Rónán Mullen (Independent)

Cuirim fáilte roimh an Aire Stait. I am especially pleased the Minister of State, Deputy Moloney, is here given the topic I have raised relates to mental health. This matter relates to the need to confirm that the mental health budget will be spared in the proposed cuts to the health budget and, in particular, that the specialist rehabilitation teams envisaged under A Vision for Change and constructed thereunder to look after the most vulnerable patients with severe mental illness will not be disbanded or disturbed in their work.

I am aware of and welcome the various commitments made in the budget for mental health care and services. It appears senior HSE mental health managers considered subsuming rehabilitation and recovery teams into other general mental health teams. This would eliminate the rehab service and redistribute its resources to these teams. The teams in question were originally established under A Vision for Change to specialise in and care for those with severe and enduring mental illnesses such as schizophrenia and bipolar disorders. They aim to provide multidisciplinary care for such patients in adherence to the recovery model which has been constructed on the belief people with such severe illnesses can, despite symptoms and disability, live meaningful and fulfilling lives in settings with support levels to match their needs.

Patients are referred from their general teams when their resources are unable to cope with the severity of the patient's illness or deficits in functioning. There are approximately 20 mental health rehab teams nationally, many of which are poorly resourced to perform their functions under A Vision for Change. It has been reported some consultants have no administrative support, do their own typing and do not have the skills mix on their teams which even the referring teams have. For example, occupational therapists have a key role to play in such teams, but not all have them. Many of the rehab teams have never been allowed to function to the optimum.

An outreach service is an essential component of rehab teams, but only two teams nationally have been resourced to construct such a service, whereby people with such severe illnesses can be looked after as far as possible in their own homes. A guiding principle of rehab services is that people should be able to access care where they are. The people concerned, because of their illness, are often the most unwell, most deprived and least able to argue or advocate for themselves. It is incumbent on us, therefore, to prioritise their needs. Their care has improved under rehab teams which can devote more time to them because they have smaller caseloads. This is the care those who have endured years of illness, stigma and marginalisation deserve. Any suggestion mental health rehab teams should be eliminated must be opposed if we are to consider ourselves a decent and civilised society.