Seanad debates

Thursday, 9 February 2006

Mental Health Services: Statements.

 

1:00 pm

John Minihan (Progressive Democrats)

I welcome the Minister of State to the House. I appreciate having these few moments to speak on a topic that is as important to debate as it is complex and difficult. The information provided by the Minister of State and the Department on the prevalence and economic cost of mental illness is quite staggering and truly places today's statements in context. One in four people will have a mental health problem at some point in their lives with an estimated total annual cost of mental ill health of €11 billion to the country. Mental disorders rank second in the global burden of disease, second only to infectious diseases.

The Minister of State has personally championed this issue over many years and has been good enough to come to this House regularly to apprise us of developments. Members of this House are, therefore, better versed than most on these matters, and I thank the Minister of State for this. Nevertheless, it is worth setting out these figures again at the outset to provide the proper context.

It has become apparent through debates in this House, the media and elsewhere that Ireland needs a new mental health framework, some defined structure within which to create and promote positive mental health across its communities. The expert group on mental health policy appointed by the Minister of State, Deputy Tim O'Malley, was charged with preparing a new national policy framework for the mental health services, which would update the 1984 document, Planning for the Future. As the Minister of State noted, a framework within which accessible, community-based, specialist services for people with mental illness must also be provided. I am heartened that today's document, A Vision for Change, provides this much-needed framework, within which we can best promote mental health and best provide services.

I thank the chair of the expert group, Professor Joyce O'Connor, president of the National College of Ireland, and the group's 18 members for the excellent, considered, efficient and laudable work they undertook over a relatively short period.

It is worthwhile to briefly examine the seven main elements of the document. When debating child care much currency is given to what is known as a child-centred approach. This is as it should be and is exactly how current Government child care policy is framed. The same logic is extended in two ways to the area of mental health in the document, A Vision for Change. Users of mental health services must be involved at all levels of service delivery and be partners in their own care. Only then can we state that provision of mental health services is truly person centred.

Another key part of the report deals with care plans for users of mental health services. The report recommends that such plans mirror users' needs, goals and potential — a concept known as recovery-orientated care — in order to properly address those community factors which hamper recovery.

I am especially interested in the report's treatment of an holistic approach to mental health services. As legislators it can be difficult to make the clear link between what we have the power to do and what is needed in society. This is particularly true with regard to complex issues such as mental health. The holistic approach referred to in A Vision for Change sets out the importance not only of the biological element, that is, medication and treatment — to which Senator Henry alluded — or the psychological element, that is, the various therapies and techniques, but also the social element, namely, education, training, employment and housing. These are facets of society which we, in this House, deal with and influence in our work. Without arguing that an excuse existed in the past, A Vision for Change sets out the linkages entailed in a truly holistic approach to mental health. As members of the wider community, Senators must be cognisant of this fact.

Before leaving the topic of the balance between biological, psychological and social elements, I will make one important point. Fears have been expressed about an imbalance in biological and therapeutic treatment. As a pharmacist, does the Minister of State agree that pharmacies have an important role to play in the delivery of care and in the area of monitoring and that they must remain independent of prescribers if they are to fully fulfil their role in monitoring therapeutic treatment of mentally-ill patients?

Before I raise the importance of taking a multidisciplinary approach, it is important we do not overlook the fact that in 2004 more than 1,200 patients had been in hospital for more than five years. Community-based services are an integral part of the recommended way forward. The objective is to provide services, including treatment and outreach services, in the home and reduce hospital admissions.

We have so many excellent professionals working in this sphere. When I spoke yesterday in the House on developments in third level education, I referred to the importance of connectedness between experts and institutions to maximise the benefits of the excellence available in that sector. In mental health, too, the need for doctors, nurses, psychologists, social workers and occupational therapists to connect and coalesce as teams on a regional basis has been made clear. We must continue to move away from the "doctor knows best" approach. Multidisciplinary teams would have the benefit of self-governance and, importantly, the responsibility to be truly accountable to service users, their families and those who care for them, with a view to empowering all those involved.

A final key element in the report is its call for a full population-based focus. The experts make clear that consideration must be given to the entire population's mental health and wellbeing from childhood through to old age. There may be a tendency to categorise current and future service users into a small number of simplistic groups. This creates the wrong paradigm within which to promote mental health and provide mental health services. It is obvious that a wider and more nuanced focus must be employed.

The voluntary sector and those on the ground who work closely with the mental health sector have responded to A Vision for Change with a statement that the report could be Ireland's final chance to develop a balanced and integrated modern mental health service. It is described by Mental Health Ireland as "comprehensive and practical and, as such, warrants careful study not alone by Government but by all groups concerned with the welfare of people with mental illness".

While the voluntary sector has welcomed the document, it would be remiss of me not to note the sense of scepticism which accompanies its commendation of the report. We must meet that scepticism head on. If the sector fears the report will gather dust or will falter due to lack of funding, we must assure it we will not let that happen. The Minister of State has placed on record the determination of the Government. He has also invested much in trying to make progress in the area of mental health services. Throughout this debate, we must restate our commitment and continue to reassure.

The mental health policy proposed in this excellent report will require substantial funding. The considerable equity of buildings and lands within the current mental health system should, if necessary, be realised. The report recommends the closure of psychiatric hospitals and re-investment of resources into mental health services, as opposed to the sale of assets to benefit the State, the Exchequer, developers or speculators. The process must be managed in a way that maximises the direct benefit to service users. I am sure the Minister of State is mindful of this imperative and I encourage him and the Department to work to this end.

Following the publication of the White Paper on the re-organisation of the Defence Forces, the Government made a similar commitment when it undertook to streamline the Defence Forces and dispose of assets, namely, military barracks. The money realised from the sale of these assets was to be reinvested in the Defence Forces. This commitment has been met and we must ensure this commitment is maintained when assets are realised in the mental health sector.

I congratulate the Minister of State, the expert group, all those who were consulted and who made important contributions to the group's deliberations. I also congratulate the Tánaiste and Minister for Health and Children for raising the matter. A Vision for Change provides an important national policy framework for moving us to the point at which society gives everything in its power to promote positive mental health across communities and provide accessible, community-based specialist services.

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