Dáil debates

Friday, 14 July 2017

Mental Health (Amendment) Bill 2017: Report and Final Stages

 

10:00 am

Photo of Pat GallagherPat Gallagher (Donegal, Fianna Fail)
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There is one amendment in the name of the Minister, which arises from committee proceedings.

Photo of Jim DalyJim Daly (Cork South West, Fine Gael)
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I move:

In page 5, to delete lines 16 and 17 and substitute the following:

“(3) This Act shall come into operation on such day or days as the Minister for Health may by order or orders appoint either generally or with reference to any particular purpose or provision and different days may be so appointed for different purposes or different provisions.”

The only amendment for consideration this morning seeks to amend section 7 of the Bill and to replace subsection (3) with text that allows for the Minister for Health to commence different sections of the Act on different dates. This will allow the flexibility required to commence individual sections if they are ready to be commenced before others. This is a standard piece of text and common to most Bills.

In the context of allowing for different sections to commence on different dates, I also remind Deputies that I stated on Committee Stage that I thought it likely that I would be bringing forward a small number of amendments on Report Stage. However, there was not enough time between Committee and Report Stages to interrogate the proposals in the way we must and therefore it is my intention to bring forward any necessary amendments when the Bill goes before the Seanad.

Photo of James BrowneJames Browne (Wexford, Fianna Fail)
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I congratulate the Minister of State, Deputy Jim Daly, on his appointment. This is the first opportunity I have had in the House to do that. I thank the Taoiseach and the Minister for facilitating the Bill which is being debated this morning. Last year, I was honoured to be appointed Fianna Fáil spokesperson on mental health. When I was appointed, Deputy Micheál Martin asked me to try to ensure real and credible change was brought about in mental health and to co-operate across the floor in trying to do so. Yesterday, we saw the first step in that with the creation of the first Oireachtas committee on mental health. Hopefully, today marks the second step.

Ireland continues to face significant challenges in the provision of mental health services and it has been known for many years that major reform is needed. Too many of the recommendations in the A Vision for Change policy remain to be implemented. The Fianna Fáil Mental Health (Amendment) Bill before Members contains significant changes to ensure people's civil rights when they receive mental health care. This Bill is fully supported by Mental Health Reform, an umbrella group which represents over 50 mental health groups. I thank in particular Dr. Shari McDaid and Ms Kate Mitchell from Mental Health Reform for their relentless and daily pursuit of the cause of mental health reform. This Bill also contributes to the fulfilment of the Government's international human rights obligations. Fianna Fáil's mental health Bill aims to reform Ireland's mental health services by insisting on the implementation of a number of the recommendations contained in the 2015 expert review of the Mental Health Act. Regrettably, only one of those 165 recommendations has been implemented to date. Demands for mental health services increased over the past six years and we must do more to protect the well-being of patients and to ensure the State meets its obligations under international human rights law.

I am hopeful that this Bill will act as a catalyst and I urge all parties and Deputies to support this legislation in order that urgently-needed reforms are implemented without further delay. Ultimately this mental health Bill is about dignity and respect for patients and it gives them a voice in their mental health treatment. I am glad to accept the Government's amendment to the Bill, which is a clarifying amendment. I thank the Minister of State, Deputy Jim Daly, and the Government and the other parties in the House that have supported the Bill to date. It is positive to see people from across the political spectrum come together to support the call for better mental health. The spirit of co-operation in advancing this issue of mental health was here before I came into the Dáil and I am glad that everyone has continued in that spirit today. I hope this spirit of co-operation will continue.

Photo of Mary Lou McDonaldMary Lou McDonald (Dublin Central, Sinn Fein)
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I commend Deputy Browne and welcome this legislation. Sinn Féin supports the amendment as moved by the Minister of State and I join in congratulating him on his appointment to what is a very challenging and important brief. I have no doubt but that he will go at it with considerable vigour and will bring much positivity to the role.

Progress in mental health reform has been painfully slow and the challenges are great. This legislation will be a step in the right direction for many but we all recognise it is merely a single step. I commend the work of Mental Health Reform and acknowledge its tremendous advocacy on behalf of people with mental health difficulties. I recognise and commend the many NGOs and community organisations in communities throughout the country that have become the difference between life and death for many people in many circumstances. The acknowledgment of people's autonomy is the key to advocacy work. They have the right to make decisions regarding the services they access and the care they need but for too many patients, this has not been their experience.

Far too many people feel coerced, disempowered and unsupported. This is how incredibly vulnerable people can feel on admission to a psychiatric inpatient unit in Ireland today.

This morning, I want to add my voice, and the voice of my party, to the demand by Mental Health Reform that the Government must now deliver on the recommendations of the expert group on the Mental Health Act. There is a very real and long-term cost to kicking this can down the road any further. Individuals and their families will continue to travel an unnecessary path of very deep distress and hopelessness, and this, in a modern country like ours, is absolutely avoidable and absolutely unacceptable. The human and economic cost is tenfold and society as a whole is all the worst for it.

Our State does not have a proud record on how we have treated vulnerable people, so when patients use words like "coerced" to describe their experience of psychiatric inpatient care, we as policy makers, legislators and Ministers need to sit up and take notice. When I spoke on this legislation during mental health month, I called for advocacy services to be independent and fully resourced. I argued that these services must be placed on a statutory footing so that every patient is guaranteed codified enforceable legal rights. Patients must have a statutory right to advocacy, and I repeat this call this morning.

Funding for advocacy services must meet demand. We need a dedicated service for children, and this must be underpinned in law and vigorously enforced. Research demonstrates that a robust advocacy system can be an empowering and encouraging experience, and, most importantly, a critical aid on the road to recovery. Having someone in their corner can be everything to people who feel they have reached the end of the road. It is now time for an ambitious programme of mental health reform, an underpinning of patient’s rights and real resourcing of services and supports. As we approach budget time in the autumn, let it be understood by everyone, particularly those Ministers with their hands on the purse strings, that we need more money. We simply need more funding for mental health services.

I have a word of caution following the establishment yesterday of the Oireachtas committee on mental health, which I welcome. Committee members will be duty bound to deliver progressive rights-based priorities for mental health, but the committee members will be fighting with two hands tied behind their backs if the Government does not commit itself now to acting urgently on the committee’s recommendations. The committee cannot be a talking shop. We want this committee to make a real and substantive contribution to improving mental health services in Ireland. This can be the case, but we know it will only happen if the Government collectively commits itself to this process. We welcome and support the legislation. We will move some amendments in the Seanad.

10:10 am

Photo of Niamh SmythNiamh Smyth (Cavan-Monaghan, Fianna Fail)
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I congratulate the Minister of State, Deputy Daly, on his new position. I also congratulate my colleague, Deputy James Browne, on bringing forward this very important Bill. It is clear that our mental health services have been struggling in recent years due to a lack of investment and increasing demand. We have no on-call service in many counties and, unfortunately, Cavan and Monaghan are two of these counties. This is shocking and clearly demonstrates the patchy nature of our mental health services. Vast swathes of the country are left without an effective out-of-hours service. There has been increased demand for these services in recent years. Despite this, we continue to underfund our mental health services. This attitude needs to change, particularly when we consider the demographic changes that Ireland faces in the years ahead. It is vital that the availability of out-of-hours mental health services for children is spread evenly throughout the country. Every child should be treated the same and awarded the same services.

The Mental Health Commission has already highlighted that underinvestment in services for children is one of the factors contributing to the continuing high number of admissions of children to adult psychiatric units. This practice is one which must come to an end. The delivery of 24-hour emergency services for children is fundamental in helping to achieve this. Children and their families find themselves in an unacceptable situation when children must be placed in an adult service. Help and support needs must be readily available.

According to the latest figures released, 47% of all positions promised under the national A Vision for Change strategy remain unfilled. This is 51 posts in the north west alone. I am deeply frustrated by the lack of urgency in adopting and implementing the A Vision for Change policy. This strategy was published more than a decade ago, but we are falling well short of the staffing targets set out in it. The scale of the staff shortages is very worrying. It is becoming obvious that the service is struggling. This will have a major impact on the outcomes for children and teenagers who depend on it. The severity of the staffing shortages in CAMHS is unsustainable and, as a result, children and teenagers are at risk. There is still no out-of-hours service available for young people in the north west, and there is no timeline or target in place for one to be established.

The Minister of State needs to take charge of this situation and fulfil the commitments made in A Vision for Change. The time has come to step up to the mark and deliver the policies recommended in the strategy. There are countless reports of children and young adults seeking support, especially during out of hours periods. There is no one there to help or support them when they need it most. We cannot allow vulnerable children and teenagers to be put aside any longer. We need to see action on this.

Photo of Pat BuckleyPat Buckley (Cork East, Sinn Fein)
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I commend the Bill and Deputy Browne on bringing it forward. I have said many times in the House there is no colour, class, creed or religion, and there should be no politics, when it comes to mental health and suicide prevention, because it affects everybody across the board. We truly have an absolutely huge amount of work to do to improve the protection of the rights of patients. This Bill goes a small but important way towards that goal. It should be the beginning of a process, which is immediately followed by the ratification of the UN Convention on the Rights of Persons with Disabilities and all the reform thereafter to live up to that convention. It is too long coming and we will not stand for any more undue delays.

I ask that everyone in the House join me in this demand, especially members of Fianna Fáil who have the ear of Cabinet. A lot of work has been done to highlight the deficiencies in existing legislation by groups such as Mental Health Reform, which published an excellent point by point response to the expert group on the Mental Health Act, but even this expert review was largely ignored, with just one of the 165 recommendations implemented, as has been mentioned in the House already, and no expression of intent from the Government to change it.

I said on Second Stage that we need an overhaul of patients' rights and an end to the violation of the human rights of patients in mental health services, as well as an end to the paternalistic system that places the final say in the planning of care in the hands of psychiatrists, regardless of the wishes of patients. Involuntary patients do not necessarily lack capacity, which in itself is a somewhat problematic concept. Involuntary patients deserve to be treated with dignity, respect and equality. We would also like to see the inclusion of a statutory right for all people who enter an approved centre, voluntarily or otherwise, to be supported in drafting advanced health care directives that place consent and honesty at the centre of care. We have an amendment on this which we will push on Report Stage in the Seanad. I have spoken to the Minister of State on this topic, and I hope it can find support across the House, and I appeal to the House now as we need to improve services. It is entirely in keeping with the spirit of the Bill published by Deputy Browne.

I make a plea to the Minister of State, and especially to Fianna Fáil, which holds great sway over the Government. Do not settle for crumbs. We need major investment in our services, as has been spoken about. Those problems that are most acute are due to underfunding. We have been stressing funding, but it is very simple: if we do not have all of the ingredients of the cake we cannot make the cake.

It is not rocket science. I ask the Ministers, Deputies and all those listening to spend the next few months convincing people within their own parties and within the Government. A figure of €15 million or some other paltry sum does not do enough. As it merely keeps the system standing still, we need more investment. This is more important than any deal the parties do. We will deal with the politics in the Chamber but when we are dealing with people, we must invest in our future. It might be our children or, please God, our grandchildren. We need to create a better, more educated and safer society where people do not get to a point where they have lost faith in the system, their own lives and their families and want to end it. It should never happen. We have a duty as legislators to drive this as far as we can. If, some day, each one of us, not as legislators but as human beings, can stand here and say proudly that we supported this, we did the right thing and we saw it grow and come to fruition, everybody inside and outside the House can be very proud. One of the most important things in life is that no member of any family should bury their children. No child should end up having no faith in life. They should be looking forward to living it to the fullest. Again, it comes back to this Bill. We must drive it forward. If we are not clear in this regard, we will know it is our choice but, more importantly, it is the choice of the parties in Government. We should remember that people will not be forgiving if we get this wrong.

10:20 am

Photo of Alan KellyAlan Kelly (Tipperary, Labour)
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I have no issue with the amendment, which is common enough. On the other amendments, the Minister of State indicated he did not have time. I congratulate him on his appointment. It is one of the Taoiseach's better appointments. I think Deputy Jim Daly will make a very good Minister of State and I wish him the best. I presume the amendments he intends to bring forward will not change the Bill substantially as otherwise they should probably be brought before this House before coming back but I presume they will not.

I congratulate Deputy Browne and his party on this very good Bill. I do not believe in "new politics" but this is an example of something we can all support. I was very much taken by a small nugget in Deputy Browne's speech when he said that there are many advocates for the change we are making here - those who came before the Deputy and those who came before me and, dare I say it, all of us here. I know and appreciate what the Deputy meant by that. He is dead right. Many people before us have advocated for this change because ultimately, this Bill is about dignity, human rights and, most of all, autonomy. It is a welcome change we in the Labour Party support and believe needs to be implemented in full. It is about giving people respect, it is about dignity and it is about changing the way we treat and think about people. It is a very good Bill.

The Oireachtas committee is all well and good but it cannot be a talking shop. It actually has to do something. I know because I have been part of many of these things previously. I want the Minister of State to act rather than participate and I believe he will. I congratulate and thank all those organisations that have been advocates for this change and further changes that will not be part of this Bill but for which they continuously advocate on behalf of people who suffer from mental health issues. Let us be honest about it. There is not a single family in Ireland, including my own, that has does not have members with mental health issues. The people who advocate on behalf of those people are powerful people. They are great people and I acknowledge them today.

A Vision for Change is a policy that needs resources to be implemented. While everyone has talked about resources here, the lack of staff - the lack of positions being filled - across the country is deeply worrying. We need to find out what is going on. Sometimes we all say it is an issue of finance but I am not sure this is the case in this situation. What is going on here with regard to filling the positions across the country? We are all public representatives and we all try to help those who come into our clinics every week but I often find that the reason people cannot get help is because there are no people there to help them. I do not believe it is actually about finance and funding these positions. What can we do to ensure that these positions are filled to help the people who need help? If the Minister of State could be honest with us and tell us that it is really about getting people who are qualified into those positions and that it is not about bureaucracy or money, it will be easy for us to explain because I believe that could be the reason.

The second issue concerns facilities across the country. Part of A Vision for Change involves providing facilities across the country. I represent Tipperary, which simply does not have facilities. I am not alone in this regard as other Members are in a similar situation. The principle of A Vision for Change is right but we lack the facilities on the ground to help people. This must be considered and addressed and we need to rethink this a little because while the principle of the strategy is right, the actual facilities are not there.

What is going on with regard to filling positions because, ultimately, that is the most important issue? Every week, I hear from people with family issues and concerns. We simply do not have the professionals in the system to help these people. I speak to senior people in the HSE and across the board. I do not think it is a willingness issue. I do not always want to come in here and give out because I do not think it is a willingness issue. I think they are willing and wish to help but we do not have the people in the system if there are only 24 hours in a day. Consequently, we should figure out what is the logjam issue here and if the Minister of State can help with that in the next few months, he certainly will make a huge improvement.

Photo of John BrassilJohn Brassil (Kerry, Fianna Fail)
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I also wish the Minister of State well in his new position, as well as complimenting my colleague, Deputy Browne, on bringing forward this Bill and on the excellent work he is doing. It is appropriate that the Minister of State is flanked by Deputy Neville, whose father ploughed a lone furrow for many years on this issue. This must be recognised in this House.

It is important that we get this issue into primary schools. It is both an education and a health issue and we must integrate education and health. We should look seriously at making mental well-being a compulsory part of the primary school curriculum because this issue needs to be tackled at a very early age and there is no better place than primary school. I would like this to progress. Possibly the relevant committee could look at those processes.

As a member of the Oireachtas Committee on the Future of Healthcare, I note that mental health formed a very large part of its report. Some of the submissions we received were appropriate and pertinent.

The submission of Galway Early Years is that one of the most effective ways of tackling the mental health epidemic now and for future generations is to focus on improving mental health from the very beginning, given how significant this period is in laying the psychological foundations of later life. Another submission came from Children in Hospitals Ireland. In recent years, despite the publication of A Vision for Change, mental health services for children have not shown any notable improvement. A submission from Mental Health Reform represented the views of particular groups, including the homeless, those with a co-morbid diagnosis of mental health difficulties and intellectual disability and those with a dual diagnosis of mental health difficulties and substance misuse experience significant challenges in assessing appropriate care. That is a snapshot of the difficulties that exist. All Members know they exist. Our job is to fund and co-ordinate a proper level of integrated services with money being spent wisely. People have come to my constituency clinics seeking counselling for their children who are on six-month waiting lists. When a child presents with a mental health issue, that need is immediate and must be tackled. There are many very good organisations such as Jigsaw, Pieta House and so on which do excellent work but they need to be co-ordinated and linked in. It is the job of the Joint Committee on the Future of Mental Health Care and the House to ensure that happens.

The EU average percentage spend on mental health is that approximately 12% of the mental health budget goes to mental health facilities while in Ireland it is half that figure. That needs to be increased. If the Government invests in this area, there will be significant savings in the system further up the line because hospitalisations and so on will be prevented.

I agree wholeheartedly with the point made by Deputy Kelly regarding positions and vacancies. A constituent of mine is a qualified counsellor who studied as a mature student and cannot get a position in the HSE despite being told that it is crying out for counsellors.

10:30 am

Photo of Alan KellyAlan Kelly (Tipperary, Labour)
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Hear hear.

Photo of John BrassilJohn Brassil (Kerry, Fianna Fail)
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I ask that each county present the Minister of State with a list of available positions and a timeline in which they should be filled because no one seems to be driving recruitment. The positions are there but they are not there and there are no interview processes. The Minister of State could spearhead that issue in his early time in his Department and get it sorted out. If staff are in position, there is a chance of getting people treated.

Once a person who is experiencing difficulties reaches the age of 18, he or she is in a different category. He or she is the same person with the same problems but the transfer is very difficult for him or her. There needs to be a seamless transition from a child to an adult service which is not currently in place. That needs to be considered.

I hope to sit on the committee. The Minister of State will have my full support. It is the job of all Members to get this area properly funded and serviced. I look forward to working with Deputy Browne, the Minister of State and other Members in getting this issue tackled in a proper setting and dealt with in an appropriate manner.

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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I am delighted to have an opportunity to speak on this very important subject and I congratulate Deputy Browne on his very important work and the Minister of State on his appointment. I wish him and the committee well. Mental health is a very intricate subject with which every Member has had some dealings in his or her constituency. It is still very much an enigma in some cases and, when something happens, people often ask why it has occurred. They ask themselves whether they should have been more alert, spotted something sooner and whether there should be more support facilities. Every person in public and private life can become an advocate in the area of mental health without imposing their inquisitiveness on others by being alert and confidential in terms of dealing with and advising people in a helpful rather than critical way. That applies to individual households and affects young children.

A couple of years ago, I tabled a parliamentary question on this issue and was shocked to discover the number of children under ten and between ten and 14 who had self-harmed and been referred to accident and emergency departments on more than one occasion. That indicates a need to address the subject and follow it up, which is hugely important.

All Members have had dealt with situations in recent years involving economic pressures arising from house repossession and people who are stressed by dealing with mortgages and mortgage arrears. The mental health of some people throughout the country has been detrimentally affected by the downturn in the economy. The doubt, insecurity, concern and worry of people about their futures was hugely exacerbated by the economic situation that developed. Unfortunately, many people succumbed to that. As Deputy Browne said, support facilities need to be alert, constant and accessible around the clock in a way in which people can rely upon them and avail of them without further stress being caused by having to search for services. All Members have dealt with people who required services and sometimes felt those services were not as available as they ought to be.

Other people require ongoing treatment. One problem is that some people need supervision and some do not. Supervision should be put in place for those who need it for medication because there is a difficulty if they do not take their medication, if it is not available or if it is not clear that an effort must be made to take it. Everyone tends to take the easier route no matter where they are in life, but that does not work in this situation. I hope that we will build upon the unfortunate experiences we have had in recent years and previously and try delicately and sensitively to put in place the support services required as the need arises.

It is an honour to be here in the presence of Members who have shown an interest in this issue. Former Deputy Dan Neville spent many years highlighting this subject. It is to his credit that he kept a focus on it throughout his political life. Approximately 20 years ago, the focus was rightly changed from institutional care to community care. The only problem was that community services were not provided to the extent required. The effects of that are still being felt. Many of the housing problems that exist result from one service being scaled down for good reason, but the support and replacement service not being put in place or is insufficient. Members should realise that in a situation when an individual of any age feels threatened or insecure and is worried about the future, he or she needs a pillar to lean against and something to draw upon. To be stabilised, he or she needs the strength of an institution or society that can be relied upon. He or she needs security. That has not been provided, which is a sad reflection on our society. We ask ourselves why these things continue to happen and reflect poorly on society. We have to bite the bullet and provide the resources. It is costly.

We are going to have to do that now. If we do not, we will find ourselves in years go come still dealing with the same situation and asking ourselves why does this problem of mental health issues and instability not go away.

There will always be societal pressures on people to a greater or lesser extent depending on their particular economic situation. I go back to what I said in the beginning, and what others said as well, on the question of support. Put in place something that is reliable and supportive for people and that they are secure and happy with and that we do not pull the plug on as economic circumstances change.

10:40 am

Photo of Mattie McGrathMattie McGrath (Tipperary, Independent)
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I too was delighted to get time to speak on this Bill. I compliment Deputy Browne for bringing it forward. Indeed, déanaim comhghairdeas leis an Aire Stáit freisin.

I thank the Minister of State for accepting this amendment and for having cross-party agreement. We all know how difficult and how challenging it is. Indeed, Deputy Durkan mentioned the former Deputy, Dan Neville, who was a wonderful champion. While I was in this House, up to the last election, he was always - he still is - an advocate and did tremendous work.

It is a sensitive and delicate issue. It is the poor relation within the HSE. We had great expectations back when I was a member of Deputy Browne's party and the then Minister of State, for Deputy John Moloney, brought forward A Vision for Change. It involved a lot of planning. I suppose A Vision for Change was the appropriate phrase but, unfortunately, it has not delivered. We were sceptical at the time. The ring-fenced budget, famously, of €50 million, for several years was never ring-fenced by successive Ministers. We were always told it was ring-fenced but it was not and it was taken off and put into different areas year after year. I remember being here when it was voted through, changed and amended and that is not good enough.

We all hear in our clinics and in phone calls every day of the week from distressed parents of youngsters and teenagers about the lack of services. We ourselves meet people who present to us. We are not - certainly speaking for myself I am not - adept at dealing with people in those situations. One picks up the phone or goes to whatever index to contact whoever one thinks one should ring and there are no services and certainly none after hours.

We see the situation with the CAMHS issue with young children and teenagers. It is a vulnerable age, anywhere between eight, nine and 14, 15 or 16 years. It is terrible: parents come in who do not know where to turn, living through hell and fear, and on 24-7 watch. There is desperation that they cannot get services. They cannot get appointments.

In my area in south Tipperary we had a fine mental hospital, St. Luke's, which was closed. It covered all the county long-term. Many of those patients - I still meet them out in the community - are doing fine but some, quite frankly, did not do fine. One cannot decide that people who have been institutionalised for so many decades will live in a community setting, because they are not able to adapt. It is a huge challenge.

Then we had a short-stay facility, St. Michael's, which was attached to St. Joseph's. A 40-bed unit, it was a life-saver for people from all over Tipperary. It also was unceremoniously closed. The former Minister of State, Ms Kathleen Lynch, at the time would not listen to anyone - the patient advocates, patients themselves who came up who were good ambassadors who had recovered and may have slipped in there as a fall-back place for some therapy and treatment once or twice a year. That was a wonderful unit of 40 beds. They abolished it. They just closed the doors on it, with no services provided. There were promises of services from a couple of community teams but they were not recruited. This is the shameful part of it. Deputy Kelly stated he did not think it was about money. I do not know what it is. If it is not money, it is downright carelessness and borders on blackguarding.

We were told to go to Kilkenny. People from Tipperary at the Limerick border were told to go to Kilkenny with no transport, no way of getting in and no beds in Kilkenny. Then all the patients have to present to an accident and emergency unit, which is totally unsuitable with the chronic situation there. If they are not in the best of form and have mental issues or any kind of psychotic attack, that is not the place to have them. They are traumatised enough and the nurses are under enough pressure.

Then there was a private taxi service that would being them. A number of nurses would travel with them, if somebody presented with a psychotic attack. That was pulled by email on a Friday evening.

Now if they present themselves voluntarily at 5.30 p.m. any evening - if it is a Friday evening I do not know what they will do - they have to sit on a chair in the hospital until 9 a.m. the following morning until an ambulance arrives. The garda fills in if it is an involuntary admission, but they have not the time either. Therefore, there are no services in south Tipperary.

I salute those who are involved in the services but it is so sad. I wish this committee, chaired by Deputy Harty from the Rural Independent Group, well. I honestly do. We need to get them doing their work but we need to come in then, put our money where our mouth is and re-evaluate where A Vision for Change failed. We have all these wonderful schemes - Deputy Mary Butler informed me that the Minister has now agreed to look at the cardiac situation in Waterford again and setting up a review - but we need to see these reviews, who is on them or who is giving them their riding instructions.

A Vision for Change was a lovely document. I am sure a lot of time and expert analysis went into it but it has not worked. It could not work when we did not put the riders on board - we did not give it the staff. We had funding there and it was not ring-fenced. It was taken off for other areas in health. Health is just gobbling up funding.

It behoves us all because, as Deputy Kelly stated, there is not a family, parish, village or townland that has not somebody somewhere who is affected. Increasingly, with the pressures that are on people now, it will be harder and harder.

For young people especially, they need a fair start in life. It is shameful. We all must hang our heads in shame and accept that we have not demanded enough. We have not fought enough for it. We have not just kicked up enough of a row about it. It is the same with people with disabilities who came up yesterday and were out here again. They are neglected.

Those are not, I suppose, glossy or nice issues, but they have to be confronted. We have to police the Minister of State, Deputy Jim Daly, on the funding and that the appointments will be filled. We see loads of advertisement and then we never see the places filled. One is told one will wait three months or four months and when one goes back the next time, one hears the place has not been filled and someone retired, is out on leave or sick leave and one waits 12 months or 15 months which is totally unacceptable. One should not be waiting 12 days for those kind of services, or 12 hours in some cases. The services are just not there. People are ending up in suicidal situations with many, many good lives destroyed, families tormented and huge trauma visited on a family and the community.

We need to deal with this amendment - it is being accepted - and move forward in a positive manner.

Photo of Eugene MurphyEugene Murphy (Roscommon-Galway, Fianna Fail)
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I am always conscious when we discuss this issue of those present here in the House who have suffered loss in their families and those who are not present. It is, I am sure, a difficult time for them when this matter is discussed.

It is also appropriate that Deputy Brassil mentioned the outstanding contribution of Dan Neville, both as a Senator and a Deputy. I can remember many years ago listening to that in many respects lone voice constantly speaking on the issue and doing enormous work to help people.

The contribution in recent years of Senator Joan Freeman and Pieta House must also be recognised. We have a huge movement now in Darkness into Light walks with thousands of people all over the country joining that campaign. Also, the former Minister of State, Mr. John Moloney, put extraordinary work into that report some years back. I watched him debate and he was so passionate about that. It was Deputy McDonald initially said we have to think of all these people who are not involved in the system, who are not being paid for work in the system but who just got up and did something because of their concern on the issue.

No doubt the Minister of State, Deputy Jim Daly, who I wish well, will take on this issue and give it everything.

I compliment my colleague, Deputy Browne. Since Deputy Michéal Martin appointed him, he has put many hours and days of work in to bringing this matter forward.

I will refer briefly to the difficulties in my constituency of Roscommon-Galway.

An external review has been taking place for over 15 months and several deadlines have been missed. In fairness to the HSE, it has made contact with the people who have been carrying out the review. One point being made by them to the HSE is that so many people want to make a contribution to the report that they have been overwhelmed. I do not want to pre-empt or prejudge the outcome of the report but I guarantee it will result in a lot of debate and talk in this House and throughout the country.

Many people cannot get services and have been turned away. I acknowledge that many people in the system are trying hard to help families. I know of a family, including a parent, that drove to five hospitals only to be told at each that the hospital could not deal with the problem. Eventually, it ended in tragedy at a health centre. We always use the word "closure" when a report comes out. There is never closure for families on this issue. For those who lost somebody 20 or 30 years ago, there is never closure. Many families will say the pain does not go away. As already said, the questions are always asked among families and individuals, who ask why the person did what he or she did.

I am convinced a few simple things could help many people. The art of talking or conversation has disappeared. Social media bears significant responsibility in this regard. Perhaps sometimes we, as adults, dismiss youngsters and tell them not to worry about what they are worried about but five minutes of conversation could change the focus of their minds. Many more people than we imagine feel rejected. It might be that engaging in the art of conversation would change everything for them. That is vital. We have silent conversation now because of social media in many respects. There can be no such thing as silent conversation because it does not work.

St. Brigid's in Ballinasloe is closed. The services in Galway city are very poor for the region. We do not have an adequate service at Roscommon hospital. As others have mentioned, there is a gap between younger people and adults. People are falling through the net at that stage, which I acknowledge the Minister of State understands well. We are on a new plane in this regard as everyone in this House, irrespective of the side, wants this matter to improve. We will not solve every problem but we must reach out to all people who are looking for the proper services and for staff to be put in place. Perhaps we should consider more drop-in centres.

Organisations such as Foróige, youth groups and Macra na Feirme have done considerable work in bringing young people together through their activities. I would like to see the Government giving further support to such groups.

10:50 am

Photo of Jackie CahillJackie Cahill (Tipperary, Fianna Fail)
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Like other speakers, I wish the new Minister of State well on his appointment. I compliment Deputy Browne on bringing this Bill before the House. Unfortunately, no neighbourhood in the country has not experienced the horror of suicide. I wish to focus on early intervention, which is crucial. It can do an awful lot to alleviate the problem and influence the allocation of resources. There is a crisis in the mental health service. As with other Deputies, I have experienced that in my constituency. The service is not improving but unfortunately continues to decline. The workload for staff is increasing. This is due to a lack of funding in the correct areas, especially early intervention. There is confusion in the service, with roles not clearly defined. On many occasions, patients are being referred to general practitioners or the Garda before the HSE is willing to engage with them. They are ultimately the responsibility of the HSE.

An after-hours crisis telephone service, whereby one can telephone a nurse, is available only until 3 a.m. but a patient in crisis can present at any hour of the day or night. There is lack of proper communications systems at place at ground level in the HSE, and there is no proper use of the technologies available in other parts of the HSE.

It is possible for a family member to commit a person to hospital. The family often meets reluctance, be it from Shannon Doc, Caredoc or even HSE staff, because of their lack of knowledge of the patient. A family member who has managed to commit a person to hospital can find it virtually impossible to have that person removed from that situation although the understanding and knowledge of the family member would make him or her best qualified to act in such cases.

Sadly, the mental health service will allow a patient under care to go to the stage of becoming maniacal, which results in disruptive or destructive behaviour. This becomes a safety issue for the patient and other members of the public. Early intervention can avert crises in many cases and it is ultimately better for the patient and more cost-effective for the HSE.

We all know someone in our community who is affected and the turmoil it brings to the family and community cannot be overstated. Therefore, we must make change to ensure the most effective outcome for all.

I want to focus on my constituency. Two other Tipperary Deputies have spoken here this morning. The lack of services in our county is absolutely frightening. I understand that more Jigsaw projects are to be rolled out in the near future and I urge the Minister of State to ensure Tipperary gets one of those projects because this form of early intervention is vital. It is impossible to imagine that a county the size of Tipperary has no psychiatric bed. People in the south of the county must go to Kilkenny and people in the north of the county must go to Ennis, where accommodation is not available.

A mental health clinic in my town services 34,000 people. It is not properly staffed or resourced. The scarcity of mental health services in our county is absolutely frightening. I urge the Minister of State to take particular cognisance of my constituency and to try to devote some resources to it. I would welcome the Jigsaw project as one of the first steps in ensuring that we start to rebuild the proper services in our county.

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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I thank Deputy Browne for introducing this Bill. I wish the Minister of State all the best in his new role. Having worked with him in his capacity as Chairman of the Joint Committee on Children and Youth Affairs, I know where he comes from. He is visionary. When he puts his mind to something, he delivers on it. I expect the same regarding mental health. It is great to see Deputy Neville in the Chamber because he is also a member of the committee. The committee places great emphasis on children, youth and mental health. One of the first items on the committee's agenda for the autumn is mental health. This comes on the back of the Minister of State's view, expressed when he was Chairman, that the committee should focus on mental health, children and early intervention. It is opportune for us this morning to focus the Minister of State's mind on what the committee, my party and I would like as we enter the recess in light of our position in the supply and confidence agreement. We request support across all parties and none in securing early intervention, which is essential for children. If we spend on early intervention, we will make savings a long way into the future.

CAMHS is at crisis point, as the Minster of State knows. Everybody has alluded to staffing. Up to last April, 84 CAMHS posts were still not filled nationwide. I compliment the Galway CAMHS team because it is doing so well in recruiting. One must ask oneself, however, whether there are gatekeepers in the HSE who simply are not letting the people in. People are actually applying for the jobs. I know that myself. It is okay being a gatekeeper but not at the expense of young people or anybody's life. We need the staff working in the industry. We are receiving some of the best curricula vitae but we are not recruiting.

We are advertising. We are doing all we should be doing but we are not putting bums on seats or putting people in front of patients to look after them. One of my suggestions relates to GP care. We have a GP intervention system for adults but we do not have one for children. GPs are the clinicians and they are on the front line. Parents do their very best and it takes a lot for a mother or father to come to the point of presenting at a GP surgery when his or her son or daughter is in crisis. If the clinician identifies that an immediate intervention is required, I need to know there is a dedicated phone line so parents can contact the local CAMHS team directly and get an on-the-spot referral. I am not talking about an accident and emergency intervention or writing a letter of referral to CAMHS. There has to be a mechanism to get somebody straight on the road to intervention.

I am also talking about 24-hour crisis support. There has to be an on-call support service for GPs and it cannot be just the accident and emergency route. When I talk about crisis intervention, there are 45 beds in Galway outside of CAMHS. There are eight CAMHS beds and 45 in the hospital. Referring a child to accident and emergency to put them in an adult ward is not the way we should be doing business. The Minister of State and I both know it is not. We need to ensure that GPs are supported so they can make the correct interventions and have the right signposts to get the right support for families. It is crucial work which every GP in the country would welcome. It goes back to the plan for supporting communities. It would support families. When we talk about children and early intervention, CAMHS is dealing with crisis cases. Every case that comes before CAMHS involves a crisis. Yet there are 2,400 children waiting to get to be seen by CAMHS. The figures are startling. The Minister of State has the budget. Hopefully, this year we will see that €35 million budget. If the Minister of State cannot spend the budget within the realms of the HSE because of staffing and recruitment issues and how long it takes to resolve such issues, let us work with the advocacy groups because they are best positioned. Many advocacy groups have trained clinicians working with them for them and they have good teams.

Deputy Cahill referred to Jigsaw in Tipperary. Jigsaw also operates in Galway and I can tell the Minister of State about the wonderful work it is doing. It is doing outreach work because we are trying to open an outreach unit in Gort in south Galway. Jigsaw has the base and it knows how matters work. People voluntarily walk into Jigsaw offices.

I wish to talk about the youth work counselling service in Galway. The Minister of State was very good to us. In the past week, he has shown his leadership in the area of mental health. He heard us debate the issue here during Topical Issues. Within a week we were in front of the HSE and by yesterday the email was back on our desk saying it will be supported. I will ask the Minister of State's Department to talk to the other Departments and to learn to engage with the Department of Children and Youth Affairs and the HSE. They should all work together because the joined-up thinking is missing. The Minister of State and the Minister, Deputy Zappone, understand the point of such thinking. Perhaps we need to get that understanding further down the ranks within the Departments and among the officials in order to break down the bureaucracy. We have to start working together. The Youth Work Ireland project in Galway was on its final lap until the issue was raised in the House. It was the Minister of State's intervention and that of the CEO of the HSE in Galway that pulled it out of the fire. I thank the Minister of State for that. I wish him well. Early intervention has a huge part to play.

11:00 am

Photo of Tom NevilleTom Neville (Limerick County, Fine Gael)
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I welcome the Bill and the debate on it. I congratulate the Minister of State, Deputy Daly, on his elevation. I worked with the Minister of State on the Committee on Children and Youth Affairs. I look forward to working with him. I acknowledge Deputy Browne for bringing this forward. When he contacted me about it a number of months ago, I believed it was a no-brainer. I sit on the cross-party mental health group. We have all tried to work apolitically on this issue. There is a spirit of that within the group. I understand politics will creep in from time to time. We are politicians who belong to political parties so we have to call it how it is. I will be mindful of my comments and sensitive in my speech for those in the Gallery and those watching proceedings. I thank Mental Health Reform for its guidance and help over the past year since I have been on the cross-party group. I thank Deputies for and acknowledge their comments regarding the former Deputy, Dan Neville. He would not want extra credit for this. He just saw it as part of doing his job as an elected Member.

Today is a watershed in driving this debate. I welcome that we will have a joint Oireachtas committee on this. It will be something with a bit of teeth so we can start getting stuck in, obtain some quick wins and send a message to the electorate that we are trying to tackle this as best we can. It is a very complex area. The biggest challenge is that it is dynamic. The issues that put pressure on people today were not issues ten or 15 years ago. Social media is an example. It can be very positive but there is also a negative side to it. There are also cultural changes. Reference has been made to younger people. When I speak to teenagers, I take heart from their attitude and perception of mental health. Their openness to it is very different from generations ahead of them. We have to take heart from that. We have to take that seed and allow it to germinate. As part of the committee's work, we have to start listening more to younger groups - such as Macra na Feirme and Foróige - and the ideas they put forward. Younger people come at this matter from a completely different perspective than we tend to do. I will speak for how my generation is approaching it. We have come from a time when it was brushed under the carpet to a point whereby we now speak openly about it. It is all part of eradicating stigma. We have to keep concentrating on eradicating stigma. There has been much work done on this issue in recent years but it is still prevalent. We need to gather intelligence on where it is most prevalent. Is it a generational, cultural or socioeconomic thing? We need to get that intelligence and data to be able to formulate policies to tackle it.

The other matter we need to address - I have been doing a lot of work on this - relates to co-morbidity and dual diagnoses. It is an area we need to tackle. There is growth in that area. There is a lack of understanding on joined-up thinking on it. There is a "No Wrong Door" policy in respect of dual diagnosis in north Tipperary and Limerick. There are some working documents on that. There is a multidisciplinary team from both sides because what happens is the patient falls between two stools when it comes to dual diagnosis. Is it the substance or is it a mental health problem? That has been a challenge all along. There is a document on the policy and there is also a working group. If we put the resources in, we can use that policy and find the positives and start to roll it out. It is a huge challenge.

To return to the issue of young people, there has been a growth in drug culture in Ireland that was not there before, particularly in the context of synthetic drugs. We need to drive education in that area. I have looked at the drugs strategy. We need to stop shying away from that area and look at educating young people on what is happening on the street and the challenges they will face. Education on mental health, cultural change and the use of drugs is key. We need to tackle this issue head-on.

I welcome that there has been a drop of nearly 20% in the suicide rate over the past six years. We still need to get the figures relating to why that is happening. Are preventative methods responsible? Is it just that there is intervention taking place at the final point? Limerick Suicide Watch, which has just received charitable status, does a huge amount of work in Limerick. Intervention is happening there at crisis point. Is the drop in the suicide rate due to intervention at crisis point or is it a result of preventative measures? We need the intelligence on that.

I welcome the work Jigsaw is doing in Limerick.

The cross-party committee worked extremely well.

I want to see that work continue. I want to send a message from the Dáil to our younger people. As our younger people do not vote, other Members and I probably do not engage with them as much and they do not see that engagement as much. Those younger people, particularly teenagers, from their perspective have different ideas from mine because I come from a different generation and background. That really needs to be tapped into. They have ideas on the use of other methodologies and treatments, such as the creative arts and sports, and moving away from the clinical approach. While we need both, we need a philosophical debate on the creative arts and what they can do.

Deputy Eugene Murphy mentioned the art of conversation and that people do not talk. What is more, the sense of community has broken down. Sporting organisations and artistic organisations can bring that sense of community back. Our focus should not be geographical because we move around much more, but should be on interest areas. This is probably more of a philosophical debate that we should have in the committee as well, but we need to start sending those messages out there because they are messages of hope.

11:10 am

Photo of Dessie EllisDessie Ellis (Dublin North West, Sinn Fein)
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I thank Deputy Browne for introducing the Bill. I wish the Minister of State all the best in his new role. I really hope he makes a difference because there is scarcely a person in this House who has not been touched in some way by suicide. Scarcely any family has not experienced suicide or some form of mental health issues.

The rate of suicide in this country, particularly among young people from 14 to 30, is one of the highest in Europe and the world. We have not gauged the full extent of suicide in this country because there are many deaths on roads that could be attributable to suicide and there are no statistics to back that up.

One of the biggest problems I have encountered is people being turned away from hospitals. That has been an absolute disaster. I have experienced it many times. My son is in the psychiatric services at the moment and I am fairly familiar with the process that takes place. The mechanism of reporting by going to a hospital accident and emergency department first has proved to be very difficult. Another mechanism is for people to go into Garda stations. That can be problematic because often no psychiatrist is at hand. A psychiatrist could be covering ten Garda stations and by the time he gets there the person might have calmed down and ends up getting released, which is an absolute tragedy.

Many young people have ended up in adult facilities, which is scandalous. There are issues with the welfare of children and we cannot allow that to continue. We need to have facilities to deal with that. I have never seen so many young people, especially young women, in the psychiatric services. I have been there constantly over a number of years. Recently I have noticed a huge surge in the number of young women, which is very worrying.

In one case a person actually ended their life in hospital while there for psychiatric reasons. It was an absolute tragedy and how it happened is another matter. I have come across many cases of people being turned away. A young lad was turned away even after his mother pleaded for him to be kept in the psychiatric services. Unfortunately when the woman left, the young lad was let out. He was found two weeks later; he had killed himself unfortunately. It is one of many tragedies we have all come across.

It is not just a lack of money; other things can be done. We need major investment. We obviously do not have enough front-line staff. It is also clear that we do not have enough psychiatrists. It is noticeable that the number of nurses and people leaving the psychiatric services is higher than in any other health service area. We need to find out what is driving people out of those services.

Sometimes even basic things such as blankets and pillows are not available and patients cannot get those extra items in the hospital. Such things should never happen when one is dealing with people who are very vulnerable.

In terms of dual diagnosis, it is my experience that a particular attitude is taken to people who are taking alcohol or drugs. We need to address that. We cannot just turn people away. Many people turn to drugs and alcohol because they have psychiatric problems and that has to be addressed. That requires education on the effects of the drugs being used. Many of them are highly psychotic and are adding greatly to the problem. We need to get the message across that drugs such as cannabis and cocaine are extremely dangerous.

We also need to have a 24-7 service and not a 9-12 one, which seems to be the Government's position. We want a round-the-clock service. People do not just get ill, or have a breakdown or a psychotic incident between 9 a.m. and midnight; it happens round the clock. We must deal with that. We also need to review the facilities for people on leaving the psychiatric services. Many of them want to live alone. Many of them need supported services and we need supported housing for those people because they deserve a quality of life as much as anybody else.

We depend on groups such as Mental Health Reform, Pieta House and other advocacy groups. As many of them are obliged to fund-raise themselves, the State is being let off the hook in respect of funding. We underestimate the extent to which our communities have many volunteers and youth organisations whose work is helping people with psychiatric and other problems. I take my hat off to these organisations, which have done a massive job not just in my area but throughout the country.

The committee has been set up and we have defined the ratios of people from different parties. While we have not determined the committee membership, it is important to have service users, as well as the advocacy groups.

The Bill is a small but significant step. We need to build on it and we need the resources to do it.

Photo of Pat GallagherPat Gallagher (Donegal, Fianna Fail)
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Before calling Deputy Butler, I want to say that Members will have recognised that I have allowed the debate almost like a Second Stage debate even though there is only one amendment. I have done that because I recognise the importance of mental health and hopefully this will raise awareness. Today is important. I am only reflecting what I deem to be the view of Members of the House. I say this because I think Members will have said what they want to say on Report Stage. Without curtailing anybody, I call Deputy Butler.

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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On behalf of everyone in the House, I wish to say that we appreciate how the Leas-Cheann Comhairle has allowed us the time to have our say.

The Bill seeks to implement immediate improvement in legislative protections for adults and children accessing acute mental health services. The Bill is important in putting the person first. As Deputy Buckley has said, this has to transcend politics and we need cross-party support.

We cannot play politics with this as there is not a family in Ireland that has not been affected by it. I listened with interest to what Deputy Neville said. We are fighting the battle against the stigma associated with mental illness. The new generation is much more open to talking about mental illness. I see that with my own children in college. I have two children going through the college system. My daughter was in Mary Immaculate College last year. Unfortunately, one of her group of friends took his own life. That had an impact on the group of friends and the entire class. There was some help but it was not enough. The suicide had a big effect on them. Most of the students felt guilt that they did not see the signs or read the signals that this young chap was going to hell and back. He was out socialising with them and attending college. His death had an effect on the rest of his classmates. They did not see the signs. They felt guilty and felt that they should have been able to help more and they did not. That is something they will have to live with for the rest of their lives. I met the Union of Students in Ireland. There is some help in third level institutions but it is not enough. That is one area we need to target.

Another area I wish to pinpoint today is something I have come across a lot and which has been alluded to by other speakers, namely, staffing levels. It is one of the most important issues. There is not a moratorium per seon replacing staff going on maternity leave, but the Department must work within its existing budget. Nine times out of ten it is not in a position, financially, to replace the person who has gone on maternity leave, and that is causing a huge issue. In Waterford we have 2.6 psychologists, which is not enough to deal with the children. Currently, one member of staff is on maternity leave. The HSE did find the budget to replace the person, but because it was only a temporary position, it was very difficult to fill the place. That is a significant issue when one has 2.6 posts for child psychology, one of those is on maternity leave for six to nine months, and the person cannot be replaced because it is only a temporary position. No one is going to uproot from another side of the country to come to work someplace else for nine months.

People have also come to me about the lack of continuity in treating children with mental health issues. They need continuity of care. If the person treating them leaves due to maternity leave, to which they are entitled, and we have all done it, or if the system changes, children find it very hard to adapt. An adult will adapt more quickly. That is another issue we must address.

Deputy Rabbitte spoke about children trying to access a mental health bed. Currently, we have 58 mental health beds for children in this country. That is not enough. It is a scandal that a child with mental health issues would have to go into an adult ward or facility. Imagine putting a child of seven or eight into an adult ward. In many cases adult wards have a mix of men and women.

We must compliment the likes of Jigsaw and Sugru that do fantastic work throughout the country. The spirit of volunteerism within those organisations is fantastic. I echo what Deputy Cahill said, that we need a Jigsaw and Sugru in every county in Ireland. They cannot be based in just one or two areas.

Many facilities are city-based, but many people live in isolation in rural areas. Mental health comes to the fore there, but the services are not as easy to access. There are many good people working in the system and they are very fair, but the problem is there are not enough of them.

My final point is one on which I speak from experience. When a member of one's family is admitted to a psychiatric ward and they come out well after being looked after, that is good but the follow-up care is very poor. There is a lack of aftercare. If someone leaves hospital after a stay of between six and eight weeks, family members can see the signs of it happening again, ahead of a medical person because when one lives in close proximity to someone who suffers from mental health issues, one does recognise the signs. The follow-up when someone leaves hospital is inadequate because there are not enough staff in place. I compliment those working in the system because there are some very good workers.

11:20 am

Photo of Aindrias MoynihanAindrias Moynihan (Cork North West, Fianna Fail)
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Molaim an Teachta Browne as an méid taighde agus as an obair atá déanta aige maidir le scrúdú ar shláinte mheabhrach agus féinmharú agus, gan dabht, an tslí a bhfuil sé tar éis an Bille seo a thabhairt chun cinn. Tá an-chuid tacaíochta faighte aige ó grúpaí deonacha éagsúla timpeall na tíre. Molaim an Teachta as sin. Is é aidhm an Bhille cuid de na moltaí atá léirithe sa tuarascáil ó 2015 a bhrú chun cinn mar tá géarghá leis. Léiríonn an méid díospóireachta, an tslí go bhfuilimid go léir aontaithe agus an tslí go bhfuil an Ceann Comhairle tar éis an díospóireacht seo a scaoileadh isteach anseo inniu go bhfuil an méid sin suime ann. Léiríonn sé chomh maith an tslí a shíneann ceist na sláinte meabhraí agus féinmharú isteach i ngach pobal timpeall na tíre agus nach bhfuil aon éalú ann uaidh. Déanaim comghairdeachas leis an Aire Stáit as a ainmniú. Tá dúshlán amach roimhe ach tá tacaíocht ann dó. Táimid aontaithe faoi seo agus is dóigh liom gur mór an cabhair é sin chun cúrsaí a bhrú chun cinn.

Díreoidh mé ar dhá ábhar faoi leith. Is féidir leis an gcóras oideachais cabhrú leis seo. Caithfimid a bheith soiléir i gcónaí go mbeidh laethanta ann nach néireoidh linn, go mbeidh dúshláin romhainn anois is arís agus go mbeidh orainn aiseirí arís agus arís eile. Resilience atá i gceist. Ba chóir go mbeadh modúl éigin sa chóras oideachais, sna bunscoileanna agus sna meánscoileanna, chun an tacaíocht agus na scileanna cuí a thabhairt do dhaoine óga chun gur féidir leo éirí arís agus arís eile agus tabhairt faoi na dúshláin sin. In éineacht leis sin, braithim go bhfuil bearna san eolas atá ann ar áiseanna áitiúla. Is iad san rudaí ar nós cúnamh ón dochtúir nó áiseanna eile faoi leith atá sa cheantar. Go minic bíonn eolas ag daoine faoi na háiseanna náisiúnta ar nós Pieta House, Childline agus mar sin de, ach ba chóir na bearnaí áitiúla a líonadh isteach chomh miath.

Gabhaim mo bhuíochas leis an gCeann Comhairle agus molaim an Bille.

Photo of Tony McLoughlinTony McLoughlin (Sligo-Leitrim, Fine Gael)
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I thank the Ceann Comhairle for giving time for Members to express their concerns on mental health. I congratulate Deputy Brown on bringing the Bill before the House and compliment him on the work he has done so far. It is a great privilege for a Member to bring such a Bill to the floor of the Dáil this morning because every Oireachtas Member deals with mental health issues and suicide within his or her constituency every day.

Reference was made to my colleague and friend, former Deputy Dan Neville, who for many years highlighted the need for mental health facilities and resources. At the time, many people were listening but, unfortunately, we did not have the resources or some of the support systems that are in place at present. I congratulate the new Minister of State with responsibility for mental health. He has a very difficult portfolio.

The concerns we are expressing are also being expressed on a daily basis in so many areas throughout the country. So many people have been touched by this issue. It is vitally important that the Minister of State take heed, and he will. I know the man and he is very anxious that we get results in respect of what is required. Mental health services are needed, not just for five days a week but on a 24-7 basis. I have attended many meetings and health forums in recent times and on many occasions I heard some of the complaints that have been made, including in respect of continuity of services at weekends and at night.

This issue is extremely important for people. Deputy Neville mentioned concerns regarding drugs and alcohol. On visits to schools and when speaking to teachers and parents, the amount of bullying that can take place within schools has been brought to my attention. This is very concerning for parents and teachers. We must start with national and secondary schools. Young people must be made aware, first, of the dangers of drugs and alcohol and, second, of what can be and is said on social media in respect of bullying of friends, colleagues or classmates. I find that issue very worrying.

We hear about the various services that are in place, such as Jigsaw and CAMHS. I represent the constituency of Sligo-Leitrim, which contains many rural areas. As some of the previous speakers have said, there are a lot of people living alone with mental health issues who must be listened to. They must have the services they require daily and weekly. We must provide those services. In the cities, all the services are provided. In the rural areas, there are concerns. Only recently, I met a father whose young daughter took her own life some time ago. He and his family appealed to me to do whatever I could as an elected representative to highlight the suffering and pain this family is going through. There are many families in every part of the country that are suffering as a result of young people committing suicide, both in terms of mental health and because of the fears they have that the services are not there to provide for young people.

I congratulate Deputy Browne and plead with the Minister of State and all of the relevant agencies in the context of the services we have in each of our constituencies and nationally. I ask first that we fill existing vacancies. There are services crying out for additional help and support. I support this new committee that will have numerous decisions to take in the coming period. I would certainly like to be associated with the comments made during this debate in respect of Deputy Browne's Bill.

11:30 am

Photo of Lisa ChambersLisa Chambers (Mayo, Fianna Fail)
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I commend my colleague, Deputy Browne, on the work he did in bringing the Bill to the House. I welcome the conversation we are having and I also welcome the opportunity to contribute.

Mental health issues are endemic in our society and are growing, particularly among younger people. By that, I do not only mean teenagers but also children as young as five or six who are experiencing mental health difficulties. I think this problem has developed in recent times and was not always as bad as it is now, although we recognise that the position has improved and that there is better reporting in respect of it. We have children of national school age who are self-harming and presenting with stress, anxiety and depression. We need to do a lot more research to help our own understanding as to why that is happening.

I agree with Deputy McLoughlin that while drugs and alcohol certainly play a role, social media has to be a major factor in creating those problems. A child as young as seven or eight might have a smartphone. Children are constantly contactable and are under constant scrutiny, although they may not realise it. They are either being excluded from or included in particular conversations. They are being tagged in photographs and commented on. There is constant commentary on their appearance, how they conduct themselves, whether they meet the standards of the group or school they are in. There is immense and constant pressure on younger people. There have been conversations more recently about having screen-free time. Parents should perhaps be better educated. Maybe we need to put in place education programmes to highlight the importance of having screen-free mealtimes. There should be a time when the phone is not accessible, perhaps at night when children go to bed. It certainly cannot be in the interests of children to be on their phones last thing at night before they close their eyes and first thing in the morning when they wake up. That has to have an impact.

I am reminded of a young lad and I think I can mention his name because what happened to him was quite widely reported. I heard Deputy Butler speak about the impact that the suicide of a friend has on the wider group. I refer to a young man by the name of Ben Garrett, from my town of Castlebar, who was a very close friend to my sister and brother. He was involved in the boxing club where my brother and sister still box. He went on to become a member of the Defence Forces. I am spokesperson for defence and this affected the defence community as well. He took his own life in County Galway where he was posted. I can see Deputy Rabbitte nodding because it was quite widely reported in counties Mayo and Galway and, indeed, nationally. I recall the search effort that went on for in excess of a month. People from the boxing club and all of his school friends were involved. They were walking along the edge of the River Corrib in Galway searching for his belongings and searching for Ben. I recall the impact that had on those younger people, my brother and sister in particular. I also recall that Ben's mother took them all aside and said they must remember the impact that this has on families, they must tell others about the difficulties they are having and they must for God's sake stay away from drugs and alcohol.

People have spoken about not recognising the signs. Ben gave the impression of confidence, happiness and things going very well. It is clear that underneath he was in a lot of trouble. If only we had taken more time to talk about it. If only there was not such stigma attached and it was more okay to talk about mental health. We are definitely getting to a stage where it is okay to talk about it. We want people to talk about it. Certainly, his group of friends in Castlebar and in the boxing club needed to talk. We had the Ben Garrett memorial cup not so long ago and we are all having a conversation now about mental health. They are all talking about it. If we are looking for a positive out of that horrific situation, that is one.

We have to look at services, particularly in rural areas. I know of one lady who had to go to Pieta House in Tuam to get counselling services because there were none available in County Mayo. I know our population might not be as large as some of the other counties but we still need services. As a result of the geographic size of our county, and because basic counselling services are so expensive, the lady had travel to County Galway because that was the only place she could get them. This is not acceptable.

Deputy Rabbitte has mentioned the out-of-hours services. Unless one presents with difficulties between the hours of 9 a.m. and 5 p.m. Monday to Friday, the options are An Garda Síochána or the accident and emergency department. If a young person is hugely distressed, presents at an accident and emergency department and then has to sit for six or more hours in a very pressurised environment, with bright lights, lots of stimulus, and various other people attending with different illnesses and ailments, it puts additional stress on that individual. We know people are being sent home. We need additional supports for youth mental health services out of hours. There needs to be a 24-7 response and facilities for those people.

We also need to address the cost of treatment. We often hear about the worst cases and those who present with the worst levels of depression, anxiety and mental health stress.

Many people are experiencing some level of anxiety. I would say every second or third person is experiencing social anxiety, pressure or stress in his or her life. There are no real services for mild mental health issues. The only services that are available are private ones. People are being encouraged to seek out cognitive behavioural therapy to deal with difficulties associated with anxiety. The average cost of an hour with a specialist in cognitive behavioural therapy is €80. This puts such services way beyond the reach of ordinary people. The cost of treatment needs to be addressed.

The Minister of State, Deputy Jim Daly, has a very difficult job. I agree with Deputy Rabbitte that he is well placed to take on this role. He has a genuine desire to do a good job in this area. I think he appreciates the particular difficulties being encountered by young people and children. I wish him well in this role. I am sure he will have the support of this House. I agree with Deputy McLoughlin that the investment of resources needs to start at national and secondary school levels. Teachers, who are very often to the fore in terms of recognising the signs of mental stress and mental health issues in younger people, need to receive training. In addition to looking at how we treat the problem and how we respond to issues, we need to look at the source of the problem to see how we can prevent these issues from developing in the first place.

11:40 am

Photo of Catherine ConnollyCatherine Connolly (Galway West, Independent)
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Cosúil leis an Teachta Aindrias Ó Muimhneacháin, ba mhaith liom mo bhuíochas a ghabháil leis an Teachta Browne as ucht an Bhille seo a chur os comhair na Dála. Gabhaim buíochas freisin leis an Leas-Cheann Comhairle, a thug cead dúinn díospóireacht beagáinín níos leithne a bheith againn. Tá súil agam go bhfuil an Ceann Comhairle den dearcadh céanna ag an bpointe seo.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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Tá mé.

Photo of Catherine ConnollyCatherine Connolly (Galway West, Independent)
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Go raibh míle maith agat. I thank Deputy Browne for bringing the Bill before us. I welcome the opportunity to support it and to speak more broadly on this issue. When I hear people whose bona fides I do not question speaking with heartfelt emotion about the problems on the ground, they say we need to talk and listen to young people and give them an opportunity to talk. I cannot help feeling a certain frustration because the time for talking - not for young people, but for those in government - is over. Successive Governments have utterly failed to deal with the mental health crisis. I have a passion for this issue, having previously worked as a psychologist. I know exactly what the problems are on the ground. They remain the same unfortunately.

In 1984, a new vision was introduced in the Planning for the Future document, which, believe it or not, recognised all the problems. However, there was a failure to deal with the recommendations in Planning for the Future. We got a new document, A Vision for Change, in 2006. I could not find fault with its ten-year vision for the period 2006 to 2015. That period ran out more than a year and a half ago. A Vision for Change set out every single thing we are talking about today. It set out the crisis in suicide and, more importantly, set out exactly what needed to be done. I have said on the record that nobody believed that any Government would implement that strategy. For that reason, an independent implementation body was established. It sat for two three-year periods and did some tremendous work. It monitored the implementation of A Vision for Change. While some things were done under A Vision for Change, the vast majority of its recommendations were not implemented. The implementation body was ultimately abolished and its work finished.

I suggest that since January 2016, the Dáil has had more open debates on mental health than on any other issue, with the possible exceptions of housing and health. We have talked and talked, but the review of A Vision for Change, which has been promised since the day we were elected to this House, has not been published. The Minister of State's predecessor was very interested in this subject and could not be faulted, but nothing happened. The review was not published. A new implementation body was supposed to be established to monitor A Vision for Change, but that has not happened. Even though the timeframe it covers has come to an end, its recommendations are still extremely pertinent. On the last day of term, we are talking again about young people, the lack of services and the high rate of suicide. All of that is accurate, but we should really be debating why successive Governments have not implemented A Vision for Change. I am afraid the current Government is on the rack now. Why has it not undertaken the review that was promised? Where is the independent implementation body that is needed to ensure appropriate mental health services are provided? It needs to be taken out of our hands.

The economic cost of mental health issues is absolutely frightening. As we do not have precise figures for this jurisdiction, we can extrapolate from Northern Ireland and other countries that over €2.5 billion is lost to the economy each year through lost productivity, additional hospital admissions, etc. That figure is increasing. A figure of €12 billion has also been mentioned. I find that extraordinary, so I am taking the lower figure. There are many problems going down through the generations because of the failure to change. I am using the language of economics to make the point that it is much cheaper to prevent and treat mental illness. I have made a similar point about domestic violence. Perhaps I might be able to get through to the men who are responsible for this issue on that level. Generally speaking, it tends to be men whose view of these issues is dominated by the economic perspective. There are some women who share that view.

On a practical level, we will save money in the long run by dealing with this issue. As a result of our failure to do so, there are just 45 beds in Galway. The Mental Health Commission visits every single year and has been called in more often. It has said in its reports that there are no individual care plans. Last year, patients in the unit in Galway had to sleep on the floor. All of these things have been set out by the Mental Health Commission. I thank Deputy Rabbitte, who has spoken about this issue, for taking action as part of her hands-on approach. A number of Deputies had to raise this matter on Topical Issues to ensure a service on the ground that caters for young people between the ages of 12 and 21 was kept open. It is operating on a shoestring budget of €42,000. I hope it will be announced that this service will receive a minimum of €62,000 in the budget for next year so it can expand to Gort, Carna and Clifden. Is airgead suarach amach is amach é €62,000. It is a ridiculous amount of money to give those who are providing this wonderful service. Over 190 young children and adolescents have gone through the hands of this service since it opened in 2012. There is no doubt that it has saved lives.

I would like to conclude by talking about drugs. A unit in Galway burned down and was not replaced. Counselling services for drug and alcohol addiction have been reduced to a level I do not want to think about. If we are seriously interested in this issue, we need to work together and move the debate on to the implementation of A Vision for Change or its successor strategy. I ask the Minister of State, Deputy Jim Daly, to tell us why the new strategy has not been published. When will it be published? Has the independent implementation body been set up? Go raibh mile maith agat, a Cheann Comhairle.

Photo of Joe McHughJoe McHugh (Donegal, Fine Gael)
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I want to make two brief points. I thank Deputy Browne for introducing this important Bill. It is important to discuss this issue and give it the attention it demands and requires. I thank the Leas-Cheann Comhairle for facilitating that. I acknowledge the leadership of the Ceann Comhairle in organising the symposium on mental health that will take place in Dublin Castle in 19 September. As a result of a decision that was made in recent days, the Oireachtas committee will be up and running before that event, which is important. It has to be acknowledged that our colleagues on the Business Committee, including Deputy Boyd Barrett, collaborated to reach consensus on this issue. There will be difficulties if leadership does not continue to come from this House and from the Seanad. We have consensus and collaboration. This shows that we can work together on difficult issues. My colleagues, the Minister of State, Deputy Jim Daly, and Deputy Neville, will work closely on this collaborative effort through the joint committee over a 12-month period. I look forward to the outcome of their work.

We live in an electronic and technological world. Like everyone else, politicians are now very accessible. The more I see the mediums, mechanisms and avenues that are available to us for communication, the more I think we are less connected at a physical level.

It is something of which people will be conscious when deliberating over this report. In Ireland in particular, if one brings it back to a parish or county level, the face-to-face, shoulder-to-shoulder and people-to-people physical interaction is very important and cannot be ignored. I always think back to an event in Letterkenny in 1996. It was a youth seminar in my days as a youth worker. I remember a young group of teenagers from Lifford who came onto the stage to make a presentation on what they felt was necessary to address the gap in youth provision. I remember they came onto the stage and remained silent for a number of minutes. We wondered what they were going to do. We did not know there were placards on the floor. Eventually the group, of about a dozen, lifted up the placards on which were the words "Why talk when nobody listens?", which I found to be very powerful and we must be conscious of it. I do not have any teenagers at the moment but I know parents struggle with that interaction. Being there in person for them is very important. When I think back to my own days as a teenager, I battled it out with my father, even though, when we were battling, we were still communicating and he was always there for me. It is something that we have to be conscious of.

Ba mhaith liom mo aitheantas a ghabháil leis na Teachtaí fá choinne a gcuid oibre ar an ábhar thar a bheith tábhachtach seo. Ba mhaith liom freisin aitheantas a ghabháil leis an gCeann Comhairle as ucht a cheannasaíocht agus a chomhoibriú le linn na hoibre seo. My final point - mo fhocal scoir - is that last year, as Minister of State with responsibility for the diaspora, I got a chance to go to Africa and such places, and I came across a bit of Swahili, umoja na nguvu, which is the Swahili for "together stronger", and it is no different to our ní neart go cur le chéile, meaning there is no strength without unity. I believe we have the strength and unity of purpose on this issue. I wish the joint committee on mental health well over the 12-month period from September and am confident that we will make progress on this issue in the future.

11:50 am

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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I thank the Minister of State. That was probably the first time we have ever had Swahili in the Chamber.

Photo of Eugene MurphyEugene Murphy (Roscommon-Galway, Fianna Fail)
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He had a good mix there.

Photo of John BrassilJohn Brassil (Kerry, Fianna Fail)
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I have heard Deputy McGrath speak it a few times.

Photo of Richard Boyd BarrettRichard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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I feel that following that last intervention, that in talking about mental health, maybe members of Fine Gael are moving to the left, because that sounds uncannily like an injury to one is an injury to all. I welcome the sentiment.

Photo of Tom NevilleTom Neville (Limerick County, Fine Gael)
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We are almost there with the Deputy.

Photo of Richard Boyd BarrettRichard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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Indeed.

Photo of Mary Lou McDonaldMary Lou McDonald (Dublin Central, Sinn Fein)
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Deputy Neville is jealous.

Photo of Richard Boyd BarrettRichard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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I apologise because I will have to leave after my contribution. I have a meeting at 12 noon. I very much welcome the discussion. I also commend the Ceann Comhairle on his proposal that we would have the symposium in September. I commend Deputy James Browne on legislation that essentially takes us further towards removing the stigma regarding mental health and recognising the legitimacy of people having mental health problems and not dealing with them in the sort of cruel and inhumane way that was the case once upon a time. Today, notwithstanding that the reasons are often slightly different, the wrong approaches to dealing with mental health issues are still taken. I do not doubt the bona fides of people who spoke. I think all of us have been touched by this. I certainly have been touched, losing some very close friends to suicide. I believe all of us have an interest in resolving this issue.

I want to input something. I am a big fan of Sigmund Freud, having been a student of psychology in university, although not of everything he said. He was a revolutionary in that he was the first to move away from the schools of psychology that imagined that, if there was a mental illness, there was something fundamentally wrong with that person. There were schools of thought at the time that Freud was developing his theories that believed that nails should be hammered into certain parts of the heads of people with mental health issues. That was how barbaric it was. That went along with the schools of incarceration and dehumanisation and simply locking people away or categorising them as beyond the pale of mental normality. We have moved a long way from that, but there were a couple of absolutely critical things about Freud's revolutionary understanding of mental health without which we will not grasp how to deal with this issue.

He understood the absolutely critical importance of children and babies being nurtured and of their early relations. He understood that the essential character of the human mind was a conflict between two things. Those are the basic needs of a human being - what he called the instinctual drives or the id - and the superego, which were the conventions of society, the rules, the norms and the pressures. In the middle was the ego, that is, you or me, in between those two things. How that balance was reconciled between the basic needs of human beings and the pressures of society would determine the mental health or otherwise of a human being. He identified the basic instinctual drives that had to be met but were often frustrated by the pressures of society, including the need to eat, to drink, to have a roof over one's head, to reproduce and have sexual relations - basic things - and to interact with other human beings. This was absolutely essential to what we were. There was also the creative impulse, which was absolutely central to Freud's understanding of human psychology and health. He pointed out that when these drives were frustrated, and pressure was denied or negated, it caused problems.

It is not difficult to see how all of this applies today. I do not think it is just about a fleeting technological change, because mental health issues far predate any of these technological things, although there is no doubt that they can exacerbate them. They can produce higher levels of alienation and pressures. These pressures come from everywhere, such as the pressure to put a roof over one's head but not being able to, the pressure to pass exams, the pressure to get a job that pays well, the denial of basic human relations and the alienation of human sexuality. All of these things have intensified and can do tremendous damage to our mental health, and in particular to young people in their development. Critically, Freud was the first to understand that the starting point of good mental health was first to ensure that those basic needs were satisfied and, in so far as people had mental health issues, he was the first to understand the talking cure. That is basic interaction between human beings, not pills or drugs - I am not saying they do not have some role - not nails in the head, not incarceration but to talk, one human being to another or a few human beings together, in order that there is real human engagement, a thing our society often denies us or puts pressure on us to deny, to become alienated from one another.

Where this comes down to real practicality is when one considers what is the biggest problem with the mental health services or indeed what is the problem with many of the services that would help to enhance health. There are not enough people to talk to other people. That is the big gap. In child and adolescent mental health services, CAMHS, we do not have enough human beings. That is why we do not have the beds open. We do not have enough human beings in the classrooms with our children, so their relationships are alienated. There are not enough teachers or special needs assistants. We need human beings. We even want to remove human beings from train stations, where the guy at the window talks to a person in the morning, and replace them with machines. We have to remember that if economic efficiency and all that are important as some people might say and if that begins to replace human beings or not make human beings available to do those jobs, we will be on a road to nowhere and we will not be able to solve these problems. That follows right through to the 24-hour services, dual diagnosis - recognising the difference between somebody who has certain types of mental health problems and others - having people in schools to talk to our young people or not having children in adult wards. All that requires human beings to provide for all these specific needs, interactions, human relations and engagement, that can allow us to really get through to people, talk to them and deal with the issues that they are facing.

12:00 pm

Photo of Frank O'RourkeFrank O'Rourke (Kildare North, Fianna Fail)
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I acknowledge the Ceann Comhairle's co-operation in allowing this conversation and debate to continue and the event he is organising, which will be held in September, on such an important and very relevant issue. I also acknowledge the work of my colleague, Deputy James Browne, in introducing this Bill to deal with such an important and relevant issue for so many families and individuals who are suffering in this area. Before we get further into the discussion and the debate, I wish the Minister of State the best of luck in his role and acknowledge the wonderful work done by so many people in this service area who are perhaps sometimes caught between a lack of resources and a lack of supports, on which we can dwell in a moment. It is important to acknowledge all the positive work done while at the same time acknowledging where the gaps are and that we must try to work together positively to put better supports and resources in place to help the many vulnerable people who suffer from mental illness.

As previous speakers have said, the issue of mental health involves that famous old slogan, "It is okay not to be okay." The reality is that no matter the age group to which people belong, if they suffer from mental health illness, they sometimes feel embarrassed or find it difficult to speak about it because they feel that if they speak about an issue, they are somehow letting themselves down or letting down people around them. Of course, this is not the case at all but, unfortunately, that is a barrier and an issue. We must get the message out more strongly to people that it is okay not to feel well and okay to have discussions on a number of sensitive issues, whatever they are, and that there are people there, whether friends, family or someone qualified to whom they can speak, to help them overcome these problems.

This leads me to the constituency I represent, Kildare North. I have raised this in the House on a number of occasions and I raised it with the Minister, Deputy Harris, yesterday afternoon when he was kind enough to meet me. We are still without a primary care child psychologist in that constituency. The population of Kildare North is approximately 110,000 and we do not have that post filled yet. It has been vacant for perhaps 18 months now. If we are serious about trying to help people, deal with the issues and prevent the problems everyone has spoken about this morning, we need to put those very simple and basic services in place to help people.

I wish to speak about a particular case and how the service does not work sometimes. I have a constituent who is 15, was suffering mental health issues and taking drugs and had many problems, so much so that it was out of control and his family was not able to control him. At the May bank holiday weekend, the gardaí had to arrive at his home, remove him and put him into a foster care environment. The very disappointing aspect of the case was that the service providers engaging with him and looking after him on behalf of the State allowed him to commute unsupervised from his foster home to the service by public transport even though he was on suicide watch, and he went missing for nearly five days and could not be found. Most alarming was that when he was found, the service provider looking after him on behalf of the State did the very same all over again, and he went missing again. Then the problem was that we had to work tirelessly with everyone, when he was found, to get him into care. It is only in the past two weeks that we have broken all the barriers and the family is now happy with the supports that are in place for this 15 year old to the extent that they believe he will not do the awful thing and commit suicide. This is why I wished to acknowledge the positives at the beginning of my contribution. However, there are negatives and massive gaps in the service that need to be addressed. As my colleagues have said, the problem is that the HSE operates on a 9 to 5 basis, Monday to Friday. It shuts down at 4 o'clock on a Friday and opens up at perhaps 10 o'clock on a Monday morning, and we see this across a myriad of services. This does not work in particular cases and for particular services and it did not work here. Even after the bank holiday weekend, when we expected services to kick in, they did not. That is a problem.

There is a group operating in my town of Celbridge called the Abbey Community Project. I have met the previous Minister and the HSE about the group, which operates on a voluntary basis. It has 40 cases on its books and carries out dual diagnoses. It gets referrals from the State agencies and, to date, has not got one bit of support from the State by way of funding or anything else. I have met and spoken to the HSE to advocate on the group's behalf. I got a hugely disappointing letter two days ago more or less saying the case was closed, the HSE will keep the matter on file and it cannot do anything to help. That is terrible. These are counsellors qualified in dual diagnosis providing an incredible service for 40 clients whom the public health services said they could not help. The HSE told us to come back in three months or six months or whatever if we wanted its help. That is too late for some of these people, as others have said, because they need the help and the intervention now. The people operating this voluntary service in Celbridge refer its clients on for further help and support but they are the first to assist them and keep them safe, and now we hear there is no support for the service. They are looking for very modest support, not hundreds of thousands of euro. If they close their doors in the next number of days, and it is looking like they may do so, 40 cases will be put back into the system which could not deal with them in the first place and which referred them to the Abbey Community Project.

My colleague, who has now left the Chamber, said it is time for us, as politicians, to stop merely speaking, and I genuinely believe this is true. We need the public looking in on this debate to keep talking if they have issues in this area in order that we can help and support them. However, as politicians, we need to stop merely speaking about this now and we need delivery and action. Of course it is hugely important to speak about the issue and bring it to the attention of everyone in order that we get the resources and supports put in place, but now we need delivery. I have identified a number of cases this morning in respect of which direct action by Government, Department and HSE would make a massive difference to people whom we want to be able to access these supports.

I wish the Minister of State well. I hope he will contact me after this contribution in order that we might get real and help in those areas we spoke about, particularly with the group in Celbridge that may have to close and send 40 clients to a service that sent them to that group in the first place.

Photo of Brendan SmithBrendan Smith (Cavan-Monaghan, Fianna Fail)
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I compliment my colleague, Deputy James Browne, on introducing this important legislation. It is obvious that this legislative measure has the widespread support of the Members of the House. It is an extremely important issue, to say the least. Regarding the comments made by my colleague, Deputy O'Rourke, in far too many instances the only services available are those provided by voluntary organisations that must continually fund-raise and try to provide a service where, unfortunately, the statutory agencies are not providing the services they are mandated to provide. I wish the Minister of State well in his work. I am sure he will put the energy and commitment into it that is needed.

Regarding Deputy Boyd Barrett's comments about the pressure on people to pass exams, we all know from speaking to teachers, school principals and their support staff of the awful pressures on children at second level, in particular, and at third level as well. The step made by the former Minister, Ruairí Quinn, of cutting the ex-quota career guidance allocation was very regressive and retrograde. The Fianna Fáil Party made a particular point in its discussions with Fine Gael regarding the confidence and supply arrangement of the provision of an adequate career guidance service in our schools. We know from speaking to career guidance teachers that they put an enormous amount of time and energy into assisting students going through difficult patches in their lives. This resource within the education sector needs to be provided with better funding, needs increased numbers and needs the resources to deal with the complex problems that students present with today.

I have spoken to a group called Inspire that provides disability services and mental health services throughout our island. They spoke to me recently about the possibility of extending their services, in conjunction with the HSE, throughout our jurisdiction. They spoke to me in particular about the pressures on students and the programmes they have put in place at third level. They spoke to me in the context of the potential and the opportunities that exist for all of us to deliver services on a North-South basis. We could make improvements to the area of mental health if we were to tackle the issues and deliver programmes on an all-Ireland basis.

I heard Deputy Eugene Murphy speaking earlier about A Vision for Change and the huge commitment, work and leadership that our former colleague in this House, Mr. John Moloney, gave in his role in the Department of Health at that time. It was a very good strategy that unfortunately has not been fully implemented. There is no point in merely talking about this. Strategies need to be put in place but they also need to be implemented. A lack of resources has curtailed the implementation of strategies at times but whatever strategy is put in place, an implementation plan should be put in place at the same time.

We have national obligations to bring in legislation. We also have international obligations because we are signed up to international agreements and international frameworks. Again, there is no point in us signing up to these agreements unless we implement them. We must have full compliance with all our legislative requirements. Those of us who represent rural constituencies are conscious of the complete lack of adequate services such as, for example, services after 5 p.m. or at the weekend. Those services are non-existent in many cases and Members are familiar with the pressures that are put on individuals and families when problems arise in a home.

I wish the Minister well in his work and again take the opportunity to compliment our colleague, Deputy Browne. He has had widespread consultation with many particular interest groups in the area of mental health and has brought forward a legislative measure that, when implemented, will make a real meaningful and positive contribution to the enhancement of services, which we all desire.

12:10 pm

Photo of Declan BreathnachDeclan Breathnach (Louth, Fianna Fail)
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I had no intention of speaking today but I want to support the work of Deputy Browne and to acknowledge the importance of this debate because I recollect the angst and annoyance of the public 12 months ago when the mental health services were being discussed regarding the lack of attendance in the Chamber to discuss such important issues. Today's debate and the work that has been done over the last 12 months is testament to the fact that we listen to the people who we represent and that we endeavour to represent their views and are trying to improve the situation on mental health. I particularly welcome that the Ceann Comhairle has indicated that there will be a symposium on the issue the day before Members return after the recess. The precedent was set last year with the symposium on Brexit and it is a worthwhile initiative to inform and involve those in the services. I compliment those who provide those services, in many cases with very little financial support.

I will focus on the lack of professional people to deliver the services. This applies not just to mental health but right across this country, whether it is in education or health, people are crying out for myriad services. We need to address the point that many people are working in the private sector rather than coming into the public sector. I was a primary school teacher for 35 years, and when the Minister for Children and Youth Affairs, Deputy Zappone, was appointed I engaged with her on what I view as a major reform of the curriculum, incorporating life skills into classrooms. Mental health has always been an issue but the mental health of younger people is something we have not spoken about enough. I attribute much of that to the boom. There is a need to bring life skills into the curriculum. For instance, the Stay Safe programme, which provides sex education for children, had a huge impact when it came into the schools. There are myriad programmes on mental health, not just in this country but across the world. They can be delivered to younger people to make them safer and healthier.

Approximately 15 years ago, under the old health board regime it was proposed - and implemented to a degree - that programmes be integrated in order that they would be available to schools. This included programmes on healthy eating, and I remember the Bí Folláin programme distinctly. That work was done and a teacher on secondment was paid for to ensure that the programmes were available to the schools. A difficulty arose within the Department due to copyright issues and schools were not allowed to use the programmes. I raise that as an issue. There are myriad programmes out there but it is important to make use of them. There must be greater flexibility within the curriculum to teach life skills, and we should talk to children at a young age. Talk may be cheap, but it is very important when it comes to mental health.

I again commend Deputy Browne. Many other people were mentioned because of their great work down the years. I am not going to name them again, but I commend them. We need to keep these issues to the fore. I have had discussions with the Ceann Comhairle on championing the issues of mental health and disability and the issue of climate change. We are sending out a much better message now about how we will deal with mental health. As a Deputy representing the constituency of Louth, I make the point that the many organisations involved in mental health need our support. This does not just involve financial support, but general support to encourage them to deliver a better mental health service.

Photo of Robert TroyRobert Troy (Longford-Westmeath, Fianna Fail)
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I thank the Ceann Comhairle for his flexibility in affording Members an opportunity to contribute to this extremely important debate and I compliment my colleague, Deputy Browne, on bringing forward this Bill. I understand it has all-party support, which indicates this is one area in which all parties can work together to enhance the service and bring about real and meaningful reforms.

I am struck by the fact that Members are talking about mental health services again. It was one of the first topics debated following the election and we had statements in the Chamber in March of last year. There has been no noticeable improvement in the service, unfortunately. In fact, there are certain services in certain areas where there has been a decline and this is a consequence of the State failing to provide the necessary resources. In certain instances in which there are State failures, local charity groups take up the slack. An organisation called Good 2 Talk provides a service in Mullingar and in Longford. After the revelations about Console the consequence was that its money was pulled because there rightly was a crackdown on how money was allocated to a charity that was not doing its work, to put it mildly. However, other charities and community groups established in other areas have suffered negative consequences. I understood from the Minister's predecessor that a review was to take place to investigate where we would get the best value for our money and what services were providing good services and would continue to be supported into the future.

Where is that review? When will it be completed and when will services know and have the confidence that they will be funded for some years into the future? It is very bad practice that the State, which should provide these services, leaves these providers waiting till the middle or end of the year before they know how much money they will get. We should see a more streamlined approach to services which are doing invaluable work, engaging and intervening at very critical stages. They need the support of the State.

I welcome the fact we are debating this area today, that it was one of the first debates after the last election and that we have had many Private Member's motions and debates on it. That is positive and removes the stigma from mental health problems, but unless there are tangible benefits, the people who need access to the services can get access to them, and we radically reduce the waiting times and increase their availability to 24 hours a day, seven days a week, we will be failing. There are many who need the services and cannot afford private therapy. They are left waiting too long.

I wish the Minister of State luck in his role and ask him to make sure the extra money committed to the service in the programme for Government for next year will be given, that it goes to the people who need it most and that he works with the community groups, who do invaluable work, to make a difference to the people who rely on the service.

12:20 pm

Photo of Shane CassellsShane Cassells (Meath West, Fianna Fail)
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I congratulate the Minister of State, Deputy Jim Daly, and wish him well. He is a very fine advocate. I also commend his predecessor, Deputy McEntee, on her work. I commend Deputy Browne on the work he has done on this Bill. I pay tribute to all those in the House who have been advocates, Deputies Neville and Buckley and all who have contributed in a positive and unified way. It is important to note that and their ideas.

The Minister of State at the Department of Arts, Heritage, Regional, Rural and Gaeltacht Affairs, Deputy McHugh spoke of the pressures on young people from social and electronic media and the simple matter of talking to his father and having that line of communication open. There are pressures on parents as well, trying to understand that dynamic and change. There should be help and support for them. Many parents are not aware of the pressures on their own children. I am not talking only about teenagers. Deputy McHugh spoke about teenagers but very young children are also exposed to those pressures. Someone said earlier in the debate "if only we knew". Parents and guardians of children need a lot of help and understanding.

I believe the Minister of State, the Government and all parties are committed to working to achieve real progress in this sphere. It is frustrating that the good work the Minister, the Government and House do is not replicated by those delivering the services. This time last year I spoke in the House about the services in my county and pressed hard to see that they were retained. Nine months after the closure of the acute psychiatric unit in Our Lady's Hospital in Navan, there is not a fully operational mental health day service there. The closure last September was part of a plan to provide a centralised acute service at Our Lady of Lourdes Hospital in Drogheda, which I disagreed with. A mental health day hospital should have been opened following the closure of the unit in Navan in order that some local supports would be available, but the HSE admits that it does not have the full-time staff or facilities in place for this service to operate. That is very disappointing, and the head of mental health services in our county has admitted that, but there is no plan to do that. There is a willingness and determination on all sides in the House, but the reality on the ground does not match that. It is deeply frustrating that having raised this with the Minister of State a year ago that the service is not in place nine months on. Will the Minister of State look into that? I wish him well in his role and hope that real change does happen. If a mental health service day centre cannot be operational nine months after the closure of a unit, there is a gap between the policy and the reality.

Photo of Fiona O'LoughlinFiona O'Loughlin (Kildare South, Fianna Fail)
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I congratulate the Minister of State on his appointment. I worked with him on the Oireachtas Joint Committee on Education and Skills and know how committed he is to this area. I do not doubt that he will make a difference. I also congratulate my colleague, Deputy Browne, on his motion and his work in the past 16 months in this area, which has been quite incredible.

I have spoken several times on this topic in this Chamber. We never talk about it enough. We could spend every day speaking about mental health and what we need to do to promote positive mental health and to help those in crisis.

The committee had a special session on promoting positive mental health in our educational services, formal, non-formal and informal education. What goes on outside the school day is very important in different settings. Is school preparing our young people for life or for a life of tests? The committee recommended that stress management and resilience should be taught rather than caught. There is an idea sometimes that young people will develop those skills in an educational environment. Some will, but there are many who are vulnerable and will flounder and need help to find their inner strength. Is our system focused on the head? We need to think about education of the heart and the soul. If we do that, we will equip our young people for life.

I recently had an incredibly enlightening conversation with a careers guidance teacher in the Patrician Brothers Secondary, PBS, school, Sean Nolan, at the Cycle for Suicide rally in Newbridge. He coined the question whether we are preparing children for a life of tests or for the tests of life. There is great resonance and significance in that for us to ponder. Managing stress and building capacity to cope with tough times are vital skills for our young people to survive and thrive. The great poet Robert Frost said, "In three words I can sum up everything I've learned about life: it goes on", but it does not go on for everyone. It should do. When we hear day after day, week after week, about young people taking their own lives, we realise life does not necessarily go on. It behoves everyone in the educational system, and us as legislators, to ensure schools and teachers are given resources, training and extra supports.

The groups that take on a lot of this work outside of schools also need the support. I refer to groups such as Kildare Youth Theatre, Griese Youth Theatre and many different organisations that work with young people to help them develop the skills they need. We have many excellent community organisations that work with people who are vulnerable to try to get them centred again. Places such as Hope(d) in Kildare need extra supports and help. There are many excellent volunteers helping to run these organisations but they need to have seed money. I would like to see a situation where they are supported financially through the Exchequer.

It is fair to say that we probably all are born with fears and feelings of inadequacy about ourselves. We tend to think that we are not good enough ourselves and that we are going to fail. Sometimes this can happen, but we are born with enough and we are born with the inner mechanisms that, with help and support, we can develop into the necessary life skills in order to thrive.

12:30 pm

Photo of Catherine MurphyCatherine Murphy (Kildare North, Social Democrats)
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I welcome this Bill and I am very happy to support it. There can be a lot of attention placed on things that do not work in the Dáil but this is one initiative where we can have a collaborative approach and it shows that some things do work well.

While it did not present scientific statistics, we all remember the roadshow that Vincent Browne took around the country prior to the general election - some of us were targets of it - and I took note of some of the key issues raised. At all those meetings there was one constant, which was suicide-mental health. It was the only topic that came up on every, single programme. It is an issue right across the country. People came along and raised this issue voluntarily in those debates. It was interesting that suicide-mental health was raised in this manner.

Public representatives see people who come through our offices for whom the system has failed, right across the spectrum. People might turn up with a housing difficulty and with other associated problems but the most difficult cases are when those people may also have a mental health problem. I can see significant failures in the system and I do not doubt that this is the case nationwide.

There are things that we absolutely need to do. One particular aspect of mental health policy we should tackle is the service distinction between addiction and mental health. Substance abuse and mental health issues often go hand in hand. The first point of contact with a service provider for individuals with a dual diagnosis should seek to tackle both in a holistic fashion. A UK study has suggested that 75% of users of drug services and 85% of users of alcohol services experience mental health problems. Obviously there is a need to have that holistic approach.

A woman from my locality approached me to point out an issue in respect of youth suicide and at every opportunity when the issue of mental health has come up, I have raised the same issue. This woman tragically lost her son through suicide. There were four young lads in the same class who also committed suicide and it was a particular tragedy because of that. This mother was looking for some meaning in what happened and how it could be resolved. She pointed to the Connecting for Life strategy and how Ireland is out of line with the EU regarding youth suicide and the problem with suicide clusters. She made the point that young people are talking to each other in a language of emotional immaturity and that wider engagement is needed. She suggested that a structured coping mechanism is needed in schools to provide for that kind of engagement. This mother is calling for an initiative of this sort to be made mandatory. At present, the language in the strategy is to "encourage" measures, but it is not mandatory to do so. Such an initiative was taken on teen pregnancies and the HSE has argued that it had worked well in that regard. This mother could see no reason why the same positive approach would not be taken on suicide. In-service training for teachers could include a module that gets people talking about the issue as opposed to not talking because they fear the topic. This is what she sought and I paid great attention to a person who had been touched so personally by the issue. I would like to see some meaning for that family.

A clinical psychologist contacted me about her frustration over how people in her category are recruited. When applicants are put onto panels it almost constitutes a discouragement to be employed. There are hundreds of people on the panel and it lasts for a year. All of a sudden the people have to reapply. A clinical psychologist can do very meaningful work in a very short space of time. Instead, people are languishing on lists and perhaps are not contributing to society in a way they would wish. It is very short-sighted to not have an easier approach to recruitment and the matter should be looked at.

Photo of John BradyJohn Brady (Wicklow, Sinn Fein)
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I welcome this Bill and Sinn Féin will support it, although we will be bringing forward amendments. It is such an important issue that has been spoken about quite eloquently and passionately over the last few hours in the Chamber. There is not a family in the State that has not been touched by mental health or suicide, and I include my own family. In Wicklow we are blessed to have a group of dedicated people, and young people in particular, who have worked extensively on promoting positive mental health. They have done Trojan work in recent years. Be Well Bray and Be Well Wicklow promote positive mental health within our young people. The groups have worked with the local partnership in Bray where a sub-committee is dealing with mental health issues. A need has been identified for the Jigsaw service to be rolled out to cover County Wicklow. While I am aware that a lot of areas are applying pressure to have that service rolled out, Bray and Wicklow have been identified. The groups have worked extensively with Jigsaw, which has committed to rolling out the service in the Wicklow area. We are, unfortunately, stuck in a situation where all the agencies agree that it needs to happen but they are stuck without a premises. A vacant premises has been identified within the county, namely, an old courthouse in Bray. It is an ideal premises. The Courts Service has been approached but at the 12th hour, it has thrown red tape in the way. The old courthouse in question is no longer in use as a dedicated new courthouse was built in the Bray area. We have been told that a review is currently under way of the Courts Service in Wicklow and while it is ongoing the old premises will not be made available to see the roll-out of the Jigsaw programme. To be fair, the Minister for Health, Deputy Harris, is across the issue and has been trying to help but the red tape is blocking the roll-out of this critically needed service.

I appeal to the Minister of State. Separate to the Bill, this is something practical, tangible and meaningful that can be done immediately. The commitment is there on the part of all the agencies in the context of seeing this rolled out, but red tape is stopping it. When it comes to mental health, red tape should not be an issue. It is badly needed and it must happen. It needed to happen 12 months ago if not 12 years ago, but the red tape is in the way. I ask that the red tape be cut. The premises has been lying empty and not been in use for seven or eight years at this stage and there was no notion of it every being brought back into use until Be Well, the partnership and Jigsaw made approaches. Then, all of a sudden, a review is initiated into possibly bringing the building back into use. It needs to happen. I ask the Minister of State to examine this and to get that premises in use so that Jigsaw is rolled out in Wicklow.

12:40 pm

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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Notwithstanding the time constraints under which we are operating and which are considerable, it was important that we have had the opportunity to hear from 28 Deputies on what is a critically important matter.

Amendment agreed to.

Bill, as amended, received for final consideration.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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When is it proposed to take Fifth Stage?

Photo of Jim DalyJim Daly (Cork South West, Fine Gael)
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Now.

Question proposed: "That the Bill do now pass."

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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I understand that Deputy Browne wishes to make a few remarks.

Photo of James BrowneJames Browne (Wexford, Fianna Fail)
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I thank the Leas-Cheann Comhairle for allowing a wide-ranging debate this morning and the Ceann Comhairle for permitting the debate to continue. That latitude is very important in an issue as important as mental health. I congratulate the Ceann Comhairle on organising the important mental health symposium to be held towards the end of September, which shows the importance the issue of mental health is to both him and the Dáil.

The contributions have been passionate and well informed. As Deputy Buckley said, no one - regardless of background, age or where a person is from - escapes the impact of mental health issues. Absolutely everyone is affected. I thank Deputies McDonald, Kelly and Paul Murphy for their contributions, as well as everyone else who contributed to the debate on this important Bill. There is a lot of negativity about Deputies and the Dáil. However, this was a straightforward amendment that was expected to take probably no more than 15 minutes this morning but we have had almost three hours of contributions on it on the last day of the session. This shows the real determination that people have in the area of mental health.

There are two things the Minister of State could take from today's debate which could be done quite quickly and which are quite practical. The first would be to reinstate the implementation body that was abandoned by the previous Government. That would be a hugely important step. The second would be to publish what is effectively a scoping review on A Vision for Change. That could be published. I understand it is ready to go.

The Bill has been carefully thought out. I appreciate that amendments may be tabled in the Seanad but it is important that any amendments do not threaten the Bill. It is quite a targeted and well-thought-out Bill and I hope that it moves through the Seanad quickly.

Question put and agreed to.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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A message shall be sent to the Seanad acquainting it accordingly.