Mental Health

Adjournment Debate in Dail Eireann introduced by Dan Neville TD on the Mental Health Services 3rd November 2010

Deputy Dan Neville

I thank the Ceann Comhairle for giving me the opportunity to raise this matter. A very serious situation has developed within the mental health services. To date, resources have been cut unfairly and disproportionately with spending reduced by 9.2% between 2006 and 2009. Currently, 5.3% of the overall health budget is allocated to mental health. That is its lowest level in modern history. In 1997, the allocation was 7%. Some years prior to that it was 13%. In the 1960s the allocation was 20%. The allocation on mental health in England and Wales is 13% while it is 18% in Scotland, yet we are down at 5.3%. This is at a time when there is an increase in mental health difficulties resulting from the economic crisis. The effect on public health is severe.

Having caused or contributed significantly to the economic crisis the Minister has a responsibility to respond to the resulting needs arising from the difficulties. People are coping with job insecurity, economic uncertainty and strain, loss of income, home repossession and restricted access to credit. That has led to a reduction in mental health well-being and marriage breakdown resulting in divorce. Serious difficulties arise due to tensions caused in families. Families break up because of the strains resulting from the economic situation. People in those positions have a loss of perceived self-worth. They suffer from a loss of daily purpose and structure. People have reduced social contact and they experience an increase in social isolation and suicidal behaviour both in terms of non-fatal self-harm and completed suicide.

It is accepted that suicide rates in 2009 increased by 25% due to the economic crisis. Each of the cases concerned represents a family in crisis. A single suicide is one too many. An increase in the rate of suicide by 25% indicates a significant increase in the level of difficulty created in many families and communities. The Government must respond to the developing situation. To date, 527 deaths have resulted from suicide. It is accepted that such deaths are under-reported for a variety of reasons. A conservative estimate is that more than 600 people died by suicide last year.

There has also been a 10% increase in self-harm. Approximately 11,000 people present at accident and emergency units having self-harmed. It is accepted by the experts that when one adds those who are treated by their general practitioner or whose family hide the fact that they self-harm, the figure rises to 70,000 people who attempt suicide and self-harm in this country every year.

The report of the independent monitoring group on the Government’s policy, A Vision for Change – a blueprint for improving the psychiatric service – is a severe indictment of the Minister for Health and Children. It is not acceptable that little substantial progress was made in 2009 in implementing A Vision for Change. The lack of clarity around the new assistant director for mental health is a serious issue, as it was one of the key recommendations of A Vision for Change in terms of developing mental health services.

The monitoring group expressed frustration and confusion about constantly changing management structures in the mental health service. The revenue allocation envisaged for A Vision for Change was not delivered in 2009 and 2010 as promised. In the absence of new capital and revenue it is difficult to see how the Health Service Executive and the Government can achieve their objective to implement A Vision for Change. The Minister should seriously examine the matter before there are any cuts and ensure that people have some hope of a response from the system in their crisis so that suicides will not increase any further

Deputy Michael Finneran

I am taking this Adjournment on behalf of my colleague, Deputy Harney, Minister for Health and Children. I thank Deputy Neville for raising this issue as it provides me with an opportunity to update the House regarding funding for mental health services. As the Deputy is aware, I worked in psychiatric services for a number of years. I continue as chairman of the Roscommon Mental Health Association so I have a particular interest in the matter.

The Government will consider the 2011 Estimates for the health service over the coming weeks in the context of the strategy for economic recovery and the target to reduce the general Government deficit to 3% of GDP by 2014.

Deputy Dan Neville

That means there will be a cut.

Deputy Michael Finneran

However, I want to make it clear to the House that our current financial difficulties do not in any way dilute the Government’s commitment in the area of mental health. I fully accept that the impact of any cuts to front-line services must be minimised and that we must ensure that the needs of service users remain the highest priority. However, I am confident that this can be achieved, and that staff at all levels will work together to deliver services in a more flexible way. Given the substantial resources already invested in mental health—–

Deputy Dan Neville

Substantial resources. Is the Minister of State serious

Acting Chairman (Deputy Brian O’Shea)

The Minister of State should be allowed to speak without interruption.

Deputy Michael Finneran

—–the reconfiguring and remodelling of resources will be the main focus for the immediate future.

Deputy Dan Neville

The Acting Chairman knows where I am coming from.

Deputy Michael Finneran

Deputies can be assured that this Government is determined to do everything possible to protect services, to respond to priority needs and to support ongoing reform of the public health services within the resources available for health.

We are all too aware that the Health Service Executive must work within limited financial resources. The health sector represents more than 27% of public expenditure so the appropriate management of the public finances means that the Health Service Executive must operate within the approved budget set out at the start of the year. Under the Health Act 2004, the HSE is required to prepare an annual national service plan which must indicate the type and volume of health and personal social services to be provided by the Health Service Executive. This plan must be approved by the Minister for Health and Children. The appropriate management of the health services also means that mental health services must be funded in an equitable and sustainable manner.

There is no doubt that the current economic situation is putting greater stress on individuals, families and communities. In response, the Government has provided additional funding of almost €l million this year under the dormant accounts fund for a programme of suicide prevention measures to help communities develop integrated local action plans for suicide prevention.

The special needs of the mental health service have also been recognised in the context of the 2010 employment control framework for the health service, which provides for an exemption from the moratorium in respect of 100 psychiatric nursing posts.

I should also draw attention to the innovation fund for disabilities and mental health, which was established to help support the transition from institutional to person-centred models of care. Some €3 million in funding has been allocated to Genio, a non-profit organisation that supports self-determination, inclusion and equality for disadvantaged and vulnerable people. Genio has established a fund with support from the Atlantic Philanthropies to support the transition from traditional, expensive group-based services to more effective individualised, person-centred supports. During 2010, 50 projects were awarded grants totalling €3.6 million. Fifteen of those projects were mental health projects with funding of €1.4 million.

It is fair to say that, despite the economic downturn, we are still making tangible progress on the implementation of A Vision for Change. It is important to recognise that in many parts of the country, services are pressing ahead with the implementation of the policy and we should not lose sight of this. Significant progress has been achieved, including shorter episodes of inpatient care, improved child and adolescent mental health services, fewer involuntary admissions and the involvement of service users in all aspects of mental health policy, service planning and delivery.

Acute admissions to St. Brendan’s Hospital, Grangegorman, have ceased following the opening of a new admission facility for north-west Dublin mental health services in Connolly Hospital, Blanchardstown, in September 2010. Construction on a 54-bed unit to replace the current facilities for long stay patients at St. Brendan’s Hospital is due to begin later this year. It is also worth noting that plans for the transfer of acute inpatient admissions from St. Ita’s Hospital, Portrane, to a new purpose built unit on the Beaumont Hospital campus are proceeding. A tendering process has been completed and the successful contractor has been notified. It is anticipated that construction works will commence in February 2011.

New community nursing units in Ballinasloe and Mullingar have been developed and it is anticipated that two new 20-bed child and adolescent inpatient units in Cork and Galway will be commissioned before the end of the year. Other construction works have commenced around the country, including the development of a new acute psychiatric unit in Letterkenny and a new child and adolescent day hospital and ancillary facilities at Cherry Orchard, Dublin. These developments will be funded from the proceeds of the sale of psychiatric assets. The House will recall that budget 2010 provided for a multi-annual programme of capital investment in high priority mental health projects and an initial investment of €50 million in the mental health capital programme.

The Government is acutely aware that mental health is a resource that needs to be promoted and protected, particularly in times of economic difficulty. I wish to assure the House of the Government’s unwavering commitment to developing our mental health services in line with A Vision for Change.