Frances Fitzgerald (Fine Gael)

I welcome the Minister of State. I also welcome his commitment to this area, as well as the work programme he has outlined. This is a time of change concerning the mental health sector, both for politicians and the public at large. That can be seen from the fact that See Change meetings around the country have, for the most part, attracted very good numbers. There is clearly a widespread interest in the campaign. I welcome the changes the Minister of State has outlined in moving some institutional care to care in the community.

Despite this being a time of change for mental health matters, it is also a time of crisis for such services. I agree with the Minister of State that we do not want to deter anyone from availing of existing services; we want to encourage people to use them. They should seek early intervention from their GPs and specialist centres. This is particularly the case with children, but it also applies to adults. Prevention of mental illness is extremely important, so the earlier people seek help the less serious the consequences of their mental health difficulties will be. Every family is affected by mental health issues, which affect one in four people. As the Minister of State said, it is time to draw back the curtain fully and to ensure that people do not feel stigmatised. This is a time of change in that regard, which we must all welcome.

All these positive aspects, however, could easily be put aside by funding cutbacks. The Minister of State and his officials know this better than most. The front page of yesterday's Irish Medical News stated that "providing services with no funding is reckless and unsustainable". That quote comes from the head of mental health services with the HSE, who expressed serious concern about the ability of service providers to continue to provide safe levels of care in a climate of diminished resources.

I do not underestimate the Minister of State's personal efforts and the changes he has outlined, which I accept. However, this is a time of crisis for mental health services, and I want to outline why I think that is so. It is obviously linked to our overall economic situation and the demands for cutbacks in the health budget. We should put the facts on the record as regards what is happening with health funding.

I will quote some more of what Mr. Martin Rogan has to say, as reported by the Irish Medical News. He says he is still seeking commitments from the Department of Health and Children about securing additional funding next year for implementing A Vision for Change. It is clear that we have the vision and we know where we want to go with mental health services. The question, however, concerns the roadmap, in addition to money, implementation and the progress that has been made. We must analyse that to see where it currently stands. Mr. Rogan says that no extra funding was provided this year for the implementation of the mental health strategy. He stated: "I will deliver the service when it is paid for, otherwise it is reckless and unsustainable", adding, "Ethically, you can't start a service with no funding for it to fall over three weeks later when you have invited people to avail of the service".

If it is not sustainable we definitely cannot go there, but what sort of message is that for services around the country? Mr. Rogan also spoke about the equitable distribution of funding within the health budget. A key challenge for the Minister of State is to get equitable distribution of funding within the overall health budget. We know that mental health services have been the Cinderella of the health sector, so the challenge for the Minister of State is to ensure that changes. At the very least there should be equity within the health budget. If he achieves that, he will be achieving a great deal.

What is the current situation? The Minister of State has painted one picture, but I want to put on record some of the existing challenges. I accept that they have not arisen overnight, but have come about over a long period. It is disgraceful that mental health services have been at the margins for far too long. As the Minister of State knows, there is a new campaign on this issue involving all interested groups. There is more publicity about mental health budgets, which is a good thing. More than 7,000 e-mails have been sent to Deputies, Senators and people interested in this. This shows the stigma has been reduced and people are willing to write to their representatives about mental health and funding.

Let us consider the challenges. The campaign says that since 2006, mental health spending has been reduced by 9.2% and currently 5.3% of the overall health spending goes on mental health. Over half of all HSE staff cuts last year applied to mental health. Many psychiatric nurses have taken voluntary redundancy. This is a real challenge but they only make up 9% of the health workforce. The Inspector of Mental Health Services continues to say some facilities are entirely unacceptable and inhumane. The Minister of State referred to being at Pieta House yesterday, a service I know very well. Many cutbacks are coming at community services level, the more progressive side of the service to which A Vision for Change outlines we need to move. At a time of cutbacks in staffing, this is what is happening. We still have 1,000 people living in institutions that are Victorian despite the major efforts by front-line staff.

Major challenges remain. In 2009, more than 200 children were admitted to adult psychiatric units. Some 14 children have been admitted this year and an investigation is taking place on why nine were admitted in Limerick. I welcome that investigation because we should not admit young children to adult psychiatric or mental health institutions. It is clearly inappropriate.

The Minister of State referred to early intervention, which is a major challenge. What is the price to the individual, the family, the community and the budget of this country if a young child with mental health difficulties must wait up to four years for a diagnosis? It is enormous. Early intervention and early assessment in local areas is the key. I welcome the fact that the Minister of State is focusing on this.

I have indicated the scale of the challenges facing the Minister of State in receiving a budget. We are having this debate because it behoves us all to support the Minister of State in trying to ensure the budget he receives for next year is higher than for this year and is equitable in respect of what is happening in the Department. This week, research published by Red C highlighted the stresses and strains people feel as a result of the economic recession. It is important that the Taoiseach and other Ministers realise that at a time of recession, the need for mental health funding is even greater. International research over many years has shown that in an economic recession, mental health difficulties increase. It is common sense but the research shows this is what happens. We see it with suicide, depression rates and stress on families. The demand for the services increases at a time of recession, which is important to note in terms of the budget.

Services must be resourced. I am sure the Minister of State saw the comments of the Irish Medical Organisation in its pre-budget submission. It pointed out the interesting fact that 25% of people in receipt of illness benefit in 2009 cited mental health issues as the reason they were unfit for work. One sees the cost of not providing services to people. People fall out of the workplace and we know those with mental health difficulties face major stigma in speaking about their difficulties in the workplace. I also welcome the article written by Dr. Muiris Houston in the health supplement of The Irish Times. He outlines the stark economic burden of mental ill-health on the State, which is estimated at €3 billion per year. This is the cost of not having in place the services we need. All of this must be recognised. This is a major challenge, which we must recognise. Everyone will fight their corner. How does one say that mental health is more important than other areas of health? One can only make the best case one can and see if we can get extra money.

A Vision for Change needs money, as the director of services in the HSE commented. Perhaps the Minister of State can provide Members with the implementation plan for the policy and how he sees it developing. What is the Government's funding commitment to the implementation of the plan?

How much money is spent on mental health services? The Department is saying one figure, the HSE is saying something else. It seems extraordinary that the HSE service plan refers to a figure of €600 million to €700 million and the Department of Health and Children suggests it is €977 million. Why do we not have clarity on funding? The Considine working group referred to monitoring and having a framework of accountability between the Government and the HSE. One sees this is missing when one asks a question about HSE funding. There is a game going on and it is to the detriment of mental health services. We need answers and we need to ask the Minister of State if he will put in place a more accountable framework for funding. By doing this, the Minister of State will gain additional resources for mental health.

Amnesty International has made the complex argument that resources should be underpinned by legislation and a statutory right to access services. That raises major legal issues but I welcome the views of the Minister of State on these demands. What is the amount of money that has been received from the sale of residential assets? Have any been sold, has the money come back and has it been ring-fenced? We need to know the baseline figures for funding to assess what can be implemented and what is feasible.