Colm Burke (Fine Gael)

I welcome the Minister of State to the House and I am pleased that we have this opportunity to discuss this report and the wider issue of mental health services provision here. It is said that a society is judged by how it treats its most vulnerable members. This must be the guiding principle of our society and Government. This must be held most true when it comes to how we care for people suffering with mental health issues.

The original A Vision for Change document summarised the vision for mental health services in Ireland as follows: "Service providers should work in partnership with service users and their families, and facilitate recovery and reintegration through the provision of accessible, comprehensive and community-based mental health services." It also contained the following aspiration: "Each citizen should have access to local, specialised and comprehensive mental health service provision that is of the highest standard." These are most laudable and worthy goals, which we must realise for we have a special duty to those who require these services, a duty we must live up to.

This is the fifth annual report and its conclusions contain a mixture of welcome news and worrying updates. The openings of new adult child and adolescent mental health care facilities in Dublin, Cork and Galway must be welcomed as signs of real progress. Similarly, the closure and imminent closure of outdated facilities and services in Wexford, Dublin, Tipperary, Galway and Donegal as well as the partial closure of similar services in Kerry, Carlow and Kilkenny are further signs of the change in mental health treatment in this country with the move to more appropriate community-based services. Many of these services and facilities belonged to a past era and were wholly out of place in a modern, community-based, patient-focused mental health service.

While some of these developments were part of A Vision for Change, the impetus for some of them were caused by the conditions set by the Mental Health Commission, MHC, and for this reason it should be commended.

On the issue of financing, the previous Government must be credited with granting the metal health services with derogation from the budget cuts last year when it only reduced funding by 1.8%. A further issue on the financing of A Vision for Change is that, unfortunately, in a manner similar to the fair deal, it was to be based on property bubble expectations. A considerable proportion of the funding for reform and new developments and facilities was expected to come from the sale of land and buildings. While this may have appeared to be a sensible idea at the time, the collapse of the property market has disappointingly resulted in the projected amount of money not being realised. This is a very serious issue regarding the implementation of A Vision for Change and I ask the Minister of State to outline what provision is being made to ensure that the recommendations for the implementation of the original A Vision for Change will be properly financed.

I would also like to raise the recommendations this report makes on the structure of mental health services administration in this country. It repeats the assertion made in previous progress reports that there is an urgent need to establish a full directorate of mental health care services within the HSE, to which the Minister of State referred. Is there is a timescale for the formation of this structure? The absence of a directorate has led to the current state of affairs within the HSE vis-À-vis mental health services whereby there is no person or body with direct, sole responsibility for the implementation of the targets set out in A Vision for Change.The was covered in the Minister of State's script but it is important that the directorate would be set up at an early date. I hope that the directorate which will be established soon will be given the full range of powers and responsibilities recommended in this report. These are that it must have authority in the reconfiguration of existing services and the development of new mental health services in accordance with A Vision for Change, and it must have control of existing and new mental health care resources.

A further report with reference to the structural issues is the committee's recommendation that a specific mental health component be included in the special delivery unitestablished by the Minister for Health in the Department. Is it the Minister of State's intention to implement that recommendation?

I wish to deal with some points in the report that are a cause of some concern. My colleague, Senator MacSharry, referred to the issue of staffing levels. An exemption to the moratorium on public service recruitment was granted in respect of 100 psychiatric nurse positions but more than 1,000 nurses retired last year and a further 1,100 are due to retire this year. The progress report states that mental health care is experiencing a disproportionate decrease in the number of posts compared with other areas of the health service and this undermines the full implementation of the model of services described in A Vision for Change. I ask the Minister of State to outline what measures are being considered to address this issue. Previous annual progress reports have criticised a disappointing lack of progress in the specialist services of forensic mental health care, rehabilitation and recovery, eating disorders, psychiatry for older people, severe mental illness, substance abuse problems and intellectual disabilities. I hope the Minister of State addresses this worrying lack of progress at the earliest opportunity.

The original strategy envisioned in A Vision for Change involves 99 multi-disciplinary child and adult mental health service teams. Five years into the ten-year plan, the HSE reports that 61 teams are in place, comprising 56 community teams, two day hospital teams and three paediatric hospital liaison teams. Under the strategy, teams consist of a psychologist, social worker, nurse and occupational therapist under clinical direction of a child psychiatrist. Amnesty International Ireland director, Colm O'Gorman, recently stated that the staff levels on many of these teams is one third less than required for efficient operation. I ask the Minister of State to clarify the position.

The report also recommends that a legislative framework be considered to fully implement A Vision for Change. While I do not want to restrict the Minister of State's role in relation to reform and administration of mental health services, I ask whether such an initiative is under active consideration in her Department and if she is in favour of legislation.

As the report notes, there is now an urgent need for the Government to turn its attention to the services used by some of the most vulnerable people in society. I acknowledge the considerable progress that has been made but more is required. I wish the Minister of State well in her effort to meet the targets.

During my campaign for election to the Seanad, I learned about a team that was set up in County Leitrim to deal with families who are concerned about relatives at risk of suicide and depression. Three people are employed in an on-call service to meet those concerned. The service appears to be working well and perhaps the Minister of State could investigate whether it provides a model that could be implemented elsewhere. We are going through difficult times and we need to address the problem of suicide, just as a previous Government addressed the issue of road traffic accidents by putting in place a comprehensive education programme.