John Moloney (Laois-Offaly, Fianna Fail)

): I am glad to have this opportunity to come to the House to speak about mental health and, in particular, the Government reform programme, A Vision for Change. A Vision for Change is a seven to ten year Government reform programme now into its fourth year. Before I continue I hasten to add and suggest that the rate of reform has not been what had been anticipated. I do not intend to use the prepared speech to discuss what has been achieved. While that has some importance, the most important part is what remains to be done. I acknowledge that much needs to be done and I intend to use my time to talk about this.

Upon my appointment some 18 months ago, I made some clear commitments in the area of the reform programme by way of the targets set. I welcome robust debate on this issue and any debate should not only be about what we in the Department are doing. I realise much needs to be done and I welcome debate on the relevant areas.

When the capital programme was announced I set myself a target of visiting all the psychiatric hospitals in the State during the past 18 months and I have visited most of those hospitals to date. While these visits were prearranged, they were in a private capacity, but they were notified to the media and local politicians in an attempt to try to work with the hospital staff, patients and their representatives to progress a development and closure plan. At the end of the round of visits the next part of the plan was to ensure we put a capital programme before Government. The capital programme was approved in this year's budget. It is a €50 million multi-annual programme dependent on the sale of properties. I will outline the properties in question but, more important, I will refer to the capital committed for this year and future years. It is important to note that the capital element is very important. I chose to say we could deliver on the closure of all the hospitals in a three year period. I did this specifically because I believed that to extend the time commitment would reduce the importance of the closures.

I intend working with the Irish Council for Social Housing on this matter. The council has visited me already and we are preparing a joint commitment and presentation which will involve the Minister of State, Deputy Finneran, myself and officials to ensure the management of the capital programme and to provide for the closure of the hospitals. This programme will also involve an element of voluntary housing and I intend to expand on this matter later during questioning.

We must ensure the commitments in A Vision for Change are based on the recovery model and that they refer to the transfer from institutionalised care to community care, which will be the cornerstone of the reform programme.

I made it clear at the beginning of my time in the Department that it was very important to have a directive for mental health as proposed in A Vision for Change. I am very pleased to have made this case to the HSE. The HSE and Professor Drumm have acknowledged this and I am pleased to note that Martin Rogan, the relevant director, is someone with a track record who has come from the psychiatric services and who has practised as a nurse over the years.

I intend to refer of a very important part of the reform programme that I will present on 15 April. Even if there were no difficulty with funding we would have to work within the terms of the available funding. The most important thing I could say in this debate is that even with all the capital support necessary to deliver A Vision for Change unless we deal with the issue of stigma and its eradication, efforts will be of little benefit.

I wish to take some time to elaborate on the national campaign I will introduce on 15 April. I realise difficulties exist in respect of the moratorium and how we can deliver the change and I will address these matters presently.

I make the point that any commitments I have made to date, I have lived up to. I believe somebody has said about me that there is a lot of vision but little change. I hope people will check the record to see if that stacks up, as I do not believe it does. I have lived up to the commitments I made on the capital programme, the director and the transfer from institutional to community care within three years. I am not big-headed enough to believe I will be here for three years, but it is important that each March the Minister, whoever he or she is, as long as the programme is place, confirms what has been achieved in the previous year and, more importantly, what is proposed to be achieved in the following year.

While many issues keep cropping up, I must prioritise. Priority must be given to child and adolescent care. As I have heard quoted by many eminent persons in the service, some 70% of mental health difficulties begin in the child and adolescent years. In that context, I have asked the Government to prioritise funding for early intervention measures. In saying this, great credit is due to the staff involved in the services. It is also important to stress that we are all in this together. It is not a party political move on behalf of anyone. I have heard Mr. Tony Bates, for instance, speak for Headstrong and see what is happening in Ballymun and Galway. I have visited those facilities. I am also pleased to say that last month we visited Roscommon where I was happy to see so many people around the table - representatives of FÁS, the local authority, the VEC and the community and voluntary sector - all promoting the concept of community support on mental health issues. I give full credit to the people involved. I refer, for instance, to the American philanthropist, Mr. Chuck Feeney, who has worked with the Government to provide the necessary funding to deliver the Headstrong programme, Jigsaw. I am pleased to say that last week the Government committed itself to funding the reform programme in Roscommon which forms part of a national campaign.

I do not want to bore Senators by talking about achievements. Clearly, they are only matched by commitments and progress on what remains to be done. I ask Senators to bear with me as I show them that while we are in difficult financial times, progress is being maintained. A total of 55 child and adolescent mental health teams are in place and a further eight are being developed. The number of inpatient beds for children and young people has more than doubled since 2007. It has increased to 30. A further two 20-bed units are under construction in Cork and Galway. I had the pleasure of turning the sod at both facilities. The commitment made in A Vision for Change is that 100 beds will be provided. I appreciate that we are not halfway there, but I ask Senators to realise that we are speaking about work in progress and delivering on this commitment before the end of the programme.

The Mental Health Commission's code of practice relating to the admission of children to adult units in approved centres was amended to require that from 1 July 2009 no child under the age of 16 years be admitted to an adult psychiatric unit, that no child under 17 years be so admitted from 1 December 2010 and no child under 18 years be so admitted from 2011. This, together with the provision of additional beds, will substantially reduce the number of admissions to adult facilities. To my mind, that is progress, but it is not enough.

The first annual report on child and adolescent mental health services was launched in October 2009. It provides comprehensive data on the level of activity in the service, as well as important information on the young people presenting and how the nature of their condition changes with age.

Some 19 additional beds in the Central Mental Hospital and six places in a step-down residence in west Dublin have been provided, as well as the in-reach service to prisons, including clinics at Cloverhill, Mountjoy, Wheatfield and Arbour Hill Prisons. Further details are contained in my statement.

The Central Mental Hospital recently won an award for best hospital project in the Irish Healthcare Awards 2009 and the An Duais Mhór trophy for its prison in-reach and court liaison service. The service is a fine example of collaborative working, involving gardaí, District Court judges and staff of the Irish Prison Service and the forensic mental health service.

It is worth noting also that shorter episodes of inpatient care have been achieved and that 50% of discharges occur within two weeks of admission. There are also fewer involuntary admissions.

Executive clinical directors have been appointed to lead reform in catchment areas serving populations of 350,000 to 400,000. I see the role of director as working with clinical directors to establish what can be achieved in A Vision for Change and, more importantly, if there are barriers to progress and, if so, to have them removed. The appointment of Mr. Martin Rogan as national lead within the HSE is an important step in implementing A Vision for Change.

I do not intend to read from my prepared script on the National Service Users Executive. The executive is part and parcel of the reform programme and involved in every aspect of implementation of A Vision for Change. I particularly thank those who were in the House last November when we debated the issue of ECT. Obviously, I thank Senators on the Government side from where I expected to receive support, but I particularly thank Senators on the other side for, as it were, stepping aside from the politics of the issue and postponing the decision until such time as we presented information to the House on the matter. I recognise we have had an opportunity to debate the pros and cons of ECT treatment in the House in the past few weeks. It is up to us to keep faith with our commitment to bring forward the heads of a Bill not later than June.

On the commitments given on the capital programme, I have always believed that, even though there has been significant progress made, the public is aware of the old grey Victorian buildings. Having had the opportunity to visit so many of them, I realise that altogether there are approximately 1,200 patients who could live outside. Clearly, there were no press statements or political announcements on the capital programme, nor do I intend to make any. This is something that should be done properly by way of the HSE making the announcements. I am pleased to say, on behalf of everyone here, that the capital programme is now under way, involving the first tranche of the €50 million. On the long-standing commitment to provide a new acute psychiatric unit in Letterkenny, this week the contractor was on site as part of a capital programme worth in the region of €6 million which will be delivered within 15 months. The capital programme also includes St. Loman's Hospital, Mullingar. I am trying to deal with the highlights in the report of the inspector each year which covers conditions not only for patients but also for the staff who work in the hospital. I understand work will begin on the new 50-bed unit adjacent to St. Mary's Hospital, Mulligar at the end of next month. It will replace St. Brigid's Ward and St. Marie Goretti Ward. On the long-standing commitment to provide the new psychiatric unit at Beaumont Hospital, I expect the Department and the HSE to seek planning permission by the end of July. There is a sum of €25 million to be provided in Senator Prendergast's area - Clonmel. I am not shouting about these developments. They are part of an ongoing process.

I was in Grangegorman sometime ago and I am pleased to be able to say that within eight to 12 weeks the enabling works will begin. The objective must be to meet the commitment given to provide the new 66-bed unit.

I ask Senators to allow me a minute or two to deal with the forthcoming stigma campaign. There is in place the capital programme, as well as the director. There is the commitment to close hospitals within three years, to ensure we make the best use of primary care centres to house community mental health teams, to meet the specific targets set in respect of child and adolescent mental health and, most importantly, that the Minister involved should be present at the launch of the report each March at Farmleigh House.

Having met the various groups involved over the past 18 months, I know the main issue is how we deal with the stigma attached to mental health illness. Senator Frances Fitzgerald and Deputy Chris Andrews invited Mr. Kjell Magne Bondevik to address the cross-party Oireachtas group on mental health. I have had the pleasure of hearing him on many other occasions.

Since I took up office I have always believed the real trick will be to ensure the issue of mental health illness is tackled in the same fashion as physical ill health. My intention is to drive a reform programme on the capital side with the closure of older hospitals and make people aware of the need to protect their mental well-being.

In the past I have referred to the time when my doctor in the Mater referred me to a psychologist in late 2007 after treatment for a nerve pain in my face which was related to stress. I am happy to say I attended five sessions and that it helped me recover from that bout. I hope this will encourage people to talk up the issue of recovery models as envisaged in A Vision for Change.

I invited people and organisations involved in mental health well-being to help drive a national campaign, Sea Change, the national mental health stigma reduction partnership. At long last, it will be launched on April 15 in the Mansion House. I thank Mr. John Saunders, who headed the effort, and all those who worked hard to bring it together. Anyone I approached to assist, be they in politics, the arts or sports, became involved in the campaign. It will bring together all the groups involved.

Going around the country, I met so many different groups and people who wanted to raise awareness about mental health well-being. Often, however, I heard them blame politicians for not being more pro-active in suicide reduction. The launch of Sea Change will be an opportunity for them to row in behind us. While I do not want to go much into the details of the campaign now, the reach-out will be to local media. National campaigns are beneficial in themselves but local media involvement is also required. Local sports stars, politicians and artists will participate in weekly magazine programmes on local radio to say it is no big issue if one needs mental health support. We have also approached people with national profiles to help launch the campaign and they have all been willing to assist.

When one in four people will suffer some mental health problem, it is important facilities are put at their disposal and that coming out about it should not affect their employment, promotional or home-owning prospects. Many are frightened of the idea of mental ill health. The campaign will also explain the different levels of mental illness and be committed to the recovery model. The various diagnostic titles such as psychosis, schizophrenia, bipolar disorder and depression are often seen as lifetime labels. This campaign will be targeted at ensuring such lifetime labels around these illnesses are reduced and eventually dismissed to allow people every available route to recovery.

The commitments made in A Vision for Change will be delivered in the existing timeframe. While I accept not all Members will sing off the same hymn sheet, we all want to see reform in the provision of mental health services. It is important, therefore, targets are set every year and their success measured. The only way to ensure continuing reform in the mental health services is to have specific funding ear-marked in the mental health programme. A proper presentation on this will have to be delivered; it cannot be shoddy. A Vision for Change can be delivered upon as it was compiled by those who use the services. It is important the supports it promises are delivered across the board in psychiatric care. It is up to us to deliver on this reform roadmap.