Fergal Browne (Fine Gael)

I welcome the Minister of State and his officials to the House. We on the Opposition side of the House welcome the report. The key aspect, as the Minister of State referred to in the latter part of his speech, is the report's implementation. It is good to make up a report over two years, but it is worthless unless it is implemented. Unfortunately, the Department of Health and Children has many reports on bookshelves gathering dust, with little else happening.

I am encouraged to see the last of the key recommendations in the report states "A Vision for Change should be accepted and implemented as a complete plan". That may be stating the obvious but it does not often happen. I welcome the aspect of the Minister of State's speech regarding the appointment of a group, as recommended in the report, to monitor the implementation of its recommendations. I hope such a group will set targets and benchmarks.

The difficulty with a ten-year plan is that it is such a long term. In real terms, that period will take in three Governments, or even more if a Government does not last five years and, were to be a Cabinet reshuffle every two and a half years it would be possible to have six different Ministers in that period. It is important that targets are set and benchmarked, and that progress is monitored. I appreciate that targets may not be achieved on occasion, but they may be achieved early in other areas. It would nevertheless be a way of ascertaining the effectiveness of the plan's implementation. I welcome those aspects.

There is much work to be done in the mental health area. I have recently been sitting, along with Senator Glynn and others, on an Oireachtas sub-committee investigating the high levels of suicide in Irish society. A valid point was made that if a person had a problem with an eye, he or she would have no qualms about contacting an optician or visiting a doctor to find help. However, if a person has a problem an inch above his or her eye, that is, mental health problems, action is not usually taken. This is true for men more than women. There is a problem in people not owning up to having a difficulty and seeking help. We should do everything in our power to remove the stigma of mental health problems.

I visited Scotland yesterday to see examples of how mental health problems are dealt with in that country. It is estimated that one in four of Scotland's population suffers some form of mental illness. This is startling. I am not sure of the figures for Ireland, but even if it is one in four or one in ten of the population, it is a high percentage.

Facilities must be put in place to address this. There is an institution in Carlow, St. Dympna's Hospital, but I am aware that the days of locking up hundreds of people for their entire lives in an institution are over. Thank God this is so. In reality, perhaps 1% or 2% of people would have severe mental illnesses that would require staying in an institution. Most people can receive treatment from time to time and recover.

Thankfully we have moved on from those days. I welcome the aspects of the report where it considers closing down the hospitals in some cases. I would be cautious about this, as we still need mental health institutions for a certain percentage of the population suffering from schizophrenia, for example, and other severe conditions. I would not recommend the closure of every mental health hospital in the country, as we should keep some open for the safety of patients and that of the public.

One can imagine the headlines if a person was released from a mental institution before committing a crime. Newspapers would be very glad to publish a major story. It could set the campaign to promote mental health back years if such a case occurred. Recently in England, a newspaper went to town on a person after a crime and the story made the front page. The same paper carried advertisements about seeking advice for mental health issues. After a campaign, the editor of the newspaper apologised and appreciated that he should not have done what he did.

There is a great facility in Carlow, and I am sure the Minister of State has visited the Delta Centre, which has done much work for people with special needs. It has an excellent multisensory garden, and there are now discussions about building a new autism unit for adults in Myshall with Ionad Folláin, which has a checkered history for a different reason. I hope this will come about and there will be a centre similar to a facility in Enfield in County Meath catering for adults with autism. Those people heading the Myshall project will shortly be approaching the Minister of State's Department with proposals. There are now many people with special needs living in special purpose houses in the community, and there is one beside my home. This is how it should be, as the days of being locked up in an institution are long gone, thankfully.

Those who were Members in 1984, before I was, have made the point that the report published then, Planning for the Future, contained many recommendations which are also contained in this report. We do not want the people in this House in 20 years' time stating that little progress has been made. Unfortunately we have seen very little progress from the 1984 report. Many of the recommendations in that report were not implemented.

It is interesting to note the level of funding. In 1984, the level of funding for mental health as a percentage of total health expenditure was 13%. By 2004 this had decreased to 7.34%. I appreciate that most of the finances in 1984 were spent on running major institutions such as St. Dympna's Hospital and others around the country. However, funding has not kept apace in the mental health area. In Scotland, 15% of the total health budget is spent in the mental health area. We have a long way to go and we should increase the funding, not necessarily for institutions but on other areas such as multidisciplinary teams, etc.

There is a major problem with young adolescents in the mental health area. There are only approximately 20 beds for this age group, in Galway and Dublin. The recommendation calls for 150 beds. This causes major problems also. A sum of €1.2 million was allocated towards the prevention of suicide this year, and Mr. Geoff Day will head up a new body. Some people would feel this amount is quite small. The stark facts are that approximately 500 people committed suicide last year, compared with approximately 400 killed on the roads. Yet the money being put into road safety is three or four times that being put into suicide prevention.

There is a startling statistic that over 10,000 people presented at accident and emergency facilities last year with evidence of self-harm. There is an estimate that the actual numbers of those who self-harm could be as high as 60,000. Some people engage in self-harm but do not require medical attention. That is also a major issue, and we must substantially increase the funding available for the prevention and treatment of parasuicide and suicide. This is especially true for the families involved, who can be left in chaos and badly affected following a suicide.

I would be cautious about using the sale of hospitals to fund new developments. This does not happen in any other area. I appreciate that money raised from the sale of a hospital should be ring-fenced for mental health projects, but such projects should not be dependent on such funding. In other areas projects have received money without a clause being involved about sale of relevant property.

The Minister of State mentioned new staff, particularly increasing numbers by 1,800. Will they be available immediately or is it over the long term? I am conscious the Minister of State has stated this will be done over a ten-year period. Would the staff be available if the process was fast-tracked over a period of two or three years? I understand such a supply of staff is not available in Ireland. I urge the Minister of State's Department to discuss this with the Minister for Education and Science, Deputy Hanafin, to ensure the number of places on certain courses are increased substantially to allow for staff increases. We should ensure we avoid the scenario, in a few years' time, where we have the money to increase the number of places, we have the facilities but we do not have the staff.

I appreciate that an extra €25 million has been provided for mental health this year but that is less than half the cost of e-voting, which was €60 million. The PPARS system cost €150 million and the Dublin Port tunnel has gone over budget by €400 million. The public is fed up with such overspends when a tiny fraction of that money could be given to worthwhile projects like mental health. The Minister of State should fight tooth and nail to increase that figure substantially in future budgets. If we can manage our money better we should see more for worthwhile projects.

I collaborated on a parliamentary question tabled by Deputy Keogh on 25 October 2005 arising from a meeting we had with a group about psychological services for young people. The question asked if the different waiting times for persons waiting for psychotherapy, counselling or associated services throughout the country would be published, and if the Tánaiste and Minister for Health and Children would differentiate between those awaiting adolescent and child services. The question was asked because we have all heard anecdotal evidence of long waiting lists, though we cannot prove it. I only received the answer from the HSE today, almost 100 days later, by e-mail. It illustrates the frustrations involved in finding out the answer to such questions. It reads:

Psychotherapy and counselling, in broad terms, describe a range of therapy interventions, sometimes described as "talking therapy". The HSE directly provides a number of services including adult and child psychiatry and national counselling services are also accessible. Counselling is also available in the context of our drug and alcohol services. The HSE provides funding and support to a number of agencies that provide counselling services, for example rape crisis centres and bereavement support groups. Counselling is also offered as an integral part of many treatments, for example pastoral care and palliative care in a hospice setting. Counselling services are also made available for those facing traumatic life-altering experiences in the context of oncology services and genetic counselling.

Many of these services are offered on a person-centred basis and no waiting lists are maintained. Mental health services (adult and child adolescent services) are available on a time-waiting basis but urgent and immediate services are available.

After 100 days I am certainly no wiser. All I can gather is we do not have formal waiting lists. I will give a copy of the e-mail to the Minister of State and I ask him to look into it because it is not a satisfactory reply. I now believe the people who have come to me and said they have been waiting many months for services because we cannot prove they are not waiting months or even years. The answer is inadequate for a Member of the Oireachtas who asked it following a submission by a group before an Oireachtas sub-committee.

I will briefly go through the recommendations in the report. The second recommendation is that mental health promotion should be available for all age groups, which I welcome. I will highlight young people in particular, whom we are failing at the moment. Adolescents should be a priority in the implementation of this recommendation.

I welcome the use of the phrase "multidisciplinary approach" because we should not leave mental health to psychiatrists, though Senator Lydon might not agree with that. Many people are involved in this area and we should ensure we get the right balance, though it is difficult. I appreciate the role played by occupational therapists, clinicians and others.

The report recommends that the link between specialist mental health services and voluntary groups supportive of mental health should be enhanced and formalised. That point came across loud and clear to me during our hearings on mental health. I was amazed at the number of groups that exist but it struck me that there was a lack of co-ordination and some replication, and that there were pockets of the country where there is no service. We should make a recommendation for greater co-ordination, to ensure we have a proper regional balance and to strengthen areas where we are weak.

Another section recommends that the organisation and management of local catchment mental health services should be co-ordinated locally. Does that go against the idea that the HSE is the one body for the whole country? Having abolished health boards and created the HSE are we now going back on that in the area of mental health?

I urge caution on the proposal for the closure of mental health hospitals because we still need proper facilities for the 1% to 2% of the population who have severe mental problems and who will probably need to stay in a mental hospital for most of their lives. Another section of the report suggests that mental health information systems should be developed locally. I again urge caution because PPARS springs to mind. I appreciate the difficulties in combining health services and information technology but I hope we have learnt from PPARS.

I am also concerned about the right to privacy of patients. If a central IT system is put in place how can we ensure patients have privacy? Names might be withheld or numbers allocated but I foresee difficulties in that area. A lady recently phoned me to complain about a neighbour who had been doing work for her through her husband, of which she had been unaware. Even though she had tried to commit suicide she found it difficult to sign herself into hospital. The hospital had to sign her in against her wishes. She was not aware that her husband had organised for her to be signed in for her own safety.

In Scotland a special group has been set up to secure work for people with mental illnesses, through job clubs, etc. Scotland has a similar population to ourselves and has a great success rate in reintegrating people into society. We should consider such an initiative here.

I welcome the report and hope that far more of it is implemented than of the last report 20 years ago. I have tried to be constructive and hope the Minister of State will take my points on board when he makes his reply.