Kathleen Lynch (Cork North Central, Labour) | Oireachtas source

The e-mail continued:

I personally am distressed at what I perceive to be the denigration of a very fine service in the interest of other agendas. We have maintained our professional dignity as we believe that public wrangling can only sow disquiet amongst those we profess to serve, our current and indeed potential future service users. However, at this juncture I can no longer remain silent and in the face of a campaign of apparent vilification, the aim of which appears to be to heap odium upon this service, I have the utmost regard for all staff members and can no longer tolerate inaccurate comments that can be construed externally as a denigration of their professional standards and care. My main concern, however, in the midst of these issues, is that any individual, whether currently attending this service or whether considering approaching this service for assistance, is deterred from doing so in light of inaccurate public comment.

I would also like to tell the Senators that the national director of mental health visited Galway University Hospital and its mental health unit. That person found that the area where the leak was - not the roof gone but where the leak was - was closed, there were empty beds in the unit, the unit was extremely calm and the executive clinical director there was very happy with the service as it was progressing. We need to be careful. There are people delivering a service which we want them to deliver so we should be very careful about how we describe them and the care they give to others.

I am pleased to have the opportunity to address the important issue of mental health in open discussion - as I have always done - on Private Members' business in the Seanad. Mental health is a subject that is obviously close to the hearts of many Senators. I am right in saying that we have cross-party support for A Vision for Change. I do not doubt that for one minute despite what we have heard in the past few weeks.

In 2006, A Vision for Change was widely welcomed as a progressive, evidence-based and realistic document that proposed a new model of service delivery which would be patient-centred, flexible and community-based. Much progress has been made in closing many of the old psychiatric hospitals and providing modern acute inpatient as well as community-based facilities and services. Someone that I always admired in this field was former Minister of State, John Moloney, and before him, Tim O'Malley. We sometimes forget their work. Through circumstances beyond their control, progress was not made on A Vision for Change programme. Even while progress was not being made by the Government, the services were progressing.

A Vision for Change recommended a move away from the old institutional system of mental health service delivery to delivering comprehensive care in a variety of settings, including the home, community and in hospital. Despite the extraordinarily difficult economic environment we now find ourselves in, much progress has been made in implementing key recommendations.

If Senators have a copy of my speech, they will see that I have deliberately focused on the pieces that the motion has asked us to deliver on. Therefore, I will not read out the sections typed in red and will concentrate on the specific points included in the motion. The first item is the call for a reform programme to be driven by a national director of mental health. In July 2013, Mr. Stephen Mulvany was appointed as the first national director for mental health and, as such, has full authority and responsibility for the implementation of A Vision for Change. Since his appointment, Mr. Mulvany has met every mental health management team across the country to create concrete, coherent and deliverable plans to realise the vision commitments in their catchment areas. This level of planning has been crystallised in the HSE's national service plan and the recently published operational plan for mental health. Each service has declared its immediate and key objectives for 2014 which are explicitly stated and documented.

Mr. Mulvany has also conducted a detailed audit of the human resources down to team level for all mental health services reporting to him. This will guide him on how the 2014 investment of €20 million will be allocated to ensure equity and drive further innovation; that a new culture is developed within the mental health service that fosters recovery and works in partnership with users of services and their relatives; and to ensure that the recovery principle should underpin all mental health service delivery in keeping with A Vision for Change.

Since 2006, the HSE has invested in many innovative initiatives to promote the service user and family perspective. Every acute unit has a trained peer advocate available to all inpatients to provide information, assistance, welfare and housing advice, personal advocacy and a recovery guide. Collaborative leadership and change management programmes have been delivered at DCU and I have had the pleasure of meeting many graduates from this exciting and integrated programme of change, which includes service users, family members and mental health professional. An academic post for an expert by experience has been in place since 2009 to provide robust evidence and rigour to the service user's viewpoint. The national mental health division has appointed an interim service user adviser to work with service user and carer organisations to ensure their viewpoint is heard and heeded at all levels in our mental health services. There are trialogue meetings with service users, family members and mental health professionals engaging in a direct debate on the needs of service and how these can be best delivered in a coherent and effective manner. The EOLAS knowledge and understanding innovative programme offers pragmatic information and guidance to families living with mental illness and we hope to extend the reach of this well regarded programme during 2014.

Advancing Recovery in Ireland, ARI, which is an incredible programme, supports mental health services in re-orientating service objectives to facilitate and not impede recovery. It must be the ambition of every service user to return to his or her home and family. ARI works with services to make sure that all aspects of service from acute community, acute inpatient, rehabilitation and recovery teams and residential supports are designed to maximise independence and progression towards a high quality of life within the community. For too long the professional knew best and this led to a power imbalance, which is being rebalanced at long last, not by rejecting the professional viewpoint, which we cannot, but by ensuring the service users and carers' voices are also heard and acknowledged.

The motion seeks "to place a stay on the closure of acute in-patient bed units until such time as appropriate holistic community-based services are in place, including St Stephen's Hospital, Glanmire and Carrig Mór mental health unit, Shanakiel and Toghermore, Tuam;". Modern community-based teams and services have being created all over Ireland by recasting the skilled human resources trapped within institutional and residential service models. Staff have developed a broad range of skills which have outgrown the confines of the bedside and wish to work with service users within their own homes and communities. Modern mental health services are predominately community-based and, as in the acute hospital sector, acute inpatient stays are reduced by investing in community-based care models. The average stay in an acute mental health unit is down to 11 days. This reflects the service users strong preference for care at home and within their community.

Along with the investment of new skills and professions on our community mental health teams, including clinical psychology, social work, speech and language therapists, child care workers and occupational therapy, the HSE has trained more than 40 facilitators to work with teams on the enhancing team working programme to ensure team effectiveness and focus. When a team is put together, one does not choose the person with whom one works. It does not automatically become a functioning team and that is why we have to work on this. However, it is not possible to run old style residential services and to develop fully staffed community mental health teams. The skilled and experienced staff required for the teams are all too often trapped within institutional service models. We must escape the gravitational effect of these old institutions and liberate the service users and the dedicated staff who serve them.

People with mental illness have been hidden away for too long living in a parallel universe away from their own communities. This is no longer an acceptable model; we can and must do better. There always will be a group of individuals who require acute inpatient care and whose mental health needs are best met in hospital. We have invested more than €200 million providing superior inpatient settings for people with mental illness. Follow-on care and continuing care plans are designed for all service users as they progress towards recovery and staff released from inpatient commitments continue to work with service users in their new home settings. Some mental health services have found it difficult to move away from residential service models and, in some instances, replaced hospital care with residential hostels but the journey has been incomplete. Service users have the same right to live within their communities and to enjoy the benefits of community living while continuing to receive support from rehabilitation specialists and community mental health teams. New improved facilities are in train to replace older facilities that can no longer meet the needs of 2014.

Since A Vision for Change was published in January 2006, we have made major investments in mental health capital developments in counties Cork, Dublin, Limerick, Westmeath, Galway, Donegal, Wexford and Tipperary to replace older and unsuitable facilities. We need to offer modern service settings for users and a modern and sustainable workplace for our staff. We will replace the Central Mental Hospital at Dundrum with a new state-of-the-art facility at Portrane by 2017, which will be supported by intensive care rehabilitation units. This is an extraordinary programme of works and all have been advanced under the guidance of A Vision for Change. It would be unethical to pause this progress and to retreat back into the past. I have no mandate for such a move and can see no good reason to lose the momentum gained since I took up this office.

The motion states, "when the additional 1,800 additional multidisciplinary staff, over the numbers working in the service in 2006, will be provided for". I attend the House regularly to discuss mental health issues. I have never said that we have reached that point. We are not there yet but the push that has been made over the past three years is significant and we need to keep going. In the context of the economic difficulties, it has not been possible to reach the 10,657 whole-time equivalent posts, WTEs, described in A Vision for Change. At the end of December 2013, a total of 9,052 WTEs were working in our mental health services. This presents a challenge and requires us to ensure all staff are positioned in the most effective settings, on the front-line, responding to current and assessed needs. The national director for mental health has an additional 250 to 280 WTEs to allocate in 2014 in addition to the 2012 and 2013 posts.

With regard to Senator van Turnhout's comments, last week I launched the HSE's fifth annual child and adolescent mental health services, CAMHS, report, which clearly shows a massive 50% increase in the number of staff working in children's mental health since A Vision for Change was published. This focused year on year investment on teams and a quadrupling of CAMHS beds in the past eight years extends the reach of our mental health services for children. Today more than 17,000 young people attend CAMHS. I agree with the Senator that even 5% is too much but it is something on which we have to keep working.

The motion then refers to creating "a plan for the full implementation of A Vision for Change with key timelines and deliverables clearly identified". The HSE's national operational plan for mental health was published on 30 January and I encourage colleagues to read this detailed document. It clearly sets out the targets and ambitions for 2014, which have been costed and are deliverable within the available resources. All these commitments are fully aligned not only to the values of A Vision for Change but also to its recommendations. With additional resources we can do more, but we must be realistic and drive forward within the known and available resources.

The motion calls on the Minister "to carry out a full, independent, transparent and fair review of the decision to close the acute in-patient bed unit in St Brigid's, Ballinasloe; and to place a stay on any further bed closures in St. Brigid's Ballinasloe, pending the outcome of that review." I am absolutely confident that the decision to close the old hospital at St Brigid's Ballinasloe is correct and I checked this again earlier. I apologise to the Senators and Deputies from the area for the confusion that was caused last night. This should not have happened. A transparent and careful set of criteria was applied by a panel of experienced mental health professionals and the decision stands. I have met senior clinicians, the service managers and local service users and there is a great desire to see the promise of A Vision for Change fully realised in counties Galway and Roscommon. I have also met people who have expressed genuine concerns but I encourage them to examine the progress that has been made in other parts of the country and to embrace the objectives in A Vision for Change.

I invite those people to visit such an area which I will arrange. Stigmatising and scaremongering can have no place in this debate. We are working to provide a range of services for young people, adults and older persons who are seeking help in an acceptable form, which they are comfortable with and are supported by modern practice and evidence.

Nothing is happening in County Galway that has not already been delivered in most other parts of the country. The staff and clinicians at Ballinasloe have worked hard for many years to return patients from St. Brigid's to their home communities and to fully support them on that journey. No one has ever told me that the staff have been behind the corner in delivering A Vision for Change. To bring that to the next stage we need to further rationalise acute bed provision. This is completely consistent with A Vision for Change recommendations. Some staff employed in St. Brigid's have recently submitted expressions of interest for redeployment to other roles in mental health services in the area. It must be stressed that modernisation of services is taking place with no impact for current inpatients in Ballinasloe.

A Vision for Change recommends 50 beds for a catchment population of 300,000. It is clear, therefore, in line with policy and operational norms nationally, that the provision of 22 beds in both Ballinasloe and Roscommon means that the current overall stock of 76 in HSE west is too high in relative terms, allied to a corresponding underdevelopment of community-based mental health services. In the context of the service improvements now under way, a purpose-built 50 bed acute mental health unit will be completed in Galway University Hospital in 2015 to replace the existing smaller unit. This unit will consist of 35 general adult mental health beds-----