Paudie Coffey (Fine Gael)

I am pleased that we are debating mental health in general. In the short time I have been in the Seanad I have heard several Senators from all parties raise the issues of mental health, its treatment and the resources required for dealing with mental health in Ireland. An excellent document was produced in 2006 called A Vision for Change. The roll-out and implementation of the recommendations of that report is a serious concern for many people involved in the mental health sector in Ireland.

Mental Health Ireland consists of many voluntary groups working with mental health patients and their families and advocates for them on a daily basis highlighting the lack of resources and the issues that affect patients. I am sure, as I have, many Senators have met these groups in recent years. They include Aware, The Irish Advocacy Network, Schizophrenia Ireland, GROW, OANDA, Headway Ireland, The Samaritans, BodyWise, The Alzheimer Society of Ireland and Recovery Inc. These groups advocate on a daily basis and deal with issues such as those we are debating. The Trojan work of these groups to educate the public and politicians about what it is like to live with, work and treat people with mental health issues should be acknowledged by all legislators and policy makers. It is important we listen to these groups as they are at the coalface every day confronting the issues.

On the Bill, it is important that legislators and policy makers keep issues of mental health as the highest priority when debating health in general. I compliment the Green Party on bringing forward this Bill. There is consensus across the House. The general thrust of the Bill is good and it attempts to address some issues of concern to the bodies and patients already mentioned.

The two procedures specifically mentioned in the Bill, psychosurgery and ECT, have been controversial within the health service and among clinicians and the people that treat mental health patients. There is a debate proceeding among those sectors. It is important that we as politicians debate the issues and that we inform ourselves, as much as possible, about the techniques used in mental health treatment. ECT seems to be a stressful treatment. I have consulted with people that have worked in this area, whether it is psychiatrists or psychiatric nurses and they have indicated it should be a treatment of last resort, that all other treatments and therapies should be explored, and that it is important that, where possible, the consent of the patient is approved before any invasive treatments such as ECT are considered. There are concerns about the regional variations of the application of this treatment and this needs to be examined.

I ask the Minister of State, Deputy John Moloney, to ask his Department to carry out studies into the way ECT has been used in Ireland. There are obviously concerns about the treatment. Some people to whom I have spoken suggest it is used too randomly and freely by some psychiatrists. Others say there is a need for ECT, but that the guidelines and protocol for its use need to be stricter and properly regulated. I call for clearer guidelines and protocol. There should be systems which properly inform patients, their families and advocate groups.

It is also important to get the views of clinicians. In psychiatry we often hear of a second opinion, so professionals differ in their views too. We need a wider examination of the treatment system in Ireland. We need to consult extensively with clinicians, patients and their families and the advocacy groups. We need proper regulation and monitoring of how ECT has been used and how it is proposed to be used in future. We need a proper evaluation on how successful it has been. I am sure some will argue it has been a considerable success, whereas others will say it has not been successful. A proper evaluation of the success of ECT should be examined.

It was suggested by my colleague, Senator Frances Fitzgerald, that there is a role for the Oireachtas Joint Committee on Health and Children to examine mental health in general, but also to examine the aspects of mental health this Bill presents. Some guidelines used in other jurisdictions have been recommended and are generally accepted by professionals and clinicians in the area. ECT is used for rapid and short-term improvement of severe symptoms after other treatment has failed, or when the condition is considered to be potentially life-threatening. Some guidelines set down in other areas include the recommendation that the therapy is used for patients with severe depressive illness, types of schizophrenia or a prolonged or severe manic episode. The decision to use ECT should be made jointly by the individual and the clinicians responsible for the treatment. Consent should be obtained where the patient is able to give such permission.

There are many areas that need to be examined. I welcome this debate and the Green Party is to be commended on putting mental health in general on the agenda. I look forward to further debates on this issue as it is certainly an area we need to discuss. The report A Vision for Change which was introduced two years ago considers a long-term plan. We are already two years into that plan and many of the advocacy groups and politicians representing those with mental health issues would agree we are not achieving our targets. The money and resources that were supposed to be allocated to treat mental health under the recommendations of the report have been cut in the budgets. There is disappointment in the advocacy groups about this. The report promised much and if the recommendations were implemented as proposed we could make serious improvements in the treatment of patients.

I sense as a public representative that we are finally lifting the stigma which in the past was attached to mental illness in Ireland. I acknowledge the role the advocacy groups are playing in educating the public about mental health issues.

I am from County Waterford and there is a institution there called St. Otteran's Hospital which does Trojan work, and I have spoken to staff there. There are concerns as the hospital is due to be sold. Promises were made that the resources and money raised from the sale of extensive property would be ring-fenced and re-invested into mental health facilities. This is only fair, because where mental health patients are returning to the community they will need the financial resources to support themselves. It is only right that any money raised from sales of lands in psychiatric services should be ring-fenced for the benefit of those patients.