Deirdre Clune (Fine Gael)

I also welcome to the House the Minister of State with responsibility for mental health services and wish her well in the portfolio. It is a highly appropriate appointment. While we do not share a constituency, we are from adjacent constituencies and the Minister of State has had a long-held interest in, and has campaigned for, this area. I am sure she knew exactly what direction she wished to take before her appointment and I wish her well.

A Vision for Change sets out an overall blueprint on how services for those with mental illness can be appropriated. While it was published in 2006, it remains a highly important guiding tool as to how progress should be made in this regard. The issue of funding has been mentioned and progress in implementing A Vision for Change has not been as good as anyone would wish. I note the Minister of State acknowledged this point in her contribution. For example, in 2007 funding of €24 million that had been allocated to implement services pertaining to A Vision for Change was diverted elsewhere. The Minister of State is faced with the challenge of ensuring that funding allocated mostly through the HSE is appropriated and spent where intended. I welcome the programme for Government statement that funding will be allocated on an annual basis. A total of €35 million will be allocated annually for the development of community services, which are extremely important.

The entire thrust of A Vision for Change is to move away from establishments and from putting people away, as the term was, and towards a focus on developing services within the community, while retaining the support of hospitals. This involves a sea-change in organisation and money for its implementation. The development of community services is the key to achieving this goal. Such services should be provided for the service users, their families and carers and it will be very important to allocate funding for this area in particular, which I will support.

One has often heard of people being discharged from inpatient care into the community with no support. While they may have been in receipt of supported services for months, they suddenly are discharged into the community with no intervention and with no one to pick up the telephone to ascertain how they are or to ensure they have accommodation. Consequently, a range of services must be co-ordinated. Previous speakers referred to the importance of the role of local authorities in respect of people's housing needs. I have worked with groups locally in Cork to try to bridge the gap to ensure that housing strategies are being established in local authorities and that the housing needs of those individuals who will need support in the community are addressed. The original A Vision for Change estimate was that non-capital funding of €151 million would be needed but thus far, only €54 million has been allocated. In this context, I reiterate the identification of ring-fencing of money in the programme for Government, which is of great importance.

The multidisciplinary community medical teams comprise a major plank of the strategy and will identify areas such as adult needs, child and adolescent needs, psychiatry of old age, intellectual disabilities and forensic medical health services. The Government must ensure the provision of well co-ordinated and evidence-based treatment for individuals in need of those services. I wish to focus in particular on the child and adolescent services, which have been neglected, although I acknowledge the entire area of mental health has been neglected and has been described as the Cinderella of the health services. I hope this no longer will be the case, particularly when one notes the relative survival of the allocation for mental health services in the budget for 2011 and that this will continue in the future. Although there has been a history of provision of child and adolescent services, the focus has been on the lack of inpatient beds. The number of such beds now has increased substantially to 52 nationally, which is greatly to be welcomed. While it had been the case that no services were available outside the Dublin region, the recently-opened facility in Bessboro, Blackrock, Cork has 20 inpatient spaces and constitutes a highly important development.

Members will have heard accounts of children and young people being admitted to adult services. Although this practice is completely unsuitable, there probably was no alternative. I read a summary report yesterday on child and adolescent services produced by the child and adolescent mental health service, CAHMS, which produces an annual report and has produced two reports thus far. It provides an update on services in the area, waiting lists and the type of problems with which it deals. In 2009, there were 367 admissions of children to inpatient units, of which 212 were to adult facilities and 155 to child and adolescent units. It also is interesting to note the length of stay in the adult unit was much shorter than was the case in the child and adolescent centres, which may reflect the level of care. While I cannot be sure of that, it is an interesting statistic.

Many groups and organisations that work in the mental health sector have been mentioned and are supported by Members. All Members are well aware of them and encounter them in their work. In particular, I have had dealings with BodyWhys, an organisation established to help with eating disorders. This is a specific area in which no dedicated bed was available for children and adolescents until relatively recently. It has been very important and while an inpatient bed is not the solution to all problems, at some stage it becomes important and necessary. The subject of eating disorders is worthy of a major discussion on its own in respect of how the media affect it and on the importance of body image. While it obviously is more prevalent among girls, that is not to state it is absent among young males, as its incidence is increasing in that area. It is reckoned that of the child and adolescent admissions in 2008, 18% were related to eating disorders, such as anorexia, bulimia or binge eating and most of them occurred within the 15 to 40 age cohort for women.

An interesting statistic from the United Kingdom shows there has been an 80% increase in hospital admissions for eating disorders over the past decade. The problem has not gone away. I draw the attention of the Minister of State to the annual report of the monitoring group which emphasised the need to ensure that recovery becomes part of the ethos. Recovery was referred to in the Vision for Change document and yet it has not filtered through the system. It is clear that a recovery ethos and the principles and practicalities of recovery are not ingrained in the mental health services. The monitoring group wished to highlight this issue in its annual report. It stated that recovery is not part of the ethos of psychiatry nor of the Irish College of General Practitioners nor of the Irish Medical Organisation. Recovery should not just be about rehabilitation but also about confirming to the individual that he or she can get to a point where he or she can live a full and fruitful life. I thank the Minister of State for her attendance and for her contribution.