John Gilroy (Labour) | Oireachtas source

I welcome the Minister of State to the Chamber. The time available only allows me the merest mention of some of the many challenges facing our mental health services. I would like to talk about them under two headings, one being what we would call operational matters, which are the function of the HSE to deliver. The challenges facing the HSE in delivering these are great and some people might even say they are insurmountable in the current circumstances. Only for the tremendous hard work of our staff, our mental health services would hardly exist. Some of the services to which I can point that are poorly resourced, include addiction services. I refer to few or poor specialist treatments for eating disorders. There are woefully low numbers of child and adolescent beds in the country, which require that children be admitted to adult wards or - almost as bad and I come across this all the time - to totally unsuitable beds in medical wards of general hospitals. We could usefully check out the numbers here. If the anecdotal evidence I am hearing is correct, we are in real trouble in this regard. There is a shortage of staff, incomplete mental health teams and the list goes on. We could devote our entire energy to discussing those matters.

The second element I want to raise involves policy issues. They should be addressed by the Government, the Department and the Minister. My comments are critical of the mental health services and I hope they are not understood to be critical of the Minister of State. She and I are old friends, constituency and party colleagues and have soldiered long and hard together for 20 years or more. Any criticism I make cannot be understood to be about her. It is about our policy implementation or the lack of it. The Minister of State was appointed and given responsibility for four areas, any one of which could usefully carry a junior Minister. International evidence tells us that at the top of all priorities for the creation of a modern and effective mental health system is the placing of mental health as a priority by policy makers. Having a Minister with four areas of responsibility shows that from the outset, we as a Government have failed in this regard. In the circumstances it is not possible for us to achieve the high standards of mental health services that we and our people require.

One of the frustrating aspects is that we have probably one of the best documents on policy that I have come across. We have examined policy in seven English speaking countries and A Vision for Change is up there as probably the best of them. It will be nine years next January since it was published and it has not been implemented in any strategic or coherent way. In 2006 all stakeholders embraced this policy and front-line staff, of which I was a member at the time, enthusiastically welcomed it as the blueprint for a fantastic way forward. Today the same staff are asking whether A Vision of Change as a policy even exists any more. That is what my former colleagues have told me. It has been a wasted opportunity and it is no longer good enough for the HSE, the Department, the Minister or the Government, when asked about our mental health policy, to quote the success of A Vision of Change because it has not been properly implemented.

The Minister of State spoke, as she often does, of the crucial necessity for a change of culture. She is 100% right about that. To achieve this, leadership is needed at every level There is a clear lack of leadership in the services. It is my understanding, and I stand to be corrected on this, that the post of director of mental health services is currently vacant. It has only been filled by a person in an acting capacity and the director has been seconded to another area. That is not acceptable. I cannot understand how that could be acceptable. I cannot understand how at a crucial time of change delivery we have not got a permanent change driver in place. Leadership at a local level is patchy at best and there seems to be no guiding principle about what our services ought to be.

These issues are constantly being brought to my attention by my former colleagues in the psychiatric service, as well as service user groups and service users. Under the old policy of Planning for the Future, we closed most of our old institutions but I fear that all we did was move the institution mindset from the old institutions to the community. There is an over-reliance on the biomedical model and there is a lack of alignment with the community and voluntary sectors, which are vital in this process. There seems to be hostility from some service delivery agents in fully engaging with community and voluntary groups. This again points to the paternalistic view of many of our senior clinicians and managers in the mental health services.

The Government cites an additional €120 million as proof that we are making progress and money is of course welcome. Nevertheless, it is not what this is really about. We must consider how services are set up, and money will not sort that out. I do not want anybody to interpret my comments as a criticism of the Minister of State but I am calling on the Government to reconfigure the Department and decouple mental health from the Minister of State's other areas of responsibility. We must stop paying lip service to the delivery of mental health services and create a Ministry with sole responsibility for mental health.

There is no question we inherited a mental health service that was in crisis. From what I am hearing around the country, it seems that mental health services are now in chaos and we must sort out the issue. As a Government Senator I am probably not supposed to make such comments but I have listened carefully to the Minister of State's contribution. It seems that the view of the Department as outlined in the document and my views are divergent on almost every point. A Vision for Change, as I mentioned, is not being implemented in any coherent way, and if I am correct, the national director of mental health is not in place, community mental health teams are not complete and child and adolescent mental health services, CAMHS, are not as they should be, although that project is to be welcomed. There has been discussion of how additional mental health posts are being achieved and I can speak to the Minister of State privately in that regard, as I certainly would not like to put incorrect information into the public domain. The Mental Health Commission does great work in many areas but the reports being published generally deal with the structure of the environment in which care is delivered rather than the quality of care. We must consider such issues.

I will briefly speak to the review of mental health legislation. I am absolutely opposed to electroconvulsive therapy, ECT, being given involuntarily to people unwilling or unable to give consent on the word of two consultant psychiatrists. There is no other element of health where two doctors can decide to give a person a treatment which he or she does not wish to have. If there is a requirement for ECT to be given on an unwilling or involuntary basis, the issue should be decided by the Circuit Court or High Court. The idea of psycho-surgery under section 58 of the Mental Health Act still being on our books is barbaric and there is no place for it. If this is relevant to a very small number of people, it is again the Mental Health Commission and psychiatrists who decide if an irreversible psycho-surgery is required. I do not agree with that and if it is necessary, the issue should be decided by court. It is alarming to see the reference in the Minister of State's contribution, although I accept it is rarely used. I cannot understand how we could contemplate doing psycho-surgery on somebody who does not want it.

The suicide prevention strategy Reach Out has not worked and it is now ten years old. It has not delivered objectives and it was flawed in its initiation because it did not set targets or direct responsibility to named individuals. It did not have a review period. I met Mr. Gerry Raleigh, who is working on the national framework for suicide prevention, and I made a contribution to that as well. I am hopeful that Mr. Raleigh can deliver on this and he deserves our full support.