John Gilroy (Labour) | Oireachtas source

I welcome the Minister of State to the House. The Minister of State and Members of the House will be aware, because I have said it often enough, that one of the reasons I entered politics was to try to add some small bit of value from my experience to the mental health services. Prior to entering politics I was a psychiatric nurse. It is looking increasingly likely I will be one again soon enough.

Some time ago, I had the good fortune to be involved in a literature review on an international level in relation to mental health policies. One of the documents reviewed was A Vision for Change which ranked high, if not foremost, among the documents being reviewed. My colleague, Senator MacSharry, and I have crossed swords many times, often robustly, in this Chamber. Senator Darragh O'Brien called for Members on this side of the House to consider the actual wording of the motion. I believe it is a decent motion. I cannot see a great deal wrong with it. It is a fair and good motion that offers us an opportunity to reflect on where we are in regard to the development of our services. When Senator MacSharry says A Vision for Change is under pressure, we could shout "politics" and "stop", but when the review of the independent monitoring group says the same we should take good care to listen to what they are saying.

We are not very good at policy in this country. I am speaking not of the Minister of State or the current Government but of governments in general. We often feed in policy at the top and expect it to come out oven ready at the bottom. We sometimes fail to realise that each step of policy needs to be mediated through different levels before the objective is achievable. A Vision for Change suffers from this weakness. It is a ten year policy and we are eight years into it. While A Vision for Change is being monitored by an independent group, there is no measurement or mid-term review built into it, which is a serious weakness. Circumstances have changed and changed dramatically since 2006 when A Vision for Change was published. We are in economic recession and it is well documented and known from international studies that recessions play a significant role in increasing morbidity in this area. We need to stop, reflect and take stock of where we are.

There is a great disconnect between policy and practice in this area. There is no question of that. Senators van Turnhout, Darragh O'Brien and MacSharry have drawn attention to legitimate concerns in this regard. As rapporteur on suicide prevention for the health committee, I am writing a report in which I am highly critical of our mental health services. I have said many times in this Chamber - this is not a criticism of the Minister of State - that we do not do mental health services well in this country. It seems to me there is nobody in charge. There are no dedicated people with responsibility for named acts or omissions in this area. This a fundamental weakness of our system.

The child and adolescent mental health services are newly established. There have been great advances in this area. However, is it acceptable that a 13 year old boy suffering from acute anxiety can be told he must wait eight months for an appointment? How could we in government or anywhere else be proud of such a service? We appear to have all the right language around this in that we all say the right things, with which everybody can agree, yet mental health services do not appear to be progressing at the rate we would wish them to.

The motion refers to several individual incidents of bed closure. I am glad it mentions St. Stephen's Hospital in particular in this regard. Prior to my becoming a Member of this House, I was a trade union representative for St. Stephen's Hospital for almost 20 years. I am glad to be able to say I was part of a team that put together a template for community development in the north Cork mental health services. A meeting was held today at St. Stephen's Hospital in regard to the very bed closures to which this motion refers. Management and the staff representatives and organisations of that hospital have been working together on how best this issue might be addressed. There are 26 beds at that hospital in two acute admission units. The proposal is that one unit be closed. This means there will in future be 18 beds on the campus rather than 26, thus freeing up 12.5 posts. I use this as an illustration of how progress can be achieved. Five of the 12.5 posts freed up will be moved to the community crisis intervention teams and five more will be moved to the amalgamated 18 bed ward. While there is not yet agreement in regard to what will happen in regard to the remaining 2.5 posts, another meeting will be held next week to discuss the best way forward in that regard. This is a bottom-up approach to the development of our services. This is how progress has been made in north Cork for as long as I can remember. As stated in the independent monitoring group's report, most of the progress taking place in terms of A Vision for Change is on a bottom-up rather than bottom-down basis. There does not appear to be any leadership in this regard.

There is a need for calmness and strategic thinking on this issue. Perhaps the Minister of State would take a more hands-on approach to it. I do not know what HSE west is doing in that it has alienated all of its staff and the community in Ballinasloe. I cannot understand that. That has not been the experience in HSE south. If HSE south can do things fairly well, why then cannot HSE west do so? These are the questions that need to be asked. Perhaps the Minister of State has a view on these issues and will share them with us. I could talk all day about mental health but prefer when speaking on the issue to make one or two important points in order that all the other points do not get lost in the cacophony of my talking.