Seanad debates

Wednesday, 22 June 2016

10:30 am

Photo of Helen McEnteeHelen McEntee (Meath East, Fine Gael)
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I am pleased to have been appointed to this position. Mental health and, more importantly, promoting positive mental health, are close to my heart, as they are to the hearts of many in this House. It is also an area where there is so much more we can do to help each other, work with each other and try to remove the stigma still attached to mental health. I refer not just to politicians but to society as a whole. The stigma is still there, and while we have made great progress during the past decade, we still have a long way to go.There has been much discussion recently on the funding of mental health, some of which has been constructive but some of which has not. I will outline a number of the facts. The national service plan mental health budget for 2016 is €826 million. Since 2012, the plan's budget has increased by €115 million. This year, there will be an increase of €41 million, or 5.2%, on the outturn last year. The number of child and adolescent community mental health teams and acute inpatient beds have increased substantially while waiting lists for child and adolescent mental health services, CAMHS, have decreased, and initiatives are under way to reduce them further. We have to understand that there is a great deal of work to do in these areas as well.

In broad terms, we have facilitated the move away from institutional care to community care, providing service users with more accessible treatment in better environments. We have closed many of the older psychiatric hospital inpatient units, providing new, improved facilities such as The Phoenix Care Centre, the new acute unit in Cork University Hospital and those due to open shortly in Galway and Drogheda. Preliminary site work has also commenced on the new state-of-the-art national forensic hospital to replace the Central Mental Hospital in Dundrum. We have helped to foster a greater awareness of mental health promotion in society through campaigns such as Little Things, while the suicide prevention strategy, Connecting For Life, has helped to increase awareness of suicide in society. While much good work has taken place in recent years, I am under no illusion that more work and further effort is required. We need, for example, to continue development of counselling services across both primary and secondary care. We need more community mental health teams, together with improved 24-7 response and liaison services. Most important, we need to ensure no group, regardless of age, ethnicity, sexuality or circumstances, is left behind or overlooked. Changes initiated as a result of new funding allocated by the previous Government have paved the way for real and lasting change for service users and we need to build on that.

The national mental health strategy, A Vision for Change, is ten years old this year. Within the next 100 days, I will initiate an evidence-based expert review of progress in the implementation of this policy and in the improvement of mental health services. The review will take account of international best practice in the area of mental health and will inform how we will develop our policy.

Perhaps the main challenge to the mental health service is the recruitment and retention of staff. Many well-trained, highly motivated people are taking up employment outside the public service, either in the private sector or abroad. I touched on this yesterday with a number of Senators. I am conscious of the difficulty in recruiting and retaining nurses in the mental health area. For that reason, I am happy to inform Senators that the HSE is reintroducing a one-year post-registration programme in psychiatric nursing for nurses who are registered in either the general, intellectual disability or children's divisions of the register maintained by the Nursing and Midwifery Board of Ireland. A total of 30 places have been made available on the programme which is due to commence in autumn 2016 in association with UCD. While this is a positive move, there is a great deal of work to do, and further recruitment of staff within the HSE requires change, for which I intend to push.

We live in an evolving world. While we can communicate with people more quickly, in many ways, perhaps, we are becoming more isolated due to the pace of our daily lives and the pressures we are under. Our pace of life is getting faster. This puts people under pressure and in need of assistance. The need to reform and to update our mental health policy and services is clear. We need to plan for this but also address changes happening now. Education is key and is most important at an early stage. Mental health issues often manifest at a much younger age than we like to think about or even discuss, but that is today’s reality. The pressures that young people face today compared with when any of us was in school are completely different. Every second of a young person’s life is online, and while it is visible for everybody to see, it is also visible for everybody to criticise - what they look like, how they dress, who their friends are, who they hang out with, where they go to school and how they do in exams. There is a different dimension to young people’s lives that was not there a few years ago and we need to start dealing with it.

In the next 100 days, I will establish a youth mental health task force. I am actively working on this. The task force will consider how best to assist young people in developing resilience and coping skills to support their emotional well-being at an early stage, and to build awareness of how to access high-quality effective services when they need them. The task force will comprise a number of non-political, non-governmental members with significant expertise in the area of youth mental health and will be supported by a significant cross-departmental effort to establish a new, co-ordinated way of working across government to advance youth mental health and well-being. This will be a critical aspect of our work. The mental wellness and well-being of young people is not simply a health issue and it should not relate specifically to the Department of Health. It is not simply an education issue either. It is an economic, social and community issue that requires the public, private and voluntary sectors and all of us to co-ordinate and pull together in order that our efforts combined achieve more than the sum of their parts and in order that every young person has the full support of the community they live in to reach their full potential.

I refer again to the marriage equality referendum last year. This was not mental health legislation but it had a massively positive impact on the mental health of many people. We need to identify the everyday issues that affect young people’s well-being and, as a community and as a society, and we need to equip them with the tools to deal with them effectively.

I thank the House for the opportunity to contribute and I am here to listen to what Members have to say. I will take on board what they say and, I hope, work them with them into the future.

Photo of Gerry HorkanGerry Horkan (Fianna Fail)
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I congratulate the Minister of State on her appointment and I wish her the best in her important role. On behalf of the Fianna Fáil Party, I would like to outline our message on mental health. Mental health issues continue silently to inflict immense damage on our country. The undercurrent of depression, anxiety and addiction is a profoundly ingrained problem for society, and no family is untouched by mental health issues. Beyond the striking statistics regarding suicide rates, the affliction of depression exacts a heavy toll on the day-to-day lives of very many people. We have successfully confronted dangerous challenges such as this. The spike in road fatalities that endangered a generation of motorists was tackled head on with the establishment of the Road Safety Authority, RSA, increased investment, the penalty points system and so on, and significant numbers of lives were saved annually. We need a similar concerted national approach to the devastating impact of mental health issues. Deputy Micheál Martin in an Ard-Fheis speech a number of years ago referred to the setting up of a mental health authority. If the Government set up such an authority with the same funding and emphasis as, for example, the RSA, it could prove similarly effective.

As a republican party, Fianna Fáil believes mental health policy is, ultimately, a question of citizenship. We believe people with mental health problems must be brought in from the periphery to the centre and encouraged and enabled to give full expression to their citizenship through employment, social engagement and the opportunity to contribute to their communities. As citizens, people with such problems have the right to equality of access and the full range of modern, cost-effective and therapeutically impactful treatments and not to be bound to the classic services of the past. Access to services must not be dependent on where people live or their earnings. The citizenship approach dovetails well with the recovery model of mental health care whereby recovery is built on a partnership approach between the person and his or her mental health care team. The model moves away from the paternalistic psychiatrist model of the past and towards a more multidisciplinary co-operative approach. The recovery model recognises that treatment is not merely about the alleviation of symptoms but about working with the person to ensure he or she can live a productive and meaningful life, despite the vulnerabilities that may continue to exist. They should be equipped with the skills, self-understanding and resources to help prevent relapse.

Flowing from that is the vision that mental health is a whole of society concern given its prevalence and its impact on individuals, their families, communities and employment. Mental health policy should be aimed primarily at preventative measures, early action when problems begin to surface and early intervention with children and their families.This approach must extend beyond the health system and be integrated with all aspects of life, including education, planning, employment and communities. The ultimate aim is to create a mentally healthy society.

Fianna Fáil's vision for mental health and well being is built on five key principles. First, public policy ought to ensure people with mental health problems are included in society and enabled and assisted in playing their part therein. Second, the recovery model of mental health care is the most appropriate in terms of individuals' well being and enhancing and defending citizenship. Third, mental health should be taken as seriously as physical health in the deployment of resources, health and safety measures and public planning. Fourth, the emphasis should be on early intervention and early action, as the Minister of State mentioned. Fifth, mental health policy must be mainstreamed across society in order to promote mental well-being and reduce the risk of mental ill health.

We need to enhance the National Office for Suicide Prevention, NOSP, increase the number of suicide prevention resource officers, expand their role and link them directly with the NOSP. We must ensure all general practitioners, GPs, are adequately resourced to provide comprehensive help for individuals at risk of dying by suicide. A system of GP practice must be put in place whereby the prescribing of anti-depressant medication must be reviewed on a monthly basis until the GP is satisfied that the taking of medication is the best course of action. We must establish out-of-hours emergency social worker teams across the State.

Regarding Child and Adolescent Mental Health Services, CAMHS, the principle of early intervention is critical, as properly addressing mental health problems in early childhood and the adolescent years leads to better educational outcomes, avoids severe mental health issues later, improves quality of life and is more cost effective than later treatment. We need to end the practice of placing children in adult inpatient units and should focus on holistic and accessible services that minimise the use of inpatient beds. The provision of counselling and a seamless integration with schools and education policy must also be central to plans. Within schools, all teachers should receive mental health training so as to equip them to identify, support and refer children with mental health problems. We must restore guidance counsellors to secondary schools; every school should have a named CAMHS worker and all children should have access to counselling services through their schools. We would anticipate a universal health check being carried out when children receive their booster vaccinations in sixth class or first year in secondary school. This check would include a mental health assessment to identify developing or existing mental health problems, thus allowing for early and efficient treatment.

We all know that this is a major issue. It affects every family in the country, every neighbourhood, every community and every workplace. We must ensure we will do everything possible to improve the service provided. I wish the Minister of State well in her role.

Photo of Kieran O'DonnellKieran O'Donnell (Fine Gael)
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I welcome the Minister of State, Deputy Helen McEntee, and wish her well in her brief.

I wish to speak about the issue of suicide, particularly in the context of the position in my constituency of Limerick City. Studies have shown that, between 2011 and 2013, it had the highest suicide rate in Ireland. At more than 21 deaths per 100,000 of population, the rate was almost twice the national average. The most recent statistics from the Central Statistics Office show that there has been a decrease to 16 deaths per 100,000 of population, but the rate is not decreasing among men. In 2015, 2014 and 2010 the figure in Limerick was nearly 29 men per 100,000 of population. In 2015 the figure for females was 3.5, although in 2014 it was very high, at 17.3. It was nil in 2010.

I want these issues to be addressed. We are attending too many funerals of people who died by suicide. It is a national emergency. More people die by suicide than in car accidents, yet there is considerable reporting, justifiably so, of deaths on the roads. Deaths by suicide must receive the same level of concentration.

Studies have shown that 70% of young males know of someone who died by suicide. For 17% of them, it was a close friend. We must address this issue. A further feature of the statistics is that 60% of people who die by suicide are 44 years or younger. They are a young cohort. This issue should be addressed in a practical way.

The Minister of State is carrying out a welcome review of A Vision for Change which is now ten years old. In the context of the position in Limerick, the fact that the rates have been consistently high needs to be addressed. A Vision for Change committed to the opening of 20 inpatient child and adolescent mental health beds in University Hospital Limerick, but that has not happened. It must happen. As part of the Minister of State's review, this should be a priority. If a child or an adolescent has mental health issues, he or she will end up in an adult ward, which in the modern age is unacceptable. Given that the levels of suicide have been consistently high in Limerick City, will the HSE or the Department carry out a specific study of the reasons for this? There is a myriad of factors, for example, alcohol and drugs.

In 2014 St. Patrick's Hospital's mental health services presented the stark result of a survey. Some 65% of Irish people believed being treated for mental health problems was a sign of failure. We must get rid of this taboo. Among young males, there appears to be a fear of admitting to any mental health problem because it is seen as a sign of failure.

Will the Minister of State discuss a suggestion with her counterpart, the Minister for Education and Skills? As part of the curricula at primary and secondary levels and as Senator Gerry Horkan referenced, CSPE subjects should include modeules on physical and mental health and well-being which must be on a par. This would have a major benefit, as people would feel it was not taboo and that, if they had mental health problems, they could treat them just as they could a broken leg. We cannot afford to have 451 people dying by suicide, as we did last year. That is the reported figure, but many suicides go unreported.

As promised in A Vision for Change in 2006, 20 inpatient child and adolescent beds should be provided in University Hospital Limerick. A study should be undertaken by the Department of Health and the HSE to discover why the suicide level in Limerick City is so high. Mental health and well-being should be included in the curricula at primary and secondary levels.

Photo of Gerard CraughwellGerard Craughwell (Independent)
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The Minister of State is welcome. This is my first time to address her in the Chamber. As I told her privately yesterday, she has taken on a tough portfolio and I wish her the best with it.

Research produced by the ESRI last year indicated that workers exposed to bullying and harassment showed high levels of mental distress, anxiety and ill health.There is ample anecdotal evidence that at least one in ten workers experience bullying leading to episodes of low self-esteem, anxiety and even suicide.

While much work has been done by organisations in drawing up and implementing dignity at work policies, I believe there is an epidemic of workplace bullying the likes of which has never been seen here previously. Last year, I hosted a series of meetings with individual workers who related horror stories to me of bullying incidents and the associated impact on their mental health. Paragraph 5 of the Industrial Relations Act 1990 (Code of Practice Detailing Procedures for Addressing Bullying in the Workplace) (Declaration) Order 2002 describes bullying.

There is a huge difference between robust management and bullying in the workplace. I recall that during my time as president of the Teachers' Union of Ireland a colleague contacted me to tell me they were suffering horrendous bullying over their timekeeping. When I asked what the problem was with their timekeeping they said, "Well, I am usually in by 9.05", to which I replied that that was not really bullying but a management issue. That is what it is all about.

I have looked into the eyes of the cowardly bullies. I have seen the bullies first-hand, and the way they work. They take the individual and destroy them psychologically. They break them down bit by bit until they become a shadow of their former selves. It is in the loneliness of that existence that I raise this issue in a debate on mental health. It is when one is in one's sitting room, bedroom or dining room at 3 o'clock or 4 o'clock in the morning looking into the darkness and wondering why one has found oneself in this position. Usually, those who suffer from what I call character and personality assassination are the strongest, best workers one will find. They are the most innovative and friendly on the staff. They are the ones who are held in the highest esteem by colleagues, yet they are the ones who are broken down.

Only last week a person came to see me. It took him two years to realise what was happening to him, and it involved sly remarks such as "We've heard enough from you, John; we don't need to hear any more" or "John, don't attend the next meeting; we don't need you" or "John, would you stop trying to make out that that job you're doing for us is the greatest thing that ever happened". That is what slowly brings a person down. Sadly, I have experienced two examples of that in my lifetime. I am convinced to this day those people took their own lives for one reason only - they had been broken by the managers they worked with, and I mean they were destroyed by them.

Currently, there is only a civil redress option for those affected by workplace bullying but within the criminal justice system there is legislation entitled the Non-Fatal Offences Against the Person Act 1997. We are crossing into two Departments here, and probably three and four - perhaps we should look across all Departments - but when we talk about bullying and the Non-Fatal Offences Against the Person Act the Minister of State might work with her colleague, the Minister for Justice and Law Reform. We must put bullying onto this footing. All of us talk about managing bullying among children in schools. Yesterday, we had statements on the murder of the MP, Joe Cox. Politicians in this House and in the Dáil, from all parties and none, related stories of the horrendous treatment they are getting online including telephone calls or people coming into their offices and pounding the table. That in itself is a form of bullying. It is time we took the bully out of the equation and became a bully-free society that will not tolerate that type of attack on an individual.

Every person has a right to their dignity. Every person has a right to do what it is they believe is the best by way of their work, their contribution to society or whatever else, yet we have those who would seek to destroy, and I am not talking about physical destruction but the mental destruction that takes place. While it crosses a number of Departments, the Minister of State can take the lead on this issue and offer those who are suffering this type of horrendous treatment a lifeline by saying she will take an interest in bullying in the workplace and its effect on the mental health of the people. If she does that, she will do the greatest service that has ever been done to those suffering from this horrendous condition. I thank the Minister of State for her time.

Photo of Ray ButlerRay Butler (Fine Gael)
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I welcome the Minister to the Upper House and congratulate her on her appointment as the new Minister for mental health and older people. I believe she will take the necessary measures to address the ever-growing and pressing issues surrounding mental health.

I am also encouraged to see that the Cabinet approved the restoration of the mental health funding for 2016. Commitment was clearly shown by the previous Government and continues now with this Government in the programme for Government. A Vision for Change provides for the ring-fencing of €35 million from within the overall health budget to develop community mental health services and to ensure early access to more appropriate services for both adults and children.

A key focus has been the additional posts to strengthen community mental health teams for both adults and children. They have been used to enhance specialist community mental health and forensic services and increasing access to counselling and psychotherapy under the suicide prevention incentives. Appropriately, 1,550 new posts have been approved since 2012 up to the end of 2016, of which 1,153 have been recruited or were in the recruitment process by the end of last year. Those posts facilitate the policy of moving away from traditional institutional based care to a patient-centred, flexible and community based mental health service where hospital admissions are greatly reduced while providing inpatient care when appropriate.

While all of those steps are working towards a common goal in looking after the needs of those suffering with mental health difficulties, there is a very long way to go. I will outline some key areas I believe need urgent scrutiny, together with a change in legislation, to help those most vulnerable in our society.

Ireland has the fourth highest rate of youth suicide in Europe. Suicide is everybody's problem, and one in four of us will at some stage throughout our lives suffer with mental health issues, regardless of age. Those at local general practitioner level and staff working in accident and emergency departments are not sufficiently trained to recognise or deal with patients who present with a mental health issue. What training is provided in this specified area? Is that training updated, and how often is it updated? Accident and emergency departments are not equipped to deal with a person in crisis. Implementation of access to 24 hour, seven days a week trained crisis support is essential.

I want to give another example of that. A young man with mental health issues had been in a Dublin hospital for a medical procedure but was discharged at lunch time that same day. That evening, he was seen by his general practitioner for a check-up and despite the fact that he was attending Pieta House, the medical professionals did not deem him to be suicidal. That young man took his own life before the day was out.

A major factor that works against those suffering with mental health issues is patient confidentiality in terms of anyone over the age of 18. Those who have a member of their family suffering with a mental health condition understand how frustrating it is for them to have their hands tied and unable to intervene to help their loved ones due to this confidentiality provision. In reality, we have a system whereby the family or a loved one of someone suffering with a mental health illness is not permitted to access the most basic level of information to support their loved ones. That does not make sense at any level. Families must be involved in the care of someone suffering with a mental health illness, and I ask the Minister to make that a priority and bring forward legislation to ensure the best possible care for all.In the case to which I referred, the mother involved said, "As a mom looking after our son, I should have access to as much information as possible in order to keep him safe." In my constituency I had a person with mental health issues, and her neighbours and I watched her die, maggots all over her body, her house filthy. The HSE told us it could not do anything, bar she signing herself in. We had to look at this, knowing what was going on behind those closed doors.

Access to counselling also needs to be a priority. Private services are not affordable for the majority. There are those who desperately need this assistance and shorter waiting times. Someone who is in crisis may not always have time on his or her side. People have been referred by the public sector to a private service as the public sector did not have specialists available. This cost €140 per session. This is not suitable for anybody. Sometimes there is no alternative except to endure endless waiting lists and hope and pray that loved ones are able to hold on.

I know the Minister of State's portfolio is close to her heart, and it has touched all of ours as well. I am excited to know which changes she will bring about and I wish her every success in her new ministerial role. I will finish with a sobering thought written by Shane Gillen:

I am a 28 year old male in Ireland. Some day I will die, and the chances of me dying by suicide are higher than the chances of me dying of liver disease, leukaemia, stomach, pancreas, oesophagus, liver or colon cancer, kidney disease, lymphomas or from a serious injury or car crash. Today's Ireland sees suicide ranked among the top ten killers in the land.

Photo of Maire DevineMaire Devine (Sinn Fein)
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I thank the Minister of State and thank all Senators for their passionate speeches and statements on mental health. Mental health, according to the World Health Organization, is the most important public health issue. Even every poor society must afford to promote, protect and invest in it. Mental illness is the world's most neglected disease and the leading cause of disability worldwide. Anyone, as previous speakers have said, can experience it. Depression and anxiety are very common conditions and affect almost half a million people in this country. One in four of us will be affected by depression at some point in our lives and, tragically, each year several hundred people take their lives, sending grief and shockwaves rippling out to family, friends and communities forever affected.

We are a society in distress and we have a moral responsibility to demand resources to guarantee the provision of a modern mental health system to meet today's needs. Public demand has never been so high. Since the establishment of the State, all Governments have failed miserably in this regard. They have no comprehension of mental distress and appear not to possess compassion, and "compassion" is a word we need to use repeatedly. We lauded yesterday A Vision for Change, which takes us from the antiquated, Victorian era. Instead, Governments have used it as a fiscal scalp to cut services without any community replacements.

Many reports by the Mental Health Commission and Mental Health Reform rage against the failure of mental health services, and yesterday saw the launch of a wonderful document by the Psychiatric Nurses Association, PNA, and the Royal College of Surgeons in Ireland, RCSI, in Buswells Hotel. I hope the Minister has a copy and goes through it. It details the failure of A Vision for Change and the stark fact that the budget was drastically reduced from 14% to a measly 6%. This is unpardonable and inexcusable. Of the recommendations in A Vision for Change, 75% have not been implemented. Regarding inpatient bed status, A Vision for Change was to seek community replacement of inpatient facilities. Figures from the report show that in 1984, there were 12,500 inpatient beds, whereas in 2004 the figure went down to 4,000 and in 2015 to 1,600. The percentage drop from 2004 to 2015 is 60%. The budget was drastically reduced at the same time. This document speaks of broken promises and heartbreak throughout the country. Mental health has always been the Cinderella of the health services but it needs to be at the top of the agenda in every Government's decision and policy-making. It needs to be a central focus of our health policy.

I applaud and congratulate community groups and families. They are standing up and are innovators in the vanguard leading the fightback to inform communities and demand the provision of appropriate care and understanding for those in their communities who are in distress. They are the mental health advocates and warriors and are challenging attitudes and changing lives.

We do not need any further reviews. We need implementation. We have reviews coming out our ears, so to speak. We all know what needs to be implemented. The will is needed to do so, and I hope the Minister of State will work with us all in this regard.

On the issue of stigma, to which the Minister of State alluded in her speech, one hopeful thing was See Change's Green Ribbon campaign, which was fantastic and really well done. It started a conversation. If people wear the green ribbon, they are open, they want to talk about mental health and they want to disperse the stigma. The research that See Change has done over recent years has shown that people are much more comfortable discussing mental health, so we just need to keep that going. In addition, last week in the Mansion House there was a fantastic community-initiated report on suicide and its effects on communities and families in the Dublin 8 area. I would love the Minister to invite the South West Inner City Network to present that report. I would like the to be brought in here, but also to be part of the youth group that the Minister of State wants to pull together. They speak from the heart. It is a community initiative. They are not professionals. They are concerned with the matter on the ground, and Dublin 8 has seen its fair share of pain and grief. Their report mostly speaks of the love that they have for the people they have lost.

I welcome the Minister's report and the postgraduate course to try to convert some of our nurses into specialist psychiatric nurses. We need to tackle the concerns of the student nurses. Their intake is 300-odd a year, with drop-outs, yet there are 1,000 vacant posts this year and we will spend 15 years trying to catch up to provide nurses to care for families in distress.

Photo of Maura HopkinsMaura Hopkins (Fine Gael)
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I welcome the Minister of State, Deputy McEntee, and wish her every success in her new role. Minding our mental health is a constant requirement every day of our lives. How we feel filters into everything we do and experience, from being involved in our community to having a job to meeting friends to financial stress, online criticism, feelings of inadequacy, bullying and feelings of depression. We must ensure at all times that all people know how valued they are. We must ensure in times of difficulty that we have someone to turn to, someone who will listen, that we are equipped with the coping mechanisms to deal with life's challenges, and above all that we have a mental health service which supports us when we need it.

The Mental Health Commission's annual report for 2015 published a number of days ago clearly emphasises that much work needs to continue in developing a properly resourced community-based mental health service with a focus on prevention and recovery. At present it is of major concern that just under half the HSE's community mental health services provide support seven days a week. It is unacceptable that in 2016, substantial areas of the country are still without full weekend support for people with a mental health difficulty. I very much welcome the contribution of the Minister of State, Deputy McEntee, today that we need more community mental health teams, together with an improved 24-7 response and liaison services.The intensive home treatment team established approximately a year ago in Roscommon works on a seven-days-per-week basis to treat more people at home. It also allows for greater family involvement. It has a consultant psychiatrist, an occupational therapist, a psychologist, a nurse and a social worker. The feedback I have received from number of service users is positive, but teams such as these need to be further developed and properly resourced so that a holistic service is provided, the service user is very much at the centre of his or her own care plan and appropriate supports are provided where necessary.

The restoration of the €35 million for mental health was absolutely necessary in light of the challenges we face in delivering a proper service. I thank the Minister of State, along with the Minister for Health, Deputy Harris, for ensuring its restoration. Following publication of the report recently, the chairperson of the Mental Health Commission stated there is still a significant absence of psychology, social work, occupational therapy and other multidisciplinary team members. There are distinct difficulties in recruiting specific professional staff despite funding being made available in 2015 for an additional 700 staff. I welcome the focus of the Minister of State on the challenges we face regarding recruitment. The HSE's reintroduction of a one year post-registration programme in psychiatric nursing is most welcome. What changes will the HSE and Department of Health recommend as needing to be made to recruit increased staff for all multidisciplinary team positions?

I very much welcome the establishment of the youth mental health task force to which the Minister of State referred. It is absolutely critical that, from an early age, young people have the coping skills to deal with life's challenges so that we deal with prevention rather than cure. As the Minister of State is well aware, much urgent work needs to be done in the area of child and adolescent mental health services. They are not properly resourced and children and adolescents are being assessed and treated at inappropriate facilities.

Voluntary organisations provide vital services, particularly in the context of education on mental health well-being and counselling services. However, they need to be provided with proper funding support from the HSE.

I am enthusiastic about the need for a review of A Vision for Change, which the Minister of State mentioned. It is absolutely critical that we respond to the changing demands of our society and I hope a review would allow us to plan our mental health services to respond to these needs. I very much look forward to working with the Minister of State and I thank her for the opportunity to contribute to this debate.

Photo of Frances BlackFrances Black (Independent)
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I will share time with Senator Kelleher. It is lovely to see the Minister of State here today and I congratulate her on her new role. I wish her well.

As many Senators are aware, ensuring that we address mental health needs throughout the country is an issue that is dear to my heart. On a daily basis, I hear from families and family members that are finding it difficult to access mental health services. Despite some excellent services and dedicated staff, the supports are sporadic, at times unco-ordinated and not always fit for purpose. There is a prevalence of mental health difficulties in Ireland and we need to stop writing reports, policies and strategies-----

Photo of Maire DevineMaire Devine (Sinn Fein)
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Hear, hear.

Photo of Frances BlackFrances Black (Independent)
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-----and start acting on implementing international best practice.

One in seven adults in Ireland will have experienced a mental health difficulty in the past year and 9% of the population aged 15 or over has a mental health problem, according to the Healthy Ireland survey. The survey also shows that mental health difficulties are an issue of inequality. The level of mental health problems is considerably more prevalent among people living in deprived areas, at 13%, compared with that relating to the overall population, which stands at 5%.

The Minister of State can see from these facts that writing reports and not implementing them fully is costing Ireland dearly, in that we are not looking after the welfare of our people. Many good people work hard in delivering mental health services throughout the country, but problems in the mental health system are far and wide. Mental health staffing is still 25% lower than recommended in the mental health policy A Vision for Change. Specialist 24-seven mental health crisis services are not evenly available throughout the country and, as a result, people may be obliged to wait for hours in accident and emergency departments. In 2015, approximately one third of child and adolescent admissions to hospital were to adult units. There is no national advocacy service dedicated to families of people with mental health difficulties or dedicated to those with such difficulties who live in the community.

We must not ignore the contributing factor that alcohol has on our mental health and how it exacerbates pre-existing mental health difficulties. Alcohol affects our ability to cope with everyday life and can have significant consequences when we face traumatic life events. Alcohol has a key impact on the number of suicides, being a contributory factor in more than 50% of cases. A total of 11,000 cases involving self-harm present to accident and emergency departments each year, and one third of all cases relate to alcohol. The World Health Organization has estimated that the risk of suicide where a person is abusing alcohol is eight times greater than if he or she were not doing so. Suicide is the leading cause of death among young Irishmen aged between 15 and 24.

In tackling mental health, it is imperative that we look at matters in a holistic way. In particular, we should look at gender analysis. The HSE and the National Women's Council, along with others, have been successful in securing the visit to Ireland in 2017 of the World Congress on Women's Mental Health. The HSE has had a successful project in policy-proofing gender analysis and we should work hard to ensure this is implemented in all mental health areas.

We must also not forget about the families impacted upon by addiction. This issue is extremely close to my heart. We need to ensure the appropriate support services are available to these families, that their risk of mental health issues is reduced by early intervention and that funding is found for organisations supporting them. On a daily basis, I deal with family members who are absolutely heartbroken because somebody they love has an alcohol, drug or gambling problem.

The task before us is huge. It is a difficult task but certainly one we should not shy away from or write a report about. We need direct action. We need to hold Ministers, officials and service providers to account and ensure that we achieve the highest quality of services for the thousands of people throughout the country affected by mental health issues.

Mental Health Reform has been campaigning on the implementation of the recommendations and I support it in calling on the Government and the Minister to implement these recommendations and put our nation's mental health as a top priority. Acting now will save further heartache, anguish and distress to our fellow citizens. A country is judged by how it treats its vulnerable. I want us to be judged well, so, please, let us start acting.

Photo of Colette KelleherColette Kelleher (Independent)
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I congratulate the Minister of State, Deputy McEntee, and I look forward to working with her on improving the lives of people with mental health issues and older people.

I want to draw attention to a particular group in our society. The rate of suicide among Travellers is six times higher than the general population. What immediate supports are in place to address this matter of crisis, tragedy and heartbreak for Travellers? Will the Minister of State provide an assurance to the effect that the independent Traveller counselling service established on a pilot basis in 2008 is now on a firm and regular footing in the context of funding?

Photo of Maria ByrneMaria Byrne (Fine Gael)
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I welcome the Minister of State. I support what my colleague, Senator O'Donnell, stated earlier about the extra beds that were to be provided at University Hospital Limerick. At present, I am dealing with three families that have members with various mental health issues. I am very concerned about one particular family.I know of an older mother who lives with a son or daughter who suffers from mental illness but she is very much in denial about the situation. It is hard to convince the family members to say there is an issue even though the neighbours are very involved and concerned about what is going on. We must explore ways to encourage people, especially family members, to say there are issues within the household and provide the family with support. Some support services have been provided in this case but the matter needs to be explored.

The shortage of beds in the University Hospital Limerick has been mentioned but I wish to commend the service provided by the hospital. I have had dealings with one family that had two members in and out of a unit in the hospital and I can confirm that the services and treatment that they received were second to none. I compliment the staff for providing such care because it is important to compliment them. I urge that extra resources and support are provided.

Photo of Paul CoghlanPaul Coghlan (Fine Gael)
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I call Senator Nash, to whom I apologise again. He has six minutes.

Photo of Gerald NashGerald Nash (Labour)
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Is the Leas-Chathaoirleach sure about that?

Photo of Gerald NashGerald Nash (Labour)
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I welcome the Minister of State at the Department of Health, Deputy McEntee, to the House and congratulate her on her appointment. She is passionate about this area of work. Her passion and commitment will make a big difference in the Department. Everyone in this House has admired the work done by her predecessor, Deputy Kathleen Lynch. Even though Deputy McEntee has big shoes to fill she will make her own mark on the Department. She will work very hard to deliver better services and change in the essential area of mental health.

There is a huge degree of unanimity in the House on what needs to be done to promote positive mental health and the type of services that we need. Just like yesterday's debate on health services in general, there will be no shortage of ideas about the areas that need to be resourced and where resources should be directed. First, we need to be very clear about stopping the almost routine discussion or threat of pilfering the mental health service budget in terms of the overall and politically sensitive general health budget. It is not an overstatement to say that, traditionally, the mental health service has been one of the Cinderella services in terms of the overall funding envelope for health. My colleague, Deputy Kathleen Lynch, fought a Trojan battle to ensure that resources were ring-fenced for mental health services during the very difficult times for this State over the past few years. If we are serious about mental health funding then we need to adequately and properly fund positive promotional campaigns. We must also fund good services - and that is the point - that are proven to work and are responsive to people's needs.

Yesterday, I met part of the leadership team of the Union of Students in Ireland, Mr. Kevin Donoghue and Ms Aoife Ní Shúilleabháin, to discuss their mental health priorities. It is an organisation that works on the front-line with young people in vulnerable situations. I pay tribute to its I Am A Reason campaign, which promotes positive mental and identifies the need for improved services across the country. That campaign, as other campaigns have pointed to, directs much of its attention towards the absence of 24-7 crisis intervention services across the country. As we all know, trauma and personal crises do not occur on a 9 to 5 basis, Monday to Friday. The official policy suggests that a network of 16 crisis houses should be provided all around the country. They would deal and provide accommodation and support to people in crisis situations, on a temporary basis, and until such time as connections could be made with the community and mental health teams to develop proper care programmes to deal with some of the issues experienced by people. Also, to address the underlying issues that precipitated the crisis in the first place. I have no doubt that the Minister of State supports this objective and I look forward to hearing her views on how the policy objective can be rolled out.

I shall conclude by responding to comments made by Senator Craughwell about bullying in the workplace. It is an insidious phenomenon. Many mental health crises that people experience can be put down to some experiences in the workplace that may have been inadequately dealt with. The Senator is right when he said that there is only civil redress available, which is a costly and slow process. Workplace bullying is a scourge and is very insidious. One of the reasons that is the case is that no clear procedures have been set down. In 2006, the task force on bullying report commented on the lack of clear and formal procedures needed to deal with bullying complaints. It also mentioned the need to outline a formal route for adjudication on bullying complaints because all too often workplace bullying complaints are not addressed quickly and efficiently and so end up in the courts, which is damaging for both the employees, who may be victims, and employers who may, in many circumstances, be doing their utmost to address an insidious situation. I wish to correct Senator Craughwell by stating that this is not a matter for the Minister of State or any colleagues in the Department of Health to address the workplace bullying, even though I am sure that the Minister of State has a view on the matter. It is a matter for the Minister for Jobs, Enterprise and Innovation. I ask her to accept the will of the Dáil as expressed in the support shown for the Labour Party's motion that was tabled three weeks ago, which included a provision to counteract such bullying by putting statutory redress in place, thus providing a formal route of adjudication to ensure that the scourge of workplace bullying, that can lead to a huge amount of mental distress, be addressed efficiently and effectively. That is not the case at the moment.

Photo of Paul CoghlanPaul Coghlan (Fine Gael)
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I call Senator Murnane O'Connor and she has six minutes.

Photo of Jennifer Murnane O'ConnorJennifer Murnane O'Connor (Fianna Fail)
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Can I give my colleague two minutes of my time?

Photo of Jennifer Murnane O'ConnorJennifer Murnane O'Connor (Fianna Fail)
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I congratulate the Minister of State on her appointment. I know she will do well in her new position. It is great to see the appointment of a woman.

No family is immune from some form of mental health issues. Beyond the striking statistics on suicide levels and the affliction of depression extracting a hefty toll on the day-to-day lives of countless people, the recovery model recognises that treatment is not merely about the listing of symptoms but also ensuring that the person can live a productive and meaningful life despite the vulnerabilities that continue to exist.

I want to ask the Minister of State about funding. As she will know, her Department has an annual allocation of €35 million for the mental health budget. I ask her to increase the allocation to €37.5 million because the Department of Health has said it needs that amount to provide all of the necessary services. Increased funding is critically important. I firmly believe that funding is the key to everything. We need to ensure that we give a proper service to people in need, in particular people who need mental health services.

I ask the Minister of State to establish a national mental health authority. Such an authority would show a sense of urgency in terms of tackling mental health issues and reducing self-harm and suicide. In this regard we must ring-fence funding for mental health services. Far too often, as the Minister of State will be aware, funding is pulled from the mental health budget and allocated to other areas. I ask her to ensure that none of the mental health budget is touched and that it is increased.

The principle of early intervention is critical. Addressing mental health problems that arise in early childhood and adolescent years leads to better educational outcomes, the prevention of several mental health issues and, in later life, it can lead to a better quality of life. This is why it is important that extra funding is allocated.

The provision of counselling is essential. Teachers should receive mental health training in order to equip them to identify whether children need support and, in particular, if they feel a child has mental health issues that they can mention their concern to someone. We must restore the post of guidance counsellor in schools.In the past such a service was in place but it has been taken out. I ask the Minister of State to reinstate it in every school. It is crucial.

A study of children's mental health in 2015 identified that while the demand for the service is increasing, the number of staff in the area is falling. A report has found that mental health services for children and teenagers are understaffed and overstretched while access to getting support is confusing. Given the confusion in this area I ask the Minister of State to look at the issue. Some 61 approved centres were inspected in 2015 and of these only six were rated compliant. The remaining number were non-compliant to varying degrees. It is critical for the Minister of State to establish a youth mental health task force within 100 days. I make this request as a person who lives in Carlow and who has been a councillor for 19 years. I have witnessed many changes. Recently Carlow has had several young suicides. Like many other counties, Carlow wants to be a part of the task force that is being established for youth and mental health.

In her contribution the Minister of State mentioned that within the next 100 days she will initiate an evidence-based expert review of progress in the implementation of this policy and in the improvement of mental health services. It is crucial that areas such as my area in Carlow and neighbouring counties play a role in the task force. Every local authority and every area of mental health can play a role and have its say. It is crucial that we all know what is happening. Information on this issue will be crucial. I ask the Minister of State to set up a national mental health authority which is key to getting this on track. I would appreciate if the Minister of State would come back to me with some answers.

Photo of Aidan DavittAidan Davitt (Fianna Fail)
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Comhghairdeas leis an Aire Stáit. I have two queries both of which relate to St. Loman's, Mullingar. Has the Minister of State any plans for the main building which is about 95% unoccupied? It is a landmark structure as one approaches the town of Mullingar. Funding has been put into some of its new infrastructures.

An issue was brought to my attention by HSE staff concerning care in the community. The policy has been to get people back into the community and care in the community. Some staff members have expressed their concerns that there are people in care in the community whom they consider should not be in the community. There have been a few incidents. I am sure Mullingar is not the only town in which this has happened. Has any assessment taken place as to how some of our clients are being cared for in the community? Perhaps some mistakes have been made in respect of some of these people and, if so, they should be assessed differently.

Photo of Denis O'DonovanDenis O'Donovan (Fianna Fail)
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I call Senator Lynn Ruane who has six minutes.

Photo of Lynn RuaneLynn Ruane (Independent)
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I wish to speak about dual diagnosis which is not raised too often in debate. Working in the homeless sector I have become increasingly worried, especially in the past decade, that having made the transition from institution and asylum type treatment, a large proportion of people who were being cared for within that structure ended up on our streets due to a big gap in services. They were not being treated in the community but began to be treated by project workers, who are not mental health professionals, within a hostel setting. To provide a little background, on any given occasion I could walk in on a shift and 12 or more people would have to be put on hourly checks because of their mental health.

As one opens the door one does not know what one will find. I have cut people down from nooses. I have had to use my stockings at one stage to stem the bleeding of a man who had slit his throat. These are people who definitely should not be cared for within a hostel setting that does not have adequate services to treat them. At any given time, ambulance personnel would arrive and the resident may refuse to go. As a project worker one would invest hours trying to convince the person who was suicidal to go to the emergency department where two things could happen. Because of the dual diagnosis, the addiction takes over and the person goes into a state of withdrawal and leaves without being given adequate treatment or else the person is seen but is told the wounds will be looked at but will not be treated. Given that dual diagnosis is normal within that sector, care plans should be in place to deal with a person's mental health and addiction rather than sending such a person from one door to another. On many occasions people have left the emergency department. Last year, a man went out and straight under a car after he could not handle waiting in the emergency department due to suicide ideation.

The report, Homelessness: An Unhealthy State, by Dr. Fiona O'Reilly and Dr. Austin O'Carroll, of which I was a part, which looked at the health status, risk behaviours and service utilisation by homeless people in Dublin and Limerick, points out that almost half, 47%, of the sample experienced mental health issues and addiction problems. This co-occurrence of mental health and addiction has been termed dual diagnosis. People who have both substance misuse and mental health problems have particular difficulties exiting homelessness and taking care of their physical and mental health. The research shows that more than half the sample had previously experienced suicidal thoughts and more than a third had attempted suicide. One in three homeless people have been so desperate as to attempt suicide. Shockingly, the statistic gets even worse for people with mental health problems with half of those with a diagnosis reporting having attempted suicide in the past. The depressing statistics, which reflect my experiences, find mental ill health the norm among the homeless population, with 58% having at least one mental health diagnosis. Some 13% were diagnosed with schizophrenia or psychosis compared with 1% in the general population.

The inverse care law states that those in most need of care are least likely to get it. That a cohort of our population exists on the margins of society where mental health problems are the norm demonstrates the existence of this inequitable inverse care law. Will the Minister of State commit to turning the inverse law on its head and bring equality and fairness to light by ensuring that those in most need of mental health care get it? Will the Minister of State commit to the following as a matter of urgency: that a coherent and specific stepwise approach to presentations by homeless people in crisis in line with national suicide prevention guidelines be established and rolled out within the homeless sector; and that a crisis house for homeless people as recommended in A Vision for Change needs to be established.

This can take effect immediately by ring fencing a number of existing beds 24-7 within the homeless sector with nursing staff linked to inpatient psychiatric care for homeless people at risk who would not be best served within an emergency department. Professional care needs to be equipped with specific skillsets to meet clients' needs, that is, mental health social workers are needed on site in homeless accommodation in numbers with the very high mental health need evidenced in this study. These professionals can identify need among the homeless individuals and navigate the many excellent mainstream services, removing barriers for homeless people, allowing them access the appropriate care. Mental health training guidance for workers in the homeless sector and appropriate supports for clients is needed. Clear recognition for dual diagnosis as a reconfiguration of services to treat this as the norm in homelessness rather than the exception is needed. Addiction and mental health services have evolved separately and without reorientation towards the service user the homeless person continues to get shifted back and forth between the two services.

Photo of Helen McEnteeHelen McEntee (Meath East, Fine Gael)
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I thank the Senators for their contributions. This debate has been useful, similarly the debate continuing in the main Chamber which is due to conclude. I assure Members I am taking on board absolutely everything that has been said. I may not be able to come back with a response on all the specific issues but I will certainly try my best during the course of the next couple of weeks.Across the political divide, there is a consensus that we need to improve services. We are all on the same page in that regard. It is important that we work together, listen to each other and work with the services to improve what is already in place. It is reasonable to say, however, there have been real and significant developments in the service initiated by the previous Government. I acknowledge the work taken on by my predecessor, Kathleen Lynch, and all of those in the Department.

Up to €115 million in additional funding has already been allocated to mental health services under the HSE’s national service plan. That funding is there to enhance all aspects of the service. New investment and new personnel have been directed towards developing specialised services which, up until now, did not receive the attention they deserve and need. I will stand over the commitment to increase mental health funding every year. Obviously, the restoration of the €35 million development fund was important to me and I am glad it is back. While I am Minister of State, I would like to say it would never happen again.

I acknowledge the work carried out by the HSE and the voluntary and statutory organisations because they are working with those who are often at the lowest point in their lives. It is a difficult environment and, with increased demands and resource limitations, we need to ensure they get all the credit they deserve.

There is a real and genuine will across all political parties to modernise our services and bring us in line with best practice. Fundamental to that is our attitude to mental health. While we have come a long way in a short time, there is still a long way to go. To reduce the stigma and isolation associated with this area, we need to start thinking of it in the same way we do physical illness. If a person breaks a bone or cuts himself or herself, he or she goes to an accident and emergency department or his or her doctor. If people feel under pressure or do not feel supported, we need to get to the point where they feel it is okay for them to seek help and the stigma is thereby reduced. In that regard, we need a concerted effort in respect of men in their 40s in the same way we targeted women through BreastCheck to deal with a specific problem and stop it at an early stage. We need such a programme to target men who are at risk, particularly those in the workplace. I hope to progress this in line with our connecting for life strategy and by placing a greater emphasis on health and wellness, early intervention and prevention. Education is key in this regard. My colleague, the Minister for Education and Skills, Deputy Bruton, is rolling out the wellness programme through his Department. Through my own task force, I would like to see it brought back to an even earlier stage.

The review of A Vision for Change is necessary but I agree that progress cannot be halted at the same time. The vision will not change, even with a review. The review needs to operate in tandem with continued investment and implementation. If changes are to be recommended at the end of the review, they should be incorporated into the policy.

As I have said previously, it is not just the Department of Health which needs to be dealing with this issue. It also touches on homelessness, the Traveller community, work environments and the judicial system, meaning I will need much support from my ministerial colleagues. I intend to ask them to identify key areas in which they need support from me.

I will come back to Senators on St. Loman's and other specific issues. If there are other specific questions I have not touched on, Senators can contact me about them.

Sitting suspended at 2.05 p.m. and resumed at 2.30 p.m.