Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I will try my best.

I welcome the opportunity to restate my and the Government's commitment to the continued development of mental health services and supports during and beyond Covid-19. The pandemic has been very challenging and, in response, a range of mental health supports has been established. At the outset, we put in place proactive measures to provide for any increase in service need. That is the most important point I can convey today. Supports were retained from last March when we had the initial wave of Covid-19. Some 85% to 90% of acute supports were retained. That message must be conveyed to the public because there is a very negative narrative circulating that nothing is being done with regard to mental health. A massive amount of work is being done. I commend every person involved in the care of people with ill mental health, be it in the acute setting or the community setting. Wherever it occurs, people are working their fingers to the bone each day to help people with ill mental health. They must be acknowledged.

Residential services were quickly identified as the highest risk areas for staff and service users. With this in mind, the Department asked the Mental Health Commission to develop a risk control and monitoring framework for these facilities to identify and address infection risks. As we know, infection prevention and control are the key issues in a mental health or healthcare setting. Facilities were reconfigured to reduce the risk of cross-infection. In addition, staff training, personal protective equipment, PPE, provision and testing were implemented to recommended levels.As a result, HSE residential mental health services have continued throughout the pandemic. To ensure safety there has been reduced capacity in some settings, especially in respect of face-to-face meetings. There had to be a blended approach to that. Much of it had to be done by telephone or Zoom but it did continue. There have been some outbreaks but the procedures in place have reduced the impact of that as much as possible.

At this point I would like to remember the 29 people who died due to Covid-19 while resident in a mental health centre. I believe that without the work on outbreak control the situation could have been much worse. I commend all those involved who worked tirelessly to keep people as safe as possible.

I will pick up on a few points made by Senators. Senators Paul Daly and Keogan raised the issue of bereavement and the many challenges posed in that regard. I want to put on record that I have allocated money this year for more bereavement counsellors to be hired but counselling hours for bereavement and for bereavement crisis have been available during the entire time of this pandemic. There is a lot of support available of which people might not be aware.

There was much talk about bereavements and funerals in the debate. I would say to Senator Keogan that the Government is not stopping people attending funerals. Covid is stopping them attending because we have the evidence to prove that there were significant outbreaks associated with funerals. My 89-year-old aunt passed away on 1 April last year. She was one of a family of ten and none of her siblings - my own mother included - could go to the funeral. Twenty people were allowed to attend it, so our generation went instead. My mother still cannot believe to this day that her sister died and she could not go to the funeral and grieve. We were lucky to be able to record the service on an iPad and they were able to watch it. I understand at first hand how difficult it is but the challenges around funerals do not arise when one is inside the church. The churches have been fantastic at keeping people socially distanced. The distances are marked out as they are in this Chamber. However, the gatherings before and after the funerals is where the challenges arise. I am a weekly mass-goer and I would love to be able to go back to mass. I know such attendance is a comfort for many people, regardless of their religious ethos. I hope we will be able to go back there as soon as possible, having started the vaccination process.

That leads me nicely to vaccinations, which is also linked to mental health. As Members are aware, we started by vaccinating the most vulnerable who were in the nursing home settings. The figures I have this week indicate that to date, unfortunately, we have lost 1,739 people in the nursing home settings. I commend again the work that has been done by public, private and voluntary nursing homes. They have been at the forefront of this pandemic for the past ten or 11 months. It has been very difficult. Unfortunately, people in nursing homes are very vulnerable. They have underlying conditions and when Covid-19 gets into a facility it spreads like wildfire. That has been very challenging. Obviously, they were prioritised first along with front-line workers but next Monday we will start the roll-out of the vaccination process for those over 70. We will start with those over 85, the majority of whom have been contacted by their GPs to arrange that. It will start with 12,000 doses of the vaccine vials being distributed to GPs next week.

This is a huge logistical challenge and there have been criticisms of the amount of time the vaccinations are taking but there are 490,000 people aged over 70 in this country. Many of them live in rural areas. Many of them might not be able to travel from their homes so the logistics around all of that are being put in place. The roll-out of the vaccine has to be safe and effective. We have also committed to giving two vaccines within 28 days. That makes it a challenge logistically but it is starting. The only limit to people getting the vaccine is supply and to date, the supply has been difficult. I was doing an interview earlier and before it I looked for the figures. We have received 273,000 doses of the vaccine and 250,000 doses have been put in people's arms. We have to keep a buffer for anyone who got their first dose of the Pfizer-BioNTech vaccine because there is a guarantee that they will get the second dose within 28 days.There has been much criticism that the vaccine is not being rolled out fast enough. Nobody is sitting on a vaccine and no vaccines are in cold storage. I would love to say there is one for everybody in the audience; there will be but it will take time. I hope the number of vaccines coming into the country will ramp up significantly in April. This has affected older people's mental health but nobody will be left behind with this vaccination process. If somebody cannot leave his or her house, plans will be made to ensure the vaccine gets to them.

There are some older people not registered with a GP in this country for some reason. They may have come into the country or perhaps they chose not to have a GP. They need to contact the HSE as a matter of priority on 1850 241850. They will be facilitated through their nearest GP and I would appreciate it if everybody could get that message out there.

I compliment Senator Black, who is a passionate advocate for mental health. She spoke about setting up the RISE Foundation and she is the Chairman of Oireachtas Sub-Committee on Mental Health. I would like to work closely with her and look forward to a meeting we will arrange in the next couple of weeks. It has been said by many today that this is not just about the Department of Health, and that is why the new Sharing the Vision policy is cross-departmental. It goes across the Departments dealing with social protection, housing and business. People's mental health can be affected for myriad reasons and having everybody working together is very important.

Community mental health teams continue to provide services, with adaptations in place to protect service usersand staff. Online psychosocial supports are now embedded in service provision. As Senator Black mentioned, there are many people with acute mental health conditions and I am thankful they are being looked after. A position has arisen in the past 12 months where people's well-being is being affected, leading to changes in mood, anxiety and depression. There are challenges with work and having enough money to pay the mortgage. They are trying to homeschool or there may be college students who cannot go to college. These people may be trying to care for others. There are many challenges but there are supports, and I will touch on that.

There are telehealth services, some of which operate seven days per week, including YourMentalHealth.ie, the information line 1800 111 888 and the crisis text line 50808. Non-governmental partner online supports include MyMind, Turn2Me, SilverCloud and Jigsaw. MyMind alone delivered nearly 10,000 free online appointments in 2020 and provides counselling in 15 different languages. We are now a country of many different races and languages, and we do not all just speak English and Irish. I was questioned in the Dáil last week about what we are doing for people in direct provision, for example, with ill mental health and those supports are there in up to 15 different languages. We are trying to ensure they are accessible to everybody. There is still some unused capacity in this area and the Department and HSE continue to plan for any surge in demand as it arises.

We do not yet fully understand the impact of Covid-19 on mental health but it is acknowledged that there have been increased presentations in certain areas. I am especially concerned about the rise in eating disorders among girls and young women. The 2021 budget allocation will enable continued development of the national model of care in eating disorders through the establishment of three new specialist eating disorder teams. I am fully committed to ensuring that the total funding of €3.94 million allocated to this important programme will be spent in full this year.

Currently, data indicate no evidence of a significant increase in self-harm presentations to accident and emergency departments, as was mentioned a lot today.The significant increase in those presenting to accident and emergency departments with self-harm has been much referred to today. It is too early to speculate on the reasons for this increase. Many of the causes might be hidden at home and may not be brought out into the open. It is also too early to speculate on suicide figures, which the Central Statistics Office reports each June, following the coroners' verdicts. However, early international evidence has indicated no increase in suicide, and a decrease in self-harm suicide attempts, early in the pandemic. These findings should be interpreted very cautiously as we await more up-to-date analysis.

Of course, a negative mental health outcome for our population following this pandemic is not inevitable, if we set about responding to the challenge in a cohesive manner. In line with the WHO guidance, the HSE has published a psychosocial framework. It builds on a range of supports that were introduced early last year in response to Covid, including self-harm and psychological first aid supports for staff. The framework acknowledges the impact of the pandemic on mental health in all areas of society, and identifies priority groups, including healthcare workers and people bereaved due to Covid. The framework provides a cohesive, co-ordinated, consistent and collaborative approach to the provision of mental health services and supports across five key levels, from mental health promotion to specialist supports.

It was stated earlier that good mental health programmes have been in place before. Senators have asked if such programmes will be implemented and how it can be ensured that the money in the budget will be spent. I am trying to think which Senator raised that issue. The implementation of the Sharing the Vision policy is proceeding. The difference between this programme and others is that the independent national implementation and monitoring committee is in place. It was established last year and meets monthly. In fact, it held its third meeting this morning. It will hold me, the Department of Health, the HSE and the Minister for Health to account. I have no doubt that it will be quick to come forward if it feels that we are not doing what we should be doing. I am positive that Sharing the Vision is proceeding and is proceeding well.

Many Senators have raised the issue of budgets. I know that Mental Health Reform will have written to all Deputies and Senators in the past few weeks regarding the budget. It is fair to say that we have the largest budget in the history of the State for mental health. It totals €1.76 billion, which is a huge amount of money. The most important thing is that the money is spent well, and there is oversight of where it is being spent.

Of the additional €50 million which was secured, €23 million is allocated to commencing the implementation of the short-term recommendations of the Sharing the Vision policy. This includes funding to recruit 153 new mental health workers. There was much talk about CAMHS here today. To be honest, I was appalled to learn that the waiting list for CAMHS has got to the level that it has. Some 29 new staff will be recruited for CAMHS, which is hugely important. It will have a significant impact. I met with the HSE last week to discuss the recruitment of these members of staff. Obviously, Covid will be with us for a long time to come, and we need to have that recruitment process up and running in parallel with what we are doing on Covid. With panels and other aspects, it takes three to four months to recruit people. With recruitment for CAMHS in particular, staff will need specific training on dealing with children. For example, a staff member could be a psychiatric nurse who has only done adult psychiatry. Sometimes staff need to upskill and complete training. It is important from that perspective. We are focusing on this recruitment. I will be meeting the HSE every two months regarding how the recruitment process is going and where we are with it. There is no point in asking the HSE for an update on the process in October or November 2021. It is most important that those members of staff are recruited.

Many Senators have raised the issue of primary care psychology for children. I believe it was raised by Senator Gavan. It is a worrying issue. When one comes into this job, it is necessary to pick and choose what can be done in a very short space of time. Psychological care for children was an area that I was particularly bothered about. I am currently working with the HSE on a proposal to fully develop, at a cost of €5.5 million, a means of targeting the waiting list.There are 4,800 clients under 18 years of age, many with quite complex needs, who have not been seen by a psychologist and are waiting over 12 months. An initiative is being planned which will supplement the enhanced community care programme to recruit staff on a one-year basis. It will be a targeted approach to get these almost 5,000 children seen this year. That will be a job well done if we can target the CAMHS and psychology waiting lists.

There are many people in posts who will be able to look after their routine lists. However, when a waiting list builds up to that extent, it is hard to target it. I want to put in a targeted one-off approach for one year only to get down the 5,000 children with complex needs who need to be seen quickly. I am hoping to have news on that soon. We are at an advanced stage on this. I have spoken to the Minister, Deputy Stephen Donnelly, and he is supportive of providing the money for it. We are just trying to finalise the details.

When issues come up with the provision of psychologists and psychiatrists, the problem is not money but getting the consultants and dedicated qualified staff to carry out this work because very few of them are unemployed. It is a question of trying to get that over the line but we are working hard on it.

Up to €15 million will provide additional capacity in private sector approved centres, more step-down beds and extra resources for community mental health teams, as well as reconfiguration of facilities.

With regard to other developments, the National Forensic Mental Health Service will be relocated this year from Dundrum to a purpose-built facility in Portrane. I thank Members of both the Upper and Lower Houses for supporting the legislation in December to facilitate this move. I am hopeful the relocation will happen in the second quarter of this year.

The review of the Mental Health Act 2001 is concluding and the heads of the new Bill will be published soon. A significant amount of work is involved in it but we want to get it right. Connecting for Life, the suicide reduction strategy, has been extended to 2024. When I came into office, it had expired, running from 2015 to 2019. I compliment the work of the National Office of Suicide Prevention, which is doing a huge amount of work in this area.

I thank all those working across the mental health sector who continue to provide services and supports during these difficult times. I am fully committed to continuing to develop and enhance our mental health system for all individuals during and beyond this pandemic. Senator Cummins referred to the stigma around mental health and its challenges. We have come a long way since last March. People are now standing up and they are not afraid to talk. It has been difficult for children, parents, students, those working from home and those who have lost their jobs. It has been the most challenging time but people are resilient and upbeat as well. The vaccines have given people much hope. It is slow at the moment as we are limited to supply. However, as soon as we have it, we will get it into the arms of every single person. I thank the vaccination teams which are doing phenomenal work in parallel to their normal work. It is absolutely fantastic that this work is being done.

Senator Cassells made an upbeat contribution. The response has been substantial from all those working in mental health supports. We need to move away from the negative narrative. A significant amount of work is being done, for example through the In This Together campaign. Up to €7 million was allocated to the Keep Well campaign. We must encourage people to keep well, to stay connected, to get out for that walk if they can and to do the very best they can to support each other. It is difficult but, by everybody pulling together, we can get through this. The light is at the end of the tunnel with the vaccine. Many people will be affected for a long time but I will not be found wanting as Minister of State to get the supports into the community that are needed.