John Gilroy (Labour)

I am happy to welcome the Minister of State to the Chamber again. I will make a point about suicide, although I do not intend to speak about the issue as it relates to A Vision for Change. It must be acknowledged that over 1,000 people have died by suicide in the past two years. Every party represented in the Chamber should consider this figure and we should have a debate devoted to the topic. Mental health services are in tatters. Not alone do such services not respond to suicide in communities, but in a great number of cases they are not even aware suicides occur. I have been a health service professional for a long time and I am very aware of this issue.

I am very happy to have an opportunity to speak to A Vision for Change. For too long the mental health service has been seen as the poor cousin in the health service and during the years the level of investment in the service has been little short of scandalous. In 1984 I started my career working with the service in Cork. When one becomes part of a system, it is sometimes difficult to see what is wrong with it. At the time there were over 1,000 patients hospital and conditions, owing to historic under-investment and wider societal views towards persons with a mental illness, were not good. Overcrowding, poorly maintained buildings and unstructured days for patients were the most serious problems. Nevertheless, the staff with whom I worked were probably the most decent people I had ever come across. They struggled daily in very poor conditions to ensure the dignity of patients received the highest priority. I learned many lessons in that old institution, the most important being decency is the most vital element.

In 1984 an important policy document, Planning for the Future, was published. It was one of the first major documents to be published. It was heralded at the time as the greatest show in town. It is unfortunate, therefore, that 27 years later, all of its recommendations have yet to be implemented. The lack of political will and investment ensured they were implemented in piecemeal fashion. Most of the institutions are now closed and good riddance to them. However, promised community developments have not taken place. It is scarcely believable that some persons in long-term care are living in institutions 27 years after the publication of a report committed to the closure of institutions and developing community services.

Some years ago I had the opportunity to be involved in an international literature review of mental health policy documents. We considered a range of policies in many countries and among the many examined we found that the national framework for mental health services in the United Kingdom offered a very good model for service delivery. I can honestly say the policy framework of A Vision for Change has no peer across Europe or the world. What particularly impresses me about it are the comprehensive views offered about the potential to create a world-class model in this country. The Minister of State, Deputy Kathleen Lynch, is driving change in this area and the prospects for delivering such a model are very bright. The creation of a directorate for mental health, as announced by her, is an excellent start, on which she should be commended.

A statement in A Vision for Change reads, "The vision that guides this policy requires mental health services to be characterised by a partnership between stakeholders". This is an ambitious statement of intent and requires a complete cultural shift in how we deliver our services. These services were and still are characterised by a paternalistic approach whereby health care professionals are seen to deliver health care to service users.

The media reported today on the case of a 40 year old man who is an involuntary patient at Naas General Hospital. His family is seeking to stop the mental health services from administering electroconvulsive therapy, ECT, to him against his will. While I fully understand the complexities surrounding this area, it is an indictment on our society that such cases have to be taken. In any other branch of medicine, or indeed life, a major invasive procedure would not be sanctioned by law. The law in this instance is section 59(1)(b) of the Mental Health Act 2001, which provides that ECT can be administered if two consultants form the opinion that it is necessary. Court orders are required in every other branch of medicine before decisions on issues of this import can be made. The Minister of State said that the health service should be seamless and that the rights of patients in one branch of medicine should be the same as the rights of patients in another branch of medicine. The case I have mentioned shows that the mental health services have a long way to go in this regard.

In addition to the need to make a cultural shift, the other challenge we face as we try to implement A Vision for Change relates to costs. The degree of change that is envisaged would involve significant investment. It is clear that adequate budgetary plans should run parallel with policy changes. I am worried about that in this instance. The challenging financial situation we face does not bode well for these changes.

I understand that the moneys to be raised through land sales will be ring-fenced for investment in mental health services. Can any of us really say, hand on heart, that we realistically believe much money will be realised from this source in the current economic climate? The Government should front-load these costs and recoup its investment at a later date when land sales are achieved.

In tandem with policy changes in mental health services, we must also effect policy change in other areas. There is no doubt that poverty and social exclusion are related to mental ill health, although the exact pathway remains unclear. We know that 70% of users of mental health services depend on welfare payments. Obviously, our policy needs to recognise this.

I know from working in the area that access to housing is an important element in the recovery and maintenance of good health. When people are discharged from hospital without having anywhere to go, it poses a significant obstacle to allowing them to return to their communities, where they want to live in quality housing. We must build partnerships between the mental health services and the local authorities in this area.

Education policy is vital. The education system has to recognise its important role in this regard. Stigma reduction measures should be included in any education policy. I recognise the importance of A Vision for Change and the Minister of State's undoubted commitment to it. We also need to recognise that policy changes in other areas are needed before we can deliver the exciting prospects that are outlined in A Vision for Change.