John Moloney (Laois-Offaly, Fianna Fail)

I thank Members for the invitation to the House to discuss the effects the recession is having on the population in terms of mental health. I propose to deal with this under three headings. One is the capital programme, and I am anxious to confirm that funding is still available for the mental health sector and, more importantly, that the Government programme, A Vision for Change, is alive and well. It is a ten-year programme and we are only four years into it. There is every possibility it will be delivered within the timeframe of the remaining six years.

The overriding demand on the Department is to deal with the issue of the stigma surrounding mental health. I will commence by discussing what has been achieved while also acknowledging what remains to be done. I will be direct and to the point and if Members have doubts about the issues I mention, they are free to question me. The first issue is what we are doing to help the population to understand the difficulty surrounding mental health and the problems that result from the stigma attached to it. In that context, two years ago I decided that the most important thing the Department could do is travel throughout the country and try to deal with the issue of the stigma and, more importantly, encourage as many groups as possible to become involved in this national campaign.

I have always been of the view that if we could encourage people to look after their mental health in the same way as they look after their physical health, it would be a determining factor in dealing with mental health issues before they became difficult and required institutional or community care. The See Change initiative is taking place in that context. So far, we have visited ten county towns and our intention is to travel to all the county towns before the end of March. The objective of the See Change campaign is to reduce the level of discrimination and prejudice. When we travel to the county towns, we bring with us professionals from the area and service users. We open the debate to the floor after the presentations.

We have visited Ennis, Donegal, Dún Laoghaire, Dublin and Tipperary. Next week we are due to visit Mayo, Sligo and Wexford. The important aspect of all the presentations has been the response from the floor. Sadly, many people are reluctant to present and often they speak on behalf of their loved ones or friends. They consistently point to the fear factor involved in presenting for mental health support. That is the result of fear of discrimination in the workplace and - a phenomenon we should deal with as quickly as possible - the fear people suffer when they make an application for a mortgage, personal loan or a job. Often there is a question on the application asking the person if they have ever suffered a mental health disability or issue. People feel discriminated against because if they answer "Yes" to such a question, it will have a negative effect on the application.

These issues are the challenge for us. Even where people apply for local authority housing, that huge fear factor exists. The See Change campaign seeks to deal with that issue which affects many people. It is also trying to educate the authorities, local and central as well as in banking and the private sector, that a mental health issue should be considered in the same way as a physical health issue. I believe we are getting that message across, albeit slowly.

The other aspect of the See Change campaign is to convince people to look after their mental health. It was never more important than in the context of the next budget. The budget for the Department of Health and Children will be reduced by approximately €1 billion, which will pose a serious challenge in ensuring we hold on to the funding we have for mental health and ensuring we use it better and wisely. I am convinced, having met many groups over the past two years, that the priority must be early intervention. Many people have advised me over recent months that 70% of mental health issues begin in childhood and adolescence. It is obvious, therefore, that this is where the funding should be prioritised and I intend to drive that programme forward.

It is also important to discuss the issue of suicide and its prevention. Many groups are making great efforts to impact locally through community organisations and individuals to bring assistance to people. Again, I must examine the budget in the context of ensuring that whatever is provided to the National Office for Suicide Prevention will be targeted at groups that are most vulnerable. That will be the new thinking as we approach this budget.

I do not intend to waste time talking about capital programmes because this discussion is about the effect of the recession on mental health and what the Government should do. It is important because there is so much negative comment to the effect that little happens in the mental health area. That partisan comment does not concern or worry me in the least. What does concern me is that the notion is abroad that because we are in a recession funding is reduced and nothing is happening to drive A Vision for Change forward, but nothing could be further from the truth. I continue to affirm at all times that the level of funding for mental health services should be increased. We have made this case in the past year and will I hope receive the appropriate response. I am not trying to fly the flag for the Department or the Government, but I do recognise that this is consistent with what was promised in A Vision for Change.

Let me give a flavour of what is happening. Under this year's capital programme, there have been significant achievements. For the first time since 1815, there will be no new referrals to Grangegorman and the service at Blanchardstown hospital is now up and running. I have often been asked about what is happening at Portrane. The development of the acute psychiatric unit promised at Beaumont Hospital will commence in February 2011. There have been questions as to whether funding has been committed; I confirm that it is guaranteed. I acknowledge there has been a delay in commencing the project due to the fact that the original site had to be changed to allow for the co-located hospital programme.

I am trying to follow up on the annual report of the Mental Health Commission inspectors on the condition of mental hospitals. In the case of St. Loman's Hospital, Mullingar, I am pleased to say that, as part of the A Vision for Change programme, we visited Mullingar to turn the sod for the new 100-bed unit that will replace the wards referred to so often in the inspectors' report. I expect the new facility to open early in the new year. The inspectors' report also referred to the acute psychiatric services in Letterkenny and called for the closure of the hospital there. That has now happened and construction of the new psychiatric unit is well under way. I visited the site unofficially during the past fortnight in order that I would have some idea of progress and was pleased to see the building was almost three quarters completed.

We have made progress on a child and adolescent day hospital in Cherry Orchard in Dublin and on hostels in Wexford and Tipperary. Deputy Neville, Senator Fitzgerald and many other members of the Joint Committee on Health and Children have often reminded me of the importance of insisting on separate child and adolescent facilities. Yesterday I met Deputy Neville and the Irish Association of Suicidology and once again they impressed on me the need to ensure that whatever we did, we needed to prioritise the provision of child and adolescent supports. We must not just concentrate on the provision of beds but also on the provision of support through mental health teams. A Vision for Change commits us to providing 100 beds by the end of the programme in approximately four years time. We have reached a figure of 55 child and adolescent beds, an important achievement which illustrates that progress has not been parked owing to the recession. A 20-bed child and adolescent unit in Cork which has been commissioned is expected to be up and running by early next year. Day hospitals in Ballyfermot and Inchicore are also in operation, while nursing units are in operation in Senator Prendargast's area, in Clonmel.

All of these works demonstrate how the capital programme for last year has been applied. We must now work out the programme for next year. Much of what will be achieved will be funded by selling assets to the tune of €50 million and reinvesting the funds. We did not realise a full €50 million last year and spent was in excess of that figure. The extra funding came by way of a transfer from the capital budget of the HSE.

I have dealt with the programme See Change and what it can achieve. It is delivering by involving many groups and encouraging them to embrace and deal with the issue of mental well-being. Some 55 groups are involved. Our next strategy must be to work in primary and secondary schools to involve students and help them to realise the importance of the delivery of services in the community to help change attitudes and help recovery.

I am pleased to be here to discuss the issues raised, in particular the fears about the current economic situation and the impact it is having on people's work and lives. Undoubtedly, it tests the coping skills and emotional resilience of individuals, families and communities. The impact of unemployment and personal financial difficulties on physical and mental health is well documented. Following job loss, people report higher levels of anxiety, stress, depression, anger and loss of personal control and self-esteem. It may also be difficult, at times, to maintain contact with friends and colleagues. There is a strong relationship between unemployment, the economy and increased mental health problems and suicide risk. Of course, there are also people who are in employment and financially secure who may also be in need of support and services. Last year there was a worrying increase of 24% in the number of deaths by suicide on the figure for 2008. This increase is a source of concern for me and the Government. We must redouble our efforts to reduce the incidence of suicide and make every effort to reach out to people in despair.

Yesterday I visited Pieta House in Lucan where I saw at first hand how this group, like many others, worked in a non-hospital setting to provide for early intervention. I was impressed to hear Pieta House had dealt with 1,200 people in the short time it had been open. I am convinced that when sitting down to decide how much of the budget should be devoted to suicide prevention measures, I must take account of the number of groups working in this area. I do not wish to offend any group, but we must take into account whether it would be more sensible to support many small groups or to target the funds available. In the next few weeks I hope to bring clarity to the issue. I was very impressed by what I had seen in Pieta House and by the fact that people were being referred to it from Tallaght hospital, by people such as Dr. Ian Daly and from Beaumont Hospital. This is the way forward. Advice from various professionals, Members, the Joint Committee on Health and Children and service users has helped me to realise that we must bring all the groups involved in suicide prevention together in order that we can target investment to achieve a better outcome.

I am not here only to say the Government has put money aside for this or that. Everyone has a role to play in ensuring the appropriate funds are put aside for mental health services. The Government has provided additional funding of almost €1 million this year from the dormant accounts fund for a programme of suicide prevention measures to help communities to develop integrated local action plans aimed at suicide prevention. I say this to stress that, even though we are in a recession, it is not true that we will park investment, A Vision for Change or the plan to place mental health issues at the top of the health agenda.

The special needs service of the mental health service has also been recognised in the context of the 2010 employment control framework for the health service which provides for an exemption from the moratorium in respect of 100 psychiatric nursing posts. I am aware that some will be surprised at this, given that the moratorium has presented a difficulty in rolling out A Vision for Change.