John Gilroy (Labour) | Oireachtas source

In 1984, there was another momentous development. In 1984, the report, Planning for the Future, was published. Planning for the Future proposed a pathway through which we would close the large institutions and move psychiatry and mental health into the community. That was followed by a series of seven-year plans, which worked and built upon the policy framework set out in Planning for the Future. Then, in 2006, we published A Vision for Change.

A Vision for Change is a visionary document. It really is the way forward. It is, on paper, the single best document that I can find in the English-speaking world where mental health services are provided. I am disappointed by the piecemeal roll-out of A Vision for Change, and I am not the only one because many, including the Mental Health Commission, have commented upon it. It seems to me, as someone who has worked in the services for more than 30 years, who was involved in the trade union movement and staff representative organisations and who remains linked in to this day to all the hospitals throughout the country, that despite the existence of A Vision for Change, there is a lack of strategic planning in the delivery of mental health services.

We are in a period of transition which is exciting for the staff working in the services. We are moving from the paternalistic sort of delivery system we have currently. Even though we closed most of the institutions from 1984, we did not really open our hearts to the new way of delivering the services. While we moved people from the institutions into the community, the walls that were around the institutions, while not physical anymore, were just as real as if they were. New therapies are evolving and older, more established therapies are expanding, and yet the mindset in the mental health services is not accommodating these new changes.

There are many matters I want to talk about in this regard and I hope I will be able to keep my talk coherent. Before Christmas I visited a major general hospital, not in Cork but in this city, where we discussed the admission of children to adult services, which is utterly unacceptable. Some 84, one in three, of all children who were admitted in that year were admitted to adult units. Those figures are not truly reflective of how bad the situation is because the staff in the hospital told me that in the previous week, 13 children suffering with mental health issues were admitted to the hospital, which is a general hospital, because there was nowhere else for them to go. If we were to say it is bad having them admitted to adult wards of psychiatric hospitals, which it undoubtedly is, those figures are not the true figures of the poor situation existing among the child and adolescent units.

Senator van Turnhout correctly mentioned the difficulty in recruiting staff. All the information coming to me from the coalface indicates that there is a problem with staff in the hospitals. There are not enough staff within the mental health services at every level. It is quite simple. Senator van Turnhout highlighted this, but why must we ask this question at all? What is so unattractive about the mental health service that it cannot keep its own staff? There are several causes. A systemic problem within the services that we have not dealt with is the cause of the lack of staffing and, indeed, of all our problems in the mental health services. I refer to leadership at local level. Leadership at local and regional level is not what we would desire it to be and leadership at national level, not at political level but at operational level, is appalling. We do not have a director of mental health services at present, rather we have someone acting in that capacity. The Minister of State spent a long time trying to find someone to fill the role of director of mental health services and as soon as the post was filled, the person was seconded out of it to a financial role somewhere. At present, we are looking. Why have we not got someone in this role?

Perhaps even more important than someone in the role is, as I have suggested for a long time, the need for us to appoint someone senior, a competent, capable and credible person, with responsibility for the roll-out of A Vision for Change. That visionary document is being criticised left, right and centre. Unfortunately, it is like Planning for the Future in 1984 which, unbelievably, is still not implemented.There are still 400 people living within the walls of large institutions as we speak, which is a fundamental breach of anybody's human rights. It was recommended 31 years ago that should not happen. I am afraid A Vision for Change is going down the same road.

I wish to speak about the €125 million extra investment. What is the number of net jobs created as a result of this investment? Concerns have been brought to my attention in several places in regard to some of these jobs. Some of these jobs are new jobs but not new posts within the service as people within the service are being promoted to different jobs within it and that is being counted as a new job, although the salary for the old job has been reabsorbed by the HSE back into general funding. How many child and adolescent mental health teams are in the country and how many have been fully populated with competent and appropriately qualified people?

As the Reach Out national suicide prevention policy expired last November, we expected the Minister of State to have a framework for suicide prevention published last November. I am disappointed it is six months late. There are many areas in mental health services that are not receiving the service provision they require. Does the Minister of State intend to provide more resources for a very intractable and serious problem affecting young people, that is, specialised care for people suffering from anorexia nervosa? There are many other questions I would like to ask but I will leave it at that.