Deputy Jackie Cahill was in possession and has four minutes remaining.
Mental Health: Statements (Resumed)
Since I was elected in February this year, the issue of mental health has been raised by a huge number of my constituents. The issue is central and fundamental to us. Mental illness is one of the most serious social issues facing our country today. There is not a townland or housing estate that has not experienced the horrific, silent funeral that a suicide brings. We all have attended funerals where the grief of the family is immeasurable.
This Dáil, the Thirty-second Dáil, has a great responsibility to make meaningful progress on this issue. It is generally accepted that the mental health service is the poor relation of the HSE. This was brought home to us when the talks on the formation of the Government were taking place. At the time money was diverted again from the mental health budget. As Minister of State Deputy Finian McGrath said in his speech, the mental health service has to get extra resources.
In 1950, 76 suicides were recorded in this country. By 2011, this number had increased more than sevenfold. From 2001 to 2007, there was a significant reduction in the suicide rate but, unfortunately, suicide has since increased very significantly. This can be linked to the lack of funding being allocated to the mental health service. We have the fourth highest youth suicide rate in Europe. It is very hard for us as elected representatives to see young people looking for help and not being able to gain access to it.
My constituency, Tipperary, feels it has been seriously hit by the lack of resources. It is hard to believe that a county with 160,000 people has no psychiatric beds. If one is in the south of the county, one has to go to Kilkenny to gain access to a psychiatric bed. If one is in the north of the county, one must go to Ennis. In my town, Thurles, there is a clinic that serves 34,000 people but it is a clinic only in name. It has no occupational therapist and no psychiatric counselling. Only medication is provided for the patients who attend. If we are to be serious about mental health and access to mental health facilities, we must put the resources in place to ensure people can avail themselves of them.
A decision was taken a number of years ago to close St. Michael’s in Clonmel. I hope that in the lifetime of this Government we can again have psychiatric beds available in our county. In the past couple of weeks, the HSE took the decision to close Mount Sion in Tipperary. It is a residential facility for people with mental illness. At its peak, the facility was able to cater for 19 patients. There are now nine patients domiciled there. Recently, elected representatives and relatives of the patients in Mount Sion met representatives of the HSE, who gave us a commitment that they would re-examine the decision to close the facility. I appeal to the Minister to meet the relatives and hear at first hand the good work the facility is doing. If Mount Sion is closed, another part of the infrastructure in Tipperary will be taken away. It will make our job of providing proper facilities for people with mental health problems all the harder. I hope the HSE will reconsider its decision and keep the facility open.
The HSE is telling us the larger units are not the way forward but the reality is that the facility has worked well. It worked well when it had 19 patients and residents. Now the HSE is saying the infrastructure is not up to HIQA standard but a very small investment would bring it up to that standard. I appeal to the Minister to have the HSE revisit its decision. I hope a positive outcome will emerge.
I welcome the opportunity to speak on this important matter. That we are now openly talking about mental health is an example of how we are moving forward in society. We are identifying that people’s mental health is not always as good as it could be and that we should not be afraid to seek help. If one sprains one’s ankle, one seeks help. One goes to the doctor or the physiotherapist until one is fixed, after which one can walk fine again. For too long, people were afraid to speak out about how they were feeling. Then the way they were feeling became normal and they probably did not realise in the end they were not well. People around them may not have realised they were not well and needed help. It is wonderful now that we can actually speak about this and ensure our loved ones are looked after. It is the Government’s responsibility to ensure the services required to help them, irrespective of their age, are put in place.
I was serving as Acting Chairman when Deputy Troy spoke about his feelings on a previous occasion in this debate. When he spoke, I felt a little like what he described. That weekend, I was speaking to some friends and my family and I said there was a very interesting contribution in the Chamber. My friends and family said they also feel a little like what I described. It dawned on me, having thought quite a bit about it, that we all experience anxiety, nervousness or depression at one level or another. Some days one might be down, which is normal enough, but it is when one cannot get back up again that one could be getting into trouble.
Post-natal depression is a big issue for women. Sometimes women feel there should not be such a thing as post-natal depression and that they should be full of joy with their new bundle of joy that is creating such love in their family. Perhaps they feel so bad that they feel so bad. It is important that people begin to realise that not feeling great is quite normal and that one can actually do something about it. They should not be afraid to do something about it and they should speak out about it.
We need to be more careful with one another. I hear people use the word “bullying” in a context that is a little facetious or in the wrong context. The word “bully” has very strong implications, whether it is used in the school yard or workplace. If the word is just thrown around and becomes commonplace, it does not receive the emphasis it should receive, and it is not recognised how wrong it is. It is not recognised that actions need to be taken to deal with bullying. I urge people to be careful about how they use the word “bullying”.
We should be leading by example in this Chamber. We should be careful with one another also. We have to mind our own mental health. I find dealing with social media very challenging. One should note the negativity, vilification and viciousness tossed at public representatives as if they were figures of stone, did not feel the same as everybody else and did not have a family the same as everybody else.
During the general election campaign, I gave up looking at social media altogether. It is hard to believe but my life was actually threatened on social media. I do not believe the person who threatened my life had any intention of carrying anything out but, at the same time, it was not very nice to believe there was a man somewhere in the county who felt the world would be a better place without me and that he would be prepared to do time if I were removed from the world. It is a horrible thing to take in as a public representative and a citizen who is free to move around. It is entirely wrong that this type of behaviour from adults is tolerated. We would not tolerate it in the playground from children. Adults are leading by example on social media. Children are on social media more often than they are probably in the playground. Their screen time is enormous. If they are looking at adults behaving in this fashion on social media, they will copy them.
Social media has no rules and involves entirely new technology. We are only learning about its potential and the positive and negative aspects of the Internet. If adults believe it is okay to call one another names on social media, what will be next? Will we start calling one another names on the television and in public debates or here in the Chamber? Is that where we are going? I feel very strongly that, as adults, we should be leading by example and show the children how to use social media in a way that is positive and constructive for them because it has so many benefits.
This brings me to the topic of children, young people and the challenges facing them. I believe there are children being bullied on social media in ways that we cannot even contemplate because we did not go through it ourselves.
We experienced childhood differently and were able to manage in the schoolyard and so on. Social media is a whole new experience. If I had a teenage child, I am not certain if I would be able to manage or even be aware of what he or she was experiencing. In the past, the bully could be left behind in the schoolyard or playground. Nowadays, the bully can follow a child into the bedroom of his or her home, supposedly the safest place we can be. While parents need to be vigilant, society must also recognise that this issue needs to be addressed. It is of critical importance that services are provided to support young people and that adults lead by example.
Suicide was not widely discussed in society in the past. The issue touches everyone, whether through extended family, friends or the local community. Suicide is so devastating that people want to do everything in their power to prevent it from happening again. We must reach out to people who are experiencing difficulties in life and let them know there are people who can help them.
According to the Central Statistics Office, men accounted for 391 of the 487 people who took their lives in 2013. Men need to be able to talk to each other and should not be afraid to reach out. Family and friends must also be sensitive to and support them.
Connecting for Life is an excellent strategy. Launched in June 2015, it will be in force until 2020. Empowering communities and individuals to improve their mental health and well-being is a good thing. If the strategy is implemented over the 2015-2020 period, we will be in a stronger position to ensure people can live positive, healthy lives and will recognise that while not everything in life goes well, mechanisms are available to provide help in such circumstances. Connecting with other people, physical activity and alternative practices such as meditation can be positive and should be encouraged.
Funding for suicide prevention has been increased from €3.7 million in 2010 to the current level of €11.55 million. This is a significant increase which demonstrates how serious the Government and society is about helping people to overcome difficulties in order that they can have the positive and productive life to which we all aspire.
Listening to the debate on mental health services, I have been impressed by the unity of purpose and sincerity shown by Deputies. This problem requires a continuous national response by the Government and a local response by wider society and non-government actors, such as the community and voluntary sector. Mental illness is widespread and there is not a family on the island which has not seen a loved one struck down by one of the conditions of the mind. In too many instances, these conditions have resulted in the ultimate act of despair, namely, death by suicide.
Suicide is not a choice. It does not imply that a person has failed to adapt or has given up. It is the terminal stage of mental illness. My colleague, Deputy Robert Troy, bravely and movingly put into words the crippling physical and emotional symptoms of mental illness. All Deputies wish him well in his recovery and thank him for the public service he provided in sharing his story.
The way in which we conduct our political and public lives must become an example that will help create a society that is respectful of the truth. Regardless of what walk of life we are in and what differences exist between us, we are all human beings on the journey of life. Too often, I have watched news reports from the Dáil showing supposedly adult politicians shouting insults at the other side as they engage in personal point-scoring. While passionate debate is welcome and to be encouraged, all those involved in public life, particularly in politics and the media, have a special duty to engage in debate in a manner that shows respect for difference and informs fellow citizens of the complexities of our problems. Debate should not be driven by shallow headlines.
The mental health crisis is a symptom of the society we create and will become greater if we do not view prevention as equal to curative measures. The Department of Health and the Health Service Executive must introduce a major mental health initiative and treat mental health on a par with cancer and heart disease. It is only by having such a deep and broad focus that mental health will become the priority it clearly deserves to be.
Modern society is too self-obsessed with perceived winners and losers. We have too much black and white when shades of grey are much more common. The pace of life is also increasing as we race to find the right school, children engage in the points race and people seek the right college and the perfect job, partner and house - in short, the illusion of the perfect life. These aspirations are all sold by a consumer society that portrays a shallow view of perfection, one that is unobtainable and is a contributory factor to the strains being felt in the area of mental health.
A positive and preventative approach is a vital pillar of delivering a coherent mental health strategy. In this regard, young people and men must be targeted by a holistic plan which empowers them to be partners in the maintenance of good mental health. I have been highly impressed by the Jigsaw project, which emanated from the Headstrong initiative. Jigsaw is a network of projects designed to ensure that every young person has somewhere to turn when in need. It does this by having centres in hub areas and pop-up clinics and centres to ensure hard to reach young people have relative ease of access to services. It recently managed to provide a service throughout County Donegal. I hope it will be able to provide county-wide services in counties Wicklow and Carlow. While the Health Service Executive is the main funder, holistic and mental health programmes for young people must involve the Department of Education and Skills and all local authorities. I am pleased to report that Wicklow County Council and the Bray Area Partnership are working to establish a Jigsaw service for County Wicklow. Both bodies can be assured of my support, although I will insist on the programme being rolled out beyond the major centres of Bray and Greystones to reach into smaller towns such as Wicklow, Arklow, Blessington and Baltinglass as well as rural areas where mental health problems are escalating at an alarming rate.
Purposeful mental health services for everyone and the beginning of the end of the silent suffering of mental illness can be the lasting legacy of this Dáil. I hope that, as elected representatives who are in close agreement on this issue, we can achieve this objective early in the lifetime of the House. This would send a strong signal to the naysayers and doubters that politics can be a force of real and positive change. For my part, I will lead by example.
The Deputy is leading by example in his timing.
I congratulate the Ministers of State, Deputies Helen McEntee and Marcella Corcoran Kennedy, on their appointments. Today, I was appointed the Fianna Fáil party spokesperson on old people, public health and health reform and I look forward to working with both the Ministers of State.
Every year, thousands of students start a new chapter in their lives when they move to third level education. This is a very exciting time for most students as it is probably the first time they have lived away from home. For some students, however, reality sets in when the initial excitement of moving away from home and into new accommodation with friends without a night time curfew fades.
The number of students in third level education seeking mental health services is mounting every year. I recently met Professor Willie Donnelly, president of Waterford Institute of Technology, to discuss university status for Waterford. I was shocked to learn that the institute of technology loses 20% of its first-time students every year. Last year, for example, 400 students out of a total cohort of 2,000 left the college.
This cannot all be linked to mental health issues, as some students make the wrong choice or pick the wrong course. Cuts to the number of career guidance counsellors can also be linked to this.
Mental health issues for third level students have become more prevalent. The waiting lists for counselling services are growing but these services are already over-prescribed and underfunded. College life should be enriching and rewarding for all our students. However, many students are struggling through their studies. Many students find the transition to college life and living away from home extremely challenging. This is having a detrimental effect on the mental health of students in colleges and universities around the country and often leads to problems with alcohol, drugs, body image, self-harm, bullying, anxiety, low self-esteem and difficulty coping with loss and grief.
Colleges and universities offer services for those suffering with their mental health, including counselling services. Unfortunately, this is not enough. The student body is ever growing. These students come from more diverse backgrounds and cultures, speak different languages and have different traditions, which can exacerbate the problem. Despite the ever increasing student population, counselling services in colleges and universities have not kept pace with the growing numbers.
Recent statistics have shown that in some colleges and universities, there has been a 16% increase in enrolments while the numbers attending counselling services on campus have increased by 33%. Research has shown that over the past six years, the number of students presenting themselves to mental health services has steadily increased. The anxiety disorder figure has increased from 19% to 32%. The figure in regard to those suffering from depression has increased from 9% to 24% and there has been an increase in academic related issues from 19% to 29%. Despite these figures, there has been no increase in funding. Counselling services in our colleges are vital, essential and expected. The lack of these services, coupled with waiting lists - in some colleges there is only one counsellor available, backed up by a pastoral care team - is having a severe impact on students' health and well-being. Improved services are well overdue. Counselling services in our universities and institutions must be increased and funded.
It is time for us to take an active approach to students' mental health because if we do not deal with the issue at this level, we are only kicking the can down the road, which will result in problems later. The issue of mental health must be addressed. There is no longer a stigma. If people break an arm, they get the problem sorted. The same approach needs to be taken for mental health issues. These issues cannot be buried in the basement of a hospital as if they do not exist.
In Ireland, suicide is a leading cause of death among young people. The rate of youth suicide in Ireland is the fifth highest in the European Union. That is 15 youth suicides per 100,000 15 to 24 year olds. The suicide rate for teenage girls is higher in Ireland that in any other EU state. That is a damning statistic. There are not many Deputies here tonight to hear this but I will repeat that the suicide rate for teenage girls in Ireland is the higher than in any other EU state while the rate among young men is the second highest. I was shocked when I read this. This is a staggering statistic and the issue must be dealt with.
I am pleased there is consensus among all parties on the seriousness of this issue. I look forward to working with the Minister of State on the issue in the future.
I congratulate the Minister of State, Deputy Helen McEntee, on her appointment as Minister of State with responsibility for mental health and older people. I also congratulate Deputy Marcella Corcoran Kennedy on her promotion to Minister of State with responsibility for health promotion. I wish both Ministers of State all the very best in their new roles.
As a Member of this House for more than nine years, I see it as very positive that every Member has had an opportunity to contribute to this debate and it is encouraging that so many Members have done so. At this stage, virtually all Members have contributed. Over the past number of weeks of debate, I have listened to many contributions. Some constructive proposals have been made by Members from across the House and I have no doubt the Minister of State will take them on board and seek to have them implemented.
It is essential that when people seek help, help is available. In the area of mental health, it is vital that people are able to find good quality services and supports. It is ten years since A Vision for Change was published but, unfortunately, the recommendations contained within that framework document have not yet been fully implemented. There is little doubt that now, more than ever, there is an increased demand for mental health supports. It is not acceptable that waiting lists are allowed to continue to grow.
For example, the waiting list figures for mental health services for children, teenagers and young people in County Clare are stark. The HSE recently confirmed the following waiting times for routine referrals. Some 54 children are waiting up to three months; 31 are waiting between three and six months; and 18 are waiting between six and nine months. In addition, 19 are waiting list for nine to 12 months; eight are waiting 12 months; another eight are waiting 13 months; six are waiting for 14 months; and one is still waiting 15 months on. The HSE chief officer for community care in the mid-west region has recently confirmed that there is no waiting list for emergency cases, as children, teenagers and young people are dealt with on an emergency on-call basis. However, every effort must be made to reduce the waiting lists associated with routine referrals for children, teenagers and young people as these waiting times are now stretching into years.
Significant positive participation has taken place through community initiatives, such as the Darkness Into Light and the Cycle Against Suicide movements. These initiatives are primarily driven by young people. In so doing, they are raising awareness about mental health issues. I also want to compliment groups like Console and the Samaritans, which do marvellous work in County Clare and throughout the State. It is important that people know that it is okay not to feel okay and that it is okay to talk about it.
The biggest challenge in the battle to improve mental health facilities and services is presented by the shortfall of approximately 3,000 key staff. If we are to tackle this issue and reduce the waiting lists, a dramatically enhanced focus on recruitment is required. A root and branch review of staffing right across the mental health service is long overdue. Funding for a new recruitment drive needs to be ring-fenced. In this regard, I was very disappointed to learn that funding of €12 million identified for mental health staff recruitment is to be used in other areas of health. If the Minister of State takes one thing from my contribution to this debate, it should be that we must have a clear strategy in regard to the recruitment of key front-line staff, coupled with a budget that is ring-fenced to be used for the engagement of key staff, as identified in A Vision for Change. I wish the Minister of State well and I look forward to working with her in dealing with the area of mental health in the future.
I congratulate both Ministers of State on their appointment and look forward to working with them on this issue, which I see as not just an issue for the Government but for every Member of the Dáil.
I will use the brief time I have available to concentrate on mental health and early intervention strategies at the education level. When it comes to mental health, prevention is better than cure. That is the reason we need to equip children at a younger age with the skills that teach them self-awareness, self-worth and resilience. The National Policy Framework for Children and Young People 2014-2020 recognises as a national aim that children should be "achieving full potential in all areas of learning and development" including "social and emotional well-being". It also states that we should be working towards "rebalancing resources to place greater emphasis on prevention and early intervention".
Early intervention is not only cost effective in the long term, it is also the best way to mitigate risks in future behaviour and promote positive outcomes for children andyoung people. We have a duty to prepare children with the life skills to be able to face challenges in the future. Education should be holistic so we need to look at a multi-strategy health promotion project which uses a whole-school approach to promote resilience in children of primary school age. This strategy needs to link into the curriculum and one of the best ways to do that is to introduce health promotion as a compulsory subject in our schools.
In the Australian curriculum, students develop personal and social capability as they learn to understand themselves and others and to manage their relationships and lives while learning more effectively. Effecting change at an early age is the best way to equip our children into the future with the skills to avoid mental distress, to recognise the signs of being unwell and to reach out for help when they are in trouble.
Adolescence is often described as the peak time for the onset of mental health difficulties with up to 50% of all cases occurring prior to the age of 14. This relatively early onset points to the need for early intervention to prevent difficulties. Using schools as health promotion sites poses difficulties. The induction of teachers and professional development to deliver the curriculum in this process are paramount but this in itself poses challenges. We need to look at developing a compulsory curriculum that goes beyond the formal learning process. Schools provide an important setting for this. The evidence outcomes from the Australian model reflect this and it is something that needs to be duly considered for the Irish education system.
We need to show immediate commitment in this area. The cuts to counselling in our schools over the past number of years need to be reversed. The spend on mental health as an overall percentage of our health budget needs to be brought in line with our EU counterparts at between 10% and 12%. GPs are inundated with problems and often have to resort to short-term medication and, as a pharmacist, I do not see that as an ideal solution. We need a holistic long-term approach. Early intervention and a new curriculum in primary and secondary school are a long-term project that will require commitment and investment but will yield results and will benefit this generation and the next generation through their entire lives. I ask the Minister to take this proposal on board in developing a new strategy for the future. If he does, it will benefit the entire population.
I congratulate the Ministers on their appointment. We all face a challenge with regard to mental health. Every day, Deputies meet people with varying levels of mental health problems and we have come across the ultimate situation where somebody commits suicide, leaving families devastated. The question is what we can do about this problem and how we can reduce the numbers. It is very important that we apply ourselves to this task as we applied ourselves in a previous time to reduce the number of people killed on the road, which we have done quite successfully.
We must look at every facet of this subject. One thing is certainly true, namely, that acute medicine has a much better ability to attract funding than continuous preventative medicine, which requires continuous investment without a very specific outcome. This House has to support the ring-fencing of budgets for mental health. We should also look at models of best practice. Suicide numbers have gone through the roof in the past 30 years but there may be good reasons for that. Some of it might be because of pressures in society but we must also take into account the much larger number of people who were locked up in psychiatric homes, although thankfully we do not treat these people in that way any more. We have to see whether there is a third way that does not go back to the totally unacceptable first way nor leaves us with the present situation. I have seen some examples of very good practice which are basically community based and very local. All of these require funding and there is a tendency in the system to prefer money to be spent on a certain number of procedures rather than on continuous care. The Minister has a major challenge in that regard but we also have a role to play. If we insist on all the funding going into acute care, we cannot complain when it does not go into continuous care.
I will touch on two other issues. One is that we seem to be living in a world where bureaucracy is becoming more and more codified and where people have to conform to the code, whether that is in housing or in something else. The code becomes more important than the personal or the individual circumstances. There is an inability on the part of people to deal with all sorts of things in life, such as farm forms or housing, health and social welfare issues, while the system always wants things to be done its way. Very little discretion is given to officials even when it is clear somebody has a health issue and this is something we have to look at. We need to get back humanity and have discretion, particularly when dealing with people who quite clearly have health issues which mean they cannot deal with things in the way other people can.
I believe in humanity and the benefits of dealing with people on their own terms. One of the great shocks I had was finding out that one cannot legally get a medical card if one has no income, which sometimes happen on account of mental health issues. Even when it is absolutely clear there is no cheating going on, people cannot get their card, which is bureaucracy gone mad. It is inflexibility gone mad. Students with problems who opt out of exams and want to go back to college are charged the full fees again. If they can prove by a certain deadline that they had a medical issue, they can avoid this but people with a mental illness often do not follow all the rubrics, instead getting themselves into a total mess. It is not just about the medical services but about society's attitude.
The third issue is our large prison population as compared to 1950. I raised this issue with somebody very senior in the Prison Service and he said the explanation is that we had a huge population in mental institutions at that time. If the Minister wants to test this theory, he should go down to the female prison, the Dóchas Centre in Mountjoy Prison, where he will find many people who should not be in prison because the issues that put them there are purely to do with mental health issues, in some cases allied to drug addiction. To criminalise what is basically a medical problem is totally cruel.
I wish my colleagues well in their important work. I worked for quite a number of years as a guidance counsellor in a second level school and I also did a lot of training in counselling with the Cork social and health education project, so I have a personal interest in mental health.
As others have already said, schools have a significant role to play in this regard. I suggest that guidance counsellors, in particular, have a fairly large role to play. The power of a significant adult in the life of a young person cannot be under-estimated. It is important to recognise that anybody - a parent, an uncle, an aunt, a teacher or a counsellor - can be a significant adult.
I am great believer in the role of youth services. We should be supporting Foróige, Youth Work Ireland and other youth services, including the guides and the cubs, because they perform a huge function out there. Quite often, a trained youth worker can identify a young person who is under pressure or stress and intervene to help him or her to get counselling or any other assistance that may be required. The presence of a captive audience of children who might not want to be there, or who might be embarrassed, can sometimes make programmes in schools somewhat artificial. Out-of-school informal education through youth services is very powerful and is something we should further develop. The self-esteem of young people who are involved in sport and physical activity can be improved by the camaraderie and teamwork involved in such endeavours. Similarly, we should encourage and help those involved with the President's award, Gaisce.
We must not forget that alcohol can play a major part in this whole area. Alcohol is a depressant, as we know. Unfortunately, it is a factor for many of the people I come across who are affected by mental illness. Many, although not all, of those who commit suicide are drunk or hungover prior to doing so. I would have a big worry and concern about the role of alcohol in this regard.
Loneliness can play a big part as people get older and are sometimes on their own. That is why we should be supporting and encouraging organisations such as Men's Sheds, which can often encounter difficulties in finding premises and places to carry out their work. It is said that men often help each other elbow to elbow or side by side. They can talk when they are working on something together. I think women can build up stronger networks, which is a strength. Men often find it difficult on their own. I think that is an area we need to focus on.
I agree with Deputy Ó Cuív that mental health is a continuum. We are all on that continuum. Some of us are strong at times. Every one of us can go down the other side when we are under pressure. Politicians, in particular, can be very vulnerable. We can get a lot of abuse. It is hard to take. It can be personal. I detect far more camaraderie in this Dáil. There is not as much aggression as there was in previous Dáileanna. I think we need to work together. That is happening more and more now. We are listening to each other a little better. Society needs to try to cut down on the aggression. The media have a role to play in this regard. When politicians are in the media, it can be gruelling to deal with people who want to catch us out and say "gotcha". That seems to be the approach. Rather than trying to find out what the issues are and having a proper discussion on them, some people prefer to take the "gotcha" route. I ask the media to move away from that. People need to try to move away from that. We need to focus on the positive rather than on the negative.
William Glasser, who was involved in reality therapy some years ago, spoke about four areas of life that we should be strong on. He spoke about the need to love and be loved, which is quite important for everybody. If one is missing that, one is in trouble. He also said we have a need for power. This involves feeling worthwhile and achieving things. Glasser's other two needs were the need for freedom and independence and the need to have fun. He maintained that a person who was not having those four needs met was in trouble. There are many different approaches to this issue. Adler looked at the outcome of behaviour as a means of explaining why someone behaves in a certain way. I could go on. Durkheim was concerned about anomie and withdrawal from society. There are many approaches to this issue. As someone said earlier, counselling and talking therapies are very important. Rather than going for the bottle and the pill all the time, it is crucially important to build self-esteem, self-worth and self-image.
As I have responsibility for equality and integration in my new job, I am conscious that mental health issues can feature strongly in debates on inequality and integration. As we have seen, some of those coming here from abroad are experiencing trauma as a result of the unspeakable things they have seen and gone through. Already this week, it has been reported that up to 900 people have drowned in the Mediterranean. That is two 747s. We are complaining about things here when these people are facing such trauma.
The high rate of mental health issues facing members of the Traveller community is of particular concern to me. My Department is currently undertaking a three-phase consultation process with a view to putting a new Traveller and Roma inclusion strategy in place. This will involve the development and implementation of a range of cross-cutting policy matters in order to address the issues facing the Traveller and Roma communities. One of the key issues to have emerged so far from the public consultation on the draft strategy is the high rate of mental health problems experienced by members of the Traveller community. In 2010, the all-Ireland Traveller health study showed that the suicide rate among Traveller men is seven times higher than the rate among men in the national population. The reasons for this are multifaceted. When the strategy is completed, it will address those mental health issues by way of specific actions to be implemented on a cross-departmental basis.
I would like to speak about the positive side of these matters as well. When I attended the Traveller Pride awards earlier today, I was impressed, inspired and moved by the array of wonderful skill, talent and dedication in the Traveller community. It was clear to me that Travellers have huge potential to contribute fully to Ireland if the barriers to their participation in society could be removed. The overall winner at today's awards was a young lad of 14 - an amazing guy - who is a world handball champion. I also met four young lads from Skibbereen who are going to do very well after making an absolutely fabulous model of one of the old Traveller barrel wagons and then deciding to mass-produce such wagons in flat packs to sell them. They cannot keep up with the orders. It is amazing. The music played at today's event was absolutely inspiring. Finbar Furey was there. There is a great deal of work to be done in the Traveller community with respect to mental health. Any group that is marginalised like that will have problems.
There is a huge amount of work to be done in this area. I wish my colleagues well in their work. We can make an awful lot of progress. We can start here in this House by being a bit kinder to each other. It does not cost anything to be nice. It does not cost anything to listen to people. Deputies should engage with people in a positive way rather than trying to put them down all the time. If we start by adopting such an attitude here, maybe that can permeate outside. Perhaps I am being naive or innocent but we should have a go. I am already detecting or sensing that the new Members who have come into this Dáil, and some of the older Members, are inclined to listen. Maybe it is because this is a minority Government. Perhaps we all have to listen now because we do not have what we had in the past. We have to work together for the good of everybody because everybody can contribute in a positive way. I am glad to have been able to speak in this debate.
I would like to share time with Deputy Thomas Byrne.
Is that agreed? Agreed.
I am pleased to have a chance to speak on this very important and sensitive topic. I congratulate the Ministers of State, Deputies Corcoran Kennedy and McEntee, on being appointed to their respective ministerial posts. I also congratulate the previous speaker, my constituency colleague, Deputy Stanton, on his appointment as a Minister of State last week.
In my constituency of Cork East, I deal on a daily basis with parents who are under great strain. Many of them have children who are waiting to be assessed to see if they have Asperger's syndrome or autism. Waiting lists for children to be assessed have spiralled out of control in my constituency. It is clear that despite the great work of the child and adolescent mental health services, they are unable to deal with the current backlog of applicants who require assessment. Parents have informed me that their children have been on waiting lists for assessment for up to 18 months. This has placed many parents under a great deal of stress. We all know that stress is one of the greatest causes of mental health illnesses. The recurring message I am receiving from my constituents is that children and their families are being messed around. A mechanism needs to be put in place to see how waiting lists for assessment for early intervention can best be reduced. Many of these children require urgent assessment, which will in turn allow them to receive the best possible treatment.
I recently spoke to a 47 year old man who has been diagnosed with Asperger's syndrome. He told me it was as if he had been given his diagnosis and then wished the best of luck.
It is evident that the supports to those who receive diagnoses are limited, such as in this instance. We now need to provide appropriate services for all ages so that people can receive the necessary care they require.
It is high time the Government recognised that those who suffer from mental health issues do not stop suffering at 5 o'clock in the evening. Parents and families who have children and siblings who require care will tell us that it is not a nine to five job for them. Voluntary organisations throughout the country and in my own constituency do their utmost to be on the other end of the phone 24 hours a day. However, many State services that are supposed to provide such support vanish after 5 o'clock in the evening. As as result, many volunteer organisations now find themselves under great strain because of the ever-increasing workload and limited resources.
We often associate the word "stigma" with mental health. I pay tribute to the mental health awareness campaign that ran through the month of May. We all had the green ribbon on and I see some of my colleagues are still wearing it today. It was a good initiative that was put in place. It is the 1916 centenary and we like to think that the words "stigma" and "mental health" do not have to be associated with each other. However, the actions of some will mean that this will be never be the case. I heard recently about a girl of 16 years of age who was taken into a hospital in Cork in handcuffs because she had tried to commit suicide. The staff and gardaí were quizzed by onlookers who were informed that it was a protocol for those situations. What would anybody in the Chamber do if we witnessed this happening to one of our loved ones? If this is the protocol, I suggest we devise a new one.
We all agree that this Dáil must find a new way of conducting business. I firmly believe that on the issue of mental health, the way forward is something on which this Dáil must, and can, form a cross-party consensus. I have no problem acknowledging the work that my constituency colleague, Deputy Pat Buckley, does to raise awareness on suicide, nor do I have any problem in acknowledging the work that the former Minister of State, Kathleen Lynch, did during her term of office with regard to mental health. I am also aware of the good work that Adam Harris, brother of the Minister for Health, Deputy Simon Harris, does in raising awareness for those with autism. However, there is now an onus on us all in this Chamber to develop a mental health service that is fit for purpose. I look forward to working with the Ministers to make my contribution.
Táim buíoch do Theachta Eamon Ó Cuív as ucht a chuid ama a roinnt liom. I am delighted to be able to contribute to the debate. I already spoke on the issue of mental health in the debate on health which took place before this one. I congratulate the new Ministers of State, Deputies Helen McEntee and Marcella Corcoran Kennedy, on their appointments and I wish them well. There is a huge job of work to do on this issue in both of their areas.
We can all talk about what we each think is best in this sector but we must leave it to the professionals. Some very important people who are hardly mentioned in the debate at all are the psychiatric public health nurses. They do tremendous work and are certainly life-savers for some people. They are at some people's beck and call. That service is patchy throughout the country and it is one I would like to see improved on. The Minister of State, Deputy Stanton, mentioned guidance counsellors. We have an agreement with Fine Gael to bring back ex-quota guidance counsellors and we want to see it implemented as soon as possible. That is very important for students at that age.
The implementation of A Vision for Change must be given leadership. There are practical consequences throughout the country. The Minister of State, Deputy McEntee, will know that a psychiatric unit is being moved from Navan to Drogheda, which has caused controversy. I do not want to add to that controversy. If someone tells me that it will actually improve the service for patients, I will accept it. Unfortunately, with the HSE over the years, we have been told certain things, particularly in regard to the removal of doctors. We were told it was in the best of patients but that turned out to be simply untrue. I am sceptical of that move and it needs to be better explained. Better leadership needs to be given on that issue. If it will improve the service for people who are in dire need, it will be accepted. Notwithstanding that, people parts of County Meath are worried that the move will have negative consequences. It has to be explained, at the very least.
I assure the Minister of State, Deputy McEntee, that I am not going to ramp up political pressure on that particular issue if I am satisfied it is in the best interests of patients. However, I am not yet satisfied as it has not been explained to me properly. I would appreciate a written brief from the Minister of State, Deputy McEntee, to explain exactly why it is happening or a meeting between the HSE and Members to explain the move and how it is in the best interests of patients. That has not happened yet. There are people who are happy to exploit any mental health issue but I am not going to do that in this case. If it is not explained to me properly, I will do everything in my power to make sure that a better service is provided in case this is simply a cutback. I note that it does involve a cutback to the number of beds in the north-east. We are told that this is what A Vision for Change recommends but nobody has sat down with Members and explained that to us. If that was done, it could alleviate the concerns. The public will accept a better service. Drogheda and Navan are not too far apart but it is a worry for people, particularly in the west of County Meath. It is incumbent on us to look at these issues carefully and strategically and to deal with them properly. We cannot always make political points, especially on this issue or on health issues in general, but nobody has made the case to me yet in regard to this move.
I would like to address a number of other issues that have been addressed in the debate, which has been very useful. As politicians, we have to make sure that the services are delivered. We have had very helpful interventions from a number of well-known people. Other people have come forward to say they were suffering in silence. I suspect a number of people have been suffering in silence. It is the very nature of the taboo in regard to mental health. We all know many people who suffer in silence from mental health issues. They will get the supports through their GPs, public health psychiatric nurses and, in some cases, through residential care in psychiatric hospital settings. The funding has to be there to pay for that. I do not want to see the Minister of State, Deputy McEntee, having to deal with what the former Minister of State, Kathleen Lynch, had to deal with over the past few years in constantly battling for money. Fianna Fáil has suggested a mental health authority. The purpose of it would be to ring-fence the money and to make sure the cash is available for mental health services, as promised. The money would then presumably be spent in the best way.
Those are my thoughts. None of us has a monopoly of wisdom on this issue but I suspect that practically all of us have experience at some level or other in this area. Some people speak about it while others do not and that is their choice. Each person's choice should be respected.
I wish the Ministers of State well. I am not speaking directly about the Minister of State, Deputy McEntee, who is only in the job a week or two but in terms of the situation in Meath, leadership is needed to explain the move because otherwise, it will become another political football where the best interests of patients are forgotten.
I understood I was sharing my time with Deputy Brendan Smith. If he arrives, he can take five minutes. If not, I will continue.
I welcome the opportunity to speak on this issue and congratulate the Ministers opposite. The fact we have Ministers with responsibility for mental health is indicative of the fact that this is an issue that has become much more prominent in the public mind and in the minds of politicians. I recall growing up as a young man when mental health in Ireland was kept in a shrouded place. People went to hospital but it was not discussed. It was very difficult for people to be publicly acknowledged as individuals who suffered from mental health issues. Fortunately, we are getting over that now. People now recognise that mental health issues are as much a problem as any physical health issues. We need to be open about it and must get away from the past of people being embarrassed about mental health issues in the family or in respect of themselves.
I welcome the fact there is a change in public attitude to mental health issues. I suspect the prevalence of mental health issues is greater now than 50 years ago but that may be difficult to appraise accurately because people kept it quiet. We have pressures in our society that previous societies did not have.
I want to talk about pressures on a certain cohort of our people who I believe are subject to many pressures. I am talking about people between the ages of 15 and 25. The reason I refer to that group of individuals is because they are at a particularly important and consequential age in their development.
It is an extremely important phase in somebody's progress through life, for a variety of reasons. First, people between the ages of 15 and 25, particularly at the upper end, begin to realise that life may not present the opportunities they thought it would present to them, and life may not be as productive or profitable as they thought it would be for them. In many respects, as people reach their mid-20s, they are sometimes faced with a reality check about life which may not be consistent with what their ambitions are or were. That is one reason I believe there are pressures on people between the ages of 15 and 25.
Another reason was alluded to by the Minister of State, Deputy Stanton. It is the age when people start taking mind-altering substances. As people get older, it is probably easier to deal with substances like alcohol because they have a stability in their life but the mental development of people between the ages of 15 and 25 is fragile and frail and they are vulnerable. That is why taking mind-altering substances, consuming excessive amounts of alcohol or taking serious hard drugs that induce psychosis give rise to potential instability in people of that age. It is something we must be aware of and it is why we need to concentrate on people of that age.
A third reason I believe that group of people needs to be concentrated on is due to the pressures this society imposes on them. It has now become accepted wisdom that, for example, every young girl has to be intelligent, beautiful and popular and have a fantastic boyfriend - that is the message we send out from society. Similarly, every young boy who is becoming a man is supposed to be an outstanding sportsman, academically gifted and successful and is supposed to go on to become a millionaire. That is too much pressure to put onto people of that age.
As a society, we need to start telling people of that age that they do not have to be exceptional and they are perfectly entitled to be normal. The norm in Ireland is that people are in the middle and are average and we need to respect that. We must stop putting pressure on people by saying they have to excel all the time. The reality of life, as we all know, is that the vast majority of people do not excel. The vast majority have normal abilities and cannot achieve the ambitions and overcome the pressures put on them by our contemporary society.
As a final point on mental health, I have recently attended funerals of people who have taken their own lives. We have to send out the message that no matter how bad mental health issues are, that cannot be an option.
I take the opportunity to congratulate the Ministers of State, Deputies Helen McEntee and Marcella Corcoran Kennedy, on their appointment. I spoke to each of them individually and I wish them well in the very important jobs they have ahead of them. Others have referred to the work of the former Minister of State, Kathleen Lynch, and I want to echo the support for the work she did. In the previous Dáil, the former Deputy for Laois-Offaly, John Moloney, also did excellent work as Minister of State. He was particularly strong in advocating the need to implement A Vision for Change rather than just having it as a strategy. He did very good work with the Oireachtas health committee at the time, with the support of colleagues on all sides of the House. A Vision for Change, which is a 2006 strategy, now needs updating but, most importantly, it needs to be implemented.
Mention was made earlier of career guidance and the unfortunate reduction in supports for career guidance services in second level schools some years ago, which I believe was a retrograde step. We all know of the excellent work career guidance counsellors do. In many instances, the first port of call for young, school-going students who are meeting particular difficulties is the guidance counsellor. I believe it is a service that should not be reduced and, in fact, it needs extra support. In our constituencies at the time the former Minister, Ruairí Quinn, reduced the funding and the ex-quota allocation, all Deputies met with guidance counsellors who were really committed to their profession and were doing excellent work. We knew this from the pupils who had gone through the various schools, from principals and from the wider school community. It is an area that needs support and I hope the reduction in support can be reversed.
I represent two very rural counties. In the past two years, in particular, there has been huge pressure in regard to housing and, unfortunately, more people are coming to us every week who have lost or are on the verge of losing their home. We all know - in many instances, we have heard this from GPs and those in the general health service - that the pressures on housing are causing huge mental stress for people. At a time like this, we need to ensure there is access to counselling. A number of constituents spoke to me at the weekend to outline the huge delays in regard to being recommended by a GP to a counselling service and this has not yet been provided. The delay in being able to access that first assessment or counselling session is far too long and, unfortunately, in many instances, it comes too late.
I refer to the whole area of alcohol and drug abuse. Unfortunately, Cavan and Monaghan have a serious problem with addiction to heroin and other psychoactive substances. I met the Cavan-Monaghan Drug and Alcohol Service recently. It is a voluntary organisation which is given some support by the HSE but not enough. A small number of people are doing excellent work in trying to provide a service with the support of some pharmacists and GPs. The Minister of State, Deputy McEntee, will be very familiar with east Cavan and part of south Monaghan. I hope we have the opportunity to have a meeting in regard to the situation in Cavan and Monaghan because that area, in particular, is facing serious difficulties. Unfortunately, it is an area that has not had the provision of a good statutory service to deal with drug and alcohol addiction. I hope it will be possible to make some progress in providing necessary services, both in terms of personnel, such as the different clinicians that are needed, and financial support for the work of the different voluntary organisations.
What was clearly stated to me at the meeting by people who work on a voluntary basis as directors of the association is that heroin is a serious and growing problem in the region, as are new psychoactive substances, but the level of funding they receive is nowhere near commensurate with the scale of the problem. They primarily see adults but they do their best to make a part-time counsellor available for those under 18. They also cite the lack of residential homelessness support services and note that when they are trying to help a homeless person, they have to use bed and breakfasts and hotel accommodation. This is not the most useful accommodation at such a time, when other residential services would be much more beneficial, if they could be accessed.
These are the particular issues that need support. We want to ensure the voluntary groups that are doing excellent work are given the support they need through additional funding and through the appointment of professional personnel.
I congratulate the two new Ministers of State, Deputies Helen McEntee and Marcella Corcoran Kennedy, on their appointment. Guím gach rath orthu ina róil nua.
I wish to be positive and a Deputy on the Government side has asked that we be nice to each other, which is very important. It is also vital to look at why we are in this state during these statements on mental health. I have sat through all of the debates to date and I wonder why we are not holding the system to account because that is our role. A Vision for Change was introduced in 2006 but, not alone that, it was based on "The psychiatric services - planning for the future", which was published in 1984. The central recommendation at that point was a new model of mental health care but because of the slow progress over a 22-year period, it was necessary to re-look at the service, leading to A Vision for Change, which was published in 2006.
Therefore, there is a history to A Vision for Change. There were urgent reasons that it was brought in and there is a background to it. The 2006 document, which I have before me and which I have read in detail, as I am sure the Minister has, detailed a comprehensive model of mental health service provision for Ireland for the ensuing ten years, including providing a framework for building and fostering mental health across the entire community and providing accessible, community-based specialist services for people with a mental illness.
We are beyond the stage of making statements in the Dáil, making positive statements or making our own suggestions, because A Vision For Change was based on the findings of an expert group established in August 2003 in recognition of the need to review long-standing policy in this area and formulate a blueprint for a modern, comprehensive, world-class service to meet the mental health challenges facing our society, not least of which is our significant suicide rate, particularly among young people.
Debate adjourned.