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Seanad Éireann debate -
Wednesday, 4 Dec 2013

Vol. 228 No. 2

Mental Health Services: Motion

I move:

That Seanad Éireann:

- notes the Government's commitment to invest €20 million in community-based, patient-centred mental health services in Budget 2014;

- welcomes the appointment of the new Mental Health Services Director;

- notes that the total commitment of this Government to mental health is €90 million to the end of 2014;

- notes the recent publication of the Assisted Decision-Making (Capacity) Bill 2013 to replace the Lunacy Regulation (Ireland) Act 1871;

- notes the changed awareness among the public about mental health and the greater openness around mental health;

- notes the increased demand for services in the past five years;

- notes the global research in relation to the predicted rise in dementia and Irish figures showing a predicted rise to 140,000 sufferers in the next thirty years;

- notes that research shows that, in line with international studies, an estimated 14% of the population has mental distress;

- notes that the Government's agreed mental health policy “A Vision for Change” supports community-based services which are managed and targeted at specific groups; and

asks the Government to ensure that:

- the community will remain central to the provision of mental health services into the future;

- the staffing levels will continue to be increased, especially in relation to suicide prevention;

- services for children and adolescents (CAMHS) be strengthened and accelerated; and

- the community-based teams will be strengthened to ensure the delivery of targeted services.

I welcome the Minister of State to the House. We are here to take stock of the progress that has been made in mental health and to urge the Government to continue the commitment to the very serious challenges facing those with mental health problems and those responsible for the delivery of mental health care. I know the Minister of State has a personal commitment to this, which is welcome and vital, but it is impossible for her to drive it forward all by herself. The building and strengthening of commitment across the HSE is crucial to the future success of mental health care in this country but we are lucky to have an advocate like the Minister of State leading that charge.

We have moved a long way from institutional care as the default position for those with mental health problems and issues. A Vision for Change set out a very clear person-centred treatment approach with an integrated care plan literally looking after each person as an individual. That is hardly rocket science as this is exactly what we provide for people with physical illnesses. A Vision for Change remains an important shift in culture and attitudes towards people with mental health issues - a shift which had to be urged on and compressed in time as we become increasingly aware of our responsibilities to those with mental health issues. It is a shift in attitude which the health services above all must accept and implement. Statistics show the mountain that we must climb. One in three people visiting a family doctor has a mental health aspect to their medical problem. Of those who live to 65, one in nine will spend some time in mental health care. Another way of putting it is that 14% of the population has some kind of mental health issue or that 43% of young adults said they had contemplated suicide at some point with 7% having made an attempt on their lives at some point.

There are many ways to provide statistics and increased statistical research is vital for the Minister of State's planning, the delivery of services and budgeting. I am sure that over the years, the Minister of State has seen many pieces of research and many statistics but the important thing is that our friends, neighbours and family are suffering from mental health issues and it is up to us to respond to that. I wonder if the numbers are rising as we become more open about mental health and more people feel able to seek help. Will we see a bulge? There are statistics showing calls to various helplines and mental health charities would all record some surge in people coming forward. I wonder if this is in part due to that. Perhaps that will settle at some point. I am not sure. It is up to all of us to own mental health, to be responsible, to talk and be open about it, to support those who have issues and problems and who are ill and to reduce the stigma and discrimination that have accompanied it. I know the Sea Change programme, which is now in its third year, is continuing that work at a local level. It encourages people to tell their own stories and trains people and organisations to understand at a very local and personal level and to be more aware of our mental health.

The removal of institutional care and its replacement is a huge gear change in management, work, attitude and cost. It is, of course, a cost to recruit new posts, train those already there, provide new services, tailor existing ones and step up care for those at risk of suicide. We welcome the Government commitment of €35 million in the 2012 budget, a further €35 million in 2013 and €20 million in Budget 2014. That is a total of €90 million that is ring fenced to modernise mental health services and, in particular, to strengthen community teams which deliver those services.

There has been much public debate about the speed of recruitment to the posts in question. That has caused an issue but we must always step back at this time and say that finding hundreds of people with the right mix of experience, skills and availability is never an easy task. However, I am grateful for the Minister of State's reassurance that substantial progress has now been made in recruitment for these posts. I see figures that show that the recruitment process is well on the way with 93% of the 414 posts that were approved in 2012 in place. That is evidence of the hard work that has been done. I trust that the HSE's national recruitment service will continue to prioritise these appointments as this is the best way to bring about the changes demanded by A Vision for Change and other research.

Senator Moran, who will be seconding this motion, will address child and adolescent mental health services. One of the basic headlines there is the urgent need for children and young people not to be in adult units. Again, there has been progress in that area but I see that some children are still in adult units and I know that is something none of us would wish to see continuing.

Primary care has received an allocation of €7.5 million for counselling for people with mild to moderate psychological difficulties. Again, this is a very practical approach. There are ten councillor co-ordinators and I know the Minister of State, Deputy Lynch, and the Minister of State with responsibility for primary care, Deputy White, helped to launch this initiative earlier this year. This is a very practical way of listening to people on the ground and asking what will work and how we can help. These are the kind of services that often do not get talked about and it is opportunities like these that allow us to praise that work because it is appropriate.

Many of us here in the Seanad and many of our colleagues in the Dáil have discussed and debated suicide, bullying and cyberbullying so I welcome the recent decision by the Minister for Communications, Energy and Natural Resources to launch the Internet Content Governance Advisory Group, which is the first such body specifically tackling the bullying of young people on-line and looking at content and how we safeguard it. The Minister for Education and Skills often spoken about bullying. I know that the guidelines for mental health promotion and suicide prevention were launched with the Minister of State earlier this year and there is a new action plan on bullying. An anti-bullying forum centred around homophobic bullying was launched with the Minister of State and the Minister for Education and Skills.

Much work has been done involving small pieces of work which themselves are very significant and practical. The National Office for Suicide Prevention continues with its various campaigns, some of which we have seen on television such as Let Someone Know, which is aimed at younger people aged under 18, and Please Talk, which is aimed at third-level colleges. Again, these are the kind of practical things that people say they never hear being done. Well they are being done, which is welcome. The National Office for Suicide Prevention supports many local organisations such as Pieta House, the Samaritans, SpunOut, SOS and Inspire Ireland - organisations that are dedicated in this area.

A local organisation, talkaboutit.ie, is active in Mayo and Sligo. During the summer, representatives of that organisation took spaces at local festivals, among cattle, sheep, baking and flower arranging. Their presence is a testament to the new attitude that our mental health is nothing to be afraid of, that it is certainly nothing to hide, and that it can take its place along with all other activities and become much more normal. I pay credit to those sitting in tents for long hours waiting to talk to people and being there to remind us of the importance of our mental health.

We know young people are vulnerable. We need to prioritise them and encourage them to be open about their mental health. I pay tribute to the work of Comhairle na nÓg. Many of its groups have done very good practical work in individual schools with their peers, raising awareness, discussing mental health and producing brochures and videos. Again, this is small work but well placed. The young people doing that work are valued. Perhaps they are sometimes overlooked when we talk about the amazing amount of work that volunteers do.

The Minister of State was in the House for the debate on a previous Private Members' motion I tabled on a national strategy on Alzheimer's disease. As she knows, 42,000 people have dementia and the number of sufferers is predicted to rise to 140,000 in the next 30 years. I know she is in the consultation phase of the new programme for dementia and I look forward to that being published in the coming months. The World Health Organization recently published a document calling on countries around the world to treat Alzheimer's disease as a public health priority. Clearly, dementia patients have a very specific need. There is considerable research into preventing dementia or finding appropriate treatment for dementia. As the world's population ages - at least in the wealthy world - it brings the burden of this illness with it. Regardless of how we legislate, as a society we must come to terms with these figures and calculate how we will pay for them because we and our children will be such sufferers in due course. Irrespective of how good it might be, no strategy can possibly address that particular aspect. Debate and conversation at this and at every other level will be vital in changing the kind of cultural prejudice and ignorance of those with a mental illness that existed and still exists to some extent. We need to shake that off if we are to address those figures and try to do something about it.

I welcome the Assisted Decision-Making (Capacity) Bill, which started its journey in the Dáil yesterday. It will provide a statutory framework to support decision-making by adults who find it difficult to make decisions without assistance. How wonderful it is to be repealing Acts from the 19th century that use the language of lunatics and that in their very concept separated and, in effect, locked away those with mental illness. Safeguarding the autonomy and dignity of those with impaired capacity is welcome. I trust there will be a very robust and worthwhile debate on that legislation when it reaches the Seanad.

I know the Minister of State is looking forward to completing the review on the reform of the Mental Health Act 2001, a commitment given in the programme for Government. People often say we do not keep promises. However, the expert group has met on ten occasions and the heads of the Bill are being prepared. I am sure we will also have robust debate on that. That is a welcome reform and we are pleased with the progress on it.

The community of people working in the area of mental health - carers, nurses, doctors, policymakers, volunteers and patients - need a firm reassurance from the Minister of State and Government that the issue of mental health has turned a corner. We still have problems and hurdles, and people are still waiting for treatment or may not be getting the right treatment. That does not mean we are not making progress. This community needs reassurance that the direction the Government is taking of patient-centred, community-based care delivered by well-trained teams is the way of the future and of the present.

There is no turning back. Budgets will continue to be spent where they need to be spent, recruitment will continue to be a priority, the changes that have been hard won will be appreciated and built on, and the momentum kept up. It is a difficult task made more difficult by the difficult times in which we find ourselves. It will require perseverance and patience but our nation's health is at stake. Ultimately, we are all responsible for that.

I welcome the Minister of State, who is a regular visitor to the House. I commend Senator O'Keeffe on bringing the motion to the House. I second the motion.

We have had many discussions on mental health in the past two years. I commend the Minister of State and the Government on the work that has been carried out and the promises that have been kept. They include promises made before coming into government and the promises in the programme for Government. I welcome the Assisted Decision-Making (Capacity) Bill that is before the other House. I attended a briefing by members of Inclusion Ireland who outlined how vital it is to give people the opportunity to make decisions where and when they possibly can in order that others are not making decisions for them when they are quite capable of making the decisions or perhaps just need to be assisted.

We have had debates on A Vision for Change and so forth. I would like to focus on areas where I would like to see improvements. First is the area of the inpatient child and adolescent services. A Vision for Change recommended the provision of 80 child and adolescent psychiatric inpatient beds, whereas there are only 44 between Dublin, Cork and Galway, which is not enough as I have mentioned on several occasions in the House. I know there will be an improvement in this. It is very important that children and adults are not mixed. I welcome the plan to phase that out, and although progress has been made in recent years, it has not been quick enough. There is a huge gap in the provision for 16 to 18 year olds. From my dealings with youth groups and people in statutory and non-statutory bodies working with young people of this age, it is clear this is of great concern.

When patients see a doctor, it is important they do not see a different doctor at each visit. I understand that doctors may be on rotation, but continuity should be maintained as much as possible.

The link between statutory and non-statutory bodies is very important. The HSE is carrying out excellent work. In my area we have St. Brigid's and the Ladywell Centre in the community doing excellent work under the HSE. The waiting lists are far too long, which is a problem everywhere and needs to be addressed. A new mental health service facility will be available shortly in Our Lady of Lourdes Hospital in Drogheda. I ask the Minister of State to ensure that will not encroach on the existing service in St. Brigid's. It can be a long journey for people based in one end of the county to have to go to the far end of the county. We need to consider that these are vulnerable people who may not able to able to make long journeys or who have become very used to where they are going.

I pay tribute to the work done by Comhairle na nÓg. The Comhairle na nÓg in Louth has done tremendous work in the area. Last year it produced an application highlighting the services available. The young people are much more forthcoming in speaking about their mental health than we were at this stage.

We talk about the improvements in mental health and that people are coming out but we have much to learn from those young people.

A Vision for Change contains a list of recommendations. They are not obligations. People are not obliged to accept them but we must ensure that schools take on the existing policies on mental health and suicide awareness because if they do not buy into them, they will be lost. They are recommendations in A Vision for Change but we could go further. We have an anti-bullying policy and a policy on the discipline problem but it is very important that we have a mental health policy for each school.

I mentioned previously to the Minister of State that a year ago in my area we had a public meeting in Dundalk of all the different agencies, statutory and non-statutory bodies and organisations providing services for people to promote positive mental health. From a personal point of view it was good for me to become aware of the different groups, and I am sure I will omit to name some of them. We have formed a forum where once a month somebody on the steering committee delivers a talk on this area. There are many agencies and groups involved in the forum but within the steering committee we have members from SHINE, Grow, the Dundalk Outcomers, a member of the Garda Síochána, a member of the Health Service Executive, members of suicide awareness groups in Dundalk and a member of Comhairle na nÓg. We have a representative of every aspect of society who delivers talks on this area but it is amazing the amount of information each of us individually and each of the bodies have fed into one another, so to speak, in that they were not fully aware of the service the other was providing. Once a month we have a talk on cyberbullying or suicide awareness. We did the SafeTALK. Last Monday we did one on coping with adolescent anger, which is a major problem for many young people who do not even realise that what they are feeling is perfectly normal but who become concerned and believe they have a mental health problem. Those talks were very well attended, and it does not cost money to hold them. Funding is not required. We simply meet to try to promote positive mental health. That is a cost effective way we can help to improve the mental health services in our community.

I welcome the Minister of State to the House and thank her for making herself available again. I commend the Labour Party group for bringing forward this motion, which we will not be opposing. I am glad to have the opportunity to highlight some issues in this area about which we have concerns.

Of all the jobs of the Ministers of State, I would hate to have the Minister's job. There is no better person for the job than her good self but it is very difficult because we know there is so much that needs to be done.

I must now criticise the Minister of State's colleagues by stating that mental health is the poor relation when it comes to budgeting. If €30 million is needed, it will be taken either from the Minister of State's budget or she will be last to get it. That is fundamentally wrong and it is a failing of all Governments over the years, not just this one. That will be the constant challenge facing the Minister of State. I wish I could go around to Merrion Street and pull out €100 million for her budget. There has not been such cross-party unity on a policy like A Vision for Change. It is a sad state of affairs when we know so much of what needs to be done and we are not capable of doing it because of money. A councillor in Sligo had a saying that the stones on the road know what needs to be done. It is just a case of getting out and doing it.

As matters stand, a great deal of excellent work is being done in isolation in trying to tackle the many challenges in this area. As John Saunders, the chairman of the Mental Health Commission, said, what we have in many instances is football teams with only half their players. Senator O'Keeffe said that while there are difficulties in securing enough qualified people as quickly as we might like, and I know that some progress is being made on that, what is unforgivable on the funding side is this €35 million, which seems to be the first service to be targeted every year. I promise not to be political in this debate but I read a comment that the Minister of State with responsibility for mental health, Deputy Kathleen Lynch, complained bitterly and colourfully about being kept in the dark on her own budgets. I agree and I can imagine that happening. The point is that it is the first funding to be taken.

The commitment for 2014 in the budget is €20 million, which is 42% less than the €35 million allocation. A commitment has been given that this gap will be made up in 2015. Does that mean that provision will be €50 million in 2015? Has the Minister of State a commitment on the ring-fencing of this funding or will it be the case that when the Minister, Deputy James Reilly, is nursing whatever deficit there will be this time next year, that €35 million allocation will be the first taken and the issues that arise in terms of the implementation of A Vision of Change will be put on the back burner once again because they are seen by so many as expendable. Its implementation is seen as a slow burn, step-by-step exercise and we fool ourselves into thinking we are moving in the right direction, but Rome was not built in a day.

The stigma associated with mental health is a major issue. Senator O'Keeffe said that one in three people who go to a GP attend for a mental health issue, but one in four of all of us will have a mental health issue in our lives. I have had a mental health issue. One in three of us hyperventilate or have panic attacks. Effectively, they signify mental distress and for many people that distress brings on such attacks. One in 20 of us will have suicidal thoughts. If I am filling out a form and I see a question asking if I have ever taken medication for depression, I find that offensive. What way is the answer to that question interpreted by people? What way is it taken into consideration when it comes to giving a person a job or in terms of the attitude taken towards the individual concerned?

In other debates I have highlighted a survey of Deputies taken two or three years ago by a marketing company. I cannot remember the broad purpose of the survey but one of the questions related to mental health and whether people with depression ought to have children, and 70% thought that they should not. That was the view of Deputies taken in a survey in the past three years. What hope have we got in changing the stigma surrounding this issue when we, the legislators, seem to have the view that if somebody is suffering from depression, ideally that person should not have children? It gives a picture of how steep the cliff is that we have to get up in terms of changing the view of mental health and getting and encouraging people to talk. The advertisements on television some years ago were very good in that they encouraged people to mind their mental health. Whether it is depression, the 'flu, arthritis or panic attacks, there are solutions to those problems and we must get that message out to the public. As both Senators mentioned, excellent groups are doing excellent work throughout the country but in isolation. We are not connecting the dots.

On the issue of suicide, Actions Speak Louder than Words was our Fianna Fáil document into which we put seven months work.

Senator John Gilroy has also done a great deal of good work in this area. Our document, which includes a range of useful proposals, was welcomed by the Minister of State's office. Everything is costed, with a total estimate of €90 million as the required funding to reduce the incidence of suicide by 30%. The problem, of course, is that there are 15 people at the Cabinet table seeking to lay claim to any moneys that are available long before they get to the Minister of State. As well as bringing forward legislation in this House to implement our proposals, as we intend to do in due course, we have also given consideration to how they might be funded. It is a question of seeking to harness the goodwill that exists among people who are effectively enjoying themselves as opposed to levying people who are selling alcohol. That touches on the whole off-sales area. Our proposal in this regard would bring in €150 million per annum. Given our estimate of a requirement for €90 million in funding specifically for suicide prevention, that would leave use with €60 million for the implementation of a A Vision for Change. In order to implement those measures, we need political will and leadership from the Taoiseach and his Cabinet.

Between now and this day week, eight men will have taken their lives. I will do everything I can, both inside and outside politics, to see the measures set out in our document implemented by whichever Government or series of Governments will do so. A very courageous young man called Brian McCann assisted with the research into the document to which I referred. Sadly, he lost his life in tragic circumstances a fortnight ago in Sligo, aged just 24. That has made me refocus my efforts to impress upon whomever is in government or has authority in this area to do something other than pay lip service to the need to reduce the incidence of suicide. The capital budget of the National Office for Suicide Prevention has not been spent in its entirety in 2013. Yet, as we saw during the course of our research, many schools have no suicide prevention policy, while those which do, in most cases, drew them up without any contact with the National Office for Suicide Prevention.

I will not go through all the measures set out in the document as it is available to Members. I wish the Minister of State well in her endeavours and we do not intend to oppose the motion. She will always have our co-operation to make progress in this area. I urge her, however, to fight harder for resources, because it is a lack of resources that is ultimately holding back progress. There can be no better person than the Minister of State in her role and she is doing a great job in very difficult circumstances.

I thank my colleagues in the Labour Party for bringing forward this motion and for their contributions to this debate. I assure Senator Marc MacSharry, as someone from the same constituency as the Minister of State, Deputy Kathleen Lynch, that she is well able to fight her corner. I have no doubt whatsoever that she will secure every possible cent for this area of the health care budget.

I propose to focus on one aspect of the motion, namely, services for people with dementia. It is an issue that will assume greater prominence in the coming years. In fact, according to Health Service Executive estimates, the number of people in Ireland suffering from dementia will increase from its current level of more than 40,000 to 100,000 plus by 2036. Advances in health care, better nutrition, improved working conditions and a reduction in poverty have all contributed to people living longer and generally healthier lives. Arising from these welcome developments is an ever increasing cohort of aging people. Unfortunately, one of the unforeseen consequences of improved health care, better social conditions and longer lives is a very significant increase in dementia, particularly Alzheimer's disease. While dementia should never be seen as a normal part of ageing, it is a risk factor for many.

As defined by the World Health Organization, dementia is a syndrome, usually of a chronic or progressive nature, caused by a variety of brain illnesses that affect a person's memory, thinking, behaviour and ability to perform everyday activities. Some 60% to 70% of dementia patients have Alzheimer's disease. Symptoms vary from the mild to the very extreme and the prognosis can vary considerably from person to person. A recent article in the New England Journal of Medicine estimates that the prevalence of dementia in the over 70s is of the order of 14.7%.

In Ireland, Central Statistics Office population projections show that the number of people over the age of 65 is set to rise from its current level of 550,000 to 1.3 million or more by 2041. During the same period, the number of people aged 80 or over is projected to increase from some 71,000 to 257,000. Enhanced longevity increases the risk of contracting dementia. In fact, international studies indicate that the number of people with Alzheimer's disease doubles for every five-year interval past the age of 65. Dementia is a deep personal affliction for sufferers. Moreover, huge emotional, psychological and financial stress is often placed on the family members who care for them. According to HSE figures, 40% of people with dementia are in residential care, while just over 40% are cared for by family members. In addition, at any one time, 18% of acute hospital beds are occupied by people with dementia. This latter figure is an indication that there are gaps in the care provision for patients with dementia. The WHO report also draws attention to the need to have a legislative framework for people with dementia to ensure their personal dignity and rights are protected.

In the programme for Government we undertook to develop a national Alzheimer's disease and dementia strategy by 2013 to increase awareness, ensure early diagnosis and intervention, and facilitate the development of enhanced community-based services. A commitment was given to implement the strategy over five years. We all acknowledge that the Minister of State is doing a great deal of work in this regard. Likewise, the HSE is making significant progress in the area of training and community support. It is imperative, however, that the Government should move decisively to develop the promised strategy on dementia. Several organisations, including the Alzheimer Society of Ireland, have made excellent submissions on this issue. As the WHO points out, people with dementia and their caregivers often have unique insights into their condition. They should be involved in formulating the policies, health plans, laws and services that relate to them. The strategy must focus on prevention, early detection, patient care, treatment protocols and research.

Ireland should begin to take a lead in the medical treatment of dementia, research into its causes and new drug treatments. The time has come for the Government to establish a national institute for dementia modelled on the various institutes assembled under the umbrella of the National Institutes of Health in the United States. This body should be part-funded by the State, with additional funding potentially being sourced from the EU's Horizon 2020 research programme. In fact, a specific portion of the research budget should be devoted to health, demographic change and well-being. In addition, there are many wealthy individuals in this country who might be persuaded to support such an institute. Dementia is an international health issue that is growing in magnitude. The WHO estimates that caring for people with dementia has a global cost of more than $600 billion per annum. An Irish institute devoted exclusively to this major health issue could soon become a centre of excellence, attracting international funding and expertise.

There is still some residual stigma attached to dementia which must be tackled. Dementia is a real and gathering challenge to us all. As the number with dementia grows, resources will be stretched. We must not ignore the challenge, however, because it will not go away. Instead, we must face it with determination and resolve and, above all, with compassion for those directly affected and those caring for them. I thank the Minister of State for the work she is doing in the area of mental health care. Now is the time for us to work together in developing new policies and strategies for dealing with this issue of national concern.

I will conclude by referring to a particular issue of concern. Many hospitals are using a tracking device to ensure dementia patients who move away from their own ward can be easily located. As I said, more than 40,000 people in this country have dementia. We should give serious consideration to developing a national scheme whereby such devices would be made available to all people with dementia, particularly those residing at home.

I am talking in particular about people who have the early signs of dementia. It is a huge concern for families. In a recent case in Dublin, a lady was missing for two days before she was located. We should look at this issue from a national point of view. We should encourage families to get involved in the strategy. It might be helpful for the HSE to organise a competition for the design of the roll-out and implementation of this strategy. That is something we should look at.

I welcome the Minister of State. I commend the Senators who have tabled the motion before the House. This is a major issue in society. I look forward to hearing from Senator Gilroy, who has much more expertise in this area than I do. The thoughts I am expressing come from outside the system. As Dr. Eoin O'Sullivan of Trinity College has pointed out, this State inherited an amazing institutional structure for mental illness in massive concentrations in places like Grangegorman, the Lee Fields in Cork, Portrane, Portlaoise, Mullingar, Ballinasloe and Castlebar. Dr. O'Sullivan has suggested that the British Government, almost as an experiment, decided to see whether the problems of society could be solved by locking up as many people as possible. People used mental illness as a way of getting rid of rivals to inherit farms or people to whom they did not want their families to be related. We committed many people, out of all proportion to the size of our population.

I suggest that Irish society has not really come to terms with this cruel episode. We blame churches for the way children were institutionalised, but many adults were institutionalised without any assistance from churches or anybody else who could be blamed. Researchers have found that people were institutionalised in Ireland to a degree that is unparalleled anywhere. That is the system the Minister of State is belatedly seeking to dismantle. I think she has our support in her endeavours. Mental illness became a major industry in certain towns. The manner in which people committed their relatives in such numbers to institutions from which they would never emerge shows us the dysfunctionality of Irish society at that time. Books have been written by people who were committed in Mullingar even though they were perfectly able to function. They could not get out because the certification of the doctors who put them in there needed to be undone. We cannot escape from this shameful episode in Irish history. We have tried to brush it under many carpets. I commend the Minister of State on her attempts to dismantle the institutional structure to which I refer.

I would like to comment on some of the things we see now. I wonder whether it is time to ban electroconvulsive therapy altogether. I believe the scientific basis for it is most unsound. Anyone who has seen movies like "One Flew Over the Cuckoo's Nest", or who knows someone who has had this treatment, will wonder what we are thinking when we put big charges of electricity through people's heads. I hope it is on the way out. The Minister of State will certainly have my support if her intention is to ban it. The science is unknown. Drug therapy is another way of anaesthetising people into a zombie-like state and subduing them so they do not ask awkward questions, shout or generally enjoy themselves. The experts tell me that we base too little of our approach on talking to patients and too much of our approach on drugging them into some kind of submission. I support everything that has been said about the need for prevention and detention.

I wish to speak about the underlying causes of mental illness. I was struck by the pessimistic reference in the motion to "global research in relation to the predicted rise in dementia and Irish figures showing a predicted rise to 140,000 sufferers in the next thirty years". I think we should take up the challenge of ensuring that figure never gets anywhere near 140,000. Economics is known as the dismal science, but the utterances of economists are positively cheerful by comparison with the unending stream of gloom that comes into this society from the media on a daily basis. People should reflect on how much gloom they need. Economists draw attention to things so that we will solve them - that is our optimism. I wonder whether the unending gloom in the media is causing the increase in mental health problems. Do we help families enough? I refer to dealings with children and between spouses. Do we know how to relate to old people? I think it would be extremely pessimistic to write off 140,000 people without taking positive health measures aimed at ensuring they do not end up in that kind of situation.

I know the Minister of State is a reforming person who wants to change things. The system of incarceration, drugs and electric treatment has long ceased to commend itself to anyone in this House. The Minister of State's attempts to replace it with something more humane, more effective and of more spiritual value to society deserve our support. When institutions are in place in Ireland, it is a hell of a difficult job to try to dismantle them and move onto something new. I hope the Minister of State will have some success in this case. I commend the Senators who tabled this motion. I have nothing further to add because I am anticipating what Senator Gilroy will say. He has experience in his life of the topics discussed in this motion. As the Minister of State said, one of the great things about the Seanad is that its Members come from so many different backgrounds. Every time I come to this House, I learn something new. I have learned something in this debate. The Minister of State is always very welcome. I look forward to hearing the views of someone like Senator Gilroy who has actually been there.

I welcome the Minister of State to the Chamber.

The Senator better have something good to say.

I was just thinking the same thing as I listened to Senator Barrett's generous comments. Perhaps I should tear up this script and make up something else.

I started to work as a psychiatric nurse in 1984, which was the year in which a policy document, Planning for the Future, was published with great fanfare. The main provision in the document was a proposal to close this country's old-style institutions. When I started working in Our Lady's Hospital in Cork, it housed over 1,000 patients. Senator Barrett used the word "incarceration", which is a good word because that is exactly what is involved. This country has been very good at locking people up in a range of institutions, including mental institutions. There seems to be something in our culture that means our first response is to remove a problem from before our very eyes in the hope that it will go away.

I am not criticising the Minister of State when I compare the position when the 1984 document was launched to the position that obtains today. I am very critical of mental health services but I hope nobody interprets that as a criticism of the Minister of State, who has been landed with an enormous legacy issue and is demonstrably interested in reform. It is a living scandal in our society that, as of 31 January last, some 394 people are still living in old-style institutions, many of which have been described by the independent group that monitors A Vision for Change as hardly fit for purpose. While there has been a great reduction in that number from the time I joined the mental health service as a young fellow, I think it is a scandal that almost 400 people are living in institutions in 2013.

A few years ago, I was involved in a literature review of international mental health policies that looked at the policies in the UK, France and many other countries. The review found that A Vision for Change stood out among all documents that had been published at that time. It must be supported because it is an excellent template for the provision of an integrated, world-class, modern, effective and humane mental health policy. This country is sometimes not very good at drawing up policies in this area and many other areas. We sometimes feel that if we feed in policy at the top, it will come out oven-ready at the bottom. We need to remember that it needs to be mediated at every level in between. I am glad that when A Vision for Change was published in 2006, an independent monitoring group was put in place in March of the same year to report on its implementation on an annual basis, or as close as possible to that, and ensure the policy is effective. A Vision for Change is not without its faults. In 2006, the independent monitoring group criticised the piecemeal and slow implementation rate. In 2012, it was equally critical of the inconsistent and slow implementation of the recommendations in the document.

We have concentrated on funding issues during this debate. I commend the Minister of State for protecting and increasing the funding that is spent on mental health last year and the previous year.

There have been some delays in recruitment but this is understandable because of the great difficulty in matching the service to the job and to the geography and the other matches that are required. We are well on the way to achieving the very ambitious targets and standards set by the Minister of State.

Strange to say, but funding issues are probably not the most important issues in the mental health service. There are cultural and structural issues to face before we can really make progress in delivering a proper mental health service. One aspect is the paternalistic approach of many senior clinicians in the service. Treatments are handed down from the top. Although the A Vision for Change strategy states that the treatment must be patient-centred, very often it is not. I know this is the case because I was a practising psychiatric nurse until two years ago when I came to this House and I have seen such treatment at first-hand. I am concerned that when community services are developed and institutions are closed there is a real danger that we might move the institutional mindset into the community and replicate the mindset of the institution in the community services. There is a danger that treatments and services are not patient-focused.

One of my bugbears is the post code lottery associated with mental health services and I hope the Minister of State will comment when she replies. It is the only part of the health service where a person's address determines the level of treatment in the public service. For instance, if I suffer from mental health difficulties in Glanmire, my catchment area is North Lee in Cork and if my clinician is an excellent clinician in North Lee then I am very fortunate. However, I will only be half happy and half lucky because my clinician also needs to be an excellent manager. If he fails to be an excellent manager I will not get the best treatment possible. This post code lottery is not acceptable. There is no way we can determine the locations of the good and bad practices - or the where the good practice is not - which may be a better way of saying it. If patients were allowed freedom of choice, very soon it would be obvious that the best clinicians and best service would attract the most patients.

Too many patients.

Perhaps, but this is an issue we must address. I accept it may result in too many patients in one service but it is a good thing that more people would be seen by the better services. There is no method for knowing where are the good and bad practices.

I am rapporteur for suicide prevention on the Joint Committee on Health and Children. I will be bringing a report to the committee and to the Minister of State some time in the new year. Some of the recommendations will challenge existing presumptions on what is the best way forward. I know the Minister of State, as a reforming Minister, will be receptive to this report and I look forward to discussing it with her.

I could speak on the subject of mental health all day but it may be better to make those points I have made rather than trying to fit in 1 million points I would like to make. I ask the Minister of State to give me some of her thoughts on what I call the post code lottery in mental health services.

I welcome the Minister of State, Deputy Kathleen Lynch, to the House. I commend my colleagues, Senators O'Keeffe and Moran, for proposing and seconding this motion on behalf of the Labour Party Senators. I am delighted the motion has cross-party support because such a topic deserves our support. It acknowledges the Government's commitment to work on mental health services and to improve the provision of such services. I commend the Minister of State for her very clear commitment to these issues and for her achievements in securing funding for mental health services. The statistics speak for themselves. Other speakers have referred to the commitments already made, such as the following: in 2012, a special measures package worth €35 million, including the approval of 414 posts; in 2013, a further €35 million and 477 posts, for which recruitment is continuing; and in 2014, a further €20 million will be ring-fenced, with approximately 250 to 280 additional staff to be provided.

The motion also refers to other developments and achievements. I refer in particular to the Assisted Decision-Making (Capacity) Bill which has recently been published and is long-awaited. As a member of the Joint Committee on Justice, Defence and Equality, I participated in the hearings with a range of different groups and individuals. We also worked with the Law Reform Commission which has carried out important research in this area. The Bill will replace the very dated current system based on 1811 and 1871 legislation which refer to lunacy and the wards of court system which denies all sorts of decision-making capacity to the person to whom it applies. The new Bill has been the subject of immense consultation and negotiation and I predict the debates will be good. This Bill is a very important achievement of this Government in the area of mental health.

Previous speakers have referred to other developments such as the recent important announcement by the Minister for Communications, Energy and Natural Resources, Deputy Rabbitte, about cyberbullying. The Law Reform Commission in its programme for law reform is committed to examining cyberbullying in the context of other forms of cyber crime. It is well known that cyberbullying has had a very damaging effect on the mental health of young people in particular, as evidenced by very tragic cases. Senator Gilroy spoke about suicide prevention strategies which must also focus on bullying and cyberbullying. Senator Moran noted that the Minister for Education and Skills, Deputy Quinn, has initiated some very important anti-bullying strategies in schools which focus in particular on homophobic bullying which is a real issue for many children.

I spoke this morning at an event organised by the National Women's Council on violence against women. The Law Reform Commission came in for some criticism by Women's Aid on a related topic. Although the Law Reform Commission intends to examine cyberbullying, it did not see the need for a reform of the law on stalking. This is unfortunate because stalking is at the extreme end of bullying and there have been some serious instances of this behaviour. The current legislation is the Non-Fatal Offences Against the Person Act 1997 provides for an offence of harassment but it is a very difficult offence to prosecute because a very high level of proof is required, nor does it cover the cyberbullying element of stalking which is carried out on social media. I suggest this could be reviewed or revisited.

Other speakers have also referred to aspects of the motion dealing with the implementation of the strategy A Vision For Change and issues such as services for children and adolescents and the Government's Alzheimer's disease and dementia strategy, the suicide prevention strategies and the Sea Change campaign, for example.

I wish to return to a matter raised by Senator O'Keeffe which underlies all of these different measures and initiatives, namely, the move from institutional care to care in the community for persons with mental health issues. This has been the subject of an important recent publication by a colleague of mine who works in the Trinity school of nursing, Dr. Damien Brennan. The Minister of State may be familiar with his book, Irish Insanity:1800 - 2000. Dr. Brennan has carried out a comprehensive study which demonstrates the scandal of incarceration over two centuries of persons with mental illness. I was privileged to attend the launch of the book at which he spoke about the scandal which is much greater in scale than the scandal of the industrial schools and the Magdalen institutions but a scandal of that nature, none the less. For very many decades, and particularly in the 20th century after independence, this State incarcerated persons with mental illness in very damaging and what we would now regard as very abusive conditions, for long periods of time and in much greater numbers than were incarcerated in our prisons. The prison statistics for the 1950s and 1960s show that Ireland had very low levels of imprisonment but there were extremely high levels of persons incarcerated in psychiatric institutions - State-run institutions - during those periods. It is very interesting to note the management and the control of those institutions which were State-run rather than institutions managed by religious orders or other groups. There is a great deal of research work to be done to uncover the figures and the human stories behind those experiences.

The Minister of State this morning launched a report on women and the criminal justice system and the incarceration of women produced by the Irish Penal Reform Trust. This report reiterates the theme of the need to move from incarceration to community care. We have made that move, happily, for persons with mental illness and psychiatric health issues.

This is an important theme running through A Vision for Change and all of the initiatives that have been taken, but we still incarcerate too many people with mental health problems in our prisons. The position paper that the Minister of State launched today highlighted this.

Given the large number of female offenders, our two women's prisons - one in Limerick and the Dóchas Centre in Dublin - are chronically overcrowded. We are incarcerating women with mental health problems. A 2005 study found that 60% of sentenced women prisoners that year had lifetime histories of mental illness. Other research on the imprisonment of Irish women shows high levels of self-harm, substance abuse and addiction difficulties, yet we continue to incarcerate them. Some diversion initiatives are useful, but it is time that we consider a more comprehensive programme of decarceration of women prisoners, particularly those with mental health issues. I am taken with the first recommendation of the report of the Irish Penal Reform Trust, IPRT, which the Minister of State will have seen today. It pointed out that, where women offenders had mental health problems, the earlier the point of mental health intervention, the better. Consideration should be given to amending the existing legislative framework to provide for the diversion of those with mental illness who have committed minor offences to community inpatient or outpatient facilities by specialist mental health courts.

Professor Harry Kennedy of the Central Mental Hospital has set up an innovative and effective diversion programme for prisoners with mental health difficulties. Clearly, there is a high need for this among the female prisoner population. The proposal has considerable merit.

If we are discussing a move from incarceration to community care for people with psychiatric illnesses, we should also do the same for prisoners with such illnesses, particularly those committed - as the majority of women prisoners are - for non-violent minor offences.

I welcome the Minister of State back to the House. It is not the first time that she has attended to discuss this issue. When she was appointed as Minister of State, our debate on mental health was one of our first engagements with her. She outlined her vision of moving from the old-style institutional care to community care settings. I commend her on delivering on some of that vision. I also commend the Labour Senators on tabling this Private Members' motion, as it gives us an opportunity to discuss this important issue. I have one problem with the motion. We did not table an amendment, but I will get to that in a few minutes.

Against a backdrop of continuing recession, the mental health of Ireland's population is under severe strain. Research shows that unemployment and income inequality are major contributing factors to poor mental health and go some way towards explaining the rise in the rates of suicide and self-harm reported in recent years.

I listened to a radio programme in Waterford a number of months ago. A local general practitioner, GP, who is a friend of mine and is active in the field of positive mental health and well being, talked about a tsunami of people attending his clinic suffering all sorts of mental health issues. Obviously, there is some link with the economy.

I am sure the Minister of State agrees that the Government has a duty to protect the vulnerable in society and must ensure that the already negative effects of the economic crisis are not exacerbated by the lack of services for people experiencing poor mental health. Therefore, I welcome today's motion and fully support the call for the continued resourcing of community mental health services, increased staffing levels in suicide prevention services and a strengthening and acceleration of services for children and adolescents.

The first part of the motion is self-congratulatory in its language and tone, which does not sit with some of the Government's commitments in the programme for Government to patient-centred mental health services. I must point out some of the differences and failures. The programme contained a commitment to "vastly improving access to modern mental health services in the community" in line with the recommendations of the mental health policy, A Vision for Change. A further commitment was given to ring-fence €35 million annually for the development of community mental health services. This has been cut by €15 million, yet the motion states: "the Government's commitment to invest €20 million in community-based, patient-centred mental health services in Budget 2014." The reality, as outlined by the campaign group Mental Health Reform, is that few appointments have been made since 2012 to staff community mental health teams. In recent correspondence to my colleague, Deputy Ó Caoláin, who is our national health spokesperson, the HSE confirmed that, of the 477 posts allocated in 2013, as and from 30 September - unless there has been a change, in which case the Minister of State might give the House the information if she has it - the recruitment process had only been completed for 4% of those posts. In the context of a gap of more than 1,500 staff in community mental health services, there is an urgent need to fulfil the promised investment.

Is that the rest of the quote from the HSE? It went on to say something else.

The Minister of State might clarify that in her response. Ireland's mental health services are in a time of positive transition, as we are moving from the old institutional model of hospital-based care to a new one of holistic, community-based services. This is not just in the case of mental health, but also elderly care and ensuring home care as a first priority. I support the Government in any move it takes towards more holistic, community-based services.

Notwithstanding the country's economic problems, it is crucial that the Government's commitment to reforming mental health does not waver. Important structural and cultural changes are under way, but any further cut to the mental health budget risks undermining the work already done. Mental Health Reform urges the Government to invest in the reform of Ireland's mental health services and support for people experiencing poor mental health. My party has called on the Government to invest in comprehensive, holistic, community-based mental health services, including an additional allocation of €35 million in 2014, as promised in the programme for Government, and an investment in governance structures to support the implementation of A Vision for Change, including resourcing support for the director for mental health. We also want to ensure that there are no further cuts to funding for mental health and related voluntary and community organisations.

It is important to ensure that there is no reduction in the living standards of people with mental health conditions who are in receipt of social welfare payments. This can be done by maintaining rates at their current levels, reducing the individual minimum contribution for rent supplement and restoring the fuel allowance cuts made in 2012. We also call on the Government to restore the incentive for participants in receipt of disability benefits to undertake community employment, CE, schemes by providing a €50 per week payment, as is already provided to participants in JobBridge. The Government should reconsider introducing a requirement for employers to contribute to illness benefit.

We must ensure funding for the mental health actions in the housing strategy for people with disabilities and implementation plan. My party has called for an allocation of €1 million to support the transition of people with low to medium needs from HSE mental health facilities to local authority social housing.

A range of measures can and should be taken by the Government. Deputy Kathleen Lynch is a reforming Minister of State and has done much work in this field, but as with any area of governance, more can and should be done. I commend the Labour Senators on tabling this motion and I thank the Minister of State for listening to our contributions.

I welcome the Minister of State to the House and compliment her on her work within the Department of Health. I thank my Labour colleagues for tabling this motion and giving us an opportunity to debate this important issue.

We all support the Minister of State in her efforts to secure more investment for mental health services, given the significant increase in mental health problems throughout our country, including the increase in suicide rates.

I come from the town of Ballinasloe which had a large institution that at one time had close to 2,000 patients. I pay tribute to the staff who worked in that hospital over the years. They gave dedicated service, care and love to people in that institution, many of whom should never have been there. Thankfully, today most of those people are happily living in the community and their lives have been enriched as a result. They receive a service from the HSE and its dedicated staff who continue to care for them in the community. Thanks are also due to the enlightened consultants who were attached to that hospital over the years. As a result of following the concept of A Vision for Change, east Galway's mental health services are second to none and the envy of many other parts of the country. Those services include the provision of some acute beds at St. Brigid's Hospital in Ballinasloe.

As the Minister of State knows, the HSE is in the process of reconfiguring services in Roscommon and Galway to improve the community element of the service, which I support. The HSE is proposing to close acute beds in Ballinasloe while keeping beds open in Roscommon. I am concerned because having recently spent €2.8 million creating a state-of-the-art facility in St. Brigid's Hospital, Ballinasloe, the HSE proposes to close it. A scoring system was used by the HSE to decide whether the beds in St. Brigid's or those in Roscommon would remain open. There is grave concern in the community about the credibility of that scoring process.

Roscommon hospital no longer has an accident and emergency unit. It is an 8 a.m. to 8 p.m. hospital which provides a much lower level of acute and chronic care services. On the other hand, Portiuncula Hospital in Ballinasloe provides a 24 hour service with many more consultants working in medicine and surgery. In addition, its consultants specialise in heart disease, diabetes, geriatric care and lung disorders. That range of services is not provided in Roscommon hospital, yet when it came to the score sheet, Roscommon scored ten points and Portiuncula Hospital, which is approximately one mile from the St. Brigid's Hospital campus, scored three. Obviously, the question of being adjacent to a major regional hospital comes into consideration.

On behalf of the community, I am asking the Minister of State to request the HSE to revisit that element of what is proposed in the HSE's plan for community services. There was virtually no difference in the scores of both hospitals in terms of mental health care provision. Those scores are inexplicable as east Galway mental care services have been able to implement substantially the 2006 recommendations on mental health policy in A Vision for Change. The Roscommon mental health service, by comparison, has become more institutional with staff being transferred from the community to the hospital, which is contrary to the direction envisaged in A Vision for Change. This is confirmed by the fact that the Roscommon unit has a higher level of patient admission, approximately 498 per 100,000, whereas St. Brigid's admits 256 per 100,000. It is second only to the Cavan-Monaghan region which is managed by the eminent psychiatrist, Dr. John Owens, who was the author of A Vision for Change.

People in east Galway also want to be assured that the resources required to deliver the promised community service will be made available. They are concerned that vacant posts will not be filled in time to coincide with the closure of beds at St. Brigid's Hospital. The situation is causing much angst in the community. I have attended two large public meetings there recently where the rating system was called into question. If that scoring system is not credible, it undermines the good work the HSE is attempting to do.

I am somewhat critical of the HSE's communications strategy and how this message was delivered in this case. Initially there was a lot of doubt and people got the story incrementally, which caused local concern. The residential beds element of the HSE's proposal should be re-examined. Many professionals in the east Galway mental health services feel that the best facility for the provision of acute beds is the recently refurbished unit at St. Brigid's Hospital.

Cuirim fáilte roimh an Aire Stáit. I was just doing the sad little mental arithmetic on this and, without putting too much effort into it, I can think of 12 people I knew who died as a result of self-harm as a consequence of mental illness over the years. A couple of them were cancer patients. Three or four of them were health workers who worked in the cancer area as doctors or nurses. Others were people I knew socially, including family members. This is a serious problem and I am delighted that so much attention is being focused on trying to reform the way we deal with it.

There is a transition phase when a modernisation process occurs, when we move from what is clearly and demonstrably the wrong way of doing things - as in the past with the incarceration and isolation model, which was a sort of leper colony approach to mental health care - to a more modern community-based approach. The danger is that as that transition is taking place, for all the deficiencies that existed in the old service as it is withdrawn, and before fully funded and adequate services are put in to replace it with a more modern community-type of approach, a huge hiatus can develop where there is no service.

I sometimes think that the Ballinasloe-Ahascragh triangle must be the epicentre of all public discourse in this country. I worked in Ballinasloe for six months and we provided the medical service in Portiuncula, a fine general hospital, for the patients from St. Brigid's psychiatric facility if they became unwell. I have two points to make about that. If psychiatric patients need to be in hospital, it makes sense that the hospital should also be part of a general hospital campus. We have had much discussion recently about co-location, bi-location and tri-location, but the idea used to be that psychiatric illnesses were treated in an entirely different kind of hospital. Talk therapy and support therapy are great, but some people need medical care for what happens when they are psychiatrically unwell. It tended to deprofessionalise the context of what was happening to these patients and somehow put them on a different plane from patients with more physical illnesses. In truth, however, most illnesses - psychiatric or otherwise - ultimately have some physical basis. I urge that great care be taken in the transition. We should be as enthusiastic in building up the new services as we are in closing the old ones, and there should be a match.

Getting back to the Ballinasloe model, I always remember one elderly gentleman who had grown up somewhere in Connemara. At an early age, as was the sad custom in those days, he emigrated to England where he worked in the canning factories near Bristol together with a group of other lads who had emigrated from his town. Over the years they never came back.

They may have returned once. Interestingly, 40 or 50 years later at the time of retirement they were still speaking Irish to one another. They had formed a little micro-society and were more or less looking after one another. When this particular gentleman, who was elderly, retired and needed to return home he could not do so because the family home was gone and his family were scattered. For a variety of medical and psychiatric reasons, he probably did not have a great capacity for self-management in a non-sheltered world different from the one in which he had previously lived and ended up, even though he was not that terribly mentally ill, in St. Brigid's Hospital in Ballinasloe where he became a long-term resident. There was no place for him to go but the hospital, which for him was a nurturing environment where he received fine and compassionate care. The point I am making is that there will be a complex set of needs unmasked as we wind down the care of people in long-term psychiatric facilities. We will need to ensure that we have places available for people in the community services.

There are other less glamorous components of psychiatric care that urgently need attention. One that springs to mind is that of liaison psychiatry. There is a huge need for psychiatric support for patients who may be in hospital with a primary diagnosis that is not psychiatric. A number of years ago, Dr. Rachel Cullivan, a brilliant young psychiatrist from the unit to which I am attached who is now a consultant in Ireland, and I both undertook research which showed that approximately one quarter to one third of all of our patients admitted with a cancer diagnosis met every criteria for a diagnosis of depression and-or anxiety. The truth is that we do not have good provision in place for these patients. There are spin-off and knock-on effects of inadequate provision in respect of the psychiatric-mental requirements of these patients, which translates into a greater demand on inappropriate use of other aspects of the physical health services.

I ask that the Minister of State, when formatting the plans, examine the need for the development of what I believe is a humane system in good quality hospital-based supportive psychiatry and, most important, one that makes sense in terms of resource utilisation. I commend the Minister of State on her reform efforts and urge that she continue her good work.

I welcome the Minister of State to the House. While I welcome also that we are discussing the issue of mental health this evening there is, in some respects, a sense of déjà vu in that we have discussed this issue a great deal over the past two years. While on the one hand, this is reflective of the priority which Members on all sides of the House give to this issue and the growing public concern about mental health problems, including depression, the alarming suicide rates and so on, on the other hand it indicates that services have not improved. While Members on both sides of the House have welcomed the additional €35 million set aside for mental health services in the last two budgets, the €35 million was not provided last year. Despite several questions having been asked in regard to whether the €35 million had been provided this year and, if so, on what it had been spent, they were not answered.

Yes. A lower allocation of €20 million has been provided for mental health services in this year's budget, which I find very worrying. The provision of €35 million is a drop in the ocean in terms of what is needed in this area. There is no doubt that we have under-spent in this area for a long time, and not only in the past two years. We have never given mental health the priority it deserves. In the UK, 12% of the entire health budget is spent on mental health services. The percentage here is much lower. What was provided for in A Vision for Change sought only to bring mental health service provision up to 8%. This issue has not been afforded sufficient priority for years.

The launch of A Vision for Change was taken as a signal of change and the provision of resources. While some progress has been made, it is not enough. During his attendance in the House in respect of the legislation for the new HSE system I debated with the Minister, Deputy Reilly, the need for a designated person for mental health within the new HSE structure. I welcome that an appointment in this regard has been made. However, I do not believe sufficient resources are in place. I share Senator Crown's concern in regard to the dismantling of existing services without having new ones in place.

There is a need for a huge cultural change across Irish society on this issue. We need to start to normalise debate of mental health issues with our young children, from preschool level to adulthood. We must make them aware that everyone experiences difficult times in their lives and to acknowledge this and to seek help is a sign of strength rather than a sign weakness. While I welcome that the Minister for Education and Skills has published guidelines in this regard for second level schools, I believe there is a need for guidelines at preschool and primary school level. I did some work on the Fianna Fáil paper on youth mental health, which involved a great deal of consultation with schools. I am aware that Senator Gilroy has been involved in a wide consultation process on the broader issue of suicide, which issue we have worked on together on a cross-party basis. However, there is a gap in this strategy. While schools welcome that there are now guidelines in place they have little resources in terms of the delivery of initiatives and practical supports on the ground. Equally they are concerned that while a lot of issues should be able to be resolved through adequate support at school level, some young people unfortunately do need access to professional mental health services, including, in some instances, acute care there are huge gaps in terms of child and adolescent mental health services provision. It is stressful for a teacher when a student who is experiencing difficulties from a mental health point of view cannot access resources.

In terms of this motion, I share the view that this issue needs to be given greater priority. I welcome that the motion, which seeks to highlight the need for greater emphasis on mental health, was tabled by the Labour Party Senators. I hope that the next time we debate this issue more concrete progress will have been made. This is a huge issue and not only in terms of suicide, the rates of which have alarmed us all. I live in Sutton which is not far from Howth. Every couple of weeks a person drives to the pier in Howth with the intention of taking his or her life. Not only are the families of people who have committed suicide in great distress, the level of depression across Irish society, caused by a wide range of issues, not least the recession, are frightening. A lot more needs to be done. There are many good precedents, for example, in terms of the work done to change people's attitudes to drink driving and road safety. Far more people than are killed on our roads are now dying by suicide. There is a need for a serious campaign, adequately resourced, in an effort to bring about a mind-shift in terms of mental health.

We are all aware of the suicide rates. People are, perhaps, now talking more about mental health than they did a few years ago because of the increase in suicide, including the death by suicide of the young girls in Donegal and others which hit the headlines. However, we know from surveys that people remain petrified of other people finding out they suffer from depression, including employers and their peers. This is frightening. We need to find a way to completely change this mindset. This will only happen by way of a concerted and adequately resourced campaign on the issue of mental health, as has been done in other countries such as Australia. I urge the Minister of State to consider that.

I welcome the Minister of State to the House and pay tribute to the Labour Party Senators for tabling this timely motion on an issue which has been given significant time in this House, in terms of discussion, over the past couple of years. It is important to acknowledge the Minister of State's deep, personal commitment to this area despite the challenging economic climate in which we find ourselves. There has been much focus on this issue for the past 26 or 27 months. We are finally seeing significant progress, although we would all like to see more. The €20 million provided in this year's budget for community based mental health services is important.

All Members have seen people with mental health challenges living within a community environment. It is wonderful that the stigma regarding mental health, which has been prevalent for many years, can be eroded by people living and interacting within communities and by spending time integrating in the towns. This is something in which it is definitely worth investing more resources as it is how one achieves respect and equality. The appointment of a mental health services director is an important incremental step in the right direction to pull together all the various services and to ensure there is a focused and determined approach towards ensuring the resources that are put in are spent wisely and effectively to achieve the maximum result.

I heard some of the debate in my office because I was trying to get some work done but I listened carefully to Senator Power's comments. Her contribution showed her finger is on the pulse, as ever. I have no hesitation in stating that she is one of the best performers in this House and very much reflects people's true values. On the recent publication of the legislation for which Members have waited for some time, the Minister of State was quite right to take her time to ensure she got it right. This legislation is extremely important from a raft of different angles and the last meaningful legislation in this area was enacted in the 1800s, when Queen Victoria had jurisdiction over this country. This simply demonstrates the work that has been done over two years to pull together this measure and to get it right. It is certain that when this Government leaves office, its successor will have a firm foundation on which to build. This legislation also will ensure that Ireland can eventually ratify the United Nations Convention on the Rights of Persons with Disabilities. On that note, I was proud to share an event that took place yesterday in Farmleigh House with the Minister of State, Deputy Kathleen Lynch, and the CARA organisation from Tralee, of which I am a board member. It is doing phenomenal work to ensure that people with disabilities engage in physical activity through sport, that barriers preventing people from engaging and participating in sport are removed and that adequate disability awareness training is made available both to governing bodies and down to the level of individual coaches, as well as training to ensure there is equal participation of all people, irrespective of their abilities or so-called disabilities. I acknowledge the Minister of State for making available funding, through the Department of Justice and Equality, to ensure this programme is rolled out to as many people as possible. I also acknowledge Joanne Cantwell of RTE becoming a patron of the organisation to ensure this issue gets the profile it deserves.

It is timely that Members are having this debate because after the Minister of State's extremely hard work for more than two years, results now are beginning to appear. Moreover, it is not all about money or about throwing money at a problem. It is about ensuring the money that is available is spent wisely, as for too many years, money has been shovelled at problems but such money then simply ended up going down a black hole. This ensures the money is targeted effectively to ensure that results are achieved. This pertains to a partnership approach, to eliminating prejudice and stigma and increasing public awareness and understanding. The recession undoubtedly has created an enormous strain on citizens and financial worries lead to mental health issues and depression. It is only right and proper that resources be made available for those people within society who, as a result of circumstances, find themselves in this dreadful situation. Members have spoken ad nauseam about the issue of cyber-bullying and the difficulties and challenges faced in this regard but all elements in society are now suffering and the numbers who have declared mental health issues have increased. It is good that people now are comfortable in discussing the issue and as a society, the cultural change that is taking place in front of people is both potent and appropriate. Moreover, the Government's response to that is also absolutely appropriate.

While I should apologise for being the last to speak, on an issue like this I believe it is always important to listen. I will start by laying out the stall. I greatly appreciate this issue being on the agenda at this time of year because Christmas is a particularly difficult time for people who have problems with their mental health. It probably has something to do with the dark nights, the long evenings and all the rest or perhaps it arises from the expectation that everyone is meant to be happy at this time of the year, while some people are not. Equally however, if Members continue to state that nothing has changed, the service is appalling and there is no one out there to help, how does one then get the message out to people telling them to seek help if they have difficulty with their mental health? This is a difficulty and one cannot simply continue to do what has been done in respect of mental health. I keep telling people the issue is different. It is not the type of debate in which one can go at it hammer and tongs, kick it around the floor and then expect it to get up afterwards and continue along its merry way. One can do that with some issues such as finances and with education and transport in some instances but mental health is different. I am convinced the script Members are now receiving will not be the speech I will give. However, they should keep it, as it will make good bedtime reading.

Senator Barrett referred to the media and their gloom and doom attitude and I believe Members are inclined to buy into it. I would also make this point were I in opposition, but mental health is different and Members cannot continue to tell people the service has not changed and that nothing is happening and then expect them to seek help. This is because people who are vulnerable and have difficulty with their mental health at any time actually do listen to Members. They take in what they are saying and I would hate to give them the wrong message. I will provide Members with the figures regarding the posts later, which are fairly comprehensive. I have just about had it with different organisations and when I challenged one as to from where exactly it was getting its information, its spokesperson just replied that it was out there. What does that mean? One would imagine that organisations that are listened to by the Government and by society in general would conduct a little research but that is not happening. This also is an issue that worries me.

What can I say to Senator Mullins? I sat here listening to him and I take on board everything he said about Ballinasloe. I accept that times are difficult for politicians in that locality at present. Moreover, I understand that people in the area who deal with the service or who have relations and families who do so are nervous and live in trepidation in respect of the service. I now wish to deal with the points made by Senator Crown in that respect. The only guarantee I can give him about the gap about which people worry regarding the transition from the old to the new is to point to what has been done in other areas. Precisely the same steps were taken in Clonmel with St. Luke's hospital as are proposed in Ballinasloe. Moreover, the same resistance was encountered but anyone who lives in Clonmel and the greater Tipperary area will tell one they now have a better service. The aforementioned hospital in Clonmel has been closed but alternatives are available when people need to be hospitalised. I agree entirely that people will need to be hospitalised and equally, at times there will be a need for medication. Even the most progressive of psychiatrists and psychologists will tell one there are points at which people become so distressed that one cannot get through to them with talking therapies and it therefore is necessary to medicate them to ensure the best possible impact.

These are not new to me. These are things I discuss every day when it comes to mental health. We need to be clear about it. However, it is not only about that service. People who have a difficulty with their mental health do not only live in a mental health box, they live in society like the rest of us. They live across a range, like all of us.

I know this is something in which Senator Moran will have a particular interest. Yesterday, I launched an e-learning site for the HSE. It is now available to every practitioner within the HSE. It is a service for people with intellectual disability and mental health problems. It was developed with the assistance of six service users who have an intellectual disability and who are availing of a mental health service. It is most accessible. There is no longer a need for a person to come to Dublin to get training. It is possible to tap into it anywhere because it is based on e-learning. We are doing that type of thing all the time. In the morning I will launch a website and information booklet on dementia. We are hoping to launch the dementia strategy in the first quarter of next year. It is across a range. It is not only the medicalised model that we are dealing with, although I emphasise that the medicalised model is expanding in terms of therapies and so on.

We should remember where we have come from. We started off with 22,000 people in long-stay institutions at a time when our prison population, as Senator Bacik, rightly, pointed out, was approximately 4,000. The morality of it is one thing, but how could we sustain that? It was not possible to sustain it. I do not care what anyone says although I recognise what Senators Barrett and Gilroy said about people with mental health difficulties in institutions over a long period. However, some people in there over a long period have no difficulties with their mental health and we should start acknowledging that as well. There is a range of how we deal with these matters and the attitudes. The Senator's point about the attitude is correct. I have no wish for people to move out of the big institution only to go into a small institution. That is not what this is about. It is about attitude. Jack Straw once said that he could not legislate for attitudes and that is a fact. However, he went on to say that he could legislate to ensure one person's attitude does not detrimentally affect another's. It is about that as well as being about a mindset and changing. It is also about ensuring that if a person has a difficulty with her mental health and if it is acute, then she need not necessarily go to the service because the service will come to her.

Senator Gilroy will be interested in this point. The fact that he lives in Glanmire means that he has a community-based 24 hour seven day mental health team. It is excellent.

I went along last week. It was very good. I congratulate the Minister of State.

The difficulty is that we do not have one on the southside, which is the more affluent part of the city. That happens sometimes because of resistance. The type of resistance we are seeing is multifaceted. On the one hand it is a little concerning because people are worried about the transition and the service not being available when they change to a different service. However, if we did not do things every time we got nervous and afraid, then nothing would ever change. I was laughing at Senator MacSharry when he referred to panic attacks and anxiety. I was going to put it to him that he should have been a Minister in this Government during the first 12 months. I could tell him about anxiety and panic attacks. It is about how we live our lives and the awful things that happen to us along the way. We are making progress.

I will tell the Seanad something else and I will be honest about it. It is not an easy task and it has not been an easy task since day one. We launched A Vision for Change in 2006. I remember it. Equally, I remember the Planning for the Future document and I still have a copy of it at home. I remember when A Vision for Change was launched and how it was lauded - rightly so - because it a remarkable work. We launched it in 2006 when the country was awash with money. Despite the fact that the other two Ministers of State who had responsibility for this area before me were as committed as I am, for some reason it simply never got done.

We are trying to drive this out at a particularly difficult time. The additional money we are getting is for specific posts. It is not about replacing what is going out. It is a different service in a different area delivered by different people. Central to all of this will be the nursing fraternity. They have done an excellent job in the past. They have been the leaders. I could name people in the service who I stand back and admire because, in some cases, they have gone against their own members and driven this out. It is vital to have such people. We cannot say that they are not doing the job or that it is not important and at the same time expect them to have the enthusiasm to do the job. I recognise that everyone wants this to work. No one wants this to work more than me. I believe everyone wants it to work because it is in everyone's interests that it works. Our attitude towards it needs to be different.

I will provide some figures on jobs because I know I am pushing it at this stage. Recruitment for the posts approved for 2012 and 2013 is continuing. I asked for the figures to be sourced from the central recruitment office rather than either the Department of Health or the HSE. It was a double-check. I received the most recent data from the HSE on the recruitment of these posts. It indicates that at the end of November the recruitment process is completed or is in the final stages for 395 or 95% of the 414 posts approved in 2012. We have a difficulty filling some posts. Of the posts approved in 2013 the recruitment process is completed for 134 or 28%, while 172 or 36% of the posts are in the final stages of the recruitment process. A further 106 or 22% of the posts are at earlier stages, indicating that 412 or 86% of the 2013 allocation has been completed or is in the recruitment process.

There are a number of posts for which there are difficulties in identifying suitable candidates. I have said all this before and it remains the same. There is a particular difficulty with these posts due to factors including availability of qualified candidates and geographic location. However, the remainder are at various stages in the recruitment process. The HSE's national recruitment service is currently working to ensure that the remaining posts will be filled as soon as possible from existing panels or through competition in the absence of panels at the earliest opportunity.

I offer what is only one example because it applies across a range. There are difficulties in recruiting people for forensic psychiatry in the area of childhood and adolescence. Let us suppose an organisation issues a generalised advertisement for recruitment calling for candidates interested in working in psychiatry in the area of child and adolescent mental health. Then, a candidate responds because she has an interest in psychiatry and the associated area. The vacancy is in Donegal. Since the candidate has gone through the process and has been offered the post she gets the vacancy in Donegal, but, in reality, she wants to work in Dingle. If an opportunity comes up or a place becomes available in Dingle, then she has the right to move. That is a major issue for us. Therefore, in certain areas we are developing specialised panels. In other words, it is not a straightforward global catch-all. We will now ask candidates whether they are interested in a given area and whether the post is where they would like it to be. We are developing that type of specialist panel.

The general panel will suit most people. The area where we have a difficulty is with psychologists. This is not just about the medical interaction. We have also given over €7 million to the Irish College of General Practitioners to develop a psychological and counselling service in order that when people go to their GP, which is where most go in the first instance, who are suffering from mild to moderate depression or anxiety, they can be referred on to that service, rather than go through the psychiatrist and the general service available in the area. We have also given the college money to develop training for GPs in the area of suicide.

I agree that the mental health service was always the Cinderella service, the poor relation. I am now being approached by people in the niche areas of the general medical area, for example, head and neck cancer and oral health, as to how they can get on board in terms of what is happening with GPs and the progress we are making in that area. While it is not my area - I have enough without taking on anything else - we are trying to direct them in the way we did it to bring them in. It is clear that other people are trying to catch up. In A Vision for Change, each chapter - child adolescence, suicide prevention, restraints and medication - has had a strategy developed around each particular area. Perhaps I am too idealistic when it comes to how we should approach mental health but in the absence of hope we despair. I really believe we need to give people hope. We have Shine, the anti-stigma organisation. I wear its badge all the time and I find it starts a conversation.

I apologise to the Chair. I am very sorry.

I ask the Minister of State not to apologise. We are delighted she spoke at the end. As she said the value is in listening. It has been a thoughtful and constructive conversation. I welcome the cross-party support. As Senator Marc MacSharry said, this is a subject in which we all have an interest and it is above politics. As a member of the cross-party committee on mental health I am glad to have tabled the motion as part of the commitment of that group to keep mental health before us. I know Senator Power said we have been here talking and we have talked but, in fact, we must keep talking because it is about change, as she pointed out, changing the culture and changing our own attitudes. Every time one of us stands up to speak we will mention it to somebody else or somebody else will listen. We cannot change the situation in the way the Road Safety Authority has changed because traffic accidents are a much more straightforward area, albeit, extremely difficult for those who have lost somebody or have been injured. In this case the complexity of mental health is such an enormous area.

Today we have tried to see where the progress has been made. Most, if not all, of us would agree that enormous progress has been made, it is just that the road is such a long one. Senator MacSharry pointed out that the dots are not joined up. I would argue that when this Government came into office, apart from A Vision for Change, even finding some of the dots was a challenge and finding the resources to find the dots to start joining them up is a challenge. After two-and-a-half years we begin to see that some of the dots are being joined up. Of course, there is always an impatience. As soon as we say "Let us change it", we actually want it to be changed tomorrow but we know that we cannot do that. Each of those pieces, putting in the app, talking to the GPs, changing how volunteers come forward and how they interact, reducing the incidence of suicide, talking to young people, takes an incredibly long time.

Certainly we feel a momentum and that we have moved away from what Senator Barrett described as the shameful legacy of incarceration. All of us probably know of somebody who was incarcerated in some way, shape or form. We were a nation who felt happy to lock people up. The process will take an incredible amount of time. The momentum, energy and will exists to address this. Even the figures that the Minister of State has given and that she checked and double-checked put to rest those arguments about whether recruitment was taking place. It is welcome that we can say that the work is being done. We all have to be patient but we have to keep the conversation going. Ultimately, there is still that default about physical health being the most important thing. We know why that has happened but it is up to each and every one of us to change that into a society where the health of our mind and our body are equal. Until we do that and can then perhaps change that poor relation status, and it is changing, each and every one of us has a responsibility. The Minister of State can legislate, as can other Ministers, and we can legislate until we fall over but unless we take responsibility for the mental health of our own country and say we have a responsibility, we have a role to play, it will not change. I am delighted that each and every one of us here this evening has made yet another contribution to that debate which will and must carry on. I thank the Minister of State for her support.

Question put and agreed to.

When is it proposed to sit again?

Tomorrow at 10.30 a.m.

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