Mary Moran (Labour)
Link to this: Individually | In context

I welcome the Minister of State, Deputy Kathleen Lynch, and congratulate her on the excellent work she has done to date. I look forward to working with her on mental health issues. I have a particular interest in this area because I am the parent of a child with a moderate intellectual disability. At this stage, I am well qualified to speak about the lack of services in mental health and disability.

In order to highlight where change is needed, I shall share the experiences of two of my constituents, who are also good friends. These individuals have suffered greatly from the lack of services in this country. Over the past two years, a young friend of mine attended her GP on at least 20 occasions. We say that we would spend our last penny to make our children better but most families also have to take account of money. At €50 per visit, 20 trips to the GP is a significant expense. At each visit, the girl in question was prescribed anti-depressants either in the form of increased dosage or different medication. As she did not make progress, she was referred to a psychologist who saw her twice at a cost of €80 per session before referring her back to the GP. After asking for help every single day, she was eventually referred to a psychiatrist who saw her three times. The initial consultation cost €300 and the remaining two were €180. Despite these visits, the patient made no improvement and she begged to be admitted to hospital. On one occasion, she told me that if she was a dog in pain something would be done to help her and she asked if anyone could help her. Coming from a 19 year old child, this is atrocious.

David Norris (Independent)
Link to this: Individually | In context

Hear, hear.

Mary Moran (Labour)
Link to this: Individually | In context

The psychiatrist eventually agreed to admit the girl to hospital but she was told she would have to wait at least four weeks before she could be admitted to a private psychiatric hospital. She was given an option of two hospitals. On a daily basis, the girl's parents and GP called both hospitals to plead for help but it took four weeks of numerous daily telephone calls to highlight their fears for her safety before she was admitted to a hospital in Dublin. The other psychiatric hospital only responded to the parents with an offer of a bed after 11 weeks. The attitude was she would have to wait. How can we tell someone who is suffering from a depressive illness that we do not have a bed? Do we ask the person to put off his or her suicidal thoughts for four weeks? It is atrocious.

This patient was treated at the highest level available but her family nevertheless saw a decline in her mental health. Before being admitted to the hospital, she was assured of intensive psychiatric care but this did not happen. This girl spent 11 weeks in a hospital in south Dublin but she was discharged in worse condition than when she was admitted. She was told to take the tablets and go away. She was given a further appointment after her discharge and her mother tried to meet the consultant on the day of discharge. They rang other wards twice but could not get to speak to a doctor. Eventually an outpatient appointment became necessary. When the girl attended the appointment, she was horrified to discover that it had been made with a separate doctor, whom she had never met in her 11 weeks in hospital. When her mother rang to asked if she could see the consultant who had treated her, she was told the consultant had not seen an inpatient as an outpatient for over 11 years, which is absolutely atrocious. We must provide for a follow-up and let the people with mental health issues who are suicidal or suffer from depression know that we care. They need somebody who believes in them rather than somebody to lecture them. If we are paying money for psychiatric services, why can there not be a follow-up with consultants providing treatment? It beggars belief that this does not happen.

A friend of mine took his own life four weeks ago. He had asked to be admitted to hospital to receive help and his family were also told there was a four to six week waiting period. He was eventually admitted to a psychiatric wing of a general hospital in my constituency. When a bed eventually became available in a psychiatric hospital, with the patient due to be transferred on a Friday morning, there was no doctor available to sign the release form to allow the patient to be transferred. His wife had to tell him he would be staying in the general hospital for the weekend as there was no one available to sign the release form. An hour later he had taken his own life, having felt scared and so alone in the hospital, feelings he had conveyed to his wife.

Such a case reiterates what I have argued for - that people should know somebody cares. This young man had a young family and had pleaded for help from the health system, as many have done. He was failed miserably. We must make A Vision for Change a much changed vision for the current system under which the most vulnerable suffer the most.

I will briefly mention that in my own child's school three 18-year old youths left and they had absolutely nowhere to go and their parents are totally distraught. If a youth leaves secondary school, there is always somebody available to help, but these children left the school without as much as a goodbye or graduation ceremony. There was no card or letter of good luck. We are working with the parents to put something in place. The system is unfair and the most vulnerable are suffering.

Recently I attended an excellent conference organised by the charity Save Our Sons and Daughters, SOSAD, which was founded by a Louth man whose son had committed suicide a few years before. At the conference it was mentioned that there had been 527 documented deaths by suicide in Ireland in 2009, although it is thought the figure is much higher because it does not take into account non-accidental drownings or road fatalities. In 2010 the figure rose to 700. The group was founded in Drogheda and has expanded across counties Louth, Meath and Cavan, although it receives calls from all over the country. One of the most important services provided by it is the listening service about which I spoke. As SOSAD is a charitable organisation which receives no public funds, I ask the Minister of State to consider assisting such groups which provide such an excellent service. To date, it has saved over 250 lives by providing a follow-up service.

John Gilroy (Labour)
Link to this: Individually | In context

I am happy to welcome the Minister of State to the Chamber again. I will make a point about suicide, although I do not intend to speak about the issue as it relates to A Vision for Change. It must be acknowledged that over 1,000 people have died by suicide in the past two years. Every party represented in the Chamber should consider this figure and we should have a debate devoted to the topic. Mental health services are in tatters. Not alone do such services not respond to suicide in communities, but in a great number of cases they are not even aware suicides occur. I have been a health service professional for a long time and I am very aware of this issue.

I am very happy to have an opportunity to speak to A Vision for Change. For too long the mental health service has been seen as the poor cousin in the health service and during the years the level of investment in the service has been little short of scandalous. In 1984 I started my career working with the service in Cork. When one becomes part of a system, it is sometimes difficult to see what is wrong with it. At the time there were over 1,000 patients hospital and conditions, owing to historic under-investment and wider societal views towards persons with a mental illness, were not good. Overcrowding, poorly maintained buildings and unstructured days for patients were the most serious problems. Nevertheless, the staff with whom I worked were probably the most decent people I had ever come across. They struggled daily in very poor conditions to ensure the dignity of patients received the highest priority. I learned many lessons in that old institution, the most important being decency is the most vital element.

In 1984 an important policy document, Planning for the Future, was published. It was one of the first major documents to be published. It was heralded at the time as the greatest show in town. It is unfortunate, therefore, that 27 years later, all of its recommendations have yet to be implemented. The lack of political will and investment ensured they were implemented in piecemeal fashion. Most of the institutions are now closed and good riddance to them. However, promised community developments have not taken place. It is scarcely believable that some persons in long-term care are living in institutions 27 years after the publication of a report committed to the closure of institutions and developing community services.

Some years ago I had the opportunity to be involved in an international literature review of mental health policy documents. We considered a range of policies in many countries and among the many examined we found that the national framework for mental health services in the United Kingdom offered a very good model for service delivery. I can honestly say the policy framework of A Vision for Change has no peer across Europe or the world. What particularly impresses me about it are the comprehensive views offered about the potential to create a world-class model in this country. The Minister of State, Deputy Kathleen Lynch, is driving change in this area and the prospects for delivering such a model are very bright. The creation of a directorate for mental health, as announced by her, is an excellent start, on which she should be commended.

A statement in A Vision for Change reads, "The vision that guides this policy requires mental health services to be characterised by a partnership between stakeholders". This is an ambitious statement of intent and requires a complete cultural shift in how we deliver our services. These services were and still are characterised by a paternalistic approach whereby health care professionals are seen to deliver health care to service users.

The media reported today on the case of a 40 year old man who is an involuntary patient at Naas General Hospital. His family is seeking to stop the mental health services from administering electroconvulsive therapy, ECT, to him against his will. While I fully understand the complexities surrounding this area, it is an indictment on our society that such cases have to be taken. In any other branch of medicine, or indeed life, a major invasive procedure would not be sanctioned by law. The law in this instance is section 59(1)(b) of the Mental Health Act 2001, which provides that ECT can be administered if two consultants form the opinion that it is necessary. Court orders are required in every other branch of medicine before decisions on issues of this import can be made. The Minister of State said that the health service should be seamless and that the rights of patients in one branch of medicine should be the same as the rights of patients in another branch of medicine. The case I have mentioned shows that the mental health services have a long way to go in this regard.

In addition to the need to make a cultural shift, the other challenge we face as we try to implement A Vision for Change relates to costs. The degree of change that is envisaged would involve significant investment. It is clear that adequate budgetary plans should run parallel with policy changes. I am worried about that in this instance. The challenging financial situation we face does not bode well for these changes.

I understand that the moneys to be raised through land sales will be ring-fenced for investment in mental health services. Can any of us really say, hand on heart, that we realistically believe much money will be realised from this source in the current economic climate? The Government should front-load these costs and recoup its investment at a later date when land sales are achieved.

In tandem with policy changes in mental health services, we must also effect policy change in other areas. There is no doubt that poverty and social exclusion are related to mental ill health, although the exact pathway remains unclear. We know that 70% of users of mental health services depend on welfare payments. Obviously, our policy needs to recognise this.

I know from working in the area that access to housing is an important element in the recovery and maintenance of good health. When people are discharged from hospital without having anywhere to go, it poses a significant obstacle to allowing them to return to their communities, where they want to live in quality housing. We must build partnerships between the mental health services and the local authorities in this area.

Education policy is vital. The education system has to recognise its important role in this regard. Stigma reduction measures should be included in any education policy. I recognise the importance of A Vision for Change and the Minister of State's undoubted commitment to it. We also need to recognise that policy changes in other areas are needed before we can deliver the exciting prospects that are outlined in A Vision for Change.

David Norris (Independent)
Link to this: Individually | In context

I welcome the Minister of State to the House. We are lucky that a person with such a passion for and commitment to this area is in this role. I compliment Senator Gilroy on raising the important issue of the involuntary subjection of patients to electroconvulsive therapy. He is probably aware that working with the Green Party, I introduced legislation in the last Seanad that would have dealt with this issue. The legislative process was not completed, unfortunately. Perhaps the Government will consider revisiting the Bill, which relates to a complex area.

I listened with great admiration to Senator Moran's superb and greatly moving speech. It was one of the best speeches I have heard in 25 years in this House. It came from the heart, but it was not just emotional. It put very clear facts before us. All of us of all parties and Governments must take some responsibility for those facts as a community. It is important for these matters to be documented in the manner that was done by Senator Moran.

I would like to comment on a couple of aspects of the Minister of State's speech. A Vision for Change is an excellent document that has unfortunately been left lying around for some time. I am glad that the Minister of State acknowledged honestly at the outset that implementation has been slow. I hope it will speed up under her stewardship. I am pleased that in the last paragraph of her speech, she said €35 million will be ring-fenced annually. I like the sound of that because it seems that something will actually be done.

The Minister of State referred to the question of involuntary admissions, which is analogous to the question of the involuntary subjection of patients to invasive treatment. I was particularly glad to hear her refer to the establishment of a national service users executive. It is important for us to involve people with mental health issues in their own recovery. We need to empower them, listen to them and involve them in these discussions. I was pleased to hear her refer to the See Change alliance and the Make a Ripple initiative, to which I have made a small commitment.

I hope I am not blowing my own trumpet when I mention a learning experience I have had in recent times. Mental health was the first of the three pillars I put down when I launched my bid for the Presidency. I thought it was a quixotic thing, that I was being an idealist. It has astonished me that people have raised this issue with me every time I have pulled into a petrol station or gone into a little coffee shop. They ask me to help to smash the stigma and break the silence on this issue, which is exactly what the Minister of State has been saying. If one is depressed, one needs the help of others to raise the burden off one's shoulders.

It is helpful to take on board the fact that mental illness is just that - an illness. I have been saying for the last six months that people are not ashamed of a broken arm or a touch of bronchitis, but they are ashamed of mental illness. The reason for that is the existence of this stigma. It can be a black mark if one is looking for a job. We need to address that, particularly now that people have been courageous enough to come out and say they have experienced mental health problems. Some 25% of people in this country will experience serious mental health crises during their lives.

I remind the House that Catherine Zeta-Jones had a bipolar episode that was triggered by her husband's throat cancer. Stephen Fry has spoken about the similar difficulties he has experienced. It is absolutely wonderful that distinguished sports people who are regarded as icons in our society have had the courage and bravery to discuss these issues. They are to be commended.

Perhaps we need to consider the definition of "mental health". I think it relates to the old Latin tag, mens sana in corpore sano - a sound mind in a healthy body. It describes how we think and feel about ourselves and other people, how we perceive and interpret what is going on in our lives, and our ability to cope and deal with change, transition and significant events. One's feelings can sometimes become so intense that they interfere with one's day-to-day activities, which leads to physical or behavioural symptoms that can be confusing for one, one's family and the people surrounding one.

We should remember that mental health spans a continuum that goes from positive mental health to mental distress, mental disorder and mental illness. Equally, we should examine the history of how this subject has been dealt with. It is remarkable that Jonathan Swift founded St. Patrick's Hospital in the 18th century when he recognised that mental illness needed to be considered in parallel with physical illness. By contrast, we spent the 19th and 20th centuries building institutions that, by the 1950s, were used to incarcerate 25,000 people. They were sometimes used as repositories for people who were awkward or difficult or were experiencing an emotional crisis. They were left there.

I am sure many of my colleagues have read a moving book, Bird's Nest Soup, which was written by Hanna Greally, who spent 40 years in an institution. When a young psychiatrist recognised that there was nothing wrong with her, she managed to get out even though she had become partly institutionalised.

I welcome the commencement of the deinstitutionalisation process. The problem is that it is a question of funding and implementation. Although community care and alternative services are excellent, they are not yet in place. I do not think we can responsibly put people back into the community until facilities are available to look after them. This kind of aftercare was referred to by other speakers. Although it is good that the number of people in institutions has been decreased to 1,200, it is still problematic.

Electroconvulsive therapy was not the worst of the forms of psychiatry that were practised in institutions in previous times. Lobotomies were carried out. Some Senators may have seen the wonderful series on the Kennedy family that was broadcast recently. It clearly depicted the distress of Jack Kennedy's mother, who emerged from the series as a remarkable woman, when she discovered that her husband had agreed behind her back to have Rose Kennedy lobotomised. The same thing happened to the sister of Tennessee Williams, also called Rose, on whom a central figure in his wonderful play, "The Glass Menagerie", was based. We have an alternative way of looking at these things now which is to see people as human beings and complex organisms with an emotional, rational, spiritual and physical presence. All of us experience periods when we feel sad, hurt, depressed or out of control. It is all a part of being human but sometimes it can become extreme and lead to suicide, a desperately important issue.

I was interested to hear Senator Moran use the phrase "take their own lives". All of us used language whose implications we did not understand, such as "committing suicide". I remember Deputy Dan Neville in this House 15 years ago operating on the decriminalisation of suicide. It is a nonsense to make it a criminal offence. What does one do? Does one imprison or fine a corpse? One cannot do anything to someone who is dead but one can affect the family and that is cruel. One commits a sin or a crime and the churches were wrong to punish the families by refusing to allow people to be buried in sanctified ground and I am pleased that has changed as well. Therefore, the language is terribly important.

I have dealt with Sosad and I was pleased that it was mentioned. I have been there, seen them and they are wonderful people. I have been to Pieta House, run by Joan Freeman, and with Mental Health Ireland, chaired by Michael Hughes. It is a tribute to our health service that people such as Michael Hughes and his colleagues in Dún Laoghaire continue their work and that people who worked in the HSE continue in their retirement. It shows an absolute and real commitment of which I am very proud.

One thing I have learned from studying the issue of suicide is that in 98% of cases the intention is not to end the life but to put an end to unbearable emotional and mental agony. This means it is possible to intervene and there are signs such as giving away something very valued, such as a personal memento, a sporting trophy or a doll retained from childhood, or extended telephone calls with friends who are abroad. It is possible to intervene at that moment. We must publicise and learn what these factors are. There is no doubt whatever that the economic climate has something to do with this. In the past week, a publication of European statistics showed that throughout the European community there has been a correlative rise in the incidences of suicide that parallels economic pressures directly. This is a significant matter.

The three most important mental health problems in Ireland are alcoholism, depression and suicide. We must approach alcoholism. I am extremely sorry to discover that the Pioneer Total Abstinence movement, founded by Fr. Matthew of Cork, is in financial difficulty. I hope some attempt will be made to remedy this. I am not a pioneer myself, I take a drink, but it is a wonderful organisation and they do fantastic work. The influence of these enormous conglomerates is awful. They are no longer Irish companies and we should remember that. They are international organisations which have meetings in boardrooms in London and New York. They look at graphs and decide and predict the drinking habits of the young. It is a remarkably powerful lobby and this Parliament should stand up to it.

I welcome the Minister of State's contribution. This is a good day for Seanad Éireann. There have been excellent speeches all around. I hope the debate will be covered in some of the media because we need the co-operation of the media to ventilate these issues and to support our colleagues who are experiencing these difficulties.

Tony Mulcahy (Fine Gael)
Link to this: Individually | In context

I welcome the Minister of State to the House. I wish to outline a local example of a possible solution which may help to meet some of the housing needs of those with intellectual disability who wish to live independently. The Brothers of Charity in Clare have gone to great lengths in recent years to provide for the accommodation needs through the rent supplement structure. Unfortunately, they have met a brick wall with the local community welfare manager. I can provide the Minister of State with her name afterwards if she so wishes. I commend the Brothers of Charity in Clare on being among the most progressive service providers in the country. I declare an interest, since my daughter, Colleen, receives a day service from them. I call on the Minister of State to liaise with the Minister for Social Protection, Deputy Burton, to examine the possibility of a rent supplement scheme or rental accommodation scheme, RAS, which could be used to provide housing for those with an intellectual disability or mental health issues.

The Minister of State could also liaise with the Minister for Finance to consider the use of houses in NAMA, of which there are a great many throughout the country. They could provide an option and the Government would have no need to find the money for these. The service providers in Clare assure me they will provide the independent living supports necessary to those who need them. We must work within the structures already in place to find a quick solution and answer and this should be facilitated. I call on the Minister of State to add the Minister of Finance to the list of Ministers who should help in this regard.

Darragh O'Brien (Fianna Fail)
Link to this: Individually | In context

Cuirim fáilte roimh an Aire Stáit. I congratulate the Minister of State on her appointment and I have no doubt she will carry our her role with distinction. It is an important portfolio. The Minister of State will agree that a former colleague of mine and a personal friend, John Moloney, did a top notch job in this area. This is an area which has cross-party support and all of us care about the areas of disability, mental health and psychiatric care. It is in the interests of all of us and all communities.

A Vision for Change sets out the vision. The progress that has been made since 2006 outlined by the Minister of State in her contribution is significant. The moves towards integration within the community, independent living and respite within the community are crucial. It is crucial to move away from the psychiatric institutions. Having said that and if I may be parochial for one moment, inpatient beds are required in my area at St. Ita's Hospital, Portrane, which has served the areas of Donabate and Portrane since 1901. It has a track record in looking after people with intellectual and psychiatric disabilities. Unfortunately, many of the admissions are due to attempted suicide.

I am concerned and I call on the Minister of State to take this back to the Department. New admissions to St. Ita's Hospital will cease from 31 August. I welcome that the Minister for Health has informed me that construction on a new inpatient unit in Beaumont Hospital will begin shortly, but what will happen in the interim? The proposed date, 31 August, is only weeks away. The staff in St. Ita's Hospital are excellent. I visit it regularly. However, there is grave concern in the area. I call on the Minister of State to take that back to her Department. I have no wish to be overly political on it. I am keen to know about construction, planning and everything else that happens. Will the Minister of State indicate today when she expects the new inpatient unit in Beaumont Hospital to be open and what are the construction timelines?

Some of my colleagues mentioned young adults. Certain organisations deserve support. The HSE and its staff carry our crucial services, but certain voluntary and community bodies carry out great work as well. Prosper Fingal looks after many young adults when they leave school and provides training for the workforce in independent living and education. It looks after hundreds of young adults. Like everything else, there is pressure on funding. However, I call on the Department to establish what can be done outside the HSE. Another example is the Caring and Sharing Association, CASA, which has branches throughout the country and in my area where it provides respite care for people and gives families a break. We should examine the value for money we are getting. Some groups are doing fantastic work and it is not a good idea to have everything centralised.

In the 2011 budget there was a 1.8% decrease in disability funding. That was significantly less compared with the other decreases that had to be brought forward in the previous budget. This was welcome, especially since we are in a deflationary environment. Effectively, the budget of €920 million has been retained, which is not insignificant. I realise we are some way from the budget but we are not too far away from the Estimates. The Minister of State will get 150% support from this side of the House. It is crucial that the budget is maintained and that mental health and disability services continue to be ring-fenced. It is also important that the sale of these assets do not simply go back into the pot and that, instead, these areas continue to be ring-fenced to provide new facilities such as Knockamann which opened up earlier this year in Portrane. Mr. John Moloney also was able to surmount the moratorium issues to ensure this area was perceived as a crucial priority, because these are the most vulnerable people in society. How the vulnerable are treated is a reflection of how progressive or good is our society. While I do not expect the Minister of State to be able to provide a figure today, she should refer to progress being made towards the Estimates project, the ring-fencing of moneys and at the very least, the maintenance of the budget that was provided for in 2011.

I wish to raise a couple of items pertaining to community group funding. There is a raft of groups nationwide. Earlier I referred to a study being carried out. Are studies being undertaken on the funding being provided to such groups with reference to the work they carry out? I refer in particular to comparing the work they do with that done within the Department of Health and the HSE. Crucial work is undertaken by organisations such as the Caring and Sharing Association, CASA, the Arch clubs, Prosper Fingal and other groups throughout the country, which are saving the State money. While this is not a monetary issue, more of this can be pushed out into the community rather than simply being controlled centrally through the HSE.

I wish the Minister of State well in this portfolio. She will receive all the support she requires from the Fianna Fáil grouping. The issue of funding services for mental and intellectual disabilities obviously transcends all political parties and she will find no disagreement from Fianna Fáil if she is able to ensure the budget is maintained and the ring-fencing of moneys for the services continues.

Deirdre Clune (Fine Gael)
Link to this: Individually | In context

I also welcome to the House the Minister of State with responsibility for mental health services and wish her well in the portfolio. It is a highly appropriate appointment. While we do not share a constituency, we are from adjacent constituencies and the Minister of State has had a long-held interest in, and has campaigned for, this area. I am sure she knew exactly what direction she wished to take before her appointment and I wish her well.

A Vision for Change sets out an overall blueprint on how services for those with mental illness can be appropriated. While it was published in 2006, it remains a highly important guiding tool as to how progress should be made in this regard. The issue of funding has been mentioned and progress in implementing A Vision for Change has not been as good as anyone would wish. I note the Minister of State acknowledged this point in her contribution. For example, in 2007 funding of €24 million that had been allocated to implement services pertaining to A Vision for Change was diverted elsewhere. The Minister of State is faced with the challenge of ensuring that funding allocated mostly through the HSE is appropriated and spent where intended. I welcome the programme for Government statement that funding will be allocated on an annual basis. A total of €35 million will be allocated annually for the development of community services, which are extremely important.

The entire thrust of A Vision for Change is to move away from establishments and from putting people away, as the term was, and towards a focus on developing services within the community, while retaining the support of hospitals. This involves a sea-change in organisation and money for its implementation. The development of community services is the key to achieving this goal. Such services should be provided for the service users, their families and carers and it will be very important to allocate funding for this area in particular, which I will support.

One has often heard of people being discharged from inpatient care into the community with no support. While they may have been in receipt of supported services for months, they suddenly are discharged into the community with no intervention and with no one to pick up the telephone to ascertain how they are or to ensure they have accommodation. Consequently, a range of services must be co-ordinated. Previous speakers referred to the importance of the role of local authorities in respect of people's housing needs. I have worked with groups locally in Cork to try to bridge the gap to ensure that housing strategies are being established in local authorities and that the housing needs of those individuals who will need support in the community are addressed. The original A Vision for Change estimate was that non-capital funding of €151 million would be needed but thus far, only €54 million has been allocated. In this context, I reiterate the identification of ring-fencing of money in the programme for Government, which is of great importance.

The multidisciplinary community medical teams comprise a major plank of the strategy and will identify areas such as adult needs, child and adolescent needs, psychiatry of old age, intellectual disabilities and forensic medical health services. The Government must ensure the provision of well co-ordinated and evidence-based treatment for individuals in need of those services. I wish to focus in particular on the child and adolescent services, which have been neglected, although I acknowledge the entire area of mental health has been neglected and has been described as the Cinderella of the health services. I hope this no longer will be the case, particularly when one notes the relative survival of the allocation for mental health services in the budget for 2011 and that this will continue in the future. Although there has been a history of provision of child and adolescent services, the focus has been on the lack of inpatient beds. The number of such beds now has increased substantially to 52 nationally, which is greatly to be welcomed. While it had been the case that no services were available outside the Dublin region, the recently-opened facility in Bessboro, Blackrock, Cork has 20 inpatient spaces and constitutes a highly important development.

Members will have heard accounts of children and young people being admitted to adult services. Although this practice is completely unsuitable, there probably was no alternative. I read a summary report yesterday on child and adolescent services produced by the child and adolescent mental health service, CAHMS, which produces an annual report and has produced two reports thus far. It provides an update on services in the area, waiting lists and the type of problems with which it deals. In 2009, there were 367 admissions of children to inpatient units, of which 212 were to adult facilities and 155 to child and adolescent units. It also is interesting to note the length of stay in the adult unit was much shorter than was the case in the child and adolescent centres, which may reflect the level of care. While I cannot be sure of that, it is an interesting statistic.

Many groups and organisations that work in the mental health sector have been mentioned and are supported by Members. All Members are well aware of them and encounter them in their work. In particular, I have had dealings with BodyWhys, an organisation established to help with eating disorders. This is a specific area in which no dedicated bed was available for children and adolescents until relatively recently. It has been very important and while an inpatient bed is not the solution to all problems, at some stage it becomes important and necessary. The subject of eating disorders is worthy of a major discussion on its own in respect of how the media affect it and on the importance of body image. While it obviously is more prevalent among girls, that is not to state it is absent among young males, as its incidence is increasing in that area. It is reckoned that of the child and adolescent admissions in 2008, 18% were related to eating disorders, such as anorexia, bulimia or binge eating and most of them occurred within the 15 to 40 age cohort for women.

An interesting statistic from the United Kingdom shows there has been an 80% increase in hospital admissions for eating disorders over the past decade. The problem has not gone away. I draw the attention of the Minister of State to the annual report of the monitoring group which emphasised the need to ensure that recovery becomes part of the ethos. Recovery was referred to in the Vision for Change document and yet it has not filtered through the system. It is clear that a recovery ethos and the principles and practicalities of recovery are not ingrained in the mental health services. The monitoring group wished to highlight this issue in its annual report. It stated that recovery is not part of the ethos of psychiatry nor of the Irish College of General Practitioners nor of the Irish Medical Organisation. Recovery should not just be about rehabilitation but also about confirming to the individual that he or she can get to a point where he or she can live a full and fruitful life. I thank the Minister of State for her attendance and for her contribution.

John Crown (Independent)
Link to this: Individually | In context

I thank the Minister of State. Without sounding like a broken record, it is very welcome to have a person in her position with such a commitment to the cause of reform in this area where reform is greatly needed. I was moved by Senator Moran's contribution. As she was speaking, I did a very sad mental inventory and I could think immediately of eight medical students, doctors or nurses I knew over the years who had taken their own lives. I knew many other patients and acquaintances who, when confronted with very bad news, had made similar decisions. These are the dramatic cases but at its most extreme, mental illness and disabilities of various kinds are a great burden for the individuals concerned, for their families and for society in general.

At the risk of sounding like a slightly different broken record, I ask the Minister of State a few questions. I do not expect her to answer them because I suspect she does not have the information at her fingertips, but these are numbers with which she will need to arm herself in analysing the situation regarding the psychiatric component of the health system. As anyone who has heard me speaking here will guess, the first question I will ask is the number of trained career-level psychiatrists available in the country. I ask how many psychiatrists are in Northern Ireland considering the population there is one third the size of ours. I ask how many psychiatrists are in the United Kingdom and in Europe. I ask what is the approximate number of trained career-level psychiatrists per head of population in our jurisdiction compared with other comparable jurisdictions. I do not know the numbers and these are not trick questions.

As a good rule of thumb, for any specialty one cares to mention, we tend to be way below the international averages. I was thinking of this when I heard Senator Moran's stories about particular hardships which people had encountered. It made my blood boil a little but I was also thinking how many patients had those doctors seen that day compared with a doctor working in a leading psychiatric institution in London or in Louvain.

I am delighted to see that an issue I have raised in a few contexts is now getting some attention. It is the question of the structures of medical education in this country. I would like to know the number of full-time academic psychiatrists attached to our six medical schools. I am guessing that with an average number of full-time faculty members, according to international guidelines, there would probably be between three and ten per medical school. I suspect the number is closer to zero. Without wishing to be provocative, I ask the number of grade eight officers in health administration whose work is entirely directed to the administration and supervision of the rather small number of full-time psychiatry professionals in the country.

The move to outpatient care is obviously an excellent decision. I do not wish to sound judgmental because we inherited them but anyone who has visited some of the truly Dickensian facilities in which patients received treatment over the years will be fully appreciative of the humanity shown in moving people from an inpatient setting to an outpatient setting. This is also a change taking place in other areas of medicine. Most oncological work is carried out in an outpatient setting and this is true for surgery where ambulatory care has also moved to such a setting. The closure of inpatient facilities without simultaneously developing the necessary outpatient facilities is a cutback by other means. It is crucial to ensure a match between what is developed in the outpatient setting and what is closed in the inpatient setting. The Minister of State and other Members will be aware of the awful financial situation and the pressure there will be to try to find means of curtailing spending at all times. I ask that we try to ensure a match between what facilities are closed and what facilities are opened.

I will probably be seen off the premises by security for being in breach of the orders of the House because we are not supposed to talk about money and raising taxes but perhaps I could suggest to the Minister of State in a friendly fashion that we might consider a ring-fenced vice tax on alcohol which could be used for nothing other than alcohol related health issues and perhaps greater issues of support for mental health services.

I thank the Minister of State for her attention to these matters. I would welcome the opportunity to have a systematic analysis of the person power available at senior specialist and other support levels within the health service. The Joint Committee on Health and Children may be the best forum for this information. I wish the Minister of State the very best with her endeavours.

David Cullinane (Sinn Fein)
Link to this: Individually | In context

Like previous speakers I welcome the Minister of State to the House. Like Senator Darragh O'Brien, who said that the Fianna Fáil Party would give the Minister of State its full support, Sinn Féin will also give her its full support on this issue. We all need to unite on issues such as this to ensure they are not used as political footballs and that we work together instead to ensure the best world-class services available for people with mental illness problems.

I have taken a significant interest in this issue over recent years, since before I became active in politics. I attended a number of events organised by advocate groups for people with mental health problems. I was always impressed by the personal stories of people suffering from various forms of mental illness and the stigma they said was attached to the illness. Many efforts have been made in recent years to challenge those stigmas but many people believe they still exist. I recently attended an event at which I spoke to a local Waterford GP. He said it was amazing how many men came to his clinic every day suffering from depression. They know they are unable to function and cannot eat. When they speak openly to their loved ones or partners or parents, they are often told to snap out of it. There is a lack of knowledge about depression and how difficult depression can be for many people. The GP in question is a pioneer in this area so he knows what he is talking about. He says it is a big problem that needs to be challenged, primarily in the case of men but also for all individuals.

I was also very impressed at the same event by stories told by people who were in State institutions. It is appalling and one of the worst chapters in the history of this State that previous generations put people into institutions often run by religious orders. We now know exactly what happened to some of those people in State care. I listened to the tragedies and the personal stories of the victims of State care. One of the most important steps taken by the previous Government, and I assume it will be supported by the present Government, is the move towards community-based care. This initiative has to be continued by this Government.

Mental illness has been the Cinderella of the health services and this view is repeated by all advocate groups and by sufferers. It is the first thing they or somebody who suffers from the illness will say. One will find it is true when one looks at the record.

Senator Crown spoke about using comparisons with the North, the UK or Europe. We always seem to fare very badly, but on this issue we fare extremely badly. My party fully supported A Vision for Change because it was a first-class document which set out a very real vision as to how we deal with these problems. Funding, the disposal of assets and the ring-fencing of funding is welcome. As a previous Senator said, given that there has been a change in the economy and the environment in which assets can be disposed of, there is very real concern that the funding necessary may not be available.

There are many other issues I could raise. The Minister of State is here to take some advice. If we are here to support the Minister of State and Government and there is to be all-party support on issues like this, the views and proposals of parties should be taken on board. My party has been pushing for all-Ireland policies and co-ordination in this area. I refer in particular to the need to have an all-Ireland suicide prevention strategy.

It is wrong that we have two different health systems and sets of policies. We need to make sure that if there is good practice in the North it is taken on board and put into practice in this State and vice versa. There is much that both Administrations can learn from. The objective has to be to provide the best services for people North and South. We also need improved accountability and transparency in planning and financing mental health service reform.

We need to modernise mental health legislation in line with the new convention on the rights of persons with disabilities. Crucially, we need cross-departmental action to combat social exclusion, prejudice and discrimination against people with mental health problems. We spoke about that in terms of stigma and perhaps this is an area which could straddle a number of Departments. It is an issue that needs to be addressed.

We have specifically called for funding for mental health services. Given that it is accepted, not just by advocate groups but the entire political system, that mental health has been chronically under-funded we have sought to ringfence 12 % of the entire health budget for mental health services. It is a policy advocated by the World Health Organization. It made recommendations on how states and countries deal with mental health.

We need to develop and promote suicide prevention strategies, ensure the provision of the required child and adolescent community-based mental health services and end placement of children in adult inpatient facilities. I remember meeting the family of a child who was put into an adult facility. It is a bad practice which needs to end. I congratulate the Minister of State, not just on her appointment but on the forthright way in which she has taken to her position.

People across all parties are delighted that we have a Minister of State who is passionate about the issue. I am sure she will do her absolute best, given the economic circumstances which prevail. These issues need to be tackled and people with mental health problems need to be supported.

I hope the document, which was one of the best produced by the previous Government, will not be a victim of the austerity measures in place. Mental health is an area we should prioritise in future budgets.

Michael Mullins (Fine Gael)
Link to this: Individually | In context

I was not listed to speak but I want to make a few comments. I join in welcoming the Minister of State. Everybody in the House agrees that she is a reforming, committed Minister of State who will do a fantastic job. I also acknowledge the fine work done over the years by the previous Minister of State, Mr. John Moloney. I was fortunate to meet him on several occasions in Ballinasloe in regard to mental health issues.

The strategy in A Vision for Change is enlightened. Our only concern is the slow pace in implementation of all of its fine recommendations. I come from a town that had a psychiatric hospital which a few short years ago had close to 2,000 patients. Very few people knew what exactly what happened there. Many of the patients should not have been there in the first place. They were there for all sorts of reasons, something to which other Senators referred. Many of them are living in the community today, supported by wonderful HSE staff, and live normal and fulfilling lives. I have had the pleasure of being at many functions over the years in which they actively participated. They are very much part of the community and are welcomed into it. We want to see that development continue.

Several Senators have raised the issue of suicide. We all want to make sure that resources are made available to assist people who are suffering from depression and in danger of taking their lives or causing themselves harm. I would be concerned that in a time of economic difficulty like that which we are currently experiencing the resources required will not be made available. I join other Senators in calling for resources to be ring-fenced for this area. We are dealing with the most vulnerable sections of our community and we all want to make sure they are given priority.

Other Senators spoke about the difficulties associated with alcohol and alcohol-induced illnesses. In my town a fine unit was attached to St. Brigid's Hospital in Ballinasloe. It was probably one of the best addiction units in the country with high success rates. Many people I worked with over the years were referred to the unit. I was a personnel officer in a manufacturing company and know of many people who came through the institution, returned to work and lived full lives. The old health board, in its wisdom, decided to close the unit and facilities were not put in place to replace it.

People who can afford to go to private institutions for treatment for alcohol addiction are looked after. However, I have represented many people over the years in my town who cannot afford to go to such facilities. The unit to which I referred was available to help people and brought them back from the brink. It enabled them to live full lives. Many people are now in dire situations, living rough and drinking outdoors on benches around the town. If the unit was open those people would not be in difficulty.

If the Minister of State disposes of buildings, particularly those in Ballinasloe, she should ensure that the moneys are ring-fenced for investment in mental health services. I know it is not a good time to talk about disposing of buildings, but I hope that when the market improves in a couple of years the moneys realised from the sale of those assets will be ring-fenced for mental health services.

I again wish the Minister of State well. I have every confidence that she is the person for the job. I know of her commitment over the years when she was in Opposition. She will relish the opportunity in Government to put many of her ideas to work.

Paschal Mooney (Fianna Fail)
Link to this: Individually | In context

I endorse all that has been said in praise of the Minister of State with whom I have worked in a variety of areas over several years. I am delighted that she has been given this portfolio because she showed remarkable commitment and dedication during her time in opposition in this area. She now brings that body of expertise to her new portfolio.

I am pleased that there has been praise on all sides of the House for the former Minister of State, Mr. John Moloney. It is particularly gratifying for those of us on this side of the house.

I could not help but reflect on the vagaries of the democratic system in that the tsunami that swept over Fianna Fáil in the last election swept away people of the highest calibre and integrity, of whom Deputy Moloney was one. It is somewhat ironic in a way how cruel the public can be in regard to a Minister of State who had worked exceptionally hard and himself had a vision in initiating and implementing A Vision for Change, as Minister of State, Deputy Lynch, graciously acknowledged. Despite or in spite of the economic woes that were beginning to descend on the country from 2008 onwards, he managed single mindedly and determinedly to ensure the A Vision for Change recommendations were implemented, in so far as he could do so, and the Minister of State, Deputy Kathleen Lynch, has pledged herself to continue that.

While that may sound like sour grapes, I do not mean it to sound like that. I simply mean it is sometimes a sad by-product of the democratic system that this happens to good people - this applies to all parties in all elections. However, to use that awful cliché, we are where we are.

I want to focus on two particular aspects that are of personal interest to me and of which the Minister of State will be aware from our informal discussions since she was appointed. I note in her contribution she refers to the fact that the Office for Disability and Mental Health is participating in the development by the Department of the Environment, Community and Local Government of a housing strategy for people with disabilities which will have a particular emphasis on the housing needs of people with mental health difficulties. The former Minister of State, Mr. Jimmy Devins, initiated a process in discussions with the Prader-Willi association here in Ireland. Our daughter, Siobhan, is a Prader-Willi sufferer and, indeed, Senator Mary Moran has a son who is also a Prader-Willi sufferer, so we have a common bond in that regard.

Prader-Willi syndrome is a unique and somewhat unknown condition. It is effectively a deletion of chromosome 15, which affects the capacity of those who suffer to be aware of when they are full. To put it bluntly, an American reference to the condition is that Prader-Willi syndrome sufferers are permanently hungry and, consequently, a great deal of stress is brought about in ensuring the sufferer does not eat themselves to death, which is quite possible if they were allowed to eat unchecked. There are other aspects to the condition, such as behavioural problems and other physical problems. It is so variable, in fact, that there is no-one-size-fits-all type, as with other chromosome deletions.

As with many other conditions where people are mildly mentally and physically handicapped, it is a mild form of disability - it is reckoned to be about 5% disability - but, none the less, the sufferers have special needs, to put it bluntly. Therefore, there is a need for respite care. To be fair to the HSE, it has gone out of its way to ensure respite is provided. I cannot but have the highest of praise for the HSE in the north west. Siobhan is now 21 and from the time she was born and we began relying on State services, they have risen to that challenge admirably.

It is rather sad that one of the aspects of the discussions I had with Mr. John Moloney and Mr. Jimmy Devins, and, briefly, with the Minister of State, Deputy Kathleen Lynch, was that a recommendation was made as a result of discussions that were taking place between the health services and parents. My wife was involved in these discussions. The Department of Health and Children, the HSE and Mr. John Moloney, as the then Minister of State, had agreed in principle that a residential care centre would be provided somewhere in the midlands that would be of benefit to those outside of Dublin. There is currently a HSE-funded residential care centre in Dublin for adult Prader-Willi sufferers, which has six permanent places, but these places are so permanent that it is unlikely there will be vacancies. It was agreed there should be a similar residence somewhere outside Dublin, and the former Minster of State, Mr. Moloney, had advanced this considerably.

All I am doing here is making a plea on behalf of parents of Prader-Willi sufferers that the Minister of State would look at the files and perhaps come back to the House at some other time, perhaps on an Adjournment matter, to indicate how far advanced the proposal is. It had certainly gone beyond the point of discussion and it had actually been agreed in principle that this would be implemented. I would be grateful if the Minister of State in her very busy portfolio would consider this aspect. I wish her well.

Mary White (Fianna Fail)
Link to this: Individually | In context

I welcome the Minister of State, Deputy Kathleen Lynch. I am confident she is an inspirational lady and, if I can be flaithúlach, she is charismatic. My 40 year old daughter, my only child, always said that Deputy Lynch, during her time as a Deputy, was the most charismatic person on television. That is the greatest compliment I could give her. My husband concurs. He saw Deputy Lynch on "Prime Time" recently and said to me: "I always told you how brilliant she was."

Michael Mullins (Fine Gael)
Link to this: Individually | In context

The Senator might join up yet.

Mary White (Fianna Fail)
Link to this: Individually | In context

There are so few ladies here, we really have to stick together. I want to put on the record some points about the document I produced in 2008 concerning what we can do about suicide in the new Ireland. It is still very much an issue that is taboo, no matter what we say. I prepared my document as a lay person. I held public meetings in the city here and spoke to parents and family members of those, young and old, who have died by suicide.

There are three elements, which it has been proven internationally in the most up-to-date academic work, that can act to reduce the incidence of suicide. One is alcohol consumption. There is no doubt that we in this country are too free and easy about alcohol. The problem goes on and on but we do not address it. Nearly half of those who die from suicide have alcohol in their blood. That does not mean they drank themselves to death but if they were feeling depressed or overwhelmed by economic problems, which are rampant during this time of economic recession, alcohol would mean they could not have thought rationally or thought of how they could get out of a situation.

We need a national campaign of awareness because we are too liberal with alcohol. As I have said many times, while I am not against alcohol consumption, just walking around a supermarket here or in the North, one can see the prevalence of tins of beer, full trolleys and so on. I have no doubt the consumption of alcohol is a huge part of the prevalence of mental illness and affects general mental health, quite apart from death from suicide.

One way of reducing alcohol consumption, which has been proven internationally, is to ensure GPs are trained up to modern, best-in-the-class standards in regard to identifying depression when they see it, and are up to date on how they treat it, whether through counselling, medication or otherwise. Having spoken to parents whose child died from suicide, I know their GPs often told them their teenager would grow out of it. The incidence of suicide is quite flat until children reach the age of 17 or 18 and it then rises very fast, especially among young men, who are four times more likely to die from suicide than women. Parents told me that their doctors told them their child would grow out of this depression, yet they died from suicide. That has been my experience from these meetings.

A second element is the restriction of access to lethal means. We have talked in this Chamber over the years of how unfair the waiting list is for children with mental problems who cannot afford counselling. I pushed in the House for the health service throughout the country to have a plan for each health service area in order that children who cannot afford it could access counselling. Hundreds of depressed children are waiting for help, and even children of ten or 12 years may be suicidal. We need to achieve delivery on this in order that we can get rid of the waiting list for children awaiting counselling, which would help them to stabilise and improve their cognitive skills.

We all feel in bad form now and again, and I am still not feeling great over our post-election trauma. I am still quite upset. I have just come from a committee. It is very frustrating being in Opposition. At that committee this morning with representatives from the Assembly and Westminster and Seanad colleagues, I was reassured something will happen that I can get stuck into. It was great when we had our parliamentary party meetings with the Taoiseach.

John Gilroy (Labour)
Link to this: Individually | In context

The Senator was in Government long enough.

Mary White (Fianna Fail)
Link to this: Individually | In context

I would much prefer to be in Government.

John Gilroy (Labour)
Link to this: Individually | In context

Fianna Fáil had 14 years in and now, I hope, will have 14 years out of it.

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context

It is good to see we can still have a bit of banter. I thank all the Senators who contributed. This was the sort of debate I hoped we would have, with individual issues raised but it was on the generalisation of mental ill health and how we deal with it.

After listening to Senator Norris's contribution, I am reminded of Ivor Brown's paper on the great illusion, which asked if it is an illness at all. We could go along with the theory that illnesses are usually caused by probably something germ related when we look at it. I am not certain that we know everything about this issue, and I am sure we will continue to learn and to see it develop.

Senator Gilroy asked about ECT and I am aware of it. Senator Norris mentioned the Bill introduced by the Green Party and Independents and it was agreed by everyone, including me, that forced ECT would no longer be part of what we offered and that will be put into legislation. That is all I can say about that now. We were all agreed that forced ECT was not the way to go.

Senator O'Brien mentioned the unit in St. Ita's. It had conditions attached to it by the Mental Health Commission, which asked that it would be closed by 31 August. It was also recommended a different part of the building be refurbished to provide a service until the Beaumont unit came on stream. That did not happen but the HSE assures me that access to appropriate acute mental health services will be in place until the Beaumont unit comes on stream. We can talk about that later. I am also told the unit in Beaumont will take approximately 12 months so that might be the gap.

I do not have the information Senator Crown requested but I am told we made a submission to the World Health Organisation recently where all the statistical data were put in and the WHO will come back to us. That will give us a huge amount of comparative information that we need to take seriously. Senator Cullinane raised the issue of an all-Ireland approach. We have an all-Ireland approach on suicide and training registration for self-harm. That cooperation is going on all the time.

What can I say about the Brothers of Charity services in Clare? They are excellent. I know the organisation and it is incredible with a different way of doing things, a different way of thinking and a different approach to what we should do across all of the services. I am surprised to hear there is a difficulty on the rental issue because we have a housing statement that has gone to Government and is now in the wider community. It is clearly directed towards dealing with people in the community who have mental health problems. I include in that, people with disabilities who have mental health difficulties because they do not live in a separate space from the rest of us. They equally have issues that must be dealt with. I will take that up with the Minister of State at the Department of Environment, Community and Local Government.

No health structure can ever be based on the vagaries of the property market; to do that is to build a house on sand. To depend on how much money is in the country and how foolish people are, does not provide a proper structure and it will not work. If there is a bubble, there will be enormous amounts of money we might not have the capacity to put into the system and, when the bubble bursts, we will be left with a system that has capacity but no money. We cannot operate like that; it must be a steady, well thought out, planned approach. I hope that is what we have now, coming down from the heady days when we had more money than capacity. I hope that is where that will go.

Fear is as big an issue as stigma and maybe it is bigger. Fear brings about the stigma. Fear of poor mental health is probably what gives it the stigma. We are all conscious that we are vulnerable to poor mental health. We could all end up in that position. It is the fear of it that keeps us at arm's length and makes us worry about people in those circumstances.

We have a big issue with staff. In nursing for mental health there is an older age profile who can retire at a younger age. That leads to problems. Our problems will be compounded next year. Senator Mullins said that next year we have the possibility of 1,200 people who could retire if they wanted. I have no doubt that they will retire because it is a difficult job. If all of those who can retire next year do retire, we have a big problem but it is solvable. I pay tribute to Mr. John Maloney and his efforts on A Vision for Change; circumstances overtook him but that does not take away from his commitment or the great things he did. He got a breach in the moratorium last year and gave us an additional 100 nurses. There was another breach this year that gave us another 100 nurses. That will not be enough in the years to come. We will need additional posts. I am reluctant to say it but I need to say it; to a great extent in the circumstances in which we find ourselves in the next few years, if we can get the breach and the 300 additional posts per year, maybe people coming from a different sector of the service might not be a bad thing because we need a different skill mix if we are to go into the community. We must be able to provide within the community people who probably come from a different culture, and I say that with all due respect, because we must deliver a different type of service in the community. It is good that we are cutting down on admissions and the length of people's hospital stays, but we must consider the fact that we will always need acute beds. The flexibility provided by A Vision for Change is important. I am uncertain as to whether we know the exact number of acute beds we will need or by how much that number will change.

We all know the funding situation. I will not trot out the usual comments about where the country is, but we are definitely not as flush as we used to be. We will need to do things differently, but this does not mean that we will not be able to provide a better level of care in the main. We can do this by changing how we do things, including our skill mix, and by providing services in different areas.

Mary White (Fianna Fail)
Link to this: Individually | In context

Smart.

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context

Not everyone who requires support needs to attend a high-tech clinic. Perhaps people need to stay in their homes and receive telephone calls or postcards. Perhaps it is just about keeping in touch.

When it comes to suicide, to a great extent people want to be treated with kindness, respect and dignity. I hear this every day. We are too wedded to the medical model when it comes to mental health. Senator White was correct about education, in that we can educate general practitioners, GPs, community workers and social workers to make them realise when someone has a difficulty. Most GPs know that the majority of people presenting to them are doing so for reasons other than the ones they give. We need to get GPs to recognise when this is the case. However, if a GP's only possible course of action is to prescribe an anti-depressant or to send someone to the local psychiatric unit, people are not encouraged to present. We should focus on the piece in the middle, namely, primary care teams, whereby GPs will be able to send someone next door to a psychiatrist, social worker or counsellor if someone presents with a difficulty. A person needs to be able to tap into those services. It could be easily done. An entire unit in the Department of Health is telling people that the Department will provide an investment of €4 million if the recipients make savings of €8 million while supplying a better service by providing it differently. We will need acute beds but, if we move the bulk of our services from large institutions into communities, not only will there be a saving, there will also be a better way of doing things.

Most people who approach a GP, community nurse or Member want a listening ear and someone to put his or her arms around them and ask whether there is a problem. Where people with eating disorders are concerned, our first port of call is foraging for beds for them. We must stop doing that. We should be able to intervene with people at an earlier stage to stop such embedded behaviour from developing. We can do it. I feel like Obama.

Mary White (Fianna Fail)
Link to this: Individually | In context

The Minister of State is doing grand.

Darragh O'Brien (Fianna Fail)
Link to this: Individually | In context

Is feider leat.

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context

We can do it with what we have. We do not have an option, so we must do it.

I thank the House for its interest. It is encouraging to hear people who are not just interested in, but also well informed on many different aspects of this matter. We all live in the one space. This is how it should be.

Feargal Quinn (Independent)
Link to this: Individually | In context

When is it proposed to sit again?

Michael Mullins (Fine Gael)
Link to this: Individually | In context

At 10.30 a.m. on Tuesday.