John Moloney (Laois-Offaly, Fianna Fail)

When I was notified about this debate, I thought it would be an ideal opportunity for Opposition Senators to criticise Government policy and I am so pleased to be able to say not one Senator has used this debate as a political outing. It is right for me to acknowledge that underlying the comments of all Senators has been their proper concern about where we go from here in terms of funding. Wearing my Minister of State hat, it is important for me to be loyal to the commitments made in A Vision for Change, but I will not use this occasion to dress things up as though I were not a member of the Fianna Fáil Parliamentary Party. I say this in the context of the difficulties we face as we move towards the budget.

In the past two years, during which time I have often been in the House or before the Joint Committee on Health and Children, people have been asking whether we will stick to the commitments made in A Vision for Change. Given the fact that four years of this ten-year programme have elapsed, issues have cropped up which must to be responded to. I do not have enough time to address all of them, although I will try my best, and ask to be invited back to the House to deal with any issues I do not have time to speak about today.

Senator Fitzgerald asked whether we would be able to fund the commitments made and properly referred to a person for whom I have a lot of time, Mr. Martin Rogan, assistant national director of mental health at the HSE. At a recent meeting I attended he posed a similar question: can we talk about providing services that we do not have the financial wherewithal to fund? That is the key question. In view of the reduction in the budget of the Department of Health and Children by €1 billion and the proposals we have made to the Government in the past two years which have culminated in this important budget, we will need to - to use a swanky word - reconfigure the spending of the Department on mental health services.

Senator Prendergast asked many questions which I will not be able to answer now, but I will respond directly to her on each one within the next two weeks. I recognise her ongoing concerns and will try to show her that A Vision for Change is based on a concept of delivering mental health support that is not confined to counties but makes use of catchment areas. I have failed to get this message across. A commitment was made that the proceeds of the sale of institutional properties would be ring-fenced for mental health services. The expenditure of the €50 million promised in the last budget was dependent on the sale of properties. Let us be open about these matters. We did not have €50 million because we did not sell €50 million worth of properties. We have spent €15 million so far and received money from the capital budget of the HSE to fund the items I mentioned. I mention this not because I am trying to fly a flag, saying "We are great because we have done this." We have done only what we were asked to do in A Vision for Change and part of this has been the closure of the old hospitals.

Many Senators spoke about the media. I will not go down that road except to say this. I do not believe for one minute that the media should pretend things are happening if they are not, nor should we expect them to. However, there are people who are dependent on the media for their education on what is happening in the area of mental health. As no one asked this question and it will not be taken up by anybody, I am really talking to myself on it. When I embarked on the See Change campaign, I was depending on the media becoming interested, but this has not happened. Members of the media did not attend the opening in the Mansion House or any of the subsequent events. I do not mind this. I attended an event in Donegal two weeks ago as part of the campaign. It was well attended and people spoke from the floor, as did Senators this afternoon, about the need to ensure funding was made available. If we do not do this, people will say it has all been a pretence. On my way home the next morning I bought The Irish Times and was disappointed, although not on a personal level, to see that the editorial referred to the See Change campaign as an overly cynical attempt to pretend we were doing something. That is a sad reaction. I would have preferred if The Irish Times, with others in the media who might have had doubts about what we were doing and our sincerity - not our personal sincerity but that of the Department - had tried to find out before they wrote such columns whether it was a pretence. The evidence was available. I received thank you cards from the organisers and those who had attended which mentioned the benefit to be gained. The See Change campaign involves visits to every county.

Some days later I did an interview with the Irish Independent - I am loath to mention the journalist, as journalists do not like to be mentioned specifically. Rather than drawing down the wrath of the media once again, I gave an interview. The journalist concerned had the idea that when I spoke about capital programmes I was talking through my hat. I explained the six capital programmes that were under way, including the closing of the hospitals referred to in the inspector's report. However, the sad reality, after I had waited the next day for a hopeful breakthrough in the media which would succeed in conveying to the public that we were going about our business, was that the commentary took the form of a message to patients at these mental hospitals that their stay would be for much longer than they had supposed. I was so disappointed to see that response because I had tried to give hope to them.

The issue of child and adolescent mental health issues was raised by many Senators. Yesterday when I met Deputy Neville and his colleagues from the Irish Association of Suicidology, I asked them what they would do and what they would like to see. I said we could not tackle the issue by way of a quick knee-jerk response to get headlines and asked them the way forward in terms of a proper strategy on mental health. They told me the most important issue was that of mental health support for children and adolescents. I concur. I accept the point made by Senator Ó Brolcháin about Jigsaw. I have been to Galway and seen it. I proposed to the Government that we should fund at least five such projects a year until we had one in each county because that is the way forward. Jigsaw and Headstrong also receive financial support from international sources; however, more important, all outputs are independently assessed.

We do not make a song and dance about the fact that we now have 52 beds in the child and adolescent mental health services, with a commitment to provide 100 beds. The real challenge is not turning sods or achieving media exposure but ensuring we have appropriate community mental health teams available. Early intervention is important. Senator Corrigan advised me that people were presenting with depressive illnesses at much younger ages, including five, six and seven years. It is clear the focus must be placed on this aspect. When a person such as Dr. Tony Bates advises me that 70% of mental health supports should be provided during the child and adolescent years, it is clear that this must be the focus of the reconfiguration of funding.

All Senators mentioned suicide prevention. Of course, Opposition Senators and colleagues in my own party wonder out loud whether we can deliver on the commitments made in A Vision for Change. I have always said the cosy way out of this is to park A Vision for Change, wait until the recession passes and deal with it then, but we are not doing this. We are giving clear and specific commitments to close the old hospitals and drive the development of community supports.

I have been reminded by my officials, whom I thank as they are, as usual, on the ball, that the expected income from the sale of properties is €13 million. At the end of this year we will need to tackle the capital programme for next year.

I ask the Cathaoirleach to invite me back to talk about specific issues raised by Senators.

Clearly we need to clarify publicly the funding in mental health services and how much it will cost to fund A Vision for Change. Our objective is combining the budget for mental health services using the strategic funding for suicide prevention and more importantly changing public attitudes towards mental health. As Senator Ó Brolcháin said, this is not a party political proposal. A Vision for Change is supported across the board by politicians and more importantly by the service users and clinical experts. Regardless of who is in power we need to drive on this change.

Many people are disappointed that 5.5% of the total budget goes to mental health. I will not ride two horses because one will always fall off two horses; there is no point in me coming to the Seanad and saying what Members want to hear. Of course we all want to see an increase in mental health funding. As we debate the challenge for funding in the cancer programme and other programmes, our argument must be that given the enormous demands placed on us by our commitments in A Vision for Change, of course we must fund it. Although we are talking about funding from, unfortunately, a decreasing pot, nevertheless we have the ability to provide funding through the sale of properties. There are some substantial resources invested in mental health and these can be moved from the old institutions to the community.

In referring to the new thinking in the Department, I thank the officials. Ministers get great credit when something goes right, but it is the officials who advised me about the setting up of specific ring-fenced funding to bring about immediate change. I am talking about the change in bringing people from institutionalised care into the community, which is working well. It is up to us to try to tap into resources in order to continue that funding and I thank the co-funders of that.

I wish to bring a message of hope by saying that at the end of the year we will make our proposal on how the funding on mental health will be spent. Of course I use the term "I hope" in talking about increased funding. I do not seek to try to separate me from my senior Minister - the pressure must go on her and the Government to provide that funding. It is up to me to make my case within this area on how this budget in health should be spent. Over the past two years I have listened to many people who advised me about the changes that should be made to do that. Next week the Minister, Deputy Harney, who has a significant interest in suicide prevention, has invited Geoff Day and me to talk about what we can do to effect change in that area. I take the points made by Senators Buttimer and Bradford; the fact that in excess of 500 deaths by suicide were recorded last year indicates that we need to prioritise mental health within the funding available.

Senator Mullen raised the issue about the media, which I have addressed. I accept I have given little response to the issues Senator Prendergast raised. I have clarified that the funding is ring-fenced as has been proved by what has been spent this year. That commitment was made in the Budget Statement by the Minister for Finance, Deputy Brian Lenihan, last year. I cannot give the Senator a response on the three wards in St. Luke's or give details on the funding there. However, we asked Dr. Hillery to engage with the staff in the hospital. The day I went there to meet the Senator and other public representatives from the area, I acknowledged that the service providers not being aware of proposals in advance is not the way to do business. I am trying to rectify that which is why I asked Dr. Hillery to engage there in order to ensure this was not an attempt to disregard the demands in south Tipperary. Those were very specific questions the Senator asked and I will arrange to meet her in the next fortnight to give her a clear briefing on those issues.

I fully support the concept of Jigsaw. Senator Ó Brolcháin and others referred to eating disorders. The Marino clinic is also taking referrals from the HSE. I have never come across so many issues pertaining to eating disorders as I have in the past year. It was something foreign to me and I was not aware of it. I recently meet Deputy McEntee and the Minister of State, Deputy Áine Brady, to discuss the enormous demand on services to address this new phenomenon, if I might call it that. I travelled to the UK to ascertain what its service providers were doing to encourage young people with eating disorders to engage with services. I was impressed by what I saw there whereby people are provided with support in a clinical setting while at the same time they have the educational facilities on campus also. In this area we are totally exposed by the lack of public beds to deal with eating disorders. The enormous costs of accessing services in that area are beyond most families' reach. In prioritising we need to recognise that we have to make changes in that area.

Senator Corrigan has often referred to the need to prioritise the needs of children and adolescents. I wish I could say that all her requests would be addressed, but they will not be. My strategy will be to retain the budget I had for last year and there will be changes in how the money is spent. It is important for people to point out to me the areas that have come under the most pressure in order that we can respond to that. Regarding the suicide prevention budget, I have met representatives of many groups in recent months who tell me that it is time to bring people together, spend money more strategically and set targets, similar to the model in Scotland.

I thank the Acting Chairman for allowing me to go over my time. I acknowledge I have left many questions unanswered and I would like the opportunity to come back in the new session to outline specifically the cost of A Vision for Change, what has been spent so far, what remains to be spent and more importantly whether we can deliver on A Vision for Change.

I forgot to answer one very important question on the effect of the moratorium on mental health services. We have been somewhat successful this year in getting from the employment control programme 100 nurses to deliver the service in Blanchardstown. It is not blocked or closed down on the mental health side. I have acknowledged the six capital projects that are in process. They are directly linked to the inspector's report on the conditions of mental hospitals. The message needs to go out that we have funded the closure of Grangegorman - for the first time since 1815 there have been no referrals. We now have a modern facility in Blanchardstown. Deputy Reilly has often quite properly asked me in the Dáil about the plans for the new acute psychiatric unit in Beaumont to allow the closure the facility in Portrane. The funding is available and the project will begin in February 2011. Senator Prendergast has acknowledged what we are doing regarding nursing in Clonmel. Six months ago we turned the sod for a new 600-bed unit in Mullingar, which will allow us to close those awful wards in St. Loman's. I am happy to say that the acute psychiatric unit in Letterkenny is near completion and will open this year. There are new beds in Cherry Orchard, Galway and Cork for children and adolescents.

I again thank the Acting Chairman for allowing me to go over my time.