Dáil Éireann Debate, Tuesday - 16 November 2021
560. Deputy Mark Ward asked the Minister for Health his plans to develop an outpatient national advocacy service for mental health; the estimated cost of establishing an outpatient national advocacy service for mental health; and if he will make a statement on the matter. [55737/21]
View answerThe Department and HSE National Mental Health Services are fully committed to ensuring that people using our mental health services have all necessary supports and that their voices are heard when decisions are being made about their treatment.
Recommendation 92 of our national mental health policy, Sharing the Vision, states that “a range of advocacy supports including both peer and representative advocacy should be available as a right for all individuals involved with the mental health services”.
As the Deputy will be aware, a General Scheme to amend the Mental Health Act 2001 was approved by Government on 13 July 2021. The General Scheme is primarily based on the 165 recommendations of a 2015 Expert Group Review of the Act, as well as the results of a 2021 public consultation, extensive consultation with key stakeholders such as the Mental Health Commission and HSE. The General Scheme takes account of domestic legislative changes, including the Assisted Decision-Making (Capacity) Act 2015 and the Mental Health (Amendment) Act 2018, and Ireland’s international obligations, including the UN Convention on the Rights of Persons with Disabilities, the UN Convention on the Rights of the Child and European Convention on Human Rights.
The Department of Health will work with the Office of the Attorney General to prepare the final Bill in line with the General Scheme. Pre-legislative scrutiny of the Bill by the Sub-Committee on Mental Health commenced on 2nd November 2021.
The Department has included a statutory right to engage an advocate under numerous heads of the General Scheme, including a definition of advocate under Section 2, information on advocacy to be provided to people in approved inpatient facilities under Section 16, 79 and 91, access to an advocate during a review board under Section 16B, during inquiries carried out by the Inspector under Section 55, or when making decisions about treatment under Sections 56 and 104.
The HSE currently provides some advocacy supports, including a Peer Advocacy Service in mental health which costs approximately €800,000 per annum. This service is concentrated on inpatient services and is delivered by an external agency on behalf of the HSE.
The HSE has estimated that the cost of extending a minimal advocacy service to all adult mental health community services, as well as inpatient units, would cost in the region of an additional €600,000, depending on the model used.
In addition to adult advocacy services, HSE National Mental Health Services currently provide an advocacy service through an external provider for young people and their families using Child and Adolescent Mental Health Services (CAMHS). Currently the CAMHS advocacy service is provided in two of our inpatient units at a cost of €80,000 per annum. This cost also covers some community advocacy in CHO2. To provide a baseline national CAMHS Advocacy service for both inpatient and community child and adolescent mental health services would cost approximately €240,000 per annum.
Therefore, based on the above, the full estimated cost of providing a National Advocacy Service for both adult and child mental health services would be in the region of €1.64 million per annum. It is important to note that this is a broad estimate and all expanded or new services would be subject to current contract arrangements, procurement rules and HSE National Financial Regulations.
The National Advocacy Service for People with Disabilities (NAS) provides a free, confidential service to people with mental health difficulties, particularly people with complex needs. NAS is funded and supported by the Citizens Information Board, which has a mandate under the Citizens Information Act 2007 and the Comhairle Act 2000 to provide advocacy for persons with disabilities.
Sage Advocacy also provides some advocacy support to people with mental health difficulties, particularly older people, in their role in supporting and enabling vulnerable adults and older people to make their voices heard in their healthcare decisions.
Access to advocacy supports forms part of Sharing the Vision, our national mental health policy, and the right to consult an advocate will be included in the updated Mental Health Act. While advocacy supports are currently available through the HSE and other actors, such as Sage Advocacy and the NAS, the Department recognises that services will need to expand in order to reach all people accessing mental health services, be that on an inpatient or outpatient basis. Discussions on how advocacy supports for people accessing outpatient mental health services will continue in the context of the implementation of Sharing the Vision.
