Dáil Éireann Debate on Health Service Plan 2012, 2nd February 2012
Deputy Dan Neville
I welcome the opportunity to speak on mental health services in the context of this debate on the health service plan. Mental ill-health is damaging not only sufferers, their families and communities, but also the economy. Many of the debates held in this Chamber deal with important economic issues but the current economic crisis also includes social elements. In 2008, the Mental Health Commission published a report which estimated the direct annual cost of mental health at a staggering €3 billion in 2006. This is the cost to the taxpayer of decades of Government neglect and isolation of services. Mental health is central in building a healthy, inclusive and productive society. Illnesses like depression and schizophrenia can be treated successfully for the vast majority of sufferers and with early intervention people can live healthy lives and fulfil their individual potential.
In January 2006, the Government adopted A Vision for Change as the basis for the development of mental health services in Ireland. The policy framework set out in A Vision for Change, which built upon the recommendations of the 1984 report, Planning for the Future, received nearly universal approval as the best model for a modern, comprehensive and world-class service to meet the mental health challenges facing our society. However, five years since its announcement there is a lack of progress in implementing the A Vision for Change. The independent monitoring group reported last July that the specialist services promised as part of the strategy have not been developed. These include forensic mental health care services, rehabilitation and recovery eating disorder services, psychiatric services for older people, services for co-morbid severe mental illness and substance abuse problems and intellectual disability services.
A Vision for Change set out a policy framework for the mental health of the entire population. In addition to recognising the importance of mental health promotion and primary care, it called for a person-centred, recovery orientated and holistic approach to mental health services. This was a vital recommendation. It also called for a shift from the current system, which is excessively reliant on institutional care and medication, to a system centred on community-based care provided by multidisciplinary mental health teams. These teams would include psychologists, social workers, occupational therapists and service users, who would work alongside psychiatrists, mental health nurses, psychotherapists and counsellors. It is that important people with mental health problems are allowed to access the services and supports they choose while continuing to live in their communities, as is their right.
Ireland is more reliant on institutional mental health care than any other country in Europe. While there are examples of good practice in certain areas, implementation of the plan has been inadequate overall. Services remain deficient with few complete multidisciplinary mental health teams in place and limited access to community care for the full range of psychological supports that should form part of a modern mental health service. In 2009, only one in five staff in the mental health service was working in a community setting. Inpatient facilities remain completely unsuitable, with 15 of the 63 approved inpatient centres dating from the Victorian era or earlier. St. Joseph’s in Limerick was built in 1825. The Inspectorate of Mental Health Services has described some of these facilities as entirely unacceptable and inhumane. The position in respect of older people and people with intellectual disabilities is even worse because specialist mental health services in these areas are in need of comprehensive reform.
The Ministers for Finance, Public Expenditure and Reform and Health have honoured their commitment to allocate €35 million this year for community care services. For the first time there will be a full director of mental health services. In respect of the €35 million in funding, it is vital that the director is appointed at the earliest opportunity. In 2006, the then Minister for Health and Children, Mary Harney, allocated €25 million for the implementation of A Vision for Change but the HSE only spent €17 million and hived off the rest of the money for other areas. Only €10 million of the €25 million allocated in 2007 was spent on mental health services, with the rest being used to address deficits elsewhere in the health service. This was discovered by a health service NGO. If a director is not appointed immediately, management of the promised €35 million will again be left to the health services and I am not confident it will be used for its intended purpose. An early appointment of a director of mental health services is required.
Under the present structure of the HSE provision of mental health services is fragmented. There is an assistant national director with responsibility for mental health policy. However, the budget for the delivery of mental health services is split across the four regional directors of operations. The National Office for Suicide Prevention which reports to the assistant national director for mental health has a budget of €4.2 million, yet a further €4.5 million is split across the four regional directors of operations for suicide prevention activities.
The Government has promised an increase in the direct allocation to the National Office for Suicide Prevention in addition to the €4.5 million. We believe that an additional €3 million out of the €35 million should go to it. The €4.5 million that is split across the four regional directors of operations should also come under the auspices of the office so that we have full co-ordination in the area of suicide prevention.
Ireland has one of the fastest-growing rates of suicide in the world. As a cause of death among young people, suicide exceeds deaths from cancer and road traffic accidents. We have the fourth-highest rate owing to neglect over the years, therefore it is important that this area is prioritised within the €35 million allocation. We are not asking for extra funding at this stage. Some €3 million to €4 million of that should be allocated to the National Office for Suicide Prevention.
The HSE should immediately produce a detailed plan for the spending of the €35 million to be debated in this House in order to prevent the hiving off of money as happened during the tenure of the former Minister for Health and Children, Ms Mary Harney. There should be a single HSE director in charge of this €35 million and that director should progressively move to controlling the full mental health budget, which is €705 million at present. The mental health services need to have a dedicated management control with the efficiencies the Minister for Health is proposing for the general health services.