Fergal Browne (Fine Gael)

I welcome the Minister and his officials to the House. I am amused to see the Minister's speech include phrases like "are now being considered", "should be developed in the future", "priority" and "commitment". The word "will" must be in the Minister's speech hundreds of times and much of the speech is aspirational. The Minister of State and his Department are in grave danger of becoming so bogged down in reports that they will not know where they are going. Perhaps it is time to declare a report-free year, where the Minister of State could begin to implement the reports already available to him. Perhaps it is time to declare a report-free year so that the Department can begin implementing the reports it already has. The Minister of State gave a good speech which was all about plans and priorities for the future. However, there is not much evidence of action. The miserable sum of €15 million for the further development of mental health services in 2005 is surely not even indexed to inflation. I am not confident in the Government's commitment to this area of the health service. Much work is being done in this area but not necessarily by the Government.

The Minister of State's comments in the Dáil last week about my colleague, Deputy Neville, do not inspire confidence. It is universally accepted that Deputy Neville, a former Member of this House, has played a significant role in the area of mental health, particularly in regard to his consistent highlighting of the problem of suicide. His contribution should be acknowledged. Perhaps the Minister of State was having a bad day when he made his comment that Deputy Neville's continuous representations were becoming "a bit tiresome". The Minister of State may have already given Deputy Neville the clarifications he has sought on this issue.

The recent Government decision regarding the closure of Mountjoy Prison and the associated transfer of the Central Mental Hospital to the new shared site on the north side of Dublin is a matter for concern. Commentators are not in favour of the linkage thereby established between a prison and a psychiatric unit. We often speak in this House about the importance of removing stigmas. The proposed move is not helpful in this regard and indicates that we are going in the wrong direction on this issue.

It has been brought to the attention of the Minister for Finance that the current tax relief schemes for hospitals exclude psychiatric hospitals. The Government should consider the extension of tax relief to the development of psychiatric hospitals. In fairness to the Minister for Finance, he agreed in his reply to a parliamentary question tabled by Deputy Bruton, the Fine Gael finance spokesman, to consider the question of introducing such reliefs for psychiatric hospitals, including geriatric psychiatric facilities. The Minister has received proposals in this regard and they are being examined by his Department. I hope the Minister of State will work to ensure these provisions are included in the next budget.

According to the Irish College of Psychiatrists, mental ill-health affects one in four of us during our lifetime. Four of the ten major causes of disability are psychiatric conditions, including unipolar depression, bipolar disorder, schizophrenia and obsessive compulsive disorder. Alcohol misuse is also listed as a factor. Research by Mental Health Ireland indicates that 73% of the population know someone close to them, either a family member or acquaintance, who has or had some form of mental illness. Furthermore, 10% of those surveyed indicated that they had suffered some mental illness, with depression, which affects 50%, the most common affliction. These are grim statistics.

The funding of mental health services by the Government is dubious. It is amazing to observe that funding has decreased from 11% of the total health budget in 1997 to 6.6% now, representing less than half the World Health Organisation's recommendation that 14% of a country's health budget should be spent on mental health services. Overall growth in the non-capital health budget between 1990 and 2001 was more than 300%, but the increase for psychiatry was only 131%. During the Celtic tiger years, 1997 to 2002, the increase in overall new capital expenditure was 120%, while the corresponding increase for psychiatric services was only 74%. According to the Irish College of Psychiatrists, when these figures are adjusted for inflation the increases amount to 72% and 36%, respectively.

Apart from the €1 million allocated to the Central Mental Hospital, there has been no increase in the financial allocation to improve mental health services in 2004. There is a lack of rationale behind the allocation of funding in this area to the various health authorities. Urban areas receive half the funding per capita of rural areas, even though urban areas have twice the rate of severe mental illness compared with rural areas. While €100 per head is provided for 100 ill people in urban areas, €200 per head is provided for 50 patients in rural areas.

An area in which Government provision is particularly poor is that of psychiatric services for adolescents, as the Minister for State acknowledged in his speech. There are only 20 inpatient psychiatric beds for children and adolescents nationally, including 12 in Galway and eight in Dublin, whereas 144 are required. As a result, adolescents end up in inappropriate adult facilities. Most child psychiatrists have a waiting list of a year before a child can even be seen. This is contrary to the professional advice which recommends that early intervention is crucial to full recovery.

Furthermore, there is no psychiatric service for adolescents aged 16 and 17 years. Child psychiatry provides services for children up to the age of 16, after which treatment is provided through the adult service. The second report of the working group on child and adolescent psychiatry, which examined the deficit in services for 16 and 17 year olds, was published in June 2003. There has been no action on this report's recommendations.

At the beginning of this speech, the Minister of State correctly acknowledged the major role played by the many services promoting mental health. He referred to the 1984 policy document, Planning for the Future, which recommended the establishment of a comprehensive community-orientated mental health service as an alternative to institutional care for persons with mental illness. That is the correct approach and it has worked well.

St. Dympna's Hospital in Carlow town is an example of what was considered the best approach to the treatment of mental illness in the past. In hindsight, however, we are aware that many patients should have not been sent there. There were some who spent practically their whole lives in psychiatric hospitals. Such events reflect a shameful period in our history which should be examined. Vulnerable people who did not suffer any psychiatric illness were incarcerated in institutions such as this as a consequence of a grievance held against them by a family member, for example. On the other hand, many patients benefitted greatly from their time in facilities such as St. Dympna's Hospital.

The Minister of State is aware of the current difficulties in regard to Kelvin Grove in Carlow town. The proposal for this facility is contrary to the essence of the 1984 report. There is no question that the level of service provided in the psychiatric hospital at Kelvin Grove is appalling and must be improved urgently. The staff there are working under difficult circumstances. However, the plan by the former South Eastern Health Board to sell the land on which the current facility is situated and build a new hospital across the road involves the removal of soccer pitches on the new site. These sporting facilities were previously used for cricket, and international hockey games have also been played there.

One must query whether this is the correct approach to take. Does it not signify a return to the policy of institutional care? Organisations such as the Delta Centre in Carlow town have done major work in assisting patients with mental illness. Patients are placed in houses so they can socialise within the community while receiving the treatment and support they require. The health board's proposal, which now comes under the aegis of the Health Service Executive, seems to be contrary to modern thinking in this area.

Will the Minister of State reconsider this proposal? Apart from the prospect of the loss of a valuable soccer pitch in the middle of the town, there are alternatives to consider. My father, a former Deputy, has been involved in this area but the answers he has received from the Minister of State's Department have been bland, merely referring his query to the HSE, which in turn responds with more letters. The Minister of State should look at that case in particular as it represents a serious issue in Carlow regarding the provision of services to patients.

According to the Minister of State, the development of child and adolescent psychiatric services has been a priority in recent years. It is time to stop calling it a priority and give it the resources it needs. I hope more speakers will support the Minister of State today. No Fianna Fáil Senator spoke on the Order of Business this morning; perhaps they are getting tired.