Wednesday, 8 February 2006
Mental Health Services.
The mental health services have been neglected and underfunded in recent years. Funding dropped from 11% of the total health budget in 1997 to 6.6% in 2003, but the WHO recommends that 14% of a country's health budget should be spent on such services. The provision of mental health services should be put on a par with the provision of general health services, both hospital and community services.
Suicide is one of the severe potential consequences of mental illness and occurs with the greatest frequency among young males and older people. As chairperson of a mental health association in County Roscommon I believe we need more awareness and education on the subject. It is also necessary to get rid of the stigma of mental illness.
The document, A Vision for Change, has a development plan for the mental health services but I am concerned that plan 1 for inpatient admissions proposes one bed for every 350,000 people. Aspects of the plan are very welcome, especially the ring-fencing of proceeds from property sales for mental health. I am being a little parochial but I believe local inpatient units such as the ones in Roscommon, Castlebar, Ballinasloe and Galway should be maintained. It is very difficult to come from Arigna in north County Roscommon to Galway, and it is impossible for someone from outside Belmullet to go to Galway. This is the Hanly report in another guise and I fear that mental health is once again being used in the context of that report. We must be vigilant and this is not the right way to go about it.
Will the Minister of State indicate if community mental health teams will be put in place? Why is my county, Roscommon, to receive nothing from the fund of €18 million that has been allocated to the development of mental health services? The county needs funding to develop mental health teams. It needs a psychiatrist, a psychologist, a social worker and specialist community nurses. We are very concerned that mental health services in County Roscommon will be left out and I appeal to the Minister to revisit the matter and allocate the money for those services. How can there be a service without inpatient beds or a fully-dedicated community mental health team?
I appeal to the Minister of State to provide County Roscommon with local inpatient units. They have provided a wonderful service and will continue to do so if they are recognised and receive appropriate funding.
I thank Senator Feighan for raising this matter on the Adjournment.
The recently published report of the expert group on mental health policy, A Vision for Change, outlines an exciting vision of the future for mental health services in Ireland and sets out a framework for action over the next seven to ten years. This report is the first comprehensive review of mental health policy since Planning for the Future was published in 1984 and has been accepted by the Government as the basis for the future development of mental health policy.
A wide ranging and comprehensive public consultation process was undertaken in the development of this policy which gave a clear indication of the expertise that exists among professionals and service providers with regard to mental health issues. It also made clear the views of service users on the present state and future development of mental health services. Building on the findings of the consultation process, A Vision for Change recommends that specialist expertise in mental health services should be provided by community mental health teams, CMHTs. These are expanded multidisciplinary teams of clinicians who work together to serve the needs of service users across their lifespans. CMHTs should serve defined populations and age groups and operate from community-based mental health centres in specific sectors throughout mental health catchment areas.
The report also recommends that a programme of capital and non-capital investment in mental health services, adjusted in line with inflation, be implemented in a phased way over the next seven to ten years. The proposed new workforce will comprise more than 11,000 staff throughout the service. Allowing for the assimilation of all existing posts, the expert group has estimated that a total of 1,803 new posts across the services and non-capital investment of €151 million per annum in addition to existing funding will be required. The programme of investment has already begun with the allocation of an additional €25 million to the HSE for mental health services in the Estimates for 2006. Significant capital investment will also be required to provide new and replacement facilities for the mental health services. This has been estimated by the expert group to be of the order of €796 million, much of which could be realised from the value of existing hospitals and lands.
The County Roscommon mental health services have undergone significant changes over the past two decades. The move away from institutional to community care has brought the mental health services in County Roscommon closer to the service user and the switch from hospital based to individualised care has empowered users to take a more proactive role in their care and treatment. This has been complemented by the provision of care and treatment by multidisciplinary teams in partnership with other health care professionals and the voluntary agencies.
As the Senator will be aware, mental health services in County Roscommon are provided in a 30-bed integrated acute admission unit in Roscommon General Hospital and through community based services based at Áras Naomh Caolin and Knockroe House, Castlerea. A range of care and treatment is also provided in the day hospitals, day centres and outpatient clinics located throughout the three Roscommon sectors. The acute admission unit at Roscommon General Hospital opened in 1992 in response to Government policy on mental health as outlined in Planning for the Future. I am informed that this was a major turning point for County Roscommon's mental health services. As a result, St. Patrick's Hospital, Castlerea, was closed and community-based mental health services were expanded, thus providing a large range of treatment options for service users in the community. These changes have been very much in line with the model of service provision now recommended by the expert group. The proposals in A Vision for Change will allow for further expansion in community services and specialised services for groups such as children, older people and those with particular needs. These changes will enhance the mental health services nationwide, including those in County Roscommon.
I am aware that the voluntary sector in County Roscommon play vital roles in providing support to the service users and carers, reducing reliance on inpatient services and enabling people to become empowered and proactive in their recovery. This is complemented through giving service users a say in their care and treatment. The patient advocacy service provides a valuable independent voice on behalf of the patient and this concurs with the philosophy of client centred care espoused in A Vision for Change.
The implementation of this policy will be a matter for the Health Service Executive in accordance with the provisions of the Health Act 2004. The HSE has stated that the national mental health directorate within the executive will immediately establish an implementation group to ensure that the recommendations are realised in a timely and co-ordinated manner. As Minister of State with special responsibility for mental health, I will be seeking the active support of all those who are involved in the mental health services so that together we can bring about the far reaching improvements recommended in A Vision for Change. I will shortly be appointing a group, as recommended in the report, to monitor the implementation of its recommendations.
A Vision for Change details a comprehensive model of mental health service provision for Ireland and describes a framework for building and fostering positive mental health across the entire community and providing accessible community based specialist services for people with mental illness. On that basis, the Senator can be assured that, in line with this policy, the level of mental health service provision throughout the country will be improved and enhanced in coming years.