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

There is nothing to apologise for. I thank Senator Crown because this is, as he rightly says, a very important issue.

We have been working to move away from the old institutional model of service delivery to providing more comprehensive care in a variety of settings, including the home, the community and in hospital. This common objective requires a change in attitudes generally towards mental health, especially in eliminating the stigma associated with mental illness, as well as the prioritisation of the limited resources which are available to us. I acknowledge that implementation of A Vision for Change has been slower than we would have liked, delayed by a number of factors including the changed economic context, constraints in public spending and the moratorium on recruitment. However, let me put it on the record that this Government remains firmly committed to reform of our mental health services. This is in line with our clear programme for Government commitment to implement this widely agreed policy.
I wish to stress, as evidenced by the significant funding provided by the Government since 2012, including in particular the €35 million given in the recent budget for next year, that the strong momentum to improve all aspects of our mental health services is being maintained. As reflected in the agreed HSE service plans, developments are taking place across all HSE regions, driven by the new mental health division, and monitored by the Department of Health. The additional funding of €35 million in budget 2015 brings to €125 million the total investment for mental health services since 2012, for the development and modernisation of the services in line with the recommendations of A Vision for Change,mostly in the way of additional posts to strengthen community mental health teams for both adults and children. The additional funding is also being used to enhance specialist community mental health services for older people with a mental illness, those with an intellectual disability and mental illness, forensic mental health services and suicide prevention initiatives.
Progress has been made with the closure of old psychiatric hospitals throughout the country and the development of new modern facilities to support the community-based, recovery-focused model of care recommended in the vision document. Almost 20 "old" psychiatric hospitals across the four HSE regions have either closed completely, or have closed to new admissions, with closure plans in place for the remaining old hospitals. We are also making satisfactory progress on new infrastructural developments for the national forensic mental health service. The project to replace the Central Mental Hospital in Dundrum with a new 120-bed unit in Portrane, together with modern facilities for forensic child and adolescent mental health services, CAMHS, and a new unit for mental health, which will deal with intellectual disability on the same site, is on target. Subject to planning permission, the hospital should be delivered by mid-2018.
The establishment last year of the HSE mental health services division, including the appointment of a national director for mental health, was a fundamental step to progressing the inter-linked policy and service issues raised by Senators. This delivers on a key recommendation of A Vision for Change.
The community mental health teams are the first line of acute secondary mental health care provision, and their presence allows individuals to be supported in their recovery in their own community. The teams are the primary mechanism for the delivery of community-based mental health care across the full range of mental health services - from child and adolescent services to general adult services, through to psychiatry of old age services. These teams provide a range of interventions in a variety of locations, including the service user's own home. In that regard up to September last, almost 75% of accepted referrals or re-referrals to general adult community mental health teams nationally were offered a first appointment and seen within three months. Similarly, 97% of accepted referrals or re-referrals to psychiatry of old age community mental health teams were offered a first appointment and seen within three months.
My priority is to advance the position regarding child and adolescent mental health services in both acute and community care settings. Acute inpatient admissions for children and adolescents are prescribed in A Vision for Change as relating to age-appropriate acute inpatient units, which are approved centres registered with the mental health commission. While there has been significant progress in reducing the numbers of children admitted to adult acute inpatient facilities, I accept that this remains a challenge for the HSE.
In 2008, only four out of every ten admissions of children to HSE acute inpatient units were considered age-appropriate - this figure had increased to almost eight out of every ten admissions by 2013.

While this is still not acceptable, nor in line with Mental Health Commission regulations which require that all children under 18 should be admitted to age-appropriate acute inpatient facilities, except in exceptional circumstances, it is clear that progress on this issue is being made. Where required, and if no public bed is available, inpatient beds are utilised in private hospitals. There is also a small number of children who may require placement outside of the State where this is deemed to be the best service option in such cases. Nationally, bed capacity has increased from 12 beds in 2007 to 46 at present. In June of this year, the operational capacity of the child and adolescent acute inpatient units was 56 beds. However, due to building works and temporary difficulties arising from loss of certain staff in three of the CAMHS units, capacity nationally has reduced to 46 beds. It is planned that these issues will be resolved as quickly as possible and that capacity will increase to 58 by the end of the year, which will help alleviate the current situation of placing children in adult units. In addition, construction work is continuing on the new 22-bed unit at the Cherry Orchard hospital site in Dublin, which will be completed in September of next year.

The child and adolescent mental health service is a key service improvement project for the HSE. I have recently asked the HSE to concentrate improvements in the areas of access to and co-ordination of CAMH services for all presenting needs, additional CAMHS bed capacity to tackle eating disorders and developing a community-based CAMHS forensic mental health team. The improvement project aims to improve access to and use of CAMHS inpatient, day hospital and community-based services, particularly in the context of agreed protocols governing the area of 16 to 17-year-olds. The first meeting of a multidisciplinary group established to progress this project took place recently. It is intended that meetings will be held on a monthly basis. The group has also met with the management teams of all four CAMHS inpatient units to review various operational issues including eliminating any restrictions inhibiting full operational bed usage in certain circumstances. Overall, the ring-fenced allocations provided by the Government since 2012 have allowed for an additional 230 posts in the area of mental health services for children in 2012 and 2013, with more posts approved in 2014. As of now, about 80% of those are in place with the remainder being recruited. This is proof in real terms of our commitment to improve these vital services for children with mental health issues.

At the end of September, 770 or 86% of the 890 posts approved for mental health services overall in 2012 and 2013 had been filled with the remainder at various stages in the recruitment process. There are some difficulties in identifying some outstanding candidates for geographic and qualification reasons. In relation to 2014, while €20 million was provided for mental health services, the HSE national service plan outlined that this expenditure would be phased in in order for the HSE to live within the overall available resources in 2014. Accordingly, it was decided that the recruitment of 2014 posts would be commenced to provide for posts to come on stream during the last quarter of this year. To this end, and informed by the analysis carried out, some 200 posts have now been identified from the 2014 allocation and the recruitment process has now commenced. The issue of whether a further €15 million should have been provided in 2014 has also been raised. Given the logistical and phasing issues arising around recruitment and properly planned service reconfiguration, the Government considered it more efficient to restore the annual programme for Government allocation to its 2012 and 2013 levels in 2015 which, coupled with the unspent 2014 moneys arising from the overall HSE expenditure management requirement in 2014, represents a considerable commitment to increased funding for and expenditure on mental health services.

I would like to reiterate today the value that I and the HSE put on the work of the Mental Health Commission. I like to think of it as the HIQA for mental health services. Similar to reports in previous years, the report of the inspector of mental health services for 2013 provides a balanced and valuable insight of what has been achieved in mental health and what improvements require to be effected.

The HSE and I take full account of the inspector's report and consider the views of the commission to be most important for the ongoing improvement of services for all users of the mental health service. As Members of the House will be aware, a review of the Mental Health Act 2001 has been under way and the expert group conducting the review has concluded its meetings with the final report to be presented to me within the next couple of weeks. Those with an interest in mental health know only too well the importance of having robust legislation, in particular to protect the rights of those who are involuntarily admitted to mental health facilities for necessary inpatient treatment. I look forward to receiving the report and expect that its recommendations will be progressive and in line with both A Vision for Change and the UN Convention on the Rights of Persons with Disabilities.
I wish to take this opportunity to say that Senator Gilroy last week mentioned in the health debate in the Senate his wish to see mental health legislation changed to remove the right to administer electroconvulsive therapy, ECT, to a patient without consent. While I have not yet seen the report of the review group, the Senator can take it that the removal of this power will be recommended. I wholeheartedly support that position.
Senator Gilroy also mentioned that he sees no reason to reference psycho-surgery in the Act and that it should be deleted. I urge caution on this. I accept that this is rarely used, either on a voluntary or involuntary basis, but I am informed that it has a role for a very small number of patients, especially those with treatment-resistant obsessive compulsive disorder, OCD. Banning any treatment for any patient group is not necessarily a good idea if a treatment might help. It should be available, albeit with appropriate safeguards. The reference to psycho-surgery in the current Act is about the safeguards for patients in the event that it is recommended as an appropriate treatment.
Dealing with the current high levels of suicide and deliberate self-harm is a priority for the Government. Policy in this area is guided by the national strategy document Reach Out. The HSE's National Office for Suicide Prevention, NOSP, has responsibility for the implementation, monitoring and evaluation of Reach Out and has been tasked with coordinating suicide prevention efforts around the country as well as supporting agencies and individuals interested in and active in suicide prevention.
The NOSP annual budget has increased significantly in recent years from €4 million in 2011 to almost €9 million this year. The increased investment has been targeted at front-line services and organisations working to reduce suicide and providing support for people in distress. In 2013, NOSP provided funding of €5 million to 33 non-profit and community organisations such as Samaritans, Console, Pieta House and many others. Other initiatives funded by NOSP include the recently launched #LittleThings media campaign - which highlights some simple, evidence-based, little things that can make a big difference to how we feel - and the yourmentalhealth.iewebsite - which contains the most comprehensive online database of mental health support services ever developed in Ireland. It is also locally based. In other words, if a person is in an area, the information the person will get will be about that particular area.
There is the Samaritans' new free phone number, 116123, for people in emotional distress. This took two years to pull over the line because it was necessary to deal with six mobile providers at that stage. Competition being what it is in terms of tariffs and so forth, they were all watching one another. However, all are agreed now that it was a good thing and something that will prove beneficial. There has been the establishment of a community resilience fund, which in 2013 provided investment of €413,000 directly to community organisations. This investment aims to resource local programmes and services focused on supporting communities responding to suicide. There is the roll-out by the end of the year of the suicide crisis assessment nurses, SCANs, initiative to eight new services. There has been an increase in the training for GPs. There has been the roll-out of dialectical behavioural therapy, DBT. There has also been the provision of the applied suicide intervention skills training, ASIST, and SafeTALK programmes. Some 3,400 people were trained in the ASIST programme in 2013, and 7,000 were trained in the SafeTALK programme.
Reach Out, the national strategy for action on suicide prevention 2005-2014, will come to an end at the end of its ten-year term this year.

As a consequence, at my request, the Department of Health and the HSE developed a new strategy framework for suicide prevention earlier this year. The aim of the new framework will be to support population health approaches and interventions, and it will assist in reducing loss of life through suicide, while aiming for improved co-ordination and integration of services and responses in this area. The number of people who were willing to come on board and partner in that approach had to be seen to be believed. The goodwill on this issue is astonishing.

Work is well advanced on the development of the new framework. The process includes consideration of all available national and international evidence and existing good practice, addressing areas such as research, policy, practice improvement, engagement, communications and media. The process also incorporates a review of the implementation of Reach Out, a public consultation process and a review of the evidence base for suicide prevention. The framework will take account of all public submissions received and the best evidence available internationally on this sensitive area. The strategy will be focused on a whole-of-Government approach, including engagement with several other Departments; the obvious ones that spring to mind are those which are face-to-face with the public, such as the Departments of Social Protection, Education and Skills and Health. People often do not link mental health with the Department of Transport, but one would be amazed at the number of people who interact with public transport every day.

I assure the House that the Government remains fully committed to mental health and suicide prevention and to the continued development of modern and responsive services in line with A Vision for Change.