Rónán Mullen (Independent) | Oireachtas source

I move:

That Seanad Éireann:

notes that:- adequate mental health services are vital to secure the dignity and wellbeing of all those within the State, including asylum seekers within the direct provision system;

- Ireland's spend on mental health services is now just 6.6% of the total health budget, compared to 13% in the 1980s;

- there are now 472 consultant psychiatrists in Ireland, approximately 240 less than are recommended by the Hanley Report to provide safe and effective psychiatric services, and that 20% of consultant posts are currently vacant;

- Ireland has the fourth-lowest number of in-patient psychiatric beds in the European Union, at 2.3 beds per 1,000 population;

- almost 2,700 children and adolescents are awaiting appointments with psychiatrists, with almost 400 waiting over 1 year; and

- there continues to be major shortfalls in 24-hour access to mental health services, including weekend and out-of-hours services; recognises in particular that:- persons seeking asylum in the State who are within the direct provision regime have particular mental health needs which are not being addressed;

- the Royal College of Surgeons has found that depression and mental health problems are five times higher among asylum seekers in direct provision than in Irish society generally;

- the mental health and psychological development of young people is particularly affected by long stays in the direct provision system; and

- many of those who have undergone trauma prior to or in the process of seeking asylum, and particularly those who have fled war and/or persecution, may have complex mental health needs which require intervention;and calls on the Government to: - ensure that staff shortages in this sector are resourced as a priority in order to meet current requirements;

- work with the College of Psychiatrists of Ireland to maximise the number of specialist training posts for psychiatrists, to alleviate the shortage of suitable candidates for vacant positions;

- ensure that a designated consultant psychiatrist is identified in each area in which a direct provision reception centre is located;

- establish multidisciplinary teams led by consultants on a regional basis, to support all mental health services that provide treatment to asylum seekers;

- introduce early and adequate assessment of asylum seekers for mental health issues and referral to specialised services as required;

- ensure that specialised services, such as psychotherapy for survivors of torture and other violence, can be accessed by those who need them; and

- ensure that interpreters are available to assist professionals to deliver services, and that existing core staff receive additional linguistic training where possible.

Cuirim fáilte roimh an Aire Stáit, an Teachta Jim Daly. Creidim gur ócáid thábhachtach í seo. Tá ábhar an-tábhachtach á phlé againn inniu. It is fair to say that Ireland's attitudes to mental health have transformed for the better over the past five decades. The most recent staging post in the development of our services was the Government strategy, A Vision for Change, which was launched in 2006. Thirteen years on, its implementation has been uneven at best. There has been partial delivery across all its core elements, but a substantial amount remains to be done. Progress on the strategy was hindered by severe staff shortages and funding cuts during the recession. I will give two examples. Despite the recommendations of the strategy and the code of practice issued by the Mental Health Commission, children continue to be admitted into adult mental health inpatient services. There were 84 such admissions in 2018. The strategy puts a focus on the need to provide mental health treatment in primary and community care settings and to avoid premature recourse to specialists. The failure to make such provision is forcing people onto psychiatrists' waiting lists. Almost 2,700 children and adolescents are awaiting appointments with psychiatrists at present, approximately 400 of whom have been waiting for more than a year. I understand that some 6,000 people are waiting for appointments with psychologists, approximately 1,600 of whom have been waiting for over a year. These figures are stark.

There are continuing shortfalls in 24-7 access to mental health services. All these problems are persisting despite record funding of our health service. The State is spending more than €20 billion on health this year. According to an OECD study last year, we spend €4,706 per capitaon health each year, which is approximately 30% more than the average across the OECD. Are the mental health services available to our young people 30% better? I am afraid not. Have they improved in line with the increase in the health budget? Absolutely not. If anything, our mental health services are treading water, at best. Far from being among the best internationally, we are very much towards the bottom of the table. We have the fourth lowest number of inpatient psychiatric beds in the EU, where community care is desired. We have approximately 2.3 psychiatric beds per 1,000 people. As I said last week, our spend on mental health services as a proportion of the overall health spend is just half of what it was in the 1980s, which was a time of crippling unemployment and economic stagnation. We spend 6.6% of the overall health budget on mental health services, compared to 13% in the 1980s. I admit that the total amount was lower back then. As this House will recall, the Government has twice - in 2012 and in 2016 - raided the budget for mental health to plug holes elsewhere in the health service. This will not have helped the yawning gap in the number of psychiatrists in Ireland. According to the Hanly report, an additional 240 consultants are needed to provide a safe service. Some 20% of posts are currently vacant and approximately one third of the posts that are filled are filled by locums, which is not satisfactory.

One of the greatest tragedies of modem Ireland is the prevalence of the mental health problems faced by young people. I am honoured to have Senator Freeman, who needs no lessons on the importance of this topic, here to second this motion. W.B. Yeats wrote that this "is no country for old men", but is it a country for young people, given that so many of them are forced to struggle - often alone - with problems which make them question the value of their own lives? There is an average of just over one suicide per day in Ireland. While men account for 80% of suicides, a recent study showed that the rate of suicide among young and adolescent girls in Ireland is the highest in the EU. Some 9,103 people presented to hospital due to self-harm in 2017, which represented an increase of 21% on the 2007 figure. Remarkably, or perhaps unremarkably, self-harm is 30 times higher among homeless people. This reality is all the more startling when we consider that more than 10,000 people are homeless in Ireland at present. Factors such as alcohol and drug abuse, decreased involvement in social and sporting activities, a decrease in religious belief, spiritual life and religious observance and pressure to perform well academically are recognised as being linked to the problem we are discussing. Bullying on social media is a factor we must consider. As a society, we need to get grips with the ugliness that has entered much of our discourse in politics and across all levels of society. I am mindful that Senator Freeman has sponsored the Children’s Digital Protection Bill 2018. I hope her Bill will give the Seanad a good opportunity to develop our discussion of this dimension of these issues.

The issue of direct provision has also been discussed in the Seanad on many occasions. Sadly, the plight of people in direct provision has not improved much since I introduced a Private Members' motion on the subject in September 2014. At that time, more than 4,000 asylum seekers were in direct provision centres. This number has increased to 6,100. As we know, many of the 40 centres are above their capacity. While waiting times have reduced somewhat, applicants still have to wait between 18 and 20 months for initial hearings. For children in the system, a significant portion of their young lives are lost in the limbo of direct provision. As many Senators have said on many occasions, the direct provision system is an affront to the dignity of human beings. The working group on the protection process and direct provision, chaired by Mr. Justice Bryan McMahon, recommended that people in direct provision should be given the right to work. This right is key to human dignity and is a positive for a person's mental health and well-being, just as the absence of that right is a negative. Under a new Government regulation, 1,743 people have been granted access to the labour market. Nasc has criticised the slow implementation of many of Mr. Justice McMahon's other recommendations. The mental health needs of asylum seekers, or of ethnic minorities more generally, was not considered in A Vision for Change. In recent years, research into their mental health needs has demonstrated the impact on them of long stays in the system. According to a paper published in 2016 by the faculty of public health medicine of the Royal College of Physicians of Ireland, "refugees and asylum seekers often have unique and complex physical and mental health needs that require specific and comprehensive healthcare attention". The paper in question, which was entitled "The Health of Asylum Seekers, Refugees and Relocated Individuals", also found that "people fleeing war and persecution in traumatic circumstances may have complex mental health needs requiring intervention".

According to a paper that was published by the College of Psychiatrists in Ireland in 2017, children "are the frequently forgotten element of the migrant crisis" and "failure to deal with their needs can result in the storing up of social difficulties and mental pain that could have serious problems for the individual as well as society in the future". The paper in question cited a range of studies from Sweden, Denmark and other countries in support of its findings. Other research has drawn a clear link between the length of the asylum application process and adverse effects on mental health. Doras Luimní has found that "residents frequently speak about how the uncertainty of their future, the overcrowded living conditions, and the prolonged periods of inactivity impact upon their well-being and mental health". This conclusion has been supported by other research for the Royal College of Surgeons in Ireland.A range of measures can be taken to assist and improve the well-being of those in direct provision, and there is broad agreement on what can be done. We need to do all we can to ensure that staff shortages in this sector are minimised. The College of Psychiatrists of Ireland has suggested that more could be done to bring suitable candidates for consultant psychiatrist posts through the system, and the Government should work to maximise the numbers. It needs to be ensured that a consultant psychiatrist can be identified in each area where there is a direct provision reception centre, which would allow for the provision of early and adequate assessment of asylum seekers for mental health issues and referral to specialised services as required. Such specialised services, including psychotherapy for survivors of torture and other violence, should be accessible immediately for those who need them. It also needs to be ensured that interpreters are available to assist medical professionals, and to avoid remarkable and unacceptable situations where children have to act as interpreters for their parents, as often happens. These are just some measures which, with increased investment, could lead to a clear and genuine improvement in the well-being of those in the direct provision system.

I turn to what can be done to help young people within the school system. Dr. Eve Griffin of National Self-Harm Registry Ireland has said that there is "an unmet need in terms of mental health services for children and adolescents ... School-based programmes to promote positive mental health should also be a priority.". I strongly agree with this, and based on my own interactions with teachers and parents, a number of measures could be taken, which could have a significant impact on problems faced by children and adolescents at an early stage. The State should make psychotherapists available to schools, perhaps on a shared basis between a number of schools within a district. I know of one school in Leinster which engages a psychotherapist for one day per week who sees 15 of their 700 students each week, and this is funded from the school’s own resources. Clearly, the vast majority of schools cannot afford to do this on their own, unsupported by the State. Professional development for teachers in mental health is needed since they face these issues in classrooms. This kind of training should be as routine as first aid training, and it should apply to people in management in all workplaces, not just schools. Pieta House runs an excellent six-week resilience programme for 14 year olds entering their second year of secondary school. Perhaps this should be rolled out throughout the second-level sector. One important point is that there needs to be strict regulation of qualifications and standards for all psychotherapists and cognitive behavioural therapists. There are some concerns about the quality of some of the services on offer, and the cost of these services needs to be more affordable for families. The HSE runs a programme which allows schools to become health promoting schools, which schools with a focus on mental health can avail of. That is very much to be commended. More needs to be done to advertise and promote this scheme to schools. These are just a brief selection of measures which could be addressed by the Government. I do not believe that it need involve significant additional expenditure within the health or education systems, particularly given our economic circumstances at this point. However, investment would result in tangible improvements in outcomes for the mental health and well-being of our young people and those in direct provision in particular, on whom I seek to place particular focus today. I look forward to seeing what colleagues have to say.