Mental Health Policy: Motion [Private Members]

I move:

“That Dáil Éireann:

recognises that:

— positive mental health is fundamental to overall health and well-being;

— mental health is central in building a healthy, inclusive and productive society;

— people’s experience of well-being may vary, with some experiencing vulnerability at some stages in their life;

— the Government’s response to the Covid-19 pandemic should ensure that measures protect not only the population’s physical health, but its mental health also, as an equally important component of health and well-being;

— many people may be facing increased levels of alcohol and drug use, insomnia and anxiety during this pandemic;

— reporting of domestic abuse has increased during the pandemic;

— bereavement, isolation, loss of income and fear are triggering mental health conditions or exacerbating existing ones;

— people with pre-existing mental, neurological or substance use disorders are also more vulnerable to Covid-19 infection;

— Covid-19 itself can lead to neurological and mental complications, such as delirium,agitation and stroke;

— the long-term socio-economic impact of the crisis is likely to exacerbate the financial inequalities that contribute to the increased prevalence and disproportionate distribution of mental health difficulties;

— Covid-19 has had a negative impact on access to mental health services and underscores the urgent need for increased funding;

— underfunding of mental health services prior to the pandemic emphasises that the health budget for mental health is struggling to meet the population’s needs; and

— the pandemic is increasing demand for mental health services;

and calls on the Government to:

— publish all data in relation to mental health and the effects of the Covid-19 pandemic;

— prioritise and build human resource capacity to deliver mental health and social care;

— ensure redeployment of mental health staff during the pandemic only occurs in extreme circumstances;

— ensure that mental health is a central part of the response to the pandemic;

— apply a whole-of-society approach to promote, protect and care for mental health, as mental health actions need to be considered essential components of the national response to Covid-19;

— include mental health and psychosocial considerations in national response plans across relevant sectors;

— respond proactively to reducing pandemic-related adversities that are known to harm mental health, for example, domestic violence and acute impoverishment;

— ensure mental health and psychosocial support are available in any emergency;

— support community actions that strengthen social cohesion and reduce loneliness, for example, supporting activities that help isolated older adults to stay connected;

— safeguard uninterrupted in-person care for severe mental health conditions;

— ensure that mental health services have the capacity to cope with the additional strain experienced due to Covid-19, which they will continue to be under into the future;

— develop strategies for more vulnerable groups in society as outlined by the World Health Organization and United Nations’ surveys;

— utilise digital platforms to provide psychosocial support and early detection and management of mental health conditions;

— invest in mental health interventions that can be delivered remotely, for example quality-assured tele-counselling for frontline health care workers and people at home with depression and anxiety;

— strengthen communication strategies to support a national campaign to highlight the mental health supports that are available;

— design all communications to be sensitive of their potential impact on people’s mental health, for example, by communicating empathy for people’s distress and including advice for their emotional well-being;

— provide access to information about positive coping methods;

— prioritise psychosocial support, including for grief and loss;

— ensure the Department of Health conducts a comparative study as to which countries perform well in the area of mental health and assess how Ireland compares;

— build support structures for mental health programme strategy across all Government Departments;

— re-establish a dedicated lead for mental health within the Health Service Executive that reports directly to the Chief Executive Officer;

— support recovery from Covid-19 by building mental health services for the future,recognising that all affected communities will need quality mental health services to support society’s recovery;

— develop and fund the implementation of national services, re-organisation strategies that shift care away from institutions to community services;

— ensure mental health is part of universal health coverage by including care for mental,neurological and substance use disorders; and

— involve people with lived experience in the design, implementation and monitoring of mental health services.”

I welcome the Minister of State at the Department of Health, Deputy Mary Butler.

I am very happy to move this motion, which is my first Dáil motion. I am doing so on my own behalf and on behalf of my very good colleagues in the Regional Independent Group.

As we have all lived through 2020, we can probably all appreciate that there is no more deserving, no more fitting and no more worthy topic of discussion than that of mental health resourcing in the State. Mental health is a vast area that requires absolute focus and absolute commitment to solve the issues we have.

From the get-go, I thank Deputy Denis Naughten and our group parliamentary assistant, Cáit Nic Amhlaoibh, who did a huge amount of research into this topic, and who also drafted the wording of the motion. I also commend the Opposition and the Government who have provided a lot of support for the motion over the past week. It is very heartening and encouraging to see that this is the case, and why would it not be the case, because mental health issues affect every party in the House, and indeed every house in the State?

I will raise three points with the Minister of State. I will first focus on the situation in hospital emergency departments from a mental health perspective. There is huge under-resourcing of infrastructure in emergency departments. We need a dedicated pathway or channel, similar to the paediatric channel. When a paediatric patient shows up at an emergency department, he or she is routed through a particular pathway. We need the same model for patients who present in psychiatric distress or with a psychiatric illness, with a separate waiting room. The current practice whereby acute psychotic patients are interacting with general medical patients is completely unacceptable and we really need to improve that set-up.

From a crisis team perspective it is not good enough to just have one clinical nurse specialist on a crisis team. We need to resource this properly so the teams can deal with multiple presentations simultaneously, and so they are not completely stressed out themselves.

I am very happy with the commitment in the programme for Government to appoint a national director for mental health, with a direct line to the director general of the HSE, currently Mr. Paul Reid. This is very important. Perhaps in her reply, the Minister of State could clarify where we are with that process and indicate if there is a likely date for the appointment of a national director.

My second focus is on mental health resourcing in the community, and especially from the point of view of the NGO sector. It is an issue nationwide. I will use as an example an excellent NGO agency in my constituency in Newbridge called HOPE(D), which has approximately 1,000 service users on its books. HOPE(D) gets no funding whatsoever from central government or through the HSE. The service relies on the charity of Kildare County Council to provide 20% of its funding and the other 80% is made up through fundraising or donations. I am sure we can all appreciate that relying on a GoFundMe page is not a sound basis on which to provide a very important service to the community. In such a case the agency is always distracted from providing that service because staff are focused on trying to keep the lights on and the doors open.

The third issue I wish to focus on is an area in which the Minister of State has a particular interest. It is assistance and the mental health of the elderly population. From my own medical practice, I am aware there has been a shift over the past 12 months in the demographics of people who present with mental illness. The shift is towards the elderly population and people who have had no history of mental illness in the past but who are now presenting. This is as a result of cocooning, isolation, bereavement and just loneliness. Again, I am very happy to see a commitment in the programme for Government that there will be a commission for care of the older person. Will the Minister of State, in her response, indicate the status of that process? When are we likely to see that commission in place? This would be hugely appreciated.

In summary, I believe that everyone in the Chamber can appreciate how precious and fragile our mental health is. It is incumbent on us all to ensure there is adequate resourcing nationwide, from a HSE perspective and from an NGO perspective, for the betterment of the public.

I wish the Minister of State well in her role in this very important sector within the health service. I am delighted to see her in the role because I worked with her over the past four years in the previous Government and I know how dedicated she is to whatever she does. I have great confidence that together we will make life and mental health services better in the State. Her decision in government to support our motion is an indication of this all-of-government approach to an issue that is above politics.

Certain issues come to mind. Some people always call for more money and more resources. At times, however, it might be a case of looking at where the gaps are and trying to find out why the gaps exist. One of the issues I come across in my constituency is parents or families of young people trying to access the services. They need to know where to go. They seem to be completely in the dark as to how to initiate help for their child who may be showing signs of a mental health issue. More than 2,000 people are waiting for a child and adolescent mental health services, CAMHS, appointment. This needs to be addressed urgently. This should not be like that and we must address it.

With the situation during and post Covid, we now have to look at and plan not only for the economic stimulus and recovery but also the health stimulus that is needed to make sure that young people are not left behind or forgotten.

I have a great admiration for Pieta House, which has a centre in my town of Tuam. The centre was purchased and developed by local people because they saw the need for it. Local business people and others gave of their time and skills to make sure that the facility was put in place but earlier this year it was under serious threat of closure. I would like to see organisations such as Pieta House, Jigsaw and Youth Work Ireland being put on a solid footing so that they do not have to hold their breath at the end of each year, not knowing what resources they will have for the following year. We must put in place a five-year plan to ensure that they have enough resources to be able to plan into the future. Those organisations get referrals from the HSE but the HSE might not back them up with financial support. That is putting pressure on a service which relies on fundraising. I would like the organisations not to have to be totally reliant on fundraising because we then end up with a service that operates on the basis of an ad hoc arrangement. It is important that something be done in that regard.

The other matter I wish to raise relates to early intervention psychosis teams. We have five teams nationally in this country, with none in Galway. These teams are a vital cog in the overall service. I urge the Minister of State, Deputy Mary Butler, to look at the issue, talk to the HSE and make sure these teams are in place, as otherwise we are battling without the full armoury of resources in place.

On the proposed mental health day hospital for Tuam, the tender for the project will go out to the contractors this week. The enabling works are currently in hand and the facility is to be based at the old Grove Hospital site in Tuam. I urge the Minister of State to ensure that the necessary funding is available within the capital plan. The funding was in the previous plan and I hope she will make sure that it is still available. The services were provided in Toghermore House and the new project is now being developed within the town centre. The old Grove Hospital site is an existing HSE building. It is important that this project is brought to fruition as quickly as possible. It is important not only for Tuam but also for the region. It would give the message that the mental health day services are active, alive and accessible to everybody who needs them and that people know where to go and what to do. I also urge the Minister of State to look at the lack of out-of-hours services, which seems to leave many in distress.

I welcome the opportunity to speak. As a member of the Regional Group, I am delighted that we have brought this Private Members’ motion to the Dáil today. We call on the Government to publish all data on mental health and the effects of the Covid-19 pandemic. We want the Government to give a commitment to the effect that mental health will be central to the plan to combat Covid-19. We also want the Government to recognise that mental heath services are an essential part of its response to Covid-19. Domestic violence and acute impoverishment have increased mental health issues during Covid-19. Emergency mental health supports must always be available. The Government must support activities that help the elderly and the isolated so that they can stay connected to their communities. We must put the resources in place to ensure that mental health services continue to function during any future pandemic or similar situation. The Government must put in place a strategy for vulnerable groups in society, as outlined by the World Health Organization and the UN.

We need a commitment that investment will be made in mental health interventions that can be delivered remotely, for example, telecounselling for front-line healthcare workers and people at home with depression and anxiety. We must provide access to information about positive coping methods for dealing with depression. We must prioritise the availability of psychosocial support, especially for those dealing with grief and loss. The Government must commit to the re-establishment of a dedicated lead for mental health within the HSE. It must provide real support to help people recover from Covid-19 by building mental health services for the future to ensure that all affected communities will receive quality mental health services to support their recovery. The Government must develop and support financially the implementation of national services and the re-organisation strategies that shift care away from institutions to community services. It is important to involve people with lived experience of mental health issues and challenges in the design, implementation and monitoring of mental health services. The pandemic has clearly shown that, as a society, we do not have the proper structures and services in place to deal with the current mental health challenges. We need to change that. The motion clearly outlines what needs to be done by the Government.

I have spoken on many occasions about the challenges faced by the younger generation. I am a great believer that exercise plays a vital part in good mental health. However, during the pandemic I have seen another group that needs our support, that is, the older generation. These people have given a lifetime commitment not only to their families but also to society and when they needed help most, unfortunately, they did not receive it. I spoke in recent weeks about the fact that public masses should have been treated as essential services. I spoke to many people, particularly members of the older generation, and one of the biggest challenges they face is the fact that they have not been able to attend daily or weekly mass services. In these circumstances, we need a more compassionate approach.

That is true in all areas of mental health. We need to take a more human approach and to view the issues in a more compassionate manner. It is not only about allocating money to a problem. It is about allocating the right resources. By that, I mean people who are properly trained to deal with mental health issues. On too many occasions in my constituency of Louth I have seen how mental health services have failed my constituents. Many times I have seen people suffering from mental health issues try to access resources, but they are turned away. On occasion, unfortunately, that has resulted in tragedy. That must not be allowed to continue. A person does not need to be a drug addict, an alcoholic or homeless in order to suffer from mental health challenges. On too many occasions I have seen situations where people did not have any outward symptoms and, as a result, they did not receive the proper treatment. Again, unfortunately, that has resulted in tragedy in a number of instances. We must not allow that to continue. We must stop now, evaluate the service we currently provide and put a plan in place to provide proper mental health services. We are facing a crisis and we must act now. The work must start in schools. We must ensure that children are properly equipped to deal with the challenges they may face in life. That must continue through their school and college life. We must also provide support to parents so they can provide the necessary help and guidance to their children as they go through their formative years. It is most important that we support the older generation. They have suffered more than any other section of society during this pandemic. I call on the Government to support this Private Members' motion, not only in words but with actions.

This pandemic has touched the lives of everyone. Life as we knew it was snatched away and replaced by a new normal, one that nobody wanted. Even the strongest among us struggled to cope. Even the hardiest did not escape unscathed. The advice of health experts focused primarily on protecting ourselves and others from becoming infected. This emphasis is to be expected during a pandemic. Guidance on staying physically well is vital at this time. While there is an ever-increasing awareness of the mental health damage being caused by the pandemic, it does appear to have taken a back seat as we journey through Covid-19. In times of life-threatening crisis, both physical and mental health should and must be treated equally. Mental health must form a central part of the overall response to Covid-19. This pandemic has shone a light on the deficiencies in the mental health service. The cumulative results of years of underfunding mean that services are not readily available to the growing number of people who desperately need them. It is alarming to note that 76% of respondents said they had to withdraw the mental health services they usually provide because of the pandemic. Not only is the reduction in services alarming, it is frightening. Part of the reason is an inability to facilitate face-to-face consultations. Telephone or virtual consultations are available, but they do not suit everyone.

At a time when research shows that one in three adults in this country reports suffering anxiety or post-traumatic stress disorder, PTSD, as a direct result of the ongoing situation, their cry for help must be heard and they must be accommodated. When the need for help reaches this level, mental health services must be adequately funded and upgraded to allow them to meet this demand. This is what happened in the provision of physical care. This clearly indicated the need for a dedicated mental health task force.

As the vaccine comes on-stream, many people will need support when they emerge from this pandemic. This will be a challenging and overwhelming time for some. It also underscores the urgent need to re-establish a dedicated lead for mental health within the HSE, not just for now, but for future mental health needs.

Many of those reaching out for help are elderly, living at home or in nursing homes. Emphasis has been placed on protecting our older generation from this virus. We have isolated them to keep them safe. We have cocooned them to keep them well. We have kept their families, including their grandchildren, away from them. We have kept them apart from everyone. This was all done with the best of intentions. No one disputes its necessity. We diligently protected them physically, but the mental health of our elderly suffered immensely.

The majority of older adults are acutely aware of the greater risk to them from the pandemic. This awareness comes with worry and anxiety. They also have concerns about access to medical care. They fear hospitalisation due to the risks. Every day they read and hear of others succumbing to Covid-19. They worry about their families when they cannot see them. They hearts are breaking because they will not share this Christmas with their loved ones from overseas. Despair fills their minds.

They are shouldering a far greater burden of stress than generations before them and yet the mental health support they receive is limited at best and non-existent at worst. It should be a central part of their care. We have zoned in so completely on protecting their physical health that their needs as human beings have been cast aside. Today's motion tabled by the Regional Independent Group seeks to support community actions that strengthen social cohesion and reduce loneliness. This includes supporting activities that help isolated lonely adults to stay connected.

At the other end of the age spectrum, 2020 has been a horrible year for young people. Not alone have their normal social activities been prohibited, but they have been singled out and targeted as virus spreaders. Many young people now consciously isolate themselves from their families. As we try hard to put old heads on young shoulders, we turned a blind eye to the sacrifices we are asking young people to make. The result is that youth mental health services, such as Jigsaw, have reported a 50% increase in demand. Loneliness, boredom, isolation, concerns for parents and grandparents and an increased dependence on interaction only on social media have all played a part in that. For young people emphasis should be placed on providing and promoting care in the community. This is of particular importance to this age group. They will be more reluctant to seek help if it might involve treatment in an adult institution. In a dedicated community setting, young people will be much more inclined to seek it out.

Our motion calls for a strengthening of communication strategy to support a national campaign to highlight the mental supports available. Overall, good health is a key objective for us all. Physical and mental health are interdependent. Without one, we cannot fully enjoy the other.

I thank the Deputies from the Regional Independent Group for tabling this motion. Supporting positive mental health and well-being is a priority for me and the Government and is particularly important during the current pandemic. Covid has presented significant challenges for people’s mental health, including increased stress, anxiety and fear. This has been exacerbated by experiences of isolation, bereavement and loss of income and work among many others. We have responded rapidly by reconfiguring existing services and putting additional services and supports in place.

I say at the outset that the Government does not oppose this motion, as it is broadly in line with the Government’s policy objectives for mental health. It also highlights a number of actions the Government has already significantly progressed. However, I am not convinced that the motion accurately reflects the Government's progress to date in improving mental health services and its commitment to continue to enhance services.

Accordingly, I welcome the opportunity to emphasise the priority given by the Government to mental health and our commitment to the continued development of all aspects of mental health services across a broad continuum from mental health promotion and early intervention to acute and specialist services. I also draw attention to the significant measures put in place to address the particular mental health challenges posed by Covid-19.

Furthermore, I reaffirm our commitment to the implementation of Sharing the Vision, the national mental health policy, in line with the programme for Government and Sláintecare and to Connecting for Life, the national suicide-reduction strategy through its extension for another four years until 2024.

The Government has invested significantly in the enhancement of mental health services. Budget 2021 allocation for mental health, of €1.076 billion, is an increase of €50 million over 2020. Of the additional €50 million for 2021, €23 million will be used to commence implementation of many of the short-term recommendations set out in Sharing the Vision. This will fund an additional 153 staff to enhance community mental health teams, including CAMHS; clinical care programmes, including in the area of dual diagnosis; bereavement counselling; and crisis resolution. There is also €15 million for Covid measures, including the provision of extra mental health beds, as required.

Deputy Canney asked about CAMHS. I am very concerned that 2,200 people are on the CAMHS waiting list. These are all vulnerable children under 18. Those figures are similar to last year's. Owing to my concern, of the new posts for 2021, 29 whole-time equivalents will be specifically for CAMHS.

Many local mental health services are also implementing innovative practices such as the introduction of a community assessment hub in Cork which provides direct access to mental health assessment and support seven days a week, reducing the need for people to present to emergency departments. This is a really innovative practice that has been put in place in Cork and is keeping many people out of emergency departments. Appropriate clinical people in the hub can point people in the right direction.

We do not yet fully understand the impact of Covid-19 on mental health and the subsequent demand on services. However, the HSE already has a range of proactive responses for any increase in service need, including online and other telehealth psychosocial supports. The Department and HSE continue to plan for any surge in demand as it arises.

This is the case, for example, with MyMind, which is a HSE partner NGO providing online counselling sessions. Additional funding of €2.2 million has been provided for 2020 to ensure that we can meet this increased demand through MyMind and a number of other providers. This funding will help to strengthen and expand psychosocial and telehealth services, such as the national crisis text line, to augment existing services and to support a transition to online and telephone support where face-to-face services cannot be provided safely.

In addition, as part of the HSE’s psychosocial response to Covid, counselling supports are available to staff impacted by the pandemic. Local support structures are also in place in each community healthcare organisation, CHO. These supports are also available to section 38 and 39 workers.

Awareness-raising campaigns which promote existing mental health services have been launched, including through national and local radio campaigns, to assist people in finding appropriate supports where needed.

This is a significant investment by any standard and the programme for Government gives a clear commitment to continue investment in mental health services as resources allow. More specifically, mental health remains a core aspect of the Government’s response to Covid-19. It is important to note that specialist mental health services have continued to operate at 85% to 90% of pre-Covid levels, although there has inevitably been some impact on referrals to specialist services which are being monitored.

In recent years, we have witnessed a major shift in our society’s willingness to discuss and address mental health issues. It is now recognised that there is no health without mental health. Furthermore, the many determinants of mental health must be appropriately addressed if we are to improve the mental health outcomes of Ireland’s population and build strong, healthy and resilient communities.

This change is reflected in Sharing the Vision and Connecting for Life. Both advocate a cross-departmental, whole-of-Government approach to delivering these policies. Sharing the Vision, published earlier this year, sets out a progressive shift in mental health service delivery from volume of supports provided to outcomes achieved for people using the services. In line with Sláintecare, it promotes enhanced access to services; person-centred care, taking account of the needs of particular groups; and flexible and community-based service provision, reducing the need for hospital admission while still providing inpatient care, where required.

I recently established a national implementation and monitoring committee, NIMC, to oversee the implementation of the Sharing the Vision policy over its ten-year life cycle. The NIMC structure will involve a broad base of state bodies, NGO service providers and service user representatives to ensure that a whole-of-government and indeed, a whole-of-society, approach is adopted in its implementation. The steering committee will hold its inaugural meeting on Friday morning of this week. The committee will be supported by specialist groups that will provide expertise to progress recommendations relating to areas such as Travellers’ mental health and the transition from CAMHS to adult services. Implementation will also be progressed through planned additional investment under annual budgets and agreed HSE service plans. The new programme for Government recommends that we examine the reinstatement of a national director in mental health to ensure the new policy is driven in the HSE. I am keen to explore this issue with the HSE in the coming months. I will also seek an undertaking from the executive that mental health staff will only be redeployed for Covid work in extreme circumstances.

While mental health care should be provided at the lowest level, not all mental health issues can be dealt with in the community. Inpatient and residential care has, and will continue to have, an important role. The new 170-bed hospital complex in Portrane will replace the Central Mental Hospital, Dundrum with a modernised national forensic mental health service. The new facility includes a 130-bed forensic hospital, due to open in early 2021, a ten-bed forensic child and adolescent unit and a 30-bed intensive care rehabilitation unit. This represents a major step forward in the care and treatment of people who require such care. I am moving legislation in the Dáil tomorrow to allow for the opening of the new service and I hope that everyone in the House will support this action. The Department of Health is also nearing completion of an extensive overhaul of the Mental Health Act 2001. The revised legislation will improve protection for the rights of mental health service users, including provision for consent to treatment for 16 and 17-year-olds. The draft heads of this legislation are expected to be finalised in early 2021.

The Government and mental health services have been particularly active in response to the pressures placed on people’s mental health due to Covid-19. At an early stage of the pandemic, HSE community mental health services moved rapidly, in compliance with public health guidelines, to provide in-person specialist services where it was safe and possible to do so for both staff and service users, and to augment this, with expanded telehealth services, to continue to provide mental health supports. To ensure oversight of the performance of mental health services in responding to Covid-19, the Department of Health worked with the Mental Health Commission and the HSE - which is important to note - to develop a risk management framework for residential facilities, identify and address structural and operational issues and track and contain infections within residential and acute units. The framework reports regularly, and infection rates in our facilities have remained low overall. The establishment of a tripartite group, with the Department, HSE and the commission, will help to monitor our service-wide response to the pandemic and to identify any potential issues as early as possible.

I ask that we maintain sight of our common goal of ensuring that the mental health needs of the nation are served in the most effective manner. I am, with the Government and the Minister for Health, fully committed to the continued development of high-quality, person-centred and human rights-based mental health services for all children, young people and adults. I welcome open and positive discussion on this important area, and I look forward to suggestions and constructive comments from the floor.

I am pleased to have an opportunity to contribute on such an important motion. It is undeniable that Covid-19 has had an impact on the mental health of many people, and this has taken many different forms, including loneliness, social isolation, stress, financial pressures, anxiety. These are just some examples. My colleagues and I, in the Regional Group, are very pleased that the Government agrees that we need to ensure that mental health is an essential part of its response to the Covid-19 pandemic. The response should ensure that measures protect not only the population's physical health, but its mental health on an equal basis. Covid-19 is a public health issue, and I believe that all of us in this House recognise that, but we have differing opinions on how best to deal with it. We must not allow our response to Covid to cause more knock-on problems than it solves.

Unfortunately, we have a mental health system that is not adequately prepared to cope with the significant increase in demand that has been experienced over the past few months. Underfunding of mental health services prior to the pandemic shows clearly that the budget for mental health is struggling to meet the population's needs. The pandemic should not be used as an excuse to deny, delay or curtail access to mental healthcare and services. In my local CAMHS unit in Wexford, where the staff there are Trojan-esque in their commitment to patients, no child psychologist or dietician has yet been appointed, and this situation has been ongoing for over two years. I have seen, first hand, the devastation caused when early intervention is not achieved with these children and they move straight into adult services. Funding is in an investment in these children's futures, and we must not take that away from them. Long before Covid-19 was ever heard of, there was a mental health epidemic and it is obvious that the pandemic has served to magnify this fact.

On the specifics of the motion, we are calling on the Government to publish all available data on mental health during the pandemic. We want to ensure that mental health is a central part of its response to the Covid-19 pandemic. This means taking more than just the potential spread of the virus into account when deciding on what activities to ban people from doing. For example, banning someone from visiting a neighbour who lives on their own may help reduce the chances of the virus spreading, but it increases loneliness and social isolation. Human beings are social beings, and thrive in the company of others, heartened by their love and support. Christmas is one of the loneliest times for older people. Likewise, how much stress, anxiety and depression has been caused by ordering businesses to close? How many people have been plunged into a state of financial despair as a result of Covid restrictions?

We call on the Government in the motion to design all communications to be sensitive of their potential impact on people's mental health, for example, by communicating empathy for their distress and including advice for their emotion well-being. With this in mind, a special mental health task force must be set up without delay to ensure the safe, efficient roll-out of the vaccine programme, and to ensure that all services are provided and the needs of patients are met. "Scaremongering" is a word that has been used many times to describe the matter in which Covid-19 information has been communicated to the people. We constantly hear bad and worrying news, and the worst-case scenarios are forecast. However, do we hear a fair share of positive news? It is five months since we received an update on the number of recoveries from Covid-19. That was on 20 July. Why have we not received such an update in five months? I recognise that the bad news is being used in a way to try to get people to take all of the restrictions seriously, but I also recognise that the constant drip feed of misery and doomsday scenario information takes its toll on people. I ask the Government to ensure that clear data is provided, not just on recoveries, but also on asymptomatic cases, and rather than reporting deaths related to the virus, report deaths from the virus to allow people to understand more.

These are just some of the reasons we are calling for mental health to be a central consideration of Government when deciding on any further Covid-19 measures. I do not have time to comment on each line of the motion now, but I am very pleased that members of all parties and none recognise the benefits of supporting the motion to help protect the mental health of our people.

I thank Mental Health Reform and Dr. Philip Hyland of Maynooth University for their assistance in drafting the motion. The Leas-Cheann Comhairle will want to join me in thanking the mental health staff who are working in hugely trying circumstances in our services across the country, and particularly in our acute services. I know this issue is close to the heart of Leas-Cheann Comhairle, as it is to mine.

I wish to raise two specific issues, the first of which concerns young adults. This group has been disproportionately impacted by the Covid-19 restrictions that have been put in place.

This is the case from a mental health perspective in particular. There has been much focus on older people and isolation and there are challenges in urban and rural areas arising from isolation. However, young people's lives have been turned upside down. These are people who this time last year would have been going out while at college and involved with clubs and societies, as well as sporting organisations. All that is gone and they are not even attending lectures now. They do not have the basic human interaction that is so normal for young adults. I am really frustrated we are brushing this matter under the carpet.

The Minister of State knows that on a number of occasions I have said directly to the Taoiseach that we must look forensically at the restrictions that have been put in place, taking into account the risks and balancing them with benefits. That is not happening because we are ignoring the vast volume of data that is there to help us make decisions. It may be that we might say to young people that they can meet people in a coffee shop or go back to lectures but if they do so, they must isolate before they visit granny or grandad, or they should keep away from older people.

The risks with younger people are far smaller once they remain within their own bubble or population cohort. The concern is that they could bring the virus to family settings and, as a result, spread the infection to older people in particular. We must be far more forensic in how we deal with this. If we believe it is vital that children have access to education at primary and post-primary level, surely the same logic applies with third level students.

Speaking about children, there is a very serious backlog in addressing mental health and behavioural concerns in the child and adolescent mental health services, CAMHS, across this country, with 2,229 children on a waiting list for assessment, never mind getting the treatment they require.

I also raise the mental health services across Roscommon, Galway and Mayo. I am astounded to find that as part of the winter initiative this year and dealing with the consequences of Covid-19, not one additional cent has been provided to our mental health services. We have been told that mental health services should, under Sláintecare, receive 10% of the total health budget but last year mental health services received 6% of the total health budget. This year, that proportion has been cut to 5% of the total health budget.

The reality is more pressure is being put on mental health services, particularly with respect to the acute mental health services in the west of Ireland. In our acute units in the west of Ireland, we are looking at a 100% occupancy rate. Taking into account Covid-19 concerns, we should at the maximum operate at 80% capacity but people are being turned away. Not only are they being turned away but there is not an alternative service available to them. The mental health support networks and services that should be in place have been wound down because of social distancing, which is compounding problems associated with isolation, particularly for people in an acute phase of mental health issues. I am afraid this will have long and far-reaching consequences unless the concerns are addressed immediately.

I thank the Regional Group for tabling the motion and keeping mental health on the agenda, and Sinn Féin will speak in favour of it today.

The tragedy of suicide has touched nearly all communities and sectors in Ireland. The Government relies on non-governmental organisations to plug gaps in mental health services but we must become proactive rather than reactive and put in place support services and policies to help prevent suicide from occurring. Access to counselling may often be a barrier to people obtaining appropriate mental health supports and we must start to move towards parity of esteem in mental health provision.

One of the major gaps in services commonly experienced by those in distress is a lack of care outside the 9 a.m. to 5 p.m. window. Currently, there is no State-wide provision of 24-7 mental health crisis services at a community level. People should have access to mental health treatment where and when they need it. Mental health concerns do not just become apparent between 9 a.m. and 5 p.m., they do not take the weekend off and they do not take a break during a pandemic.

In response to a parliamentary question asked this week on the number of people who have died by suicide this year, I was told that:

All unnatural deaths, which includes deaths from intentional self-harm must be referred to the Coroner's Office. However, the Coroner's Court did not hold public hearings as a consequence of the restrictions imposed due to the COVID-19 pandemic and this would impact on the number of deaths registered and subsequently assigned an Underlying Cause of Death of intentional self-harm.

In layman's terms, this means that deaths by suicide are not being counted in real time.

However, on 17 September, the Tánaiste stated in this Chamber that the most recent figures he had seen indicated a "decrease in suicide in Ireland and a decrease in people self-harming". He also said "That is very welcome but we have a long way to go.". Where did the Tánaiste get these figures and could we have access to them? Could they be shared as we need transparency? I want the Government's assurance that data will be collected retrospectively.

It is quite worrying that I, as an Opposition spokesperson on mental health issues, cannot get access to the number of people who died by suicide this year but the Tánaiste apparently can. Data are really important as they inform policy and allow public representatives like me to suggest solutions. Without this information, we are hampered in making those suggestions that could help reduce death by suicide. Why is that? Does the Minister of State have those statistics? If not, I suggest there be a conversation with the Tánaiste and ask him for the information in order that it can be shared with all of us.

I am a member of the Oireachtas Joint Sub-Committee on Mental Health and last week we received representations from general practitioners. I asked plainly what one action would help them to help people suffering from poor mental health and they asked for ease of access to counselling. In Sinn Féin's alternative budget, we said we would deliver exactly that, were we in government. We would introduce universal and free counselling on GP referral, and this could be easily rolled out in order to make a major difference in people getting the help they need where and when they need it.

It was also stated at the meeting that GPs would have capacity in their buildings to host a counsellor in practice. Imagine having a one-stop shop where a person's physical and mental health needs could be met at the same time. Failure to appropriately resource mental healthcare in general practitioners has led to an over-reliance on drug therapy. Any move from a policy of "every ill has a pill" is welcome and access to talk therapies like counselling is central to such a change. Sometimes the best ideas are the simplest but they just need political will to have them implemented.

I again thank the Regional Group for keeping mental health on the agenda today. It is very welcome that we are having this discussion.

I also thank the Deputies of the Regional Group for tabling the motion. I have spoken in this House on a number of occasions about the need to balance mental and physical health as we deal with this pandemic. I recently spoke in the debate of a Bill tabled by my colleague, Teachta Ward, regarding parity of esteem for mental health. It called for mental ill health to be given equal status to physical ill health. If we are serious about this, we must also give both types of ill health equal consideration from a preventative aspect. Aristotle is reported to have said "Before you heal the body you must first heal the mind", and he was far ahead of his time.

The winter plan was launched in September with no mention of mental health issues, which is a damning indictment of the Government's commitment to the area. We cannot allow mental health to be left in the cold.

It is a matter of life or death for some people. My heart goes out to those who have lost loved ones during the pandemic. Losing a person close to you is difficult at any time, but with the restrictions on visiting the sick or dying and attending funerals, it has been especially difficult. I know that many of the bereaved have been comforted by the fact that some people come out of their homes or workplaces when a funeral is going by to acknowledge in a small way the person's passing. We need to ensure that those who have been bereaved get the support they need.

I commend the work of groups such as Grow Ireland, Shine and Jigsaw, as well as HOPE(D) in Newbridge, which help people to cope with the stress of life, particularly the various stresses brought on by the pandemic. I have spoken at length previously in the Chamber about HOPE(D) in Newbridge. I have spoken to Terri, who works there. The complications around this issue are severe. HOPE(D) gets no funding but the HSE sends clients to it. That needs to change. It has adapted admirably to help those who are struggling to cope. It is to be hoped that, with the recent breakthrough on vaccines, there will be light at the end of the tunnel.

I thank the Regional Independent Group for tabling the motion. I will cut straight to the chase with some headlines published in the media between June and four days ago. The headlines are: "Children with mental health issues forced to wait up to 18 months for help"; "Mental health budget allocation falls by 1% - PNA"; "More than 2,000 children waiting to access mental health services"; "Tele-psychiatry delivery to plug regional staffing gaps"; "Concerns raised over plan to move HSE child mental health staff"; "HSE report details staff shortages in child mental health teams"; "Inpatient psychiatric care for under-18s exposes health system flaws"; "Psychiatric stays for drug disorders on a par with alcohol admissions"; "Almost half of youth mental health service teams have unfilled posts"; and "Fallen through the cracks and there is no help in sight for them". That is a synopsis of media headlines in that period.

I do not have much time, so I will cut straight to the chase. The Minister of State stated that the motion is broadly in line with the proposals of the Government on mental health. In my experience, nothing has happened on this issue. She said the motion is broadly in line with Government proposals, but then she started criticising what the Regional Group has done and many solutions that have been put in place. I have seen what was done by the previous Government and is being done by this Government. It is about time that the Government took mental health seriously. Deputies come into the Chamber again and again to discuss this issue. It is a talking shop. The people affected by this issue are brothers, sisters, mothers, fathers, uncles or aunts. This problem knows no colour, class, creed or religion, and it does hurt. I appeal to the Minister of State to take things seriously. I have been a Member of the Dáil for I do not know how many years. We are speaking about real people. Let us start coming up with a real plan because all we get from the Government is excuse after excuse every time.

In 2018, the first legislation I published was the suicide prevention and training Bill. It was a very simple Bill to require all those working in a public body or the public domain to complete a suicide prevention training course, similar to the requirement for some workers to complete the Safe Pass programme. It was about education. It did not even come before the House because it did not get past the Ceann Comhairle. This Government and the previous one have not taken this issue seriously. I again appeal to the Minister of State to please take this issue seriously because, let us be honest, there is a tsunami of suicides coming down the road. I spoke to members of An Garda Síochána who found the body of a young fella last week near here. He died from suicide.

The figures are another problem. The figures we get are two years old. One must wait for two years to get the figures from the Central Statistics Office and even then we do not know whether they are factual. I echo the call of Deputy Ward for the Government to give us the figures. It does not matter that we are members of the Opposition. We are all here together and we are agreeing on mental health issues. The Government should give all Members the figures and the data to allow us to work together and get things right.

During the recent debate on the Mental Health Parity of Esteem Bill brought forward by Deputy Ward, Sinn Féin drew the attention of the Government to how mental health services tend to be an afterthought in overall health policy and service provision. That was apparent pre Covid-19, but it has become more pronounced now that, as a society, we are facing the challenges brought on by the fear of contracting Covid-19, as well as by the measures we must take to stop its spread.

One word that describes the situation that affected many people before Covid and which has became more of a topic of national discussion with the onset of the virus is "isolation". The poor provision of mental health services had already left many communities almost isolated. Through the years in County Tipperary there has been a very active and widespread campaign to get proper mental health services for the county, but what is in place still falls far short of being a comprehensive network of mental services that are available to all, no matter one's age or geographic location. The consequences of the pandemic have brought this into sharp focus. We have found ourselves in a situation in which people have been confined to their homes for months on end. They have also been unable to engage in social pursuits which all Members know benefit one's mental and physical well-being. Some people are now afraid to leave their homes because they are worried about contracting the virus.

What must be taken into account is that so many families who have lost loved ones during this crisis have been unable to grieve in the healthy way they would have previously, when communities would gather around the bereaved. The consequences of this issue are mounting with the increasing isolation. The pandemic has limited people's ability to avail of the mental health services they need. All kinds of outreach services for communities in rural areas have been restricted, including services for victims of domestic violence. This comes at a time many people have been confined to unhappy homes. In short, the ability of people to avail of the services they need has been reduced.

Many people will postpone or have postponed seeking help and support. We have heard of that being the case with regard to many physical illnesses, but we have not heard as much about how people are postponing appointments for or are unable to get the mental health supports and counselling they need. We must ask why that is the case. Again, it comes down to parity of esteem. This is why attention must be paid to the motion.

We must no longer allow a person's geographical location to determine who can avail of services. Work must be done to bring these supports to the people who need them but cannot get them. The health service must link with community service organisations to ensure nobody is forgotten as a result of their isolation. Covid has changed the way we are able to go about our business and the health services and social services must adapt quickly to that.

I have just finished a telephone call with the principal of a post-primary school. One of the many things we discussed was the pressure and stress her students facing and, in particular, the anxiety and mental health pressures they are under. She has never seen anything like it. It is an absolutely enormous issue. There is no doubt that many of these issues have been exacerbated by Covid. Social outlets have been closed off and the world has seemed very disturbed, disrupted, frightening and worrying. That has caused significant issues. When it is added to the fact that mental health services for children and young adults was totally inadequate in the first place, particularly in the part of the world from which I come, it is a recipe for disaster.

There are 2,200 people on waiting lists for CAMHS in the Cork and Kerry region, with 160 or more of them waiting for more than a year and some for as long as 18 months. There is no excuse for that in the context of Covid or in any other context. It is putting families under incredible pressure. It is not the case that someone makes an appointment and waits for it and hopes things are okay. The family has to deal with the consequences of the pressure and strain all the time. Doing so against the background of the pandemic is extremely difficult. I once again urge the Minister of State to try to tackle that issue. There are similar problems in universities, where demand for mental health supports has doubled since the pandemic began.

A report by the Mental Health Commission found that 15% of those over the age of 60 suffer from a mental illness. In a very different but very real way, older people have been put in an extremely difficult position, particularly those in care settings such as nursing homes, as a result of social isolation. Even those who live in their own homes do not have the social interaction they once had, as social outlets have been closed off to them too. It is an issue that we need to talk about more. We need to factor it into our solutions. We really need to focus on it in terms of resources as we emerge from Covid restrictions.

I agree with the point made by Deputy Ward regarding statistics. We are not getting the full picture we need.

I have previously made the point that we need to ensure that those graduating from universities with a psychology degree have the opportunity to continue in that career. At the moment, many of them cannot afford to become psychologists. We need to work on that issue and I will keep raising it with the Minister of State.

First, I thank all the people working in mental health services. Mental health in Ireland has always been treated like a headache, the flu or something a chemist might fix but it is a much bigger issue than that and the signs have been apparent for years. Between 2009 and 2019, we had 5,426 people, 4,370 males and 1,066 females, die as a result of suicide. In fact, one person dies every 21 hours in Ireland as a result of suicide.

Stigma is a significant problem for people who experience mental health conditions and it has been identified as one of the most difficult aspects of living with a mental condition for the person involved and for his or her family. Stigma is recognised as a barrier to the recovery process. People do not seek help because they fear being labelled as mentally ill. The consequences of stigma are shame and humiliation and can lead people to delay or avoid seeking help. We need people with mental health conditions to know that help and resources will be put in place, that recovery is possible and, with the right treatments and support, that they can go on to lead rewarding and fulfilling lives. Mental health conditions are very common. Research indicates that one in four people will experience a mental health difficulty in their lifetime. Out of 36 European countries, Ireland rates third highest in the context of mental health problems. Breaking down the stigma associated with mental health needs all our voices to create a society in which people with mental health conditions are treated with dignity, respect and equality. A mental health condition can feel just as bad if not worse than a physical condition and needs treatment and support.

The issue of suicide is a significant healthcare and societal problem and the rates among young people give rise to particular concerns. The statistics only tell one part of the story. Behind each of those statistics are families and communities devastated by these tragedies. While I welcome the additional funding in the budget for mental health services, this is an enormous issue that needs to be properly resourced. We need to develop mental health services and facilitate campaigns that focus greater attention on the issue of suicide.

Today's motion from the Regional Group has been brought forward against a severe backdrop for the people of Ireland. Covid-19 has had an unprecedented impact on our nation's physical and mental well-being. At a time when demand has increased, service delivery has slowed and, in some cases, stopped, meaning that the pandemic has had a double hit on our nation's mental well-being. With higher levels of depression and anxiety recorded across many nations, the UN has warned that the pandemic risks sparking a major global mental health crisis. We know this to be the case in Ireland as well. Research carried out in this country has shown that, at a minimum, one third of people in Ireland have experienced serious mental health difficulties during the pandemic. In young people the situation is worse, with that figure rising to over one half.

Isolation and depression are on the rise as a result of the pandemic and referrals for mental health services have increased significantly. Services which were already chronically under-resourced have been left completely overwhelmed and people who are in serious need of urgent care have been left waiting. At the start of 2020, there were almost 2,000 on the waiting list for CAMHS. That was prior to Covid. It illustrates how strained mental health provision was before the additional impact of the pandemic. Since then, we have seen a 25% increase in the number of children and young people on the waiting list for CAMHS. In primary case, more than 10,000 people across all ages are on waiting lists to see a psychologist. We have seen this replicated across the sector. Some 92% of Mental Health Reform members have said they require additional resources to deal with the impact of Covid. How can the Minister of State accept this scandal? There is no other way to describe it but to state that it is a scandal. Mental health needs to be front and centre in the context of the response to Covid-19. The evidence clearly shows this will have a massive impact on our population well beyond the timeline of Covid-19. Many people will be faced with a permanent mental impact from this very dark year and this must be taken into account as well.

Last week, An Garda Síochána confirmed that domestic violence and abuse have continued to increase as the pandemic has worn on. It stated that violence moved indoors during the pandemic, with domestic violence up almost 17% since last year. The victims of domestic violence have been left to feel literally trapped in abusive homes as a result of the restrictions. No doubt they will feel the impact of this year well into the future and this Government and those that will succeed it need to be in a position to offer increased support.

The people to whom I refer are not the only ones who will suffer from the pandemic in the long term. The Institute of Fiscal Studies has stated that the economic downturn resulting from the pandemic will have significant consequences for people's mental health outcomes in the short and longer term. We already know that severe socioeconomic inequalities can give rise to mental health difficulties. The full fiscal impact of the pandemic still remains to be seen but I urge the Government to take heed of how those who have lost employment as a result of the pandemic may be affected well into the future. Most importantly, the Government must ensure that mental health services are targeted towards the areas of greatest need, especially the most disadvantaged areas.

The motion makes reference to investing in mental health services. I want to touch on the amount of investment in the services so far this year. First, it was disappointing that the winter plan contained no additional provision for mental health at a time when it is so desperately needed. The only saving grace was the €50 million investment in budget 2021. That is made up of €38 million for new services and €10 million for existing services. Although €50 million is a significant sum, it must be said it falls short of the €80 million which Mental Health Reform predicted will be needed this year. It is crucial any gap in funding for existing services, which is likely given that funding falls below predicted costs, is not met using the funds for new service development. People in Ireland depend on mental health services for their well-being and consistent, chronic underfunding has led, as we know, to extremely long waiting lists. New services are absolutely essential and if their funding is slashed to make up for other shortfalls, we will be waiting a very long time to see any significant improvements.

Finally, I must mention Sharing the Vision because it is a really important document. It is a pity that there is no mention of it in today's motion. The policy has a detailed action plan to create a more integrated whole system continuum of care. That goes to one of the central pillars of Sláintecare, which aims to bring healthcare closer to home by strengthening primary and community care. As most people in this Chamber know, the Government has been sluggish in implementing and funding Sláintecare. Sharing the Vision lays out a very clear pathway to improving our mental health services but, without the overarching health framework funded and implemented through Sláintecare, it is difficult to know what real follow-through the Government will have in respect of these initiatives. If we are to have any hope of meeting mental health needs, Sharing the Vision and Sláintecare must be top of the Government's list of priorities.

The Social Democrats strongly supports this motion and the call to make mental health a priority in Covid-19 planning. With the promise of a vaccine quickly becoming a reality, it is to be hoped that the immediate threat of Covid-19 will lessen over the course of next year. For many people in Ireland, however, whose mental health suffered as a consequence of the pandemic, Covid's impact will be felt for many years to come. It is up to this Government and future ones to ensure the right supports are in place for all those people.

I welcome the opportunity to speak about the crisis of mental health that exists in our society. The Covid crisis has shown the strengths and weaknesses of our society in many ways. We have seen huge solidarity from ordinary people assisting one another in big and small actions to work through the pandemic. We have seen the amazing work of our health professionals on the front line and other front-line workers in fighting this virus and enabling society to continue.

The crisis has also exposed gross weaknesses, in particular the underfunding of public services over an extended period and the resulting crisis. Our mental health services have been some of the most chronically starved of funding over years and the result is that they are struggling to cope with the pressure they are under. That pressure existed before Covid but it has undoubtedly been exacerbated by the conditions of Covid, which have resulted in isolation and alienation for a significant number of people.

I wish to mention the abuse of the issue of mental health by some Government Deputies and political parties of the right. These parties and politicians have not in the past expressed much concern about mental health and certainly have not indicated much concern about mental health through their actions, such as the cuts carried out by the previous Government. However, they have a new-found concern for mental health in the context of Covid, where mental health has been used as a byword for undermining the public health advice. Sometimes when people refer to mental health in this Chamber what they mean is pubs. One would sometimes get the impression that pubs are mental well-being centres, as opposed to places that profit from selling depressants. I do not mean to undermine the importance of socialising, of which for many people, including me, going to the pub can be a part, but I oppose the cynical abuse of this issue of mental health to push a particular agenda. I suspect that some of the Deputies in some of those parties will forget about their new-found concern about mental health as soon as the restrictions are gone. I hope they do not because there was already a plague of mental health in our society before the onset of Covid. It has undoubtedly been exacerbated but it previously existed.

The late socialist author Mark Fisher wrote, "Capitalist realism insists on treating mental health as if it were a natural fact, like weather". We need to ask how has it become acceptable that so many people, especially so many young people, are ill. There has been an explosion of mental health problems, not just in Ireland but right across the world. That explosion relates to the levels of alienation and oppression that exist within our society. The WHO has estimated that by 2020, depression would be the largest contributor to disease burden in our societies. In our country, a quarter of people have a mental health problem in the course of their lives and the figures are much worse for young people. Incredibly, by the age of 13, one in three young people will have experienced a mental health problem. By the age of 24 that will have increased to one in two. It is horrific that Ireland has the highest rate of child suicide of girls in all of Europe, and ten people die by suicide every week.

It is worth asking why that massive rise is happening. It can partly be attributed to the reduction in stigma surrounding mental health. That means an increased percentage of mental health problems are being reported, which is a positive. It is hard to avoid the conclusion that, even in pre-Covid-19 times, we faced an epidemic of mental health problems. There are multiple contributing factors to that but there is increasing widespread recognition of the role of social and environmental factors. To be blunt, neoliberal capitalism has created a society with deepened and dramatic inequality. It has driven the atomisation of people and the breakdown of communities. That created the conditions, now added to by Covid-19, in which mental health problems thrive. The Royal College of Psychiatrists in the UK has stated that inequality is a major determinant of mental illness. The greater the levels of inequality, the worse the health outcomes are. Children from households from the lower income deciles have a threefold greater risk of mental health issues than children from higher income households. That risk grows even higher for those facing homelessness, where the impact is massive. The risk and incidence is massively increased again for those facing oppression such as young LGBTQ people, who are four times more likely to have mental health problems, or Traveller communities, whose suicide rates are six times those of settled communities.

We have to take the stigma out of mental health but we also need proper funding and staffing of our mental health services right now. While we need universal access to counsellors in primary care, 24-7 direct access and mental health clinics supported by telephone support around the clock, we do not have that. It is also time we introduced mental health and mindfulness classes in secondary schools. We need to make professional counselling and psychotherapy services available in schools for those who need them, free of charge. A UNICEF report highlights that six out of every 100,000 Irish adolescents between the ages of 15 and 19 die by suicide. As it stands right now, there are over 8,000 children and teenagers waiting for treatment from a psychologist and more than 3,000 of those have been waiting for over 12 months. It is absolutely scandalous that in this day and age anyone, let alone teenagers and children, should have to wait more than 12 months just to see a psychologist for what should be basic healthcare.

We need to invest now in proper mental health services for young people. We also have to tackle the general inequality in our society, including the crises of homelessness, poverty wages and job insecurity. We must tackle those environmental and economic situations that add to the stress, struggles and suffering of those fighting mental illness. For example, part of tackling the mental health crisis would be the reintroduction of the full eviction ban. It is tough to put into words the emotional strain and stress of being threatened with being made homeless or actually being made homeless during a pandemic. A full ban could at least remove this one fear from people's minds and it would not cost the Government a penny. We need to fight for a better society with a right to housing, healthcare, a living wage for all. We must provide the stability and support people need to overcome the alienation, to fight mental illness and allow them to flourish in full lives.

I thank the Regional Group for bringing this motion and putting the spotlight on mental health, particularly in time of Covid. It was forgotten about, certainly at the beginning of the pandemic. I will focus on the Mental Health Commission, which I noticed that the Minister of State did not mention. I acknowledge that she cannot mention everything but she gave a very long speech. I welcome that she is going to bring legislation before the Dáil to reform the 2001 Act. I welcome the fact that we are getting nearer to the implementation body and I will come back to that if I have time. I am a little concerned about its independence. That is subject to the Minister of State telling me it is totally independent and who the members are because it is an essential feature in the mental health area.

The Mental Health Commission's annual report for 2019 stated that now was the time for real reform. It noted:

The current Covid-19 pandemic has highlighted in stark terms the need for a modern, well-staffed, holistic community-based mental health service. This can only occur when mental health is appropriately prioritised.

Clearly it has not been. This and previous commissions have been continuously forced to highlight that the system is ad hoc, sporadic, lacks integration and much of the mental health interventions are still linked to institutional care in the community.

In the 1980s, the Planning for the Future policy was to de-institutionalise care. That has happened in name but not in reality. Then there was A Vision For Change, which was a wonderful document but was not implemented. The current policy is Sharing the Vision and its implementation will totally depend on whether there is an independent monitoring committee because as the record shows, no Government can be trusted on mental health.

To return to its report, the Mental Health Commission found that compliance with regulation, that is, with obligatory measures, remained similar to 2018 at 78%. It said it was disappointing that the modest improvements since 2016 did not continue. There was also a thematic report on physical health from the inspector, which pointed out that physical health is not a top priority when it comes to those who also suffer from mental illness or a psychological problem. This is stark. It remains a fact that in the 21st century, people with a mental illness will die 15 to 20 years earlier than their peers in the general communities, in many cases due to preventative physical illness. The historic separation of physical and mental healthcare within the organisation has led to a situation where specialist mental health training and the associated practices have not been put to the fore.

I will conclude with some statistics. There were 208 instances of over-capacity in 2019. The report noted "It is clear that a significant amount of premises are no longer suitable and need to be replaced." Some 23 centres, 49%, were non-compliant due to poor structural or decorative condition. There were 54 child admissions to 15 adult units. While the trend is down, that is still totally unacceptable. The report remarked on the poor quality in monitoring the physical health of residents and the impact of staffing shortages, and the final thing I will mention is the delayed discharges in Galway. The Mental Health Commission spoke of patients being there for more than six months. I would like a breakdown of that figure because some have been there for years.

I was very happy to co-sign this motion on mental health and am delighted to speak on it this morning. For me, when we talk about mental health and access to timely and affordable support, we are talking about everyone. Mental health should be like climate action; there should be a cross-party, all-Government committee and it should be taken into consideration for every aspect of policy making. I heard the Minister of State speak of legislation. I hope that does not end up like the climate action legislation, which waters down everything which had been proposed. It concerns me because while we are very good at passing legislation, we are very bad at implementing it. If we only implemented the legislation that exists at present, we could have a process that works very well for everyone.

What better way to address mental health supports than to actually listen to people? A great deal of talk therapy is just having someone to listen, and depending on whether it is cognitive behavioural therapy or other forms, it is about a person having a safe space to talk through their feelings. Someone with €60 or €70 per week spare can access private counselling sessions. If someone cannot pay privately, he or she effectively is finished and will be obliged to wait and wait. Covid means that many will only have access to therapy online but what of those who do not have a computer, smart phone or safe space to talk to their counsellor? Undoubtedly, Covid has had a huge impact on people's mental health but our services were already diabolical before its onset. Although we are saying that we want to get back to that, we should set the bar much higher in terms of seeking to move beyond that.

What of those in emergency accommodation, a cramped hostel or in direct provision? What of those in distress but who also use drugs? Pieta House and other services will not provide emergency support to people who smoke cannabis. The suicide rate for members of the Traveller community is unacceptably high, as activists and advocates told the first meeting of the Joint Committee on Key Issues affecting the Traveller Community in September 2019.

If vulnerable, marginalised or targeted groups say "nothing about us, without us", we should listen. We should allow them space to tell us what they need and then we should do everything we can to take action. That will make a difference to people’s mental health, together with the resources for timely and affordable access to supports. I commend the Irish Examiner on giving a platform to trans activists, Noah Halpin, Aoife Martin and Fionn Collins at the weekend. I also wish to comment on two podcasts, "The Tortoise Shack" and "The Week at Work" with Dave Gibney and Clare O’Connor, which invited trans activist Lillith Carroll on to have her voice heard. It was a particularly tough week for trans people last week and I offer my full support, as always, but it is important that their own voices are heard.

We all need to create the space for people to feel comfortable talking about their mental health. Help must be available when someone reaches out. I ask that the Government accept this motion, fully resource the "Sharing the Vision" strategy, and not get caught up in thinking there is a need for new legislation, rather than implementing what we have.

This is a very important issue. As others have said, services were strained before Covid ever arrived on our shores, but the onset of Covid has had an enormous impact. We have no way of assessing its damage because people are cocooned or unable to access medical centres, which have great pressure on them. Tipperary is particularly challenged, as the Minister of State will be aware. I thank her for coming to visit us. There is a dearth of mental health beds there. The implementation of A Vision for Change destroyed our services. It took away our acute day hospital. We were promised a Rolls-Royce community service but, sadly, that never materialised. It is the same up and down the country and applied to many services but mental health services are acutely affected. In north Tipperary, people must travel to Ennis and in south Tipperary, which is a huge area, they must travel to Kilkenny. They do not want us in Kilkenny; it is nothing personal about matches or games, they are full from the south-eastern region itself, and have no space. The Minister of State also paid a visit there. She told us at a meeting that there was a lot of capacity in Kilkenny but that is not our experience. People cannot access it and it is costing a fortune in transport services and the delayed time of consultants driving to Kilkenny is farcical. The previous Minister of State, Deputy Jim Daly, acknowledged in the House and at meetings with the HSE and the Department of Health that Tipperary had a deficit of 15 beds which we were working to close. I wish the Minister of State, Deputy Butler, well - we are good friends and represent neighbouring constituencies and work on issues together - but I am devastated to hear that the HSE has moved away from that position. I note she was successful in having beds put into Waterford recently. They were badly needed there and there have been different reports on this point in the past but we need beds in Tipperary, full stop. We need access to interventions in order that when people have acute episodes, they do not have to go to emergency departments, which are packed and unsuitable. It is the same in any part of the country. There have to be dedicated areas for people to go when they are unwell, not something like a crowded ward. I will keep the pressure on. The beds and staff must be delivered, together with proper community services, to Tipperary, including south Tipperary.

Mental health is a huge issue in my constituency and throughout the country. I often say that we concentrated so much on Covid-19 that we took our eye off the ball for people with cancer or mental health stress. Some say there has been a huge increase in suicide. A proper register of people with mental health and death by suicide might show that those deaths might be at about the same level as Covid. Services have almost ground to a halt. People have been trying to get appointments for their young people who are in mental health distress but have been unable to do so, unfortunately. West Cork had a fabulous service in Cara Lodge in Enniskeane, which closed about two months ago.

It is incredible to think that a service like that, which was dealing with young people with stress and mental health issues and which was open for many years, was closed at such a vital time. Young people with issues relating to drugs misuse also availed of the services provided at Cara Lodge. It was stated that the opportunity was being taken to look at a different service. Cara Lodge could certainly have provided by a far different and better service than it was allowed to provide. The excellent staff of Cara Lodge are now fighting for redundancy packages. I have received so many emails from young people who had been there and who had emerged the better for it. Obviously, however, I am talking about a facility in west Cork, an area that does not come on the Government's radar. I mentioned the matter to the Taoiseach - I should have telephoned Boris Johnson because I would have got a better response - but he did nothing and sat idly by.

People are dealing with high levels of stress. During the pandemic, people in rural areas have not been able to go down to their local pub to have a little drink or whatever. This does cause stress. There is no reason as to why the rural pubs had to be closed. Rural pubs could have remained open. God knows that publicans are the most professional people in the world when it comes to dealing with individuals with mental health issues. If these pubs had remained open, people would have had a chance to get out and have a break and a chat. However, they were prevented from doing so. I have been receiving quite a number of calls from people who are supposed to be getting married and who cannot even have a little music - not dance but music - at their weddings. That is very sad, particularly in these times. People have said to me that live music is a great source of relief.

We then have people who tell me every day of the week that they cannot sleep because of mortgage distress, because they are trying to work with the banks and because they are losing their homes. Many publicans have informed me that they are trying to work with the banks because their premises are closed. The banks are just ignoring their pleas and are literally just taking their businesses off them. These people are at the edge and the State is standing idly by and allowing this to happen. We closed these people's businesses but we do not assist them in any way other than throwing crumbs to them during these times.

Covid has shown us that mental health issues can arise as a result of people being lonely. Deputies Michael Collins and Mattie McGrath referred to this. Mental health issues in rural settings are on the increase because everything is closed. In the context of children and families, as Christmas approaches, drive-through Santa's grottoes are either being closed or cannot go ahead.

What is the Government doing? People need to meet. In that context, they can take personal responsibility and safeguard themselves and the people around them. The Government should empower people so that they can go out and meet each other in small groups and at small gatherings in, as Deputy Michael Collins just stated, settings like rural pubs. A publican in a rural area contacted me during the week and stated that his pub is not about drinking, it is about meeting friends, it is a home and it a way in which people can communicate. This is because that pub is the only thing left open for them.

I am asking the Government, in the context of Christmas, to have a small bit of common sense. This message is also for Dr. Tony Holohan. People in rural Ireland and in rural Limerick have common sense and they can take personal responsibility. The Government should empower them in order that they can meet others in a safe environment this Christmas. There is a minority in all groups that has no respect for anyone. However, the majority of people have respect for themselves and for those around them. For people’s mental health this Christmas, the Government should give them a small bit of credit that they will do the right thing and let the authorities deal with the people who do not.

I receive phone calls every day from people who are stressed. I received a number yesterday from people who could not bring their children to see Santa Claus. For God’s sake up, the Government is not a dictatorship. It should empower people and allow them to behave reasonably and sensibly. Those who do not behave in this way should be dealt with by the heavy hand of the law.

I am conscious that I missed Deputy McNamara and I apologise to him. I am giving him two minutes because that amount of time is available. I will then ask the Minister of State, Deputy Feighan, to respond.

I thank the Ceann Comhairle and I very much appreciate being facilitated in contributing to the debate on this very important issue.

The Minister of State, Deputy Butler, sat over there when I spoke in the debate relating to the rolling over of emergency powers. I asked what mental health data was being considered and I was told that it would be published. Since then, I have ascertained that there are essentially two bodies collecting mental health data. The first of these is National Self-Harm Registry Ireland. We know that its work ceased during the first lockdown and that it recommenced collecting and collating data at the end of August, both prospectively and retrospectively. As of now, we know that we only have that data in respect of 45% of hospitals, or 12 of the 36 emergency departments in the country. I say to the Minister of State that this is simply not good enough.

I have been informed that public health doctors consider mental health data. Let us not worry that National Self-Harm Registry Ireland is not functioning because there is a HSE national clinical programme for collecting data on patients presenting to emergency departments following self-harm. That programme is run by the HSE and the College of Psychiatrists of Ireland. In a parliamentary question I tabled, I specifically asked for the information collected by this programme and I got nothing back. I presume that public money is being used to facilitate the collection of this data. I am assuming that there is no data because if there was, I know it would have been provided. Does the HSE consider it good enough that there is a programme for collecting data which does not collect this data? As already stated, the programme is jointly run by the HSE and the College of Psychiatrists of Ireland. We are told, and I believe, that psychiatry is data-led and that it is an empirical science. Does the College of Psychiatrists of Ireland think it is good enough to proceed without data? I am of the view that it is simply not good enough.

Finally, I want to flag the lack of information on suicide in Ireland. The reason that we do not have centralised or up-to-date data is because there are 37 coroners' districts but no centralised database. An Garda Síochána has to investigate causes of death if a deceased person has not been very recently attended to by a doctor. In 2000, a review carried out by the then Department of Justice, Equality and Law Reform recommended that there be a centralised database for all coroners in Ireland. That report was produced 20 years ago this month. I call on the Minister of State to act in respect of the three matters to which I refer, namely, the provision of a centralised database, the position regarding National Self-Harm Registry Ireland and, above all, the national clinical programme which the HSE is running - by means of moneys provided by the taxpayer - in conjunction with the College of Psychiatrists of Ireland and which is not providing any data to anybody.

I thank Deputies from across the various parties for moving this very important Private Members' motion on mental health and Covid-19. I echo what my colleague, the Minister of State, Deputy Butler, said in her opening remarks about this issue being raised during what has been a difficult and distressing period for most people.

As stated at the outset, the Government is not opposing the motion. In fact, we welcome the opportunity to discuss the very important topic of mental health. I assure the House that people’s physical and mental well-being have been priority considerations for the Government at all times during the pandemic. This has been reflected in the policies introduced to safeguard the well-being of the entire population, including targeted initiatives for priority groups.

The Minister of State, Deputy Butler, highlighted many of the initiatives that have been introduced or accelerated as part of the Government’s response to Covid-19. In addition, we have introduced specific, targeted initiatives aimed at dealing with issues affecting vulnerable groups. For example, the programme for Government contains a commitment to retaining specific actions for improved access to addiction services during Covid-19. To this end, €480,000 in once-off funding has been provided to support the restoration of drug and alcohol services during Covid-19.

Budget 2021 also provides an allocation of €175,000 for initiatives relating to the victims of domestic violence and the LGBTI community. From this allocation, €50,000 will be provided for online training programmes for health care professionals responding to victims of domestic violence.

The worldwide outbreak of Covid-19 is a source of significant stress, anxiety, worry and fear for many people. This arises from the disease itself, as well as from impacts such as increased social isolation, disruption to daily life and uncertainty about employment and financial security.

A number of studies have been conducted in an attempt to measure the impact of Covid-19 on our mental health and well-being. These include the Healthy Ireland survey, an annual interviewer-administered face-to-face survey commissioned by the Department of Health. It monitors the health and well-being of people living in Ireland. It was paused at the commencement of the Covid-19 restrictions because collecting data face to face is not compatible with those restrictions. The survey fieldwork has started with a new phone questionnaire, with an emphasis on living with Covid-19. It includes a module on mental health and suicide, and the results will be available next year. The CSO has published four rounds of its survey on the social impacts of Covid-19 in Ireland. The results provide data on people's lifestyles and well-being at various stages of the pandemic and levels of restriction. Results of the surveys can be found on the CSO's website.

Additionally, research and a number of studies have been conducted by third-party organisations, including the National Suicide Research Foundation, Mental Health Reform and an international Covid-19 psychological research consortium. The studies examined the impact of Covid-19 on mental health and well-being, and results of these studies can be accessed by contacting the relevant organisation. The Government and mental health services have been particularly active in response to the pressures placed on people's mental health due to Covid-19. In this regard, we recognise the importance of dealing with any non-specialist mental health issues, such as anxiety, before they become more severe. With this in mind, a cross-party Government well-being campaign, In This Together, promotes resources and initiatives from across government to support health and well-being under Covid-19 restrictions. In addition, a well-being and resilience campaign was recently launched, under the theme, Keep Well, to promote resilience, physical health and well-being, and positive health. A sum of €7 million is being invested in this campaign to support initiatives with a range of partners. Included is a component entitled Keeping in Contact, which includes the Community Call programme. It is aimed at people who might be experiencing isolation, and it offers befriending services.

Simple things like keeping active, staying connected, switching off, being creative, eating well, minding one's mood and socialising, while adhering to social distancing and hygiene guidelines, all help to maintain our mental health. However, if someone is feeling low, depressed or vulnerable, the Department, in conjunction with the HSE, has developed many telehealth supports. These may be accessed by contacting the mental health information telephone line 1800 111 888. Alternatively, they may be accessed online at www.yourmentalhealth.ie. In addition, the Minister of State, Deputy Butler, has circulated a mental health information leaflet to 4,000 schools throughout the country to promote awareness of existing mental health services and supports for children, young people and their families. It contains many contacts from many of our NGO partners, including Jigsaw, MyMind, BeLonG To and Pieta House. As mentioned by the Minister of State, it is recognised that vulnerable groups have been disproportionately affected by Covid-19. In response, the Department of the Taoiseach has established a cross-government group for higher-risk groups to achieve this.

Covid-19 has highlighted the vulnerability of people in homelessness and with an addiction. They comprise a group with complex health needs. The HSE has established the Covid-19 Dublin homeless response team and has appointed a HSE clinical lead for the Dublin Covid-19 homeless response. The team co-ordinates the response for the homeless population across the Dublin Region Homeless Executive area. It must be acknowledged, however, that the impact of Covid-19 on socially excluded groups was greatly minimised by the intensive and collaborate approach of the Government, the HSE and society. Socially excluded groups in congregated settings are subject to priority action in detection, case management and contact tracing. A fast-tracked, flexible approach was used for complex cases in these communities. This enabled rapid action and minimised further spread.

The HSE has provided Covid-19 guidance for homeless and vulnerable groups. The guidance document gives general advice on preventing the spread of Covid-19 in homeless settings and other vulnerable group settings, including direct provision. In Dublin, more than 1,000 additional beds were provided, and 400 additional beds were put in place in other local authority areas nationally. The actions being taken in this area are supported by funding provided to the local authorities by the Department of Housing, Local Government and Heritage. Furthermore, €5.5 million is being provided to enhance health services for people who are homeless and with an addiction as part of the HSE's winter plan. This will ensure that the protective public health measures developed during the pandemic will continue for the medically vulnerable homeless population.

The interdependence of physical health and mental health is was recognised. The need for a whole-person approach to achieving the highest possible standards of physical and mental health and well-being has been recognised in formulating our mental health policy, as has the need to support the wider psychological aspects of physical health. Key to the Government's response to Covid-19 has been enhanced co-operation between the Departments, agencies and NGOs. I thank all who have assisted in the mitigation of Covid-19 in all settings, particularly where vulnerable members of society live.

Next year, the HSE's service plan will reflect prioritised new developments across the health sector. These will include initiatives to improve the mental health of the nation through well-being programmes. In addition, the implementation of Sharing the Vision will have an increased impact on all age groups by focusing on mental health promotion, early intervention, acute care, forensic inpatient care and postvention supports in the community. Greater attention will also paid to improving the integration of mental health and other services, including primary disability services and the judicial sector. Sharing the Vision recommends the continued implementation of the national strategy and policy for the provision of neuro-rehabilitation services. I anticipate that this will act as an important enabler in the realisation of Sláintecare.

Let me address two issues that were raised. We are carrying out an audit of all mental health beds and capacity throughout the country. Twenty-nine new staff were secured in budget 2021 to tackle the CAMHS waiting list. These will be targeted directly at the waiting list.

I thank all Members for the opportunity to discuss the important issue of mental health. I thank them for their input, which will assist us in improving the service.

The Government's response to Covid-19 to date has been nothing short of seismic as Ireland borrows billions of euro to protect against the worst outcomes of the pandemic. Recent positive news regarding the development of a vaccine is pointing the way to an exit from the coronavirus but the lessons of lockdown and its resulting effects will last for a very long time.

Our social fabric has suffered intense change and damage, which can be seen in current and future challenges to business, health access, livelihoods and mental stability. We have long known about the stigma associated with mental health issues but I doubt if anyone could have predicted the scale or range of the problem, or how isolation, financial hardship, addiction, loneliness, antisocial behaviour, unemployment uncertainty and damage to personal esteem could result in mental health challenges that are so varied and intense for so many.

In truth, our mental health services have always been challenged in trying to look after the chronically unwell. This has been exacerbated by significant underfunding in services and in capital allocations for many years. We may not be able to quantify fully the number of people suffering from mental duress but we are aware of many of the situations involved, the cases where mental breakdown, depression or suicidal ideation is occurring.

We think of the bachelor farmer who can go weeks without interacting with a single human being, the semi-skilled worker realising his well-paid job will never return and the business start-up that has failed and left the promoters with significant personal debt. We think also of the under-30s who find themselves unable to provide bankable employment such that they can get onto any step of the property ladder and the couples who wish to undertake IVF to begin their families but have no realistic chance of saving the money, thus being denied the gift of parenthood. We think mostly of the socially vulnerable who have started with a poor hand of cards, many of whom are targeted for drug addiction and migrate into homelessness and endless social exclusion. Not all of these situations have been created exclusively by Covid-19 but are being exacerbated by it.

The State's response to these challenges must be as full as the strategy plan devised to combat the coronavirus. Point 1 of that plan recognised the importance of individual life, regardless of age, and sought to protect it by deploying vast revenues to meet the challenge. The epidemic of mental illness in this country must also be prioritised and similarly targeted. A two-track approach to dealing with the mental fallout of Covid-19 should be considered. For many, this can be achieved through integration with primary care, the GP community and social care concerns, with help from non-governmental organisations, NGOs, as well as social security supports.

For those suffering more severe mental illness, ongoing institutional supports are needed and capital assets must be expended to meet this need. In my city of Waterford, our regional mental health acute services consist of a single facility of 44 beds with no access for children beyond emergency overnight admission. That is a region of 600,000 people and one of the nine model 4 category hospitals in the country. Underfunding has been a constant refrain for decades in south-east hospital services. We have had years of promises of capital asset upgrades to our adult mental health services and to provide continuing child psychiatry access. To date, these promises remain hollow and unfulfilled.

The Regional Independent Group motion calls for the Government to protect our population's mental health. It makes many calls on the Government to prioritise, build, implement and deliver. It also calls on the Government to build our human resource capacity to deliver on mental health and social care. It asks for mental health to be prioritised as a central part of the Government's continuing response to Covid-19. It asserts the need for the Government to re-establish a dedicated lead for mental health within the HSE executive function and to ensure that mental health is part of the universal health coverage by including care for mental health, neurological and substance-use disorders. Most of all, the motion calls on the Government to act based on the core understanding that we cannot value that we which we do not respect, or respect that which we do not value. It is time for the Government to value the work of our mental health services fully and to show due respect to those who require them. We cannot solve the national problems of mental health until we understand and adopt the position that we have taken to combatting Covid-19, that is, understanding that we are all in this together. We need a new, dynamic, co-ordinated response and I would argue that the basis of such a response is contained in this motion, which I commend to the House for approval.

I welcome this important motion and praise the Regional Independent Group for bringing it before the Dáil. I would like to give a special mention to Cáit Nic Amhlaoibh, who did massive work in the development of this particular motion. This is a strong motion and, if implemented, would make a radical change to hundreds of thousands of lives around the country. I also welcome the fact that the Regional Independent Group has done good work in trying to get cross-party support for this motion. I ask that the Government does not just give a nod to this motion if a vote is required but takes the bull by its horns and implements it. We would be wrong to think that all of the words that have been articulated in the Dáil with regard to mental health over the years have made a difference in people's lives. The truth is that we need to put actions where goodwill has been articulated in this Chamber.

I would like to take the lens back a little bit, if I can. The society that we are building throughout Ireland at the moment is having an increasingly negative impact on mental health. Families are pressured by work and commuting. Children have to deal with social media and bullying. Alcoholism and drug addiction etc. also impact families. We can add to that the pressures that are now coming from Covid restrictions. An economic wasteland is developing among many sectors of society that will have an enormous impact on people's lives. The debt that has been accrued to this society, knowing the Government's track record, will likely lead to austerity over the next number of years which, in itself, will have a shockingly negative aspect on people's lives. Human interaction and relationships are some of the best ways to deal with mental health issues and they have been taken away from many people in Irish society.

Another aspect of all of this is the fact that the Government is no longer measuring the key indicators in this area. I have asked a number of key questions of the Minister for Health around suicide rates etc. and he has not been able to answer them. If one cannot measure, one cannot manage. I have spoken to NGOs that have told me that there are increasing mental health pressures on families around the country. I put in a parliamentary question to the Minister on the matter. He has admitted to me that he has received letters from NGOs which show an increase in mental health pressures and suicide rates during the pandemic. His response indicates that he has been contacted and that concerns have been expressed about the increase in suicides. However, the Minister, unfortunately, has not elaborated. I would like the Ministers of State, Deputies Feighan, also to look into that matter.

The increased restrictions have had an enormous effect on community-based mental health services. They have had to change radically the way in which they operate by shifting to remote consultations, telephone calls etc. Many therapies for drug and alcohol addiction have become one step removed from human interactions. That has significantly reduced their impact.

In the short time I have left, I want to talk about one important element. Consultants have spoken to me in depth about the fact that there is a shortage of psychiatric beds in Ireland at the moment. The situation is actually getting worse because Government policy has been to reduce the number of psychiatric beds despite the fact that we already have one of the lowest proportions of beds per capita in the developed world. My county of Meath is a microcosm of that. Four or five years ago, we had a 24-hour mental health unit in our local hospital. That was closed by the Fine Gael Government and now the 200,000 people living in the county have to go to County Louth to access services. We were told that we would be left with a day hospital for mental health services in County Meath but the trend has continued in exactly the same way and that day hospital has been closed in recent times. People from right across the county have to exit Meath to get to mental health services. That is a county with probably the fifth highest population in the country. In real terms, by closing beds, we are sending people into either homelessness or prison. We are sending them into difficult situations.

I call special attention to older people in our society who have been the most exposed by the Government during this pandemic. We have lost an enormous number of older people in the past year. Well over 1,000 older people have died in nursing homes because of the pandemic. They are under increasing stress and strain and now have to deal with isolation and the lack of human interaction with their families because they do not get the level of visits that they normally would. They also now have the question of the vaccine coming in front of them. I ask the Ministers of State, Deputies Feighan and Butler, to do their best to make sure that we get supports to older people so that they can deal with the stresses, strains and threats that they are experiencing within nursing homes.

Question put and agreed to.