Wednesday, 8 December 2010
Mental Health Services
Cuirim fáilte roimh an Aire Stait. I am especially pleased the Minister of State, Deputy Moloney, is here given the topic I have raised relates to mental health. This matter relates to the need to confirm that the mental health budget will be spared in the proposed cuts to the health budget and, in particular, that the specialist rehabilitation teams envisaged under A Vision for Change and constructed thereunder to look after the most vulnerable patients with severe mental illness will not be disbanded or disturbed in their work.
I am aware of and welcome the various commitments made in the budget for mental health care and services. It appears senior HSE mental health managers considered subsuming rehabilitation and recovery teams into other general mental health teams. This would eliminate the rehab service and redistribute its resources to these teams. The teams in question were originally established under A Vision for Change to specialise in and care for those with severe and enduring mental illnesses such as schizophrenia and bipolar disorders. They aim to provide multidisciplinary care for such patients in adherence to the recovery model which has been constructed on the belief people with such severe illnesses can, despite symptoms and disability, live meaningful and fulfilling lives in settings with support levels to match their needs.
Patients are referred from their general teams when their resources are unable to cope with the severity of the patient's illness or deficits in functioning. There are approximately 20 mental health rehab teams nationally, many of which are poorly resourced to perform their functions under A Vision for Change. It has been reported some consultants have no administrative support, do their own typing and do not have the skills mix on their teams which even the referring teams have. For example, occupational therapists have a key role to play in such teams, but not all have them. Many of the rehab teams have never been allowed to function to the optimum.
An outreach service is an essential component of rehab teams, but only two teams nationally have been resourced to construct such a service, whereby people with such severe illnesses can be looked after as far as possible in their own homes. A guiding principle of rehab services is that people should be able to access care where they are. The people concerned, because of their illness, are often the most unwell, most deprived and least able to argue or advocate for themselves. It is incumbent on us, therefore, to prioritise their needs. Their care has improved under rehab teams which can devote more time to them because they have smaller caseloads. This is the care those who have endured years of illness, stigma and marginalisation deserve. Any suggestion mental health rehab teams should be eliminated must be opposed if we are to consider ourselves a decent and civilised society.
I acknowledge the Senator's interest in and commitment to this area. I thank him for raising the matter as it provides me with an opportunity to reaffirm the commitments made in A Vision for Change and allowing me to dispel the notions that funding for mental health services has been parked. The capital projects continue. The new psychiatric units in Letterkenny, Clonmel and at St. Loman's, Mullingar are near completion. For the first time since 1815, there are no further referrals to Grangegorman, with the opening of a new admissions facility for north-west Dublin mental health services in Connolly Hospital, Blanchardstown.
The Government is acutely aware of the vulnerability of mental health service users and fully accepts that the impact of a reduction in funding on front-line services must be minimised. We will ensure the needs of service users remain the highest priority. In that regard, I particularly welcome the special consideration given in the budget announced yesterday to the mental health and disability sectors, which will ensure a maximum reduction of just 1.8% in the 2011 allocation for the sectors. The relatively lower reduction, compared to other health sectors, recognises these services are provided for vulnerable groups. It is anticipated that the savings necessary will be achieved through efficiencies, economies, innovation and flexibility. In the circumstances, I am satisfied mental health services will be maintained and that the question of cutting front-line services can be avoided. The central challenge facing the health service is to continue to remove costs from the system, while also delivering broadly the same level of services next year.
The Government recognises the financial and staffing constraints within which all budget holders within the HSE and its funded agencies will be required to operate next year. Undoubtedly, the levels of commitment, innovation and flexibility required by all concerned will be greater than ever before to protect services. We must demonstrate an approach to managing within financial constraints that takes account of relative priorities. In particular, this requires that services provided for the most vulnerable members of the community should be afforded the appropriate priority. This consideration should inform decision making at all levels in the HSE.
Despite the requirement to achieve savings of up to €6 billion in the budget, an additional €1 million was allocated to the National Office for Suicide Prevention. This funding will enable the office to build on initiatives taken to date and bring added momentum and new impetus to its activities to address the increasing incidence of suicide. The See Change initiative will address the stigma attached to mental health issues. It will help various groups to reach out to individuals to help them understand the support structures available. It also aims to help in reducing the high suicide rate. In particular, the additional funding will target increasing the number and range of training and awareness programmes, the improvement and standardisation of the response to deliberate self-harm, the development of capacity within primary care to respond to suicidal behaviour, consider new models of response and the co-ordination of helpline supports.
I must acknowledge the commitment of Deputy Neville and the Irish Association of Suicidology which I have met several times recently. They have come back to me with new thinking and offered to be the regulator of the various groups which want to assist in suicide prevention to ensure we are all on the same message.
Despite the economic downturn, we are still making tangible progress in implementation of A Vision for Change. It is important to recognise that in many parts of the country services are pressing ahead with implementation of the policy, a fact of which we should not lose sight.
While the emphasis is on community mental health teams, I will not brag that some of them are staffed to the maximum. The real challenge is to ensure the moneys saved as a result of the closure of the old institutions are put back into community mental health teams. Significant progress has been achieved, including shorter episodes of inpatient care, improved child and adolescent mental health services, improved forensic mental health services, fewer involuntary admissions and the involvement of service users in all aspects of mental health policy, service planning and delivery. Representatives of service user organisations sit on local committees to ensure they are involved in all initiatives taken under A Vision for Change.
Acute admissions to St. Brendan's Hospital, Grangegorman have ceased following the opening of a new admissions facility for north-west Dublin mental health services at Connolly Hospital, Blanchardstown. I visited that hospital last week and was pleased to see a great sense of determination to deliver A Vision for Change, given that part of that process was to secure a new hospital setting away from Grangegorman.
Enabling works are under way on a 54-bed unit to replace the current facilities for long-stay patients at St. Brendan's. It is also worth noting that plans for the transfer of acute inpatients from St. Ita's, Portrane, to a new purpose-built unit at Beaumont are now proceeding.
New community nursing units in Ballinasloe and Mullingar have been developed and it is anticipated that two 20-bed units for adolescent inpatients in Cork and Galway will be fully operational by January. Other construction works have commenced, including the development of a new acute service in Letterkenny and also at Cherry Orchard in Dublin. These services will be funded from the proceeds of the sale of psychiatric assets.
On the specific point raised by Senator Mullen, there is a commitment to continue to support community services. I acknowledge the strong contribution and commitment of service providers when they continue to work in 2011 to ensure the maximum delivery of services in an efficient and effective manner, with priority being given to those in greatest need.
I thank the Minister of State for his response. I welcome the extra €1 million in funding for the National Office for Suicide Prevention. Will the Minister of State urge HSE management not to subsume rehabilitation and recovery teams into other general mental health teams?
That has to be a given. In talking about A Vision for Change we must be real and separate it from the funding part. To do what the Senator suggests the HSE might have in mind would be a retrograde step. It would certainly not be in keeping with A Vision for Change. That must be the clear message as we start the new programme in 2011. If there is any evidence of subsuming such teams, I would like to be made aware of it in order that we can make direct contact with areas in which the HSE may be implementing that programme.