Frances Fitzgerald (Fine Gael)

I welcome the Minister of State, Deputy Moloney.

The launch of the Sea Change campaign on 15 April is critical and I assure him of 110% support from this side of the House. It is an initiative I welcome. The issue of a stigma around mental health issues is enormous and blights people's lives, self-esteem, employment prospects and their families every day. It is critical we begin to deal with it nationally, as well as helping people deal with it personally. I hope it will be a multifaceted campaign and will continue for as long as it is needed.

The stigma surrounding cancer only began to lift in recent years. There was a time when women were too frightened to speak about breast cancer. Only in retrospect can we see how ridiculous that was. Only when we tackle the stigma around mental health issues will people get more effective help earlier. Many mental health difficulties arise in adolescence. It is critical those it affects get help in time and the services they need. When people are too afraid to speak about it in school or to their employer because of the stigma associated with it, it only leads to further difficulties.

I welcome the Minister's personal commitment to this area. He spoke of his own experience which will be helpful for many people. I refer to the 400 patients in care in old psychiatric hospitals who should not be there. It is interesting to see the report from the Department of Health and Children. There are 4,700 people in old hospitals. The Department report refers to 400 people who should not be there. I welcome the commitment to capital funding.

The Minister of State should clarify what will happen if the sales of these properties do not go ahead or if the properties have been greatly reduced in value. We know the property market at the moment. What are the implications for mental health funding? Is there a guarantee from the Government for the €50 million over three years or is that dependent on the sale of property? If dependent on sales this year, it could be very problematic even if new facilities can be built at a cheaper rate. The Minister of State can clarify the funding mechanism with regard to the sale of these lands . If the lands were being sold in the Celtic tiger era, one would be optimistic about the money they would generate which could then be ring-fenced. It is important the money is ring-fenced. What will happen if there are no sales this year? What will happen to the sum of €50 million for this year, next year and the year after? I would like as much information as possible on that point.

There have been difficulties with the transparency of mental health funding. I am aware of the economic downturn. Perhaps the Minister of State will comment on the fact that it seems the proportion of spending on mental health is now 5.4%, far below the Government's commitment to 8.24%. I ask the Minister of State to address the implications of this and explain how it happened. What is included in that figure of 5.4%? I have a number of questions on the money that will be spent in A Vision for Change. It is quite difficult to get this information in meetings of the Joint Committee on Health and Children. I have no doubt the heart of the Minister of State is in the right place and he has good intentions but good intentions will not fund our mental health service. Funding questions are critical if we are to see the provisions in A Vision for Change implemented. This programme is far behind but the fact that Mr. Martin Rogan is in place as director and the existence of the service users council are positive developments.

If A Vision for Change is to become reality, there will be community mental health teams and rehab and recovery teams in place. To close outdated facilities, proper community facilities must be in place. Is the HSE committed to putting more teams in place this year, for both adults and children? What is the number of teams? For example,the target for the plan for child and adolescent mental health teams was 55. Is that 55 for 2010 and does this represent the same 55 talked about for 2009? In other words, is the sum 55 teams in total? I am assuming the figure is not 110 in total but that may be the case. There have been a number of announcements.

I refer to waiting lists for child and adolescent services. A number of the teams will only accept acute emergencies where patients are psychotic or suicidal. Many parents are unable to go to local mental health teams and be assured of an assessment service within two years. Waiting lists vary greatly throughout the country. Many parents cannot get access to the service unless one is in a total crisis. Are figures available for waiting lists throughout the country? Is the Minister of State gathering these and is there an intention to deal with them in a particular timeframe?

I welcome the commitment by the Minister of State that children will not be admitted to adult inpatient units. That will cease completely by 2011. This shows the importance of having targets and monitoring what is happening. We can monitor this over the next three years.

The HSE had targets for a number of areas regarding mental health last year, including reducing the proportion of admissions that are readmissions and reducing the involuntary admission rates. These targets are not met, perhaps in part because of the lack of a comprehensive community-based mental health service. This raises the question of getting the community services in place as quickly as possible.

What is the relationship between the Minister of State, the Department and the HSE? The Minister of State sets targets and talks about what he wants to achieve. Then I see the HSE trying to implement the targets but not achieving them. The policy of the Minister of State is not being implemented. What is the mechanism to ensure targets set are met? What are the concrete plans to achieve these targets? When we have this information available regularly, the credibility of the Minister of State will be much greater. There is a gap at the moment and it is quite confusing when we try to get clear answers on the issue of funding in meetings of the Joint Committee on Health and Children. It is very difficult to get clear answers on what funding is ring-fenced and what money is allocated to the mental health budget. The proportion has decreased and this speaks for itself. The financial information given by the HSE, especially for the service plan for this year, shows the budget for mental health services is €240 million lower than the 2010 Revised Estimates. Where has the €240 million gone? Has this been allocated to the general health budget? It is a matter of transparency and trying to see what has been spent in this area. I have laboured the point but it is important in terms of the credibility of the programme. We must have clarity on the funding, the amounts, the percentages and the targets set for proportions of the mental health budget in 2010 and 2011.

It is important to highlight that mental health is not a matter for one Department and that it concerns other Departments. The Minister of State provided the example of the housing section in the Department of the Environment, Heritage and Local Government and its critical role in this area. It would be helpful to find out how other Departments implement A Vision for Change. In the field of equality, for example, we asked every Department to quality proof its policies. It would be useful to ask Departments to provide a response to A Vision for Change and the aspects of it that involve them. We should ask for reports from them. The Minister of State with responsibility for mental health should be a super junior position because so many Departments are involved. The housing section of the Department of the Environment, Heritage and Local Government has a part to play, as does the Department for Social and Family Affairs and, particularly, the Department of Enterprise, Trade and Employment. I would like to hear from the latter Department about the links it can make to the Department of Health and Children. The stigma and the nature of some mental illnesses, where people move in and out of the workforce, means there is a need for particular support and understanding from employers or social welfare officials dealing with those coping with mental illness. Much work remains to be done with these Departments and we need a multi-departmental approach to the implementation of A Vision for Change.

Some organisations, such as Amnesty International, are very keen to see if we can introduce legislation to underpin A Vision for Change. Service provision is always a difficulty because of the limits of what the Government can promise but it is an interesting area to consider. I wish the Minister of State well with the new initiatives and I recognise that some progress has been made. However, A Vision for Change is far behind schedule and there have been serious problems in respect of funding, some of which has been siphoned off to the general health budget. I would like greater clarity in the future on the current funding mechanisms, the proportion being spent on mental health and the funding generally the Minister of State envisages over the next three years.