I thank the committee for the invitation to attend today's meeting. I am here in a private capacity, as the Chairman noted. The members are all aware that A Vision for Change was published in 2006 and it has since provided the framework for mental health policy. It is unusual in that the policy has been accepted across parties and everybody sees that A Vision for Change is the policy framework. As we all know, the big problem has been in implementation.
Today I will consider the framework for the delivery of mental health supports and services, and in doing so I will deal with three matters for discussion. The first is the wider view of mental health supports and services. The second is the establishment of an interdepartmental group at national level that would deliver locally; it would be a cross-governmental working group. All of us are in the community health care organisation areas and we can influence what is happening in these areas because we live there. Although the issue is national, it is also local and it affects everybody. The third area on which I will speak is the Mental Health Act 2001, particularly the amendment of the Act to include the idea of an approved clinician. I will speak to that later.
When speaking about mental health services, we must take a wider look as it involves both supports and services. In the documentation there is a diagram from A Vision for Change and the members are familiar with it. It highlights the matter. Community support, primary care and mental health services are outlined but the vast majority of people, or 90%, are seen within that big area. It is where GPs and primary care comes in and people with mental health difficulties use them for help. We need to create a public awareness and shared understanding of what is mental health. This is about mental health supports and early intervention at an early stage. It is about delivery for mental health services. Mental health is a continuum, as we all know, and we can all get into difficulties. We do not necessarily need mental health services but we need early intervention. If we are lucky we get it from family, friends or community but we can also get it from GPs, who are the gatekeepers of services and support. In creating a shared understanding of mental health, we will have the key to the delivery of effective services. It will help young people and adults to assess services. If we have a prevention model, we will be able to do our work much more effectively. We know from international research that 75% of all mental disorders have already begun under the age of 25. The early intervention is important.
Within the GP service and community there is an array of elements. I will leave my colleagues to speak for GPs and primary care, and I am sure they will do it more effectively than I can. There are other people in the community, including nurses, psychologists and counsellors. There is an array of people in that community. One of the problems - with due respect to colleagues - is that not all GPs know about these services. They do not have the time but they are still the gatekeepers. We need to consider how we resource GPs and that community service. In the wider group of mental health elements, there are a number of issues to be considered. We are beginning the process.
As political leaders in this area, the members can make this happen. We need consultation and advocacy at an early stage. We need awareness and training for GPs, teachers, youth leaders and communities. This includes members of the GAA, rugby and soccer, as well as all kinds of organisations that meet young people. We need to examine how to be more effective with online mental health supports, which are really important. I do not know if the committee is familiar with reachout.com, which is geared towards those aged between 18 and 25. It is for young people having difficulties rather than young people with severe and disabling disorders.
We need to promote families and support them to promote mental health among their young members. We must also support schools and third level institutions.
If we have that within the lower section to which I referred, and I believe many of these services are in place, we need to ask ourselves how we align supports and mental health services and provide access to them. What do we need? We have the building blocks in the community but we need to change the system. I will cite the example of the child and adolescent mental heath services, CAMHS. We all know given the prominence of the issue in the public domain that there are waiting lists for CAMHS. These waiting lists are symptomatic of a system that is fragmented, with referrals for support often inappropriately going to CAMHS. If we spent all our time and effort eliminating waiting lists, we could do so but they would return after a month. We must ask, therefore, what is wrong and the answer is the system. We know, for example, that five of the nine community health organisations, CHOs, do not have waiting lists of more than a certain time. What is needed, therefore, is effective leadership, co-ordination and teamwork, close to full staffing and no recruitment problems.
While members may be aware of this, I was surprised to learn that almost 100,000 staff support young people in different way. They are funded by the Government for mental health supports and services and almost €300 million is spent on youth mental health. This is all documented very well in the Pathfinder report. There is also no single policy for youth mental health or a single Department responsible for it. The focus has not been on local circumstances or areas. What do we need? The joint committee can make a major difference in this regard. We need a system change because while the blocks are in place, the system is not working effectively. We need an interdepartmental working group consisting of representatives of all the Departments and agencies, as well as non-governmental organisations working in the community. This national body could deliver mental health services effectively by providing national co-ordination. Locally, a liaison person would be in place who would help signpost in each CHO area all the services and supports available in the area in question. He or she would also work with general practitioners and identify gaps in services locally.
Some members may remember the severe jobs crisis the country experienced in the early 1990s when unemployment in certain areas stood at between 30% and 40%. At that time, the Department of the Taoiseach brought together representatives of the relevant Departments, agencies and communities to address the issue of jobs. This was a highly effective approach and I suggest we adopt a similar strategy in the area of mental health, taking an overarching, a cross-departmental and an across-Government approach. While there is another approach, it would take longer implement. We should start, therefore, with the area based approach. There are legal requirements in the Public Service Management Act 1997 but the changes required could be made over time.
I suggest that we have a liaison person in each CHO area to co-ordinate the provision of supports and services and identify gaps. These individuals would work to standard operating procedures and there would be appropriate communications protocols, standard assessment processes and co-ordination of the services. This approach would cut waiting times immediately and standardise referral processes. People who badly need mental health services would have access to them, while all others would be directed to general practitioners and community services. There would be an appropriate intervention at a time, place and pace that is appropriate for the person and it would be much more effective. While these changes are under way, systematic change is needed to make a real difference. The importance of interagency co-ordination cannot be overstated. I ask the joint committee to consider this proposal.
My third point relates to the Mental Health Act. I refer specifically to the emphasis placed on the consultant psychiatrist in the Act and the consultants' contract. This is viewed as an impediment to multidisciplinary working. However, a review of the Mental Health Act in 2015 did not recommend introducing the role of "approved clinician" but proposed instead that the matter be considered again. I ask members to consider the introduction of the role of approved clinician, which has been introduced in other countries very effectively. It has been in place in the United Kingdom since 2007, for example, and could be introduced here through a statutory instrument.
There is good evidence that multidisciplinary working can be achieved and lead to approved outcomes. It is not possible to become an approved clinician overnight and a person must complete extensive training and do considerable work to achieve this designation. However, there is also a supporting training programme which has been developed in the United Kingdom. It is known as the choice and partnership approach or CAPA and has been used in Australia, New Zealand, Canada, the United Kingdom, Malta and Belgium. I understand its use here has commenced. The value of the programme is that it enables people from different backgrounds to work together more effectively. While I do not have time to discuss it in detail, at the end of the process an administrator makes appointments for all team members without consulting them. This means the diaries of all team members are put together. This approach has been highly effective in other countries.
I ask the Chairman and members to help make the changes I have set out. The first step would be to make a statement about the wider view of mental health supports and services to help people to understand the complexity of this issue. It is also a simple issue, however. Most of us are at the lower level to which I described and any of us could need help at an appropriate time. However, we will never get it if we have to try to access it at the high level. Members should help people to understand this. This does not require money but belief and commitment.
I ask the joint committee to propose the establishment of an interdepartmental working group to create policy at national level which would be delivered locally. As such, members would know what was happening in their respective areas. They would know what services were available and what could be delivered. This would be very powerful as it would mean everybody could effect change.
The final change would be to amend the Mental Health Act to introduce the role of an approved clinician. I thank members for their attention.