Keith Swanick (Fianna Fail) | Oireachtas source

I welcome the Minister of State, Deputy Jim Daly, to the House. I congratulate Senator Freeman on her election as Chair of the Joint Committee on the Future of Mental Health Care and I commend her on bringing this motion before the House. It is unfortunate that she has had to introduce a motion asking the Government to spend money that has been allocated for vital and often lifesaving services. It is not unreasonable to ask for resources in the mental health budget to be allocated to ensure there is comprehensive 24-hour access to services at weekends and out of hours. Like all other health emergencies, mental health crises are not confined to the hours between 9 a.m. and 5 p.m. from Monday to Friday. The requirement for crisis services can be demonstrated in the prevalence of individuals presenting to emergency departments with mental health difficulties. While there is a lack of data in Ireland, a UK study has found that a significant 5% of all accident and emergency presentations are related to mental health issues.

A Vision for Change recommended that arrangements should be evolved and agreed within each community mental health team, CMHT, for the provision of 24-7 multidisciplinary crisis intervention; and that each catchment area should have the facility of a crisis house to offer temporary low support accommodation if appropriate. More recently, the suicide prevention framework, Connecting for Life, included a commitment to "provide a co-ordinated, uniform and quality assured 24/7 service" for individuals in need of mental health care. Over ten years on from A Vision for Change, mental health services are not uniformly providing a basic model of care that includes 24-7 crisis intervention and home-based and assertive outreach treatment with crisis houses as the norm in all areas. In the absence of community-based supports, the accident and emergency department is often the only option for an individual in crisis. As a doctor who spent time working in the accident and emergency unit in Connolly Hospital in Blanchardstown, I can tell the House truthfully that an accident and emergency department is not the place for a person who is suffering a mental health crisis. I also had the pleasure of working as a psychiatric registrar in St. Ita's Hospital in Portrane. I see many patients with mental health difficulties on a day-to-day basis in my surgery. Thankfully, most cases can be handled in the community setting. We are talking today about crisis cases, however.

During the Seanad Public Consultation Committee's consultation on mental health, which took place before the summer recess, we listened to parents who told horror stories of having to bring their children to accident and emergency departments. One mother told the committee:

On another night my son attempted to seriously self-harm and we took him to the emergency department because it was out of hours. Rhys and I were put into a small waiting room and we had to wait for over two hours for the on-call psychiatrist. Rhys escaped from that room that night and ran through an emergency department full of adults screaming, "Please let me die". He was trying to escape from the hospital and get outside. He said that he wanted to run under a car and die. I took flight after him. Security and a nurse did likewise. We caught him and had to bring him back. It was so distressing. We were in this room and all these people were looking at us. It was awful. An emergency department is not the answer. It is not able to deal with this situation. The environment is wrong. It is not very safe. I was in that room with him and he was still able to get out of that room. It is not a suitable situation for a child. When we saw the on-call psychiatrist that night, he was put on medication to calm him and help him sleep, but he was sent home that night. He slept in between us. He did not really sleep but spent the night hitting his head in an attempt to get the voices out.

We need to approach this situation in a pragmatic manner that is driven by solutions. What is wrong with my suggestion of a 24-hour GP phone line that would ensure there is rapid access to child and adolescent mental health services in emergency situations? It would cost practically nothing to provide such a service to vulnerable young adolescents who are suicidal. I do not think it would be abused. I would say my own busy practice would probably use it twice a year. The 24-hour emergency helpline I am proposing would be specifically for GPs who need to contact child and adolescent mental health services so that their patients can access such services rapidly. It would prevent unnecessary referrals to accident and emergency departments. The remarks made at the Seanad Public Consultation Committee that I have quoted have stayed with me not only because I am a father of two small children and cannot imagine ever being in that situation, but also because I have worked in accident and emergency departments that are frightening for a grown man, let alone a child in distress.

A Vision for Change committed €35.4 million over five years for the development of mental health services. However, €20 million of that fund went unspent in 2017. There are extensive waiting lists in mental health services. I refer not only to child and adolescent mental health services, but also to psychology appointments in primary care. Some 520 approved positions that were allocated in 2015 and 2016 remain unfilled while these waiting lists continue to grow. A further 390 posts were to be provided for by the end of 2015, but by July 2017 just 150 of them had been filled. Similarly, 360 positions were allocated as part of 2016 funding, but by the middle of this year a mere 80 of them were in place. As there are severe staff shortages, these crucial positions urgently need to be filled. Realistically, almost 2,000 new staff need to be recruited in mental health services if the Government is to provide the level of care envisaged in A Vision for Change. Fianna Fáil is seriously concerned with the slow pace at which the HSE is recruiting. At this rate of increase, it will take another 11 years for A Vision for Change to be implemented in full. The Government and the HSE need to up their game in this regard. It is not acceptable to take 22 years to fulfil a ten-year plan.