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Seanad Éireann debate -
Wednesday, 19 Feb 2014

Vol. 229 No. 14

Mental Health Services Provision: Motion

I move:

That Seanad Éireann –

notes:

- that the mental health policy, A Vision for Change, published in 2006 was a landmark policy in advocating both for closure of the old psychiatric hospitals and continued building up of community-based services as well as cultural change in the form of human rights-based and recovery-orientated services;

- that A Vision for Change was also progressive in taking a whole of population approach to mental health, recognising the importance of improving the mental health of the whole population of Ireland;

- that A Vision for Change recommended the strong participation of users of services and family members at all levels of the mental health service;

- that A Vision for Change recognised the importance that community networks play in the recovery model;

- that it was with the publication of A Vision for Change in 2006 that a recovery-orientated, holistic view of mental health was adopted; and

- that it was envisaged as a ten-year policy, due to be fully implemented by 2016,

expresses concern that:

- progress on implementing A Vision for Change has been slow;

- the Inspector of Mental Health Services found that mental health services were "stagnant and perhaps have slipped backwards in 2012";

- the Inspector of Mental Health Services also found that most people will be offered a more traditional, medicalised version of mental health treatment rather than the holistic service propounded in A Vision for Change;

- people still regularly must resort to seeking help through A&E when in crisis due to the lack of universal community-based crisis support;

- A Vision for Change stated that 1,800 additional multidisciplinary staff would be needed to fully implement the policy but, despite promises to hire 891 new staff over 2012 and 2013, the total number of staff in the mental health services at the end of December 2013 was five less than in December 2012, and 908 less than the total staffing in September 2009; and

- home treatment is also not provided universally across the country;

- pending the development of an appropriate holistic community-based service, it is contrary to public health that the HSE continue to close any further acute inpatient beds;

- there is a lack of transparency and fairness in the process by which the HSE determined the choice of Roscommon over Ballinasloe for the retention of a 22 acute inpatient bed unit; and

- that there is a shortage of staff and appropriate infrastructure for mental health services notably in the Dublin north-east HSE area,

calls on the Government:

- to initiate a national programme of reform driven by the National Director of Mental Health;

- to ensure that a new culture is developed within the mental health service that fosters recovery and works in partnership with users of services and their relatives;

- to ensure that the recovery principle should underpin all mental health service delivery in keeping with A Vision for Change;

- to place a stay on the closure of acute inpatient bed units until such time as appropriate holistic community-based services are in place, including St Stephen’s Hospital, Glanmire and Carrig Mór mental health unit, Shanakiel and Toghermore, Tuam;

- to state when the additional 1,800 additional multidisciplinary staff, over the numbers working in the service in 2006, will be provided for;

- to create a plan for the full implementation of A Vision for Change with key timelines and deliverables clearly identified;

- to carry out a full, independent, transparent and fair review of the decision to close the acute inpatient bed unit in St Brigid’s, Ballinasloe; and

- to place a stay on and further bed closures in St. Brigid’s Ballinasloe, pending the outcome of that review.

As always, the Minister of State is welcome to the House to discuss these issues. We did not table the motion lightly. Such motions are sometimes interpreted as highly political or not in the best interests of patients or not in keeping with the configuration of our health services. However, this is different. As I have often said, nobody doubts the Minister of State's commitment to this issue. Sadly, the treatment by the Government of her office, notwithstanding her commitment, is nothing short of disgraceful. Successive governments throughout the history of the State have paid lip-service to our mental health services. None of us could be proud of the evolution of policy up to 2006 but the policy, A Vision for Change, was then agreed and, as she correctly stated on radio this morning, this was signed up to by all Members of both Houses at the time. We passed the eighth anniversary of the report lately and on that night I was promoting my own document on suicide prevention, Actions Speak Louder Than Words.

Sadly, A Vision for Change is failing. It remains a noble aspiration that all of us support. According to John Saunders, chairman of the Mental Health Commission: "What we have are football teams playing with half of their players". I watched Manchester City play Barcelona last night and as that game proved, the best teams can be made to look mediocre. That is what is happening on the ground in the context of our mental health services. Sadly, the fight against loss of life through suicide is being lost hand over fist. The National Office for Suicide Prevention is being starved of resources, is poorly structured and is buried within the bowels of the HSE, subservient to the budgetary demands of the Department and the HSE. Media reports prior to the budget highlighted the Minister of State using stern and colourful language in exchanges with the Minister for Health and the powers that be about the fact that her budget was due to be stripped of €15 million of the mythical €35 million budget that is supposedly ring-fenced every year for mental health services. I do not necessarily want her to confirm this.

This is always the first port of call. The HSE said it would fill the 70% of posts in this area that remain unfilled but recently the HSE stated that it would pick up the pace and employ people. This will get the Government parties through the local elections but the reality is the Government continues to treat the Minister of State with contempt and with no respect whatsoever and despite her commitment, she is unable to do what she knows is correct, which is the speedy implementation of A Vision for Change.

Geologists will have to ascertain the pace of the kind of change required. It was envisioned that it would cost €150 million and be completed in ten years. We are a million miles away from where it should be. As the Minister of State is aware, her Department is being starved of resources.

We are losing the battle with mental health issues such as suicide prevention. There are higher incidences of mental health issues. One in four has a mental health issue; one in 20 will have a suicide ideation. It is okay if one does not need a counsellor in a school, a 24-hour social worker or any other support.

It now seems that in Ballinasloe, as well as certain parts of Cork, acute state-of-the-art services that cost €3 million or more will be stripped back. In the case of Ballinasloe, the service will put into UCHG, University College Hospital Galway, in a department which was condemned by the Mental Health Commission as unfit. Anecdotal evidence suggests two patients at this unit have been sitting on trolleys in one of the busiest accident and emergency departments in the country waiting to be treated.

Is that the vision A Vision for Change promotes? Does this give people dignity and respect at their most needy hour? No, it does not. Why is this? It is because there is no respect for the Minister of State or her office. The Minister for Health, Deputy James Reilly, kicks it around. If he needs €10 million for the health services, he will take it from mental health services. Mental health service provision will be put on the never-never and no one cares who dies from a mental health issue.

The decision on the Ballinasloe service was based on a flawed evaluation. The Minister came up with criteria that suited himself for primary care centres. What criteria were used to shut down this facility which has been described by Dr. O’Grady and the 15 general practitioners in the area as clinically imprudent? I understand the criteria used date back to 2006 which means it could not take cognisance of the up-to-date improved facility and staff complement.

The people of Roscommon have been treated disgracefully by the Government. In an act of political delinquency, signed letters came from the Taoiseach and the Minister promising to keep the accident and emergency department at Roscommon County Hospital. These were not worth the paper they were written on. In the same way, the Minister of State has been given false and mythical commitments by her senior Minister. She is subservient to him because he will not give her the money for her services. There is nothing she can do about it.

Several years ago, the then Minister of State, Deputy Shortall, saw the light. She knew she had a job to do but she could not be expected to do it as she was not given any funding. The facility at Ballinasloe will be shut and moved to a site where haematologists and physiologists using it have described it as beyond capacity. Last week, when the Minister of State was defending the decision to Deputy Colm Keaveney in the other House, the roof at the site was falling down. It is now held up by RSJs, rolled steel joists. Has the Minister of State been in Galway lately? I am listening to the people on the ground telling me this site is beyond capacity. The choice of stuffing this service into Galway is to placate Roscommon for the disgraceful way it was treated. The Government lost Deputy Denis Naughten, one of the best there has been in Leinster House, because of the lies told to the people of Roscommon about their accident and emergency department. The Government must now do something for poor Deputy Frank Feighan who will be cleaned out of it because of the lies told before the election. This is political expediency, as well as a flawed evaluation process which dates back to 2006. The core principle in A Vision for Change is that there would be a consultative process for service users. How many were consulted on these closures? None.

John Saunders and Dr. McDevitt have claimed that the lack of pace in hiring key nursing and other staff is making it impossible for them to run inpatient outlets. A Vision for Change is dead. I will put it to the Minister of State again. Her own senior Minister is treating her like muck. He is making her look stupid because he will not give her the money she needs.

The latest victim to this headless chicken approach to health management and planning is this state-of-the-art unit in Ballinasloe. Excellent services have been provided heretofore and the community is not ready to wind down such services. I am sure some consultant or other will be wheeled out to claim this is the best way forward but the reality is it was a flawed evaluation process. I, along with Deputy Colm Keaveney, have requested it to be published. I know from freedom of information requests that it is impossible to get information from the health service but we will get to the bottom of this.

Closing this service will be a serious mistake by the Government. A Vision for Change is all but dead in the water because the Minister of State is starved of resources. Despite her wish and that of her predecessor as Minister of State, former Deputy John Moloney, who commissioned it, to deliver on it the reality is that it is failing. It is failing because this Government does not give a tuppenny damn about mental health services. The proof is in the pudding. The Minister of State should not take it from me but from John Saunders and Dr. McDevitt, as well as the people from Ballinasloe here tonight who now see the latest innovation in the Government’s headless chicken approach to mental health services.

I second the motion.

My colleague Senator MacSharry has covered many of the points. Members opposite should note we could have been far more critical when drawing up this motion. It allows, however, the Government to review some of the decisions with which we strongly disagree. While Senator MacSharry has addressed the issues concerning the Ballinasloe unit, the motion also covers St. Stephen’s Hospital, Glanmire and Carrig Mór mental health unit, Shanakiel and Toghermore, Tuam, and the speedy implementation of A Vision for Change.

We debated this matter last year. At the time, I put it to the Minister of State that putting one’s personal commitment aside, her office is failing in mental health service delivery. A Vision for Change sought 1,800 additional multidisciplinary staff to fully implement the policy. Despite these promises, in 2012 and 2013 the total number of staff by the end of December 2013 was five fewer than 2012 and 908 fewer than September 2009. If any Government Member argues we have sufficient resources in the mental health area, they must accept we do not.

Last week, I attended the funeral of a young man in north Dublin who died by suicide. The priest officiating deplored the lack of adult mental health services in north Dublin. I raised this with the Minister of State over 12 months ago and have continued to do so with the Minister, Deputy Reilly. The Department shut the Curam Clinic, Swords, which provided adult mental health services for the whole of north Dublin and shoe-horned it into the back of a health centre.

I will read the Minister of State a quote from the main clinical psychiatrist for the whole north Dublin region. This goes back to 11 April 2013, it is still not resolved and we have still not managed to meet the senior Minister. The clinical psychiatrist has been writing back and forth to the HSE and one of the e-mails states:

I have just been informed that the psychologist employed for the mental health team in Swords has been working in the primary care centre in Coolock for the past few weeks. This is because there is not enough space in the Swords health centre for her to work. Another unusual upturn is that some of the nurses in this mental health team [which, by the way, was held up in 2010 as an example for the rest of the country regarding how this team would work under Dr. Declan Murray] are now based in Balbriggan, 20 km away, a surprising eventuality as when Cuirim clinic was closed last October, they were assured there was plenty of space in the unit.

That is just one example. There is not the space that is required and nothing is being done about it.

When one looks at the numbers and the commitment to ring-fence €35 million, I would ask the Minister of State to enlighten us as to the pre-budget discussions, in particular her discussions and her submission, to try to retain the €35 million she and the Government promised would be ring-fenced for adult mental health services, €15 million of which is gone. While I am not questioning the Minister of State's personal commitment, I have to say this is a failure. It is a failure on her and her Department's behalf not to ensure this funding was not cut.

Let us consider the situation in the whole Dublin region in regard to adult mental health and early intervention for children, which is another matter that has been brought to the Dáil's attention. There is not one early intervention team in the whole Dublin area. Not one child has been added to a waiting list since June 2012. Does the Minister of State know the HSE is not adding to the waiting lists and will not even take applications for the waiting list? It is true. It will not add to them. Children cannot even get a transitional plan or an occupational therapy report, and all that is being done is that charities are paying for it to be done on a private basis.

This is an important debate to highlight the issues that exist. I ask Members to read the motion, which calls for something we have all agreed, namely, the swift implementation of A Vision for Change. It calls for proper resourcing of the mental health services. All it calls for in Ballinasloe and at St. Stephen's Hospital in Glanmire is for the Government to put a stay on the closure of those beds to allow a review to take place. That is all it calls for. I cannot understand why anyone in this House would vote against this motion. There is no reason to do so. Read it. It is not politically charged. It is stating facts and is putting forward a path to allow the Minister of State to say: "Let us hold off on this before we make a mistake. Let us review it."

If the Government moves ahead with the closure of these beds, we should remember what happened at St. Ita's in Portrane. When it had to be closed, the Government promised that 38 beds would be available in Beaumont but those 38 beds are not available. Last week, two people who presented for mental health beds in Beaumont Hospital waited for eight hours to be admitted and they left. The clinical psychologist in north County Dublin does not know where those two individuals are now. They waited for eight hours but there was nowhere for them to go.

We have to take this seriously. I am not questioning the Minister of State's commitment to A Vision for Change. What we are trying to do is to assist and to get the Government to see this as an absolute priority. Look at the funding we give the RSA or-----

The Senator is almost two minutes over time.

My apologies. I will conclude. I will be interested to hear the Minister of State's response. I am happy to second the motion. I ask colleagues opposite to just read it. It contains nothing they should not be able to support.

I move amendment No. 2:

To delete all words after “Seanad Éireann” and substitute the following:

“notes that –

in line with the commitments in the Programme for Government 2011-16, the Government:

- is progressing the recommendations of A Vision for Change, including reducing the stigma of mental illness, ensuring early and appropriate intervention and improving access to modern mental health services in the community;

- notes that, in the context of primary care reforms, patients can access mental health services such as psychologists and counsellors in the primary care setting;

- notes that this Government has provided additional ring-fenced allocations for mental health in the period 2012-14, totalling €90 million;

- notes the ongoing closure of unsuitable psychiatric institutions, and the moving of patients to more appropriate community-based facilities;

- notes the ongoing reduction in the practice of placing children and adolescents in adult psychiatric wards;

- notes that a review of the Mental Health Act 2001 is currently being conducted, in consultation with service users, carers and other stakeholders, informed by human rights standards (and the introduction of a Mental Capacity Bill that is in line with the UN Convention on the Rights of Persons with Disabilities);

- notes the renewed focus given to the implementation of A Vision for Change by the establishment of the Mental Health Division in the HSE, with its own defined budget, and appointment of a National Director for Mental Health Services;

- notes the commitments and timelines contained in the HSE Service Plan 2014 for Mental Health including completion of recruitment, substantially achieved, of 2013 approved posts by Q2 2014, and the completion of recruitment of posts approved from Budget 2014 by Q4 2014;

- notes the reconfiguration of services towards a more community-based recovery-orientated model of delivery of service in all areas, including HSE West, HSE South and the Dublin North East regions;

- notes the 2012 Report of the Inspector of Mental Health which highlights the continued progress towards ending the use of outdated and unsuitable buildings to provide inpatient services and the continued development of child and adolescent units while, at the same time, acknowledging that the pace of change towards a modern, patient-centred, recovery orientated mental health service is slower than desirable; and

- notes the commitment to the National Forensic Mental Health Service (NFMHS) project, including the provision of a new National Forensic Hospital, for which planning is under way, and the provision of Intensive Care Rehabilitation Units (ICRUs) as part of this project.”

The Minister of State is welcome to the House. I thank her for the work she is doing and has done in this area, and I know she is fully committed to reform. However, reform is not something that is easily achieved. It is something that affects people directly, in particular those who have been providing the services. A Vision for Change was published in 2006. It is interesting that my colleague across the House seems to forget that his party continued to remain in office for a number of years after it was published. When we came in, the amount of change that had occurred was little or none.

It is interesting to read the extract from the executive summary of A Vision for Change, which states:

Specialist expertise should be provided by community mental health teams (CMHTs) - expanded multidisciplinary teams of clinicians who work together to serve the needs of service users across the lifespan. CMHTs should serve defined populations and age groups and operate from community-based mental health centres in specific sectors throughout re-configured mental health catchments areas.

Basically, the whole issue is about community-based teams, and that is what the Minister of State has been working through in this reform. I accept there will be change and that it will not be achieved overnight. The main point of the reform is the creation of a new division dealing with mental health, with its own budget and the appointment of a national director for mental health, which is proceeding. There is a whole reconfiguration of services, which is proceeding. The Senator referred to the budget. The budget for this year for mental health is of the order of €766 million, which is a substantial budget, so I am not sure from where my colleague across the House is coming. Yes, we would like to put more money into mental health services, and we would like to create all of the changes overnight, but, unfortunately, we also have to deal with what we inherited in regard to the economy and, therefore, we have a limited budget and we have to accept that. It is about using the budget we have in the best way possible and trying to bring forward the reform in the fastest possible timeframe.

For example, the Government in 2012 prioritised the creation of 1,100 posts - 414 in 2012, 477 in 2013 and 250 in 2014. Community health teams are to be made up of a number of different groups of people. However, there are difficulties in filling all of these posts because, in some areas, we do not have people with the required qualifications. For example-----

We need to put it back to the end of the year. That is what the budgets are saying.

Senator Burke, without interruption.

There are certain areas where we need to make sure we get qualified people to fill the posts. We need consultant psychiatrists, psychiatric nurses, clinical psychologists, social workers, occupational therapists, speech and language therapists and social care workers. That is what the teams consist of and all of those posts cannot be filled in all cases. However, the Minister of State is working towards filling every one of those posts that need to be filled. Figures are already available with regard to what posts are filled and with regard to the targets for the end of this year. I know the Minister of State will do everything possible to make sure those positions are filled.

There is also the whole issue of moving mental health towards primary care, in particular the counselling in primary care service, which was launched in 2013 to provide access at primary care level. The target is to provide short-term counselling to more than 13,000 people, with eight counselling sessions to address mild to moderate psychological difficulties. In July of this year, this was made available, and 2,648 referrals were made between just July and October, which shows that change is occurring. While it will take time to implement and will not happen overnight, the Minister of State is doing everything possible, as are the Department and the people working within the HSE. I accept there will be difficulties in certain areas and we will have to deal with those difficulties and move forward.

A Vision for Change sets out that we would move away from the traditional institution-based model.

I was involved some years ago in dealing with several nursing home cases. One of them involved a member of the Army who was 18 years of age in 1956. The Army authorities had written to his parents at that time to say that if they did not come to collect him, he would be admitted to a psychiatric hospital. Fifty years later, he was still in that facility, even though everybody acknowledged there was nothing wrong with him other than that he had become institutionalised. That is the system we worked with in this country for far too long. That was the accepted norm in the 1950s, 1960s and 1970s.

We are trying to change the system so that such things cannot recur. That change involves the provision of community-based services involving a comprehensive team of staff and a range of expertise. The stigma that was attached to mental health problems in the past must be removed forever. The Minister of State is working to ensure the changes set out in A Vision for Change are fully implemented. By the end of the Government's term, substantial progress will have been made, in contrast to the delays that occurred between 2006 and 2011. Certainly, within the next five years the bulk of the programme will have been put in place and fully operational. I ask my colleagues to support the Government amendment.

I welcome the Minister of State to the House and thank her for the constructive and open manner in which she always approaches debates on mental health issues. I have had many vibrant and robust discussions with her, both in this Chamber and at meetings of the Joint Committee on Health and Children. I am assured of her commitment as Minister of State with responsibility for mental health to delivering the comprehensive reform of mental health policy set out in A Vision for Change. At the same time, I thank my colleagues in Fianna Fáil for using their Private Members' time to raise these important issues for debate.

A key component of A Vision for Change is the move away from a dependency on inpatient care towards a focus on the provision of community care. That commitment is one of the main reasons I am a champion of A Vision for Change. In practice, it will amount to a significant and welcome realignment of perspective. Unfortunately, however, the evidence suggests that we have a long way to go to achieve it. The reality is that we have not developed community services to the extent that is necessary, particularly the child and adolescent mental health services, CAMHS, and the multidisciplinary approach encompassed in the provision of community teams.

The fifth annual CAMHS report that was launched by the Minister of State last week paints a worrying picture. While there are improvements in some areas, there are others requiring urgent attention. Only 66 of the 107 multidisciplinary CAMHS teams recommended in A Vision for Change are in place, with some of these only partially established. Seventy additional posts in CAMHS teams had been filled by the end of 2013 compared with the end of September 2012, which is very positive. However, looking at the whole-time equivalents figure of 531.76, we see that the total number of staff in place at the end of September 2013 was only 44.6% of what is recommended in A Vision for Change. My understanding from talking to people outside the child and adolescent mental health sector is that these shortfalls in service provision are replicated across the adult sector. Likewise, there is welcome progress in the indication that 50% of children and young people are now seen within one month of referral and 71% within three months. My job, however, is to focus on the 5% of children who waited between six months and a year to be seen and the 4% who waited more than a year for a first appointment. Adolescence is a critical time in a person's development. The reality that almost 10% of young people are waiting between six months and one year plus to avail of services is of huge concern.

I have received a considerable volume of correspondence concerning the decision to close the inpatient bed unit at St. Brigid's Hospital in Ballinasloe. I am sure the Minister of State has also received correspondence on the matter. One can feel the hurt, upset and distress people are experiencing because of these types of decisions. At the health committee yesterday we discussed the closure of Mount Carmel Hospital. The main issue here is the way in which decisions are communicated and how the transition is managed. People are chiefly concerned with their own situations, and we must find a better way of communicating with them. Grand schemes are great, but people need to have certainty in regard to their personal situations.

An issue of particular concern is the perception, which was all too prevalent in the past and persists to some degree even now, that inpatient care for people with mental health problems is an end destination - that once one goes in, one will never come out. That is not and should not be the case. Inpatient care is part of a continuum of care which people may or may not need to access, depending on their needs. Furthermore, it must be provided in an appropriate and timely manner. I am not sure, however, whether the Health Service Executive is always the best choice to facilitate that process. Perhaps we need to look to some of the private providers so that access in the timely manner that is required can be assured. There must be an examination of how the State accesses and provides that type of care.

Of course, we must also ensure that inpatient care is of the highest possible standard. To that end, all services in approved centres must comply with the regulations set out by the Mental Health Commission and accord with our international human rights treaty obligations. It is incumbent on Ireland to ratify the UN Convention on the Rights of Persons with Disabilities. All individuals, particularly children, have a right to a mental health service that is compliant with agreed standards. This means not putting children and adolescents into adult units, as we continue to do in this country. There were 102 children in adult units during 2012 and 68 from January to September 2013. We all agree that this practice must be eliminated, but it continues to happen.

The motion rightly highlights the difficulties encountered by people experiencing a mental health crisis in accessing services. This difficulty emerged as a paramount concern for people during Mental Health Reform's public consultation process in 2013. One individual who shared her story with Mental Health Reform has given me her consent to share it with colleagues. The name "Sandra" is a pseudonym but no other detail has been changed. Unfortunately, her story is one with which many people who experience a mental health crisis will identify. Sandra described as a "complete nightmare" the experience of having to seek help through a hospital emergency department. She spoke of waiting nearly five hours to be seen, during which time, as she observed, she or anybody in that situation could easily go off and harm themselves. According to Sandra, an accident and emergency doctor agreed that she was suicidal but informed her there were no beds. She was sent home with a promise that somebody from the emergency department would check in with her by telephone the following day and that the community mental health team would be informed of her situation. Neither of these actions was taken. Having arrived at the emergency department by ambulance, Sandra was asked to make her own way home after being discharged at 5 a.m., a distance of more than 14 miles.

I am sure the Minister of State agrees that this is an unacceptable state of affairs. Several contributions at Mental Health Reform's public meetings make it abundantly clear that for those experiencing a mental health crisis, the difficulties involved in going through emergency departments exacerbate their distress. It was pointed out during the public consultation that accident and emergency is one of the only services available to people with mental health difficulties outside normal working hours, even though it is neither a desirable nor appropriate forum for accessing support and advice.

I conclude by referring to the role of education in tackling mental health problems. The number of children and adolescents presenting with mental health difficulties, including alcohol and other substance misuse issues, is a cause for serious concern. We had a debate in this House yesterday on homophobia. The incidence of suicide, suicidal ideation and self-harm among LGBT young people points to the need for greater linkages between the education and health systems. Early intervention and prevention are essential.

Key to this is education at primary level rather than only at second level. Mental health needs to be part of the curriculum. We need to normalise and destigmatise mental health difficulties and distress. Teachers tell me they are not armed with the information they need to speak authoritatively about mental health, to spot the signs or to access the resources and services they need. If they believe a child is in crisis, they must watch while he or she waits three to six months to access services.

I wish to raise again with the Minister of State my concern that the child and adolescent mental health services was not transferred to the Child and Family Agency. I believe they should have been transferred to that agency and that such services are clearly the remit of the new agency. I am concerned and will remain so until it has been proven to me that the protocol for agreement between social workers and child and adolescent mental health services will work. They told us they had difficulties when they were all part of the HSE. They are now part of two agencies. Will children have access in a timely manner to the services they need? I believe we are on the right road but there is a long journey to go on this road of progressing mental health. The Minister of State knows I will not go away on this issue. We will meet one another regularly at meetings of the Joint Committee on Health and Children. We have to do more. Access to community services in a timely and appropriate manner in the context of the situation in which someone finds themselves is important. When a person is in distress and has mental health difficulties, three months is three months too long.

I welcome the Minister of State to the House. The Minister of State and Members of the House will be aware, because I have said it often enough, that one of the reasons I entered politics was to try to add some small bit of value from my experience to the mental health services. Prior to entering politics I was a psychiatric nurse. It is looking increasingly likely I will be one again soon enough.

Some time ago, I had the good fortune to be involved in a literature review on an international level in relation to mental health policies. One of the documents reviewed was A Vision for Change which ranked high, if not foremost, among the documents being reviewed. My colleague, Senator MacSharry, and I have crossed swords many times, often robustly, in this Chamber. Senator Darragh O'Brien called for Members on this side of the House to consider the actual wording of the motion. I believe it is a decent motion. I cannot see a great deal wrong with it. It is a fair and good motion that offers us an opportunity to reflect on where we are in regard to the development of our services. When Senator MacSharry says A Vision for Change is under pressure, we could shout "politics" and "stop", but when the review of the independent monitoring group says the same we should take good care to listen to what they are saying.

We are not very good at policy in this country. I am speaking not of the Minister of State or the current Government but of governments in general. We often feed in policy at the top and expect it to come out oven ready at the bottom. We sometimes fail to realise that each step of policy needs to be mediated through different levels before the objective is achievable. A Vision for Change suffers from this weakness. It is a ten year policy and we are eight years into it. While A Vision for Change is being monitored by an independent group, there is no measurement or mid-term review built into it, which is a serious weakness. Circumstances have changed and changed dramatically since 2006 when A Vision for Change was published. We are in economic recession and it is well documented and known from international studies that recessions play a significant role in increasing morbidity in this area. We need to stop, reflect and take stock of where we are.

There is a great disconnect between policy and practice in this area. There is no question of that. Senators van Turnhout, Darragh O'Brien and MacSharry have drawn attention to legitimate concerns in this regard. As rapporteur on suicide prevention for the health committee, I am writing a report in which I am highly critical of our mental health services. I have said many times in this Chamber - this is not a criticism of the Minister of State - that we do not do mental health services well in this country. It seems to me there is nobody in charge. There are no dedicated people with responsibility for named acts or omissions in this area. This a fundamental weakness of our system.

The child and adolescent mental health services are newly established. There have been great advances in this area. However, is it acceptable that a 13 year old boy suffering from acute anxiety can be told he must wait eight months for an appointment? How could we in government or anywhere else be proud of such a service? We appear to have all the right language around this in that we all say the right things, with which everybody can agree, yet mental health services do not appear to be progressing at the rate we would wish them to.

The motion refers to several individual incidents of bed closure. I am glad it mentions St. Stephen's Hospital in particular in this regard. Prior to my becoming a Member of this House, I was a trade union representative for St. Stephen's Hospital for almost 20 years. I am glad to be able to say I was part of a team that put together a template for community development in the north Cork mental health services. A meeting was held today at St. Stephen's Hospital in regard to the very bed closures to which this motion refers. Management and the staff representatives and organisations of that hospital have been working together on how best this issue might be addressed. There are 26 beds at that hospital in two acute admission units. The proposal is that one unit be closed. This means there will in future be 18 beds on the campus rather than 26, thus freeing up 12.5 posts. I use this as an illustration of how progress can be achieved. Five of the 12.5 posts freed up will be moved to the community crisis intervention teams and five more will be moved to the amalgamated 18 bed ward. While there is not yet agreement in regard to what will happen in regard to the remaining 2.5 posts, another meeting will be held next week to discuss the best way forward in that regard. This is a bottom-up approach to the development of our services. This is how progress has been made in north Cork for as long as I can remember. As stated in the independent monitoring group's report, most of the progress taking place in terms of A Vision for Change is on a bottom-up rather than bottom-down basis. There does not appear to be any leadership in this regard.

There is a need for calmness and strategic thinking on this issue. Perhaps the Minister of State would take a more hands-on approach to it. I do not know what HSE west is doing in that it has alienated all of its staff and the community in Ballinasloe. I cannot understand that. That has not been the experience in HSE south. If HSE south can do things fairly well, why then cannot HSE west do so? These are the questions that need to be asked. Perhaps the Minister of State has a view on these issues and will share them with us. I could talk all day about mental health but prefer when speaking on the issue to make one or two important points in order that all the other points do not get lost in the cacophony of my talking.

I welcome the Minister of State to the House. I do not believe she is the slightest bit comfortable here. While she is always welcome here and is a good Minister and conscientious person, she looks thoroughly miserable. Her body language is wretched and she looks ashamed and miserable. I feel really sorry for her. I believe she is in a very difficult position and that her heart is on the side of the patients and the people.

Senator MacSharry made a passionate speech. It was splendid. However, the person I honour most here is Senator Gilroy who spoke from the heart and told the truth, which is what we want to hear. We do not want partisan point scoring. It is for that reason I consider the Sinn Féin amendment rubbish. It is tripe and part of a ritual. What makes people cynical is that we are not telling the truth. We need to tell the truth and face the truth. If money is an issue, let us say so. Let us face what our European partners, in robbing and stripping us during our financial collapse, which was their fault, have done to this country.

As it happens, I will be supporting the Fianna Fáil motion. I pick and choose. Sometimes I support the Government, sometimes I support the Opposition and sometimes I support the Independents. The motion quotes the inspector of mental health services, who stated that mental health services were stagnant and perhaps had slipped backwards in 2012. That is what he said, yet, with unbelievable gall, the Government motion "notes the 2012 report of the inspector of mental health which highlights the continued progress". That is rubbish. How can people believe in politicians if the director of mental health says it is stagnant or going backwards but the Government says there is progress? It is an absolute tissue of lies.

The amendment refers to the ongoing closure of unsuitable psychiatric institutions and the moving of patients to more appropriate community-based facilities. That is rubbish. In fact, suitable psychiatric institutions are being closed and patients are being stuck out and left rudderless in the community. That is what is happening. When I was trying to run for President I went throughout the country. It was pretty bad then but it must be a hell of a lot worse now. The inspector's report consolidates this. I met people, some of whom were in wonderful facilities largely created by voluntary work and fund-raising, and I saw people in the State sector who were heroic. They were reducing staff and not replacing them. People were working and exhausted but only because they were devoted to their patients.

The chairman of the Mental Health Commission said: "But it is clear from reports of the independent body monitoring the implementation of this policy that insufficient community services have been put in place." That is the official statement. How can anyone possibly deny it? Dr. Devitt, the inspector of the health services, said nursing staff numbers continue to dwindle. This is what I was witnessing in 2011. There were unfilled vacancies resulting in professionals being pulled out of community services to plug gaps in inpatient care. That is the work of the State. Worse still is what is going on to this day. I was one of the signatories of a Bill presented to the House relating to involuntary electro-convulsion therapy. Apparently, it is still being used. This is a shame and a disgrace.

In the final part of my contribution I will concentrate particularly on the situation at Ballinasloe. The reason I came to the House was because my heart was broken when I read some of the material that came in. I have an e-mail from a clinical psychologist who is very concerned about the decision to close the beds. From reading all the e-mails that have come in, it seems the points system by which these decisions are made is seriously flawed and has been interfered with to gear it in one particular direction. That is grossly wrong.

Earlier, I referred to putting people into a rundown facility in Roscommon. We are told that there will be a new 50-bed unit at University College Hospital Galway in March 2015. This is 2014 and there is no sign of anything; not a blade of grass has stirred in it. What the hell is going on? These are people without a voice. The voice they have is the voice in Seanad Éireann and thank God it has been preserved.

I do not intend to mention the name of this man or his daughter but her mental health failed her early in her life and she has had a desperate lifetime. Now, they want to close the only remaining acute unit. This man's daughter was a patient in the unit until last March when she moved into a house in the community. He is concerned that if she needs readmission there will be no place for her to go. The patient is forgotten and the plan reigns supreme.

The position is that these institutions are returning money. How is it that they are returning money from the budget every year? Why are they not spending it? This is a political decision as well as a financial one. They spent €3 million in the past year on the unit in Ballinasloe. That is a total waste. Why are they still pouring money down the drain? It is the single most modern piece of infrastructure in that area of the west. It seems to me quite extraordinary that it would be treated in this manner. The survey carried out was a major disaster. I wish to make a practical point born of human experience. What about the damage suffered by the place in Galway? We all know about it. The Minister of State shook her head but I believe the roof is not even still on the building. The man who contacted me said that he lives in Ballinasloe and that the trip to the overcrowded traffic-choked unit in Galway could take him two hours, while the trip to Dublin is one and a half hours. That is what the Government is doing to them. It is worse than going to Dublin.

The final example I want to highlight is a real heart-breaker. It is from a woman who has a sister to whom she is devoted and who suffered from epilepsy when she was young. That appears to have triggered some further mental distress. She was put into care in Ballinasloe and her situation appears to have deteriorated. She has lost her real emotional connection with her family. She insisted her parents were kidnappers and not her real parents. She said her real parents were coming to get her but that she would not be there because she would be at the Rose of Tralee festival. She said her boyfriend was coming to get her and that she was going to be in a movie. She said that she had all her bags packed and that she would wait. It was heart-breaking. That was her reaction to being five minutes from her home. What on earth would the devastation to that poor bewildered woman be like if she is moved so far away from where she is? We must also consider the impact on the patient's family. It is not only devastating for the patients themselves. Then there is the fact that there was no proper consultation process.

I will end with the most heart-breaking thing of all. A woman wrote to me and said that when she was a child she used to watch her parents looking after her sister while she had an epileptic attack. She said she would hear the screams that preceded a seizure and she would run through the house, the classroom, the schoolyard or wherever - it did not matter. She would cradle her sister's head and let her dig her nails into her arm. The woman had watched her mother and father do this and so she did it too. She said she figured the e-mail was simply another way of trying to cushion her sister's fall and keep her head from hitting the floor. It was a way of cradling her and letting her nails sink in because she loved her sister.

We should consider this in the light of the fact that money is put back into the Exchequer and in light of the contradictions in the motions. I know the Minister of State and how humane and decent she is. I do not know how difficult it is to be in government because I have never been in government and I never will be. However, I will continue to be a gadfly on the rump of Irish political life for as long as I can. I am sorry if it stings my friends - the Minister of State is definitely one of them - but I urge her to take this debate as support in her fight to look after the people who are most vulnerable.

I welcome the Minister of State to the House. I thank my Fianna Fáil colleagues for using their Private Members' time to discuss this vital topic of mental health services. I welcome the many friends from the community in Ballinasloe who are present in the Visitors Gallery for the debate this afternoon.

I acknowledge the personal commitment of the Minister of State to driving the Vision for Change concept and her success in securing the resources required to deliver a community-based service, which is gradually being put in place and working well in many parts of the country.

I accept that not as many resources as the Minister of State would wish are being put into the service, but I recognise she is fighting a good battle in that regard. The experts tell us this delivers the best possible outcomes for patients. However, there will always be a need for acute beds in the system. A Vision for Change recommends 50 beds for a population of 300,000 people. Currently there are 35 acute beds in Galway city and 22 each in the hospital in Roscommon and St. Brigid's Hospital, making a total of 79 beds for a population of approximately 315,000 people.

I accept that under A Vision for Change this is too many beds. A steering group assessed the merits of Roscommon and Ballinasloe and, using a scoring system, decided that the Roscommon facility was preferable. In my opinion and in the opinion of mental health clinicians and hospital consultants, the scoring system was flawed and does not stand up to close scrutiny. As the Minister of State is aware, the Roscommon unit is located beside a category 2 hospital while the Ballinasloe unit is close to a category 3 hospital, Portiuncula Hospital. Despite this, under the scoring system used, Roscommon scored ten under the heading "adjacent to a main or regional hospital". This is just one of a number of scores that do not add up. For any major project in the health area to succeed and to gain acceptance by those using the service, their families, the staff and the community, there must be honesty and transparency in decision-making. There must be respect for patients, staff and community and good communications. It is with great regret that I say to the Minister of State that HSE west management displayed total disrespect for patients, staff and the people of Ballinasloe by their actions in dismantling beds in the acute unit in Ballinasloe last night in the knowledge that a Seanad debate was taking place today. If it wanted to alienate a community, it went the right way about it. They showed no respect to me or to my colleagues, as Members of the Oireachtas, given that we were led to believe no beds would be removed in advance of today's debate. I welcome the fact that following my intervention last night, the beds were returned to the acute unit.

As the Minister of State is aware, Ballinasloe has been synonymous with the provision of mental health services for more than a century. The services have changed from an institutional setting to a community-based model. East Galway mental health services have been implementing A Vision for Change effectively for many years and in many instances are well ahead of the curve in comparison with other parts of the country.

I place on record the appreciation of the community, the service users and their families to the wonderful staff who provide mental health care in our community. I have been deeply moved, as has Senator David Norris and others who have spoken, by the huge volume of testimonies I have received from so many patients and their families who have benefited from care in St. Brigid's Hospital acute unit. The acute unit in University College Hospital Galway is a 1970s building in very poor condition. It is on an exceptionally cramped site and is difficult for patients and families to access and has totally inadequate parking facilities. The Roscommon unit is beside a category 2 hospital while a state-of-the-art facility costing €3 million is on a fabulous site close to a category 3 hospital.

It makes sense to use that beautiful facility in Ballinasloe. I am not asking, and neither is the proposer of the motion asking, the Minister of State to reverse any particular decision in relation to A Vision for Change. I support the whole concept of A Vision for Change but I am unhappy with the scoring system used. I implore the Minister of State to review the scoring system that decided the Roscommon facility was more suitable than the Ballinasloe facility. That is not too much to ask. While that review is taking place, I ask the Minister of State to give a commitment that no further beds will be removed from the facility in St. Brigid's Hospital. I support the concept of A Vision for Change but I appeal to the Minister of State, in order for the system to have credibility and to get the support and the buy-in of the community and the people of Galway and Roscommon, to ensure there is no doubt about the honesty and the veracity of that scoring system. The Minister of State would do a great service to the provision of mental health services in Galway and Roscommon if she can accede to that part of the motion.

I welcome the Minister of State. I ask her seriously to consider putting the brakes on and offering an independent review of the marking scheme that is taking beds away from Ballinasloe. I have looked at the facts. The unit for Galway is not due to be in place until March 2015. I serve Galway city. University College Hospital Galway is overcrowded. It is our centre of excellence for cardiac, cancer and many other issues and does not need the mental health unit there as well. It is overcrowded and to decide to put more facilities in University College Hospital Galway is to downgrade that hospital. For example, there is a proposal to move the addiction and counselling service from Merlin Park to that hospital, which I vehemently oppose. We know the unit in University College Hospital Galway is not fit for purpose. It is leaking, having been flooded recently. Some €2.8 million or €3 million has been put into the unit at Ballinasloe and now it is being taken out. I grew up in and lived in east Galway where there has been a history and a tradition of mental health services being offered and there is no rhyme or reason to move it. I am supportive of the principles of A Vision for Change but to move the beds into University College Hospital Galway, an area that is already overcrowded and, may I say, reading between the lines, where it is not wanted by the hospital, is not the answer.

I know what the Senator is saying.

Acting Chairman (Senator Diarmuid wilson)

Senator Healy Eames to continue, without interruption, please.

I am putting this on the record. I want to see University College Hospital Galway maintained as a centre of excellence. I do not want to see people under so much pressure all for the swipe of a pen. Meanwhile, Ballinasloe is almost written off the map. Senators such as Senator Michael Mullins and others have tried for many years to put Ballinasloe on the map. Now we learn there is an attempt to move the maternity services out of Portiuncula Hospital into University College Hospital Galway. This will have to stop.

St. Brigid's Hospital in Ballinasloe serves the majority of east Galway and some parts of south-west Roscommon. It is working brilliantly. I have seen the commitment of the staff and the testimonials that have been sent to me. I say we should stop the madness now, at the very least give Ballinasloe an independent review and not move the beds to UCHG until something substantial is put in its place in the community. We all know that people with mental health difficulties are at risk where their lives are concerned. We need to be very careful in how we deal with this issue. We know that people at risk of mental health issues do not deal well with change. Where they have been served and taken care of well, let us maintain it. I recognise the Minister of State is in a very difficult position and has inherited a brief that is loaded with difficulties, but Ballinasloe and St. Brigid's are asking for very little, just an independent review of the marking scheme.

I have questioned them on it and they are willing to accept the review.

We are seeking a stay on this closure until the outcome of the review and until University College Hospital Galway, UCHG, has a unit fit for purpose. I do not support the transfer of this unit to UCHG, should it be transferred, it should be located in Merlin Park, where there is ample space, an amenable setting and an environment that is right for people with mental health issues.

My preference is that the unit should remain where it is and at the very least I request that an independent review be conducted.

I welcome the Minister of State, Deputy Kathleen Lynch to the House. I welcome the people from Ballinasloe who are in the Visitors Gallery. I wish to express my sympathy for the situation in which they find themselves because as a Roscommon man, I have been in that position and know what they are going through. People have better things to do with their time. Many of those in the Visitors Gallery are nurses who worked late last night and could do without having to come to Dublin to be here for this debate.

I was critical of the Fianna Fáil Party motion, but I do not think the Members opposite formulated it. I believe it was formulated by somebody else with the intention of embarrassing a number of Senators on this side. That includes the Members from Roscommon - myself, Senator Terry Leyden and Senator Michael Mullins in particular. The motion does nothing more than hoodwink the people of Ballinasloe. Private Members' motions do not get accepted unless they get Government backing. If everybody voted in favour of the Fianna Fáil motion it does not mean that anything will be different. It does not mean the HSE will change its plans.

This motion is similar to a letter to Santa Claus, it is aspirational and no more than that. Even when a Bill - legislation has greater weight - is passed by this House, it may be parked by Government if it does not suit. I introduced such a Bill that was parked. Many of the decent people who contacted me in the past couple of weeks were not aware that this was the situation. They were convinced that if this House voted in favour of retaining the psychiatric services in Ballinasloe it would reverse the proposed closure. No matter how the vote goes it will not reverse the decision. The person who designed the motion should be ashamed for misleading the people. In the words of Mark Twain, a lie can go half way around the world before the truth comes out.

What is wrong with the motion?

Senator Kelly without interruption.

What does the Senator find objectionable with the motion?

What would result from a rethink of Government policy? I am sure the nurses and people of Ballinasloe would know, but Members may not know that if there was a rethink on the closure of St. Brigid's hospital in Ballinasloe it would directly impact on Roscommon. The threat facing those who represent the people of County Roscommon is that if the unit in Ballinasloe is saved, the hospital in Roscommon will go. I was told that again this morning by a member of the HSE. That is the option I am facing.

What does the Minister say about that?

That is why it is particularly difficult for me to support this motion. The people of Roscommon have already suffered enough with the loss of the accident and emergency unit in Roscommon hospital.

The Fianna Fáil Party has supported the policy of a Vision for Change but now wants to cherry pick from it. The unions were agreeable to that policy document.

Three years in government.

This motion sets out to embarrass certain members on this side of the House.

That is not true.

I will not be supporting this motion but I will not be voting against it because I have concerns about the other side of the coin.

The Government's amendment to the motion must have something for the people of Ballinasloe. I attended many of the meetings that took place in Ballinasloe and also several meetings with the Minister, and other meetings with Oireachtas Members and county councillors. There are grave concerns about the voting mechanism that selected the closure of the unit in Ballinasloe over Roscommon hospital. I will be the first to admit that, as I will not lie. I am deeply concerned about it.

That is what this motion is about.

The major problem is the roll-out of the community mental health teams. I spoke to the Minister last week on the appointment of 78 new staff. The HSE gave me documentation that shows that not even 44 appointments have been made. During the period of the threatened closure of the accident and emergency unit in Roscommon I, as the then mayor of Roscommon, contacted Professor Drumm, the then CEO of the HSE, about a proposal to keep the accident and emergency unit open for six months in tandem with the advance paramedic teams so that we could prove to the people of Roscommon that the advance paramedic teams would work. He agreed to do it, but things changed and Professor Drumm moved on. We know that the Taoiseach came to County Roscommon.

I am not in favour of the institutionalisation of people with mental health difficulties. I worked in a psychiatric hospital for a number of years in the 1980s. My request to the Minister is not to close St. Brigid's unit in Ballinasloe until the community mental health teams are fully in place and working for a period in tandem with St. Brigid's unit and that we can prove that the new provisions work to the satisfaction of the service users. I am asking the Minister to look after the nurses who have been asked for expressions of interest in relocating in Galway or Roscommon. If one is taking the nurses out of the system, one is not acknowledging that we have a problem with mental health in that region. I cannot see a reason to take nurses from the area if we are transferring patients to the community.

I am seeking a positive response on this suggestion from the Minister, however without such positive action I will not support the Government motion.

Is Senator Kelly formally abstaining from voting?

Yes, I will abstain.

I welcome the opportunity that this Private Members' business motion presents.

I very often agree with the views expressed by Senator Kelly, but I do not agree with his views on Private Members' business. To suggest that a motion of this importance is being tabled by the Fianna Fáil Party to embarrass certain Members is clearly missing the point. The objective of the motion is to stand up for people who deserve the full support of the State, those who have mental health difficulties and deserve the services, which the State should provide, whether the services are provided in Ballinasloe, Letterkenny, Cork, Athlone, Falcarragh or anywhere else in the country.

The Senator has never agreed with anything.

It is deplorable that the Government has cut funding which it had committed to provide. It had committed to ring-fence funding of €35 million for the psychiatric services. We now learn that the funding has been cut to €20 million this year. As a result of the cuts of €15 million, from the €35 million to which the Government had committed as a minimum requirement, we see what is happening in Ballinasloe. That is only an example of what will happen throughout the country.

General hospitals, community hospitals and mental health service are suffering. Mr. John Saunders, the chairman of the Mental Health Commission outlined the change from the old style institutional model of care to the community based model and this change was widely supported.

Without question, we support that on this side of the House.

That will take years.

They are not my words.

There is plenty of work for five years.

They are not my words.

Senator Ó Domhnaill please, without interruption.

The chairman of the commission, Mr. Saunders, went on to point out: "But it is clear from reports of the independent body monitoring the implementation of this policy [the movement towards a new policy] that insufficient community services have been put in place." In other words, the teams exist but they do not have the resources and manpower. That is like Arsenal playing in the European Champions League tonight.

That reference was used a while ago.

They are allowed to field 11 players but they are only fielding six.

That reference has been used.

The Minister of State is not giving the teams a chance.

The Senator needs to get a new example.

The resources must be provided. It is clear that there are difficulties in the health service. The Government is under pressure and there are competing demands, but the number of people with mental health difficulties has increased. The number of suicides has also increased due predominantly to financial pressures and the great burdens that people are under. There is a need for resources not only to support lives, but to support the development of lives. It is unacceptable that such essential services are being cut at a time of greatest need.

There are areas within the Department of Health where savings can be made. For example, targeted savings could be made in respect of generic medicines. It is not a question of competing demands with other Departments. There are areas within the health budget where savings could be made. The HSE is overrun with middle management and there is a lack of services being provided on the ground.

It was the Senator's Government that put them in place.

Senators come in here and try to debate issues. The Government is playing in the premier league now but it is still blaming Aston Villa or the team that was relegated three years ago. If the Government is on the pitch, it should kick the ball. It should not blame the team that was there three years ago because it did or did not kick the ball.

If they do not believe that they were a good team, they cannot play first division football.

There is a need to deliver services but the Government is blaming someone from three or four years ago because the services of today are not meeting the need.

Not true. It is because the money has stopped.

It was not there.

The Government side is clearly missing the point. There is a need to deliver on mental health services. There is a need to find the resources that were promised and committed to. The Government promised resources would be provided and ring-fenced and if they are not delivered, clearly there will be more stories like those from Ballinasloe, and there will be cutbacks and a lack of services where they are required. Savings can be made within the Department's budget. If the Minister of State wants to have a debate in the House on any day, we will clearly identify for her where some of the savings can be made. We need an approach that will reduce red tape and bureaucracy and deal with some of the issues that need to be addressed.

I am delighted that this Private Members' motion was tabled tonight. It seeks to address and raise issues of critical national importance for people who struggle with mental health difficulties. We fully support the Minister of State in her work but she needs to find the money that was promised. It was not promised by the previous Government; it was promised by the current Government which has a responsibility to the people to find the money that it promised in the programme for Government. The programme for Government was agreed between the Labour Party and Fine Gael. That promise will be broken if the Minister of State cannot give a commitment here tonight.

I hope I will receive a little latitude because this is a very important debate and a few points need to be put straight.

A lot of Senators have indicated a wish to contribute to the debate.

I promise the Senator I will do my very best.

I received an e-mail today from someone who works in the service in Galway University Hospital, the contents of which are distressing. It states: "What is therefore most disappointing and demoralising is the inaccurate and demeaning portrayal in some quarters of this inpatient service." That is the service talked about by Senator Healy-Rae - I am sorry, Senator Healy Eames.

She is not wearing her cap today.

The e-mail continued:

I personally am distressed at what I perceive to be the denigration of a very fine service in the interest of other agendas. We have maintained our professional dignity as we believe that public wrangling can only sow disquiet amongst those we profess to serve, our current and indeed potential future service users. However, at this juncture I can no longer remain silent and in the face of a campaign of apparent vilification, the aim of which appears to be to heap odium upon this service, I have the utmost regard for all staff members and can no longer tolerate inaccurate comments that can be construed externally as a denigration of their professional standards and care. My main concern, however, in the midst of these issues, is that any individual, whether currently attending this service or whether considering approaching this service for assistance, is deterred from doing so in light of inaccurate public comment.

I would also like to tell the Senators that the national director of mental health visited Galway University Hospital and its mental health unit. That person found that the area where the leak was - not the roof gone but where the leak was - was closed, there were empty beds in the unit, the unit was extremely calm and the executive clinical director there was very happy with the service as it was progressing. We need to be careful. There are people delivering a service which we want them to deliver so we should be very careful about how we describe them and the care they give to others.

I am pleased to have the opportunity to address the important issue of mental health in open discussion - as I have always done - on Private Members' business in the Seanad. Mental health is a subject that is obviously close to the hearts of many Senators. I am right in saying that we have cross-party support for A Vision for Change. I do not doubt that for one minute despite what we have heard in the past few weeks.

In 2006, A Vision for Change was widely welcomed as a progressive, evidence-based and realistic document that proposed a new model of service delivery which would be patient-centred, flexible and community-based. Much progress has been made in closing many of the old psychiatric hospitals and providing modern acute inpatient as well as community-based facilities and services. Someone that I always admired in this field was former Minister of State, John Moloney, and before him, Tim O'Malley. We sometimes forget their work. Through circumstances beyond their control, progress was not made on A Vision for Change programme. Even while progress was not being made by the Government, the services were progressing.

A Vision for Change recommended a move away from the old institutional system of mental health service delivery to delivering comprehensive care in a variety of settings, including the home, community and in hospital. Despite the extraordinarily difficult economic environment we now find ourselves in, much progress has been made in implementing key recommendations.

If Senators have a copy of my speech, they will see that I have deliberately focused on the pieces that the motion has asked us to deliver on. Therefore, I will not read out the sections typed in red and will concentrate on the specific points included in the motion. The first item is the call for a reform programme to be driven by a national director of mental health. In July 2013, Mr. Stephen Mulvany was appointed as the first national director for mental health and, as such, has full authority and responsibility for the implementation of A Vision for Change. Since his appointment, Mr. Mulvany has met every mental health management team across the country to create concrete, coherent and deliverable plans to realise the vision commitments in their catchment areas. This level of planning has been crystallised in the HSE's national service plan and the recently published operational plan for mental health. Each service has declared its immediate and key objectives for 2014 which are explicitly stated and documented.

Mr. Mulvany has also conducted a detailed audit of the human resources down to team level for all mental health services reporting to him. This will guide him on how the 2014 investment of €20 million will be allocated to ensure equity and drive further innovation; that a new culture is developed within the mental health service that fosters recovery and works in partnership with users of services and their relatives; and to ensure that the recovery principle should underpin all mental health service delivery in keeping with A Vision for Change.

Since 2006, the HSE has invested in many innovative initiatives to promote the service user and family perspective. Every acute unit has a trained peer advocate available to all inpatients to provide information, assistance, welfare and housing advice, personal advocacy and a recovery guide. Collaborative leadership and change management programmes have been delivered at DCU and I have had the pleasure of meeting many graduates from this exciting and integrated programme of change, which includes service users, family members and mental health professional. An academic post for an expert by experience has been in place since 2009 to provide robust evidence and rigour to the service user's viewpoint. The national mental health division has appointed an interim service user adviser to work with service user and carer organisations to ensure their viewpoint is heard and heeded at all levels in our mental health services. There are trialogue meetings with service users, family members and mental health professionals engaging in a direct debate on the needs of service and how these can be best delivered in a coherent and effective manner. The EOLAS knowledge and understanding innovative programme offers pragmatic information and guidance to families living with mental illness and we hope to extend the reach of this well regarded programme during 2014.

Advancing Recovery in Ireland, ARI, which is an incredible programme, supports mental health services in re-orientating service objectives to facilitate and not impede recovery. It must be the ambition of every service user to return to his or her home and family. ARI works with services to make sure that all aspects of service from acute community, acute inpatient, rehabilitation and recovery teams and residential supports are designed to maximise independence and progression towards a high quality of life within the community. For too long the professional knew best and this led to a power imbalance, which is being rebalanced at long last, not by rejecting the professional viewpoint, which we cannot, but by ensuring the service users and carers' voices are also heard and acknowledged.

The motion seeks "to place a stay on the closure of acute in-patient bed units until such time as appropriate holistic community-based services are in place, including St Stephen's Hospital, Glanmire and Carrig Mór mental health unit, Shanakiel and Toghermore, Tuam;". Modern community-based teams and services have being created all over Ireland by recasting the skilled human resources trapped within institutional and residential service models. Staff have developed a broad range of skills which have outgrown the confines of the bedside and wish to work with service users within their own homes and communities. Modern mental health services are predominately community-based and, as in the acute hospital sector, acute inpatient stays are reduced by investing in community-based care models. The average stay in an acute mental health unit is down to 11 days. This reflects the service users strong preference for care at home and within their community.

Along with the investment of new skills and professions on our community mental health teams, including clinical psychology, social work, speech and language therapists, child care workers and occupational therapy, the HSE has trained more than 40 facilitators to work with teams on the enhancing team working programme to ensure team effectiveness and focus. When a team is put together, one does not choose the person with whom one works. It does not automatically become a functioning team and that is why we have to work on this. However, it is not possible to run old style residential services and to develop fully staffed community mental health teams. The skilled and experienced staff required for the teams are all too often trapped within institutional service models. We must escape the gravitational effect of these old institutions and liberate the service users and the dedicated staff who serve them.

People with mental illness have been hidden away for too long living in a parallel universe away from their own communities. This is no longer an acceptable model; we can and must do better. There always will be a group of individuals who require acute inpatient care and whose mental health needs are best met in hospital. We have invested more than €200 million providing superior inpatient settings for people with mental illness. Follow-on care and continuing care plans are designed for all service users as they progress towards recovery and staff released from inpatient commitments continue to work with service users in their new home settings. Some mental health services have found it difficult to move away from residential service models and, in some instances, replaced hospital care with residential hostels but the journey has been incomplete. Service users have the same right to live within their communities and to enjoy the benefits of community living while continuing to receive support from rehabilitation specialists and community mental health teams. New improved facilities are in train to replace older facilities that can no longer meet the needs of 2014.

Since A Vision for Change was published in January 2006, we have made major investments in mental health capital developments in counties Cork, Dublin, Limerick, Westmeath, Galway, Donegal, Wexford and Tipperary to replace older and unsuitable facilities. We need to offer modern service settings for users and a modern and sustainable workplace for our staff. We will replace the Central Mental Hospital at Dundrum with a new state-of-the-art facility at Portrane by 2017, which will be supported by intensive care rehabilitation units. This is an extraordinary programme of works and all have been advanced under the guidance of A Vision for Change. It would be unethical to pause this progress and to retreat back into the past. I have no mandate for such a move and can see no good reason to lose the momentum gained since I took up this office.

The motion states, "when the additional 1,800 additional multidisciplinary staff, over the numbers working in the service in 2006, will be provided for". I attend the House regularly to discuss mental health issues. I have never said that we have reached that point. We are not there yet but the push that has been made over the past three years is significant and we need to keep going. In the context of the economic difficulties, it has not been possible to reach the 10,657 whole-time equivalent posts, WTEs, described in A Vision for Change. At the end of December 2013, a total of 9,052 WTEs were working in our mental health services. This presents a challenge and requires us to ensure all staff are positioned in the most effective settings, on the front-line, responding to current and assessed needs. The national director for mental health has an additional 250 to 280 WTEs to allocate in 2014 in addition to the 2012 and 2013 posts.

With regard to Senator van Turnhout's comments, last week I launched the HSE's fifth annual child and adolescent mental health services, CAMHS, report, which clearly shows a massive 50% increase in the number of staff working in children's mental health since A Vision for Change was published. This focused year on year investment on teams and a quadrupling of CAMHS beds in the past eight years extends the reach of our mental health services for children. Today more than 17,000 young people attend CAMHS. I agree with the Senator that even 5% is too much but it is something on which we have to keep working.

The motion then refers to creating "a plan for the full implementation of A Vision for Change with key timelines and deliverables clearly identified". The HSE's national operational plan for mental health was published on 30 January and I encourage colleagues to read this detailed document. It clearly sets out the targets and ambitions for 2014, which have been costed and are deliverable within the available resources. All these commitments are fully aligned not only to the values of A Vision for Change but also to its recommendations. With additional resources we can do more, but we must be realistic and drive forward within the known and available resources.

The motion calls on the Minister "to carry out a full, independent, transparent and fair review of the decision to close the acute in-patient bed unit in St Brigid's, Ballinasloe; and to place a stay on any further bed closures in St. Brigid's Ballinasloe, pending the outcome of that review." I am absolutely confident that the decision to close the old hospital at St Brigid's Ballinasloe is correct and I checked this again earlier. I apologise to the Senators and Deputies from the area for the confusion that was caused last night. This should not have happened. A transparent and careful set of criteria was applied by a panel of experienced mental health professionals and the decision stands. I have met senior clinicians, the service managers and local service users and there is a great desire to see the promise of A Vision for Change fully realised in counties Galway and Roscommon. I have also met people who have expressed genuine concerns but I encourage them to examine the progress that has been made in other parts of the country and to embrace the objectives in A Vision for Change.

I invite those people to visit such an area which I will arrange. Stigmatising and scaremongering can have no place in this debate. We are working to provide a range of services for young people, adults and older persons who are seeking help in an acceptable form, which they are comfortable with and are supported by modern practice and evidence.

Nothing is happening in County Galway that has not already been delivered in most other parts of the country. The staff and clinicians at Ballinasloe have worked hard for many years to return patients from St. Brigid's to their home communities and to fully support them on that journey. No one has ever told me that the staff have been behind the corner in delivering A Vision for Change. To bring that to the next stage we need to further rationalise acute bed provision. This is completely consistent with A Vision for Change recommendations. Some staff employed in St. Brigid's have recently submitted expressions of interest for redeployment to other roles in mental health services in the area. It must be stressed that modernisation of services is taking place with no impact for current inpatients in Ballinasloe.

A Vision for Change recommends 50 beds for a catchment population of 300,000. It is clear, therefore, in line with policy and operational norms nationally, that the provision of 22 beds in both Ballinasloe and Roscommon means that the current overall stock of 76 in HSE west is too high in relative terms, allied to a corresponding underdevelopment of community-based mental health services. In the context of the service improvements now under way, a purpose-built 50 bed acute mental health unit will be completed in Galway University Hospital in 2015 to replace the existing smaller unit. This unit will consist of 35 general adult mental health beds-----

Is there any chance we could contribute to this debate? The Minister of State is hogging it and I cannot understand it. She must have been speaking for 40 minutes already.

The Senator is out of order.

It is grossly unfair.

Senator, resume your seat. You were not in the Chamber when the Minister started. You are out of order.

On a point of order-----

Senator, you are out of order. You are not entitled to interfere.

The Minister of State is preventing other Members from speaking in this debate because she is running down the services at Ballinasloe.

That is a matter for me to decide. I propose we will extend the debate by five minutes to allow other Members to come in. is that agreed? Agreed.

This unit will consist of 35 general adult mental health beds with the remaining 15 beds relating to psychiatry of later life, eating disorders, and mental health and intellectual disability. The acute unit in Roscommon will continue to provide 22 general adult mental health beds.

We must make rational decisions if we are to create and reinforce the community mental health teams around which A Vision for Change model is built. A Vision for Change recommends a catchment area of this size would have nine community residences for rehabilitation and continuing care. There are currently 58 such hostels in this catchment area, 11 of which cater for people with an intellectual disability. This level of support has absorbed a significant amount of resources and we need to see how we can best marshal our available resources to the best effect. We need to look to the future. Excellent models like Jigsaw in Galway city have been supported by reworking old resources. The funding for the brand new 20-bed child and adolescent unit at Merlin Park has been fashioned from the reinvestment of savings achieved through the decommissioning of older services.

Why would we stop now? We must remember that St. Brigid’s Hospital opened in 1833 and accepted patients from all over Connacht. The hospital had a long and honourable tradition of care and support when hospitalisation was the only model of service available to distressed and mentally ill members of the community. Today, we have better options to offer, so we must modernise. At the end of 2013, there were 920 posts in the Galway-Roscommon mental health service. We now need to create a sustainable model of service. In 2013, this service spent over €61 million which is €194 per head of population, significantly above the national average of €168. Galway-Roscommon has a population of over 314,000 people, 6% of the national population, but currently spends 10% of the national mental health budget. This creates an equity issue as overspend in one area creates a corresponding underspend elsewhere. This imbalance also occurs within the catchment area with a significant imbalance of resources for the population living in sectors Galway-Roscommon 1, Galway-Roscommon 2, and Galway-Roscommon 3. The overconcentration of resources in one area is at the expense of its neighbouring catchment. This cannot continue in a nationally managed mental health service.

National and local managers are working to address this imbalance to ensure all communities can avail of resources that are fairly and evenly distributed. We welcome the passion and commitment people have shown to protect their mental health services. I invite the people of Galway and Roscommon to work with us to reshape this resource into a more modern and dynamic service model. This service has a history of innovation and has adopted many of the recommendations of A Vision for Change and, indeed, 1984’s Planning for the Future. Now that we are about to take the final steps into the community, we should not pause on the progress made but continue what we have started.

A comprehensive review of services in this area has shown there are sufficient resources to deliver on all aspects of A Vision for Change, but we need to ensure it is properly configured to meet the modern needs of the population particularly young people, adults, older adults, people with very particular needs. Are we suggesting we halt the extraordinary progress made across the country where clinicians, managers, professional staff and service-users have worked to move away from this institutional model of care? Have we learned nothing from our past? We have recently dealt with residential homes, Magdalen laundries and old and remote psychiatric hospitals. I heard a Deputy in the other House earlier talking about allowing people wander the fields. Surely not. We continually encourage people at a time of distress to come forward, talk it through, seek help and treatment. The historical legacy of the asylum still lingers on in the public imagination, however. We are now towards the end of that journey. Are we to turn back and reverse the work of the past 30 years? Let us not forget the stigma which has been associated with these services in the past, the hopelessness and the sense of abandonment felt by service users. We cannot halt the progress of A Vision for Change and we can no longer disappoint vulnerable individuals in our communities who wish to re-gather their lives, have treatment and return to school, college, work, their families and their homes.

I acknowledge the professionals, staff, managers and various leaders who have done so much, in difficult circumstances, to modernise our mental health services and who have no desire to hold back the tide of progress and return to limiting, stifling and institutional ways. When we look back at the services in the past, we must admit they did it with the best intentions and to ensure the best care was provided. I hope when people look back on us, that they will be as kind to us. We do no better and we know there is a better way.

On a point of order, I want to clarify a point for the Minister. I am not in any way denigrating the good service offered by Galway University Hospital. The problem is the time is not right and it is unfair to Ballinasloe and Galway. It should not be done until the unit is built.

That is not a point of order. I call Senator Cullinane.

I welcome the Minister of State to the House, as well as all those in the Visitors Gallery who have come to listen to this debate.

I do not envy the Minister’s job. It is always a difficult job when one has to balance competing demands.

I have listened very carefully to this debate. I have listened to people from both the Government and Opposition over the past hour and a half. I remember how about four years ago in Waterford, a geriatric care unit, which was coincidentally called St. Brigid's, in St. Patrick's Hospital closed. At the time it was closed, I remember that promises were made by the then Government that replacement beds would be put in place. I remember saying that once the unit was gone, it would be gone forever and that without a guarantee of replacement beds, I was not going to buy a pig in a poke. What happened? The ward was closed. Guess what? There were no replacement beds and we are still waiting for a new community nursing unit in Waterford.

I can certainly understand the fears of the people of Ballinasloe. St. Brigid's Hospital will be closed but the Minister of State tells us we will see replacement units built and additional services.

St. Brigid's is not closing.

I apologise. The reality is that if the beds are taken from Ballinasloe, it will be a loss to that area and community and I can understand its fears.

I have listened to this debate for the past hour and a half. Even a number of Government Senators have talked about the criteria process, which they believe has not been applied fairly. I know they are from the constituency and are perhaps under political pressure. These are not Opposition Senators but Government Senators. One said he would abstain and another was quite critical of the decision that was made. I must take cognisance of that as well. If this was in Waterford, I would be as upset as the people in the Public Gallery and the people of Ballinasloe generally. The motion contains a reasonable request for the carrying out of a full independent, transparent and fair review of the decision to close the acute inpatient bed unit at St. Brigid's and for a stay on the closure of the unit pending the outcome of that review. If that embarrasses anybody, so what? Somebody said earlier that they are embarrassed. There are many motions tabled and we can all say we can be embarrassed. There is no reason to be embarrassed. One would be embarrassed only if one believed one would be voting for something one should not be voting for. That is the only reason any Senator would be embarrassed so I do not think there is anything wrong with the wording of the motion. My party tabled an amendment to the motion, which seeks to remind Fianna Fáil of its failures in government in respect of A Vision for Change. I believe this had to be done as well because Fianna Fáil also had opportunities to deliver on this issue.

I will now move to the broader issues of A Vision for Change, which is important because we must have an holistic debate on mental health services in the context of the Minister of State coming to the House today. The issue of mental health is of great importance to Sinn Féin. This is reflected in our party's health manifesto entitled Healthcare in an Ireland of Equals, which was published in 2006. This rights-based policy has informed our approach to mental health. It has been reflected in successive election manifestos, including the one in the previous general election when we called for the development of mental health services on an all-Ireland basis progressing from increased co-operation to integration of services on the island; improved accountability and transparency in planning and financing mental health service reform; modernised mental health legislation in line with the Convention on the Rights of Persons with Disabilities; promotion of cross-departmental action to combat social exclusion, prejudice and discrimination against people with mental health problems; the ring-fencing of 12% of the annual Department of Health budget for mental health services in line with the World Health Organization recommendations; the development and promotion of suicide prevention strategies; the provision of required child and adolescent community-based mental health services; and the ending the placement of children in adult inpatient facilities.

In the current Dáil, my colleague Deputy Ó Caoláin is a co-convener of the Oireachtas cross-party group on mental health. The fact that there has been cross-party support on mental health issues and A Vision for Change has been to the benefit of the entire political system. I very much hope that continues despite some of the rancour we have seen in the Chamber today and the understandable frustrations and concerns felt by people in Ballinasloe, which have been rightly expressed by Members here today. The Oireachtas cross-party group on mental health has made very clear that at its core it has the conviction that now more than ever, in a time of recession, we need to prioritise mental health. In light of this, the Oireachtas cross-party group on mental health made the following recommendations in respect of budgets. The first is that in line with the programme for Government, we would see the implementation of A Vision for Change and that this should continue. The second is that funding for mental health must be held at the budget 2011 level and that the funding attached to any mental health post must be preserved and used for the recruitment of multidisciplinary community-based mental health staff. The third recommendation is the ring-fencing of €35 million annually from within the health budget to develop community mental health teams and services as outlined in A Vision for Change and that this occur to ensure early access to more appropriate services for adults and children and improved comprehensive community-based mental health services that are linked to primary care.

The recommendations agreed by the Oireachtas cross-party group on mental health are obvious, clear and deliverable but, unfortunately, not all of them have been delivered. We have highlighted the fact that mental health difficulties cost the economy around 2% of GDP annually and that most of these costs occur in the labour market as a result of lost employment, absenteeism, lost productivity and premature retirement. I do not have the time to finish the rest of the speech and I will send a copy to the Minister of State. There is a lot more than we can be doing in this area. It is also close to my heart because a number of people close to me have suffered mental health problems. I have watched them suffer but I have also seen that services are not always there when they should be there for them. We should do whatever we need to do and put in place whatever resources are necessary. On the last occasion the Minister of State was in the House in connection with this issue, I reminded her that both our parties share a common philosophy in respect of progressive taxation. If we need to raise taxes on those in this State who earn more to pay for people who need services, be they mental health or other services, we should do so and ensure people get the services rather than coming in and saying we do not have the money to do things we should be doing.

Some people will be disappointed because I cannot fit everyone in as everybody is eating up each other's time. I call Senator Michael D'Arcy.

What time are we extending the debate to?

That is a matter for my discretion. I said I would give it an extra eight minutes.

It is not. It is the Leader who decides.

The Deputy Leader gave me discretion to extend it by a few minutes to allow the Minister of State to respond.

We started at 4.05 p.m.

The Senator is interrupting business. He may not get in.

I will not be squeezed out of this debate.

If the time is up, it is up.

With the Leas-Chathaoirleach's permission, I will offer one minute to Senator Conway.

Is that agreed? Agreed.

If one looks at the Minister of State's speech, one will see a reference to St. Senan's Hospital in Wexford. This hospital was closed and we lost all of the beds. I was in the same position as Senator Mullins is in today in respect of this type of thing. That happened a number of years ago. St. Senan's Hospital is now closed and we now have a service in County Wexford that is far superior to anything that was available in St. Senan's. The reason I have spoken today is because there are not that many success stories within the HSE. A Vision for Change is one of them. The criticisms of the Minister of State and the Government are fair and valid in that it has not been done quickly enough. If it can be done more quickly, it should be done more quickly.

I attended public meetings attended by 500, 600 and 700 people. What was going to happen to St. Senan's was terrible. All the Members of the Oireachtas in County Wexford met and agreed that we would push through A Vision for Change. If what is available in County Wexford is available in the areas about which we are talking - Roscommon and Galway - they will have a far superior service. There is no comparison. I can say from experience that the staff, clients and everybody involved will tell one that. It is easy to generate fear and to be afraid. I heard Senator MacSharry speak. He is a complete gombeen man if ever I heard one in respect of what he went on with earlier today. It is the exacerbation of fear-----

That is an inappropriate adjective to use. Senator D'Arcy should reflect on it. That was an unfortunate remark.

If it is inappropriate, I will withdraw it.

The remark is withdrawn.

It is a terrible thing to call someone a gombeen man. A far superior service is available. In respect of whether what is available in Wexford can replicated in the areas in question, I will not get into a debate about whether it should be Roscommon or Ballinasloe. That is unfortunate party politics that we normally do not do in this Chamber. I feel a bit aggrieved and annoyed. I do not know Senator Mullins particularly well but I know he is an honourable and decent fellow.

He has been put in a stupid position because of a motion that carries no weight.

I wish to put on the record the reason the service is far superior. In my part of north County Wexford, where we serve 35,000 people, there are no acute beds, nor is there any in County Waterford. Rather, they are in Wicklow. The number of admissions in 2013 was 46, one third of the national average. This is the direction of A Vision for Change. We do not want to put people into institutions like St. Senan's. I know nothing about St. Brigid's, but St. Senan's was a terrible place to put people.

In my area, the average length of stay is 11.67 days, 44% of the national average. This is the direction of A Vision for Change. The bed occupancy rate in Newcastle in County Wicklow is 14% of the national average. In Gorey, 54% of all admissions are for one week or less. The old way of people being somewhere for a prolonged period of time and having a stigma attached to mental health services is not the way forward. If what we have in Wexford is put in place for the people of Ballinasloe and Roscommon, they will have a far superior service, but they must buy into it and the Minister of State must provide the services.

Senator Mullins is not only one of the most decent, honest and hard-working people in the Seanad, but in both Houses. That someone has put him in this invidious position is appalling. His request is simple - he seeks an independent review of the methodology used to make the decision referred to. The Houses have had plenty of independent reviews during the past three years. The least that Senator Mullins and the people of Ballinasloe deserve is an independent review. No one is criticising A Vision for Change. It is an excellent document. However, when something needs to be tweaked or we must ask whether it is the right course to take. Following a period of confusion or doubt an independent person should examine the matter and determine whether it is right or wrong.

The Senator's time is up.

There are honourable, decent Senators. Michael Mullins is one of them.

The Senator has made that point.

It is the least he deserves.

I would be the first to defend Senator Mullins's honour. He is my cousin but Senator Conway is missing the point.

If Senator Mullins is a victim, it is not of this motion. He is a victim of a party Whip system that is ruthless and will not allow a politician to vote according to his or her convictions. Scandalously, a Government is hiding under the umbrella of A Vision for Change. In the case of Ballinasloe in particular, however, what we have seen is a vision for short-changing people. It is certainly not a vision for consultation. It is good for the Minister of State that she is not running in east Galway or Galway-Roscommon at the next election, as she would not get one vote.

It is funny that Senator Mullen is. He is a disgrace.

She and her Government are very unpopular precisely because of the-----

This is preposterous-----

(Interruptions).

Senator Moran should stick to the content of the motion.

-----arrogant way they have treated people over this issue.

I visited the unit in St. Brigid's and spoke with its consultants. I saw a state-of-the-art facility that had been renovated at considerable public expense, yet its beds are being sent elsewhere. I learned about the bogus consultation and scoring procedures that saw Roscommon score 10 and Ballinasloe score 3 on a question of adjacency when Ballinasloe is a level 3 hospital and Roscommon is level 2. I mean no disrespect to the services available in any of these hospitals, but when a decision does not add up, people are rightly - "discouraged" is too mild a term - scandalised by how they have been treated.

I also spoke with the head of community and primary care services, Ms Catherine Cunningham, about this matter when I visited St. Brigid's. I made it my business to meet her when she was passing through. I got all the usual civil and public service arguments when a decision has been taken and there will be no going back on it no matter the quality of the arguments being made by the other side. I was treated courteously and heard how she hoped that the money would not be wasted and would go to whatever services existed, but I walked through a state-of-the-art facility that had been superbly upgraded. It was located in a place where A Vision for Change was being implemented and there was a quality movement towards community-based care in respect of mental health.

People do not understand what has happened, why the Government is not listening, why their local, highly valued facilities should be targeted for cuts in this way or why it was so arrogantly proposed to remove beds from the facility on the eve of a Seanad debate. They regard that as thumbing the nose at them. They are in the Visitors Gallery and outside Leinster House in large numbers because they do not feel good about how their services are being targeted by the Government.

There is only one way to vote, and that is in favour of the motion. We all support centres of excellence and the more intelligent consolidation of services, but people across the country want excellent services to be available close to them.

I have been asked by my colleague, Senator Crown, whether I can share time with him. I would like to do so.

There are just two and a half minutes left. Is that agreed? Agreed.

I conclude on that point.

I thank Senator Mullen, who has graciously shared his time. I am not an instinctive "save our hospital" type. I understand that, sometimes, hospitals need to be closed and units rationalised. Nor am I anti-Roscommon. It is a matter of public record that I was staunch in my defence of an unfair closure of the emergency services in Roscommon in the face of data that were shown to be clearly inaccurate. Those services should never have been retracted by the Government. It was a great shame.

I also used to work in Ballinasloe hospital where I saw many patients from St. Brigid's Hospital who had developed acute medical problems and were transferred between those two fine institutions. They had suffered heart attacks, strokes, pneumonia and so on, the usual issues that an often elderly population, although sometimes including young people, encounter. They suffered these problems at night time, on weekends and during the day. For the life of me, I cannot understand how Roscommon hospital is not considered an appropriate place for the management of these medical emergencies 24 hours per day, seven days per week, yet it is so considered when the patients are transferred from an adjacent psychiatric unit.

I have studied the methodology used in the questionnaire. I have published quite a few papers and have a nodding acquaintance with statistics. The methodology was unbelievably subjective. I could see no logic to it whatsoever. I hate to say it, but there must be a whiff of politics about this. Before the last election, the current Taoiseach and Minister for Health, then Opposition politicians, personally wrote and assured everyone in Roscommon that the unit's status would not be changed. They had to make an about-face on that assurance in the face of data that we now know were inaccurate. There is a desperate need to be seen to be doing something for Roscommon. I am unsure as to whether this is not an example of robbing Peter to pay Paul. An error is being made and the methodology needs to be re-examined. I urge the Minister of State and the other officials to study the way the assessment of these units was conducted.

Senator MacSharry has four minutes to conclude.

Do I not have five?

No. We have gone over time.

I thank everyone who has contributed to this debate.

On a point of order, I was set down as the second speaker for Labour.

The time is up, unfortunately.

I resent the fact that others were allowed to speak but-----

If I allow Senator Moran to speak I will have to allow Senator Leyden in. We are ten minutes over-----

I have been sitting here since 4 p.m.

That is not my fault. I was not here when the list was drawn up. I call Senator MacSharry to conclude. I remind the House that the Minister, Deputy Hogan, is waiting to take the Adjournment and he says that if this goes on any longer, he will not be able to stay so some other person will be upset. We are already 12 minutes over time. I have been very fair.

Can I propose an amendment to the Order of Business to provide for the additional speakers? With respect, if the Minister, Deputy Hogan, has to wait for two weeks, we are not subservient to the Minister.

That is not for you to propose. You have four minutes to conclude.

Sorry, I have proposed it. Do the Members opposite want their colleagues to speak or do they not?

I have made the decision. We are not going to stay here all night on this issue. Senator MacSharry has four minutes to conclude.

I must protest. I chaired the Seanad for 45 minutes today and was not allowed-----

Do I take it the Senator will use the four minutes?

Do not take my time like that.

Okay. Let us-----

Through the Chair, I would say to have a bit of respect.

You have been given four minutes to conclude.

A little bit of respect. I have given none of my time. I am merely trying to facilitate people who will be speaking contrary to this motion.

I have ruled on this. You were due to conclude at 5.55 p.m. and it is now 6.10 p.m.

That is entirely the fault of the Minister of State.

That is unfair. It was agreed. One minute of your time is already gone.

Yes. I am ruling on this now.

You can rule all you like. I am not putting up with that bullying. It is as simple as that.

The clock is ticking.

I will speak and I will be heard. That man over there can call me a gombeen man all he wants, but I am speaking on behalf of these people. If he wants to call us gombeen people, he can, but we will have our say.

(Interruptions).

I will not debase a serious issue in this House by name calling.

The clock is ticking.

I have four minutes, a Leas-Chathaoirleach-----

-----and I will take them.

You will take what I give you. Do not try to bully the Chair and be fair.

Do not be unduly critical of those trying to speak because you happen to be from the same party. The Cathaoirleach would not be so critical.

The Senator should respect the Chair.

Excuse me. If the Senator wanted to participate, she should have come in.

Senator MacSharry, the clock is ticking.

It is as simple as this. I will start with a few points. First, to the people in the Opposition - get over it. The last election took place, Fianna Fáil lost 53 seats and they deserved to lose them. The Minister of State is in government now. Act accordingly, take the decisions and take your bloody medicine when you make a mistake. Let me be the first to say Fianna Fáil lost 53 seats because they made mistakes. It must take a stupid government to come in and not learn from the mistakes of its predecessor, at the very least.

Second, with no disrespect to the Minister of State personally, her ministry is an abject failure because the senior Ministers and the Government to which she is subservient have starved her of resources. Does she know what they have done to her? They announced a few weeks ago through her colleague, the Minister for Education and Skills, Deputy Quinn, that they now have guidelines for a whole-school approach on mental health. What was the net result of that? Nothing. They now expect teachers to do the job of the guidance counsellors they cut and lacerated. In the words of Brian Mooney, one of the foremost guidance counsellors in this country, we might as well expect passing motorists to bring victims of car accidents to hospital instead of ambulances. That is the kind of medical planning we have seen by this Government. That is the gombeen approach to somebody who is questioning the Minister of State on it. Call it that if they will.

The Minister of State has been starved of resources. The reality on the ground is that, sadly, the incidence of suicide is increasing and nothing is being done. We consistently pay lip-service in these Houses to mental health and we pontificate about what should be done. We are not doing it. The Minister of State needs €100 million a year and she is being given a skittery €20 million. She is a failure for her inability to make sure that she maintained the €35 million she said she would have.

That is too personal.

In the report, Shari McDaid from Mental Health Reform noted that the HSE National Service Plan 2014 indicates that certain initiatives and places will not be put in place until the back end of the year so savings can be made. As Ms McDaid rightly said, mental health does not operate according to time delays. It is a real-time scenario and people need services.

The Minister of State has heard from the best medical names in the country, including Senator John Crown and John Saunders, the chairman of the Mental Health Commission, as to what is wrong. The process evaluating this was flawed - it was wrong. It now amounts to austerity for the mental health patients of east Galway. That is what it means, yet the Government blatantly disregards it.

As for Senator Mullins, I have no sympathy for him. And for Senator Kelly, who did a runner to get out of here because he has not the balls to stay and vote one way or the other-----

I am not finished.

You will finish when I tell you.

Senator, resume your seat.

Let me say to Senator Kelly, if this motion is about nothing, then that is because of the failure of the political administration and their choice to do nothing about it.

Is amendment No. 2 being pressed?

It is their choice to do nothing. That man from Wexford can call me a gombeen all he wants. I take pleasure in defending-----

I must put the amendment.

A Chathaoirleach, it is unfortunate you are not capable of looking after this debate in an appropriate fashion, given the way you talked over me and other colleagues. I expect more from a parliamentary colleague.

I ask you to withdraw that remark.

Under no circumstances. You did not even give me the protection of the Chair when I was being abused from the other side. As a party colleague, you were wrong.

Resume your seat.

Amendment put:
The Seanad divided: Tá, 30; Níl, 22.

  • Bacik, Ivana.
  • Brennan, Terry.
  • Burke, Colm.
  • Clune, Deirdre.
  • Coghlan, Eamonn.
  • Coghlan, Paul.
  • Comiskey, Michael.
  • Conway, Martin.
  • D'Arcy, Jim.
  • D'Arcy, Michael.
  • Gilroy, John.
  • Hayden, Aideen.
  • Henry, Imelda.
  • Higgins, Lorraine.
  • Keane, Cáit.
  • Landy, Denis.
  • Mac Conghail, Fiach.
  • Moloney, Marie.
  • Moran, Mary.
  • Mulcahy, Tony.
  • Naughton, Hildegarde.
  • Noone, Catherine.
  • O'Brien, Mary Ann.
  • O'Donnell, Marie-Louise.
  • O'Keeffe, Susan.
  • O'Neill, Pat.
  • Sheahan, Tom.
  • van Turnhout, Jillian.
  • Whelan, John.
  • Zappone, Katherine.

Níl

  • Barrett, Sean D.
  • Bradford, Paul.
  • Byrne, Thomas.
  • Crown, John.
  • Cullinane, David.
  • Daly, Mark.
  • Healy Eames, Fidelma.
  • MacSharry, Marc.
  • Mooney, Paschal.
  • Mullen, Rónán.
  • Norris, David.
  • O'Brien, Darragh.
  • O'Donovan, Denis.
  • O'Sullivan, Ned.
  • Ó Clochartaigh, Trevor.
  • Ó Domhnaill, Brian.
  • Ó Murchú, Labhrás.
  • Power, Averil.
  • Reilly, Kathryn.
  • Walsh, Jim.
  • White, Mary M.
  • Wilson, Diarmuid.
Tellers: Tá, Senators Paul Coghlan and Aideen Hayden; Níl, Senators Ned O'Sullivan and Diarmuid Wilson.
Amendment declared carried.

As amendment No. 2 is agreed, amendment No. 1 cannot be moved. Is the motion, as amended, agreed to?

Question put: "That the motion, as amended, be agreed to."
The Seanad divided: Tá, 29; Níl, 22.

  • Bacik, Ivana.
  • Brennan, Terry.
  • Burke, Colm.
  • Clune, Deirdre.
  • Coghlan, Eamonn.
  • Coghlan, Paul.
  • Comiskey, Michael.
  • Conway, Martin.
  • D'Arcy, Jim.
  • D'Arcy, Michael.
  • Gilroy, John.
  • Hayden, Aideen.
  • Henry, Imelda.
  • Higgins, Lorraine.
  • Landy, Denis.
  • Mac Conghail, Fiach.
  • Moloney, Marie.
  • Moran, Mary.
  • Mulcahy, Tony.
  • Naughton, Hildegarde.
  • Noone, Catherine.
  • O'Brien, Mary Ann.
  • O'Donnell, Marie-Louise.
  • O'Keeffe, Susan.
  • O'Neill, Pat.
  • Sheahan, Tom.
  • van Turnhout, Jillian.
  • Whelan, John.
  • Zappone, Katherine.

Níl

  • Barrett, Sean D.
  • Bradford, Paul.
  • Byrne, Thomas.
  • Crown, John.
  • Cullinane, David.
  • Daly, Mark.
  • Healy Eames, Fidelma.
  • MacSharry, Marc.
  • Mooney, Paschal.
  • Mullen, Rónán.
  • Norris, David.
  • O'Brien, Darragh.
  • O'Donovan, Denis.
  • O'Sullivan, Ned.
  • Ó Clochartaigh, Trevor.
  • Ó Domhnaill, Brian.
  • Ó Murchú, Labhrás.
  • Power, Averil.
  • Reilly, Kathryn.
  • Walsh, Jim.
  • White, Mary M.
  • Wilson, Diarmuid.
Tellers: Tá, Senators Paul Coghlan and Aideen Hayden; Níl, Senators Ned O'Sullivan and Diarmuid Wilson.
Question declared carried.

When is it proposed to sit again?

At 10.30 a.m. tomorrow.

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