Phil Prendergast (Labour)

I thank the Minister of State for coming to the Seanad once again. As Senator Feeney has said, he is no stranger. Mental health services continue to report an increase in the number of people suffering from stress. This has been linked directly to the recession, as has been identified by other speakers. The report by the Samaritans last year showed one in ten of the calls it received related to the financial crisis and issues relating to debt. There is an unquestionable link between times of economic hardship and increased demands on mental health services which are in need of reform. A failure to act will have long-term consequences.

The impact of the global economic difficulties on mental health has been recognised by the secretary general of the World Health Organisation who said, "It is essential … to learn from past mistakes and counter this period of economic downturn by increasing investment in health and the social sector". The inadequate funding of mental health services in times of economic prosperity has impacted on the present situation. We cannot neglect these services because they are needed much more than ever before given the scale of the impact of the recession. Mental health services are reporting people visiting them daily who are suicidal, depressed or both because they have lost their jobs or their incomes have collapsed. I know many people who have had the sad reality of suicide visited upon their families. This is always a very difficult subject, and especially difficult is the lack of closure in such cases where it might have been thought possible to have helped someone before he or she took the final, awful step.

Having been a member of the sub-committee on suicide as well as of the Joint Committee on Health and Children when the Minister of State was in the Chair, I am very well aware of his interest in this subject. He recognises that people have a whole change in their sense of self worth and cannot see any way out. Losing a job or having a chronically reduced income can have a major impact on someone suffering from mental illness.

I suggest that to reduce services drastically is not the way forward. People who have never suffered from anxiety or depression are expressing that view to me now at my clinics. A report by the Mental Health Commission, entitled The Economics of Mental Health Care in Ireland, estimates that the annual overall cost of poor mental health in this country is €3 billion or 2% of GNP. That would suggest that any cuts which serve to deepen this problem would simply create a false economy and fail to address the forthcoming budget in any meaningful way.

In the middle of economic recession, the enormous cost of mental health problems for the economy cannot be swept under the carpet. We need to enhance investment in mental health care. As the Irish Medical Organisation has pointed out, 25% of people in receipt of illness benefit in 2009 cited mental health issues as the reason they were unfit for work. If we are serious about getting people back to work, we cannot ignore these figures.

Amnesty International, working with people who have directly experienced mental health problems, have offered three proposals for dealing with the current situation. First, it suggests that the Mental Health Act 2001 be reviewed and updated in line with the new UN Convention on the Rights of Persons with Disabilities. It says the relevant Department, not just the Department of Health and Children, should take action on mental health and that new legislation should be introduced to deliver appropriate community-based mental health services. These are all aspirations in A Vision for Change, and I add my support to the proposals.

An issue very close to my heart and on which I have not received any clarity is the decision to close St. Michael's in the constituency of Tipperary South which was announced on 9 January last. This stunned the entire community because there was no consultation with local health users, the staff or management of the unit. It was obvious that a proper assessment of the needs of mental health patients had not been carried out. This was confirmed when I discovered that the option appraisal was, in effect, a collection of random thoughts, riddled with errors and incomplete sentences which did not serve to allay any misgivings I had about that decision. The decision has further impacted because the 49 beds in that acute unit in St. Michael's are part of the general hospital complement and therefore impact on the size of the hospital. It is obvious that to take 49 beds out of the hospital will have a serious impact. Can the Minister of State clarify the matter?

I want to ask as well about the three recently vacated wards in St. Luke's that are undergoing extensive refurbishment. It seems considerable money is being spent on them. Will the Minister for State give the reason and purpose of this? It is a pity this money was not spent when there were patients in those wards because it would have made much more sense. The Minister of State visited the unit and his horror was evident as he discussed the medieval conditions within which these people and the nursing staff had to operate. I would like if he could clarify this issue.

I reaffirm my belief that A Vision for Change, which is supposed to be the blueprint for the future of mental health services, is being used as a propaganda tool. I do not understand how the needs of service users in Kilkenny require greater relevance than those in Tipperary South. Again, I have an issue with clarity and ask the Minister of State how much money has been realised from the sale of HSE lands in Tipperary South. When the Minister of State was Chair of the Joint Committee on Health and Children, he said that any money realised from the sale of mental health facilities or HSE lands would be red circled and reinvested in the mental health services. We were delighted at the time to hear that the money was going to be reinvested in the mental health services.

As regards closing mental health units without the community services being in place, I still have serious concern that the announcement that the unit in Tipperary South is to close and the services are to be transferred to Kilkenny. Not a block has been laid yet, even though the Minister of State officiated in turning a sod there. South Tipperary has some of the worst employment blackspots in the country. We have seen the reconfiguration of health services there being driven by a group of people whose personal interests seem to be hell-bent on centralising services in Kilkenny. That goal, I believe, is being put before patient welfare.

There is no clarity on how decisions are arrived at. I submitted a freedom of information request last February in this regard which indicated that local stakeholders, including patients, their families, consultants and nursing staff, were told the news by Mr. Pat Healy at a Tuesday executive hospital meeting, which news became a formal announcement the following Friday and without any consultation whatever. It flies in the face of every sort of communication mandate possible, and the people of Tipperary South are still reeling from that decision and asking what is left for the community and patients, where the community facilities are and whether there are home-based treatment teams, crisis houses, their location in the event, how much money has been invested in them, etc.

I have asked the Minister of State a number of questions about the services in Tipperary South and how the geography was divided up. He said it was a matter of some concern to him as Minister of State with responsibility for mental health that "People with a mental illness are a hidden minority who suffer from pervasive discrimination." I do not accept that people with mental health illness, of whom there are as many in south Tipperary as anywhere else in the country, should suffer geographical discrimination. I would like to know how a hospital in Kilkenny, which is operating to full capacity - I have checked this with the staff who tell me the unit is as busy as the unit in south Tipperary - is to deal with patients from south Tipperary. The Mental Health Commission has stated there is in place a legal agreement in regard to services at South Tipperary General Hospital, of which the acute unit is part.

An announcement was made by a director of nursing in the psychiatric service that the night superintendent, a CNM III grade, is to be downgraded to a CNM II grade from January next. Perhaps the Minister of State will set out the reason for this downgrading and the diminution of management structure within the service. I thank the Minister of State for his attention and ask that if he cannot answer all my questions today, some of which I appreciate are fairly parochial, he do so at a later date. The people of south Tipperary are interested in having the best possible services irrespective of their geography. There should be equity and fairness in respect of mental health services, in particular given there are so many lands and properties within HSE ownership which the Minister of State agreed would be red circled for the future mental health needs of the people of south Tipperary.

Perhaps the Minister of State will explain the reason for the disconnect in respect of past decisions and announcements of which neither he nor the Minister were aware and how people within a regional structure can announce decisions to close services, announcements which came as an absolute surprise to everyone from the top of the structure down to the service user.