John Gilroy (Labour) | Oireachtas source

I was just thinking the same thing as I listened to Senator Barrett's generous comments. Perhaps I should tear up this script and make up something else.

I started to work as a psychiatric nurse in 1984, which was the year in which a policy document, Planning for the Future, was published with great fanfare. The main provision in the document was a proposal to close this country's old-style institutions. When I started working in Our Lady's Hospital in Cork, it housed over 1,000 patients. Senator Barrett used the word "incarceration", which is a good word because that is exactly what is involved. This country has been very good at locking people up in a range of institutions, including mental institutions. There seems to be something in our culture that means our first response is to remove a problem from before our very eyes in the hope that it will go away.

I am not criticising the Minister of State when I compare the position when the 1984 document was launched to the position that obtains today. I am very critical of mental health services but I hope nobody interprets that as a criticism of the Minister of State, who has been landed with an enormous legacy issue and is demonstrably interested in reform. It is a living scandal in our society that, as of 31 January last, some 394 people are still living in old-style institutions, many of which have been described by the independent group that monitors A Vision for Change as hardly fit for purpose. While there has been a great reduction in that number from the time I joined the mental health service as a young fellow, I think it is a scandal that almost 400 people are living in institutions in 2013.

A few years ago, I was involved in a literature review of international mental health policies that looked at the policies in the UK, France and many other countries. The review found that A Vision for Change stood out among all documents that had been published at that time. It must be supported because it is an excellent template for the provision of an integrated, world-class, modern, effective and humane mental health policy. This country is sometimes not very good at drawing up policies in this area and many other areas. We sometimes feel that if we feed in policy at the top, it will come out oven-ready at the bottom. We need to remember that it needs to be mediated at every level in between. I am glad that when A Vision for Change was published in 2006, an independent monitoring group was put in place in March of the same year to report on its implementation on an annual basis, or as close as possible to that, and ensure the policy is effective. A Vision for Change is not without its faults. In 2006, the independent monitoring group criticised the piecemeal and slow implementation rate. In 2012, it was equally critical of the inconsistent and slow implementation of the recommendations in the document.

We have concentrated on funding issues during this debate. I commend the Minister of State for protecting and increasing the funding that is spent on mental health last year and the previous year.

There have been some delays in recruitment but this is understandable because of the great difficulty in matching the service to the job and to the geography and the other matches that are required. We are well on the way to achieving the very ambitious targets and standards set by the Minister of State.

Strange to say, but funding issues are probably not the most important issues in the mental health service. There are cultural and structural issues to face before we can really make progress in delivering a proper mental health service. One aspect is the paternalistic approach of many senior clinicians in the service. Treatments are handed down from the top. Although the A Vision for Change strategy states that the treatment must be patient-centred, very often it is not. I know this is the case because I was a practising psychiatric nurse until two years ago when I came to this House and I have seen such treatment at first-hand. I am concerned that when community services are developed and institutions are closed there is a real danger that we might move the institutional mindset into the community and replicate the mindset of the institution in the community services. There is a danger that treatments and services are not patient-focused.

One of my bugbears is the post code lottery associated with mental health services and I hope the Minister of State will comment when she replies. It is the only part of the health service where a person's address determines the level of treatment in the public service. For instance, if I suffer from mental health difficulties in Glanmire, my catchment area is North Lee in Cork and if my clinician is an excellent clinician in North Lee then I am very fortunate. However, I will only be half happy and half lucky because my clinician also needs to be an excellent manager. If he fails to be an excellent manager I will not get the best treatment possible. This post code lottery is not acceptable. There is no way we can determine the locations of the good and bad practices - or the where the good practice is not - which may be a better way of saying it. If patients were allowed freedom of choice, very soon it would be obvious that the best clinicians and best service would attract the most patients.