Kathleen Lynch (Cork North Central, Labour)

It is good to see we can still have a bit of banter. I thank all the Senators who contributed. This was the sort of debate I hoped we would have, with individual issues raised but it was on the generalisation of mental ill health and how we deal with it.

After listening to Senator Norris's contribution, I am reminded of Ivor Brown's paper on the great illusion, which asked if it is an illness at all. We could go along with the theory that illnesses are usually caused by probably something germ related when we look at it. I am not certain that we know everything about this issue, and I am sure we will continue to learn and to see it develop.

Senator Gilroy asked about ECT and I am aware of it. Senator Norris mentioned the Bill introduced by the Green Party and Independents and it was agreed by everyone, including me, that forced ECT would no longer be part of what we offered and that will be put into legislation. That is all I can say about that now. We were all agreed that forced ECT was not the way to go.

Senator O'Brien mentioned the unit in St. Ita's. It had conditions attached to it by the Mental Health Commission, which asked that it would be closed by 31 August. It was also recommended a different part of the building be refurbished to provide a service until the Beaumont unit came on stream. That did not happen but the HSE assures me that access to appropriate acute mental health services will be in place until the Beaumont unit comes on stream. We can talk about that later. I am also told the unit in Beaumont will take approximately 12 months so that might be the gap.

I do not have the information Senator Crown requested but I am told we made a submission to the World Health Organisation recently where all the statistical data were put in and the WHO will come back to us. That will give us a huge amount of comparative information that we need to take seriously. Senator Cullinane raised the issue of an all-Ireland approach. We have an all-Ireland approach on suicide and training registration for self-harm. That cooperation is going on all the time.

What can I say about the Brothers of Charity services in Clare? They are excellent. I know the organisation and it is incredible with a different way of doing things, a different way of thinking and a different approach to what we should do across all of the services. I am surprised to hear there is a difficulty on the rental issue because we have a housing statement that has gone to Government and is now in the wider community. It is clearly directed towards dealing with people in the community who have mental health problems. I include in that, people with disabilities who have mental health difficulties because they do not live in a separate space from the rest of us. They equally have issues that must be dealt with. I will take that up with the Minister of State at the Department of Environment, Community and Local Government.

No health structure can ever be based on the vagaries of the property market; to do that is to build a house on sand. To depend on how much money is in the country and how foolish people are, does not provide a proper structure and it will not work. If there is a bubble, there will be enormous amounts of money we might not have the capacity to put into the system and, when the bubble bursts, we will be left with a system that has capacity but no money. We cannot operate like that; it must be a steady, well thought out, planned approach. I hope that is what we have now, coming down from the heady days when we had more money than capacity. I hope that is where that will go.

Fear is as big an issue as stigma and maybe it is bigger. Fear brings about the stigma. Fear of poor mental health is probably what gives it the stigma. We are all conscious that we are vulnerable to poor mental health. We could all end up in that position. It is the fear of it that keeps us at arm's length and makes us worry about people in those circumstances.

We have a big issue with staff. In nursing for mental health there is an older age profile who can retire at a younger age. That leads to problems. Our problems will be compounded next year. Senator Mullins said that next year we have the possibility of 1,200 people who could retire if they wanted. I have no doubt that they will retire because it is a difficult job. If all of those who can retire next year do retire, we have a big problem but it is solvable. I pay tribute to Mr. John Maloney and his efforts on A Vision for Change; circumstances overtook him but that does not take away from his commitment or the great things he did. He got a breach in the moratorium last year and gave us an additional 100 nurses. There was another breach this year that gave us another 100 nurses. That will not be enough in the years to come. We will need additional posts. I am reluctant to say it but I need to say it; to a great extent in the circumstances in which we find ourselves in the next few years, if we can get the breach and the 300 additional posts per year, maybe people coming from a different sector of the service might not be a bad thing because we need a different skill mix if we are to go into the community. We must be able to provide within the community people who probably come from a different culture, and I say that with all due respect, because we must deliver a different type of service in the community. It is good that we are cutting down on admissions and the length of people's hospital stays, but we must consider the fact that we will always need acute beds. The flexibility provided by A Vision for Change is important. I am uncertain as to whether we know the exact number of acute beds we will need or by how much that number will change.

We all know the funding situation. I will not trot out the usual comments about where the country is, but we are definitely not as flush as we used to be. We will need to do things differently, but this does not mean that we will not be able to provide a better level of care in the main. We can do this by changing how we do things, including our skill mix, and by providing services in different areas.