Tuesday, 8 April 2008
Mental Health Services
I thank the Cathaoirleach for the opportunity to raise this issue. I accept the Government is committed to the development of appropriate mental health services and this is clearly seen in the allocation of money to those areas of the health service. My question is about the allocation of €25 million for the implementation of A Vision for Change in the 2007 budget.
On 20 December last, I asked in an Adjournment debate where this money had been spent. The reply I received indicated the laudable projects to which the money was allocated, but it did not indicate whether the money was actually spent on these projects. My concern is that the evidence available does not appear to indicate that the €25 million was spent on mental health services. The purpose of this debate is to examine the concrete progress on those projects. Just under €8 million, for example, was allocated to services for children and adolescents. That included provision for 22 inpatient beds for children and adolescents. However, we do not have 22 such beds. I have spoken to people in the Health Service Executive and have asked Professor Drumm whether any adolescent beds will be provided this year. He indicated that it appears unlikely. However, the reply I received in December stated that the money had been specifically allocated last year for the provision of those beds.
The reply also stated that eight teams were being developed specifically for children and adolescents. Has that happened? I was also told that €12.5 million was being allocated to improve specialist mental health services for older people, to improve specialist mental health services for people with intellectual disabilities and to increase the number of adult teams in the community. Will the Minister indicate whether that money was spent in the areas for which it was allocated? Can he give a progress report on each of the projects identified to me in December as being in receipt of that funding? There is no evidence they received the funding.
I am replying on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney. Under the Health Act 2004, the Health Service Executive is obliged to operate within its overall Vote. In this regard, it took steps to ensure it met this objective in 2007 by delaying some of its planned developments, including developments in mental health.
I understand from the HSE that some mental health services funded in 2006 and 2007 will be put in place in 2008. These include the provision of eight additional consultant child psychiatry teams; the provision of 18 additional beds for children and adolescents at St. Anne's, Galway, St. Vincent's, Fairview and St. Stephen's Hospital, Cork, to increase the bed complement from the current provision of 12 to 30 during 2008; and the construction of two 20-bed units for children and adolescents in Cork and Galway. Construction on these units is expected to commence in 2008 and be completed in 2009.
A Vision for Change, the report of the expert group on mental health policy, which was launched in January 2006, has been accepted by the Government as the basis for the future development of mental health services. Implementation of the report is the responsibility of the HSE. The estimated additional cost of the implementation of A Vision for Change is €150 million over a seven to ten-year period.
Substantial resources have been invested in mental health. A total of €51.2 million has been allocated since 2006, which represents more than a third of the overall requirement. In addition to the extra funding required to finance A Vision for Change, existing resources need to be remodelled and reallocated. Implementation of A Vision for Change is dependent to a much greater extent on the remodelling of existing resources than on new additional funding. Additional investment must be phased in parallel with the reorganisation of mental health services and resources. In view of the significant additional investment in 2006 and 2007, it is entirely appropriate to pause and review the situation to ensure consolidation of the investment to date.
In the context of ever rising demands for health resources, mental health expenditure should be closely monitored to ensure services demonstrate effectiveness and efficiency. Before any further additional funding is provided it is essential the HSE is in a position to demonstrate that money allocated for mental health services is used efficiently and that the substantial changes in the organisation and delivery of mental health services envisaged in A Vision for Change are progressed.
An independent monitoring group was established to monitor and assess progress by the Health Service Executive, Departments and other agencies in implementing the recommendations set out in the report. The monitoring group's first annual report was published in May 2007. The report acknowledges the progress made but expressed concern about the lack of a systematic approach to implementation of the report and the lack of clarity in responsibility for implementation in the HSE.
In January 2008, the Government announced the establishment of the Office for Disability and Mental Health. The office will support the Minister of State with responsibility for disability and mental health in exercising his responsibilities in four Departments, namely, the Department of Health and Children, the Department of Justice, Equality and Law Reform, the Department of Education and Science and the Department of Enterprise, Trade and Employment. The office brings together responsibility for a range of different policy areas and State services which directly impact on the lives of people with a disability and people with mental health issues. It has a remit to drive the implementation of A Vision for Change, working in partnership with the HSE and other stakeholders to achieve implementation of agreed targets. It aims to bring about improvements in the manner in which services respond to the needs of people with disabilities and mental health issues by working to develop person-centred services, focusing on the holistic needs of clients and service users and actively involving them in their own care.
The Health Service Executive recently approved an implementation plan which sets out six key priorities for 2008 and 2009. Following concerns raised by the Office for Disability and Mental Health regarding the need for a longer-term focus, the HSE has indicated it will prepare a more comprehensive plan before the end of this year. I assure the Senator of the Government's commitment to the development of mental health services in line with the recommendations in A Vision for Change.
I thank the Minister for his response, which is more realistic than the one I received in December. I do not find it acceptable that the HSE can be allocated money specifically for projects for which there is a greater need and that it can indicate to the House that the money was spent when it was not.