Seanad debates

Wednesday, 4 October 2017

Mental Health Services: Motion

 

10:30 am

Photo of Jim DalyJim Daly (Cork South West, Fine Gael) | Oireachtas source

That is fine. I had anticipated that I would have two opportunities to speak and that I would be making an opening statement and a closing statement, but I believe I will make one contribution so I will do my best to be as efficient as I can and to combine my statements. I wish to respond to as many of the individual issues as I can.

I thank Senator Freeman, who moved this motion. I acknowledge the sentiment that has been widely expressed throughout the House in acknowledging her contribution to the area of mental health. Senator Freeman is held in high regard across the board from every side of the House. Everybody recognises the benefit of the real and practical experience that she brings to this debate. With that in mind, I welcome this Private Members' motion. It provides an opportunity to discuss an issue that is so real and relevant that there is no family in the country that is not affected by this issue. I am delighted to have an opportunity to discuss it, to listen and most importantly of all to learn from people such as Senators Freeman, Black, Kelleher, Hopkins and many others, including Senator Swanick who has left the Chamber who all have real life practical experience of dealing with it upfront. I have learned and what I can do with that learning remains to be seen. That is a work in progress for all of us.

The Government will not be opposing this motion, as it is aligned with our direction and focus on this issue. We continue to be committed to the ongoing development and improvement of our mental health services. This can be seen in the undertaking outlined in A Programme for a Partnership Government to increase the mental heath budget annually to build capacity in existing services, along with developing new services. I know that figures which are trotted out ad nauseam can become boring, but it is worth reminding ourselves of the investment since 2012, which were not very sunny years economically, of €140 million which has been added to the mental health budget in the past five years. Of course, the money is never enough, but to be fair, the commitment to the service in times of scarce resources, particularly in the earlier part of that five year period, must be acknowledged. There were no additional resources. The overall budget allocated to mental health services has increased by more than 20% in that period. I do not know of a budget for any other service that has increased by that much in that period. In itself that signals a commitment on the part of the Government to the issue of mental health. I welcome the Ceann Comhairle's initiative at the opening of this session, where he had a symposium on mental health. It is the second time such an initiative was rolled out. Last year it was Brexit, which is an all encompassing noble topic. This year with Brexit out of the way in terms of dealing with it, the Ceann Comhairle very rightly identified mental health as a top priority for the Oireachtas to debate. I welcome the new political focus that has come on mental health and the ensuing additional budgets that have become part of that.

Staffing, of course, has an impact on the overall delivery of the mental health services, including the movement towards increased seven day cover and ultimately a full 24-7 service, and as such it is important that there is an understanding of the current landscape.

In line with the recommendation in A Vision for Change, our national mental health policy, the Government has prioritised the development and expansion of community-based mental health services.

As of June 2017, the mental health division has 9,738 mental health whole-time equivalent staff. Since 2012, despite recruitment challenges, roughly 1,500 new posts have been approved, of which 1,200 have been filled. We are all aware of the continuing challenges but in the interest of balance and fairness it is important to acknowledge the work that is being done in the HSE. The HSE has developed a broad range of initiatives, including the conversion of agency employed staff into HSE direct employees, national recruitment campaigns and offering all graduating nurses full-time contracts.

The Department, the HSE and the psychiatric nursing unions reached an agreement in August 2016 that included a number of measures to address the position. In particular it was agreed the number of undergraduate student places would increase by 130 to increase the supply of graduating nurses. It was agreed to put 60 additional places in autumn 2016 and a further 70 in autumn 2017.

There are other positive developments to note in this area also, such as the recent commencement of the recruitment of 114 assistant psychologist posts in primary care. Many Members spoke about the need to have lower level intervention and to have better access within primary care. The assistant psychologists will be key to reducing waiting lists for child and adolescent mental health services. Introducing mental health expertise in primary care has the potential to provide quicker access to mental health supports for families and children where difficulties have arisen.

By taking an overview of the problem and the contributing factors we can progress innovative solutions such as these alongside further recruitment and retention efforts. It is just such a measured and concentrated approach that is necessary in progressing what we want to do today, that is about bringing about a seven day 24-7 service in mental health.

When it was launched in 2006, A Vision for Change was universally welcomed as a progressive, evidence-based and realistic document which proposed a new model of service delivery which would be patient-centred, flexible and community based. The Government accepted A Vision for Change as the basis for the development of our mental health services and significant successes can be noted in how the supports and services in place serving mental health have changed in the intervening years. I think everybody acknowledges that progress has not been fast enough but as a society we have moved far away from the deplorable actions of consigning mental health to institutions where people were locked up. Moving away from that has been a gradual and steady shift, but one that has been very welcome.

One important point noted in the document is that "mental health services must be accessible to all who require them; this means not just geographically accessible but provided at a time and in a manner that means individuals can readily access the service they require". This relates directly to the motion that Senator Freeman has brought before us, which has been seconded by Senator Kelleher.

The Government recognises that mental health crises do not operate on a nine to five schedule. We know that for those who are in need of our mental health services, timely and considered supports are crucial to successful care outcomes. For those in need of urgent care, this is currently provided through a number of interlinked components across the service. This includes community mental health teams, which are available to respond to crises during normal working hours. These teams have an established pathway of contact for existing patients, and other individuals can be referred through their GP. All of these mental health teams keep slots for urgent referrals when a person is acutely suicidal or severely depressed. I think everybody in the House acknowledges that there is a service available from 9 a.m. to 5 p.m. Outside of normal working hours, an individual in crisis may present to the emergency department. The HSE's mental health division has now ensured that all level four hospitals have a liaison psychiatry service available on the site of the acute hospital, with this service providing prompt assessments in the emergency departments. Additionally, most level three hospitals now have either a service in place or one planned. This is one of the ways we are striving to provide those among us who may be experiencing distress with efficient, quality mental health care.

Another initiative which began in 2014 was the National Clinical Programme, NCP, for the assessment and management of self-harm in emergency departments. It has trained and deployed 25 senior mental health nurses at clinical nurse specialist level to emergency departments around the country. This facilitates an on-site, rapid response to those who have self-harmed and-or are suicidal. It supplements and works with the liaison psychiatry service to provide a bespoke response to those who are suicidal or have self-harmed.

There are other services available such as consultant psychiatrists on-call outside normal working hours who together with a psychiatric registrar or senior house officer on duty in acute hospitals, provide the urgent crisis response to people presenting to emergency departments.

A review of weekend access by the mental health division of my Department earlier this year shows that weekend mental health services are provided in nine of the 17 mental health areas. A further seven areas have partial cover.

We know that more than 90% of mental health needs can be successfully treated in a primary care setting, with less than 10% being referred to specialist community-based mental health services and of this number, a further 10% being offered inpatient care. However, this does not mean that we can ignore the very real needs of those who need access to seven day services and 24-7 services and whose mental health can be drastically impacted without such access - a point that all the speakers stressed today. With this in mind, while the HSE currently provides a range of services on a 24-hour basis through the interlinked components just outlined, work is ongoing to expand upon the services available in the community to ensure a comprehensive seven day cover. The recognition of timely connection is seen in the inclusion of the development of a model for the provision of enhanced seven day services within the HSE mental health division 2017 operational plan.Specific steps have been taken to further that aim since early this year. These include: the establishment of a steering group with agreed terms of reference; the completion of a scoping exercise; and the identification of pilot sites, with subsequent consultation with the relevant management teams to discuss the requirements of a seven-day service.

There is a specific focus on ensuring that the design and delivery of such a service will be informed by international best-practice models so that a consistent model of care can be adopted. This service must be integrated and evidence-based to ensure the provision of high-quality services to service users, which must at all times remain at the centre of our efforts. The current situation is that, following the collection of extensive data and information nationally, the HSE has now identified the areas that require additional resources to achieve seven-day cover. I am happy to say that engagement with local management teams has commenced, with the aim of achieving implementation of seven-day cover by the end of this year.

Alongside this, the HSE mental health division is establishing an evidence-informed model, including detailed clinical, governance, training and performance measurement structures, for the operation of a full 24-7 service. A working group is capturing views from across the service pertaining to what form these extended services should take. Building on the development of seven-day services, these views will be presented to management for consideration and implementation. Funding has been secured for the move towards a full seven-day service, with €1 million agreed for 2017 increasing to €4.5 million in 2018. This measured and deliberate approach - the scoping of services and the identification of what needs to be implemented with considerations first for a seven-day service and then a 24-7 service - is the best we can take. It will ensure that the service we ultimately provide will be evidence-based and high-quality and, most importantly, effective in meeting the needs of service users. It shows that the Government recognises that we cannot afford to be complacent about mental health.

If time permits, I will refer to some of the issues that were raised. Many similar points were made in the context of all of them. I do not wish to speak on the individual cases that were mentioned, each of which is heartbreaking. The individuals are real people and their cases are a great way to illustrate the human effect when a system fails or lets us down. I welcome listening to that but I do not wish to comment on the cases when I am not familiar with them. One point is worth making. I am not attempting to be defensive in what we are discussing here because I appreciate that we are all working collectively. However, the report I launched last week for the National Office for Suicide Prevention, NOSP, showed that the number of people dying by suicide in this country is stabilising. That is not a great jump-up-and-down story but it is a significant step in the right direction. It is an important message. At the launch in question, I spoke to a gentleman who is the CEO of a prominent charity in this area. He told me the organisation was holding a dinner the following week and the report would be helpful news as the number of people who give their time and volunteer to fundraise, help and support need to hear good news and that their efforts count for something. It is important that we recognise the positives as well as the negatives to give due deference to all of those who are contributing such vast amounts of their time, energy and effort into achieving a more successful and sustainable life for all.

Senator Kelleher mentioned the Cork issue and CUH. That has improved dramatically. She is probably aware of the consultant, Professor Eugene Cassidy, who provides an excellent service for adults in CUH. I acknowledge that homelessness and associated issues are a huge challenge in light of the number of people who are homeless and presenting with additional challenges.

The Roscommon report was mentioned by Senators Feighan and Hopkins. While the report is very local in its substance, it is national in what we can learn from it in terms of the lessons in it and the implementation of the recommendations. The reason I am taking a particular interest in it is that there are lessons to be learned and replicated across the country.

Senator Swanick asked about the slow pace of HSE recruitment. It is one of the questions I asked in my Department soon after my appointment. The HSE does all its recruitment nationally and Tusla recruits regionally and locally. I asked the Secretary General to talk to the HSE about the possibility of it conducting some more localised and regional recruitment. I believe that would be more efficient. The Senator also suggested avoiding the accident and emergency department by providing a GP telephone line to the child and adolescent mental health services for out-of-hours service. That is an idea I have not heard previously and I will take it on board.

I am conscious of time so I will try to be brief.

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