Mental Health Parity Bill 2017: Second Stage [Private Members]

I move: "That the Bill be now read a Second Time."

I am happy to move Fianna Fáil's Mental Health Parity Bill 2017 on Second Stage. This Bill, if enacted, will compel a conceptual shift in attitudes and behaviour towards mental health at the highest level of policymaking and governance within the Department of Health and, consequently, the Health Service Executive, HSE.

Fianna Fáil’s Bill establishes, on a legislative basis, the principle of parity of esteem of our physical and mental healthcare and identifies a legal mechanism for the Minister to compel the implementation of this principle. This Bill, if enacted, will place a legal duty on the Minister for Health to promote health parity and to ensure all organisations within our health system meet parity obligations in regard to mental health.

Ensuring access to timely and appropriate treatment for people with mental health needs on a par with physical health is a major policy concern for the Fianna Fáil Party. The overarching principle of parity of esteem is that of equality. It means, among other points, equality of access to care and treatment, equality of efforts to improve quality of care, and equality of levels of choice of care and treatment. It means the allocation of time, effort and resources on a basis commensurate with need, that mental health has equal status within healthcare education and practice, and that there is equal status in the measurement of health outcomes. It means also that the stigma and prejudice about mental health care and treatment is tackled head on, that there is an understanding, acceptance and execution of the principle that our physical, mental and social health are inextricably intertwined and interdependent, and that there is no health without mental health.

One of the key motivations for bringing forward this Bill now is the downgrading of mental health services within the HSE. A Vision for Change requires the appointment of a mental health directorate, yet the HSE recently abolished the role of the national director of mental health and has reverted to the old system of separating strategy and budget responsibility within mental health services. That did not work in the past and it is difficult to understand why it is believed it will work this time.

The reality is that the relationship of mental health is that of Cinderella to the Department of Health and the HSE. It is ignored for the most part, regarded as something other or lesser, and is the first to be treated badly in difficult circumstances. That is reflected in the fact that for some time now the investment in mental health as a proportion of the health budget has been decreasing. There is ample evidence that if we place mental health on a parity with physical health in our policies and in our healthcare system, we will improve outcomes for mental, physical and social healthcare.

The Government consistently says it has been doing all that it can, but the facts speak for themselves. To provide the Minister with some recent examples, we still have a significant number of children being placed in adult units, some for up to six weeks at a time. Sometimes they are placed in chairs and at other times they are placed in hallways. The recent report from the Mental Health Commission highlighted the fact that it still does not have the powers to regulate community mental health residences, a power that the Health Information and Quality Authority, HIQA, has in respect of similar non-mental health residences. We have patients being kept in prisons due to a lack of space in adult units. We have a chronic problem of mental health issues linked to social media such as cyberbullying and body dysmorphia, yet there is still no appointment of a digital safety commissioner.

We have the revelation that we spend €400 million on psychotropic medicines and only €10 million on community psychology. Our mental health system seems to be geared towards triage and crisis intervention. This is particularly acute in children’s primary care psychology and child and adolescent mental health services, CAMHS. We know that 50% of mental health issues arise before a person turns 14, and 75% arise before they turn 25, yet early intervention for young people is limited, inconsistent and ad hoc. There is clearly a mental health treatment gap with a very significant unmet need in terms of access to care and treatment. That gap must be closed.

It is obvious that the mental health area is underfunded, and not just in real or relative terms. It is also underfunded relative to its potential impact. By that I mean that there is evidence that investment in certain early interventions can save more money than the interventions cost.

As stated earlier, this Bill, if enacted, will establish on a legislative basis the principle of parity of esteem of our physical and mental healthcare and will place a legal duty on a Minister for Health to promote that parity. I implore Members on all sides of the House to support the Bill.

For someone in a vulnerable position who summons the strength to reach out and seek help while feeling helpless and alone requires a strength like no other. Sadly, too many do not get that vital help when they seek it. Sometimes it is only when someone has taken that drastic decision to try to end their life that the health system kicks in to try to help them survive. What we need is early intervention and more positive action at an early stage.

There is no doubt that our mental health service has serious deficiencies which result in long waiting lists for services for some of our most vulnerable citizens. We are all aware of where the problems lie. Chronic underfunding is a massive issue. Even the 8.2% figure set out in A Vision for Change has yet to be met. For all the talk about mental health as a political priority, we remain far below the 13% figure we managed in the 1980s. Without a meaningful and sustained increase in overall levels of funding, we will not be able to tackle the mental health crisis in our society.

The Mental Health Commission's recent reports on 43 units made for alarming reading, with serious deficiencies found in many of the residences, including the Lakeview unit in Naas and in Portlaoise, where there is an agreement on transfer late at night.

This Bill does not aim to solve the funding, staffing and morale problems in mental health services. Rather, it will ensure that, going forward, mental health will be placed, rightfully, at the heart of all key decisions made by the Department of Health.

That will require a conceptual shift in attitudes towards mental health at all levels of policy making and governance. Mental health must be placed on an equal footing with physical health and given the parity of esteem to which it is entitled. This means equal access to effective care and treatment and equal efforts to improve the quality of care our constituents receive. It also means equal status within healthcare, education, practice and measures of outcomes. Mental health supports need to be holistic, providing individuals with care that addresses their physical and mental needs equally. Urgent action is needed to address the crisis. As a society, we need to move beyond the so-called stubborn stigma and treat mental and physical illnesses in the same way. Compassion, acceptance and kindness are the cornerstones of a caring and compassionate society and should be reflected in healthcare policies and adequate levels of funding for mental health care.

I commend my colleague Deputy James Browne for introducing this Bill which seeks to put mental health on a par with physical health. The aim is to provide equality of access to care and treatment for every patient. There is no doubt, given the lack of resources, that we are now rationing mental health services. People who need treatments and therapies are being told that they can access one, two or three hours of same but no more than that. That is not sufficient to deal with patients' needs and provide them with the services they require. Only 6% of the overall health budget is spent on mental health services which is very low by international standards and must be increased. One of the key issues that needs to be addressed is the lack of out-of-hours mental health services, particularly in rural communities such as mine in County Mayo where the only out-of-hours option is to present at the emergency department. Let us think about that for one moment; think about a person in severe mental distress presenting at an emergency department which is overcrowded, under-resourced, manic and chaotic. That is no place for somebody suffering with severe mental health difficulties.

The cost of treatment is also an issue. Cognitive behavioural therapies, CBT, and other talk therapies which we know are effective are not being provided to the level required. Medication is often the first port of call and while there is a place for it, we must also adequately resource the provision of talk therapies. A single CBT session can cost between €80 and €120 per hour, which is far beyond the reach of most individuals. Many talk therapies are out of the reach of people who are relying on the public health system and cannot gain access to such treatments.

We do not have equality of access to care and treatment. If someone has private health insurance or adequate resources to pay for private treatment, he or she will probably be okay, but the public health system is not functioning properly for those with mental health difficulties who do not have insurance or sufficient means. We see the reliance of many on organisations such as Pieta House, the annual fundraising walk of which, Darkness into Light, will take place soon. That annual event shows that communities and citizens across the country are voluntarily giving of their time and money to fund mental health services which should be funded by the State. If we did not have such voluntary services and charitable organisations, where would we be? Many communities would be devoid of any mental health service.

I commend the Bill to the House and urge the Government to address both the non-existence of out-of-hours services in most communities and the very low percentage of the overall health budget spent on mental health services.

I commend Deputy James Browne on bringing the Bill before the House. I also thank the Minister of State at the Department of Health, Deputy Jim Daly, for meeting me and Deputies Mattie McGrath and Seamus Healy earlier today.

I will be very parochial in my comments because there is a crisis in health services in my county. In County Tipperary we have no psychiatric bed of any description. We were promised capital investment in South Tipperary General Hospital and if such capital investment is forthcoming, it is essential that a psychiatric unit form part of it. We also need a psychiatric unit in Nenagh in the north of the county. We have mental health clinics in the county which are completely under-resourced and both GPs and patients have lost faith in them. A GP visited my constituency clinic in Thurles last Saturday morning and told me that he would no longer refer any of his patients to the mental health clinic in Thurles, which serves 34,000 people. In recent weeks three teenagers have been in the paediatric unit in Clonmel hospital - one has been there for 11 weeks - while awaiting admittance to an acute psychiatric unit in Cork for adolescents. The position is just untenable. When Deputy Helen McEntee was Minister of State at the Department of Health with responsibility for mental health services, we were promised a Jigsaw project in County Tipperary, but that has not happened. The county is in crisis in mental health services which are completely under-resourced. We need funding for psychiatric beds and mental health clinics to be properly resourced.

As we discuss this issue I am always conscious of those in the Chamber who have suffered heartbreak. We should always reflect for a short time out of respect for their suffering and to let them know that we share that heartbreak. It is also true for many associated with this House and the many thousands outside who have been affected by mental health issues. I commend Deputy James Browne who has done extraordinary work on this issue, as Members of the House will acknowledge. We must stop the repeated failing of people with mental health issues.

Unfortunately, when it comes to mental health services, County Roscommon has been in the headlines for all of the wrong reasons. Members will be familiar with the external review of mental health services in the county. It was a damning indictment of a service in crisis mode. It found a service in which a culture of blame, secrecy and negativity abounded. Following the review it was suggested the committee's 27 recommendations be implemented without delay. A management team was put in place but to this day, as far as I am aware, very few, if any, of the recommendations have been implemented. The programme for Government contains a commitment to improving mental health services throughout the country. Like my colleague Deputy Jackie Cahill, I am being parochial because what has happened in my county is appalling and outrageous, although I know that the situation is almost as bad in other parts of the country. We must remember that the aforementioned external review commenced in August 2015 but was not completed until September 2017. Despite the seriousness of the situation, it took two years for the report to be finalised. I will not speak any further about this matter because the facts speak for themselves and we all know what we have to do.

I ask the Minister of State, Deputy Jim Daly, to review the situation in County Roscommon and ensure the 27 recommendations made by the external reviewers will be implemented as quickly as possible.

I also commend my colleague Deputy James Browne on bringing forward the Mental Health Parity Bill 2017, which aims to address the unequal treatment of mental health services by placing them at the centre of all key decisions taken by the Department of Health. I have addressed the Minister of State with responsibility for mental health services, Deputy Jim Daly, and his predecessor, Deputy Helen McEntee, on numerous occasions on the issue of mental health. I must acknowledge that we now have an Oireachtas Joint Committee on the Future of Mental Health Care which is drilling down deep into the subject. The committee has been bringing in guest speakers who have been telling members about what is happening on the ground. In recent weeks representatives from Community Health Office, CHO, 2, covering the Galway area, were before the committee and told members that there were 20 Child and Adolescent Mental Health Services, CAMHS, beds for nine counties. In the context of the Mental Health Parity Bill, that spells it out clearly for me. There are only 20 CAMHS beds to cover nine counties, which is in no way sufficient.

The aforementioned Oireachtas committee has also learned a lot about the great work certain groups are doing in their communities in supporting young people. We heard from the Galway branch of Youth Work Ireland, which is providing a youth counselling service. That service has helped 200 vulnerable children in sixth class in primary school through to third year in secondary school. They had issues in adjusting to secondary school. The counselling service is receiving referrals from Tusla and schools because they recognise the importance of early intervention. There are some very appropriate and easy ways for us to improve matters and there is some low hanging fruit of which we can take ownership, but mental health must be on a par with physical health and treated equally.

Like my colleagues, I commend Deputy Browne on the preparation and introduction of the Mental Health Parity Bill 2017, the aim of which is to put mental health and well-being on an equal footing with physical health. For far too long, mental health has been seen as the poor relation in the health services. The shortcomings in mental health care have been outlined on numerous occasions, most recently in last week's "The Big Picture - Young and Troubled", which focused on adolescents who are seeking emergency help. When one looks beyond the services, one sees there is a great deal of goodwill and energy at grassroots level. People are volunteering their time, funds and efforts to plug the gaps that are being left by the State. For example, the Darkness into Light walks will take place on many doorsteps next week. Walks have been organised in many places in my constituency, including Inchigeelagh, Ballincollig, Kilmurry and Aghabullogue. Many cyclists from around the country, including my sister, Gobnait Moynihan, who is a local county councillor in Macroom, are taking part in the Cycle against Suicide tour of the country at present. They are volunteering their time and effort to increase the profile of these issues and to raise the funds that are needed to plug the gaps I have mentioned. The message is that mental health has to be on an equal footing with physical health. Caithfear sláinte mheabhrach a chur ar chomhchéim le sláinte fhisiciúil ionas go mbeidh sé lárnach i ngach cuid den chóras sláinte.

I join other speakers in welcoming this Bill and paying tribute to Deputy Browne for the manner in which he has proposed it, thereby giving this House an opportunity to comment on the good work that has been done in recent years. Various policy documents have been published, but unfortunately they have not translated into mainstream health provision as we would have liked. Despite all the commitments and the improvements in monetary allocations within the budget system, it has been difficult to put enough professionals in place to meet the level of demand we regularly encounter at our clinics and elsewhere. Even though magnificent work is being done by people in the voluntary sector and advances have been made in other areas of healthy living that improve the health of the mind, many people are still not able to access the sorts of facilities we would expect everyone to be able to access in the modern society we live in. A Bill like this is essential to ensure in legislation that this country provides access to facilities, services and care in a way that is comparable to all other aspects of health provision to which we aspire. I want to add my voice to the voices of many Deputies on all sides of the House, of all parties and none, who are keen to enable the Dáil to be in a position to ensure these services and facilities are easily accessed. It is because we regularly leave our clinics with a great sense of frustration and worry that we are seeking to ensure a level of expertise and professionalism of which we can be proud is available in our health service. As legislators and as elected representatives, we cannot sleep easily if we do not know full well that services and facilities which should be available as a matter of course are in place. Everyone has a duty to ensure such services and facilities are provided.

I fully support the contention that as a Government and as an Oireachtas, we must continue to do everything we can to address the mental health issues faced by many of our citizens. I am sure all Members of the House agree that we must prioritise our work on enhancing mental health and well-being. I acknowledge Deputy Browne’s commitment to maintaining a focus on mental health. I assure Deputies that the Government will continue to promote a comprehensive health service that is designed to secure improvements in the physical and mental health of all our people.

The stated aim of the Mental Health Parity Bill 2017, which is sponsored by Deputy Browne and was published on 26 September 2017, is to place mental health on a par with physical health with a view to securing improvements in physical and mental health and in the prevention, diagnosis and treatment of physical and mental illnesses. The Government does not oppose the Bill in principle. While the maintenance of the equal status enjoyed by mental and physical health in the health care system is a laudable and desirable objective, the Government has some concerns about the legislation that has been proposed. Its aims are general and aspirational in nature and appear to differ from the background to and stated purpose of the Bill as set out in the explanatory memorandum. In its current form, the Bill raises serious questions regarding how we can achieve the aims that have been set out through additional legislation.

The World Health Organization's definition of health, which has not been changed since 1948, provides that health is "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". This broad holistic definition of health recognises the interconnectedness of the various factors that contribute to overall health and does not seek to prioritise any one factor over another. Under the Health Act 2004, the purpose of the HSE is "to use the resources available to it in the most beneficial, effective and efficient manner to improve, promote and protect the health and welfare of the public". The same Act clarifies that the HSE "shall manage and shall deliver, or arrange to be delivered on its behalf, health and personal social services". This makes it clear that mental health is acknowledged as an inherent component of health and health legislation, part of and indivisible from the whole. Deputy Browne's Bill seems to refer to this in its effort to ensure "the Minister for Health shall continue the promotion of a comprehensive health service designed to secure improvements in physical and mental health".

Legislation must be clear and specific and should be, to the greatest extent possible, easily understood. The inclusion of policy aspirations in legislation is not generally regarded as good practice. The implications of such an approach can be difficult to predict. The possibility of unforeseen and potentially negative unintended outcomes must be borne in mind. It may be easy from a policy point of view to understand putting mental health services on a par with physical health, but what does that mean when it is put on a statutory footing? How do we determine in precise legal terms whether a service delivered for an individual in one context can be equated with another service delivered for another person in a different context? Does the existing legislative text not already imply that all health, both mental and physical, should already be delivered on an equal basis? If so, how is that to be measured?

In the limited time available to it, the Department of Health has not identified a model in other jurisdictions for legislating for mental health parity. The British Secretary of State for Health and Social Care has a legal duty to secure improvements in the physical and mental health of the people and in the prevention, diagnosis and treatment of physical and mental illness. It is not clear that the concept of parity could be given a legal basis and, even if it could, that it could be operationalised in light of the vast spectrum of illnesses that influence both physical and mental health.

Another of the stated aims of the Bill is to compel the integration of mental health services with physical health services. This is already legislated for in the Health Act 2004, which states that the HSE shall "integrate the delivery of health and personal social services". Over the last decade, there has been a move away from the traditional psychiatric hospital model to treatment in specialist units associated with acute hospitals. Ultimately, there should be a focus on achieving the best outcomes for people who are suffering from mental illnesses. I have concerns about whether a prescriptive legislative approach is an appropriate method of achieving that focus.

The draft Bill has not yet been discussed with Deputy Browne. Along with officials from my Department, I intend to meet the Deputy to discuss the aspirations of the draft Bill with a view to establishing whether and how an amended wording might be considered. We need to consider whether the stated aims of this Bill can be achieved by legislation, or are already being implemented more effectively through existing health policy. I will expand on the implementation of various initiatives in mental health shortly. While the importance of legislation cannot be overstated, laws in and of themselves do not heal people - only treatment and services can do that.

The Deputy hopes this Bill will result in mental health issues informing the highest level of policy making and governance. I assure him that mental health is and will remain a priority for the Government. Since 2012, approximately €200 million, or 28%, has been added to the HSE mental health budget, which now totals over €910 million. This extra funding has allowed us to approve approximately 1,800 new mental health posts over this period. Funding has been provided to recruit 114 assistant psychologists and 20 psychologists in primary care and 111 of those assistant psychologists have now been recruited. In addition, funding has been provided to increase the number of undergraduate psychiatric nurses by 130 per year. This will bring the total number of psychiatric nurses graduating each year to 400 by 2021.

A comparative positioning of Ireland internationally suggests that the percentage resource allocation today is close to the median level across EU member states. The Government is committed to increasing funding as circumstances allow. Of course there are challenges in agreeing what does and does not constitute mental health spending. If the percentage spend on mental health is to be increased, it may mean reducing the spend elsewhere in the health budget or increasing allocations to mental health far more than increases in all other areas over a fixed period of time. If the percentage of the overall budget assigned to mental health is to be ring-fenced, it opens the possibility for applications to ring-fence funding for other specific areas of care, such as cancer and maternity services.

As I have said, significant work is required to establish fully how robust legislation can be drafted that achieves the stated goals of this Bill while avoiding unforeseen and undesirable outcomes. This will be the focus of my officials' work in the immediate future. On the basis of these further discussions that will take place, the Government does not intend to oppose Deputy Browne's Bill at this time.

I thank Deputy Browne for raising this matter. The crux of the Bill is something we have been trying to address for some time in this country and, historically, we have treated mental health differently, including how we engage with people with mental health problems, how we address them and the funding given to the mental health area. However, I do not agree that in recent times mental health has been treated badly. The Minister of State has already outlined that our budget has increased by 28% or €200 million, which is significant given the times we were in and that other budgets were cut significantly.

I thank the Minister of State for allowing me to share this time with him and I know Government time is short with Private Members' business. Allowing time to debate this is very important. I welcome the commitment of the Minister of State with responsibility for mental health, Deputy Jim Daly, to this area and his offer to work with Deputy Browne to ensure the intention of the Bill can be achieved. We all hope this can be achieved through an agreed text that is legislatively sound and effects change. I note the concerns of the Minister of State from a legal perspective, and to be viable perhaps the Bill needs to be a little clearer and specific, taking into account good practice, as we are talking about policy aspirations in legislation and that generally does not happen. However, the intention and statement of the Bill is that mental health should be addressed in the same way and with the same urgency and care as physical health. There should be no distinction between the two when it comes to care and treatment.

I acknowledge the Minister of State's comments that the Government takes into account the 1948 World Health Organization definition of health, which is unchanged since that time. It defines health as a state of complete physical, mental and social well-being and not merely the absence of ill health, disease or infirmity. In other words, we are looking at a holistic approach. This is about ensuring everything we do as a Government takes into account services and the right kind of support for people who need services at a time when they need them. When we speak about diagnosis and prevention in particular, mental health should be on a par with physical health.

I have had the opportunity to engage with many organisations over many years. Over the weekend, I had two fantastic volunteers taking part in Cycle Against Suicide stay as part of a home stay. I had the opportunity on Sunday morning to speak to our cyclists as they headed off on their day. I was asked to encourage people to look after their own mental health. From my time as Minister of State with responsibility for mental health and my engagement with young people, I know the only way we will be able to put mental and physical health on a par is to teach people from an early age to look after their health. We must encourage them to eat well, get enough sleep, exercise regularly and speak with somebody if they are not feeling well.

Bringing benefits to physical and mental health will only come about through improving services together and not separately; we must not separate our physical and mental health. It is somewhat of a paradox that we have a Minister of State with responsibility for mental health. It highlights the importance placed by the Government on mental health but it also takes away from it in that we are separating it from physical health and putting it in a separate box. I commend the Deputy on raising this as an issue and it is something we have been trying to deal with it. As it stands, the Government is trying to ensure that services are improved in mental health in the same way as they are in physical health. We are looking to ensure that funding can be increased in mental health in the same way as it is with physical health, with the outcomes being essentially the same with respect to prevention, diagnosis and treating people.

I commend Deputy Browne on bringing forward this Bill. I am glad to have an opportunity to speak more on mental health in the Dáil. As I have said many times, the mental health services have a responsibility to address and to treat mental ill health. These are two of the biggest issues I come across on a daily basis in my work as a public representative.

Everything in our lives impacts on our relative state of mental health. This includes our work, education, family, social lives and the climate we live in culturally, politically and environmentally. Our mental health is also tied to our physical health and vice versa. Prolonged illness in either regard has an impact on the other. The parity of mental and physical health is an undeniable fact because of this link and there is potential for either pillar of our health to have a devastating effect on our quality of life should illness befall us and go untreated or unresolved. This does not necessarily affect the policy of this Government. Political decisions are far too often not based on fact, rational decision making or even what is effective but on compromise in order to serve an ideological goal.

Mental health sits not in parity with physical health but quite far below it in Government policy. It is often seen as a soft touch where Government divestment from public service provision could be pursued and important functions of State institutions could be outsourced to community and voluntary bodies, undermining service provision and the rights of workers and patients in turn. The problem is not one of law, although we support this Bill. It is one of policy and political will. Mental health services are seen by the political class that has run this country for decades as an expensive and complicated burden, much like housing. That does not change with a paragraph of stand-alone legislation but it can change with real policy and real political will to deliver world-class public services as a function of a State that sees its role as one of caring and providing for its citizens. This would be a good point to remember when Fianna Fáil discusses its relationship with Fine Gael as an enabler to a Government that has completely failed to address the problems in our mental health services, which although complicated by their enduring presence are essentially the day-to-day tasks of running a service.

There are difficulties with recruitment but they would be far less damaging to our service if they had not been allowed to deepen by heaping the brunt of austerity on people working in them over many years. This affected nurses, in particular, but all levels of the mental health service have had to work in chaotic, dysfunctional and sometimes dangerous conditions, overworked and too often underpaid. That problem was allowed to develop without intervention for many years and now with services at breaking point and national scandals like the crisis in CAMHS, it is a Government problem of its own making, although it is not insurmountable. We cannot play the waiting game while lives are at stake, hoping unrealistically that things will get better. No medical professional would ever advise a patient to ignore a problem and hope it goes away, and nor should any Government.

Speaking on First Stage, Deputy James Browne, who has given his support to this Government stated:

It sets out a pathway for addressing staff shortages and other resourcing issues affecting our mental health services. It is imperative that all organisations within our health system need parity obligations and this Bill will help bring Ireland into line with international standards on the provision of mental health care.

This Bill does not provide a pathway to anything other than speaking time in the Dáil. There is a pathway for addressing the problems he correctly outlines as being seriously damaging to our services. That pathway is the work of the Oireachtas Joint Committee on the Future of Mental Healthcare and the recommendations of its interim report on which the Deputy, I and others have worked on. Fianna Fáil should be using its position to hold this Government to account on these issues and ensuring speedy implementation of this pathway. This Bill, however well-meaning, will not do that.

We need a more positive and realistic approach and I appeal to all parties to stop the talking and head-nodding. Now is the time to invest in our mental health services. We should remember that Fianna Fáil and Fine Gael did not support our proposals for €37.5 million in additional funding in 2016 or the roll-out of 24-7 services. The Minister of State mentioned a while ago an additional 1,800 new posts but the latest report I have is that 1,700 staff could be lost in the next five years due to retirement. That will have a negative effect again. I will finish by calling on the Minister of State to commit to maintaining the mental health committee beyond the final publication of its report and indefinitely to work in parallel to the health committee. That would be a real step towards parity. I know Deputy Browne supports this and I ask that he bring the full weight of his party on the Government in seeing this become a reality.

I take this time to speak specifically about the child and adolescent mental health services, CAMHS.

I speak as a parent of someone who has had personal experience. It is an issue close to home for me. I do not want to talk about the waiting times because we all know there are significant delays in getting into CAMHS. The waiting times are disgraceful. There is nothing we can say about that only that we need to recruit more staff so that there are not waiting times. I want to talk about when a person first realises that their child potentially has a mental health difficulty. It could be the parent who notices or it could be a teacher who brings this to the parent's attention. It is a difficult thing to deal with. No matter what is said and no matter how often it is said it is okay not to be okay, a parent still feels he or she is still failing a child if he or she has to access CAMHS. There is no point saying anything else about that.

I find it is an extremely faceless service. It is all paperwork. The bunch of forms are asking questions at a time when it is hard to process what is going on and what the difficulties might be. People have 14 days to return the forms. Then a whole load of information about drop-in and walk-in clinics is sent out. It states that if a parent is concerned for a child, he or she can drop into this or that clinic. Of course the parent is concerned for his or her child. That is why he or she is accessing CAMHS in the first place. Much of the information is difficult to digest and it has to be dealt with at an already difficult time in the lives of parents and children. Many people at that point just cannot cope with it and do not know where to go or what to do with the information. It would be far better if there was a phone service or a face to face service where people could go in and speak to someone who could assist with the forms. A parent is not a mental health expert and cannot say what category a child falls into. That is really important because we need to have it as an accessible service at the very start.

Then we need to look at the waiting times. It is extremely frustrating when a parent knows there is a difficulty but cannot do anything about it. As a parent, not being able to help a child is one of the worse feelings in the whole world. The child is on a waiting list and the parent is pulling his or her hair out trying to deal with it. It is okay for people who can access private services. However, not everyone is going to be able to do that and not all the private services suit children's mental health. We need to make CAMHS much more accessible, much more friendly, much more helpful and we definitely need to look at the waiting times and the lists. We need to ensure children are not left languishing on a list and then turn into an adult with even more difficulties and problems.

I have raised this issue many times with the Minister of State, Deputy Jim Daly, and with others here. Staffing is the problem. It is a problem for the service users but also a huge problem for the people working in the service. I have come across people in a stressed situation on numerous occasions. I was recently talking to someone working in the administration side of CAMHS. She is nearly in need of mental health services herself at this stage. She feels terrible talking to parents and to people and making up excuses as to why there is not a service for them. This person is now looking for work elsewhere. The pay is fine, it suits her and she is happy to be in the employment she is in. However, she is continually stressed at finding herself in the position the system has put her in. She is becoming a block to people getting the service. When the phone rings, she is the person who has to try to deal people who are in a terrible state because their child is suicidal, self-harming or is in a difficult situation. They are trying to get an appointment with a psychologist that in many cases does not exist or are they trying to get a review of medication that was done six or eight months ago and they cannot get an appointment to get that review to happen.

I refer to the mental health service in all its aspects. It is the same in the adult health mental service. A mental health nurse in Sligo tells me that the position is the same there. They are understaffed and conscious that their service is not up to scratch. These people are dedicated to what they do. They feel they are letting down the public. Then they look around and recognise that the reason is that there are not enough of them. It is as simple as that. Additional staff is the one thing that would make the biggest difference to the mental health services. The Minister of State has said that more money has been put in and there has been an increase here and there. I acknowledge that. Those increases have come in the aftermath of such a terrible disaster over the last ten to 15 years. The service was gutted. When there is a crisis in government or in the economy, the first part of the service to be hit is the community service and the services that are at their weakest. Mental health fits into that category nicely. Bringing parity to this is certainly required. What we really have to do, though, is recognise that mental health services are a priority. It has to be made a priority not just of the Department of Health but of the Government.

I thank Deputy James Browne for bringing forward this Bill. It gives us the opportunity to highlight the inadequate funding for mental health and the continual reluctance of the Government to address the problem. I am aware of the need for more funding and resources for mental health in my constituency of Limerick City. I commend Jigsaw in Limerick city. I visited that project recently and it does great work in offering mental health support to young people and their families. Jigsaw aims to ensure that no young person feels alone, isolated and disconnected from others around them. It provides vital supports to the mental health of young people by working closely with communities across Ireland. Limerick Suicide Watch also provides an invaluable service in Limerick city. It patrols our streets at night time. Unfortunately, its services are needed far too often. The huge efforts of these volunteers should not go overlooked. They are a credit to our city.

Data compiled earlier in the year by the national suicide research foundation found that from 2014 to 2016 the average rate of suicide in Limerick city was 23.7 per 100,000. This is higher than the last report from 2011 to 2013. That recorded a rate of 22.4, in the midst of the economic crisis and austerity when suicide tends to increase. While the figures for suicide nationally are declining slightly, unfortunately Limerick figures have risen. It is both shocking and upsetting that the suicide rate for Limerick city is more than twice the national average of 10.5. This clearly demonstrates that a properly resourced 24-7 crisis intervention service is essential for our region.

In 2015, figures also showed that 425 people took their own lives nationally and that twice or three times as many men as women die by suicide. Unfortunately, accurate figures for death by suicide are hard to obtain, as the Minister of State knows. Many other cases of death by suicide have been recorded as accidental death when the individual may have died by suicide. The only way to get real figures and a true insight as to the actual rate of death by suicide is by talking and listening to the families that have lost loved ones. In 2016, the national self-harm registry Ireland recorded 11,485 presentations to hospitals due to self-harm. Accident and emergency departments do not offer appropriate care or follow up for those in acute mental stress. I know that from friends. The provision of 24-7 crisis intervention services is required. That could provide assistance to people day or night when they require help and hopefully reduce the number of suicides.

Currently, there are 2,603 children and adolescents waiting for an appointment with a CAMHS team, which treat vulnerable children in Ireland with moderate to severe mental health problems. This is largely due to a failure to recruit the staff needed to operate a CAMHS team fully. Currently, and for quite some time, about half the positions in CAMHS teams across the country are vacant. Figures released recently to Sinn Féin also show that the child and adult mental health team in the Limerick region is operating with only 58.7% of the recommended staff set out in the strategy, A Vision for Change. That strategy recommends that youth mental health services be fully staffed at 1,047 people. As of December 2017, however, the CAMHS teams had just 587 doctors and nurses. The sad reality is that without adequate resources and the provision of proper services for those in acute mental distress, the figures for death by suicide by self-harm will only continue to increase. The Government needs to sit up and take notice of the public desire for more funding and resources to be allocated for mental health services across the State.

I commend Deputy James Browne on his work on this Bill and express the support of the Labour Party for it. Ireland, and indeed the world, has come a long way in respect of mental health but a lot remains to be done.

It is poignant that we are discussing Second Stage of the Bill at this point, given that the Darkness Into Light event run by Pieta House takes place on 12 May, a little over a week from now. I imagine Members across the House will join me in praising this fantastic initiative which aims to raise awareness and funds for people suffering from mental illness. I encourage people to take part, if possible. I shout out to some of my friends, including Mick Matthews, Jackie Morrison and those involved in the Skerries Cycle Against Suicide group.

The intention of the Bill is to place mental health on a par with physical health. It is an important Bill which, if enacted, will bring Ireland further into line with international best practice in medicine. I hope it will be enacted soon.

Our goal should always be to treat a patient with a mental health issue with the same compassion and clinical excellence we would expect for someone with a physical health issue.

I am keen to reference some examples from overseas related to mental health parity or parity of esteem, as it is also known. In the United Kingdom the then NHS director for people with long-term conditions, Dr. Martin McShane, succinctly put the issue of parity of esteem for mental health on the table in 2014. He stated:

To me parity of esteem means tackling mental health issues with the same energy and priority as we have tackled physical illness.

It is about changing the experience for people who require help with mental health problems.

It is about putting funding, commissioning and training on a par with physical health services.

And parity of esteem is about tackling and ending the stigma and prejudice within the NHS which stop people with serious mental health problems getting treated with the same vigour as if they had a physical illness such as, say, diabetes.

That stigma can be demonstrated like this: if you fall down and break your hip, an ambulance will be with you in eight minutes to give emergency care at the scene before taking you to A&E. If, however, you suffer an acute psychotic episode in the street, you are just as likely to be attended by a police car and taken to a cell.

We must end the stigma associated so often with mental health. We must raise awareness of the importance of mental health care and recognise the inadequacies of how we have regarded mental health in the past. This means raising awareness within the NHS itself. And we must create parity for mental health care in reality – rather than just issuing rhetoric and paying lip service to it.

On 2 February 2011 the British Government published a 109 page report entitled, No health without mental health – a cross-government mental health outcomes strategy for people of all ages. The comprehensive document listed key achievements required to bring the NHS up to date in mental health care. The report references the fact that there are many interdependencies between physical and mental health. In principle, this is a departure from prior thinking, which suggested mental health was a separate and distinct area never truly considered to be on a par with physical health. The NHS mandate 2014 to 2015 directly states the objective of the NHS is to put mental health on a par with physical health. That is what the Bill also seeks to achieve.

In 2009 Harvard Medical School published an article entitled, Benefitting from mental health parity. The article referred to the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act 2008 which came into law in the United States on 1 of October in that year. Prior to enactment patients suffering from bi-polar disorder and schizophrenia were liable to vast costs. Many insurance plans now fully cover these illnesses.

The importance of the Mental Health Parity Bill 2017 is the proposed establishment of a legal commitment to have equal and due regard for psychiatric patients when provision is being made for improvements in the health service. In Ireland today we bear witness to children waiting 15 months to see a psychologist and, more generally, a total of 2,500 young people awaiting access to public mental health services. There is a crisis in the provision of child and adolescent mental health services. General practitioners are referring patients to a waiting list because there is a serious lack of immediate counselling services available. This, in turn, has a knock-on effect on the clinical outcome for these patients. A striking example arises in cases of moderate to severe depression, in which a combination of medication and psychotherapy is recognised as the optimum treatment. Owing to the lack of psychotherapists, a shortage of cognitive behavioural therapy specialists, an inability to fill vacancies for adult and child psychiatrists, as well as the shortage of other mental health care specialists, patients are often left solely on anti-depressant medication without the additional counselling intervention that has been proved to be beneficial in tackling the underlying issue. I am dealing with a mother who is at her wits' end because her son is being left on anti-depressant medication and nothing beyond. It is frustrating and unacceptable.

It is important to note that currently private health insurance cover has a focus on inpatient psychiatric care as opposed to care on an outpatient or community basis. For example, there is full cover available for inpatients in a psychiatric hospital up to 100 days per calendar year. There is a separate arrangement for people suffering from substance abuse. Often such persons are covered for 91 days in a five-year period. Depending on the insurance plan, patients who see mental health teams on an outpatient basis receive limited cover for outpatient expenses. For example, if an initial consultation fee to see a psychiatrist is €180, the patient may receive a refund of €60. Naturally, the crisis in child and adolescent mental health services is masked by this dependence on private care. If we are serious about seeing parity between physical and mental health, we need to drastically improve out-of-hospital mental health care services. Inpatient care is, by its nature, unsuitable to deal with all cases of psychiatric distress. Research into outcomes for patients strongly favours community-based care to treat certain classes of depression and other less serious psychiatric illnesses. We have heard much over the years about a shift towards care in the community. With the further development of primary care centres, I am hopeful psychiatric care will become integral to everyday medicine at a local level.

I alluded to the shortage of adult and child and adolescent psychiatrists and the fact that the HSE regularly advertised posts that were not filled. To tackle waiting times, we need to be more proactive in staff recruitment and retention. I could develop the point further, but I will leave it at that. I thank Deputy James Browne and look forward to serious engagement on the issue and enactment of the Bill.

Gabhaim buíochas leis an gCeann Comhairle as ucht an deis labhartha seo. I welcome the Bill. It is both important and timely and I commend Deputy James Browne on bringing it forward. It is warranted.

For decades we have struggled to adequately finance and operate physical health services. As a result, mental health medical services have always been put to the back of the line. They have not received the priority or attention they so richly deserve. There is now an unacceptable situation throughout the State where many children and young people are experiencing mental health difficulties and not receiving the age-appropriate timely services or supports they badly need. This is impacting on them and also has consequences into adulthood. It also impacts on their families, communities and schools. We need to give it urgent attention. I am pleased the Bill suggests intervention in terms of equivalence and that nothing else is required. This includes specialist 24-hour psychiatric first responders who could be deployed with every ambulance dispatched, with psychiatric consultants and registrars being rostered over 24 hours in every emergency department. We have all heard of situations where young people with mental health difficulties are referred to emergency departments. It is a shocking and humiliating experience for any young person to encounter and must stop. We need specialists in place to deal with the problem.

Community-based primary care services must, as a matter of course, engage specially trained psychiatric medics in GP services. A mental health condition should be treated by such services, with the same access to qualified medical practitioners as someone who presents with any other medical condition. Why should a mental health condition be treated differently?

Mental health care will only attain parity with physical health care when both are co-located within easy access for any member of the public. The underlying premise is that any person at any given time may require mental health care. We need to break down barriers and de-stigmatise the area of mental health. I am keen to acknowledge the great work being done by many organisations throughout the State. Were it not for organisations such as Sosad Ireland, Jigsaw and Pieta House, we would be in even more serious difficulty.

I hope that serious provision will be made in the upcoming budget for our mental health services this year.

It is good we are having this debate. We have had a debate on this issue in this House on numerous occasions during the past two years. It is healthy to have this debate. I understand Deputy Browne's Bill is largely aspirational. It has much merit. Ensuring there is parity between our physical and mental health is very important, but the reality is very different. Other Deputies have stated that 6% of our health budget is spent on mental health services but largely in Europe the expenditure on this sector is approximately 12%. Where there is a lack of funding, one finds a shortage of staff and that people fall through the cracks.

I want to bring to the attention of the Minister and Members an article reported in the newspapers at the weekend, which I found extraordinary. The clinical director of the Central Mental Hospital stated that 26 ill patients are currently in prison and cannot get into the Central Mental Hospital. He stated that is completely detrimental to their mental health. They are a danger to themselves and to other people. He further stated that, under the laws of the land, he is almost in contempt of court for not meeting his obligations as the clinical director of the hospital. Unfortunately, it gets worse. There is capacity for ten extra patients in the Central Mental Hospital but it cannot fill vacancies due to the shortage of psychiatric nurses. That facility has cost a great deal of money but it cannot get staff. That is the crux of the issue. Retaining and recruiting staff, particularly psychiatric nurses, is extremely difficult. Psychiatric nurses are demoralised in some ways because of the state of the health service and they are feeling the pinch. It is extremely important to address the issue of the retention of staff.

I am to blame at times for lambasting our mental health services. There are some extremely positive aspects in terms of the staff in those services and the voluntary bodies in the State but when we look deep down there are serious anomalies in the services. Last week's RTÉ programme "The Big Picture", which showed how young people are being failed by the State, would break one's heart. That failure is the result of austerity and lack of funding of our mental health services by successive Governments. We have seen the State fail people when they have sought services. The services fail them, they fall through the cracks and some people die because of that disgraceful situation. There is a shortage of staff.

Another issue, which many speakers have raised, is our child and adolescent mental health services, CAHMS, which is in crisis. I am a member of the Joint Committee on the Future of Mental Healthcare. What it has found is damming of our health service. It found chronic staff shortages with staffing levels as low as 47.5% of what was recommended in some regions. The child and adolescent mental health services have only 56% of the number of staff who were meant to be employed. It is pretty bad. The social damage that does is incalculable and people die because of a lack of services.

A Vision of Change, which I believe was introduced in 2007, was a very good document but like all documents that come into this House it never gets implemented. A Vision of Change is quite conservative regarding what the funding should be. It is 8.6% in the State but in line with European levels it should be double that. Until we tackle the chronic underfunding, particularly of our mental health services, we will have a constant crisis in our mental health services. I welcome the debate on this issue but until the Government tackles the danger posed by the lack of funding of our mental health services, we will continue to have this debate and people will continue to die.

I welcome the introduction this Deputy James Browne's Private Members' Bill. An increase in the provision of mental health care in this country is urgent to say the least. We should be very careful about how this parity between physical and mental health proceeds and we should be especially careful about how we frame the discussion. It is important to be conscious of the fact that the term “mental illness” is a highly loaded and ideological one that takes away agency and certain types of possible treatment from a person. When one says someone is ill, one presumes to understand what a healthy person would look like. This is well and good for physical problems like diseases, and degenerative diseases, but if one applies this to the mind, then we are in very different territory. No one in the history of humankind has ever seen a mind, or been able to study one in anything resembling what we call the scientific method, and anyone who pretends to know what a healthy one looks like is not telling the truth.

I do not have time to go into how over time the brain has become the realm of science and consciousness has been left to the philosophers but a number of major problems result from that ideology. One of them is drugs. Pharmaceutical drugs that are used to treat so-called mental illnesses are physical things and that means that they can only have a physical effect. If the mind of a distressed person is a purely physical thing and our mental distress is purely the result of a malfunctioning of a person’s material brain, then there is a possibility that these may work. That is, presuming that the manufacturers of these drugs understand the human brain and how all the different parts of it relate to all the different diagnosed illnesses. However, any neuroscientist who is honest would tell you that we do not have a clue how the brain works. Any one of us here knows from our life experience that the circumstances in our lives and in the lives of those who are routinely diagnosed with so-called mental illnesses are a major factor in people presenting with distress and mental health issues. These life experiences and how we react to them are not physical things. The drugs are only designed to alter how people perceive their lives, not change them. The problems that lead to someone having a breakdown are not solved by taking the drugs: the problems remain. People can bury immense trauma deep in their consciousness in order to survive and it can be triggered years, even decades, later in the form of what a psychologist would diagnose as a severe mental illness. The drugs will not help these people build the tools to cope in a world where that world has violated them in an unimaginable way - the grief will remain.

A second problem is related to the first in a profound way. Talking therapies are rarely used by the HSE. One reason for this is that psychologists are running the show and they do not see any scientific value in talking to people they diagnose as mentally ill, the problem being scientifically, a materially, brain-located one. Another is that there is no regulation of psychotherapy, a problem the Minister has said he is working on, but people should not hold their breath. The lack of regulation leads to an issue of insurance for the HSE, and only those educated in the art of denying the existence of human consciousness, with their PhDs from the highest institutes in the land, are a bankable proposition in this regard.

A third problem is that it is costly and time consuming to talk to people, and if one listened to what they are saying it would undermine the dominant medicalised model of mental health care, which is so cosy with the pharmaceutical industry. If one presents to a general practitioner, GP, he or she has the power to prescribe very powerful drugs. Usually this prescription is based on a few questions about one's behaviour - is one anxious, has one trouble sleeping, has one negative thoughts and so on. The GP will not ask, nor is he or she qualified to ask, what has been going on in a person's life and how he or she might deal with that. What is more, a GP will commonly not tell a person about the side effects of these powerful drugs. The number of people committing suicide because of the reckless prescription of these drugs is a scary reality in Ireland and nothing is being done about it.

At a meeting in New Ross just over a year ago, at which Independents 4 Change was presenting a submission on how to improve mental health provision, the executive clinical director for mental health services in community healthcare organisation area 5, CHO5, responding to a query as to why there were not more talking therapies provided by the HSE, told one of my staff that the mentally ill were not to be trusted, so there was no point, scientifically, in talking to them.

If we are to increase funding to the mental health services in Ireland, powerful people in the HSE who hold such positions should not be part of the process. We need to wake up to the reality that many people who are in charge in the HSE mental health services would not last long if we stopped talking about mental illness and started to talk to people about what is going on in their lives.

I have spoken in this Chamber on a number of occasions in the past while about five children who have presented with suicidal ideation in Wexford in the past year and a half. These are children, as young as seven years old and ten years old, and up to 14 years old, who want to kill themselves. Every one of these children has had to wait for over two years to access child psychiatry services. As I stated the last time I spoke here about suicide prevention services, I appreciate that not everyone presents with suicidal ideation and that it is, of course, not always possible to identify signs that someone might be suicidal, but from speaking to those trying to avail of mental health services in Wexford there seems to be an incredible lack of an emergency response to those who present with suicidal ideation. It is unforgivable. We have to take these threats seriously. We already know of very young children in Ireland who have committed suicide.

I was contacted this week by yet another mother, the mother of an eight year old boy who also presented with suicidal ideation. It is not easy reading about her son. For parents who are experiencing this for the first time, the lack of services and the length of time they will have to wait for these services comes as a shock. Having had experience of dealing with other parents in the same situation previously, I know what the waiting times are like. I dread breaking the news to the parents who are dealing with this for the first time. This poor mother has only just realised that the waiting time for her son who has presented with suicidal ideation is two and a half years. What must it be like? What is even more infuriating is that in Wexford we have someone who many people believe to be one of the best child psychiatrists in the country, Dr. Kieran Moore, but children cannot get access to him because the waiting lists are so long. I have never met or spoken to Dr. Moore but I have spoken to a number of parents who speak incredibly highly of him, not just as a psychiatrist but as a human being who cares deeply about his patients and, I have been told, goes above and beyond for these children and parents.

I recently received a letter from a woman in Wexford who said the recent suicides of two of her friends had spurred her to write to me. Suicide is an epidemic in Wexford. It is a remarkable letter. I would not mind showing it to the Minister, if I got the woman's permission. It is handwritten, and she lists 20 different individual significant problems with mental health services in Wexford. I have raised a number of these issues over time in here, but not all of them. The letter is a remarkably comprehensive and insightful list. In isolation, each problem she lists causes massive problems for people in Wexford but by listing all 20 problems together in her letter, she shows the overwhelming extent of the lack of mental health services in Wexford. As well as the list, she makes a perceptive observation, one that explains to some extent why parents in Wexford have not revolted. She states that many parents cannot advocate publicly because they are worn out just getting through each day keeping the children safe.

We have an awful lot to answer for in this place. What is going on is too bad and I am sorry but it is not changing. It is getting worse in Wexford, not better, and all the talk in the world will not sort it. Our approach is wrong, there is not enough funding and one cannot blame the parents for feeling that the organisations and apparatuses that run this country just do not care enough because that is how they feel.

The Rural Independent Deputies have nine minutes. I understand Deputy Mattie McGrath is sharing.

I am sharing with Deputies Michael Collins and Danny Healy-Rae.

I am happy to make some brief comments on this Bill. Allow me, ar an chéad dul síos, to salute Deputy Browne for his commitment to the issue of mental health and the time and effort he and his staff have put into drafting this Bill.

There is absolutely no parity between how physical and mental health are treated in this country. This Bill seeks to amend that. Indeed, Deputy Browne described it in the memorandum for the Bill, as follows:

The neglect of Mental Health is a deep seated cultural issue at policy, institutional, organisational and individual levels. This Bill aims to offer hope and provide a catalyst for better Mental Health care by ensuring that vulnerable persons with mental illness are cared for effectively and equally.

We also saw in the Joint Committee on the Future of Mental Healthcare's second interim report, the launch of which I was privileged to attend in the AV room last week, that "[t]he lack of cohesion between primary care and mental health services often means that the most marginalised people are the most adversely affected in terms of accessing mental health services." That is telling. This is a very good report and I salute the committee, chaired by Senator Freeman.

The interim report goes on to state that the HSE, at a meeting on 30 November 2017, confirmed to the joint committee that only 60% of the 114 community mental health teams in Ireland have a seven days a week service. It is appalling. What about the places that do not have it? Even the ones that have a seven days a week service, it is scant at times. Like other Deputies, I salute those working on the front line. The vast majority of psychiatrists and everybody else do a wonderful job. The report indicates that “[i]f these teams are really to be the bulwark of the service they were envisioned to be in A Vision for Change, Ireland should be working towards a situation where supports are available seven days a week and 24 hours a day...". They should at least have that.

Tragically, this is clear in my own constituency where we have children and young adults languishing in paediatric wards for months without any access to appropriate levels of care. At present, there are two languishing there. One, a girl of 14, is waiting 11 weeks and she is from County Waterford, Deputy Butler's constituency, but my parish. Another girl is six and a half. Imagine that girl is in her 11th week. It will be 12 weeks come the weekend. This is scandalous. I raised the matter last week in a Topical Issue debate and instead of receiving clarity about what will be done, I received a dry official reply about how wonderful the funding levels are. There is nothing more insulting than that when we all know of the horror and the trauma. It was pathetic. In the meantime, the children suffer and their parents are driven to their wits end.

That clearly demonstrates the need for a Bill of this type and I compliment Deputy Browne on bringing it forward. The situation is just not good enough. One of these girls who is taking up a bed in the children's ward is 14 years of age and is almost an adult. However, there are eight beds lying idle in Éist Linn in Cork because of bad management, mismanagement and stubbornness by the management. I appeal to the Minister of State, Deputy Jim Daly, to try to make some effort.

I am happy to speak on this Bill and I thank Deputy Browne for bring it forward, as I believe mental health is an area in Ireland that has been neglected. According to the Healthy Ireland survey 2015, 10% of the Irish population over the age of 15 have a probable mental health problem at any one time. Everyone has somebody in his or her life who has an issue with mental health, whether it be depression, anxiety, stress, alcohol issues or drug issues.

Approximately 6% of the overall health budget is spent on mental health each year, which is totally inadequate and needs to be changed. The Government needs to fully realise its commitments to mental health and adequately invest in mental health and update current legislation in order to improve the mental health outcomes of adults and children living in Ireland.

I am hearing from my constituents about a number of issues around mental health. Many families tell us horrific stories when dealing with child and adolescent mental health issues. There are only 69 child and adolescent mental health services, CAMHS, teams when it is recognised we need 95 such teams to adequately cover the country.

Many of the child and adolescent mental health teams are inadequately resourced and as a result, the patients and families are suffering. It is vital that we have early intervention but, unfortunately, this is not always the case. The health service has stated that emergency response times to child and adolescent mental health issues should not be greater than 72 hours. We need 24 hours seven days a week access to our mental health services.

The issue of children and adolescents being admitted into adult mental health facilities is totally unacceptable and needs to be addressed. According to United Nations International Children's Emergency Fund, UNICEF, difficulties in accessing the mental health services and closure of beds are adding to the seriousness of Ireland's teenage mental health issues.

The UNICEF report states that Ireland's teenage suicide rate is the fourth highest among high earning countries. We need considerably more supports and treatment centres for people suffering from eating disorders. Some people suffering from eating disorders are being admitted into adult psychiatric hospitals due to the lack of specialised units. Supports for people with postnatal depression need to be improved. While I accept some improvements have taken place, a lot more needs to be done. I acknowledge the great work being done by self-help and advocacy groups across the country, such as Lisheens House in Skibbereen. The Men's Sheds Association is a good initiative. Organisations such as Pieta House are doing outstanding work. Without organisations such as Pieta House, our mental health service would be in a much worse position.

People suffering from mental health issues can no longer be seen as objects. They must be involved in a meaningful way in making decisions about their treatment and care and in any legislation that seeks to increase the standards of mental health care in Ireland.

I thank Deputy Browne for introducing the Bill and for the opportunity to talk on the issue. The Deputy is right that we are not giving treatment to people who present with mental health issues comparable with the treatment given to people who present with physical or other health issues. I will talk about Kerry. To go back in time, there were 1,200 patients in St. Finan's mental institution. There were many people in there who should not have been there. There were people in there who needed treatment. We have gone from that figure down to very few in our county. Young people presenting with mental health issues are not able to get one-to-one treatment which they need 24 hours a day, seven days a week. I know of a family that lost its lovely 23 year old son. He told his parents that he had problems and issues. I will not say where he was taken but he did not get treatment and he is, sadly, no longer with us. His family is heartbroken. There is a vacant chair at the table and he will never sit in it again. He was very good. He told them all he had a problem but he did not get the help he needed. There are many other cases like that. We do not have enough to deal with them. It is a serious issue. There are only hours in it. Some people who were seen are fine. They are living and are with us today.

I thank Denis and Marie O'Carroll in Killarney who lost their son Nathan 11 years ago. They started the Darkness into Light walk every year. It has been done since then and we will be doing it again this year. I thank those in Pieta House for the help and work they do and the other people who volunteer around Killarney and Tralee and elsewhere around our county who are trying to help people who present with mental health issues. We need more assistance from the HSE. It needs to be recognised more by the Department of Health. What Deputy Browne is asking for should be acceded to.

Another issue is that when young fellows or young girls who were getting treatment or help from doctors have to leave the treatment because they turn 18, the do not get the continuity of service they received until they were 18. There is something wrong with this because they are still very young at 18 and 19 years of age and they should be getting the same treatment.

While the principle of the Bill is one I wholeheartedly support, it represents only a starting point. I think that is generally accepted. The experience in the UK shows that similar legislation, while having a positive effect on the provision of mental health services, is by no means a panacea. The 2012 Health and Social Care Act in the UK enshrined in law parity of esteem for mental health and is defined as valuing mental health equally with physical health. Despite being a central plank of NHS policy for six years now, serious issues remain with mental health services in the UK. It is a system that, even when parity was introduced in 2012, was years ahead of our own in terms of service delivery and treatment provision.

While the concept has merit, it is not a silver bullet. We all know what is needed to fix out mental health services - funding, a reform plan and the political will to deliver on both of those. The absence of these things has hampered the effective implementation of A Vision for Change almost since it was first published. This is partially due to economic circumstances and partially due to the political decisions that were made as a response to those circumstances. The slashing of mental health funding during this period, aside from being wholly unjust, was a classic example of short termism. Individuals who would have benefited from earlier interventions to address mental health issues at the lowest level of complexity were abandoned or offered inappropriate pharmaceutical treatments in the absence of any kind of talk therapy. We simply do not know the impact it will have in the future and it is likely that it is having an impact now. Studies have shown that later, more complex interventions for mental health illness are less effective and more costly. Long-term planning and not panicked crisis-to-crisis reaction is the truly transformative measure that has been sorely missing from not only our mental health services but our health services in general.

The implementation of the Sláintecare report would represent a grounded first step towards achieving parity for mental health. The 2018 budget for mental health services is €917.8 million, 6.3% of total health spending. This is below the level advised in A Vision for Change and compares very badly with similar states. A Vision for Change recommended it should be over 8%. The Sláintecare report recommended as an initial target 10% of the overall health budget being ring-fenced for mental health services. A Vision for Change recommended well-trained, fully staffed, community-based, multidisciplinary mental health teams be rolled out across the community health areas. The report also detailed the additional staffing requirements for these teams. Indicative funding needed to deliver on this amounts to just over €120 million, adjusted for population growth. The Sláintecare report recommends this funding be phased in over five years. This includes funding for child and adult mental health teams, child and adolescent liaison, old age psychiatry and mental health services for people with intellectual disabilities.

People with medical cards can avail of counselling through referring clinicians. This is a new service which 9,374 people utilised in 2016. For this service to be extended to the whole population, a budget increase is needed over time. Given the limited availability of talk therapies and community mental health teams, extending counselling in primary care would represent a way to address mental health needs at a lower level of complexity and in a much more effective way. The Sláintecare report recommends the provision of universal access to six to eight counselling sessions for those whom their GP determines are in need of this service. The allocation for this service in 2016 was €6.5 million. The report recommends doubling this spend over a three-year period. A further allocation of €5 million would allow additional psychologists to be hired as part of primary care services to work with people who do not need a referral to community mental health teams.

The Sláintecare plan offers the only grounded and achievable roadmap for achieving the transformation in our mental health services which is badly needed and which would allow us to reach the minimum level of care that was promised 12 years ago in A Vision for Change. We can only hope the Government does not allow to slip through its fingers this once-in-a-generation chance for real reform of our mental health services and an achievable way of ensuring parity for mental health. We must act on implementing Sláintecare as a matter of urgency.

I welcome the opportunity to speak on the Mental Health Parity Bill 2017. I compliment Deputy Browne on bringing it forward and I confirm my support for the Bill. The Bill represents another step in the journey to bring mental health into the heart of the community and give it equal status with physical health.

When I think of the journey of institutional care to the centrality of community-based services I think of my late dad, who worked as a psychiatric nurse at St. Luke's Hospital, Clonmel for over 40 years. He joined the staff in 1932 as a warder - there were no psychiatric nurses then. Although he was always a very gentle and compassionate man, the emphasis in the work at the time was on physicality and patient restraint. In his early days, St. Luke's had little or no contact with the outside world. There were locked main gates controlled by gate lodges, 8 ft high walls and locked wards but his generation of work colleagues quickly became qualified psychiatric nurses and began the journey to create a humane service. They tore down the walls, did away with the gate lodges and the locked gates and invited local people in to integrate the hospital and its patients into the local community.

They did Trojan work and they came a long way but a lot more needs to be done. The challenge now is to make mental health services truly community-based and able to provide an immediate response to persons experiencing mental health difficulties in the same way as we have now for people with physical health difficulties. The key to this is to resource and fund mental health properly. For too long it has been the Cinderella of the service. We need a proper out-of-hours service, 24-7 crisis intervention teams providing rapid assessment and a comprehensive primary care counselling service. We also need to staff our community-based teams and the child and adolescent mental health teams fully. It is also vitally important to resource and support community organisations which do tremendous work across the country. In my area there is the River Suir Suicide Patrol, TaxiWatch and the C-Saw community suicide awareness workers. They are all volunteers but they work tremendously long hours on an ongoing basis in support of persons with mental difficulties. Talk therapies are important in this journey to truly community-based mental health services whereby we can react immediately to persons with difficulties.

I know the topic is no stranger to the Minister of State at the Department of Health with special responsibility for disabilities, Deputy Finian McGrath, and I do not doubt his personal commitment. It is a shame the Minister of State at the Department of Health, Deputy Jim Daly, could not make time to be here for the entire debate because it is a very serious matter. There are not many debates about mental health in the House, or on legislation specific to it, so he could have cleared the diary if the inclination was there. Whether it is his own fault or that of his diary secretary, it does not augur well for the approach of this House to this very important area.

I fully support the Bill put forward by my colleague, Deputy James Browne. It brings us in line with international best practice as regards parity, as is seen in our nearest neighbours. It ensures that mental health is central to health issues. Sadly, over the years, mental health has consistently been the poor relation and we have seen scandals of various descriptions at different times. There have been a few flashes of spin-managed celebrations by Governments but A Vision for Change, which all parties have bought into over the years, cannot celebrate its successes because less than 50% of it has been implemented, despite the fact that we are at or around the 12th birthday of the initiative.

In my constituency of Sligo-Leitrim North, and in south Donegal and north Roscommon, as Deputies Scanlon, McLoughlin and Martin Kenny will verify, we have a shambles of a service, notwithstanding the very hardworking professionals in it. The national staff numbers are 600 down on what they should be for an adequate service and for us to do what we are supposed to be doing. Our clinics are inundated with people of every party, colour and creed, desperately trying to get a child assessed, sometimes just for a follow-up on ongoing medication to ascertain whether it is necessary for them to continue to have the prescribed dosage of what are often very heavy medications. In some instances they may need to be increased but in many more they need to be decreased and it is arguable that children are being badly affected by this.

Our health system generally, although it is populated by many hardworking professionals, is packed with managers, administrators and so on but is absent of leaders and this is underpinned by this week's crisis. I hope the Minister will take some of these issues on board.

I compliment Deputy James Browne on introducing this Bill which will ensure that mental health is to the forefront of key decisions being made by the Department of Health. The Mental Health Parity Bill will see mental health well-being treated the same as physical health and we believe there should be parity of esteem.

I will focus on the number of children who present with mental health difficulties but for whom, unfortunately, the correct facility for their needs is not available and the only option in some cases is in an adult facility. The latest batch of inspection reports from the Mental Health Commission in March shows that children were admitted to the acute psychiatric units at UHL, the centre for mental health care and recovery at Bantry General Hospital, the Lakeview Unit, Naas General Hospital and the Aisling Centre in Dublin. The department of psychiatry in University Hospital Waterford and Drogheda hospital's department of psychiatry also admitted children. None of these facilities has age-appropriate facilities and they are not suitable for children.

The Minister of State at the Department of Health, Deputy Jim Daly, has left the House but I want to put on record the assistance and support I have received from him recently on these issues. I see, at first hand, his own frustration with the current system and with minors being in adult facilities. A Vision for Change mental health strategy, published in 2006, outlined that Ireland would need 100 inpatient mental health beds for children and adolescents to meet patient demand. The national numbers for operational psychiatric beds for children and teenagers as of November 2017 stood at 68, though I am open to correction on this. There are four CAMHS acute admission units in Ireland with a maximum capacity of 76 beds but only 68 beds for every single minor in Ireland with a psychiatric need.

In recent weeks we have seen the failure of the system to deal with the demands being placed on it and, last week, RTÉ exposed the serious gaps in our child and adolescent mental health service, in a special programme "Young and Troubled" which focused on children and mental health services for the young. The stories were heartbreaking but for many families these experiences are all too familiar as the standard of care children receive can depend on where they live.

I thank Deputy James Browne for bringing forward this Bill in the area of mental health, which is so important to so many of us. The whole service for mental health is simply not being delivered, despite the funding that has been put into it, and a number of speakers have illustrated this quite eloquently.

I recently debated a Topical Issues matter with the Minister related to the Kildare North service, where, as recently as last Christmas, a man with mental health issues showed up and was told to go away as the service could do nothing for him. Prior to that, a child on suicide watch who had been allowed to move from A to B without supervision went missing for over five days on two occasions. There are many examples where services are not in place. When I met the Minister, Deputy Simon Harris, last July, I told him about a good service in operation in Celbridge known as the Abbey Community Project. It is a voluntary organisation with qualified, trained counsellors and psychiatrists that has been operating for ten years and deals with people with a dual diagnosis. The Minister said this model should be developed. For the past two years I have been dealing with the HSE, the Department of Health and the task force on the provision of funding for this organisation, but it has not received one cent. It operates on bucket collections. When its public liability insurance policy was due for renewal recently, everyone involved had to put in a few quid to pay for it. That is not balanced mental health services provision. The Abbey Community Project in Celbridge services much of north Kildare and has in excess of 90 cases. It receives referrals from the HSE, but it gets no State funding. The Minister said this model should be developed and supported, but for two years this organisation has not received one cent in funding. No one is giving it any support, good, bad or indifferent. How long can a voluntary organisation that is providing a service that is not being provided by the State continue to exist without support? It is shocking. The people reporting with mental health issues have nowhere to go. If we are to get real, we need to deliver. We need to put funding into the right services. Let us stop talking and provide the services needed.

Ensuring access to appropriate treatment for people with mental health needs is a major policy concern. The public health system is in crisis. Ireland's youth suicide rate is now the fourth highest in Europe. The inner workings of the HSE remain a mystery, with no accountability offered. The Bill places a duty on the Minister for Health to promote health parity and ensure all organisations within the health system meet parity obligations in mental health care.

It is important to point out that there are amazing health professionals who are committed to helping, treating and comforting the most vulnerable in our society. Sadly, the system is failing both their efforts and the requirements of those whom they treat on a daily basis. We have all heard the accounts of those in suicidal crisis turning up at emergency departments only to be sent home, with a vague hope of receiving an appointment to see a mental health professional in the near future or, worse, with medication which could well become a drastic means to an end in the absence of specialist intervention. This cannot continue indefinitely. With due respect, no number of special Government committees can stem the steady tide of those who lose the will to live while waiting for a solution.

Services are way behind where they should be. The Government is simply not investing enough in them or supporting resources, as illustrated in the RTÉ "Prime Time Investigates" review of waiting times for adolescents who seek emergency help. The stories were heartbreaking. Sadly, many of us are hearing from people every day who find themselves in similar situations. There are those who cannot or simply will not speak out about their experiences.

There are also serious deficiencies in children's mental health services. I have spoken many times in the House about the child and adult mental health services, CAMHS, in the north west. I thank Ms Teresa Dykes and her staff for the work they do. There is no question but that this service has improved and that its waiting lists are getting shorter.

Fianna Fáil recently received data which show that at the end of January, there were 6,181 children waiting for a primary care psychology appointment, over one quarter of whom had been waiting more than one year, which is not good enough. If we want to help vulnerable children and young people in need of essential mental health services, the Government needs to take a lot more action. The State and the HSE have a duty to do better. It is crucial that every person be treated with dignity, fairness and respect, regardless of their mental health status.

In regard to people who present at doctors' surgeries, what we need is a 24-hour helpline through which GPs can access advice from mental health consultants because they do not know where to turn when families present with a young child with suicidal tendencies and so on. Such a helpline would be of valuable assistance.

On behalf of the Minister of State, Deputy Jim Daly, and the Government, I thank Members for their contributions to this wide-ranging debate. This is an important debate which addresses our common desire to ensure the mental health service meets the highest international standards. There is no doubt that the subject of mental health, in all its aspects, rightly concerns all parties and Independent Deputies represented in the House. As such, when the particular mental health topic is legislation, it is only right and proper that all Members of the House be afforded the opportunity to have their say on how we should proceed in ensuring best practice in legislating in the area.

I thank Deputy James Browne for introducing the Bill. The area of mental health is one of the priorities of the Government and the Deputy’s ongoing work serves as a strong reminder that all stakeholders in the area want to ensure the issues are debated regularly. This point has been well made and is accepted on this side of the House. As alluded to by the Minister of State, Deputy Jim Daly, there is extensive work under way in the Department of Health on far-reaching changes to mental health legislation, both in the short and medium term. This involves continuing work on the general scheme of a Bill to amend the Mental Health Act 2001 on the basis of the comprehensive recommendations of the expert review group, as well as Private Members' Bills focusing on mental health. In addition, there is also a process under way to refresh A Vision for Change, the national mental health policy. The oversight committee responsible for this refresh is making significant progress and it is intended that it will have completed its work by the end of the year. We are also closely following the work of the Oireachtas Joint Committee on the Future of Mental Health which is working to achieve cross-party agreement on the implementation of a single, long-term vision for mental health care and the direction of mental health policy in Ireland. We await with interest the publication of the committee’s final recommendations.

Additional funding in the order of approximately €200 million between 2012 and 2017 supported modernisation of mental health services in line with A Vision for Change and previous programme for Government commitments. A key focus has been the provision of additional posts to strengthen community mental health teams for adults and children. It has also been used to enhance specialist community mental health and forensic services, to increase access to counselling and psychotherapy and for suicide prevention initiatives. The Government is committed to continuing this trend of increased funding in the area as economic conditions allow.

The objective of placing physical and mental health on a par in legislation which is the stated aim of Deputy James Browne's Bill must be carefully considered to avoid unintended and undesired consequences. Without doubt, this poses challenges. Significant consultation will be necessary with all relevant stakeholders to ensure any new or amended health legislation will be effective in improving outcomes for citizens. In that regard, we should also investigate the experience in other jurisdictions in developing similar initiatives and learn lessons appropriate to our unique circumstances. We always need to be mindful of improvements in the way we attend to the mental health and welfare of citizens and amend or expand our legislation, as necessary. We also need to ensure that when the changes are made, they are the right changes and will have the intended effect. Most important, we need services to be accessible and without stigma. We need to encourage people to engage with services at the earliest opportunity and ensure the mental health service is attractive to those we want to work in it. We all accept that the service can and should improve, but in levelling unjustified criticisms we risk discouraging people who need those services from using them and those interested in working in services from applying for the many posts available.

As I said, we already have several pieces of legislation relating to mental health currently under consideration, each of which is at a different stage of progression. When enacted we will monitor the beneficial effects of these legislative changes on the full landscape of mental health services provision and will be mindful of how this affects further proposed legislation in this area including this Bill.

I assure the House that the Minister of State, Deputy Daly, and the Department of Health will review all the comments made this evening in the context of Deputy James Browne's Bill. These comments will be borne in mind as work progresses on our mental health legislation objectives and the delivery of health and personal social services.

I commend Deputy James Browne on this Bill and on his huge efforts during the run-in to last year's budget to ensure a proper multiannual framework for budgeting. All of the work the Minister of State has spoken about with regard to legislation is coming from this side of the House, from the Opposition. The priority the Opposition has given, collectively, to pursuing mental health legislation and funding places in a very poor light the long-fingering we have seen again in the Minister of State's statement.

Legislation such as Deputy Browne's Bill can only do so much. Ireland needs a complete change of culture and attitude. Can one imagine running emergency departments on a Monday to Friday nine-to-five basis? It would not be allowed to happen. This is, however, what we are doing with our emergency mental health services.

We also need a change in the culture among our general population. One of the biggest examples of a culture change in environmental awareness, for example, has been the green flag programme in schools. Children at national school level have led the change - and the change in tone - around how we treat our environment in each household. I would like to see a similar programme introduced around mental health awareness at primary school level to equip teachers with the resources and the skills they need to be alert to the mental health of their pupils and to encourage children from an early age to talk about mental health in the same way we talk about physical health.

The legislation can be put in place, the resources can be put in place, but we also need a change of culture so we treat mental illness in the same way we treat physical illness. When physical illness hits a family the meitheal goes around the family with the chain of supports. There are, however, often cases where the support does not come around when it involves mental health and people tend to stand back. This could change with programmes such as a school programme.

The culture within Government also needs to change completely. The organisations that work in the area of mental health should be given the same priority in government and by the Government as this Opposition has given to them.

Deirtear sa seanfhocal "is fearr an tsláinte ná na táinte" - your health is your wealth - but I have found that it is fast becoming "Your mental health is your wealth". This is indicative of the crisis we are in with regard to recognising the issue. I commend Deputy James Browne's Bill for the equal status of mental health with physical health.

I shall not go through all of the various recommendations in A Vision for Change and the various programmes that have been broadcast on RTÉ recently. Suffice to say Ireland has a dark history in the context of mental health and how we look after our young and old in that department.

We need to end the discrimination and stigma of mental health illness to ensure that patients have access to quality healthcare and that equal resources are given to the mental health system as are given for physical health and well-being.

It is absolutely shocking that there are cases where adults are being kept in prisons because there are no beds for them in the Central Mental Hospital. People with mental health problems are being failed by this Government and by successive Governments. Imagine what it is like for the families of those being treated in such a way. A physically ill patient would not be held in prison-like circumstances while waiting on a bed, so this should not happen to a person who has a mental illness. We are living in a first-world country where patients should expect a high level of healthcare for physical and mental health.

The Bill will give a statutory basis to the acknowledgement that mental health is on parity with physical health. This parity of esteem will shift the mindsets of those who thought it acceptable to hold mentally ill patients in difficult circumstances, or those who think that a mental health illness is not as urgent or does not deserve the same level of care as a physical illness. I commend the Bill.

From the figures we can see the reduction in child and adolescent mental health services, CAMHS, and a reduction in the availability of services. Sometimes it feels as though we are going backwards instead of forwards. I hope we can improve the situation for people who are suffering and their families.

May I say how well the role of Acting Chairman suits the Deputy.

I am delighted with and very proud of my party colleague, Deputy James Browne, for introducing this Bill. Time and again persons with mental health difficulties are sidelined and made to feel that their plight comes secondary to those with physical health issues.

It is both sad and embarrassing to have to admit that the real gravity of the mental health situation in Ireland is unknown because we are only aware of those suffering once they take the brave step to seek help.

The purpose of the Bill is to introduce parity of esteem. This needs to be the new phrase when speaking about mental health. All aspects of health have to be addressed on an equal footing. Mental health should not be referred to as though it is a separate sector. For too long mental health organisations have been surviving on the remnants of the health budget once every other sector of the health service has been funded. This does not help waiting lists, which are currently unacceptable. Pieta House will host its tenth Darkness into Light event in ten days' time. More than 200,000 people will walk side by side in their communities to raise money to fund its brilliant services.

People understand the necessity to have mental health normalised and treated as the serious health issue it is. Many of the amazing facilities, of which we are all aware, receive no funding from Government. There is a fantastic facility in West Cork called Lisheens House. I shall attend a meeting there tomorrow evening to discuss issues around rural isolation. The staff there have said that lack of knowledge is the biggest barrier for them. They are currently providing question, persuade and refer, QPR, training to 40 people. In addition, they have eight counsellors providing counselling in six locations in Cork and they have a helpline that is getting busier by the day. This service is all financed by local fundraising. They do not have money to advertise and the service relies on word of mouth. How can this be acceptable in the 21st century?

We need to bring Ireland into line with international best standards and this Bill is a huge step in the right direction.

The mental health area has suffered systemic neglect and lack of resources. If anybody is in any doubt about this they only need to see RTÉ's "The Big Picture" from last week. It is, unfortunately, truly reflective of what so many parents and patients throughout the State are experiencing with mental health services.

The numbers are reflected in the percentage of funding that is spent on mental health out of the overall health spend. It is currently barely over 6%. A Vision for Change provides that it should be 8.4%. Sláintecare has said it should be 10%. The World Health Organization, WHO, recommends that the spend should be 12%. The confidence and supply agreement inserted a requirement that A Vision for Change would be funded over the lifetime of the Government. This was reflected in a proposed €35.4 million per year over each of five years. In budget 2017, however, when the €35 million was announced we found out subsequently that only €15 million could be spent in the following year. How this adds up is beyond me.

We were then given an undertaking that in budget 2018 the baseline would include the original €35 million and an additional €35 million would be added. After the 2018 budget we discovered that this also was not the case. For budget 2019 we have had to get a signed undertaking that €55.4 million would, in fact, be available and that we could finally commence a multiannual budget. It is expected that this money will be there this year.

I believe that this shortchange was led by the Department of Health and one wonders if any of the funding would be available today without the confidence and supply agreement.

The WHO's definition of mental health was referred to. Why is this definition not included in Ireland's equality and employment legislation? Why has the legislation not been updated to include the definition if it is being relied upon by the Department of Health? Where is the Bill to implement the expert group review of the Mental Health Act 2001?

Only one out of 165 recommendations has been implemented to date. Where is the Bill to give powers to the Mental Health Commission so that it can have powers equal to those of the Health Information and Quality Authority, HIQA, to investigate 24-hour residential community care centres? Why was the role of the director of mental health removed by the HSE this year? Why has the number of referrals seen by child and adolescent mental health services, CAMHS, dropped by more than 2,000, from just over 12,000 to just over 10,000? All of this reflects the fact that mental health simply is not being given priority in the Department of Health. That was the catalyst to bringing forward this Bill. This Bill mimics and reflects similar legislation in the UK. There is little or no reason for the Government not to be able to enforce this legislation. The Minister of State seemed to imply there would be some sort of difficulty in doing so. It was flagged several months ago with the Minister of State with responsibility for mental health and it is a pity that he is not here to hear the closing speeches. It was flagged with him several months ago so it was no surprise that this Bill was coming forward.

I believe that the lack of parity for mental health is partly due to a deep-seated cultural issue at policy, institutional and organisational levels and at individual levels at the height of the Department of Health. It is seen as something other and something lesser within the Department and it is not given the priority that it deserves. The previous Fianna Fáil Mental Health (Amendment) Bill 2017 that came through the Houses is now on Final Stage in the Seanad, having worked its entire way through the Dáil. I expect it will pass all Stages in the Oireachtas within the next two months. I intend to pursue this Bill with the same drive as that with which that Bill was pursued and I will not let it rest there. I commend this Bill to the House.

Question put and agreed to.