Vision for Change

Adjournment Debate – Dail Eireann on Report on Mental Health Serices in Ireland – Thursday 8th July 2010

Deputy Dan Neville

This is my first opportunity to raise these issues as regards the development of the mental health services. Some people will say this will not be noticed but at least I take every opportunity I can to raise the matter.

The independent monitoring group report on the blueprint for improving the psychiatric service is a severe indictment of the Minister for Health and Children and the Government. It is not acceptable that little substantial progress was made in 2009 in the implementation of A Vision for Change. The lack of clarity around the new assistant director for mental health, the lack of authority around this post and the emerging clinical management and administrative structures within the health services is totally unacceptable. The monitoring group expressed frustration and confusion about constantly changing management structures. The assistant director for mental health that has been appointed, incidentally, is an excellent first-class public servant and this has nothing to do with either his ability or potential.

It is difficult for the newly appointed executive clinical directors to carry out their task when there is an absence of detail in their precise roles, the relationship with clinical directors and the management structure of the HSE. It is another damning indictment that the monitoring group found an absence of mental health leadership.

The revenue allocation envisaged in A Vision for Change was not delivered in 2009 as promised. In the absence of new capital and revenue resources, it is difficult to see how the HSE and the Government can achieve their objective to implement A Vision for Change.

There is a continuing drop in the expenditure on mental health. In 2009, expenditure was at 5.3% of total health care which reflects a continual decrease in the last number of years. The Government must immediately introduce an overall national strategy to ensure the service user and family involvement is an integral part in the mental health care service development.

The independent monitoring group report on the blueprint for improving the psychiatric service is a severe indictment of the Minister for Health and Children and the Government. I call on the Minister to account for this neglect and to honour the Government commitment to develop the mental health services.

There is a continuing drop in the expenditure on mental health. In 2009, expenditure was at 5.3% of total health care. It is extremely disappointing and unacceptable that little progress has been made in establishing fully developed and staffed community mental teams, both in adult and specialist mental health services. In the absence of developed resources and staff, it is difficult to see how a vision of a community based mental service can be implemented.

The Minister and the Government must immediately explain why there was a lack of significant progress during 2009 in the development of appropriate specialist mental health services such as rehabilitation, in recovery for older people, people with intellectual disability, forensic psychiatry, the homeless, co-morbid severe mental health, substance abuse problems and eating disorders. I met Ms Jacinta Hayes from Bodywise today to discuss the problems to do with eating disorders. There is also liaison, neuropsychiatry and borderline development disorder to be addressed. No progress has been made on those issues.

There was some progress as regards child and adolescent mental health services, but nonetheless these services have not received the priority and urgent attention they require. In the absence of any child and adolescent psychiatry anything would be seen as progress, but nonetheless I welcome whatever tentative steps have been made in this regard.

Ireland deserves a 21st century community-based person-centred mental health service grounded on the principles of recovery. People recover from mental illness. One in four will suffer a mental health problem at some stage of his or her life. Early intervention means complete cure while delayed intervention presents difficulties. Finally, the Government and the HSE must immediately renew their commitment to the full implementation of A Vision for Change.

Minister of State at the Department of the Environment, Heritage and Local Government (Deputy Michael Finneran)

At the outset, I would like to thank Deputy Neville for raising this report on today’s Adjournment. It is an issue close to my heart. I have been chairman of the Roscommon Mental Health Association for many years and hold that position at the moment.

When A Vision for Change was published in 2006, it was universally welcomed as a progressive, evidence based and realistic document which proposed a new model of service delivery that would be patient-centred, flexible and community based. The Government accepted A Vision for Change as the basis for the development of our mental health services over a seven to ten- year period. Much has happened and much has changed economically in the four years since the report was launched, but it remains a progressive document and our roadmap, charting the way forward for our mental health services.

Deputy John Moloney, Minister of State with special responsibility for mental health, published the 2009 annual report of the independent monitoring group for A Vision for Change on 1 July last. The report acknowledges progress in relation to the development of child and adolescent services, the appointment of an assistant national director for mental health, executive clinical directors, and the gradual movement towards the creation of catchment areas as outlined in A Vision for Change.

However, overall the monitoring group was disappointed with the progress achieved since the launch of A Vision for Change over four years ago. I know that the Minister of State, Deputy Moloney, shares that disappointment and accepts progress on implementation in some areas is too slow. It is important to recognise and acknowledge, however, that in many parts of the country, services are pressing ahead with the implementation of A Vision for Change.

Some significant steps have been taken over the past several years, including an increase in the number of inpatient beds for children under 18 and the doubling of bed numbers since 2007. In addition we now have 55 child and adolescent mental health teams in place. Additional beds have been provided in the Central Mental Hospital and a six-bed, high support step-down facility was opened in west Dublin to cater for patients on temporary release from the hospital.

We are now providing in-reach services to prisons in Dublin and the midlands. A court liaison service has been introduced to try, where appropriate, to divert persons from the criminal justice system to local psychiatric services. We now have fewer involuntary admissions and shorter episodes of inpatient care have been achieved. Up to 50% of discharges occur within two weeks of admission. We have established a national service users executive which works on a partnership basis with the HSE and the Mental Health Commission on the planning, delivering, evaluating and monitoring of mental health services.

The results of a recent survey of service users were very encouraging with satisfaction levels very high for some local services. Within the HSE, a national lead on mental health has been appointed to ensure the delivery of mental health services in line with legislation and the Government’s policy. Executive clinical directors in psychiatry have also been appointed to lead reform in catchment areas serving populations of 350,000 to 400,000.

A significant amount of work on the ground and preparatory planning has taken place within the HSE which will, I am confident, show tangible progress in 2010 and 2011. This coupled with the provision in budget 2010 for a multi-annual programme of capital investment in high priority mental health projects, which will be funded from the proceeds of the disposal of psychiatric assets, will allow further progress to be made in the implementation of A Vision for Change. In 2010 the HSE will proceed to dispose of surplus assets and reinvest an initial sum of €50 million in the mental health capital programme. Provision for continued funding of the programme will be made in the 2011 Estimates and subsequent years, in the light of the previous year’s programme of asset sales.

Major initiatives for 2010 include the completion of two 20-bed child and adolescent inpatient units in Cork and Galway. Construction has commenced for a new acute psychiatric unit in Donegal, a new child and adolescent mental health facility in Cherry Orchard, Dublin, a new community nursing unit in Mullingar and Clonmel and a new acute unit at Beaumont Hospital to replace the acute unit in St. Ita’s Hospital, Portrane. Acute admissions to St. Brendan’s Hospital, Grangegorman, will transfer to Connolly Memorial Hospital, Blanchardstown. Investment of over €18 million will be made in County Wexford for the development of a modern mental health infrastructure to replace St. Senans.

A Vision for Change is a work in progress. I accept progress has been somewhat slower than anticipated. I am confident, however, the pace of implementation will improve now that the funding for the modernisation of our infrastructure has been secured and a care lead for mental health has been appointed in the HSE to drive the reform programme.

I want on behalf of the Minister of State, Deputy John Moloney, to assure the House of the Government’s unwavering commitment to the implementation of A Vision for Change.