Seanad debates

Tuesday, 23 March 2010

4:00 am

Photo of Maria CorriganMaria Corrigan (Fianna Fail)

I welcome the Minister of State. Along with Senator Fitzgerald, I found his contribution to be very interesting and thought-provoking, especially when he deviated from the script. It reflected the personal commitment, enthusiasm, dedication and energy he has brought to this portfolio.

Members have sought this debate for a long time. All of us have raised it on the Order of Business at one stage or another because of the concern that this can sometimes be an area that is neglected. However, it is important to start with a message of positivity. It is important to say that we can intervene effectively for people experiencing mental health difficulties. We can prevent mental health difficulties arising and we can promote and enhance our mental well-being. We can be ambitious in terms of people with mental health difficulties being facilitated to make a full contribution to our society. That is the tone in which this debate takes place and it reflects the contributions all of us have made previously, whether in other debates or on the Order of Business.

The Minister of State referred to A Vision for Change, which is undoubtedly an outstanding blueprint for the development of state of the art mental health services that will ensure we provide access for all people. It is a plan of which any country would be proud. As the Minister of State said, one of its undoubted strengths is that it is the product of a combined effort on the part of patients, family, staff and services and that it is supported and has the confidence of all concerned.

Achievements have been made, and it is important to acknowledge those achievements. The Minister of State referred to them but said he did not want today to be all about those achievements because many challenges lie ahead. However, I would like to acknowledge some of the achievements. The establishment of the Office for Disability and Mental Health was a particularly important step. The developments that have taken place regarding the increase in the number of beds available for child and adolescents are important, as is the commitment given that we will reach a stage where children under the ages of 18 will not be admitted to mental health wards. The naming of Mr. Martin Rogan as the lead person for mental health is another important step. It is important on a day like today to take the time to acknowledge that. I would like to take up the Minister of State's invitation to discuss also the challenges involved, of which there are many. I will try not to repeat those already outlined by Senator Fitzgerald because we are all under pressure in terms of time.

The first challenge we must discuss is the confidence people have in the implementation of A Vision for Change. As a result of its slow start, many people's confidence in it was somewhat shaken. That has some of its origins in the role played by the Health Service Executive in particular and its engagement in it. I do not want to knock the Health Service Executive. I am well aware there are many staff members in front-line positions within the HSE who work very hard to deliver quality mental health services. However, serious concerns have been expressed over the years about what happened to all the additional money allocated to mental health services. We all recall when the extra €25 million that was indicated would be needed for the implementation of A Vision for Change was allocated in the budget but it could not be traced or found to have been spent in the mental health areas. Indeed it was one of the reasons no additional funding was provided in the budget for mental health services in one year because there had not been a demonstration that money had been spent within that area.

I welcome the steps the Minister of State has taken to bring the implementation of A Vision for Change back on track. I welcome the plan outlined on 1 March in his Department and at the Farmleigh event. It was clear there was a renewed confidence and vigour among everyone attending and it gave them great heart but given that questioning, I ask the Minister of State if there is a role for the Oireachtas to play in the overseeing of the implementation of A Vision for Change. Is there a need for a specific Oireachtas joint committee to be established to which the HSE would have to report regarding the implementation of A Vision for Change? If such a step were to be taken, it would renew confidence and would also send out a positive message that mental health is a priority for the Oireachtas. Not a week goes by in the Seanad or the Dáil that Members do not advocate for mental health but somehow, and especially in this economic recession, mental health is not covered in the national media and can be seen, therefore, as something that is not necessarily the priority we all know it to be. Giving the Oireachtas a role in the implementation would be one way forward.

I welcome the capital project the Minister of State outlined on the previous occasion but I want to address the revenue provision that will be made for ongoing service development. I welcome the commitment and the identification of early intervention and adolescent services. We are aware that the earlier we intervene, the more positive the prognosis. We see that in projects such as DETECT that have been run by Dr. Eadbhard O'Callaghan and his team in St. John of God Hospital. We are aware also that other projects such as Headstrong, which is run by Tony Bates, intervene with adolescents at an early age and remove the stigma around the issue for adolescents by making it a natural part of development. If a teenager is not feeling well and he or she wants to call in to Headstrong, he or she can do so. There is no big deal about it. That is an important message and I welcome the fact that the Minister of State is prioritising those services.

I ask the Minister of State not to forget about older people with mental health issues, which is a major challenge facing us. Issues will arise for people in nursing homes with age related disorders in that initially they will qualify under the fair deal scheme but when they require that extra support in a dedicated mental health facility, even within the nursing home, they will no longer qualify. We are aware that people are living longer and with age related disorders we are seeing more challenging needs that require a greater degree of support. I ask the Minister of State to provide for those.

I echo the point raised by Senator Fitzgerald. I, too, would like to know about the apparent difference between the HSE service plan and the Revised Estimates, which is approximately €240 million.

I ask the Minister of State also if it would it be possible for us to set in stone a proportion of the health budget to be spent on mental health, whether it be 8% or 9%. Could that money be ring-fenced in some way to ensure it is not appropriate for that money to be diverted to any other part of the health service? Investing in mental health is a positive investment for our communities.

Regarding A Vision for Change, what measures will be taken to provide mental health services for people with intellectual disabilities? Also, has a decision been made yet regarding the location of the new Central Mental Hospital? It would be an awful shame, in the context of the Sea Change campaign being run by the Minister of State, if the Central Mental Hospital were to be located on the grounds of a prison. I believe this would be counterproductive in terms of what we are trying to achieve.

While funding is an important part of A Vision for Change, it is not all that is necessary. The Minister of State identified some of the other challenges in terms of the moratorium and employees being required to change jobs, train and upskill. Legislative issues also arise. Some changes recently introduced by way of legislation are positive. However, the mental capacity legislation must be brought before us as quickly as possible. This legislation could have a profound impact on so many different sectors of society. It is of the utmost importance that we are given the maximum possible time to consider and debate it as its implications will be felt for a long time.

I welcome the progress made in the area of suicide. The training programmes, such as Assist, run by the National Office for Suicide Prevention, have been worthwhile. Part of A Vision for Change focuses on prevention and early intervention and enhancing our own psychological well-being. I put it to the Minister of State that as a first step in this regard we need to link with schools' SPHE programme. If we want to address stigmatisation, much of which arises from a lack of information and awareness, we must ensure children are at an early stage given a positive understanding of the challenges in this regard and are given, upon leaving school, a proper toolbox in terms of coping and tolerance skills. Again, if we want to pursue early intervention, a key element will be ensuring there is information and awareness in terms of mental health challenges and the help available. When we undertake projects, such as that outlined by the Minister of State, it is crucial, if we can encourage people to talk about mental health issues and to come forward regarding mental health issues, that we have in place a response system to assist people who come forward. That is the role that community mental health teams must play.

On deinstitutionalisation, the plan to close institutions and move people into communities is important. However, I have concerns in regard to community housing. I was delighted to hear the Minister of State speak about voluntary housing. I would like to see us embrace a framework of supported living. There is a danger of community houses becoming mini-institutions. Where community housing is established, what will be the position in this regard in terms of the inspectorate given they will no longer come within the remit of the inspectorate of the mental hospital? An issue of concern, even in terms of adults with intellectual disability, is that there is in place an inspectorate in this area.

I thank the Minister of State and wish him well.

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