Susan O'Keeffe (Labour) | Oireachtas source

I move:

That Seanad Éireann:- notes the Government's commitment to invest €20 million in community-based, patient-centred mental health services in Budget 2014;
- welcomes the appointment of the new Mental Health Services Director;
- notes that the total commitment of this Government to mental health is €90 million to the end of 2014;
- notes the recent publication of the Assisted Decision-Making (Capacity) Bill 2013 to replace the Lunacy Regulation (Ireland) Act 1871;
- notes the changed awareness among the public about mental health and the greater openness around mental health;
- notes the increased demand for services in the past five years;
- notes the global research in relation to the predicted rise in dementia and Irish figures showing a predicted rise to 140,000 sufferers in the next thirty years;
- notes that research shows that, in line with international studies, an estimated 14% of the population has mental distress;
- notes that the Government's agreed mental health policy “A Vision for Change” supports community-based services which are managed and targeted at specific groups; andasks the Government to ensure that:- the community will remain central to the provision of mental health services into the future;
- the staffing levels will continue to be increased, especially in relation to suicide prevention;
- services for children and adolescents (CAMHS) be strengthened and accelerated; and
- the community-based teams will be strengthened to ensure the delivery of targeted services.

I welcome the Minister of State to the House. We are here to take stock of the progress that has been made in mental health and to urge the Government to continue the commitment to the very serious challenges facing those with mental health problems and those responsible for the delivery of mental health care. I know the Minister of State has a personal commitment to this, which is welcome and vital, but it is impossible for her to drive it forward all by herself. The building and strengthening of commitment across the HSE is crucial to the future success of mental health care in this country but we are lucky to have an advocate like the Minister of State leading that charge.

We have moved a long way from institutional care as the default position for those with mental health problems and issues. A Vision for Change set out a very clear person-centred treatment approach with an integrated care plan literally looking after each person as an individual. That is hardly rocket science as this is exactly what we provide for people with physical illnesses. A Vision for Change remains an important shift in culture and attitudes towards people with mental health issues - a shift which had to be urged on and compressed in time as we become increasingly aware of our responsibilities to those with mental health issues. It is a shift in attitude which the health services above all must accept and implement. Statistics show the mountain that we must climb. One in three people visiting a family doctor has a mental health aspect to their medical problem. Of those who live to 65, one in nine will spend some time in mental health care. Another way of putting it is that 14% of the population has some kind of mental health issue or that 43% of young adults said they had contemplated suicide at some point with 7% having made an attempt on their lives at some point.

There are many ways to provide statistics and increased statistical research is vital for the Minister of State's planning, the delivery of services and budgeting. I am sure that over the years, the Minister of State has seen many pieces of research and many statistics but the important thing is that our friends, neighbours and family are suffering from mental health issues and it is up to us to respond to that. I wonder if the numbers are rising as we become more open about mental health and more people feel able to seek help. Will we see a bulge? There are statistics showing calls to various helplines and mental health charities would all record some surge in people coming forward. I wonder if this is in part due to that. Perhaps that will settle at some point. I am not sure. It is up to all of us to own mental health, to be responsible, to talk and be open about it, to support those who have issues and problems and who are ill and to reduce the stigma and discrimination that have accompanied it. I know the Sea Change programme, which is now in its third year, is continuing that work at a local level. It encourages people to tell their own stories and trains people and organisations to understand at a very local and personal level and to be more aware of our mental health.

The removal of institutional care and its replacement is a huge gear change in management, work, attitude and cost. It is, of course, a cost to recruit new posts, train those already there, provide new services, tailor existing ones and step up care for those at risk of suicide. We welcome the Government commitment of €35 million in the 2012 budget, a further €35 million in 2013 and €20 million in Budget 2014. That is a total of €90 million that is ring fenced to modernise mental health services and, in particular, to strengthen community teams which deliver those services.

There has been much public debate about the speed of recruitment to the posts in question. That has caused an issue but we must always step back at this time and say that finding hundreds of people with the right mix of experience, skills and availability is never an easy task. However, I am grateful for the Minister of State's reassurance that substantial progress has now been made in recruitment for these posts. I see figures that show that the recruitment process is well on the way with 93% of the 414 posts that were approved in 2012 in place. That is evidence of the hard work that has been done. I trust that the HSE's national recruitment service will continue to prioritise these appointments as this is the best way to bring about the changes demanded by A Vision for Change and other research.

Senator Moran, who will be seconding this motion, will address child and adolescent mental health services. One of the basic headlines there is the urgent need for children and young people not to be in adult units. Again, there has been progress in that area but I see that some children are still in adult units and I know that is something none of us would wish to see continuing.

Primary care has received an allocation of €7.5 million for counselling for people with mild to moderate psychological difficulties. Again, this is a very practical approach. There are ten councillor co-ordinators and I know the Minister of State and the Minister of State with responsibility for primary care, Deputy White, helped to launch this initiative earlier this year. This is a very practical way of listening to people on the ground and asking what will work and how we can help. These are the kind of services that often do not get talked about and it is opportunities like these that allow us to praise that work because it is appropriate.

Many of us here in the Seanad and many of our colleagues in the Dáil have discussed and debated suicide, bullying and cyberbullying so I welcome the recent decision by the Minister for Communications, Energy and Natural Resources to launch the Internet Content Governance Advisory Group, which is the first such body specifically tackling the bullying of young people on-line and looking at content and how we safeguard it. The Minister for Education and Skills often spoken about bullying. I know that the guidelines for mental health promotion and suicide prevention were launched with the Minister of State earlier this year and there is a new action plan on bullying. An anti-bullying forum centred around homophobic bullying was launched with the Minister of State and the Minister for Education and Skills.

Much work has been done involving small pieces of work which themselves are very significant and practical. The National Office for Suicide Prevention continues with its various campaigns, some of which we have seen on television such as Let Someone Know, which is aimed at younger people aged under 18, and Please Talk, which is aimed at third-level colleges. Again, these are the kind of practical things that people say they never hear being done. Well they are being done, which is welcome. The National Office for Suicide Prevention supports many local organisations such as Pieta House, the Samaritans, SpunOut, SOS and Inspire Ireland - organisations that are dedicated in this area.

A local organisation, talkaboutit.ie, is active in Mayo and Sligo. During the summer, representatives of that organisation took spaces at local festivals, among cattle, sheep, baking and flower arranging. Their presence is a testament to the new attitude that our mental health is nothing to be afraid of, that it is certainly nothing to hide, and that it can take its place along with all other activities and become much more normal. I pay credit to those sitting in tents for long hours waiting to talk to people and being there to remind us of the importance of our mental health.

We know young people are vulnerable. We need to prioritise them and encourage them to be open about their mental health. I pay tribute to the work of Comhairle na nÓg. Many of its groups have done very good practical work in individual schools with their peers, raising awareness, discussing mental health and producing brochures and videos. Again, this is small work but well placed. The young people doing that work are valued. Perhaps they are sometimes overlooked when we talk about the amazing amount of work that volunteers do.

The Minister of State was in the House for the debate on a previous Private Members' motion I tabled on a national strategy on Alzheimer's disease. As she knows, 42,000 people have dementia and the number of sufferers is predicted to rise to 140,000 in the next 30 years. I know she is in the consultation phase of the new programme for dementia and I look forward to that being published in the coming months. The World Health Organization recently published a document calling on countries around the world to treat Alzheimer's disease as a public health priority. Clearly, dementia patients have a very specific need. There is considerable research into preventing dementia or finding appropriate treatment for dementia. As the world's population ages - at least in the wealthy world - it brings the burden of this illness with it. Regardless of how we legislate, as a society we must come to terms with these figures and calculate how we will pay for them because we and our children will be such sufferers in due course. Irrespective of how good it might be, no strategy can possibly address that particular aspect. Debate and conversation at this and at every other level will be vital in changing the kind of cultural prejudice and ignorance of those with a mental illness that existed and still exists to some extent. We need to shake that off if we are to address those figures and try to do something about it.

I welcome the Assisted Decision-Making (Capacity) Bill, which started its journey in the Dáil yesterday. It will provide a statutory framework to support decision-making by adults who find it difficult to make decisions without assistance. How wonderful it is to be repealing Acts from the 19th century that use the language of lunatics and that in their very concept separated and, in effect, locked away those with mental illness. Safeguarding the autonomy and dignity of those with impaired capacity is welcome. I trust there will be a very robust and worthwhile debate on that legislation when it reaches the Seanad.

I know the Minister of State is looking forward to completing the review on the reform of the Mental Health Act 2001, a commitment given in the programme for Government. People often say we do not keep promises. However, the expert group has met on ten occasions and the heads of the Bill are being prepared. I am sure we will also have robust debate on that. That is a welcome reform and we are pleased with the progress on it.

The community of people working in the area of mental health - carers, nurses, doctors, policymakers, volunteers and patients - need a firm reassurance from the Minister of State and Government that the issue of mental health has turned a corner. We still have problems and hurdles, and people are still waiting for treatment or may not be getting the right treatment. That does not mean we are not making progress. This community needs reassurance that the direction the Government is taking of patient-centred, community-based care delivered by well-trained teams is the way of the future and of the present.

There is no turning back. Budgets will continue to be spent where they need to be spent, recruitment will continue to be a priority, the changes that have been hard won will be appreciated and built on, and the momentum kept up. It is a difficult task made more difficult by the difficult times in which we find ourselves. It will require perseverance and patience but our nation's health is at stake. Ultimately, we are all responsible for that.