Deputy Seamus Healy is sharing time. He has four minutes, and Deputies Halligan, Boyd Barrett and Clare Daly have two minutes each.
Mental Health Services: Motion (Resumed) [Private Members]
The following motion was moved by Deputy Caoimhghín Ó Caoláin on Tuesday, 1 July 2014:
That Dáil Éireann: notes that:
— mental health is an issue of vital concern to the nation in general and should be of special concern to policy-makers and legislators in particular;
— mental health services must be designed and delivered to aid the recovery of the individual;
— a person-centred approach is vital to the achievement of the best results; and
— the 2013 Annual Report of the Mental Health Commission, published on 25 June 2014, has highlighted many of the key issues and requirements for action by Government; affirms:
— its continuing commitment to the implementation in full of A Vision for Change;
— its commendation of the work of the Mental Health Commission;
— its support for the work of the National Office for Suicide Prevention;
— its appreciation of those non-Governmental organisations, national, regional and local who actively promote positive mental health and seek to reduce the incidence of suicide and self-harm;
— its commitment to eliminate the stigma in relation to mental illness; and
— that the mental health of each citizen and of the nation as a whole is a positive resource that contributes to our general social, cultural and economic well-being; and calls on the Government to:
— ensure a consistent high standard of care and support for all requiring access to mental health services;
— provide for independent monitoring of the roll-out and progress towards full implementation of A Vision for Change;
— commit to an annual allocation of €35 million for the development of community mental health teams and to make good any shortfall in any given year in the subsequent year's allocation;
— properly resource mental health services across the board, including the provision of appropriate and adequate staffing and with a key focus always on recovery;
— promote awareness of the unacceptability of certain practices and continue to discourage their use, for example, the application of electroconvulsive therapy on detained persons against their will;
— end the practice of admitting children to adult psychiatric units;
— progress relevant legislative undertakings including completing the ongoing review of the Mental Health Act 2001 and to bring the Assisted Decision-Making (Capacity) Bill 2013 through Committee and Remaining Stages;
— require the Health Research Board to again carry out a national survey of psychological well-being and distress, last carried out in 2005-2006, and to continue to conduct such a survey at regular two or three yearly intervals;
— ensure a cross-departmental response to the risk of suicide and self-harm, including from the Departments of Health, Education and Skills, Children and Youth Affairs and the Environment, Community and Local Government;
— provide the necessary resources to establish and sustain a 24-7 crisis support service for people experiencing severe mental or emotional distress, to operate in conjunction with the local community mental health teams;
— arrange for greater co-ordination of all existing suicide prevention initiatives across all sectors and groups working in the area;
— ensure the prioritisation of address of the mental health needs of marginalised communities;
— guarantee that the new national strategic framework for suicide prevention will place mental health awareness among children and young people at the top of its programme; and
— provide an appropriate accessible alternative to general accident and emergency department presentation to victims of self-harm.
First, I compliment the various staff providing mental health services to the people of south Tipperary. They work above and beyond the call of duty on an ongoing daily basis. Despite their best efforts, the service has serious difficulties and is less than adequate.
Some would say the service is dysfunctional and others describe it as being in crisis. The reason for this is the changes over recent years by the Minister and the HSE to the mental health services for the people of south Tipperary. These changes were bulldozed through by the Minister of State, Deputy Lynch, and the Health Service Executive. There was sham consultation and no engagement whatsoever with stakeholders by the Minister and the HSE.
Stakeholders who were 100% committed to A Vision for Change were dealt with in an arrogant and dismissive manner and it was suggested in a mischievous and dishonest manner that stakeholders were opposed to A Vision for Change, which could not be further from the truth. The staff associations, service users, general practitioners, consultant psychiatrists and public representatives were not listened to and staff felt bullied, threatened and intimidated. Indeed, the Minister of State, at a deputation, indicated that not only were the changes she was proposing set in stone, but that they were set in blood. Of course, the Minister of State and the HSE have refused to honour the various commitments they made at the time.
For instance, there are five community mental health teams in south Tipperary, including three sectoral adult teams. None of these teams is properly staffed. Not a single team has the staffing levels provided for in A Vision for Change. The rehabilitation team, for instance, has no allied health professional of any kind. Earlier this year, clinics could not be held because of the shortage of consultant staff. Indeed, the closure of the inpatient beds at St. Michael's unit in Clonmel and the transfer of those beds to St. Luke's Hospital, Kilkenny has been a disaster. I am told by service users and family members that south Tipperary patients are being delayed in admission to that unit, south Tipperary patients are subject to early unsupported discharge from that unit, and family members find it difficult to visit and support their relatives who are patients in the unit. There is no continuity of care for south Tipperary patients at consultant level. The crisis house promised for south Tipperary has not been built and now, apparently, is on the back burner and the interim crisis house meant for short stay, a maximum of 72 hours, is being used for stays as long as weeks and months.
Particularly disturbing are the contents of a letter sent by nine consultant staff in the service in Carlow-Kilkenny and south Tipperary to the Minister of State, Deputy Lynch, in June 2013. That letter speaks of the service in terms of being unsafe, of them having serious concerns, of excessive numbers of deaths, of inadequate local governance arrangements, of nine fatalities between August 2011 and January 2013, and of meetings having been a sham. No response has been made to that letter since then, over 12 months ago.
The people and the service in south Tipperary have no confidence in the Minister of State, Deputy Lynch, or the Health Service Executive. I call on the Minister to personally intervene to ensure that a quality safe service is available to the people of south Tipperary.
Any move to improve mental health services in the country is to be welcomed. We all are keenly aware in our constituencies of the rise in suicide rates since 2008 and the devastating effect that has in homes and communities everywhere in the country. The male suicide rate is approximately five times higher than the female suicide rate, with the highest rate of male suicides between the ages of 60 and 64. The sad reality is that this can be closely linked by all agencies to economic recession.
While I support the principle of the motion, I would have questions about how it would work and its implementation. I would hate to see elements of it gathering dust, as the current Fianna Fáil designed national drugs strategy is doing under the current Administration. With regard to the creation of a 24 hour national help line, I acknowledge that Samaritans are already working hard to fill this role.
What I would like to see in the motion is greater attention to the manner in which dual-diagnosis services are handled, for example, where service users present themselves with both addiction and mental health problems which is often the case. In the south east, dual-diagnosis services are limited and this is creating serious problems for both addiction and mental health professionals. They are working with the mental health problems of persons, for example, who are self-medicating, and addicts with mental health issues where there is little inter-agency collaboration. It has been acknowledged, even by Government, that it is a serious problem. That needs to be addressed. I would urge Sinn Féin to consider the inclusion of this aspect as it would make the motion some way relevant.
As I stated initially, any improvement is to be welcomed. However, the serious problem at present is the dual difficulty of both mental health and drug issues. Agencies across Ireland accept that this is a significant problem.
I commend Sinn Féin on raising this issue. In two minutes, one can say very little but I want to make a general point and a specific point.
The mental health crisis is serious and getting worse. As well as dealing with such matters as treatment and facilities, one also must ask the question, "Why?" There is a clear documented relationship between the rise in unemployment and the rise in suicide levels. The senior public health doctor in the NHS in Britain yesterday came out and said that if they moved to a four-day week, they would contribute more to reducing the level of stress and anxiety-related illness that is overwhelming the British health service. Cuts, austerity and unemployment - all the issues that are worsening the situation for many ordinary people - are contributing directly to a mental health crisis and, therefore, health services are overwhelmed.
In response to this, there is a consensus about A Vision for Change and having a common shared view about how we address this mental health crisis. A Vision for Change is a wonderful document. The problem is the resources are not being put in place to make it a reality and the claim that progress is being made is just not true. Under A Vision for Change, it was proposed there should be 12,000 staff in mental health services. At that time, there were 10,000 staff and now there are 9,000. A Vision for Change proposed an increase in the number of staff in this area, but there has been a reduction and the resources are not being put in. Similarly, with children being admitted to adult hospitals, the situation is not being progressed. There are still large numbers, which is unacceptable. The alternatives for children are not being put in place.
Lastly, the multidisciplinary teams are not being staffed. Some 54% of the multidisciplinary teams do not have enough staff to function.
We need to adopt the slogan "Care not custody" as an absolute principle in terms of our social policy. People with mental health problems do not belong in our prisons, yet successive research has shown that people with a mental illness are greatly over-represented in our prison population. Almost 8% of male remand prisoners have current or recent psychotic symptoms, which is way out of kilter with the rest of the population. The evidence shows that large numbers of these people could have been accommodated in a local mental health facility if the correct policies were in place.
We know from research undertaken that large numbers of mentally ill prisoners have been in touch with social services as children. Many of them were in touch with the juvenile system and many of the women were victims of abuse. Early intervention and assistance, as an alternative to imprisonment, have got to be examined. We are far out of kilter in that regard. We have one specialist forensic mental health facility. I know that the Minister of State, Deputy Kathleen Lynch, has previously pledged to deal with regional ones to take people out of the criminal justice system, but it is not happening and so it is not working.
It is a question of resources. When such people end up in prison, we discover that our prisons are not equipped to deal with what are, in essence, health problems. Mental health is a very serious problem. Some Deputies met the family of a young man from Derry who was on suicide watch in Maghaberry Prison less than four weeks ago. He first cut his throat, then his testicles and finally gouging his eyes out, thus blinding himself. That was on the third night in a prison where he was supposedly being watched. Too often, prisoners' behaviour is treated as a punishment or not understood for what it is, so they do not get the proper care and attention.
People with mental health issues do not belong in prison. We need to address this issue, and I appeal to the Minister of State to do so.
Acting Chairman (Deputy Bernard Durkan)
Deputies Áine Collins, James Bannon, Helen McEntee, Dan Neville, Michelle Mulherin and Paul Connaughton have five minutes each.
Over the years, we have been trying to deal with many and various injustices of the past, issues like child abuse, mother and children homes, and the Magdalen Laundries. As a society our attitude towards mental health has been appalling. We stigmatised people with mental health problems and in many cases committed them to institutional care. Care was not the motivation. We simply locked these people up in institutions that were more like prisons than care homes. The prevailing policy was "out of sight out of mind".
Thankfully, in recent times huge strides have been made in addressing these mistakes of the past. The Government and the Minister of State, Deputy Kathleen Lynch, are making huge efforts to address the issues raised in this motion.
In rural areas suicides, particularly of young males, continue to be a huge problem. Social deprivation, drugs and alcohol are huge contributors to this situation. Social isolation, unemployment and lack of services are adding to the problem in rural Ireland. We must increase our support for organisations working with these vulnerable people.
The inability of communities to maintain sporting and cultural activities due to financial constraints adds to these difficulties. There is general acceptance that single-driver fatal accidents might be masking the real figures for suicide. Indeed, some cases have tragic outcomes, as happened in my area when a suicidal driver created an incident which resulted in the deaths of an entire family, except for the mother. This remarkable woman has since become involved in a campaign to ensure that gardaí are properly trained in how to deal with incidents like this. That woman recently met with the acting Garda Commissioner and will meet shortly with the Minister for Justice and Equality. Hopefully, as a result of those meetings, more emphasis will be placed on this aspect of training by the Garda authorities.
The real difficulty in dealing with mental health is the fact that we cannot generalise. Each person with mental health problems must, to a large extent, be dealt with on an individual basis. As the motion says a "person-centred approach is vital to the achievement of the best results".
The Government must strive urgently to provide the necessary resources to establish and sustain a 24/7 crisis support service. This service must operate in close conjunction with local community health teams. This is critical for people experiencing severe mental or emotional distress.
Since 2011, the Government has prioritised reform of mental health services. Some €90 million has been provided, mainly to strengthen community mental health teams both for adults and children.
One issue that constantly arises is the ongoing practice of placing children and adolescents in adult psychiatric facilities. The Minister is doing everything possible to address this issue. It is hoped that community-based services, coupled with an increase in beds from 44 to 80, will soon put an end to this unacceptable practice.
About one in four people experience mental health problems in their lifetime. Some 90% of these cases of mental health problems are dealt with in primary care. The aim is to move from traditional institutional care to a community-based mental health service where the need for hospitalisation is greatly reduced. This approach will lead to closing strategies for the remaining old institutions.
It is recognised that appropriate services and accommodation will be necessary for some patients. The provision is currently being planned and implemented for these patients.
Replacing the Central Mental Hospital with an appropriate modern facility is a clear sign that this Minister and the Government is determined to change and reform the whole attitude towards mental health. It must be recognised that the Minister has been working, and continues to work, tirelessly towards achieving all the desired changes and improvements being suggested in this motion.
Enormous progress has been made, particularly considering the horrific economic circumstances this country has suffered for the last seven years. The work continues and will be accelerated as soon as funding allows.
In these circumstances, I commend the work of Minister of State, Deputy Kathleen Lynch, to the House and I support the Government's steps in this regard.
Mental illness is a private matter with very public consequences. It is devastating when people's lives collapse around them and it can tear families apart. The reconfiguration of mental health services is key to the implementation of A Vision for Change. I welcome the fact that this comprehensive change programme is underway within a number of the mental health areas around the country.
It is important that we address this crisis by giving mental health increased focus and attention and by reducing the stigma of mental health. This stigma has forced many to live in shame rather than seek support, even as their lives unravelled.
Mental health promotion remains the most underdeveloped area of health promotion in Ireland. There is an increasing recognition that there is no health without mental health. The need for positive mental health promotion is universal and relevant to all of us. It is important that, as policy makers, we comprehend that mental health and mental well-being are basic issues of everyday life. In doing so, we must place a greater emphasis on promoting positive mental health.
Positive mental health demands co-ordinated action by all concerned, including the Government, the HSE, various social and economic sectors, voluntary organisations and the various media outlets. We must develop a range of mental health strategies to increase public awareness and change public attitudes towards understanding mental illness in addition to the importance of maintaining positive mental health.
The stigma against the mentally ill is so powerful that it has been codified for years into our laws. Few people outside the mental health system even realise it. This systemic discrimination in medicare laws has accelerated the emptying of State psychiatric hospitals, leaving many of the sickest and most vulnerable patients with few places to turn.
The system is in poor shape, starved of funding while neglecting thousands of people across the country each year. The failure to provide treatment and supportive services to people with mental illness both in the community and in local hospitals has overburdened emergency beds, crowded our jails and left untreated patients to fend for themselves on our streets.
The State routinely fails to provide the most basic services for people with mental illness, something the country would never tolerate for patients with cancer and other physical disorders. The health system also discriminates against those with mental illness by limiting the number of days during which patients can receive inpatient psychiatric care. The system imposes no such limits for physical health. Mental health is a separate but unequal system.
Many people have died and have been disabled because of inadequate care or suffered from mental illness for years before getting help. These delays have led to frequent panic attacks, drinking and drug use, abusive relationships, suicide attempts and crime convictions. We need a comprehensive review of the country's mental system to ensure the Government's resources are being targeted effectively so that persons with mental illness and their families have access to treatment and support services.
I urge the Government to allocate a special fund for suicide prevention programmes that would raise awareness about how to deal with those who are suicidal and ensure services are available for people in crisis. We must ensure early intervention by improving access to modern mental health services in the community. I commend the various voluntary organisations, including the Samaritans and Aware, on the great work they do in this area. It is important that we focus our attention on mental health by reducing the stigma associated with mental ill-health. Longford-Westmeath Regional Hospital is deemed to be one of the best performing hospitals in the country but even though €57 million was ring-fenced for phase 2 of its development plan in 2003, the project never got off the ground. The development plan includes an acute psychiatric unit with 36 beds. This was subsequent to the closure of St. Loman's hospital. I ask the Minister of State at the Department of Health, Deputy Alex White, the current position of this project.
I welcome the opportunity to speak on this Bill because this is an issue that affects everybody. Sometimes our debates on Private Members' business or legislation can be focused on particular sectors or groups of people but mental health does not discriminate on the grounds of age, gender or nationality. Mental health is a vital issue for the nation and I agree with the motion. As policy makers and legislators, we should make mental health our concern. As Deputy Áine Collins pointed out, one in four people will experience mental health problems in their lives. Nearly everybody in this building has been affected either personally or through somebody else.
I printed a copy of A Vision for Change some time ago but I am still making my way through it because it is a lengthy document. The person-centred approach for service users, carers and providers is already playing a part in reducing the stigma attached to mental illness and physical disabilities. All of us know that a huge part of tackling mental illness is to take the first step of acknowledging it and speaking about it. We need to keep a close eye not only on the roll-out of A Vision for Change but also how it is being received. I have discussed this issue with a number of people recently. There is a fear of the unknown because people are afraid to move away from the norm. Even if they have an opportunity to access better facilities and services they may fear that if they move away from what they have now they will get nothing in the future.
In the past few years we have seen a significant change in attitudes towards mental illness. We are beginning to discuss the issue and to promote good mental health. I have experience with a variety of organisations in my own county, including charitable organisations and groups of local people, which have sought to raise awareness. Unfortunately these efforts usually come on foot of knowing somebody who suffered from an illness or, in the worst-case scenario, died. At one stage at home, we had four similar deaths in a short space of time, one of which was my Dad. People are fantastic in rallying around but we need to do everything possible to prevent such situations from arising. Four young men in one community is a horrendous tragedy. We need to create a thriving environment, including the economy and living conditions, and put the wheels in motion to support communities and each other. Everybody should be able to avail of support systems when they need it.
I welcome the increased funding for mental health provided by this Government. The budget for mental health services this year is approximately €766 million, including the additional funding of €90 million provided over the last three budgets. This money has funded an increase of 1,100 new mental health posts.
There are many different types of mental illness arising in a wide variety of contexts. Some are hereditary and others arise from accidents, years of drug and alcohol abuse or stress. Sometimes it can affect young people when the pressures of life become too heavy. We need to start with our young people in schools by educating them. Now that we say it is okay to have a bad day or admit we are feeling down, it is easier to discuss these issues. Recently I met a man who was not afraid to tell me that he had a bipolar disorder. Now that we are moving away from the stigma, it is time to address mental ill-health at an early stage in life. As parliamentarians we can be role models in this regard. I have great respect and admiration for the Irish celebrities and sports men and women who have admitted to living with mental illness. These individuals are role models for young people and we must strive to be the same.
We must continue on our current path of implementing A Vision for Change but we must also keep an eye on how it is being received by people. We must also address the growing issue of alcohol and drug abuse, which often leads to mental illness. Finally, we need to look after young people and educate them. This Government is dedicated to tackling this issue. I thank Sinn Féin for introducing this very important motion.
I welcome the opportunity to contribute to the debate on this motion. I have been aware for many years of Deputy Ó Caoláin's interest in this area and his contributions to the debate. This is a difficult issue which affects 25% of the population at some stage in their lives. They are affected by something that has been neglected not only over the decades but also the centuries in terms of services for those who suffer from problems of mental ill-health. While improvements have been made in recent years, we are coming from a low base.
A Vision for Change was a very good document but the commitment to implementing it has not been convincing. While the Government has invested an additional €90 million in mental health over the last three budgets, I am disappointed with the roll-out of that money by the HSE. In the first year it was allocated, recruitment did not commence until the October. I do not know if anyone had been recruited by the end of that year. What happened to the €35 million that was allocated? According to 2012 figures, there were 395 out of 414 posts, or 96%, which is fair enough. In 2013, €35 million was allocated for 477 posts but only 326 of these posts have been rolled out. Very little of the €20 million provided last year has been rolled out in respect of the additional 250 to 280 posts that were to be created. These posts were very important because they were in community based mental health services and were intended to establish teams of practitioners rather than having an individual professional deal with cases. The posts were for psychiatrists, psychologists, occupational therapists, family therapists and nurses. A care and recovery plan was to be developed in the community. We have one of the highest rates of in-patient care for mental illness in Europe because of a lack of community based care.
The Government announced that it would allocate this money when it came into office. The first thing the HSE should have done was to make plans for its expenditure. When the money rolled in, it should have been ready to publish advertisements rather than wait until May of the first year and then start recruiting in October.
I will speak to issues with A Vision for Change. There is a need for the strategy to be recovery-oriented, with an absolute need for willingness by professionals to involve service users, or patients. There may be a debate about how to refer to these people but I am certainly a patient of my GP. There is still much reluctance by professionals to engage with service users and families in a recovery plan. Family carers are often excluded from a care plan and not consulted or informed. Their role should be recognised, as if a person goes to a consultant because a parent, wife or child has a serious illness, there would be discussion of aftercare and what happens when a patient returns home. If a person has had a heart attack, for example, there would be discussion of how much exercise he or she should have and what other treatment should take place. If such issues are discussed, why would there not be something similar for mental health issues? I am not painting all psychiatrists in this light and some of them are very good. I am only talking about a minority. That aspect of A Vision for Change should be considered, and there may be a battle to have the professions open up. There is another issue with individual care plans, as there is a reluctance in some areas to implement them for inpatients. Only 60% of institutions have individual care plans for the recovery of service users or the person attending for medical intervention.
There is another issue, which we raised last week and which is contained in the motion as well. It is completely unacceptable that children are in adult psychiatric units, and the matter has been flagged by the World Health Organization and recognised throughout all the institutions. Every professional would say it is not in the interests of the recovery and well-being of children, or those under 18, to be in these units. Some children under ten years old are in adult units, and they may be sharing it with people ranging from 20 years old to 90 years old with various conditions. Children should not be in that position.
I must call the Deputy's colleague.
I welcome that this is an agreed motion and the House will not divide on it.
I also welcome that this is an agreed motion, although it is a good opportunity to critique the service. The mental health issue is serious and I am thankful it is now being viewed in that way, so we must critique it and be honest about it. I welcome that as a society and country, we have progressed to a point where mental health is not just on the margins for discussion or a kind of taboo subject that should only be discussed now and again as a crisis arises. We are a more mature society now, consisting of holistic beings that are physical, mental, emotional, etc. To ignore one major facet of our being would not make sense.
We have progressed to the point where we expect life to be about more than just managing to survive and getting by, living with some terrible, black issue by oneself. I hope at least that the message is now that there is always hope. As a person can be ill physically, he or she can be ill mentally, but there is help and hope for recovery, as Deputy Neville has stated. When we support and encourage good mental health for all our citizens, we are supporting the general well-being of our nation.
One welcome and wonderful initiative is the rolling out of the counselling and primary care service. This is aimed at individuals experiencing depression, anxiety or stress arising from a particular recent problem or life event, such as an injury, illness, loss and bereavement, or relationship or business difficulties that may impact upon a person's quality of life and the ability to cope. The idea of this counselling is to support people through a tough period, which can occur in anybody's life, as we know. When people feel overwhelmed and are weighed down, and if they feel they cannot get out of such feelings, this is the sort of service they need. It is an eight-week counselling service and a person is referred by a GP. It is part of the mental health service but it could stop people from having to enter acute services or developing more long-term mental health issues. It is the kind of initiative we need. This is currently only available to people with medical cards but we know there are people in different areas who could do with this type of assistance, which is perhaps transitional to a person returning to full health. We should look to open that service more fully.
In keeping with the way society has developed, I welcome the prioritisation that the Government gave when it took office in 2011 and through 2012 for the reform of mental health services. An additional €90 million has been provided, as well as 1,100 staff across the system. Having spoken to managerial personnel in my county, I know we have benefited as well. For example, there is an extra child and adolescent mental health service team. It is a big county and there is a counselling and primary care service in six different centres, so a person is not limited to just one location.
We must do more with the service within the community and, for example, crisis teams should provide a seven-day service. As planned, inpatient beds for mental health services have been closed and there must be support for people in the community who may have traditionally occupied those beds for a few days and weeks. We must also consider people with special needs and mental disabilities. There is a disparity in the medical care aspect of the educational system in special schools. There are children with high medical needs but some of these schools do not have nurses. The provision of nurses is ad hoc, with some of them funded through a block grant from the HSE and some through direct employment. We must also consider oversight issues and the lack of medical guidelines or expertise within boards of management. The HSE should have an oversight aspect to nurses in this area, as the process is now ad hoc. In the UK, nurses work in a school environment. I know there is a budgetary issue but this is a serious matter.
I am thankful for the opportunity to speak to this debate. The vision which underpins the provision of mental health services in Ireland is based on a model of service where the emphasis is increasingly on service provision in a community setting. Although the ongoing employment of team members for community mental health teams is welcome, it is crucial that the people seeking help receive appropriate treatment in a safe and compassionate setting.
The question that needs to be asked continually is what the experience is of a person with mental health difficulties who presents at the various points of the health service. I understand that 90% of patients who present with mental health difficulties are dealt with in a primary care setting, but what happens to the other 10%? What level of service is presented to these people and what is their experience?
In recent weeks I have been approached by a number of families in County Galway who related their experience of mental health services to me. A major period of transition is under way but it has emerged that communication is a major issue at this time. This specifically concerns communication between community health teams and GPs, and between various health practitioners who may not be fully aware of the workings of the new system.
We cannot allow situations to exist where people experiencing real, acute mental health difficulties are sent from pillar to post because health practitioners are not aware of the changes under way. Greater cognisance needs to be taken of people experiencing suicide ideation who present at the accident and emergency departments of acute hospitals. How are these people treated? Accident and emergency departments are often chaotic places where staff work at a frenetic pace to assess and treat patients. There must be ongoing assessments of the people presenting at these departments, their treatment, the level of service they receive and the time lag between their initial presentation and their next involvement with the community mental health team. This is a crucial juncture. In the former institutionalised setting those patients were in a safe and secure environment but now that treatment is increasingly community-based we must ensure their safety and well-being are not jeopardised at this critical time.
There is huge anger in the Ballinasloe region and further afield at the closure of inpatient beds at St. Bridget’s hospital, in particular at the lack of consultation and clarity around how this decision was arrived at. There is also concern about the pressure this closure will put on the inpatient facility in Galway city. Staff in the psychiatric unit in Galway city have expressed major concern about their working conditions. I want the Minister of State and his colleagues to address those concerns and needs as quickly as possible.
Most, if not all, mental health professionals are in favour of moving treatment from an institutional setting to a community setting. It is crucial, however, that no patient loses out as this period of transition is under way. Every effort must be made at every level to ensure the transition is as smooth as possible. It is only through a properly equipped and staffed service that community health teams can provide the optimum service and it is imperative that a particular focus is placed on staffing levels in the Galway region as this important transition takes place. Much can be learned from regular reviews of patient experiences and while there has been significant engagement with service users and family members efforts on this front must be redoubled during the transition phase such as that under way in east Galway.
I welcome the fact that in recent years there has been a significant reduction in the number of children and adolescents treated in adult psychiatric units. In 2008 a total of 247 children and adolescents were treated in adult psychiatric facilities. Last year this number had reduced to 91. I look forward to the day when no children or teenagers will receive inpatient treatment in an adult psychiatric unit.
Staffing is the key issue in this transition. Recruitment is complete for 95% of the 414 posts allocated in 2012. One third of the posts allocated last year have yet to be filled, although the recruitment process is under way in all cases. The extra 1,100 posts being put in place throughout the country will pay rich dividends in terms of assistance to people with mental health difficulties and their families. This is an investment in people and communities, rather than institutions that is crucial to our future success. Over 250 new posts will be created this year and I urge the HSE to make every effort to ensure these posts are filled as soon as possible. I understand the recruitment has commenced but it must be progressed as quickly as possible to ensure that all available resources are spent on community mental health teams.
The mental health services of this State are in danger of "stagnating and moving backwards" claims the Mental Health Commission in its latest report. That stagnation has already taken place and mental health care is deteriorating. Like many of the vital services which cater for the most vulnerable in our society the mental health services were given a bit of a tidy up during the Celtic tiger period. Plans were laid out for reform and improvement but were not fully delivered and the necessary funding was never realised. Now that the economic climate is more difficult the mental health services have fallen victim to the austerity agenda and so too have the people who depend on these services. According to the most recent report of the Mental Health Commission, 56% of the services are operating under the standards for staffing laid down in regulations. There is a shortage of at least 3,000 staff across the service where a total of 9,000 are employed. This comes after long years of hard work by mental health professionals to reform the system and to bring it more in line with international best practice. Much has changed in the treatment of mental health problems and it has become easier for people to reach out and seek the care they need. Unfortunately, the ability of the service to respond in kind given its very limited resources is a major problem that needs to be addressed. This understaffing which has been a growing problem over the past few years of austerity has taken its toll not just on patient care but the morale of workers, their conditions and safety in their workplace. The work of mental health professionals, their ability to intervene and provide care can often be a matter of life and death. These professionals face challenges daily which, if handled incorrectly, can have far-reaching and tragic repercussions. Yet we refuse to ensure they have adequate support. A mental health service must ensure the best conditions for its workers in order to ensure the best treatment for those suffering health problems.
The recent spike in suicide rates and the fact that many of our acute mental health units operate at or above capacity certainly indicate that the best environment for treatment is not being provided. I know from my work with many constituents that there is a serious problem. The system is not adequately resourced to provide the care needed. I have dealt with many families who have been distraught when their loved ones have been discharged early without being admitted for treatment to a mental health service despite presenting at accident and emergency departments with self-inflicted injuries, either as a result of self-harm or a suicide attempt. This is due to the pressure on the system to provide care to so many with so little. The consequences of this situation are dire. It has undoubtedly led to people who should have been in care engaging in further self-harm and ending their lives.
Recently a young man from Finglas was discharged in a clearly unfit state having made a number of attempts on his life in the recent past. He was admitted in a very serious condition to the Mater Hospital and was placed on a ventilator for three days. When he had physically recovered he was discharged. His mother pleaded with the doctor and staff to have him admitted to the mental health services as he was a danger to himself. He was allowed to sign out and was seen on CCTV leaving the hospital. He went missing for over a week and his body was found in the canal.
This man died because of a failure in the system. He was in the hospital. It was clear he was a danger to himself and that his mental state had not improved following his treatment for his injuries. There were not sufficient staff to ensure that his case was dealt with properly and that he was admitted for treatment under the Mental Health Act 2001, as would seem to have been the necessary step. This is one case but it does seem that in similar situations doctors have been slow to act on admitting people involuntarily who are a threat to themselves.
The Psychiatric Nurses Association at its recent conference said that it was aware of several cases in which people had been discharged or turned away. These people went on to end their lives by suicide. The clinical director of Beaumont Hospital, Professor Shane O'Neill, resigned recently because of the serious state of the service. He said he could not stand over significant clinical risks. He was referring to the treatment or failure to treat many severely unwell people at grave risk of suicide or self harm.
In response to his resignation, Mental Health Reform stated that acutely psychotic patients were being left in emergency departments for hours on end. They do not receive appropriate care there nor are they in an appropriate environment given their mental state. The distress that is being caused for sufferers who have attempted suicide and their families being turned away from accident and emergency departments is hard to fathom. They can see that their loved one needs immediate care but because of understaffing and a lack of beds they are being left to their own devices and in too many cases this has led to a tragic ending. Families I have spoken to have tried all avenues to have their loved ones admitted but the obstacles due to lack of resources block their way. Some have gone to the gardaí but have had to wait hours for the doctor on call, who may or may not sign an order.
Their families had made numerous requests for them not to be discharged. They wanted them to be readmitted immediately. This is the tip of the iceberg. There is no family in our small country that has not been touched by suicide and mental illness. Every sector of society, particularly those in vulnerable and disadvantaged positions, has been affected by this problem. These people are victims of the inequality which is so tightly wound into this State's DNA. They have been failed by the State. They have been wronged by austerity throughout their lives. When they are on the brink, they are far too often failed again by a system that does not want to resource services that could save their lives.
My family is not very different from many other families that have had to deal with the challenges that arise when a loved one is plagued by mental health problems. I know the details of the cases I have mentioned all too well. I have been in an accident and emergency department with a loved one, pleading for them to be admitted. I have seen at first hand the obstacles that are placed in the way of those who seek to have a family member cared for properly in life or death circumstances. I know what I have said about the struggles of these families to be true because I have lived with it for the past three years. Times were very dark at one stage, but our family banded together. With the help of the work of the excellent staff of Connolly Hospital, we have come out of those times and there is hope again. The nurses and doctors succeeded in this case in spite of the obstacles and challenges they faced in their vocations. Their dedication was second to none, but they had an uphill struggle due to the understaffing and inadequate resources with which they had to deal.
We have fantastic mental health professionals and good strategies, but we need the right focus. We need to resource our mental health services and prioritise suicide prevention. We can turn back the tide which has undermined the progress of A Vision for Change. We must begin now by helping our excellent mental health professionals to do their jobs. In the past, citizens were put into mental health institutions by their families, their friends and State bodies. Many people spent long numbers of years - in some cases, their whole lives - in these institutions. Some people did not see the light of day even after the family members who had put them into these institutions had died. This is another example of a scandal in this State that needs to be investigated. I urge the Government to examine the scandalous manner in which people were put away in some of our mental institutions over the years. It should be hitting the radar because it has huge implications for many families. I commend this motion and ask the Government to support it.
It is a very good statement that the entire House is united here tonight in support of this comprehensive and constructive motion. It is also an indication of the commitment and diligence of my party's health spokesman, Deputy Ó Caoláin, and his staff to campaigning for the provision of a proper mental health service in this country. It is plain to see that we need to improve our mental health services, particularly in the area of suicide prevention. My own county of Kerry has a very bad suicide record, particularly among young men living in rural areas. Families across the county have been devastated by the loss of loved ones to suicide. Kerry has the second highest rate of suicide of any county in Ireland, according to reports from the HSE and the National Office for Suicide Prevention. Crucially, that rate dropped after a young lad in Kerry, Donal Walsh, who is known to many people, went on the national airwaves while terminally ill to plead with young people who might be in a bad place to appreciate the importance of the gift of life and to hang in there. Even though Donal has gone from us, there is no doubt that his example and his plea had a huge impact on young people. The suicide rate among young people in County Kerry dropped as a consequence of his work.
There is a responsibility on the Government to provide the necessary funding to assist people suffering from depression and similar illnesses. Equally, it needs to assist those who deal with mental patients who are often very sick. I have been in contact with the Psychiatric Nurses Association of Ireland regarding the mental health services provided at Kerry General Hospital. I have been told - this is on the record - that there has been a sharp increase in the number of assaults on staff in the acute psychiatric service at Kerry General Hospital. The association believes this is a serious health and safety issue. I would like to read into the record details of the litany of physical assaults on the staff of the acute service last month. On 1 June, a female nurse was bitten. Three days later, a male nurse was scratched. On 6 June, there were two separate incidents, with a female nurse and a male nurse being assaulted. The following day, a female nurse was injured. On 17 June, a female nurse was assaulted and another was struck with a telephone. The following day, a female nurse was injured and a security man was assaulted by being sprayed with aerosol that was ignited using a cigarette lighter. A female nurse was assaulted on 27 June and the same thing happened on 29 June. All of what happened during the single month of June can be attributed to a lack of staff. There is not enough nursing care to help the patients who are in need. They cannot be blamed because they are ill. If an appropriate number of staff is not made available to provide an adequate service, the consequence will be what happened at Kerry General Hospital in the month of June. This is widespread across the State.
When I was coming up here tonight, one name kept coming into my head. John Michael was my neighbour. He lived around the corner from me. I knew John Michael very well. He was a relative of mine. John Michael came from a broken family. His mother was an ill person. She had been in and out of psychiatric homes. John Michael ended up on drugs. He made a big effort after he was released from prison, but he slipped and went back on the drugs. He ended up taking his own life. I expect that every Deputy has a John Michael somewhere in his or her family background. That is why there is such an onus on all of us to do what we can - everything possible - to ensure all the John Michaels out there get the support necessary to help them. Facilities need to be available, in the community and elsewhere, to help them.
Many Deputies will recall what happened some years ago in a fishing village not far from where I live. I grew up there. We had five tragedies, one after the other, within the space of a year and a half. All of them involved young men under the age of 23. Four of them came from one small housing estate and one of them came from an adjoining village. The manner in which these tragedies were portrayed by the terrible gutter press affected the families that were grieving and suffering terribly as a consequence of what had happened. I say that to remind the House that the press has a responsibility. Role models are there to help people who need assistance. As legislators, we have a responsibility to do the right thing. The Government is responsible for providing the funding that is necessary.
I welcome the opportunity to speak on this important motion on the issue of mental health. While mental health problems manifest themselves in many ways, suicide is the most dramatic expression of them. Suicide rates in Ireland, particularly in this State, have been increasing steadily over the years. Perhaps the most alarming aspect of this trend is the increase in the number of young people taking their own lives. In 2013, this State had the highest rate of suicide among young women under the age of 19 in the entire EU. We had the second highest rate of suicide among young men in the same age group. It is striking that more than twice as many young men as young women choose to end their lives in this way. This should be a matter of real concern. It is clear that this serious issue - the mental health of young people - needs to be addressed as a matter of urgency. To that end, our motion recommends that the continuing practice of admitting children to adult psychiatric units should be ended as a priority under the national strategic framework for suicide prevention.
The issue of mental health awareness among young people must also be addressed.
Another worrying factor that has emerged in recent years is the high rate of suicide among men living in rural communities. To their credit, the GAA, Irish Farmers Association and others have sought to address this, but it is clear that many of the changes implemented for economic and financial reasons have contributed to the type of isolation that can cause mental health problems, which in some cases leads the person affected to take their own life. Isolation is fundamentally caused by people living on their own, particularly in rural areas, but cutbacks in public services such as transport, policing and rural post offices have contributed to cutting people off from regular contact with others. In addition, hundreds of thousands of people are in negative equity and struggling to meet their mortgage repayments and other debts. Too many people are teetering on the edge on a daily basis, wondering how to break out of the trap in which they have found themselves. Many elderly people living in rural areas feel very isolated and vulnerable to being targeted by violent criminals, which is a significant source of stress.
My own county of Laois, which has a higher than average rural population, had the seventh highest rate of suicide in the State between 2008 and 2010. Sixty-one people took their lives in the county between 2000 and 2009. In fact, more people died by suicide in that period than died in road accidents. Our neighbouring county of Offaly had the highest rate of suicide in those years. In Portlaoise, which is close to my own home, in one relatively small housing estate there were two suicides and one attempted suicide in the space of a few weeks. Of course, not every case of death by suicide is recorded as such, so the figures could well be higher. Urban areas have the lowest rates of suicides, which suggests that living in rural isolation is a significant factor contributing to suicide. However, urban working class areas of Dublin city and Cork city have higher rates than those applying generally to those counties.
Another issue of concern is the suicide rate among the Traveller population. Yesterday I had the privilege of speaking at the annual conference of the Irish Traveller Movement, where participants heard that suicide and issues of mental health generally are of real concern within that community. A 2011 UCC study showed that suicide rates within the Traveller community are six times that of the settled community and accounted for 11% of all suicides. These are alarming statistics which cannot be ignored. Without wishing to be too cynical, the fact that Travellers traditionally have not voted in elections might account for why this issue has not been given the priority it merits. They are now voting in increasing numbers, but even if that were not the case, this is a need that must be addressed. I am aware that some good work is being done in this area, but it needs to be ramped up and a programme of action put in place by Government.
Community-based programmes to tackle suicide such as those run by GROW and Pieta House are doing an excellent job of raising awareness and responding to the needs of those people with whom they come in contact. However, despite the great efforts of those involved, such initiatives can only hope to skim the surface of the problem. As our motion states, the mental health of our citizens and measures to prevent suicide are the responsibility of the State. Families and communities have a responsibility in this regard, of course, but it is primarily a matter for the State to ramp up its efforts in this area. The figures in regard to the services available and the shortage of staff have been well highlighted and I will not reiterate them. I welcome the all-party support for the motion. As somebody who has had to deal with this issue twice within my extended family, I urge the Minister of his State and his colleagues to give this issue the attention and priority it deserves.
There are two viewpoints regarding the issue of mental health and suicide in Ireland, one being that we are facing an epidemic in the not too distant future and the other that we are already in the middle of that epidemic. Figures released by the European Child Safety Alliance in March show that Ireland has the highest rate of suicide in Europe among young females and the second highest rate among young males. What is going on in this country that we are seeing such worrying statistics? Part of the answer can be found in the recession and austerity policies of the past six years, which have led to huge job losses, home repossessions and homelessness. Men and woman in all age brackets have been thrown into mental health crises as a consequence and some have ultimately died by suicide.
According to NGOs and specialists in this area, there is a particular mental health impact for men who have lost their jobs and livelihoods. Societally enforced ideas of masculinity, which place an emphasis on their being the breadwinner and provider, are also a factor. These ideas emphasise the importance of being a strong man who takes everything in his stride and does not speak about his feelings to friends, family or professionals. When people get knocked off track and feel they have failed to live up to these and other stereotypes, it can lead them to self-harm or even take their own lives. There is not a family or community across this island that has not been rocked by suicide.
I wish to send a clear message this evening to everybody in this Chamber, in the Visitors Gallery or watching at home that it is okay not to feel okay. It is a very important message. I have attended too many funerals of suicide victims, all of which saw a huge turnout. What everyone says on such occasions is that if the person who has died had only known how many people cared and were willing to help, things might have turned out differently. Not long after I was first elected to this House, I was asked to identify the remains of a friend of mine in a field in Tallaght. To this day, I am haunted by the memory of Seán lying dead in that field. Another case in my constituency involved a young child who came home from school one day to find her mother hanging in the attic. What does one say to a child in that situation? In yet another instance, a woman, tiny in stature, came to me seeking help for her son who is 6 ft. 3 in. and suffers from psychosis. She told me how he had beaten down the door, assaulted her and even threatened to rape her. What does one say to a mother in that situation? Should one advise her to telephone the Garda Síochána or to seek out professional help that might not be available? These are the types of difficulties facing people on a daily basis. Deputy Ellis spoke about families presenting at hospital emergency departments and begging the services to take their loved one in. What happens too often, however, is that they are released and some end up taking their own lives.
We need to tackle this epidemic. We have heard the figures in regard to staffing levels and so on. We have heard heart-breaking stories of parents in absolute despair and begging for help only to be turned away in many cases. We are all agreed that this is a massive problem and now is the time for action. It can be tackled effectively with the right resources and funding and, more importantly, the right approach. The message that should go out to those who are hurting is that there are people who love them and will want to help them. That is the message we are all trying to get across. We should also be able to say to the people out there who are seeking support that it will be provided, whatever the difficulties in terms of resources and so on. We all want to see an adequate service delivered, and the responsibility to achieve it rests on us all.
Gabhaim buíochas leis an Teachta Uí Chaoláin as ucht an rún seo a chur os comhair na Dála. Is maith an rud é go bhfuil sé glactha ag an Rialtas go bhfuil gá ann labhairt amach ón Teach seo le haon ghuth amháin. Táimid i gcruachás. Tá fadhb mhór sa tír seo. Ní fadhb pholaitiúil í, ach ba cheart dúinn na maoine a chur ar fáil agus gach rud eile gur féidir linn a dhéanamh chun déileáil ní hamháin le ceist an fhéinmharaithe, ach freisin le ceist na meabhairshláinte ina iomlán.
Over the past two evenings, much has been said about mental health and the state of the services in this State to help those suffering from a variety of mental health ailments. There has been an acceptance by the Government that more needs to be done to deliver the responsive, community-based services and supports, as envisaged in the mental health strategy, A Vision for Change. By accepting the Sinn Féin motion, the Government and all Members of this House are committing to an urgent response to a crisis facing our society and our health service.
Without the response outlined in the strategy and in this motion, we as a society will see far too many of our friends, neighbours, colleagues and relatives die as a result of suicide. We must remember that suicide is not the end result of mental illness for the vast majority of those suffering from mental illness but it is the tragic end for far too many people, especially young people. Like Deputy Crowe, I have been to far too many funerals of friends, loved ones and neighbours over the past couple of years, in particular. It is heartbreaking for me as a friend, but how much heartbreak do close colleagues and close family members suffer? It is becoming far too common, especially in this era of economic distress.
Some of this is as a consequence of cutbacks in our health service. The shortage of social workers affects families. I have dealt with families who are frustrated trying to get social workers to listen to them and to return their calls. It is not the fault of the social workers because they have a workloads over and above what they are supposed to have, sometimes covering the caseloads of two or three social workers. I know how CAMHS is affected by a lack of resources and a lack of professionals on which it can call, especially for young teenagers. It does not have the level of resources and the number of professionals required.
Like Deputy Ellis, I know of tragic cases where people have presented in accident and emergency departments. I have come across cases of late where people have sat in the queue but have died very quickly thereafter in the hospital. That is part of the scandal. We need another way. It is not an appropriate response that people must present in accident and emergency departments to get emergency help. There must be another way in these chaotic times for those families and friends who end up bringing people to look for the services and who sometimes must go from pillar to post.
Without the help of Pieta House, Teenline, turn2me and Console, we would be in a much worse situation. A great debt of gratitude from society is due to those organisations and they deserve every support this Government and any future Government can give them.
I refer to a group of people who are often forgotten in this, namely, the carers of those suffering from mental illness, because they face major challenges. One of the challenges to which I refer is the fact that they are often left out of the clinical and medical decisions and we need to look at some way in which health professionals can share information with those who will care for people so they are not a danger to themselves, their carers and their families. That little bit of work should be done. As the Carers Association said, a change to the Mental Health Act might be needed to require health professionals to involve the carers, or future carers where somebody is not identified straight away, to ensure patients get full treatment when released into the care of the home.
I welcome the opportunity to conclude this debate on behalf of the Government side concerning the important issue of how best to progress mental health policy and services into the future. I and the other Government representatives have listened carefully and seriously to the constructive contributions made in this debate. I welcome the obvious commitment of contributing Deputies of all political parties to developing mental health policy and service. In that spirit, it is right that the House should not divide on this issue.
As the Minister, Deputy Reilly, indicated yesterday, a fundamental requirement that applies is the need to change attitudes to and reduce the historic stigma associated with mental health issues. The debate has focused on the progress made on mental health in recent times and the continuing clear need to develop many aspects of mental health and suicide prevention services. In not opposing the motion on this occasion, the Government recognises a common desire to build on what we have achieved and to pursue the same overall objectives.
This Government has taken real action in terms of hard decisions and prioritised investment to develop mental health policies and services. It should be remembered that by common consent, the service had significant historic deficits and these have only begun to be addressed in a meaningful way in the past decade or so. We have provided €90 million and approximately 1,100 new posts since 2012, resulting a total provision of approximately €765 million this year for the HSE and, more important, we are ensuring the new investment and the new personnel are targeted towards what is actually needed to effect real change in the system.
I would like to address briefly some of the issues raised during the debate. I, too, acknowledge the tremendous work being carried out by the many voluntary and statutory agencies working in the mental health area with those experiencing a personal crisis. In these difficult economic times, with increasing demands and resource limitations, it is important we work together in an effort tackle this serious issue and create an environment that is enabling for people in distress. The Government recognises that this cannot be done in isolation. Managers, professionals, service users and carers must all work together, utilising resources and actively involving people in their own recovery. Notwithstanding the fact we must take cognisance of overall and evolving resource pressures each year, the Government will continue to develop our mental health service in line with A Vision for Change and the programme for Government.
With the benefit since 2012 of new investment coming through, we will continue to reduce the incidence of children and adolescents being accommodated in adult facilities. That point is well taken and was repeated in this debate.
As reflected also in the debate, reforming mental health services requires a multi-agency and multifaceted approach. The Department of Health and the HSE will continue to work with other organisations in addressing the needs of vulnerable groups and tackling issues such as cyberbullying, negative Internet messages and eating disorders in addition to having better diversion mechanisms between the judicial and health systems.
A strong thread coming through the debate was the need to balance change, in particular in the context of safety and quality, against genuine concerns that may exist at local level. Such is the case, for example, with the changes that have occurred or are planned for mental health services in the Carlow-Kilkenny and south Tipperary areas or in HSE west. The HSE has engaged, as appropriate, to address all genuine concerns while taking account of recommendations arising out of reviews of mental health services at local level. We will continue with this approach so that all involved have an appropriate and meaningful say in modernising services. Change can only work through a responsible and co-operative approach by all concerned. I reassure the House that we will continue to improve our policies and services relating to suicide prevention, primarily through a new strategic framework over 2015 to 2018 to replace and build upon the Reach Out strategy.
Again I thank Deputies, in particular Deputy Ó Caoláin and his colleagues, for providing the House with this opportunity to discuss a matter of concern to all, whether inside or outside this House. As stated repeatedly in the debate, there is hardly a family in Ireland not affected in some way by mental health issues and, indeed, some Deputies spoke in a very affecting way in respect of how they are affected by such issues. There is no reason people in this country suffering from mental health problems cannot have the same modern high-quality service that works so well elsewhere. We will continue to work with these aims in mind and will continue to co-operate with colleagues across the House to achieve these objectives.
Sinn Féin has tabled this Private Members' motion hoping to highlight the ongoing need to improve the State's response to mental health and to highlight the need for a comprehensive response to suicide prevention. No one Member of this Oireachtas is immune to mental health problems. No family is immune to the tragedy of suicide. Three years ago tomorrow I lost a good friend who took her own life and I miss her every day. We must also remember that none of us know when we will need to access mental health services. The mental health of the nation is a positive resource that can help both economic and social recovery. The World Health Organization's paper on mental health in times of economic crisis, published in 2007, said:
Mental health is an indivisible part of public health and significantly affects countries and their human, social and economic capital. Mental health is not merely the absence of mental disorders or symptoms but also a resource supporting overall well-being and productivity.
Thankfully in recent years the stigma in regard to mental health is reducing. The Government has run successful campaigns, including the recent Green Ribbon campaign, and See Change where mental health champions speak about their own experiences. That has done a lot to address stigma. Unfortunately, there are huge challenges in our mental health services. Many of the shortcomings are a result of Government policy. Cutting back on funding and resources in the current climate is a recipe for disaster with serious life-threatening consequences. The Mental Health Commission, the Government watchdog, indicated in its annual report that mental health services are in danger of stagnating and moving backwards. That is due to a combination of staff shortages and slow changes to work practices meaning progress in some areas has ground to a halt. Only 44% of services complied with staffing requirements last year, while 60% met regulations on individual care plans for patients. That is unacceptable. In all, a total of 9,000 staff work in mental health services in the State, although official policy states there should be 12,000. Our health care system is overstretched and understaffed.
The Labour Party in its election manifesto 2011 gave a commitment to develop, "a strengthened role for GPs, and through the ongoing development of community mental health teams and child and adolescent mental health teams, as resources allow". Unfortunately the party has not seen fit to grant the necessary resources to community mental health teams. The fact that at the end of December 2013 the overall staffing levels for community mental health teams were still nearly 25% less than recommended in A Vision for Change points to the need for increased investment. Another unacceptable practice, to which the Minister of State alluded, is the placing of children in inappropriate adult hospital wards. Sadly, last year a total of 91 children were placed in adult psychiatric units despite warnings from the commission that such practice should only occur in extreme cases.
We must also ensure that those in prison receive appropriate mental health care. It is totally inappropriate for people to be isolated from supports and services simply because they are awaiting trial or in custody. They still have rights and the State has a responsibility to ensure those in prison receive proper care. Prisoners should have access to mental health services, visits and supports in order that the isolation of incarceration does not take hold. The denial of family visits and supports has certainly contributed to suicides in the prison system.
Suicide is a complex issue that demands a national, cross-departmental, co-ordinated response. We must have a comprehensive, all-Ireland suicide prevention strategy. The World Health Organization suggests that national suicide prevention strategies can make a difference to suicide rates. International research has shown a 10% to 17% reduction in suicide rates can be achieved over a three-year period when suicide prevention strategies involve a range of approaches at an individual, community and whole population level. A key priority for suicide prevention in Ireland is the development of an adequate 24/7 crisis support service for people experiencing severe mental or emotional distress. A Vision for Change states that a protocol for crisis intervention should be agreed upon for each area by the local community mental health team, CMHT, and that the agreed-upon response should be available 24/7. The motion seeks to refocus the Oireachtas on mental health and suicide prevention and on the need to implement A Vision for Change by ensuring sufficient resources and firm political commitment.
Gabhaim buíochas le gach Teachta a ghlac páirt sa díospóireacht seo. Tá súil agam go leanfaimid ar aghaidh tar éis na díospóireachta ag obair le chéile agus ag cur sláinte intinne chun cinn sa tír seo.
I thank all the Deputies who have taken part in the debate last night and tonight. I acknowledge also all the groups and individuals who have had an input into the debate, in terms of informing the construction of the motion itself, the contributions we have heard over both evenings, and also the attendance in the Visitors Gallery last night and tonight and the ongoing work of so many of those present with us this evening on the issues of mental health and suicide prevention. I record our thanks to each of them.
I very much welcome the decision of the Minister for Health and the Ministers of State, Deputy Alex White and Deputy Kathleen Lynch, not to proceed with the Government amendment and to accept our motion as tabled. That is a good development. Where consensus can be reached in the Dáil it should be achieved. It is very appropriate that on these issues of mental health and suicide prevention we have achieved consensus over these two evenings.
The basis of the cross-party consensus on mental health is support for A Vision for Change, its principles and its implementation. The Minister in his contribution last night reaffirmed the Government's commitment to that plan and to reform of our mental health services. Of course, that commitment carries no weight unless it is backed up with sufficient resources. In that regard I recommend that the Minister for Finance and the Minister for Public Expenditure and Reform should read the report of this debate and, especially, that they should read the agreed motion carefully. The Minister stated last night that implementation of A Vision for Change has been affected by a number of factors, including constraints in public spending and the moratorium on recruitment. That should be noted by the Cabinet colleagues of the Minister for Health, regardless of who the Minister may be after the reshuffle next week. More resources must be made available and the recruitment embargo must be lifted if A Vision for Change is to be implemented and if existing services in this and other areas of health care are to be maintained, let alone expanded.
The Minister pointed out that the promised €35 million for development of mental health services was delivered in 2012. However, it must be pointed out that in that year the funding was not all used for mental health services. There is a significant question over how much was spent on the area, if at all. The same sum was made available again in 2013 but in 2014 the figure has been reduced to €20 million. The Mental Health Commission in its 2013 report has noted the ministerial commitment to the reinstatement in 2015 of the expected €15 million not forthcoming in 2014. Although the Minister did not restate it last night, I trust that commitment stands. I say to the Minister of State, Deputy White, that we will certainly hold the Government to that commitment.
Much progress has been made in recent years but, as I stated in proposing this motion last night, much, much more remains to be done. The recruitment achieved thus far is welcome but, as was clear from the Minister's outline of the figures and timelines last night, the process is far too slow and every effort needs to be made to accelerate it. An important element of the motion, which I highlighted in my earlier contribution, is to provide an appropriate accessible alternative to general accident and emergency presentation to victims of self-harm. The experience of many people in mental distress in accident and emergency departments is totally unacceptable. The Minister stated last night that if by "appropriate" we mean there is no physical or medical risk, we are on the same page. That is the correct interpretation and, I would add that we mean also that an alternative should be available where and when appropriate. Alternatives must be in place.
We cited the various reactions of people to mental health issues and reform in advance of this debate.
People in accident and emergency departments can be in grave mental distress and this cannot be ignored. It should be added also that this must be seen in the context of the pressing need to address the chronic overcrowding and excessive waiting times in hospital accident and emergency departments that so adversely affect all patients and not only those in distress. Eliminating that scandal must be a Government priority too.
I want to highlight another aspect of mental health that I did not get a chance to include last night due to time constraints and that is the link between eating disorders, mental health, self-harm and suicide. I commend the organisation Bodywhys on the work it has done on this area. It points out that anorexia has the highest mortality rate of any mental health condition, either through suicide or organ failure, each of which constitutes 50% of fatalities caused by anorexia. Up to 200,000 people in Ireland may be affected by eating disorders, including anorexia nervosa, bulimia nervosa and binge eating disorder. These are complex and serious mental illnesses. A report on mortality in eating disorders found that women with anorexia nervosa face more than 50 times the risk of completed suicide and suicide was determined to be the second most common cause of death in anorexia nervosa cases.
Suicide attempts occur in up to 20% of patients with anorexia nervosa and 35% of patients with bulimia. The mortality rate associated with anorexia is 200 times higher than the suicide rate of females in the general population. As relapse is high and recovery often episodic, the disorder can result in lifelong physical and psychiatric morbidity and risk of suicide. Furthermore, mortality due to eating disorders is likely to be higher where service provision is inadequate. The recent My World survey found clear evidence to link suicidal behaviour and eating pathology. Fear of being overweight was significantly associated with having thoughts that life was not worth living, deliberate self-harm and a suicide attempt. The prevalence of self-harming behaviour among adolescents is especially high in those with eating disorders. Official death certification may underestimate the incidence of suicide associated with this disorder and this, all too sadly, is the case across the board. These findings underscore the severity and health significance of eating disorders.
Bodywhys reports that it is often the first port of call for people affected by eating disorders as the crisis often occurs out of hours. It also points to the lack of regulation of counselling and psychotherapy professionals, which can put those who are vulnerable at severe risk, and the organisation suggests that regulation of this area needs to be progressed. In examining in detail the contributions made to this debate last night and tonight, it is very important that we look at these issues holistically and in the round. This is why I have taken the time to expand into the area of eating disorders, which was otherwise overlooked yesterday and today.
I thank all Deputies for their participation in this mature and sincere debate. Government and Opposition Deputies have contributed, all parties participated and Independent voices have been heard. There is unanimous agreement on this and I look forward to us moving forward on this issue in the same spirit of co-operation. We must vindicate the rights and needs of all who use our mental health services and significantly reduce the level of suicide in the country. We must enhance the mental health of Irish society.
I thank the Minister of State and his colleagues for the wise and welcome decision to allow this motion through unanimously.
Question put and declared carried.
The Dáil adjourned at 9.05 p.m. until 9.30 a.m. on Thursday, 3 July 2014.