recognise the time-lag involved in new staff taking up posts and the completion of preparations for the introduction of these services. It is estimated that the revenue spend in 2017 associated with the increased allocation will be some €15 million. There will also be a further additional spend of €9.7 million in mental health associated with increased pay costs. This increase in wages will, I believe, go a long way towards realising the full implementation of A Vision for Change in the coming years. The additional allocation of €24.7 million for 2017 will see the mental health budget increase to €851 million. This represents an increase of 3% over 2016 and a 20% increase in the mental health funding since 2012.

In addition, the Government has given the go-ahead for the construction of a new national forensic hospital at Portrane. I encourage my colleagues to visit the Central Mental Hospital to meet the staff, patients and their families. In this way, Deputies would understand why this major health infrastructure project is needed. Furthermore, Deputies would see how some of the most vulnerable people in our society will benefit from significant capital investment in 2017, when spending on this new hospital and other minor initiatives will total in excess of €50 million. Deputies have referred to one-off projects. This is possibly one of the largest one-off projects we will invest in and it is certainly worthwhile.

I am very much focused on modernising our mental health services in line with A Vision for Change. That is why overall spend next year on mental health will be over €900 million. In addition to the substantial ongoing funding commitment to service development, I have started the progress of updating our current mental health policy, A Vision for Change. I have commissioned an evidence-based expert review which will focus on the progress made to date in implementing the policy, including a review of current delivery of services in Ireland. The review will also take account of current international best practice and will inform the next steps in the development of a mental health policy, having regard to human rights and health and well-being objectives. The review will provide a solid evidence base to determine the policy direction of a revised A Vision for Change. It will provide a basis for further service development in this area and shape our future mental health policy. This is important work.

In line with the commitment given to Dáil Éireann on 6 October this year, an oversight committee will be established within three months of the review being finalised to oversee the development of a new policy for mental health based on the outcome of this review. The successor policy to A Vision for Change will include a multi-annual implementation plan to inform the allocation of resources in future years. As per the commitment to Dáil Éireann the HSE will be directed to develop a multi-annual approach to the development of mental health services.

Implementation of A Vision for Change has been affected by a number of factors since 2006, including the economic collapse and the troika. Deputies have spoken of insufficient funds. These factors resulted in no increase in funding from previous Fianna Fáil Governments. Public spending constraints and the moratorium on recruitment have affected the sector as well. However, recent years have seen investment in this areas prioritised by Fine Gael led Governments and significant advances made in the reconfiguration and delivery of services.

Although I agree that it is not enough, the increased investment in mental health services in recent years has helped to increase the number and staffing levels of adult and children and adolescent community mental health teams. Of the additional 1,550 new mental health posts approved since 2012, a total of 1,150 have been or are in the process of being recruited, notwithstanding the general challenging recruitment market in which the HSE is operating.

We must continue to invest in our mental health teams. Those working at the front-line carry out important work and we must support them. I intend to continue in this regard. Earlier this summer, I allocated €400,000 to provide 60 additional training places for psychiatric nurses. The number will increase to 70 next year. In the coming four years we will increase the number of training places by 45%. Since the summer psychiatric nurses have seen the re-instatement of their community fund and of some of their wages. I imagine Deputies will agree that we are doing our best to try to ensure we can plan for our future.

Increased investment has also funded the development of specialised services recommended in A Vision for Change, including forensic, eating disorders, psychiatry of later life and mental health intellectual disability services. We are also seeing continued development of community mental health teams as well as improved seven-day responses, liaison services, perinatal mental health care and two new clinical programmes specifically for ADHD in adults and children and dual diagnosis of those with mental health and substance misuse.

I agree with all Deputies who have spoken already in the sense that I agree there are difficulties within the service and we do not always get it right. The aim is to try to continue to improve the services. This year we are also advancing the development of counselling services at primary care level. We are providing considerable extra funding to extend services such as jigsaw, which offers free access in a more informal environment to younger people.

A Programme for a Partnership Government recognises the need to promote awareness and prevention strategies further in our education system. This is why I have established a task force on youth mental health. The task force has met on three occasions thus far. At the most recent meeting, the task force met younger people, family members and service providers to discuss the difficulties they are facing. This week, our first youth engagement panel will meet. The panel is for people between the ages of 19 and 25 years.

We have already identified key areas which we wish to progress, and I look forward to updating my colleagues more on this in the coming weeks.

I think we will all agree that the mental health needs of this country have somewhat changed. The review of the implementation of A Vision for Change will help to monitor this, but the need to plan could not be clearer. I acknowledge those in the Gallery this evening and those who are listening to this debate. There is a momentum behind this. We are all behind this, but if anybody is unsure in that regard, let me be very be clear: as Minister of State with responsibility for mental health, I and this Government are 100% committed to implementing A Vision for Change. We are 100% committed to supporting our younger people. We are 100% committed to planning for the future because lives will be lost if we do not do so. Lives have already been lost. I welcome the very open and positive discussion tonight and I thank Deputy Browne for tabling this motion.

9:05 pm

Photo of Tom NevilleTom Neville (Limerick County, Fine Gael)
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I echo the sentiments of the Minister of State and welcome some of the comments made by Deputy Browne that in the 1990s, particularly in this House, people were very slow to wake up to this issue. This was the case until recently, going back over a number of elections, as I have mentioned previously. I very much welcome the fact that all sides of the House are driving this issue forward and speaking about it. I also acknowledge with sensitivity those in the House or in the Gallery who may have been affected by these issues. We should be mindful of our comments and how we articulate them here. I understand that everyone has a particular approach to this issue and that everyone wants to see the best outcome possible for it. Fine Gael is committed to that. I welcome the overall budget of €900 million for mental health, with €50 million allocated to the Central Mental Hospital and an overall increase of €74.7 million on the previous budget. The task force set up on youth suicide must also be welcomed. The problem particularly affects young males, among whom suicide continues to this day. That is well worth noting.

A project was organised in my constituency last week by a number of young people, the Drive against Suicide. There were about 120 to 150 cars. It was an excellent initiative by young people who came together and used a medium to communicate to other young people, particularly young males in my constituency. Much of the time politicians find it very difficult to connect with young men. Cars were a medium through which connections were made with these people. Many of them had been affected directly by mishaps in their own families. It was a fantastic initiative and was a way of communicating and connecting with these people. It was quite therapeutic for them and also a way to share their experiences, raise awareness and connect with that demographic. Trying to connect with a certain cohort of young people, particularly young males, is a problem we have within the establishment and within politics. We need to continue to strive to connect and we need to use such media, as well as media such as the creative arts. I have looked at Dr. Pat Bracken's work on this. He has put out a lot of papers and information on this. He states that using these media as opposed to directly communicating with these people is a way to speak to them and get them involved, complemented with a technical approach.

Photo of Pat BuckleyPat Buckley (Cork East, Sinn Fein)
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I move amendment No. 1:

To delete all words after “Dáil Éireann” and substitute the following:“notes:
— the commitment by Fine Gael in its post-election agreement with Fianna Fáil to increase funding annually for mental health services and fully implement A Vision for Change;

— that the July 2016 estimate from the Department of Health indicated that the required resources needed to fully implement A Vision For Change are €177.3 million or €35.4 million per annum over five years;

— the recommendation of the Oireachtas Group on Mental Health that an increase of €37.5 million should be made in spending for the service in 2017;

— that in 2017 the funding committed for new developments is just €15 million;

— that such an increase would represent only a 1.8 per cent investment in new developments for mental health compared to the 2016 Budget; and

— that even including the €9.7 million announced for increased pay rates in mental health services, this represents an increase of just 3 per cent in revenue funding for mental health, much less than the 7.4 per cent increase in revenue spending for the health budget as a whole;
commits once more to the complete implementation of A Vision for Change as soon as possible;

resolves to:
— increase the mental health budget for 2017 by a minimum of €37.5 million; and

— ring-fence all and any monies allocated to mental health, and that go unspent within a financial year, for use the following year and for such monies not to be returned to the exchequer and/or expended elsewhere; and demand that a multi-annual plan be published by Government, within three months, outlining how the full implementation of A Vision for Change will be realised including provision for required future funding increases.”

This Government was founded on an agreement between Fianna Fáil and Fine Gael which sought to lay down the basic objectives for the Thirty-second Dáil. The agreement stated that support would be given by Fianna Fáil to Fine Gael and its Government so that these objectives would be followed through on. It provided Fine Gael with the chance to remain in power and Fianna Fáil with the ability to keep one foot in either side of the Dáil, criticising what it did not like and claiming credit for policies with which it agreed. Much was made in the recent budget of Fianna Fáil's claims to have exerted positive influence on the Government to achieve certain initiatives. Tonight we debate one glaring failure of this Government to live up to its agreement and a glaring failure of Fianna Fáil to hold the Government to that up to this point.

I welcome this motion. It could be stronger but it is necessary, and the Sinn Féin amendment is in keeping with its spirit, which is to pressure this Government to adequately fund our mental health services and implement the necessary reforms laid out a decade ago by A Vision for Change, a document which promised much but went largely unimplemented by Fine Gael and Fianna Fáil while in government. Fine Gael may have felt it had a soft commitment in the agreement with Fianna Fáil. I ask the Government to fully implement A Vision for Change. However, anyone who knows much about A Vision for Change and the mental health services currently in place knows that while this objective is all too achievable, it requires significant commitment and political will, which has been absent in the last decade.

One crucial part of seeing A Vision for Change implemented is the issue of funding. Our mental health services have long been underfunded, with their share of the overall health budget shrinking again and again. At present mental health funding makes up just 6.4% of the health budget. In 2017, it looks like that will be closer to 5.7%. If we take the model in the UK and Canada - we should take a leaf out of their book - it is 13%. This does not sound like mental health being prioritised but it sounds like more of the same - a lot of talk about mental health but very little substance.

In 2015, we remember the then Minister for Health lauding a supposed increase of €124 million for mental health in 2016. When this year's plans were revealed to remove €12 million of this funding, this was only thwarted by the voices of mental health advocates and campaigners who simply refused to accept it and took to the streets and the airwaves to force this Government to back down. In the end, funding for 2016 was €45 million less than had been stated on budget day. A Department official in a freedom of information request said the Minister had "overstated" funding and was "not correct". This year we were told that €35 million would be added to the mental health budget for 2017. No further detail was provided. The figure being just short of that called for by groups such as Mental Health Reform and the Oireachtas group on mental health was welcomed. I welcomed it while stating that more details were needed. In the coming weeks it became apparent that once again the media, the public and the Opposition had been misled and given incorrect information. As soon as budget fever died down, the truth was revealed quietly in response to the questioning of Deputies. Instead of €35 million, just €15 million would be added to the budget for 2017, a pathetic increase of just 1.8% which would barely allow the services to stand still in a time of increasing demand. The Government knew that this was an unacceptable figure. It knew it was not good enough. This was clearly the reason it hid the figure as best it could.

In Fine Gael's election manifesto it promised €175 million in additional mental health spending over five years. This would have meant €35 million per year extra on average. The 14 promises included: to extend youth mental health services, such as Jigsaw, which is free to access and does not require general practitioner referral; to extend counselling in primary care services to more people; to ensure greater access to counselling and psychological services; to support mental health recovery by offering follow-up training and booster self-help courses; to expand the national educational psychological services; to ensure integration of psychotherapy, counselling and social care services with primary care teams; and to build on reduced waiting times for child and adolescent services. None of these were achievable in the context of such low spending on mental health, but those funding levels are achievable now. If the Government is claiming an additional €35 million over two years, are we to expect only €10 million in additional funding for 2018?

We cannot wait any longer for the political will and the funding needed to bring about the needed reforms underpinned in A Vision for Change. The Government can no longer talk out of both sides of its mouth on this issue. Members of the Government will surely deny this is the case, but how can they do so credibly when the figures are there in front of them? We have a lot of work to do and we need to start it now. Our services are overstretched in every sense and staff are underpaid, overworked and undersupported. Those who depend on these services are not being treated adequately, or at all in some cases, not due to the failures of the front-line staff but rather the political failures which have left the cupboard bare. In the past eight years, the number of staff in posts across the mental health service has decreased by almost 1,000. Child and adolescent mental health teams were at 50% of the recommended staffing levels at the end of 2015, while referrals increased by 50%. Staffing levels across the service are well below what is recommended.

Referrals to counselling in primary care services increased by almost 20% from 2014 to 2015. Just five mental health and intellectual disability consultants for children are in post throughout the country, which is 3% of the number of positions the expert group on A Vision for Change recommended. Ireland has the fourth-highest rate of suicide among young men and women aged 15 to 19 years across 31 European countries, with increasing levels of self-harm also being reported.

I am glad this motion has been taken today and I hope Fianna Fáil will follow through with the appropriate pressure needed to ensure Fine Gael lives up to its commitments. Sinn Féin will work with anyone to improve mental health funding and put it where its needed. The Minister of State and her Government must listen to the Dáil tonight and to the activists and the people who depend on these services. It is simply not good enough and they can and must do better. Tonight is an opportunity to do the right thing, which many of the people in the Government parties would like to see. The Government should stand by its commitments to the people, those made in the election and afterwards.

I will conclude by mentioning something posted recently by a friend on social media. It was her story, the story of a young woman who, having endured some hard knocks in life, found herself feeling utterly beyond hope. She attempted to take her own life but awoke a day later in hospital having done serious damage to her kidneys. Her life continued on a cycle of behaviour that only hurt her further because she could not see through the fog of her own mental ill health and value the brilliant young woman she is. Eventually she worked up the immense courage and strength to make a change and to seek help. Today I am sure her life is not perfect but she has put herself on the long road to recovery. If someone so young, dealing with all of that, can be so strong and so courageous then we too must match that example. We must not shy away from the challenge of building a mental health services for those who seek it in their darkest hour or just on the little bumps along the road; it is for every member of our society because we all have mental health. This is a service for all of us and its neglect fails us all.

9:15 pm

Photo of Donnchadh Ó LaoghaireDonnchadh Ó Laoghaire (Cork South Central, Sinn Fein)
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Ba mhaith liom buíochas a ghabháil le Fianna Fáil as ucht deis a thabhairt dúinn labhairt ar an gceist seo. Is léir go bhfuil an-chuid dul chun cinn fós le déanamh ó thaobh na físe atá ag an Rialtas i leith na meabhairshláinte. The implementation of A Vision for Change is a considerable distance from happening. We have seen a reduction of approximately 1,000 staff since 2008 at a time when demand has expanded massively. In child and adolescent mental health services, CAMHS, the number of referrals grew by more than 50% between 2011 and 2014. The most recent Health Service Executive performance report from July 2016 indicates a waiting list of 2,298 children and adolescents for a first appointment with CAMHS and I have heard stories of inordinate waiting times of over a year in some instances.

During a contribution to a previous debate on mental health in this House I went to great lengths to emphasise that the many issues relating to mental health are multifaceted, complex, varied and go much beyond depression or suicidality. I maintain that opinion and there cannot simply be a discussion around suicidality or depression as we must emphasise good mental health as well. I underline that point again before going any further. However, given what has happened in recent weeks in my constituency, it would be remiss of me not to raise the following issue in the course of this debate on mental health.

We have had a significant number of suicides on the south side of Cork city in recent weeks, particularly in the south west, with many of the victims being teenagers. I speak on behalf of a community that is hurting and which has been shocked and traumatised by the loss of many people in recent weeks. It is grieving and frightened, particularly for our young people. We are at a loss. I knew two of the deceased personally and one of them I knew quite well. I know teenagers locally who have lost three friends in scarcely a month. The devastation of so many is very evident, from families to neighbours and friends. I am proud of how our community has responded. It has come together and tried to provide the best support it can for the bereaved. Last Friday night I attended a candlelight vigil at the lough and despite appalling weather, there were over 200 people there. Last night there was a postvention session in the local scout hall that also drew a crowd. I commend those who were involved with those initiatives but the community can only do so much.

I support the call, made initially by Counsellor Mick Finn, for a critical incident team to come together to tackle this issue in the city. I have written to agencies in support of this. We need all the agencies, from councils to the Garda, the HSE, Tusla, all the voluntary bodies, schools and public representatives to come together on this. Schools in particular are essential and I appeal to principals to take an active role in this. I call on all our local Deputies to throw their weight behind this as well. If we can bring all these bodies together for major flooding events or accidents, surely we can do so when so many lives have been lost. That meeting must happen soon and action must come from it.

I do not want to play politics with this and I am not interested in blaming anybody. I urge the Minister of State to ensure her Department and the HSE take an active role in this and will be represented. There are gaps locally and we need assistance in filling them. I believe Jigsaw is due to come to Cork soon but the question must be asked of why it has taken so long to come to the second-biggest city in the State. There are four such services in Dublin and it must be delivered urgently. For context, according to some measures, Cork city has the highest rate of suicide in the State at 18.5 per 10,000, with the suicide rate in Cork city considerably higher than the national average for more than 12 consecutive years. The need is very clear.

I put down a parliamentary question indicating that the Togher and Ballyphehane area has been without a permanent psychologist since June 2015. The locums are doing what they can but this is bad for continuity of care, and people in difficult positions and crises need to be able to build a relationship with professionals. I do not have a parliamentary question to hand but I also understand there has not been a child psychologist service in south Lee for some 18 months. All these gaps must be filled and I urge the Minister of State to help assist in tackling the issue.

As our neighbours and friends attempt to pick up the pieces and comfort the bereaved, some may find it difficult to cope. I urge those who struggle to please contact the services and reach out. There are so many people willing to listen, especially after what our neighbourhoods have been through. I urge the Minister to ensure no stone should be left unturned in helping our community to deal with this critical issue and resourcing our services to tackle mental health matters nationally.

Photo of Jan O'SullivanJan O'Sullivan (Limerick City, Labour)
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I welcome the debate and I know we have had a number of debates on mental health issues. What is really important is not so much that we have a debate but that we ensure there is action and implementation with regard to A Vision for Change and specific and deliverable developments in the area. Funding is important and ring-fencing funding is particularly important. I refer to the work of former Deputy Kathleen Lynch when she was Minister of State with responsibility for mental health. She insisted on having a ring-fenced budget as there had been a tendency for money allocated for mental health to be taken back into the general health budget. It is important that money should be ring-fenced, with money allocated specifically to mental health being spent in the area. To suggest that money that was to go to the area in 2016 - with a similar amount for 2017 - would be cut sends a signal to services that they will not continue to develop in a similar way to when the ring-fenced money was used in recent years.

A Vision for Change set out much more focus on prevention and community services rather than the old idea that everything had to be done in acute services and through psychiatry rather than areas like counselling.

Many people felt they could not talk about mental health. They thought they could not say they had a mental health issue. The whole mindset needed to be changed. In particular, services needed to be rebalanced in favour of local community care and alternatives to the acute care-based model that was previously followed needed to be provided.

When the money was ring-fenced, it was used to support community organisations, to educate GPs on suicide prevention, to fund a primary care counselling service, to facilitate access to psychology and psychotherapy services, to make additional beds available for child and adolescent mental health services, to employ clinical nurse specialists to respond to those who present with self-harm in accident and emergency departments, to finance the national clinical programme for eating disorders, which is an area that had been neglected, to provide training in behavioural family therapy and to provide for the roll-out of Jigsaw, to which a number of previous speakers have referred. Jigsaw is a good example of a service that is welcoming and accessible to young people in particular. I think it is an example of the way we need to go. I welcome the fact that it is being rolled out. We need to continue to roll out this service. I know that the Limerick and Cork areas are targeted at present. I was really impressed by it when I had an opportunity to see it in action in Galway. When I speak to young people, they tell me they want to be able to access a service that is open to them. They do not necessarily need psychiatry. In many cases, they need other models like counselling. It strikes me, based on the research that has been done on young people who present to the mental health services, that they often require this kind of service rather than the traditional kind of service that was made available in the past.

I want to make the case for ensuring counselling services in primary care are made available to young people. I know that a service has been delivered for adults, but it should also be available to younger people. We need more community services like the Jigsaw example I have mentioned. Many community organisations throughout the country are doing great community support work to bring mental health services out to people in the community and to let people know what is available. I believe they need to be well supported. It is important that we are having a debate about funding this evening. If we do not ring-fence funding, it is inevitable that it will be spent in other areas. I wish the Minister of State well with that. I think she should get the support of her colleagues in government as she seeks to ensure funding is retained in the mental health budget. I know there have been issues with regard to recruitment, but I think many of them have been addressed. I think there is now a capacity to recruit that did not exist in 2011. The Government needs to ensure it continues its efforts to recruit staff and to broaden things out into the community.

As a number of Deputies have said, the education system now places a much greater emphasis on mental health and well-being. When we were reforming the junior cycle, we concentrated on making well-being a compulsory subject for the junior cycle. That is due to be introduced next year as a way of ensuring all young people get an opportunity to talk about mental health and well-being, to recognise there are places they can go for support when, as a part of life, they do not necessarily feel all that well at certain times and to understand that it is okay to talk about these matters. The cultural change that is needed must be accompanied by the practical measures that are set out in A Vision for Change. We need to ensure sufficient money is available to implement these programmes, particularly those that provide access in people's local communities, GP services and primary care services. This will ensure people can seek help and get it when they need it, rather than after they have been suffering for a period of time without knowing where to go forward or who to go forward to. This is a welcome debate. We need to continue to raise mental health issues. This area has been neglected in the past. I hope the emphasis that was brought about by the ring-fencing of funding by the previous Government is continuing in the current Government. We should continue to strengthen our mental health services, particularly by making them accessible.

9:25 pm

Photo of Mick BarryMick Barry (Cork North Central, Anti-Austerity Alliance)
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We are discussing the mental health budget, which is due to increase by €15 million, or less than 2%, next year. Ten years ago, A Vision for Change set targets for mental health spending as part of a ten-year plan. The truth is that A Vision for Change could and should have been fully implemented by now. We should be moving on to other issues at this stage, such as the need to provide resilience training to young people through schools across the country. Ten years on, the State is still far short of achieving the targets set in A Vision for Change. If that is to change, over €35 million per annum, or more than double the increase allocated in last month's budget, will be necessary over the next five years. Clearly, this is a very poor performance on the part of the Government. I do not doubt that many people, including those facing mental health crises and their family members, have been badly let down.

I want to focus on the deeply cynical game that is being played by Fianna Fáil. I can explain what I mean by that by referring to a statement made by Fianna Fáil's spokesperson on mental health, Deputy Browne, on 6 August last. He said that "the Confidence and Supply Agreement between Fianna Fáil and Fine Gael commits to the full implementation of the Vision for Change policy, and this is a key priority for us in Budget 2017". The key words in that statement are "key priority for us". As a minority Government, the current Government could not survive for 24 hours without the support of Fianna Fáil. If mental health funding was truly a "key priority", it would have been delivered and one of two things would have happened. Either €177 million would have been allocated in the budget for the full implementation of A Vision for Change, ten years on, or - at the very minimum - a one-fifth share of €35.4 million would have been allocated for the first year of a five-year programme aimed at meeting the targets set in A Vision for Change. Neither the first option nor the second option was taken. Instead, a mere €15 million was allocated by way of an increase. As I have already said, this was less than half of the minimum figure that would have been in line with reaching the targets. Did the Government fall? No, it did not. Was the budget shot down? It was not shot down because Fianna Fáil did not make mental health a key priority in the budget. It broke the promise that had been made on 6 August and on many other occasions before budget day. Governments are well known for breaking promises. When Fianna Fáil is in government, it is pretty good at it.

This is a new one on me. Breaking promises to the most vulnerable people in society from the Opposition benches is some achievement and is not one to be proud of. What is happening here tonight? We have a motion which is designed to make Fianna Fáil look like the champions of mental health funding. It is designed to provide headlines, such as the one it was given on The Irish Timeswebsite a few hours ago: "Government willing to put mental health 'on the backburner', says Fianna Fáil". It is certainly true. The Government has put mental health on the backburner. I hope people do not forget that Fianna Fáil put mental health on the backburner too. That is what tonight is about, in large measure. It is about covering Fianna Fáil's tracks in what has been a shameful episode, given the way this has played out in the past weeks and months.

For the people who need improved mental health services and for their friends, families and supporters who are looking at this charade in this House, a discussion needs to start now about what steps can be taken, difficult as they are, to increase pressure on the Government and on Fianna Fáil. I think people are striving to do their best in difficult circumstances. We need to have a discussion about finding some way to increase pressure on the Government and on Fianna Fáil. I am talking about people-power pressure where huge numbers of people in this country find a way to make their voice heard and to light a fire underneath these parties, which have let people down once again.

9:35 pm

Photo of Maureen O'SullivanMaureen O'Sullivan (Dublin Central, Independent)
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I wish to share time with Deputies Joan Collins and Thomas Pringle.

Photo of Pat GallagherPat Gallagher (Donegal, Fianna Fail)
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Is that agreed? Agreed.

Photo of Maureen O'SullivanMaureen O'Sullivan (Dublin Central, Independent)
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Ceapaim go bhfuil sé in am dúinn stad a chur leis an gcaint agus leis an díospóireacht toisc go bhfuil a fhios againn cad ba cheart dúinn a dhéanamh. We know what we should be doing because it is all in A Vision for Change. There is general agreement that this document is very important. It was published in 2006 with a ten-year framework, which is now up. The question is what has been achieved. I acknowledge the progress that has been made. There is a greater awareness of mental health and we have more people speaking more openly about mental health issues. There is an acceptance that, at the very least, it is okay to say "I feel down" or "I feel depressed".

I believe we are all committed to implementing A Vision for Change but that means ensuring the resources and the staffing are in place to do that. In the last Dáil I was a member of the cross-Oireachtas group on mental health and, each year, we were able to agree on a pre-budget submission. One thing that can be learned from this strategy, and from all strategies, is the need for an implementing and monitoring committee to meet regularly - at least every six months - with very specific targets and indicators. That has not happened and there was no information system on the outcomes of delivery.

The restructuring of health and the reconfiguring of management and delivery saw mental health not getting the attention it should have. In addition, the economic crash played a huge role in regard to funding, resources and staff, which it should not have. No one likes to take a cut in their salary or allowances but under no circumstances should somebody with a disability, whether mental, physical or intellectual, have to take a cut. They have additional costs of living that the rest of us do not have, as well as other difficulties.

The last Dáil was a kind of Lanigan's ball with the €35 million - it was there, then it was not there and then €15 million reappeared. I am still not quite sure where that €35 million went. Any strategy has to fit the people it is serving, not the other way around. The real test of a strategy is how it deals with those who do not fit into the particular categories and those whose needs are not being met in the course of a strategy. Therefore, there is a need for flexibility.

I want to mention those with mental health issues and those who are in addiction. There is a lack of counselling services for such people, apart from one service I know in the north inner city, the Oasis-Deora counselling service. Its funding is minimal but it is taking referrals from the bigger organisations which do get a lot of funding because those organisations either cannot or will not see those with a mental health issue who are also in addiction. A person presenting with a physical ailment will have a battery of tests and a range of treatments offered to them; if they present with a mental health issue, they could be diagnosed within 20 minutes and then be put on medication.

Another point is that we need dedicated intellectual disability nurses in accident and emergency units. In addition, teachers and youth workers identify young people with a mental health issue very early on, and it is at that point the intervention is needed.

Photo of Joan CollinsJoan Collins (Dublin South Central, Independent)
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I welcome the debate on mental health reform. I believe this should be debated every couple of months in order to have checks and balances in this regard. I particularly support Deputy Jan O'Sullivan's point about having a monitoring group looking into this every six months and checking where we have come from and where we have not addressed issues that need to be addressed.

The most devastating part of this conversation is that, after being told the €35 million was going to be added on to mental health services, it is not being added and the figure is just €15 million. We must have a House that holds the Government to account and makes it keep that budget of €35 million because we still need that support.

Dr. Shari McDaid attended the Committee on the Future of Healthcare last week and graphically outlined the needs and problems in mental health services. She rightly said:

In 2013, the WHO recommended redirecting mental health spending towards community-based services, including the integration of mental health into maternal and child health, enabling access to better and more cost-effective interventions. A recent evaluation of a parenting programme in Ireland indicated that for every €1,463 spent per child, a saving of €4,599 per child was realized. In this context, it is worth noting that between 2008 and 2015 there was a 38% cut to funding for family resource centres.

That is where money could be put if we do not have staff ready to move into areas of primary care, namely, we could put it into schools to support teachers in dealing with children who are trying to deal with the issues they are facing. That should be taken on board by the Government.

A young woman came to us yesterday. She is a lone parent with four children who is working in a local school for ten hours a week. Her landlord had just written to tell her that her rent was going up by €200 from €1,150 to €1,350 in December. She was in dire straits. Her whole mental and physical health just crumbled in front of us. We see that every day of the week and I am sure other Deputies see it in their clinics, where people come in who are not able to deal with an issue they feel they cannot get over. We have to start looking at those areas where people can access help immediately, but if the Government keeps taking money from where it is needed, that will not happen. The fundamental point made by Dr. Shari McDaid is that what we have now does not go any way to addressing what is a fundamental long-term problem or move us towards a more progressive and reformed mental health service.

Photo of Thomas PringleThomas Pringle (Donegal, Independent)
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Ten years on from A Vision for Change we are still awaiting its full implementation. When we consider that poor mental health costs the State some €3 billion a year, surely the provision of €35 million a year would not be too much to ask. It would help to achieve A Vision for Change and ensure people can get services when they require them and when they are desperate.

Much has been made of the difficulty in recruiting staff, which creates real difficulty on the ground. I recently had need to contact a mental health team in north Donegal to try to get a nurse to call to a person's son, who was badly in need of help and whose family were very worried about him, but there was no nurse available in that team and it could not deal with the issue. In south-west Donegal, because the psychiatrist has retired and has not been replaced, and no locum has been put in place, people presenting with issues cannot get referred on or get treatment. There are situations where psychiatrists are trying to cover a whole county. It is not acceptable that this should be allowed to continue.

It is not acceptable at this stage that it should be allowed to continue. Its impact on people across the State is immeasurable. People are going without treatment and are left without services. For the sake of €35 million a year it is not too much to ask that it be provided for. The funding could be ring-fenced to ensure that A Vision for Change would be implemented. Non-governmental organisations, NGOs and groups such as the family support centres that I know in south-west Donegal are overrun with requests for counselling for children and young people to assist them and they cannot keep up with the demand yet this Government slashes their funding by 38%. They are the bodies filling the gaps left because A Vision for Change is not being implemented and resourced. The NGOs include BeLonG To which piloted a very successful programme called safe and supportive schools to assist young lesbian, gay, bisexual and transgender, LGBT, in schools in Donegal. That programme is being rolled out across the country but it needs to be funded and resourced to achieve what it sets out to do. It can make a difference and building that awareness among children and young people will help them.

We will have another motion next year wondering where the €35 million went. That is the problem and unless the Government addresses that and implements A Vision for Change, we will continue to have motions like this.

9:45 pm

Photo of Michael HartyMichael Harty (Clare, Independent)
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I am glad this debate is being carried out in a calm and constructive manner. The motion has several objectives, including the full implementation of A Vision for Change, which is ten years old. It is astounding that we are still trying to implement that document ten years after it was published. It recognises the financial requirements to complete A Vision for Change as €177 million, €35 million a year yet only €15 million is being provided to deliver new services in 2017. It calls for a review of this inadequate spending and for multi-annual budgeting. It is emerging from the Committee on the Future of Healthcare that we need multi-annual budgeting to be able to plan constructively for the future as planning from year to year with inadequate budgets will not provide the best results. It also calls for the unspent financial allocation for mental health services to be retained within the mental health budget and not returned to the Exchequer and spent elsewhere. It is quite unacceptable that over many years funding for mental health services has been promised but not delivered. Kathleen Lynch, when she was Minister of State with responsibility for mental health services, was promised funding on several occasions which was withdrawn from her by the then Minister for Health, Senator James Reilly. The former Minister for Health, Deputy Varadkar, removed €12 million from the mental health budget prior to the formation of this Government. The pattern is being repeated which sends out the wrong message, that mental health funding can be siphoned off to other areas of the health service under the guise that it cannot be spent in the current year. We know, however, that many areas of the health service are crying out for funding. There are many voluntary organisations that supply mental health services which would give their eye teeth to get their hands on this funding. They collect money on a voluntary basis and if they had this funding they would target its use.

I propose that any funding allocated to mental health services which cannot be spent in the current year should be set aside to buy services in a manner similar to that of the National Treatment Purchase Fund, NTPF, which buys medical and surgical services for those on long waiting lists. Such a fund should be set up for the mental health services. It would supply services to those who are homeless and suffer from mental illness and drug addiction, address our unacceptable suicide and attempted suicide rates and provide counselling, psychological and cognitive behaviour therapy services, mental health services for young people through the child and adolescent mental health services, CAMHS, and dementia services. If money is unspent and I am sure it was hard fought for in the budget, it should be set aside for a mental health purchase fund using unused funds to buy services from the private sector. I would like the Minister of State to consider that.

Photo of Danny Healy-RaeDanny Healy-Rae (Kerry, Independent)
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Mary of the Angels in Beaufort caters for 77 people with very serious mental disabilities but there is a decongregation policy that suggests these people should be left to fend for themselves in community settings. The proposal, however, in this instance will break up a community setting. Sadly, there is no funding for this policy because it cost €600,000 a year to cater for one person. This person was not in a seriously bad way. Another person cost up to €2 million. It is wrong to put him out in the community.

There is not even money for this policy even though hundreds of thousands of euro are spent by managers, advisers and policymakers trying to put this policy together to break up a place like Mary of the Angels. This is shocking. Will the Minister for Health and the Ministers of State go to see the people I am talking about before breaking the place up and disbanding it? The land and the place were given free and it was built up by voluntary fund-raising. It is shocking to think it is about to be taken down. No patients are being taken in there now. This decongregation policy has to be reconsidered because one size does not fit all. It may suit the odd person but it certainly does not suit most of the people in Mary of the Angels. For God’s sake will the Minister and Ministers of State reconsider what they are doing because they do not have a clue what they are doing when they have not seen the people? The policy should be debated in the Dáil and should be applied where it is appropriate.

Photo of Mattie McGrathMattie McGrath (Tipperary, Independent)
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I compliment Deputy Browne on putting forward this motion in spite of criticism from some people who have the answers to everything. It is good that we have debated this issue three times since this Government was formed because it is a huge one. I invite the Minister of State to attend Mount Sion in Tipperary. Like the place Deputy Healy-Rae mentioned in Killarney, it is a lovely home, given freely. Friends of Mount Sion do much work there but the Minister wants to get the people out of it and bulldoze it. It is the job of some managers to design this. I will not say who is in charge on this island. The Minister of State knows who I am talking about, namely, the HSE.

Money has been allocated over the past five or six years but it has not been spent and has been returned to the Exchequer or taken by the senior Minister back into the Department of Health. That is a scandal.

I know cases of dual diagnosis. Dr. Harty and other medical people would know that is a very difficult diagnosis. I know 80 year old parents with a 45 year old son who has languished in a mental health institution with dual diagnosis for 12 months because there is no place for him. The nearest place for him is in Drogheda. I know a 25 year old who has been diagnosed with autism and slight mental health problems. He is in St. Luke’s in Kilkenny waiting for a place. There are no places. The Government attacked and ravaged services in St. Michael’s in Clonmel and closed it. Now the patients have to attend at the accident and emergency department. That is a traumatic experience for any of us, let alone for people having psychotic attacks. They are supposed to get transport to Kilkenny but if they attend there after 5 p.m., they have to wait until 9 a.m. the following morning to get a taxi. It is disgraceful.

There seem to be heartless people running this. It is nothing personal to the Ministers of State present. There seem to be heartless people with no feelings for the trauma, bullying and everything else going on running this. The services are being removed and stripped, despite the fact that, as in the housing crisis, this and that are promised.

There is a leakage of funding. Successive Governments have failed to ring-fence the funding. The mandarins in the Department have not ring-fenced it. They have taken it from mental health and put it back into the Exchequer. How mean can one be, when so many community facilities could do with some of that money, not all of it, as some Deputies have said? It could deal with some services for the ordinary people who need it. They are the most vulnerable people in society and we should all be indicted at the way they are being treated, and rightly so. It is inhumane, degrading and only due to the fact that plans are made and drawn up inside in offices. People get promotion on the basis of getting rid of these people from these places. They have no feeling of understanding of how the patients or their families are going to manage or can manage. It is heartless in the extreme.

9:55 pm

Photo of Catherine MurphyCatherine Murphy (Kildare North, Social Democrats)
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I am sharing time with Deputies Martin and Healy. While I broadly welcome the efforts to fully implement A Vision for Change in the area of mental health, this evening we are seeing more confusion around who is in Opposition and who is in Government. I believe the policy is suffering as a result of that confusion. The Social Democrats are committed to delivering on all aspects of the 2006 A Vision for Change strategy as a cornerstone of the country's mental health policy. The A Vision for Change strategy is a decade old now and it is shameful that no Government has been able to deliver the required changes in that time. The Social Democrats believe that a properly implemented strategy would not only be responsive to individuals suffering from mental health issues, it will also help to equip those with the necessary tools to strengthen awareness of their own mental health and to recognise when to seek help.

Recognising when to seek help is one thing and help being available in a timely way is quite another. We all have very real stories to tell that we have heard from people who come to us. For example, I have had several people come into my office who said that they were feeling suicidal. What does one do in that scenario, where the services are not available? We have to stop thinking of a policy as a document and start looking at it as something that is living. We must look at where the funding is to implement it and do so in a timely way. For example, Ireland has one of the highest rates of youth suicide in Europe. We have to build skill sets into teacher training. We have to reskill those who are finished their training in order that it is possible to deliver classes on positive mental health, particularly in our secondary schools. The restoration of guidance counsellors would be one step in the right direction, with best practice training able to identify and respond to children in need. It is simply not acceptable that people should have to wait for crisis intervention, and that is happening.

The decades of under-resourcing are part of the problem, as it was not just a starting point of 2006. Society requires that this issue be addressed as an absolute priority. Where there are positive moves, they are not moving fast enough. For example, I watched every one of the people's debates last year, mad and all as I might be for doing so. There was not one of the debates in which this issue was not raised. It was the only issue that was a common denominator. This is a problem across the country and it needs urgent intervention.

Photo of Catherine MartinCatherine Martin (Dublin Rathdown, Green Party)
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This is the third time since my election to Dáil Éireann last February that we have discussed mental health in this Chamber. Despite the Government's commitments to implement A Vision for Change, it refuses to lead effectively from the front, refuses to implement real and positive changes to our mental health services and refuses to prioritise the mental wellbeing of our most vulnerable citizens. By reneging on its commitment to invest appropriately in our mental health services, this Government has signalled its contempt for the human rights of those with mental health symptoms. It confirms in the minds of the many shattered families that their agonising wait for appropriate interventions and supports for their loved ones will be a weight that will continue under this Minister's watch. Tragically for some, this weight has and will continue to prove fatal.

It copperfastens the sense of hopelessness that they have become accustomed to since A Vision for Change was launched. It is a blueprint document full of vision that has been accompanied by a snail's pace of change. It is an excellent document and it does not need review but full implementation. According to research, those who suffer from mental illness need a sustained sense of hope. However, this Government feeds them with hopelessness. Even more inexcusably, this Government promised a false dawn and an increase of €35 million in the recent budget to respond to their needs. However, within days of the budget, the harsh truth emerged that a significant proportion of the promised funding would not be allocated in 2017. This Government has yet again pressed the pause button on the recovery of thousands of its citizens. The message is very clear for those who, because of their symptoms, cannot rise and be heard and for those who, with enduring mental illness who sometimes cannot advocate for themselves, will be pushed aside as this Government balances its books.

The brilliant poet, singer and songwriter, the late Leonard Cohen, is on record sharing the sheer debilitating impact that mental illness, in his case, depression, had on his own life. He famously wrote, "There is a crack in everything. That's how the light gets in". To those desperately awaiting therapy and support, it must feel as though every crack has been filled in and light might never break through. Further delays should not and cannot be countenanced. No more reviews and no more false dawns. There is a need to instil a proper sense of extreme urgency in order, for once and for all, to tackle one of the most critically important challenges of our time. Where there is a will, there is a way. However, the Government must prioritise, invest, inject hope and deliver appropriate supports and real solutions, translating words into tangible hope and delivering a real, effective, coherent and sustainable response.

Photo of Séamus HealySéamus Healy (Tipperary, Workers and Unemployed Action Group)
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I welcome the opportunity to speak to and support the motion. A Vision for Change, published in 2006, is a template for a community-based progressive and modern mental health system. The policy emphasises provision of a mental health system based on community services and supports provided by community-based multi-disciplinary teams with a significantly reduced need for inpatient services. Ten years later, there is a crisis in our mental health services arising from and compounded by the abject failure to fund, resource, staff and implement the A Vision for Change policy. The Government failed in budget 2017 to address the resource issues needed for mental health services. In July of this year, the Department of Health stated that €35.4 million per year over the next five years was needed to implement A Vision for Change. Despite that, only €15 million was provided; a shortfall, therefore, of €20 million.

The mental health services in my own constituency of Tipperary are a good example of the malaise in which the services are at both a local and national level. Despite the best efforts of staff, the service is dysfunctional. In 2010, then Fianna Fáil Minister of State, John Moloney, decided to close the county's inpatient services at St. Michael's unit in Clonmel. His successor, then Labour Party Minister of State, Kathleen Lynch, implemented that closure, despite the opposition of service users, carers, doctors, nursing staff and the public generally. South Tipperary inpatients were sent to Kilkenny and north Tipperary inpatients were sent to Ennis. That was done in 2012. The Minister of State sold the closure on the basis of a promise, quid pro quo, of a Rolls-Royce community-based service.

Three years later, we have the worst of all worlds. We have no inpatient service, community services are under-staffed, under-resourced and under-funded, and community-based teams are struggling to provide a safe service. They are deficient of staff across all categories of nursing, medical and paramedic staff. We have no 24-7 service. The new crisis house promised has not materialised. Patients are assessed in wholly unsuitable, busy and overcrowded accident and emergency departments with no privacy or confidentiality. The inpatient services in Kilkenny and Ennis are regularly overcrowded, there is difficulty in gaining admission and very often inappropriate early discharge. There is the proposed closure of the unit at Mount Sion in Tipperary town. The situation is wholly unacceptable. I call on the Minister of State to immediately implement A Vision for Change in Tipperary, including the provision of 24-7 services, the recruiting of additional nursing, medical and paramedic staff for our multi-disciplinary teams, the re-opening of the inpatient unit at St. Michael's in Clonmel and a commitment to keep the Mount Sion unit open.

I acknowledge the excellent work being done by various voluntary organisations in the area of mental health locally.

I acknowledge organisations such as the consumer mental health panels, C-SAW suicide awareness group, the River Suir Suicide Patrol, Taxi Watch, the Wellness Recovery Action Plan support group and the Carrick-on-Suir River Rescue organisation among many others. I call on the Minister of State, Deputy McEntee, as a matter of urgency, to meet with a deputation from County Tipperary about the mental health services in the county.

10:05 pm

Photo of Pat GallagherPat Gallagher (Donegal, Fianna Fail)
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I call Deputy Jack Chambers, who I understand is sharing time with Deputies O'Loughlin, O'Rourke and Eugene Murphy. Is that agreed? Agreed.

Photo of Jack ChambersJack Chambers (Dublin West, Fianna Fail)
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I thank my colleague, Deputy James Browne, for introducing a very positive motion. We all embrace what A Vision for Change is trying to do. It is a roadmap to achieve proper and substantive community-based mental health services and to improve existing services. My criticism of what is happening is not of the Minister of State, Deputy McEntee, who was recently in my constituency in Dublin 15 to talk about the work with Jigsaw projects and youth mental health, which is very important. She has embraced the role very positively.

I am reminded of what the national director of mental health services, Anne O’Connor, said on television in the spring when she was asked about recruitment in the mental health area. When she was asked why she did not spend her allocated budget she said that people emigrate and travel and that is just the way it is. That was her justification for returning the funding to the Department and the HSE. We need a total change of attitude at the top level of the HSE in the mental health area if we are ever going to deliver and implement A Vision for Change. It is a strategy that works but, for example, when we take child and adolescent mental health services there is a massive haemorrhaging of existing community-based teams in many areas. Staff members on maternity leave and sick leave are not replaced and people must wait for significant periods to get help. Families are in despair. Figures indicate that more than half the staffing posts are not being filled and we need a proper recruitment strategy to ensure we fill the posts that have been advertised, as that is crucial. I will hand over to my colleague.

Photo of Fiona O'LoughlinFiona O'Loughlin (Kildare South, Fianna Fail)
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"It is horrible to think that people are being pushed to the point where they feel suicide is the only way out. There are bullies everywhere you go; everyone always has something bad to say, some people might wonder, where are all the people who are nice?" They are not my words but those of Robert Supple from Newbridge on 24 October on his Facebook page. Ten days later Robert took his own life, three days after another young teenager in the town.

Earlier this year Newbridge was blighted by the suicide of five young men. Hardly a person in the town was not deeply affected by this epidemic. We cannot allow so many to perish from the silent killer that is mental illness. Sufferers cannot continue to sit in misery in accident and emergency departments waiting for a unit to open. There must be a place for teenagers to go to get help when they are suffering, and there must also be a place for their parents and guardians to seek help.

Every one of us has a role both inside and outside the Chamber in giving shape to a nation that cares for the mental well-being of all citizens. We must nurture a culture in society in which people in distress are encouraged not to feel any less of a human being or any less worthy of help, and to realise that mental health can be recovered after it has been lost; a culture in which we do not feel embarrassed about our own, or a family member's, mental health. It all starts with each and every one of us and our own prejudices, ideas and actions.

The people of Kildare implore the Minister of State, Deputy McEntee, to listen to their cry for help. We have the lowest spend on mental health in the country and the lowest investment in the country on young people aged under 24. Funding is urgently required for Lakeview, the psychiatric unit in Naas hospital, which is an antiquated area designated for people suffering with acute mental illness. We desperately need €5 million. I will hand over to my colleague.

Photo of Frank O'RourkeFrank O'Rourke (Kildare North, Fianna Fail)
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I welcome the opportunity to speak on tonight’s motion on mental health. I also welcome the presence of the Minister of State, Deputy McEntee, in the Chamber. I thank my colleague, Deputy Browne, for the work he has done in this area and I also thank those in the Gallery.

It is hugely disappointing to see the lack of supports and resources in this area for some time. The time for talking about mental health and making promises is over. We must now deliver the service. That is what people expect of us as public representatives, namely, to deliver the service and stop talking about it. If we put half of the energy into delivering the service as we do talking about it we would have a much improved health service, in particular in the area of mental health. We will only restore people’s confidence and trust when they see the service being delivered on the ground.

The child psychology service in my area of Kildare North is exceptionally poor. There are massive gaps in the area. I have a reply from the HSE which confirms that is the case. That is an issue that must be examined as a matter of urgency. From December 2008 to 2015, for example, we lost 1,000 staff from the mental health service area. When services are put in place, supported properly and adequately resourced we see the positives that result. For example, we see the advantages in Kilcock of the psychiatric day care service. The Abbey community project in Celbridge provides services for 40 referrals, including from State agencies, although it operates on a voluntary basis with no funding. I wish to speak further with the Minister of State about that. It is not adequate for a service to operate without any funding.

We cannot have a mental health service that shuts down at 4 p.m. on Friday and does not open until 9 a.m. on Monday. We must have a 24-hour service in place and teams to deal with people if they are referred with mental health issues. We must also examine and introduce alternative treatments. We must send out the message that there is no stigma or judgment attached to mental illness. It is the same as any other illness.

Photo of Eugene MurphyEugene Murphy (Roscommon-Galway, Fianna Fail)
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Before I came to the Chamber I did some research but I have now changed my script completely. I am now speaking from the heart. I recall the previous debate on the issue. There is a distinct difference between it and the current debate. Previously, there was unity of purpose from every side.

In engaging in such a debate I think of the Minister of State, Deputy McEntee, Deputy Buckley, and others in the Chamber or Gallery who have been affected by suicide. I also think of family connections and friends who have been affected by suicide. I sat in the living room of one such family recently in my constituency. The one thing that resonates in my mind is that the mother of the young man who had committed suicide pleaded with me to fight ferociously with the Government to get funding but not to get into the blame game of who did this and who did that. I had no intention of saying that this evening.

Deputy James Browne, a new Deputy, is one of the most sincere individuals one could meet. The Minister of State recognises that. He has done Trojan work in this area. He is very concerned about the issue. On numerous occasions he has spoken passionately at parliamentary party meetings on the issue. He has spoken on a one-to-one basis with so many people.

I acknowledge that the Government is listening and acknowledges what we on this side of the House are doing. I do not want to say what I will say next but I must do so. We waited ten weeks to form a Government in this country. It did not happen. At the end of the day, we on this side of the House - unlike some of our critics here this evening - did the right thing and formed a Government. The only reason I say that is because if we had a second election €40 million would have been lost and the mental health services would be much shorter of money than is the case. Having said that, we all need to step up to the mark and the Government needs to put the funding in place that was promised.

I have figures going back to April 2016 which refer to a shortfall of 2,687 in the mental health whole-time equivalents for the full implementation of A Vision for Change. In every health board area there are red figures and a minus, which means that the teams that should be in place to look after people up to 18 years of age are not there. We must put those teams in place as a matter of urgency.

We need to be very serious about addressing this matter because many people are suffering. It is a massive challenge for people inside and outside this Chamber and in our constituencies and wherever we find it, we must find the funding to deal with it.

On community health services, there is a major issue in my constituency of Roscommon-Galway for people living in hostels who have been taken out of large institutions. An attempt is being made to move them out of the hostels where they are happy. However, I acknowledge that on two occasions at the weekend the Minister of State, Deputy Helen McEntee, telephoned me in response to messages I had left for her. I also acknowledge what she is trying to do. I know that she is sincere and that her heart is in the right place, but I ask her to, please, try to secure the extra funding promised for mental health services because it is needed.

10:15 pm

Photo of Pat GallagherPat Gallagher (Donegal, Fianna Fail)
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I understand the Minister of State, Deputy Marcella Corcoran Kennedy, is sharing time with Deputy Tony McLoughlin.

Photo of Marcella Corcoran KennedyMarcella Corcoran Kennedy (Offaly, Fine Gael)
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I am sharing time with him.

On behalf of the Government, I welcome the opportunity to restate its commitment to our mental health policy and the development and improvement of mental health services. Real and significant developments in mental health services have been initiated since 2012. At a time when other budgets were being cut, investment was prioritised and increased to develop mental health policy and services. Additional funding of €115 million wasallocated in the Health Service Executive's national service plans the peiod from 2012 to 2016, inclusive. In addition, budget 2017 has provided for additional spending of €35 million, on a full-year basis, on service enhancements to enable further improvements to be made across a range of areas. This funding will help to meet the key priorities to be addressed in the HSE's 2017 service plan, including youth mental health services, further improvements to child and adolescent and adult services, older people's services and an enhanced out-of-hours response for those in need of urgent services.

Recognising the time lag in new staff taking up posts and the completion of preparations for the introduction of these services, it is estimated that the revenue spend in 2017 associated with the increased allocation will be €15 million. There will also be a further additional spend of €9.7 million associated with increased pay costs. This will bring the mental health budget to €851 million in 2017, an increase of €140 million since 2012.

In addition, the Government has given the go-ahead for the construction of a new national forensic hospital at Portrane. This major health infrastructural project will benefit from significant capital investment in 2017, with spending on the new hospital and other more minor mental health projects planned to exceed €50 million next year.

New investment and personnel have been directed towards developing specialised mental health services. A commitment to increase mental health funding every year has been given and the Government will stand over that commitment.

I acknowledge the tremendous work of the HSE and the many voluntary and statutory agencies working for those who are often at the lowest point in their life when they seek treatment. With increasing demands and resource limitations, it is important that we work together for the benefit of service users to fully develop positive mental health policy and services that will underpin that policy into the future.

As well as ensuring the right services are in the right place to meet the mental health needs of the population, it is important to promote good mental health and try to prevent mental health difficulties arising. One of the key obstacles to health and wellness is excessive alcohol consumption, one of the key causes of mental health difficulties in Ireland. Alcohol is a contributory factor in half of all suicides and cases of deliberate self-harm; in 2014 one in three self-harm presentations was alcohol related. Three people a day are dying as a result of alcohol misuse, or 1,056 people annually. We must never forget that alcohol is a psychoactive drug and a depressant, if one consumes more than the body can process. It is a drug that reduces a person's ability to think rationally and distorts his or her judgment. In the long term it can cause mental health problems, leading to anxiety, stress, potentially depression and, sadly, suicide. As a nation, we must reduce our alcohol consumption and the forthcoming Public Health (Alcohol) Bill will help to address this issue. The Bill is a measured and evidenced based response to deal with the very real harm caused by alcohol. The seriousness of the problem we have with alcohol led to the renaming of the regional drugs task forces as the regional drugs and alcohol task forces. If we really care about the nation's health, every Member of the Oireachtas will recognise the importance of the Bill which remains a priority for the Government.

Listening to the very constructive contributions made by colleagues across the House, it is evident that there is a clear will across all political parties and Independent Members to modernise policies and services to bring us into line with current best practice and international norms, while retaining and further developing what is best about current HSE services which are meeting a very substantial demand across the country.

The Government is giving all Deputies a commitment that we will work with them to help to improve the lives of those affected by mental health issues. I recognise the support we have received across the House in this regard.

Photo of Tony McLoughlinTony McLoughlin (Sligo-Leitrim, Fine Gael)
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Before I begin my brief contribution to the debate, I thank the Ministers of State, Deputies Marcella Corcoran Kennedy and Helen McEntee, for agreeing to allocate some of their speaking time to me. I also thank Deputy John Browne and the Fianna Fáil Party for giving us an opportunity to again debate the serious issue of mental health in the Dáil.

As I am sure the Leas-Cheann Comhairle is very much aware, mental health issues can affect any home in the country. They can affect people from any background and of any gender or age. That is the reason they present one of the biggest challenges the Government and we, as elected representatives, face. I am sure we all have examples in our constituencies of homes that have been devastated by a suicide caused by underlying mental health problems or of a person suffering from depression or anxiety who does not know where to turn. It is a terrible reality for families to face and no one is immune from its grip. That is the reason the development and implementation of mental health policy and the upgrading of facilities and staffing allocations are key priorities for the Government. It is also the reason they will remain key priorities for it, despite what one may read on Twitter or Facebook. I take the opportunity to reaffirm to the Dáil our full commitment to the development and improvement of mental health services.

Members may recall that one of the first decisions the Government took on taking office was to sanction the appointment of a dedicated Minister of State with special responsibility for mental health services. That highlighted the seriousness of the issue for the Government and the fact that it was of such importance it needed a dedicated Minister of State to ensure agreed targets were achieved.

L0ike Fianna Fáil and all parties represented in this House, we agree that there is an urgent need to make significant progress in this area. That is why we agreed with Fianna Fáil, as a matter of priority in A Programme for a Partnership Government, that we would continue to increase annual spending on mental health services, develop new facilities and services nationally and fully implement the modernisation of mental health services in line with the policy A Vision for Change. I am glad to see that is exactly what the Government is working very hard to do and it is what we will continue to do until we leave office.

It is important to highlight again the revenue allocated for mental health service in 2017. I say this because people often become confused when discussing the annual mental health budget. A constituent of mine contacted my office recently seeking to understand why the entire mental health budget was only €15 million. When I asked where she had read that information, she replied that she had read it online. We need to be clear and unequivocal that the mental health budget for 2017 will be €851.3 million, which represents an increase of over €24.7 million, or approximately 3%, on 2016 levels. That sum of €851.3 million will be supplemented by a further €50 million in capital funding. In that regard, I welcome a new development at Sligo University Hospital. The mental health budget will continue to rise in 2018 and 2019 under this Fine Gael-led Government. This funding will enable key priorities to be addressed in the HSE's 2017 service plan, including youth mental health services, further improvements to child and adolescent and adult services, older people’s services and an enhanced out-of-hours response, 24/7, for those in need of services.

I would like the House to acknowledge the work being done by the HSE and the many voluntary bodies that are working extremely hard the length and breadth of the country.

10:25 pm

Photo of Pat GallagherPat Gallagher (Donegal, Fianna Fail)
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I call Deputy Eamonn Scanlon, who I understand is sharing time with Deputies Butler, Rabbitte and Browne.

Photo of Eamon ScanlonEamon Scanlon (Sligo-Leitrim, Fianna Fail)
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I will take the time allocated to me to appeal to the Minister for Health to address the waiting times for child and adolescent mental health services. Children and parents are suffering right across the country and pressure needs to be put on the HSE to develop appropriate services within existing resources as a matter of urgency.

I have figures provided to me last week from the HSE in response to a parliamentary question in relation to waiting times for child and adolescents in Sligo, Leitrim, south Donegal and west Cavan. They are extremely worrying and critically highlight the gaps in mental health services and supports for children and young people, including staff shortages in child and adolescent mental health services. There are currently 221 children on the child and adolescent mental health services, CAMHS, waiting list in the areas I mentioned: 48 are waiting between nought and three months; 45 between three and six months; 43 between six and nine months; 28 between nine and 12 months; and 57 over 12 months. Twenty-six per cent or a quarter of all children in my area are waiting over a year for assessment.

The principle of early intervention is critical when addressing mental health problems, leading to better educational outcomes, avoiding later severe mental health issues, improving quality of life and being more cost effective than later treatment.

In response to a separate parliamentary question, I was informed by the HSE that in July 2015 two positions of child psychiatrist attached to the child and adolescent mental health team became vacant in Sligo, Leitrim, south Donegal and west Cavan. One of the positions remained vacant until December 2015, but this consultant has since resigned. A second consultant was recruited and took up the post only in October this year.

I understand there are staff shortages in most areas but this has to be radically addressed now, and not next year. We need to see increased staffing for the child and adolescent community and mental health teams. The delivery of 24-hour emergency CAMHS in all community healthcare organisations, CHOs, and the proper resourcing of CAMHS community services are fundamental to achieving this. However, this will not be possible with such a low staff complement.

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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Mental health services for people with intellectual disability should be provided by a specialist mental health of intellectual disability, MHID, team. Three hundred posts for adult MHID were recommended in A Vision for Change. However, only 17.5 consultants are in post, which equates to 6% of recommended staffing levels. I accept difficulties in recruitment have meant that numbers of recruited staff are significantly lower than recommended.

Yesterday, I visited Carriglea Cairde Services outside Dungarvan in County Waterford. This facility has both residential and day-care patients with intellectual disabilities. They accommodate 170 patients. Of these 70 are day-care attendees and are so well looked after and were so happy and involved in so many activities. They were swimming, singing, involved in artwork and colouring. They did not realise I was visiting that day. There was no plan and I was pleasantly surprised. I was delighted to see these attendees being so well looked after.

However, at 4 o'clock in the evening, these attendees leave. Thirty-six of them are now living in communities. They are living well in their communities. I note many people feel that they cannot be decongregated back into the communities but in this instance, 36 of them are and it is working well. The younger patients seem to adapt much easier than much older patients.

The rest of the 70, that is, 34, went back to their families. These families care for their loved ones from 4 p.m., with many of them not getting much sleep. The families are the full-time carers at the weekend when the fantastic services in Carriglea are not available. These families receive two weeks respite per year, two weeks when they can avail of a holiday, take a break, sleep, catch up on household jobs or simply relax. These two weeks are a lifeline for families and carers.

The Minister of State should consider the difference an extra week of respite would make to these families. Eventually, a full four weeks in a calendar year would make all the difference. Many of these carers, parents and family members are ageing and they find it increasingly difficult to care for their loved ones. A week's respite per quarter would make life so much easier and it would also mean that people with intellectual disabilities could stay at home longer with the support of day-care services.

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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My two minutes do not facilitate all that I should say. Mental health in Ireland has many connotations. It is broad-ranging and far-reaching and it crosses every boundary of age, gender and status, and defies adequate coverage by me here this evening. All I can say is I concur with all who have spoken before me.

We know we do not have enough funding currently, but I would like to come at it from a different aspect. Deputy Joan Collins spoke about the family resource centres. They play a significant role in the communities and supporting the counselling services there.

I also want to talk about something that has come through CAMHS and the National Educational Psychology Service, NEPS. I do not know whether the Minister of State is aware of this, but the operation procedure issued by CAMHS in June last, to which I referred on the last occasion I spoke here, states, "It is not the role of CAMHS to make recommendations that determine the provision of specific educational supports/resources as this is the responsibility of the Department of Education and the National Educational Psychology Service." I will translate what exactly that means. School principals tell me that this is a clause that is used as a cost-saving detour by ensuring that CAMHS psychiatrists are precluded from making recommendations for the services for children presenting with difficulties, be they ADHD, emotional behaviour disorder or autism. Their statements of fact would fall short of recommending a route to solutions in terms of school-based resourcing. Basically, there is a way of joining certain dots there in the schools and that is where we can get CAMHS and NEPS talking together. In fact, the teachers are the ones who can pull it together. Deputy Ó Laoghaire said it earlier. We need to engage with schools and we need to engage with principals because that is where we can start with a bottom-up approach.

Finally, last week I got a response from the HSE as to where we have come in the ten years of A Vision for Change. It recommends that we have 15.5 teams across the country looking after our children. Currently, as the Minister of State knows as well as I do, we have five based teams. That is what we have. They are currently recruiting another five based teams. Regrettably, it is not enough.

Photo of James BrowneJames Browne (Wexford, Fianna Fail)
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I thank every Deputy in the Chamber for their contributions and the many Deputies from across the House who would have loved to contribute but who, due to the shortage of time, simply were not able to get the opportunity. Every Deputy, bar one, made constructive challenging remarks and was focused on mental health. I also thank the patience of those in the Gallery for whom we are having this debate for their contributions outside of these debates that keep us focused on these key issues.

I listened carefully to every contributor. It is clear from across the House that there is no county, no family and no individual who has not been touched by the issues around mental illness. In my county of Wexford, there are all too many tragic events that have happened in recent times.

It is unchallengeable the social, ethical and, for those who even need it, the economic arguments for supporting mental health and providing increased services in this country. It is a question of citizenship and providing full access to participation in society. That is why we need to focus on it.

Many issues were touched on here and there were many issues we did not get to. Among them, dual diagnosis is something that needs to be urgently reviewed. I accept that alcohol causes mental health problems but many with mental health problems end up in alcoholism. Unless we treat the root cause of that issue one will not resolve the alcoholism issue, and similarly with drug addiction.

Decongregation was mentioned. We must be very careful. The next Leas Cross will occur in people's homes because the oversight is not there in the community. We are putting people from congregated settings into the community but without ensuring the supports and the oversight are there to keep an eye on what is happening.

An issue we did not get to touch on is the increase in self-harm of young women. That is not only reflected in Ireland. It is coming out of the UK, the US and across the western world, and it is something that we will have to attend to as well. Issues around social media and family resource centres, which are underfunded and need considerable support, were touched on.

I am glad the Government will not oppose this motion. The motion seeks an urgent review of the budget allocation. It seeks a multi-annual plan to set out how A Vision for Changewill be set. It will give a final guarantee to ring-fence funding so that any funding unspent in mental health will be carried over.

We do not want to be back here again. The Minister of State, Deputy McEntee, has our support but she needs to ensure that the people needing the services are also getting support.

Amendment put.

Photo of Pat GallagherPat Gallagher (Donegal, Fianna Fail)
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In accordance with Standing Order 70(2), the division is postponed until the weekly division time on Thursday, 17 November 2016.