Seanad debates

Wednesday, 1 February 2017

Commencement Matters

Mental Health Services

10:30 am

Photo of Gabrielle McFaddenGabrielle McFadden (Fine Gael)
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I welcome the Minister of State to the House to discuss an issue that affects families and individuals from all walks of life. While mental health is an issue that affects all of us at one time or another, I want to talk about two groups who have specific needs with regard to mental health, namely, young people and people who are homeless.

I came across a situation recently involving a 12 year old boy who is suffering from panic attacks. He has not attended school for the past 18 months because of his anxiety and is unable to leave his home. He had been on a waiting list for months to see a psychologist but by the time an appointment came, he was unable to make the journey to Mullingar, which is 30 miles from his home. Months later, after several failed appointments, he still has not received the intervention he and his family so desperately need.If that intervention had arrived in a timely fashion, I have no doubt the child would be in school today. Instead, there is now a risk that his life opportunities have been thwarted. There are many similar situations in which young people have difficulty accessing mental health services in Athlone and throughout the country.

Accessible and informal mental health services play an essential role in preventing mental health problems in vulnerable young people. The economic benefit of local rapid-response mental health services has been proven. The personal benefit is incalculable. Services, such as those provided by Jigsaw, which are free and do not require GP referral, are informal and therefore attractive to young people. I urge the Minister of State to make Athlone a priority for the development of the next Jigsaw service since the town is the largest in the midlands.

Another group who suffer disproportionately are the homeless. Up to 47% of homeless people have been diagnosed with at least one mental health problem. Recently, I have been in discussions with the Midlands Simon Community. Those running the service have explained to me that it is not uncommon for homeless people to face two, three or even four such challenges. For example, they may have a mental health diagnosis, an addiction, a history of abuse and a brain injury. Each time the Midlands Simon Community attempts to access services on behalf of a client, the service provider states it cannot accept the client because of an addiction issue that needs to be resolved. The service provider also states it cannot accept someone who has a brain injury or someone who is actively suicidal. It seems there is no joined-up thinking yet and no appreciation of how hard life is for people. There is little appreciation that some people have multiple hardships and simply do not fit neatly into one box or another.

We need more accessible services but we also need special tertiary services for people with complex needs in order that someone who has fallen into addiction as a way of coping with trauma can be helped. Every community in Ireland has been afflicted by suicide or self-harm and the emotional turmoil associated with such ideation does not confine itself to business hours. My concern is that someone who is suicidal and who turns up outside normal hours often has nowhere to go. No one who is suicidal should be turned away. I am aware of a number of cases in which people have sought help or tried to get a place in a psychiatric hospital only to be told they would have to get the underlying addiction treated first.

For some, the place on an addiction service has come too late. I am passionate about this issue. Not a single parish in the country has avoided the devastation of suicide. The tragedy is that all those deaths were avoidable. Were Ireland to take mental health as seriously as we have taken road deaths, for example, we would be a healthier and safer country in which to live.

Photo of Helen McEnteeHelen McEntee (Meath East, Fine Gael)
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I thank the Senator for raising this important issue. I agree that people who are suicidal or who have mental health problems should never be turned away, whether it is morning, noon or night.

Improving access to mental health services is a key priority of the Minister. In many cases, mental health issues are ongoing and may require immediate treatment at any time, day or night. Significant work is under way in this area. It is important that I outline what is in place at present in order that we can identify what we need to do in future.

The current provision of out-of hours mental health care involves various interlinked components, for example, access via community mental health teams during normal working hours, that is, from 9 a.m. to 5 p.m. between Monday and Friday. During this period, access is also available through emergency departments. If necessary, this involves the existing liaison psychiatric services for hospitals or alternative arrangements at local level. There is psychiatric-consultant-led cover in place in hospital emergency departments for both normal working hours and the weekend period.

The national clinical programme for the assessment and management of self-harm was initiated by the HSE in 2014 and is being developed on an ongoing basis. We already have seen the positive effects because while we discuss suicide, self-harm is probably more prevalent overall. The HSE has indicated that weekend access is provided in nine of the 17 mental health areas, with a further seven areas having partial cover. The HSE has prioritised the provision of improved out-of-hours liaison and seven-day responses for all people with mental health issues as a key priority under the national service plan this year. Services for all adults and those under 18 years of age are being developed in the light of significant new investment for mental health. This is balanced against an acknowledged difficulty for the executive in securing suitably qualified and experienced staff for the care programme.

My objective, and that of the HSE, is to improve all aspects of mental health care nationally for all children and adults, including better access outside of normal working hours via emergency departments. The HSE is keen to ensure that each region provides access to a weekend service for people currently attending the service. In recognition of this, a service improvement project with a dedicated project manager was set up in November last year. Data on timely access to services are collected for each team on a monthly basis. Thus far, the data indicate that 68% of children referred are seen within 12 weeks. Obviously, we need to see this number reduced further. In addition, a total of 74% of working age adults and 97% of older adults are seen within one week. This illustrates the improved response times for those with mental health problems.

Work is under way by the HSE to determine the existing level of service provision and to examine international models of best practice on the most appropriate model of service delivery for use in the Irish context in order to enhance the seven-day services. In addition, the HSE is progressing a detailed plan for provision of seven-day services throughout all HSE mental health service areas. We are keen to avoid a situation whereby some services in certain areas provide a fantastic service and provide 24-7 cover, while other areas do not even have a seven-day service. For now, the priority is to identify the gaps. Earlier, I referred to the nine areas that have full cover and the seven areas that have partial cover. Currently, we are working on identifying and providing a plan to fill in the gaps in these areas. In tandem, we are working to deliver a detailed plan for provision of 24-7 care but it is important that we walk before we can run.

The Senator referred to specific people and areas. An additional €2 million in ongoing funding was made available in 2016 to address the specific mental health needs of homeless persons in Dublin. This is part of the response to and recognition of difficult cases. To identify service needs of people with substance misuse, including alcohol and drugs, alongside mental illness, a clinical programme for dual diagnosis was initiated last year. To date a programme manager has been appointed to oversee the clinical programme. In addition, a clinical lead has been identified at interview and will be seconded pending discussions with the local addiction services. I will continue to work with the HSE on this area, taking account of agreed policy and evolving service priorities and resource availability overall.

I wish to specifically touch on the area of young people, which is a key priority. Senator McFadden referred to the task force. All the work under way at the moment will benefit all our people and society. The four key objectives of the task force are to improve awareness of our services, to improve accessibility of our services, such as the development of the seven-day week and 24-7 services, to align our services in order that public, private, community, voluntary and online services are all working together and are all aligned and to work towards supporting younger people to build up their own resilience in order that they can deal with the many stresses and pressures they face. I hope these young people will be able to take these skills with them later life. I thank the Senator for raising this important matter.

Photo of Gabrielle McFaddenGabrielle McFadden (Fine Gael)
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I accept that significant work is ongoing. While I also accept and acknowledge the commitment of the Minister of State to the issue, there is a serious need for 24-7 emergency care for people with mental health issues.

The Midlands Simon Community obviously is based in the midlands and recently, it had a client in emergency accommodation who was taken to a psychiatric service because he was suicidal. The person was sent home or back to the emergency accommodation. The Midlands Simon Community then had to monitor that person all night to ensure that he did not self-harm.

The Simon Communities and other similar organisations do not have the facilities or money to put staff in place. It is not appropriate to have one member of staff in emergency accommodation to monitor someone with a mental health issue. That person cannot be expected to do that job and look out for others in the service as well.

Another area that needs to be examined is funding and training for staff in organisations like the Midlands Simon Community and other organisations. It is also important that no one is turned away from a psychiatric service. A lady who visited my clinic last year went thrice to St. Loman's Hospital, Mullingar to state she was suicidal. Each time she was sent away and told she was not.If someone is trying to commit a person, that is one matter, but if a person turns up, stating he or she is suicidal, the person should never be turned away.

Photo of Helen McEnteeHelen McEntee (Meath East, Fine Gael)
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I wholeheartedly agree with the Senator. Nobody should ever be turned away, day or night. Whether the person has a substance abuse problem or whatever the issue is, the person should always receive that support.

This year we will spend €853 million on the mental health services. A total of €15 million was allocated in this year's budget which will develop into €35 million worth of spending next year. Every year we are developing new services. Every year we are hiring new staff.

A total of 1,550 positions have been approved in recent years. While not all have been filled and we have a difficulty in that area, a lot of work is under way to try and fill them. If we do not have the staff, we cannot provide 24-7 services. The priority is to ensure we can hire staff.

The National Office for Suicide Prevention, NOSP, has a budget in excess of €11 million. The funding goes to support many of the organisations provided they can show where their funding is going and they provide the service they say they do. Training forms part of what that funding is provided for, if the Senators wants clarity on that.

On the Jigsaw network, this year we will develop a further five new Jigsaw projects in Cork, Limerick and Dublin. The HSE is actively engaging with Jigsaw to develop a new programme whereby other counties and areas can actively engage with organisation. I would encourage the Senator to engage with her local organisations and the local HSE to get as much groundwork done as possible because when the conversation has finished between the HSE and Jigsaw will be the time to put her case forward. I am sure the Senator has a strong case.