Kathleen Lynch (Cork North Central, Labour)

I welcome this opportunity to make a statement to the House on A Vision for Change. While I will read the official speech as there are details contained in it which the House needs to know, I hope the debate which will ensue will be more free-flowing.

In 2006, A Vision for Change was widely welcomed as a progressive, evidence based and realistic document which proposed a new model of service delivery which would be patient centred, flexible and community based. Although progress on implementation has been slower than expected, it is important to recognise and acknowledge that in many parts of the country, services are pressing ahead with developing new ways of working and initiatives to implement A Vision for Change.

Progress on implementation to date includes the following: a 17% decline in the number of patients resident in Irish psychiatric facilities since 2006; fewer admissions, including involuntary admissions to approved centres; the number of patients readmitted to hospital has shown a year-on-year reduction since 2001, and this reduction points to an improvement in community based services; the length of stay in approved centres has reduced, so that in 2010, 48% of patients were discharged within two weeks of admission; the child and adolescent mental health service has seen a very significant improvement, with 61 mental health teams now in place around the country; bed capacity for children and adolescents has increased from 12 beds in 2007 to 52, with further developments planned which will bring capacity to 66 by 2012; and the increase in bed capacity is reflected in a 37% decrease in admissions of children to adult units since 2008.

Despite the slowdown in the economy, work on the capital programme is continuing. Work on the Linn Dara child and adolescent mental health day facility in Cherry Orchard, Dublin is close to completion, acute admissions to St. Brendan's, Grangegorman have ceased and enabling works are under way on the development of a 54-bed replacement long-stay facility as part of the Grangegorman redevelopment project. In addition, an application for planning permission has been submitted for an acute inpatient psychiatric unit at Beaumont Hospital to replace the unit at St. Ita's, Portrane. The closure of the long-stay accommodation at St. Senan's, Wexford, will be completed during 2011-12, with the implementation of an approximately €16 million capital investment programme. A residential unit is under construction in Clonmel which will allow for the closure of St. Luke's Hospital and community services are being developed which will provide alternatives to inpatient admissions. A community nursing unit has opened in Ballinasloe and the long stay patients have been transferred there from St. Brigid's Hospital.

The active involvement of service users is one of the most significant reforms that have taken place in our mental health services in recent years. The establishment of the National Service Users Executive is one of the major success stories of A Vision for Change and service users are now actively engaged in the planning and development of services. Service users have a unique insight into the experience of mental illness and have a greater understanding of mental health and service needs and, therefore, have much to contribute. NSUE's 2010 second opinion report, "Always Look on the Bright side of Life", was published in January and the findings of the report provide real evidence that our services are improving and, importantly, that the recovery ethos underpins that service.

In recognition of improved services, NSUE awards were made to three services: Loughrea/Athenry community health services for best community mental health team; to Tara Suite mental health day centre, Dunshaughlin, for best day hospital/day centre; and to west Cork mental health services for most improved service. The results of the survey of service users show that services are improving in some areas and while there is scope for improvement, services are moving in the right direction.

The remit of the Office for Disability and Mental Health, established within the Department of Health in January 2008, includes bringing a new impetus to the implementation of A Vision for Change and to work in partnership with the HSE and other stakeholders, including other Departments, to drive implementation. The director of the office is a member of the senior officials group on social inclusion, which monitors progress on the Government's commitments on social policy. The Office for Disability and Mental Health is also participating in the development by the Department of the Environment, Community and Local Government of a housing strategy for people with disabilities which will have a particular emphasis on the housing needs of people with mental health difficulties.

Within the HSE, the assistant national director with responsibility for mental health ensures the delivery of mental health services in line with legislation and Government policy. Executive clinical directors have also been appointed to lead reform in catchment areas serving populations of 350,000 to 400,000, which is in line with the recommendations in A Vision for Change.

Implementing A Vision for Change will involve using our existing resources more efficiently and effectively. It will require the reallocation and remodelling of existing resources to move away from care in institutions to providing care in alternative settings or in the individual's home. The focal point of modern mental health services should be within a community setting and thus the further development of community based facilities is the priority. Almost 90% of mental health needs are dealt with at primary care level and this Government is committed to developing closer links between mental health services and primary care, which is a key recommendation in A Vision for Change.

Centres which house primary care and mental health professionals will provide the full range of care for individuals and will represent a significant step forward for service users and their families. Having community mental health teams collocated with primary care teams will also help to build and cement closer relationships which will benefit service users and their families, carers and professionals alike.

Budget 2011 gave special consideration to the mental health sector through a reduction of 1.8% in the allocation of funding for this sector. An additional €1 million in 2011 was approved for the HSE's national office for suicide prevention. This funding will enable the office to build on initiatives to date and bring added momentum and new impetus to its activities to address the increasing incidence of deaths by suicide.

We must change our attitudes and our thinking about mental health; we need to create an environment that recognises and treats people with mental health problems similarly to other health needs. We must put out the message that it is okay not to be okay. It is only by openly speaking about mental health that we will change attitudes and normalise mental illness. In light of this, as part of See Change, the national stigma reduction campaign, I was pleased to launch the Make a Ripple campaign, which aims to recruit a dedicated online community of ambassadors, advocates, story tellers and volunteers who can help to push the campaign's objectives and messages on to the national agenda. I hope this campaign will contribute to eliminating the stigma so often associated with mental illness.

Looking to the future, I assure the House that my priority as Minister for State with responsibility for mental health will be to further advance the implementation of A Vision for Change. I am aware that annual reports of the independent monitoring group for A Vision for Change have highlighted concerns with the absence of a detailed, timelined and costed implementation plan and with the lack of effective leadership within the HSE to implement its recommendations. I have therefore asked the HSE to prepare an implementation plan which will identify specific recommendations of A Vision for Change to be progressed over the next three years, with timelines, detailed costs and persons responsible for implementation.

I am also in discussions with my officials with a view to establishing a directorate within the HSE to drive implementation and I hope to be in a position to make a decision on this over the coming months. I assure the House that this Government is committed to reforming our mental health care services and the implementation of A Vision for Change. This commitment was clearly shown in the programme for Government which provides that €35 million will be ring-fenced annually in future budgets to develop community mental health care services and to ensure early access to more appropriate services for adults and children.

I look forward to listening to the contributions from Senators. While we have A Vision for Change as a template, there are times when we need flexibility in service delivery. As I read more about this area, I realise how little we know about it.