Written answers

Tuesday, 8 July 2014

Department of Health

Mental Health Commission Reports

Photo of Billy TimminsBilly Timmins (Wicklow, Independent)
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694. To ask the Minister for Health the position regarding the chairman's forward to the Mental Health Commission annual report 2013. in which he states that, since 2007, staffing in mental health services has been reduced by the implementation of recruitment embargoes and employment moratoriums; the medium and long-term effect of such policies is to endanger the delivery of confident and responsive community-based services as envisaged in A Vision for Change; this situation needs to be reversed by the continued allocation of new revenue for the full development of community mental health teams and concomitant services; and if he will make a statement on the matter. [29202/14]

Photo of Kathleen LynchKathleen Lynch (Cork North Central, Labour)
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I have noted the position indicated in the Report referred to by the Deputy in regard to staffing requirements for mental health services. The Government is committed to the continued reform of mental health services, notwithstanding the substantial overall reduction in resources available to the health service in recent years. Towards this end, ring-fenced funding of €90 million and some 1,100 posts are being provided between 2012 and end 2014 to develop community mental health services and suicide prevention resources. The budget for mental health services in 2014 is significant at approximately €766 million.

A Vision for Change indicates a requirement for 10,647 WTE staff which, when adjusted for the 2011 population census, equates to around 12,240 WTE staff by 2016. However, given the changed economic circumstances since the publication of Visionin 2006, the Government had to reduce the numbers employed across the public service in order to meet fiscal and budgetary targets. While the health sector must make its contribution to that reduction, the HSE can make staff appointments once it remains within its overall employment ceiling, and has the financial resources to do so. The HSE Service Plan for 2014 commits to developing workforce planning to bring greater certainty around essential replacements, and the streamlining of recruitment to allow for more local control and specialisation, where appropriate.

While staffing levels in the mental health service have fallen, there are positives that must be acknowledged. Many of the staff numbers lost were supporting the excessive numbers of beds which are no longer part of the service user recovery focused, modern, community-based model for mental health. The overall reduction in numbers has been mitigated due to the priority ring-fenced Programme for Government investments in 2012, 2013 and again in 2014. This has allowed the HSE to begin to re-balance the staff skill mix in mental health and to introduce new staff in the historically under represented disciplines recommended in A Vision for Changei.e. psychologists, social workers and occupational therapists.

Recruitment of the additional posts in 2012 and 2013 is continuing with 95% of the 2012 posts filled as at the end of May 2014. The recruitment process is complete for 68% of the 2013 posts, with the remainder in various stages of the recruitment process. These posts continue to come on stream, and are targeted to be in place by the end of Quarter 2 of 2014. Decisions on the breakdown of the new 2014 posts (between 250 - 280 posts) are being made by the HSE, following a business case and analysis process to ensure that the required professional grades are recruited to fill identified service gaps. It is intended that these posts will be in place by end of 2014.

Photo of Billy TimminsBilly Timmins (Wicklow, Independent)
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695. To ask the Minister for Health the position regarding the chairman's forward to the Mental Health Commission annual report 2013 in which he states that mental health services are designed to assist in a person’s recovery rather than simply to manage their illness; in that context, that the concept of recovery is now well understood but implementation of it is uneven; that the information provided in this report points to a serious deficiency in the development and provision of recovery-oriented mental health services; that service delivery is still largely delivered by medical, psychiatric and mental health nursing staff; that there is still a significant absence of psychology, social work, occupational, and other multidisciplinary team members; and if he will make a statement on the matter. [29203/14]

Photo of Billy TimminsBilly Timmins (Wicklow, Independent)
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696. To ask the Minister for Health the position regarding the chairman's forward to the Mental Health Commission annual report 2013 in which he states that in order for a fully developed recovery-oriented service to be delivered, there needs to be a cultural shift in how we deliver services away from a linear medical model towards a more holistic biopsychosocial one; and if he will make a statement on the matter. [29204/14]

Photo of Kathleen LynchKathleen Lynch (Cork North Central, Labour)
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I propose to take Questions Nos. 695 and 696 together.

In line with the recommendations of 'A Vision for Change', a recovery orientation should inform every aspect of service delivery and service users should be partners in their own care. There is a growing recognition that, with a recovery approach, it is possible to live well despite any limitations caused by disability or illness. I have acknowledged previously that there is more to be done in developing a focused recovery orientation for some patients. I also accept that adopting a recovery based approach has not been without its challenges which include reconsidering some fundamental concepts such as what it means to be a service delivery organisation, a professional, a person who uses services or a family member, and how we judge effective treatments. The Recovery approach that we want to see places a unique emphasis on the value of each person and their understanding of their illness and should be seen as natural process which service users believe can put greater choice and control back in their hands.

As acknowledged by the Chairman of the Mental Health Commission in his foreword, the 'Advancing Recovery in Ireland' (ARI) initiative which is a partnership project between the HSE and other bodies is a welcome development. The initiative focuses on service level structures, systems and practices that can maximise personal recovery opportunities and outcomes for service users. It aims to achieve this by facilitating the individual to manage their personal recovery and by the development of recovery focused mental health practice in the service. It recognises the service provider, service user and family as equal stakeholders. Some of the innovations being developed through ARI are Recovery Colleges, Peer Support Working and the Recovery Context inventory Tool. The ARI is an 18 month initiative which is being rolled out on a phased basis to allow maximum benefit, the initial phase of which commenced in May 2013.

The Community Mental Health Team is the first line of acute secondary mental health care provision and their presence allows individuals to be supported in their recovery in their own community. Community Mental Health Teams need to have expertise from all the core disciplines of psychiatry, psychology, social workers, occupational and other therapists as well as mental health nursing. With this in mind, some 1,100 new posts have been funded by a special allocation of €90 million since 2012 primarily to strengthen Community Mental Health Teams for both adults and children and to enhance specialist community services. To date, some 740 of the posts have been filled and the recruitment process for the remaining posts is continuing by the HSE.

The Mental Health Act 2001 is the key piece of legislation regarding the rights of people involuntarily detained and treated in approved centres within our mental health services. The Act is currently under review, and an Expert Group set up by me in September 2012 is currently finalising its deliberations. I expect to receive its report by the third quarter of 2014. Whilst I am not in a position to comment on any recommendations of the Expert Group in advance of the completion of the final report, I would expect that the Group will take into account the importance of recovery when finalising their report.

Photo of Billy TimminsBilly Timmins (Wicklow, Independent)
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697. To ask the Minister for Health the position regarding the chairman's forward to the Mental Health Commission annual report 2013 in which he states that the commission is also concerned regarding a number of specific areas of service provision which impinge on human rights and where, in 2013, standards fell below what is acceptable; and if he will make a statement on the matter. [29205/14]

Photo of Kathleen LynchKathleen Lynch (Cork North Central, Labour)
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The principal functions of the Mental Health Commission are to promote, encourage and foster the establishment and maintenance of high standards in the delivery of mental health services and to take all reasonable steps to protect the interests of persons detained in approved centres under the Mental Health Act 2001. The Commission also appoints the Inspector of Mental Health Services, who in accordance with the Act, is required to visit and inspect every approved centre annually and, as the Inspectorate think appropriate, to visit and inspect any other premises where mental health services are being provided.

I welcome the Annual Report of the Mental Health Commission and note the specific areas of service provision which require improvement that have been highlighted by the Chairman. Under the 2001 Act, the Commission has a number of powers in relation to approved centres which includes the attachment of any conditions it considers appropriate to the registration of such centres and such conditions could include the requirement to introduce or to review specified policies, protocols and procedures relating to the care and welfare of patients and residents. In addition, the Commission can prepare codes of practice for the guidance of persons working in the mental health services. As a consequence of the Commission carrying out its functions, I am satisfied that the rights of patients are regularly and appropriately reviewed in line with our mental health legislation.

The Mental Health Act 2001 provides the legislative framework within which people who require admission on a voluntary or involuntary basis can be cared for and treated in approved centres within our mental health services. The 2001 Act introduced a human rights ethos into our mental health law and it is currently under review by an Expert Group which I set up in September 2012. I expect to receive the final report of the Expert Group by the end of quarter 3 this year and while I am not in a position to comment on any specific recommendations of the Expert Group in advance of its final report, I would expect that the Group has considered the matters raised by the Chairman with a view to ensuring that the human rights of patients are upheld and strengthened further.

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