Tim O'Malley (Limerick East, Progressive Democrats)

I thank the Senators for participating in an informed debate on mental health services as they evolve. We are discussing evolving services to a vulnerable section of our society. It is the responsibility of the Government and the Health Service Executive, HSE, to ensure that those who suffer from mental illness are the principal people in this reformation. Too often in the past they were not. Services evolved for other reasons. Anybody who knows anything about the mental health services knows exactly what I am talking about. Many points have been raised and I have only seven or eight minutes remaining, so I will try to answer some of the queries.

Senator Henry mentioned that in Ireland we have a propensity to send people to hospital. We must face the fact that of all European countries, Ireland, in spite of the wealth that has been created, has for many years had a propensity to hospitalise people with mental health difficulties. A new stream of thought must be brought into being by everybody involved in services for mental health patients.

According to the majority of expert opinion worldwide, 95% of people with depression and mental health difficulties can and should be treated in the community. That is different from the services we have evolved over time. I do not criticise what went before us because the knowledge did not exist. We must structurally and strategically place our services in a new model in the community to ensure patients get the best services for them and their families.

Senator Henry said people in long-term care need advocates. It is an indictment of our modern society that many people in long-term care for mental health difficulties have nobody to visit them. Fantastic work is done by those who advocate on behalf of such patients. People would do a wonderful service if they would become involved in community-based organisations such as Grow, Schizophrenia Ireland, Aware, Console and many more. They do fantastic work in the community and people who wish to help should get involved.

There have been several damning reports recently on the lack of information to patients about their medication and its side effects. I was delighted to hear Senator Glynn mention that this issue is of concern to the Joint Committee on Health and Children. I look forward to the committee's views on this area, about which I have great concern, as I have publicly said for many years. I have much experience in this area and have seen many bad practices evolve that I do not like. While I do not suggest that psychiatric medicines are unnecessary, they should not have the place they have in the treatment of people with mental illness. There is a major conference in Dublin this weekend, which I hope will bring much attention to this topic.

We had well-informed contributions from the Senators today, many of whom are members of the Joint Committee on Health and Children. I urge them to become involved in this area because it will be of serious concern to anybody involved in the treatment of people with mental illness and it behoves us all to listen. Although we try to be objective, we are all prejudiced by our life experiences when we discuss the treatment of people with mental illness. Much work has been done and it is time to listen to the patients. They have no prejudices. They are objective. They are telling us their stories of being on these potent drugs. We all have a responsibility to listen to them. I ask the members of the Joint Committee on Health and Children to take this matter seriously. I will be delighted to attend the committee to listen to them and participate in their debates.

While I do not have time to discuss all the issues raised by Senator Ryan, I take on board his well-made comments on design and the separate entrance and identity of the new Central Mental Hospital as a distinct complex. It is a new, state-of-the-art mental hospital under the jurisdiction of the Department of Health and Children. Project team members are studying hospitals throughout the world to ensure that when we replace the existing Central Mental Hospital, built more than 156 years ago in 1850, by moving to Thornton Hall, it will be not just physically new, but will embrace all the best in forensic psychiatry. I look forward to everybody working together to ensure that happens. I take on board Senator Ryan's well-made point that we must ensure it is a separate entity from the Department of Justice, Equality and Law Reform and the Prison Service.

Senator Ryan and others mentioned the problem that we do not expedite change quickly enough in this area. I feel the frustration the same as many Members of this House. However many of those frustrations, especially in recent years, have been caused by industrial relations problems which are outside the remit of the Department of Health and Children or the HSE. I ask the Senators who have expertise in mental health and bringing best practice to fruition to give as much attention to industrial relations problems that delay the implementation of necessary changes in the health services as they give to the lack of facilities. The provision of facilities for vulnerable people is often delayed by people with vested interests using those people and the strong positions they hold in society to ensure that certain things do not happen. They know these things should happen and that it is best practice that they do, but they delay those changes for their own selfish interests, which are often contrary to the best interests of the patients whom they are there to serve. I say that of all professionals in this area. The patients are the most important people when discussing mental health.

Senator Ryan asked about the escorts. Again, there is an industrial relations problem in this area. Important high level talks are taking place at present between the Department of Justice, Equality and Law Reform, the Health Service Executive, HSE, the Department of Health and Children and the other stakeholders. I do not know if the matter is resolved yet. I hope it will be. This industrial relations problem could again delay things for patients.

I do not have time to discuss every issue raised by Senators. Senator Feeney referred to Sligo. I was delighted to hear that a service has evolved there where cognitive behaviour therapists are assigned to general practitioner units. That is advanced thinking in action. It is desirable that people throughout the country should have direct access to psychological therapies. The gatekeepers, that is, the general practitioners and the psychiatrists, have not always held the view that people should have psychological services but there is now a general recognition that they should. I hope a situation will soon evolve whereby people will be able to get these services of their own accord or be referred directly by a general practitioner. That will mean a huge change in the general medical service.

Obviously, if people pay for their services, they can pay for whatever services they require, but for medical card patients a system will have to evolve whereby patients can be referred by their general practitioner for psychological services. That system is not yet in place but there is a desire that it would happen.

Senator Browne mentioned the National Treatment Purchase Fund and how it can be used for vulnerable people. That is a good idea and I will examine it. However, there are issues involved whereby systems could be abused in order that certain people might earn more money. That is as kindly as I can put it. It would be preferable if proper multidisciplinary teams were in place.

Some speakers mentioned the Criminal Law (Insanity) Act. It is causing certain problems for the Central Mental Hospital at present but we are trying to resolve them. Seven extra beds have now been assigned to the Central Mental Hospital to deal with the problem of people being referred directly from the courts to the hospital.

Senator Norris referred to the recent report by Dr. Dunne on psychological services. I spoke at the seminar on the psychological services. The Government is doing a huge amount to ensure there are more psychology students in our universities and that more psychologists graduate to be employed by the HSE. Unfortunately, it takes some years for people to get through the courses involved.

I have also spoken to the counsellors and encouraged them to do as much as they can to work together to establish standards. Some psychological practitioners have very high standards but, unfortunately, some people have low standards in this area. The objective is to get a via media or middle road whereby we will provide good psychological and counselling services. Counsellors will be regulated properly under the Health and Social Care Professionals Bill. However, they must agree on the issue themselves. We continue to liaise with them.

Senator Ormonde mentioned several matters about which I feel very strongly, as do all Members who spoke in the debate. The words "respect", "empathy" and "dignity" are important when treating people with mental health problems. This is not just a matter for the Department of Health and Children or the Government. All parts of society must deal with this issue. It is ironic that there was never such wealth in our country previously but, parallel with that, there has never been as much depression and unhappiness. That sends a strong message that the opinion makers, our educational system and our sense of values need to be examined closely and challenged.

As a society we do not spend enough time with vulnerable people or listen to people or their problems. There is a definite connection between the excessive consumption of alcohol and depression and suicide. Our society has created great wealth but that wealth, in monetary terms, means nothing if we are not happy people or are unable to look after ourselves. I challenge everybody in society to realise that life is not about money but about how we live as a society. There is a huge sociological task to be done in terms of the discussion about mental health.

I thank the Senators for their valuable contributions to this debate. I look forward to continuing to work with them to ensure that the people for whom we are responsible are provided with the best services.