David Norris (Independent)
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I welcome the Minister of State, but I doubt I will welcome what she has to say in her prepared speech. This issue concerns once again the continued asset stripping of community resources, particularly from rural areas. I have raised a number of these issues in the past with various Governments, including the issue of the Bethany homes in Carlow - also the location of the issue I am raising now - Abbeyleix in my home county of Laois and Valentia hospital. Many of the cutbacks are mean-minded, hamfisted and inefficient because, in the long term, they lead to greater Exchequer expense.

I have visited St. Dympna's in Carlow the resource that is the subject of this matter and have been immensely impressed. St. Dympna's deals with people with intellectual difficulties of one kind or another and emotional problems and is very much a community-based service. I was very impressed by the environment, the staff and by one of the patients who remembered me. It took me some time to recall him, but I had a long conversation with him and he was extremely flattering about the impact the services have had on him personally. I believe he is a person who will suffer if the services are cut back or abolished. It would be wrong to do that.

It has been suggested that staff levels at St. Dympna's, and on the STEER system in particular, are above the average. This fails to take into account that many of the staff complement work in a remarkable intellectual disability unit in the grounds of the hospital. If this was taken into account, the situation would be clearer. This is matter that is not just parochial and of importance to Carlow. It is symptomatic and for that reason it is being taken up actively by the Psychiatric Nurses Association. Mr. Des Kavanagh, the general secretary of the PNA made the point that people in the Carlow region are extremely annoyed to see model services that have been built up in this area over a long period being slowly dismantled. He said that clients have had services cut, outreach services have been halved and in the case of a very effective service, the supported training education employment referral, STEER project, it was being dismantled completely. He went on to say that the result of this scale of cutbacks on services would be to outwardly put more demands and costs on other areas of psychiatric services in the long run. All of those concerned in the mental health services are united in demanding these cuts are reversed. In the long run, these cuts are not cost savings.

The assertive outreach service, which provided much needed support to service users will be effectively halved. This move, as well as being unfair to service users and staff, is short-sighted and will cause an even greater spend in the long run. These clients now face even greater risk of relapse. STEER supported and reassured patients and gave them opportunities that ensured they were integrated in society and given possibilities that made them less likely to relapse. It also improved their quality of life and gave them access to choices and helped them return to education. Its work was very impressive. It may seem to those who might be intellectual snobs, with university degrees and so on, that the level of attainment is quite small - FETAC and so on - but that level is a huge achievement for somebody with an emotional or intellectual disability, difficulty in adjusting and who has never had the benefit of systematic or proper education. For them to achieve this is remarkable.

There is also a service entitled Clann Nua a name that tells us it provides a "new family". Clann Nua provides a familial environment for vulnerable people. It is a day service for clients living in hostels and sheltered accommodation. The service users in question whom I know personally are completely dismayed at the possibility of the loss of this service as it is vital to them. They find assistance from it with everything, from managing their budgets to medication management. It is significant for them to get this assistance from people they have come to know and trust. The alternative management centre is a considerable distance away and puts unbearable difficulty on them.

The STEER approach is to move clients away from the industrial unit sheltered workshop base back to mainstream work or education, rather than keep people within the mental health services area. I am sure the Minister of State will agree this is important. This system motivates patients. The figures are impressive. In one year, there were 176 job referrals. The results of the intervention are that people are happier as noted in the shifts of mood recorded - STEER keeps detailed records on this - even after just the third session. For people who experience this kind of difficulty, it is important this service should be there. There is significant contact with groups that can provide jobs, such as FÁS, FETAC and so on. These organisations maintain personal contact with the management and tutors and like to get referrals from STEER because of its reputation. Prior to the STEER programme, people would have remained unemployed for years.

The impact of the proposed reconfiguration will be that the assertive outreach programme will be damaged. It provides a service for 26 active clients who are among the most vulnerable users. Crisis intervention will also be inhibited. With a single nurse on duty, it will not be possible to have crisis intervention and this will hamper the capacity for relapse prevention and early detection. The day services will also be affected.

I remind the Minister of State that this is a situation where there are vulnerable people and where it is possible there will be cutbacks to the services. I have raised the matter of cutbacks in other areas where it has been shown that there was mean-minded application of HIQA criteria, like closing a facility because of peeling paint. Does the Minister of State seriously believe that bothers people? Perfectly adequate facilities are being closed down, with a destructive impact on the community and an ultimate cost on the Exchequer although it may appear there is an immediate saving. I appeal to the Minister of State to look again at this situation.

Róisín Shortall (Dublin North West, Labour)
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I am replying to this debate on behalf of my colleague, the Minister of State, Deputy Kathleen Lynch, who has responsibility for disability, equality, mental health and older people's issues. I thank Senator Norris for raising this matter.

In line with a Vision for Change, a comprehensive change programme which will deliver a modern patient-centred quality and responsive community-based model of mental health services for the people of Carlow, Kilkenny and south Tipperary is currently under way. Central to this is also the closure of old long stay institutional-type facilities. To this end, the HSE has developed a very detailed plan for the further development of mental health services in the Carlow-Kilkenny and south Tipperary areas in line with A Vision for Change. This plan will see the majority of patients and clients being treated in the community by enhanced community mental health teams, newly formed home-based treatment teams and the expansion of the acute day services and day hospitals in both Carlow and Kilkenny. These comprehensive community services will mean that far fewer people will require care in an acute inpatient hospital setting.

The budgetary situation in 2012 will challenge all areas of the health service to provide continuity of services that are both appropriate and safe for patients. Like other care areas, savings are being required from the mental health service. Due to staff retirements from Carlow mental health services, there is a requirement for the HSE to reorganise services and to match staffing resources with service and activity priorities.

STEER, the supported training education employment referral programme, to which the Senator referred, is a community-based vocational rehabilitation service which provides assistance to mental health service users to gain access to mainstream education and employment. It is currently staffed by one whole-time nurse. It is proposed to redeploy this staffing resource to Carlow day hospital. The provision of the STEER service will continue, however it will now be provided by members of the community mental health team.

In addition, it is proposed to redeploy allied health professionals to assist with the provision of this important aspect of a person's recovery and integration into mainstream activities. I very much welcome the general approach which the Senator outlined that STEER has taken in regard to bringing people closer to mainstream services.

I am also glad to say that it was possible in budget 2012 to announce a special allocation of €35 million for mental health services. This funding will be used primarily to strengthen community mental health teams in both adult and children's mental health services. I think we all agree it is important that we get best value for our available resources. We need to co-ordinate our efforts and work together to develop our mental health services in line with A Vision for Change recommendations. In essence we need to provide more with less and, in effect, this has already been successfully achieved in mental health service provision in other areas.

This House can be absolutely assured of the Government's unwavering commitment to our mental health services. The provision of an additional €35 million in the current very difficult economic circumstances is evidence of our commitment in that regard.

David Norris (Independent)
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I thank the Minister of State. Of course, I welcome the €35 million and I complimented the Minister of State on the savings in the Bill discussed earlier. She is a very good stand in-----

Paddy Burke (Fine Gael)
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A brief question, Senator.

David Norris (Independent)
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I am warming up.

Paddy Burke (Fine Gael)
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We are quite a while at this.

David Norris (Independent)
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The Minister of State is a very good stand in for the Minister of State, Deputy Kathleen Lynch, whose speech she read. I know all about A Vision for Change and remember when it was produced. I read it and discussed it with some of the people who were looking for it. However, it has not been fully implemented. It has been partially implemented in order to save money. The Minister of State spoke about the closure of old long stay institutional-type facilities-----

Paddy Burke (Fine Gael)
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Senator, there is no provision for-----

David Norris (Independent)
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These are the ones the people want. I ask the Minister of State to convey to the Minister of State, Deputy Kathleen Lynch, the needs of the community and to ask the community. The Minister of State said the plan would see the majority of patients being treated in the community by enhanced community mental health teams and newly formed this, that and the other. I simply do not believe that will happen because the resources are not there. Will the Minister of State suggest to her colleague that she ask those people who are actively employed and working extremely hard in this area what their view is? If one wants to know the truth, one should ask the people who are at the receiving end of, and who are delivering, the service? They are the people who know.

Róisín Shortall (Dublin North West, Labour)
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I am not for one moment trying to defend what has happened up to this current year. We all know the problem is that A Vision for Change was not implemented. However, there is a very strong commitment on the part of this Government to ensure it is implemented and that is why an additional €35 million has been provided this year and will be provided for the next three years at least in this regard. Anybody who has heard the Minister of State, Deputy Kathleen Lynch, speak about this issue and witnessed the actions she has taken over the past year will not be in any doubt about her commitment in this area.

David Norris (Independent)
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I acknowledge her absolute commitment.

Róisín Shortall (Dublin North West, Labour)
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She is absolutely determined to implement A Vision for Change as it is the way to go and everybody is agreed on that. I assure the Senator that the Government will deliver on it.