Jillian van Turnhout (Independent) | Oireachtas source

I welcome the Minister of State to the House and thank her for the constructive and open manner in which she always approaches debates on mental health issues. I have had many vibrant and robust discussions with her, both in this Chamber and at meetings of the Joint Committee on Health and Children. I am assured of her commitment as Minister of State with responsibility for mental health to delivering the comprehensive reform of mental health policy set out in A Vision for Change. At the same time, I thank my colleagues in Fianna Fáil for using their Private Members' time to raise these important issues for debate.

A key component of A Vision for Change is the move away from a dependency on inpatient care towards a focus on the provision of community care. That commitment is one of the main reasons I am a champion of A Vision for Change. In practice, it will amount to a significant and welcome realignment of perspective. Unfortunately, however, the evidence suggests that we have a long way to go to achieve it. The reality is that we have not developed community services to the extent that is necessary, particularly the child and adolescent mental health services, CAMHS, and the multidisciplinary approach encompassed in the provision of community teams.

The fifth annual CAMHS report that was launched by the Minister of State last week paints a worrying picture. While there are improvements in some areas, there are others requiring urgent attention. Only 66 of the 107 multidisciplinary CAMHS teams recommended in A Vision for Change are in place, with some of these only partially established. Seventy additional posts in CAMHS teams had been filled by the end of 2013 compared with the end of September 2012, which is very positive. However, looking at the whole-time equivalents figure of 531.76, we see that the total number of staff in place at the end of September 2013 was only 44.6% of what is recommended in A Vision for Change. My understanding from talking to people outside the child and adolescent mental health sector is that these shortfalls in service provision are replicated across the adult sector. Likewise, there is welcome progress in the indication that 50% of children and young people are now seen within one month of referral and 71% within three months. My job, however, is to focus on the 5% of children who waited between six months and a year to be seen and the 4% who waited more than a year for a first appointment. Adolescence is a critical time in a person's development. The reality that almost 10% of young people are waiting between six months and one year plus to avail of services is of huge concern.

I have received a considerable volume of correspondence concerning the decision to close the inpatient bed unit at St. Brigid's Hospital in Ballinasloe. I am sure the Minister of State has also received correspondence on the matter. One can feel the hurt, upset and distress people are experiencing because of these types of decisions. At the health committee yesterday we discussed the closure of Mount Carmel Hospital. The main issue here is the way in which decisions are communicated and how the transition is managed. People are chiefly concerned with their own situations, and we must find a better way of communicating with them. Grand schemes are great, but people need to have certainty in regard to their personal situations.

An issue of particular concern is the perception, which was all too prevalent in the past and persists to some degree even now, that inpatient care for people with mental health problems is an end destination - that once one goes in, one will never come out. That is not and should not be the case. Inpatient care is part of a continuum of care which people may or may not need to access, depending on their needs. Furthermore, it must be provided in an appropriate and timely manner. I am not sure, however, whether the Health Service Executive is always the best choice to facilitate that process. Perhaps we need to look to some of the private providers so that access in the timely manner that is required can be assured. There must be an examination of how the State accesses and provides that type of care.

Of course, we must also ensure that inpatient care is of the highest possible standard. To that end, all services in approved centres must comply with the regulations set out by the Mental Health Commission and accord with our international human rights treaty obligations. It is incumbent on Ireland to ratify the UN Convention on the Rights of Persons with Disabilities. All individuals, particularly children, have a right to a mental health service that is compliant with agreed standards. This means not putting children and adolescents into adult units, as we continue to do in this country. There were 102 children in adult units during 2012 and 68 from January to September 2013. We all agree that this practice must be eliminated, but it continues to happen.

The motion rightly highlights the difficulties encountered by people experiencing a mental health crisis in accessing services. This difficulty emerged as a paramount concern for people during Mental Health Reform's public consultation process in 2013. One individual who shared her story with Mental Health Reform has given me her consent to share it with colleagues. The name "Sandra" is a pseudonym but no other detail has been changed. Unfortunately, her story is one with which many people who experience a mental health crisis will identify. Sandra described as a "complete nightmare" the experience of having to seek help through a hospital emergency department. She spoke of waiting nearly five hours to be seen, during which time, as she observed, she or anybody in that situation could easily go off and harm themselves. According to Sandra, an accident and emergency doctor agreed that she was suicidal but informed her there were no beds. She was sent home with a promise that somebody from the emergency department would check in with her by telephone the following day and that the community mental health team would be informed of her situation. Neither of these actions was taken. Having arrived at the emergency department by ambulance, Sandra was asked to make her own way home after being discharged at 5 a.m., a distance of more than 14 miles.

I am sure the Minister of State agrees that this is an unacceptable state of affairs. Several contributions at Mental Health Reform's public meetings make it abundantly clear that for those experiencing a mental health crisis, the difficulties involved in going through emergency departments exacerbate their distress. It was pointed out during the public consultation that accident and emergency is one of the only services available to people with mental health difficulties outside normal working hours, even though it is neither a desirable nor appropriate forum for accessing support and advice.

I conclude by referring to the role of education in tackling mental health problems. The number of children and adolescents presenting with mental health difficulties, including alcohol and other substance misuse issues, is a cause for serious concern. We had a debate in this House yesterday on homophobia. The incidence of suicide, suicidal ideation and self-harm among LGBT young people points to the need for greater linkages between the education and health systems. Early intervention and prevention are essential.

Key to this is education at primary level rather than only at second level. Mental health needs to be part of the curriculum. We need to normalise and destigmatise mental health difficulties and distress. Teachers tell me they are not armed with the information they need to speak authoritatively about mental health, to spot the signs or to access the resources and services they need. If they believe a child is in crisis, they must watch while he or she waits three to six months to access services.

I wish to raise again with the Minister of State my concern that the child and adolescent mental health services was not transferred to the Child and Family Agency. I believe they should have been transferred to that agency and that such services are clearly the remit of the new agency. I am concerned and will remain so until it has been proven to me that the protocol for agreement between social workers and child and adolescent mental health services will work. They told us they had difficulties when they were all part of the HSE. They are now part of two agencies. Will children have access in a timely manner to the services they need? I believe we are on the right road but there is a long journey to go on this road of progressing mental health. The Minister of State knows I will not go away on this issue. We will meet one another regularly at meetings of the Joint Committee on Health and Children. We have to do more. Access to community services in a timely and appropriate manner in the context of the situation in which someone finds themselves is important. When a person is in distress and has mental health difficulties, three months is three months too long.