Ann Ormonde (Fianna Fail)

I welcome the Minister of State and wish him well. He has shown great sensitivity in dealing with the problem of mental health and the quality of mental health services. I was distracted by Senator Norris's beautiful quotation, from memory, of a letter written by James Joyce. I share the author's sentiments as we try to move on from the past.

This debate focuses on a vision for change for mental health services. The 2005 report of the Mental Health Commission seeks to ensure high standards are promoted and fostered in the delivery of mental health services and sets out how this can be done. As the Minister of State indicated, a strategic plan has been developed which sets out how best we can move from the old concept of mental health with which we all grew up. In the past, anybody who had a mental deficiency was immediately removed from society, placed in a mental institution and stigmatised for the rest of his or her life. I welcome the changes outlined in this report and the report of the Inspector of Mental Hospitals, including the new practice of carrying out inspections of mental health institutions and residential care centres in the community at 24 hours notice.

It is worthwhile to dwell on the determinants of a quality mental health service. One must be respectful and have empathy for the patient and those who provide the service. People must be made to feel important and the system must be community based, accessible, user friendly and must encourage user participation. The environment must respect the dignity of the individual and his or her carers and family. Leadership and a good, effective management system are necessary. High skilled, multidisciplinary teams must be in place and evaluations and reviews carried out. One cannot deviate from these determinants and if the Minister of State ensures they are implemented, Ireland will have a quality mental health service. My vision of change is one which focuses on keeping matters simple and tight.

I will focus on adolescents as they are an age group with which I am familiar. The Minister of State noted the requirement to recognise the need to address mental health as an integral part of improving overall health and wellbeing. I worked as a counsellor in a school. Considerable work must be done to get all the stakeholders working together. The fabric of society is crumbling around us and dysfunction is increasing. How do we handle a 14 year old from a dysfunctional background who takes drugs and suffers from depression? Teachers must be the first port of call in such circumstances. For this reason, we need a school programme that will detect problems and determine the best approach to referral. It may not be possible to assist the family. Multidisciplinary teams consisting of teachers, psychologists, psychiatrists, psychotherapists and counsellors do not appear to have been established. The National Educational Psychological Service, for example, is not yet fully up and running. When a problem arises, it is difficult to get a psychologist to come to a school to carry out an assessment.

Autism and attention deficit hyperactivity disorder, ADHD, and attention deficit disorder, ADD, are major problems which, if not detected on time, can result in the system breaking down. The kernel of the solution is to ensure stakeholders are brought together. It is not to be found in a pharmacy or by psychiatrists prescribing pills but in developing an integrated, holistic approach. In many cases, the problem lies in a person's lack of self-confidence when he or she withdraws into himself or herself in response to society's pressures. While it is widely accepted that places will be always needed for acute patients, locking people away and cutting off communication to the outside world is not necessary in the majority of cases.

A holistic approach is required. The Minister of State referred to the psychological health and wellbeing of individuals, families and communities. I welcome the shift towards a community centred approach in which everyone works together. It is time people in communities became aware of the problems around us and how best we can all play our part. It does not always have to be left to the professionals. We must be aware of where help is needed in a society and help families that need it. All stakeholders need to rethink the society of the future. That will help the delivery of good mental health care. I reiterate the determinants of good quality of service. If that is included in the vision of change for the future, the Minister will have done a marvellous job and I know that is his thinking.