Rónán Mullen (Independent) | Oireachtas source

I join other colleagues in congratulating Senators Freeman and Coghlan and all those involved in the creation and bringing about of this thorough and thought provoking report on child and adolescent mental health services. It has been said many times in this House, and is restated in Senator Coghlan's introduction to the report, that mental illness should be treated no differently from physical illness. I wholeheartedly agree.

Mental health and mental illness can take a terrible toll on individuals, families and communities. It takes many forms. I think of my own father's condition, Alzheimer's disease, which is formally recognised as a mental illness. That has brought me closer to this issue from one particular perspective.

Public discussion around mental health has come on significantly in the past decade. I can still remember a time when to discuss depression was considered a personal failing and some kind of secret shame to be concealed. Thankfully, we are moving away from such times. To paraphrase the report, we all know somebody in our family or community who is affected by mental health issues and the effects of that on family and friends can never be overstated.

The focus of our public discussion is often on adult mental health services in the context of the A Vision For Change report launched in 2006. That report was a comprehensive blueprint of how we, as a country, were to recognise and properly fund our mental health services but, sadly, significant gaps remain. Today's report shines a welcome and much needed light on the neglected area of children's mental health services.

In that context, it is sad to be reminded that according to the United Nations children's emergency fund report, Building the Future, published in the weeks before the committee sat, Ireland has the fourth highest teenage suicide rate among 37 nations of the developed world. That report further highlighted that Irish children aged between 11 and 15 are presenting with emotional issues on a weekly basis at the second highest rate in Europe. That shows graphically that our young people and children are vulnerable to mental health issues. Even more shocking is the fact that the report shows that the increases in mental health problems in the child population in Ireland are not matched by an increase in services.

Senator Freeman and her team have catalogued the fact that there has been a reverse trend in overall budget funding for services. The percentage of the total health budget for mental health has decreased from 13% in 1984 to 7.3% in 2004 to the current 6.1%. At a level of percentage, that declining allocation of funding is in stark contrast to many other western European health systems such as those in France, Germany and the United Kingdom, where spending on mental health services comes in at approximately 10% to 12% of the overall health budget. This chronic underfunding shows a repeated failure by State agencies and reflects that failure to build the necessary capacity to provide adequate mental health services to children and adolescents.

In the weeks prior to the committee's oral hearings, which took place on 29 June and 6 July of last year, one of four child inpatient units in Ireland for acute mental health problems closed 11 beds, lowering the national bed complement in Ireland, with a population of 1.25 million children, to 48 beds. The reasons for the closure cited by the Government were nurse shortages.

Before I speak about staffing problems, I want to return to an area colleagues will have heard me highlight in the past, that is, the provision of community based mental health services. If we look at Galway, my own county, we will see in microcosm the dysfunction in Health Service Executive, HSE, community mental health services. The HSE in Galway has decided to centralise all mental health treatment into an overcrowded mental health unit in the university hospital. That is partly the result of the fact that in 2015, the HSE closed a state-of-the art mental health facility at St. Brigid's Hospital, Ballinasloe, which cost over €3 million to renovate. At the core of the vaunted A Vision for Change plan for mental health services was the recommendation that care be given close to the communities where the patient lives. In Galway, the opposite is now happening. All mental health care is being centralised in the city hospital.

In addition to poor use of physical resources, there is the ongoing chronic failure to recruit and retain staff. I am glad the report has highlighted that issue as a major problem.

The Government recently committed to invest tens of millions of euro in child and adolescent mental health services over the next five years. Those commitments also include the creation of a 29-bed inpatient unit at the new children's hospital that is due to open by 2021. This service will increase the bed complement in Ireland but ignores the HSE's chronic inability to recruit the nurses and child psychiatrists who will be needed to put these beds into commission. Crucially, there is no point in opening beds without a nurse or a doctor to operate them. That is the lesson the renovated and subsequently closed unit in Ballinasloe teaches us.

This report reinforces what many of us have been saying for years about mental health services in this country. We cannot provide a service where there is a chronic failure by the HSE to recruit psychiatric nurses and consultant child psychiatrists to operate the existing bed complement in Ireland.

We need a plan by the Minister of State to show how he will target pay and working conditions to attract specialists in this area. Unless we can find and keep the staff, there is little point in unveiling expensive new units with empty beds. The last I heard they were storing records in the expensively refurbished St. Brigid's unit in Ballinasloe.

I welcome this report. I agree with the conclusions regarding recruitment of staff and I look forward to hearing innovative proposals from the Minister of State.