Developments in Mental Health Services: Statements

I welcome the opportunity to discuss developments in the mental health services overseen by this Government and to outline my plans for the future.

Promoting positive mental health and well-being in general is obviously important to us all. Mental health, for many reasons and in many respects, is a complex and emotive issue. It is encouraging that, in my time as Minister of State, I have generally found a consensus in both Houses to improve the area of mental health, including implementation of the widely supported policy, A Vision for Change.

This Government has consistently prioritised investment in mental health and the HSE has been steadily implementing change on the ground. While I remain as open as ever to constructive criticism or realistic suggestions, I ask that objectivity and, above all, the best interests of service-users remain paramount today. Reform of mental health services has led to much needed additional investment but it also requires new approaches to enable the capacity of our system, in terms of new delivery models, to realise a common vision. This ranges from overcoming staff recruitment and retention issues to rebalancing services at local level between acute and community-based care in order to achieve the objectives of A Vision for Change.

The implementation difficulties we face on the ground in some areas, which I have often acknowledged in the past, do not relate primarily to a lack of money. As I have indicated on many occasions, it is more a question of change catching up with the funding provided. This Government has provided €125 million ring-fenced funding between 2012 and the end of this year to develop and enhance our mental health services. The aim is to ensure that services are person-centred, user-friendly, responsive to need and recovery orientated. I am pleased that I have secured a further €35 million for 2016 to continue this important work.

To date, a key focus has been additional posts to strengthen community mental health teams for both adults and children. This funding is also being used to enhance specialist community mental health services for older people with a mental illness, those with an intellectual disability and mental illness, the forensic mental health services and suicide prevention initiatives. Some 1,150 new posts have been approved since 2012. Over 90% of the posts approved for 2012 and 2013 are in place and 110 of the 250 posts allocated for 2014 have been filled or are under offer.

Many areas have seen great advances, including those that have embraced the Recovery agenda, the expansion of the forensic services, including the achievement of planning for the new forensic hospital at Portrane, and the ongoing reconfiguration of both adult, and child and adolescent teams countrywide. Other achievements include the development of the counselling in primary care service, CIPC, for adults over 18 years, who are medical card holders; the implementation of national clinical programmes; a greater awareness of fostering mental health promotion in society; publication earlier this year of the expert review group report on the Mental Health Act 2001; and the new suicide prevention strategy, Connecting for Life.

Waiting lists for child and adolescent mental health services is an area of particular interest to me. Last March, I asked the HSE to undertake a detailed validation of the waiting lists with the aim of minimising waiting times and, in particular, reducing the number of those waiting over 12 months. This exercise involved the introduction of a new standard operating procedure for both inpatient and community CAMHS services. I am pleased to note that good progress has been made and that the HSE has given a commitment to eliminate the over 12 month list entirely by the end of this year. In this regard, the latest figures from the HSE indicate a reduction from 479 in March to 214 at the end of September in the over 12 months waiting category, a decrease of 55%. The number of cases waiting over three months has also decreased over the same period. There has also been a significant improvement in the number and range of CAMHS services at community and inpatient level over the past number of years. There are now 58 operational CAMHS beds across four units in Dublin, Galway and Cork. This represents an increase of almost 400% in the number of beds over eight years, from a figure of just 12 beds for the whole country in 2007. Furthermore, an additional eight beds will become available in early December when the new Linn Dara facility opens.

A priority issue for me is address of children and adolescents having, at times, to be admitted to adult acute units. Figures for 2014 indicate that there were 89 admissions of children to adult psychiatric units, with the majority being voluntary and involving parental consent. While these inappropriate admissions have decreased continuously in recent years, from a peak of 247 admissions in 2008, I believe there is still room for improvement.

The Health Service Executive is monitoring carefully all potential admissions to adult units to avoid this as much as possible. However, in some cases, it may be the only available option if an adolescent is to obtain early treatment.

Another topic to which I attach great importance is legislation in the area of mental health. Such legislation provides the necessary safeguards and protections on which people rely if the State uses its power to detain them because they are suffering from a severe mental illness. The report of the expert group set up to review the Mental Health Act 2001 was published in March this year. Government approval has been received for the drafting of a general scheme of a Bill to amend the existing legislation to reflect the recommendations of the expert group. Work is progressing in the Department on these important amendments. In addition, Government approval has been received for an early change to the existing legislation in respect of the use of electroconvulsive therapy, ECT. The effect of this change will be to remove the authority to administer ECT without consent in any circumstance where an involuntary patient is capable of giving consent but is unwilling to do so. The heads of the short Bill relating to ECT have been agreed in recent days with the Attorney General's office and, subject to securing Dáil time for this priority measure, it is my intention to bring it to the Oireachtas in December. Work is ongoing on the heads of the larger amending Bill.

Another important subject I have prioritised during my term of office is the issue of suicide. We are all aware that suicide remains far too prevalent in our society and is a complex problem which requires a multifaceted solution. While there are no easy answers to the problem, we can and must make every effort to reduce the number of lives lost to suicide by ensuring there is co-ordinated partnership among a broad range of Departments, State agencies, non-statutory organisations and, perhaps most importantly, through the involvement of local communities in tackling the issue. Dealing with the current high levels of suicide and deliberate self-harm has been and continues to be a priority for the Government. Earlier this year we launched Connecting for Life, our new strategy to reduce suicide, covering the period 2015 to 2020. The strategy which has an implementation focus on youth mental health sets out a vision in which fewer lives are lost through suicide and communities and individuals are empowered to improve their mental health and well-being. This includes a greater focus on the important issue of support for families and communities in suicide prevention and will involve providing community-based organisations with guidelines, protocols and training in effective suicide prevention.

For those who might ask what good another strategy can achieve, I emphasise that Connecting for Life is much more than a vision. It provides a detailed and clear plan to achieve each of the goals it proposes, with defined actions and a lead agency and key partners in place for each individual objective. The plan will be supported by robust implementation and governance structures, as well as resourcing and communications frameworks. Monitoring and evaluation will be embedded into the implementation process and the National Office for Suicide Prevention has been given a clear role and authority to support implementation of the strategy.

Having noted the progress made in recent years, I take the opportunity to outline to the House my plans and priorities for next year. As I mentioned, a further €35 million is available to us to continue our development work. Next year, in addition to continuing the development of general adult teams and child and adolescent health services, as well as improved 24-7 response and liaison services, priority will be given to the continued development of early intervention and prevention counselling services by HSE mental health and primary care staff, especially for young people. Investment in clinical programmes will continue, including in two new clinical programmes. One of these programmes will deal with ADHD in adults and children, while the other will deal with dual diagnosis of those with a mental illness and substance misuse problems, an issue Deputy Maureen O'Sullivan has raised on numerous occasions in this Chamber. There will be continued development of services in the area of psychiatry of later life and for those with a mental illness and substance misuse problems. An area that has not received the attention it deserves is that of perinatal mental health. Some of the funding secured for 2016 will be used to develop this important service.

A Vision for Change is a progressive, evidence-based strategy. When published in 2006, it provided a comprehensive framework for building and fostering positive mental health across the community and providing accessible, community-based or specialist services for people with a mental illness. It was designed to have a ten-year lifespan, which means that next year will be its final year. Discussions are under way within the Department of Health on the parameters of a review of the strategy. Any new mental health policy should be broader in its scope than just mental illness and recognise the importance of health and well-being, positive mental health and resilience and the wider social influences in that regard. It should also have regard to the evidence of national and international best practice. I hope to be in a position to agree the parameters of a review in the coming weeks.

I assure the House that the Government remains fully committed to mental health and suicide prevention services and the continued development of modern and responsive services in line with A Vision for Change.

One of the most gratifying developments in the past decade in challenging prejudice and stigma has been the improved attitudes in society towards mental health. We should not be complacent, however, as there is much left to be done, but we should acknowledge the significant improvements we have seen in challenging stigma and delivering improved treatments. Where people with mental health problems were once hidden away behind high walls, with other groups of stigmatised persons such as single mothers and their children, our society has now firmly and rightly rejected that approach in the context of the word "care". We have, in the past 20 years, faced up to much of the darkness of our past, which included industrial schools, laundries and mother and baby homes. When it came to some of those past abuses, the State was able to share the blame with other bodies such as the Catholic Church or it managed to disguise its own failures behind those of others. However, in terms of the sheer numbers involved, the abuses perpetrated within the mental health system dwarfed everything else. On the human rights abuses that occurred in the old asylums, the entire blame lies squarely and solely with the State. That past has yet to be investigated and acknowledged and an apology has yet to be given to victims.

Among the factors that played a part in my choice to join Fianna Fáil was the excellent work done by that party in government from 2000 onwards in improving mental health services and moving the approach to treatment away from an institutional model towards a recovery-based one. The two key achievements of Fianna Fáil during that time in mental health policy were implementation of the Mental Health Act 2001 and the reforms set out in A Vision for Change which, as the Minister of State indicated, will be ten years old next year. While both are now in need of review, they represented a significant change of mindset ain how we approached the issue of mental health.

A Vision for Change was published in 2006. It laid out a ten-year strategy for the reform of mental health services and signalled a new approach to the delivery of services to users. Significant progress was made between 2006 and 2011 in advancing that vision and providing the investment required to ensure its success. In 2011 Fine Gael and the Labour Party promised in their programme for Government to press on with the development of community mental health teams and ring-fence funding for that purpose. They have failed to honour these commitments. Not one cent of the €35 million allocated for the development of community mental health teams in 2015 has been spent. Vulnerable people in desperate need have been left to cope by themselves. As well as being a complete neglect of duty, this situation places a massive strain on the families and friends of those most in need of help. Only 24% of mental health posts approved last year were filled by 31 March this year. Delays in hiring within the year where posts are promised have been a consistent feature under the Government.

For the Health Service Executive to claim the only reason there are enormous gaps in front-line mental health services is it has been unable to find suitable staff is inexcusable. The notion that it has been actively seeking to recruit front-line staff within the timeframes of A Vision for Change does not ring true. In reality, there has been a deliberate and sneaky slowdown in the recruitment of promised community mental health service staff. The HSE’s own 2014 national service plan outlined strategically plans to delay the recruitment of mental health service staff until the latter half of the year to save money. The plan specifically stated certain recruitment initiatives, including the appointment of community mental health workers, would be “specifically targeted towards the latter half of 2014 to allow ... savings to be utilised on specific services on a timing delayed basis". That was a political and deliberate decision by the Government to ensure staff would not be recruited in this area. As a result, the funding that had been ring-fenced for the recruitment of specialised community health teams under A Vision for Change remained unspent. There are now 1,000 fewer filled mental health posts than when the Government took office in 2011, this at a time when the greatest public health crisis of our generation requires an investment focused on mental health. The implications of failing to recruit the promised community health teams are grave. We cannot continue to allow a situation to continue where someone in severe difficulty has nowhere to go. The Minister of State needs to explain the failure with respect to the allocation in last year's budget, as 76% of promised front-line posts remained unfilled. The Government has failed to deliver a functioning mental health service, despite prioritising other sectors. Units such as St. Brigid’s in Ballinasloe have been closed and not replaced with community mental health teams. As a result, major backlogs are developing in the system. The real aim of the closure of units such as St. Brigid’s has more to do with cost savings achieved than with the development of community structures. In the past two years there was a €70 million underspend in the national mental health budget. This money has been moved from the mental health sector to other parts of the health service for political and electoral reasons.

There are many other serious issues within mental health services, but I want to highlight two as critical. First, there is the continuing practice of placing children in adult wards. This is an abuse of the rights of children and leaves us in contravention of our international commitments to human rights. The other issue is the recent notable and significant increase in the incidence of electroconvulsive therapy being administered against the expressed and clear will of individuals. This practice also needs to end. It is welcome that the Minister of State has outlined that progress will be made in December in amending legislation to address this issue.

Mental health issues continue to have a devastating impact on our society. The Ireland we want to build must commit itself to an all-out effort to help people and reduce the number of cases of self-harm and suicide. In doing this we can learn from initiatives that have already worked well. Since the Road Safety Authority was established, it has helped to halve the number of deaths on the roads. That means that the lives of more than 200 people a year have been saved. It is time to do the same in the field of mental health.

Accordingly, Fianna Fáil proposes the establishment of a national mental health authority to be charged with adopting an agency approach to lead the promotion of positive attitudes to mental health, while reducing the incidence of self-harm and suicide. One key feature of this idea is challenging political interference with the mental health budget whereby it has been stolen, as I referred to. The authority would provide for a definite ring-fenced approach to funding mental health services and prevent moneys from being pulled from mental health services to shore up other parts of the health service. The establishment of the authority would mean that a vote of the Dáil would be needed to alter the budget for the proposed mental health authority, ensuring full accountability. The authority would be a separate body from the HSE, with its own director general. It would remain under the authority of the Department of Health, working in co-operation with the HSE through a range of mutual service-level agreements. I look forward to making the argument for the establishment of the authority in the forthcoming general election and ensuring mental health will feature as one of the key topics of debate in the context of our vision for the future for mental health services, as well as the continuing effort to reduce any remaining stigma with regard to it. Stigma is a great stealer of innocent human lives.

I acknowledge and welcome the commitment given by the Oireachtas to facilitate this debate on this important policy area.

According to the most recent statistics available for suicide in the State, 459 persons - 368 males and 91 females - took their own lives in 2014. During the same period there were 62 undetermined deaths which in the North and other countries would be normally counted as suicides. At the same time, around 300 citizens in the North die each year by suicide. It is generally accepted that the real figure for suicides is higher and that as many as 1,000 citizens die across the island each year by suicide.

The human cost for families and communities is devastating. The reality is that all sections and generations of our society are affected, from the very young to the very old, in rural and urban areas alike. Mental health is traditionally an area in which Ireland has performed badly. While society has started to deal with the issue in a more open way, mental health remains a taboo subject for many and mental health care has been poorly provided for. While there have been attempts to reconfigure health spending and ensure mental health care is prioritised, we see funds earmarked for mental health services spent in other areas.

Preventive and early intervention mental health care remains underfunded. One in seven adults in Ireland, 644,000 people, has experienced a mental health difficulty in the past year. Despite a perceived openness about mental health, the number of suicides has remained high, with between 495 and 554 deaths per year between 2009 and 2012. Lack of staff in the sector is a major problem. Despite a greater need for mental health services, there are 1,200 fewer mental health staff now than there were in 2006. A report in June 2015 highlighted an 11% decrease in posts since 2008, despite 1,200 being promised. Between 2008 and 2015, there was a loss of over 1,000 mental health staff and staffing levels were only 77% of the recommended level in A Vision for Change.

The situation is more severe in child and adolescent mental health services, with just over half of the staff required in post. There have been considerable staff losses in mental health nursing, with a reduction of 1,063 nurses between March 2009 and September 2014. Around the clock mental health services for adults in acute mental distress are still lacking across considerable parts of the State. The overall budget is insufficient also.

Nine years on from the publication of the strategy, just 6% of the total health budget goes to mental health services, compared to 7.2% in 2006 and far short of the 10% target. In 2015 the figure is predicted to be only 6.5%. In 2014 there was a €15 million shortfall in funds due to be ring-fenced for community based mental health and suicide prevention services. There were also delays in spending the €35 million promised in budget 2013. In fact, in practically every year of this Dáil term the Government has not even spent the amount to which it has publicly committed.

We need to see a modern bio-psycho-social model of care available locally across the disciplines, with a focus on primary care, counselling and 24/7 access to emergency supports. We also need to address the issues of housing, employment and discrimination in line with proposals made by Mental Health Reform, on some of which I will touch. The proposals contained in the overarching framework document for the sector, A Vision for Change, are sound, but they have never been fully introduced and so-called ring-fenced funding has, in some cases, not materialised. A Vision for Change was published in January 2006 and originally supposed to be reviewed after seven years, but that is only now occurring. Sinn Féin believes A Vision for Change still needs to be implemented. Additional funding should be provided and directed towards community mental health services.

Ireland’s new strategy for suicide prevention, Connecting for Life, needs to be incorporated. It sets a target to reduce the incidence of suicide and self-harm by 10% in the next five years, based on WHO targets. A continuation of the roll-out of suicide crisis assessment nurses is needed. These nurses liaise with GPs where there are concerns about patients who may be suicidal. The data available for the impact these nurses have had to date are very encouraging. However, only 24 of the 35 nurses approved for the programme have been recruited, which is unfortunate. The full initial complement must be recruited and deployed as a matter of extreme urgency.

Greater support must also be extended to people with mental health issues to access housing. Recent housing lists showed a need for just over 1,000 places for those with mental health difficulties. There was a 36% increase in admissions of homeless people to psychiatric units between 2006 and 2013. We need increased supports to access appropriate housing to aid integration and recovery.

In January 2015, 429 children were waiting more than one year to be seen by the Child and Adolescent Mental Health Service, CAMHS. That figure has improved, as the Minister of State recorded, but we need to focus on early intervention. There has been investment in child and adolescent mental health teams but just half of what was recommended in A Vision for Change and far from enough to meet the 50% increase in demand for the service. By the end of 2014, there were 63 partially complete community CAMHS teams in place, but in A Vision for Change 77 teams were recommended.

On crisis supports, more than nine years after publication of A Vision for Change, mental health services are still not uniformly providing the basic model of care that includes 24/7 crisis intervention and home based and assertive outreach treatment, with crisis houses as the norm in all areas. The HSE reports that in nine of 17 mental health areas there is weekend cover for existing mental health service users across the entire catchment area, while in the remaining eight areas they are partially in place. A clear framework for collaboration and referral between mental health services is lacking. This issue must be addressed.

People with mental health difficulties, like other forms of disability, disproportionately experience unemployment which can, in turn, exacerbate their health difficulties. Sinn Féin supports the expansion of Employment First supports, whereby a person’s work preferences and skills are assessed quickly after coming into contact with mental health providers, a suitable placement in the workforce is identified and appropriate supports are offered within the work environment. Mental Health Reform is leading a pilot project, Integrated Employment and Mental Health Support, in which four EmployAbility companies are participating. The Department of Health provided €250,000 to allow each of the companies to employ an additional job coach for the two year period. The pilot project is based on a British Individual Placement and Support, IPS, model of supported employment. It espouses an employment first approach in which a person's vocational skills and work preferences are assessed quickly after coming into contact with mental health services. Being job-ready is not a requirement; rather a suitable setting in the workforce is found and support is provided to develop skills within the work environment. A report for the British Department of Work and Pensions found that for every £1 invested in IPS, there was an expected saving to the Exchequer of £1.51.

Primary care services should also play a central role in supporting those suffering from mental health difficulties. Many find it very difficult to access help when needed, while some cannot afford to make use of private counsellors. The Counselling in Primary Care, CIPC, service is an early intervention programme that provides medical card holders with mild to moderate mental health difficulties with access to a limited number of sessions. It is imperative that this service capacity is increased in order that those on low wages who often find it very difficult to access such care are looked after appropriately.

I welcome the opportunity to contribute to this very important debate on the current state of mental health services and the urgent need for more reform and development. I totally support the Children's Mental Health Coalition which consists of more than 50 organisations from a variety of backgrounds and sectors, including children's rights, human rights, education and mental health services. I also warmly and strongly support the recommendations made in the coalition's report from 2013, Someone to Care, which identifies the experiences and mental health needs of children and young people in the care and youth justice systems. I strongly support implementation of the national guidelines on mental health promotion for primary and post-primary schools.

What is the reality on the ground? As of December 2014, the number of staff posts in the Child and Adolescent Mental Health Service, CAMHS, was 499.5 whole-time equivalents. This is just 41.7% of the staffing level recommended in A Vision for Change - 1,196 whole-time equivalents - and represents a 2.9% decrease in the number of staff in the CAMHS at the end of 2013. According to the Minister's performance assurance report at the end of 2014, the waiting list for the CAMHS has increased to 2,818 cases, an 8% increase on the figure for the same period in the previous year. A total of 405 children and adolescents, or 14%, have been on the waiting list for more than 12 months. By the end December 2014, there had been 290 child and adolescent admissions, 31% of which were to approved adult mental health inpatient units.

Yesterday I visited a community education project in Donaghmede in my constituency. The organisation which runs the project, Target, is excellent, but it is facing many difficulties. The HSE pulled support from its special needs programme, thereby depriving the most vulnerable people of the opportunity to learn new skills which would give them confidence and enable them to live independently in their communities. The real benefit for students was in integrating, over a cup of tea, and improving their social and communication skills.

However, the HSE no longer funds a manager or clinical director of its counselling service. On the retirement of its manager, who was on secondment to Target by the HSE, the funds were directed towards a clinical director for a counselling service. It had a clinical director two days a week but after two years the funding was cancelled. We also had an excellent mediation service in Coolock through the Northside Community Law Centre. This, too, is under fierce pressure.

It is important to ensure voluntary organisations on the ground are supported. What do we need to do? We need to prioritise the full range of mental health services from primary to specialist mental health services. CAMHS should provide mental health services to children and adolescents aged zero to 18 years of age. Service users, carers and their families should be given the opportunities to influence developments within the mental health services based on their experiences. Finally, mental health promotion and primary prevention should be targeted at child populations at risk.

We know that progress is being made and I acknowledge the role of the Minister of State, Deputy Kathleen Lynch, in that regard as well as the role of the families, individuals and various organisations. I also acknowledge the role of the Oireachtas group on mental health. We are probably the only group who can agree a pre-budget submission.

We know the old way was to medicate, institutionalise and use some horrific procedures. I welcome what the Minister of State said on ECT earlier. We should dedicate it to the memory of the late John McCarthy of Mad Pride Ireland and Pat Bracken, who did so much work in this area.

We know the growing figures but I will mention two in particular. The first is the number of young boys who are presenting as having self-harmed. The other concerns Pavee Point. Yesterday I attended a celebration of its 30 years in existence. An increasing number of male Travellers are coming forward and telling of suicide ideation.

Accident and emergency units are chaotic, busy and hectic. Presenting with a mental health issue in an accident and emergency unit adds to the person's distress. This applies, in particular, to people with autism and Asperger's syndrome as noise is so difficult for them. We need to look at the possibility of having dedicated intellectual disability nurses in accident and emergency units, especially for those who present with mental health issues on their own.

The priority across the board should be prevention and early intervention. In particular, we should be working with young people. It is parents, teachers or youth workers who will first see it when they present as suffering mental health difficulties. Such difficulties in early life place young people at increased risk of further episodes during their adult lives. The numbers of clinical staff in CAMHS have to get to the levels recommended in A Vision for Change.

Integration of services was mentioned by the Minister of State in her speech. There is an issue around dual diagnosis of mental health issues and substance misuse. The underlying issues are not being addressed because they are being treated separately.

We know that it is people from disadvantaged backgrounds who are most susceptible to mental health issues. Family support is vital. In the meantime, however, can the budgets be restored? There were cuts of 30% and more to the addiction, community and youth projects working at the coal face with these young people.

I cannot believe I will now defend smoking but there are plans for all HSE facilities to be smoke free. There are facilities dealing with people who are in vulnerable situations and dealing with other addictions. Smoking is the least of their difficulties. I do not believe in a blanket ban. I understand the rationale but I do not believe it to be the way forward.

The Minister of State mentioned suicide prevention. She visited the Oasis Centre and knows the work it is doing with vulnerable people. She knows it has qualified counsellors and psychotherapists but minimal Government funding.

I ask the Minister of State to be open to innovative programmes. I met a midwife yesterday who works with women suffering from addiction who are pregnant. She came across a lovely programme abroad. It brings in women to cuddle babies who are born into addiction. We need to be open to those types of innovations.

I accept the Minister of State's bona fides in terms of tackling youth mental health but reading her speech today it would be unclear to anyone that we are facing a crisis in mental health services. I spoke recently at a conference held by the Association for Child and Adolescent Mental Health. I spoke to youth mental health workers and psychiatrists beforehand. One of them told me there is such low morale in the service that they are finding it impossible to hire people for youth mental health posts. A psychiatrist told me that access to youth mental health services is currently so bad that GPs outside of Dublin are writing letters advising that the young person is at serious risk of suicide. They are advising that young person to go to an emergency department in a Dublin hospital with the letter in order to skip the queue and get access to youth mental health services. That is what is going on in our country but there is no recognition of how bad the situation is in mental health and youth mental health services.

A Vision for Change recommended that 8.24% of the health budget should be spent on mental health services. We are at 6%. The UK is at 12%. In the past seven years, we have lost more than 1,000 mental health staff. This means that our staffing levels are less than 80% of what is recommended in A Vision for Change. As well as adequate funding, the system needs to be seriously modernised. The mental health integration index examines the progress of European countries in helping people manage their mental health to recovery. It looked at areas such as the provision of a stable home and family environment, access to health services, the improvement of work and education opportunities, the reduction of stigma and the increasing of awareness. Of the 30 countries surveyed, Ireland ranked in 14th place. It ranked 16th on access and 17th on opportunities for those in need of mental health support.

In youth mental health, the situation is critical. Young people in Ireland are facing a suicide rate that is in the top four in Europe. More than one fifth of young adults indicated that they have engaged in self-harm. A study of LGBT young people found that one in five has attempted suicide. One in four has self-harmed and one in three has thought seriously of ending his or her life in the past year alone.

What is Ireland's response? As of December last year, we had just more than half the staffing level for youth mental health services recommended in A Vision for Change. There are many solutions. We need to move urgently from a paediatric-adult model to a paediatric-youth-adult model.

Go raibh maith agat, a Theachta.

I will finish on this point, a Leas-Cheann Comhairle. Young people should not be entering the system via health centre waiting rooms but via suitable access that is stigma free. We must remove the siloed access that only kicks in at critical stages for young people and move to early detection and a comprehensive suite of services. We must move from a paternalistic approach to youth mental health and actively include young people in designing a system that is appropriate for them.

I welcome the opportunity to contribute to this debate and welcome the Minister of State to the House. We come from a very low base, historically, in terms of our mental health services and how we have dealt with people who suffer from mental illness. My mother was a psychiatric nurse in the 1940s. The institution she worked in was known in her time as the mental hospital but 20 years before that it was known as the lunatic asylum. We are coming from that low base which goes back decades and centuries.

Even in recent decades we have neglected the opportunity to improve the area. Things have moved on and when A Vision for Change was published there was an increased concentration on the issue and the opening up of debate. Society had a greater awareness of the need to have a modern approach to dealing with mental health services. I welcome the Minister of State's statement that there will be a nine or ten year review of A Vision for Change next year. It will be interesting to see the analysis of its implementation.

Child and adolescent mental health services and the 89 admissions to adult hospitals last year were already mentioned.

There is a difficulty with this situation. In Limerick, for example, 20 beds were promised for the mid-west, but that was shelved some years ago. Now, somebody in Limerick must go to Cork, Dublin or Galway and somebody in Donegal must go to Galway. That creates a difficulty for parents in continuing to visit their families, which is very important for young people.

I welcome the review of the 2001 Act. This has been sought for some time so I welcome the fact that legislation will be brought forward in December. The €35 million allocation has been mentioned in previous discussions. There is an issue with the rolling out of improvement in the mental health services following the commitment by the Government. There is a full commitment of €155 million to the development of mental health services - €35 million each year, except for one year when the allocation was €25 million. There appeared to be no plan in place to respond to that. It was part of the programme for Government so the HSE should have anticipated it, but it appears that the plans for recruitment commence on 1 January rather than having everything ready to go. As a result the people are not recruited until the end of the year. That is an issue we have raised over a number of years in respect of the roll-out of the improvement in the mental health services.

Stigma has been mentioned. It is a key issue in educating people with regard to understanding mental health services. One in four people will suffer from a mental illness at some stage in their life. Mental illness does not exclude anybody: anybody can suffer from a mental illness. Stigma is a crucial issue in seeking assistance and in the demand for services by people in difficulty. There is still a sense of hiding it, unlike with other illnesses, when there should be an opening up and a demand for the services. I hope to deal with this in a letter.

Another issue in mental health is the coverage of mental health by Voluntary Health Insurance, VHI, and other bodies. There is discrimination in the coverage of mental health services. The VHI covers 180 days for general health issues and hospitalisation while the psychiatric policies vary from 100 days to 180. Likewise, GloHealth Insurance has no time limit on physical health whereas there is a time limit of 100 days for mental health services. Laya Healthcare has coverage for hospitals of 180 days, but it is 100 days for psychiatric inpatients. It is difficult to understand why there is discrimination in this area.

We have heard the figures for suicide. Suicide is a particular problem among young people. The suicide rate for young people is particularly worrying. The suicide rate among teenage girls in Ireland is the highest of any EU state, while the rate for young Irish males is the second highest. Ireland has the fourth highest rate of youth suicide in Europe, that is, of people under 25 years of age. While our suicide rate is generally just below the European average, our youth suicide rate is one of the highest in Europe. That is of extreme concern.

I welcome Connecting for Life, and I wish I had more time to discuss it. The World Health Organization warmly welcomed and praised its publication, content and objectives. We have targets of 10%. Reach Out had targets as well. In fact, the Reach Out ten-year programme from 2005 to 2015 recommended that there would be overall targets for the reduction of suicide rates, which should have been set by the then Government to advise the then Minister for Health and Children, when the Minister was satisfied that the suicide rates had been reasonably accurately determined. However, that did not take place. There was a strategy for action which was discussed and introduced in 2008 and 2009. A reply to a recent parliamentary question I tabled informed me that in 2009 there was a strategy to reduce it by 10% from the 2005 figures. However, when one analyses the figures one finds that the average for the five years up to 2005 was 494 while the average for the five years up to and including 2014 was 497.

Did Reach Out attain any of its objectives? The main objective was to reduce suicide rates and that did not happen. We must ensure that when we set targets the programme that is applied will meet those targets. The content and implementation of Reach Out did not reduce the suicide level, as the figures suggest. We will be given all types of explanations for that situation, but they are not good enough. Extensive resources were provided to achieve the objectives of Reach Out but the facts show that it did not happen.

Finally, I wish to raise an issue which I have been raising for the past ten years. I have encountered serious examples of this. It relates to the regulation of psychotherapists and counselling. I was given two serious examples recently by people who have suffered extreme difficulties with people who are not qualified and not members of professional associations. After ten years of examining this issue since the Health and Social Care Professionals Act was passed in 2005, I again urge the Minister that the regulation of counselling and psychotherapy is vital to ensure that people who access those services are dealing with competent people. I have heard examples of absolute exploitation and abuse of people who accessed psychotherapy and counselling which did not have the expertise available, as well as the abuse of using psychotherapy and counselling to damage people rather than assist them.

I welcome this debate and acknowledge that the Minister provided the time to have statements on mental health services. It is timely. I wish to put in context the conflict that exists with regard to the Government's commitment to, and funding of, this service. The cut in the marginal rate of tax, for example, was lauded by many but one could argue that it has been wiped out by increases in car insurance and medical health insurance. In doing that the Government further put off the potential to provide the type of funding that is required in this area.

It is also against the background of there being a 6% growth rate in the economy this year. While that and the progress in regard to inward investment are to be welcomed, and while favourable exchange rates assist that process, society must acknowledge, as this House has heard umpteen times, there is a crisis in the provision of housing throughout the country, a crisis in regard to waiting lists and the provision of accident and emergency services in our hospitals, and a crisis in the funding of local authorities, which have been told to raise commercial rates and property taxes to meet the shortfall, while Irish Water is subvented with regard to its rates and subvented further through car tax revenue. My point is that while that continues apace, the Government has to make priorities and has to decide where it will focus its energies and its funding to meet the demands placed on it. In this area, it is quite disappointing that while the programme for Government committed to an annual ring-fenced €35 million in funding for community mental health services, this commitment was broken in 2014, with funding reduced to €20 million.

The whole area of mental health is one which has, in a sense, been radicalised in recent years, which we commend and welcome. At this point, it is only right and proper to pay tribute to and commend the various NGOs in this area which work tirelessly and give great service to the State and to many of its inhabitants. I particularly want to congratulate Jigsaw Offaly for its Pride of Place award last week, and I also pay tribute to the many other voluntary bodies which, as I said, work tirelessly in this area and help State services to provide the assistance that is needed by the many people affected by mental health issues. I also want to acknowledge and commend the many people who have spoken out about their own issues in this area, in particular the many prominent figures in sport, business and so forth who have helped to alleviate the stigma that has historically been associated with illnesses in this field.

While that continues apace, and it is a great and welcome turnaround in Irish society, I do not believe the Government is giving this issue the priority it deserves. I acknowledge the effort and commitment of the Minister of State, Deputy Kathleen Lynch, in this area, and I am sure she is fighting the good fight with regard to the services which she has responsibility for funding and assisting. However, it would appear that drive, commitment and support does not feature highly enough in the Government's reckoning. After coming into office in what were, as we acknowledge, difficult times, it made a commitment in the programme for Government to ring-fence a certain amount of funding to meet the demands placed on it by virtue of the A Vision for Change strategy. As I said, it is very disappointing that this commitment has been lost.

As one of many Members of the House who will be a candidate facing the electorate in the coming months, I feel obliged to say that we need to reaffirm our commitment to this area and we need to state categorically where we stand. From the perspective of my political organisation, Fianna Fáil will reform and restructure the National Office for Suicide Prevention as a distinct entity within the mental health authority, giving it a ring-fenced budget, performance targets and an independent employment system, with clear interdepartmental input at Government and Secretary General level. We would want to enhance the size and role of the National Office for Suicide Prevention to undertake matters such as the development of a new national strategy and the creation of a national 24-hour helpline. We would propose to increase the number of resource officers for suicide prevention, enhance their role and link them directly to the National Office for Suicide Prevention. We would want to implement a system of GP practice whereby the prescription of antidepressant medication has to be reviewed on a monthly basis until the GP is satisfied the medication is the best course of action. We would want to establish out-of-hours emergency social worker teams across Ireland.

To refer back to our own role within our constituencies when we meet people affected who wish to avail of services, the difficulties they and their families have in accessing those services is something we have to reiterate and put on the record. For example, with regard to the backlog in the waiting list for psychologists, figures released to us earlier in the summer appear to show that 5,432 people were waiting more than three months for an appointment with a psychologist. Those figures are just a glimpse into the unfortunate and dire situation that people using the mental health services are facing. People have already been told by their GPs that they have been referred to a specialist for assessment. What is worse is the fact that more than 1,000 people are forced to wait more than a year.

On the issue of child mental health, it is very challenging for us all to meet the demands placed on the services and to acknowledge those children should be to the forefront of any policy. The HSE figures released at the end of last year suggested there were more than 3,000 children and teenagers waiting to access mental health services in the community, and more than 400 of those were waiting over a year. This has to be a great cause of concern and relates, more than likely, to the lack of staff, which contributes to rising waiting lists. I know the HSE said it has had difficulty in recruiting staff, which I find unfortunate and amazing. I would like to know from the Minister of State what progress has been made in recent times in order to address the supposed difficulty the HSE claims exists. With regard to the community mental health teams for children and teenagers, it appears these have just 42% of the number of staff recommended in the Government's own mental health strategy, A Vision for Change, which represents a 3% drop-off in staff compared to the previous year.

Those are some simple and obvious insights into the situation with regard to the provision of services throughout the country, and particularly in my constituency, given the national figures mentioned are evident in my community. These are issues which I have an obligation to voice and share with the Minister of State in the hope that the Government can respond to this in a positive manner and reaffirm the commitment contained in the programme for Government and, more importantly, reaffirm the monetary commitment it made in order to give effect to all that was contained within A Vision for Change. I expect there would be an audit of that in the short term and that the Government would make a statement on the goals set within it which have yet to be achieved, or which have not been funded.

I welcome the Minister of State to the House to discuss this important issue. I acknowledge the fact that this Government has ring-fenced €125 million for mental health funding. Mental health is a private illness with public consequences. It is devastating when people's lives collapse around them. In addition, mental illness does not discriminate and can affect anybody at any time; indeed, it can tear families apart.

Given that I have a relatively short speaking time slot, I would like to focus my comments on some of the outstanding work on mental health that goes on in my constituency of Longford-Westmeath. Some months ago, I met with two local students, Thomas Ganley from Longford and Niamh Tubridy from County Westmeath. Their goal is to promote positive mental health through the "Let's Go Mental" campaign.

Thomas and Niamh are passionate about this project. The campaign is a series of 31 regional events for teenagers to promote positive mental health. One of these regional events took place in Longford town and it focused on the small, positive things we can do every day which make a big difference to how we feel. It was a great event which was very well run. All credit should go to Thomas, Niamh and the rest of the event's organisers.

We already have an excellent Good2Talk centre in Mullingar. The centre supports positive mental health by providing effective and accessible counselling services. I have been informed by the Minister that negotiations are ongoing with a view to opening a Good2Talk centre in Longford. I would urge the Minister to ensure that these negotiations reach a favourable conclusion as soon as possible.

Between 2014 and 2015, nine applied suicide intervention skills training workshops were delivered in Longford and Westmeath to a total of 220 individuals. Meanwhile, 25 SafeTalk programmes were delivered to a total of 375 people. Despite the financial pressures, €21 million has been allocated to Longford and Westmeath in 2015 for mental health services. While this is welcome, we must continue to rebuild and sustain our funding of mental health services, especially in the midlands where rural isolation is a real issue.

I cannot speak in this debate on mental health without mentioning the exceptional work that takes place in St. Christopher's in Longford town. My mother, Marcella, was a founding member of the service and I have been attending the school's annual general meetings for decades. St. Christopher's runs a great service and provides many programmes to equip service users with personal, social and work-related skills that will enable them to progress to greater levels of independence. In 2014, I ensured the financial stability of the services by lobbying the Taoiseach, the Minister for Health and the HSE to cover cashflow issues encountered by St. Christopher's, which started back in 2008, long before the current Government took office. However, the National Council for Special Education recently informed the school of a reduction in two special needs assistant posts. This news is a big worry for staff, pupils and families who are dependent on those services.

One of the aims of St. Christopher's school is to enable children to become as independent as possible. The loss of two staff members will have a detrimental effect on pupils' well-being, education and independence. In addition, pupils' access to the curriculum will be restricted, as the school will not have staff available to enable full participation. I have already raised this serious issue with the Minister, but I want to take this opportunity to put it on the record that we must do all we can to ensure both of these SNAs are reinstated as a matter of urgency.

Mental health promotion remains the most undeveloped area of health promotion in Ireland. The need for positive mental health promotion is universal and relevant to all of us, so we need to ensure it is adequately funded. I thank the Minister of State for attending the House for this important debate. Mental health issues have affected communities around the country, while over the years every parish has been afflicted by suicides. We must therefore strive to ensure that sufficient funding is in place to upgrade mental health services in every single part of the country, but particularly in rural areas where isolation is prevalent.

Mental health in Ireland is, thankfully, being increasingly discussed in an open and transparent way. For too many years there has been a stigma attached to mental health, which portrayed mental illness as a sign of personal weakness and a taboo subject within society in general. Mental health is not just the absence of mental illness but is in fact a level of mental well-being which equips us to deal adequately with the day-to-day challenges of life while achieving our potential in a professional and personal capacity. This means it is something which affects all of us.

Mental illness in this country is still a widespread problem with high levels of depression and other illnesses across our communities. The number of people living with mental illness has risen sharply over the past few years. This is partly due to the impact of extreme stress and hardship which people experienced during the height of austerity, but it is also because more people are coming forward to seek help.

This new willingness to seek help is a direct result of the increased public discourse on mental health and public awareness initiatives. A huge amount of credit must also go to campaigners who have shared their stories of survival and perseverance. There is no doubt that the intervention of such people and their very human stories have inspired people to speak out and have in the process saved lives.

The phrase which has been popularised in recent years, that "It is okay to not be okay”, sums up well the drive for people to feel comfortable to seek help and for others to support their friends and families. These types of conversations should be actively supported.

A lot of progress has been made in how we as a society treat mental health and illness, but the number of people who take their lives each year shows that we have a long way to go. We can also see that a high number of people engage in self-harm or para-suicidal behaviour but we must remember that mental illness is not just about suicide or self-harm. Many people who suffer with depression, anxiety or psychosis may never seek to end their lives, nevertheless, their illness is debilitating and limits their potential for happiness and success in life.

As with our medical system, our approach to mental health must not be solely about treating emergency situations but also about guarding against them and improving society as a whole. In Ireland today, it is estimated that one in five individuals suffers with mental health issues in one form or another. I would speculate that the actual figure is higher. This is because of a stigma still being attached, whether it be with young men and their perceptions of masculinity, or with older generations due to the position held by the Catholic Church for many years.

According to the latest figures available, there is evidence that suicide and mental illness are not specific to a particular demographic but are applicable to all walks of society. We all know of someone who has been a victim of mental illness and the effect that such deaths have on those closest to them. These deaths are undeniably tragic, but are also preventable if the commitments the Government has made were to be followed up on.

We have to ask a number of questions. Do we have the right strategy and, if so, is it realistic and properly funded? Workers within the sector have consistently highlighted how resources and funding made available to them annually are nowhere near enough to enable them to provide an efficient service based on a proactive approach, rather than a reactive one. Anecdotally, I am told by some mental health professionals that they have noted a stark increase in demand for their services in recent times, thus putting more pressure on their resources.

Mental health services have been historically underfunded in this State to a shameful degree. We are very lucky to have so many excellent charitable and voluntary bodies which have championed those who are struggling with or overcoming mental health issues. For far too long, they have filled the gaps that have been left by a failure of the State to address mental health with the seriousness and focus it deserves. These services rely greatly on donations and fund-raising. They are often severely over-stretched and they should not be used to absolve the Government of its responsibility in the provision of mental health services, allowing it to distance itself from these services at a time when substantial additional funding is greatly required. One group, SOSAD, deals with between 450 to 500 people on a weekly basis and almost its entire budget goes on providing these vital services. It is stretched to the last cent of its funding and this limits the ability to provide training to its volunteers. It also puts major strain on the people involved and their morale.

This is about the expense incurred by a young person and the substantial costs of services. The issue of cost is something that alienates people from availing of these services and may be the difference between people getting the help they need or not getting it. Unfortunately, we all are too aware of the consequences of people being unable to access these services. Rural Ireland has once again disproportionately suffered in this regard with most services based in urban areas. Limited transport to these centres may mean travelling up to 20 or 30 miles for some people and could result in a large portion of their time being taken up. The lack of basic services must be addressed if we are to reduce suicide and mental illness figures in any significant way.

The predicted funding of 6.5% of the overall health budget does not go far enough in the provision of mental health services and is still a long way off the 10% recommended. Last year alone, there were 459 deaths that were known suicides. This is one and a quarter deaths per day. How many of these may have been preventable if more proactive and accessible services were in place? One of the major problems is our after-hours services and weekend services, which are practically non-existent. We need a 24-7 service with psychiatrists on hand in accident and emergency departments. The Government promised this but it does not seem to have been delivered. A recent case of mine involved a person who was turned away by an ordinary doctor. There was no psychiatrist available. This led to serious consequences. There is a shortage of nurses and the number of those leaving or retiring from the services is disproportionately higher in mental health services compared with other hospital services. People are being turned away from accident and emergency departments and are not being diagnosed properly. It is high time that we really began to regard this issue as one of paramount importance. Since 2011 alone, we have lost over 2,000 of our citizens to suicide. Many of these were young people whose lives were taken far too soon - lives with so much potential that will never be fulfilled.

In A Vision for Change, the Government promised to keep people in their communities. A total of 40 people met regularly at the Tus Nua facility in Ballymun. It was going very well. The people were interacting and working with each other on a regular basis. They are now being dispersed across the service in the different areas around Ballymun leaving us with no proper service in Ballymun. This goes against the philosophy of A Vision for Change. I would also like to mention Finglas Suicide Network, Pieta House and all the volunteers who have worked so hard to help people over the years. They have helped people significantly. The Tree of Hope, which the Minister of State may have heard of, is an organisation that is highlighting suicide. It operates across the country and has spread to Europe where it plants trees for those who died through suicide. People come along and put names on the trees. Those trees have been left in parks the length and breadth of the country and the organisation is now moving into Europe. It was begun by a woman in Tallaght and keeps awareness high. Even young people who come to the parks, some of which have been vandalised, do not touch these trees. The trees are a reminder that some of their friends have been lost through suicide. Initiatives like that have been proven to help in the fight to get services and make people aware of this major problem that affects practically every family the length and breadth of this country.

I am proud to say that I have a history of volunteerism in this area. I was the inaugural chairperson of Bailieborough Mental Health Association for a number of years in the mid-1990s. That association went from strength to strength and became involved in a wonderful number of wide-ranging activities. I worked with the development officer of Mental Health Ireland in respect of the association's work for a number of years and I am happy to say that this association still exists and remains very strong. One of its former volunteers, Sean McKiernan, became a regional development officer in Mental Health Ireland and did an exquisite job in that area. I am very proud of that record of volunteerism so I like to think it gives me certain credentials to speak in this debate. Regardless of my credentials, I certainly have a passion for this area. I am very proud of Bailieborough Mental Health Association but I am equally proud of Bailieborough Mental Health Centre, which was one of the first community mental health centres in the country and continues to do an excellent job. It is a great hub and social centre in the town.

I am also proud of the Cavan-Monaghan Mental Health Service, which has been very avant-garde, progressive and far-reaching. After the fall of the Iron Curtain, when eastern Europe was getting rid of some its atrocious institutions, which were worse that the worst Irish institutions, they sent their administrative and professional personnel over to look specifically at services in Cavan and Monaghan as a model for the development of modern services in their countries.

I am very proud of the input of Alan O'Mara at national level. He is a Cavan football star and a native of Bailieborough who has talked about his own mental health issues on national television and radio and talked to young people at many events around the country. It has had a huge effect. He is a very important role model for our young people, as is another Cavan man from the Ballyjamesduff area, Jamie McGrath, who has recently written a book on anxiety. This has also been very reassuring and pioneering work. Mr. McGrath is also an important role model for young people. These are the real leaders young people need. They have created great awareness.

Cavan County Council held a debate in the past couple of weeks on this issue. It is great to see this at local authority level. Needless to say, a cross-party consensus emerged about the importance of suicide awareness. Training in suicide awareness will be provided for members of Cavan County Council and front-of-house staff. This is very progressive. I am proud of those things and proud to come from that kind of background.

The traditional neighbourliness, meitheal and camaraderie that existed historically in rural and urban communities in Ireland was possibly born out of poverty or a time when the non-nuclear or extended family was far more focused than it is nowadays.

That old neighbourliness was a great assistance to good mental health, maybe unwittingly, and we must try to re-establish it.

I commend the Minister of State, Deputy Kathleen Lynch. Nobody could doubt her credentials as a very passionate and professional Minister of State in this area. Anyone who listens to her knows what a feel for the subject she has. A former Minister of State, John Moloney, was also very passionate and did a very good job in this area. It is great to have political leadership like that. I am happy the Minister of State confirmed that €125 million was ring-fenced by this Government in the worst of times. That is a real commitment to A Vision for Change. Of course it is not enough and I could write the speeches for those who would decry it as not being enough but it was very significant funding and an earnest of good intent which produced results. I am heartened that the Minister of State has committed to ring-fencing €35 million in the coming year. She says there have been 1,150 new posts since 2012 and the community mental health teams have been augmented satisfactorily. Therein lies the secret to minimising institutionalisation. Tragically, there are times when that is unavoidable but it is the last option.

I am delighted that the Minister of State is committed to making sure that the child and adolescent mental health service, CAMHS, is supported. I am a teacher and parent of three boys, and have many friends in the teaching profession and know parents, all of whom rate the CAMHS service highly. It is important that there would not be waiting lists for CAMHS but that people are seen and dealt with immediately. A waiting list is not good at any age but is particularly dangerous for children and teenagers. The Minister of State does not need a lecture from me on that. It is very important to have enough personnel in CAMHS that there are no waiting lists and that the community mental health teams do not suffer any lack of resources or people. As increasing resources become available, when there is great optimism around Exchequer returns for 2016 to 2018, it has to be the mark of a civilised, advanced and progressive society that it gives a significant share of resources to, and positively discriminates in favour of, good mental health services. I hope that when she sums up this debate the Minister of State will recommit herself to making sure there are no waiting lists for CAMHS, that the community health teams will be well resourced and ready to go and that in future there will be an increase on next year’s €35 million, especially at a time when independent economists are optimistic about Exchequer returns.

As the Minister of State often says, it is not all about money. That is far from being the only problem in respect of mental health. The big issue is attitude and our willingness to support each other and to destigmatise it. In my lifetime there has been huge destigmatisation and improvement. There is a long way to go, we are not there yet but there is a huge improvement in the attitudes to mental health that were prevalent many years ago. That is changing but there is a need for further change. The biggest challenge for us as legislators is to contribute to that change. We need the help of people like Jamie McGrath and Alan O’Mara and various sportspeople, who are role models for young people and will speak out of their own experience.

This is an important debate. The Minister of State is passionate and has been doing an excellent job. I ask her to make sure there are no waiting lists for CAMHS and to make sure we augment the community health teams. We have to continue to work for destigmatisation. That is our biggest challenge and we have a collective role in that.

I do not suppose there is a community that is not affected by suicide. In my area there were several clusters of young people who lost their lives through suicide. One parent came to me, and probably to every other public representative in the area, because she was looking for it not to happen to anyone else, if that was possible. She was still very raw. She had gone through the strategy documents and referred particularly to Connecting for Life. I had erroneously thought that the group most at risk of suicide was middle-aged men but she showed me the graph on page 3 of the document which showed the level of suicide among 15 to 19 year olds. We are very much out of kilter with many of our European counterparts. Greece and Spain are the two lowest on that scale which shows that disadvantage is not the reason for suicide.

This parent pointed to a section on page 116 of the document which refers to “SPHE, CSPE and PE, in Junior Cycle”. At senior cycle, however, the word “encourage” is used. That is the area that worries her because she said there is no in-service or specific teacher training for teachers who may be engaged with young people when something could be done. She thinks this should be mandatory rather than encouraged. She noted that the HSE has been at pains to point out how teen pregnancies have been reducing because of interventions. This is something, she said, that is at least as serious if not more so but there is no mandatory provision or discussion at that level. Her point was that we avoid talking about it. This is a cohort of people who have neither the emotional maturity nor the language to talk about it. Unless we provide it in a space where we are not dealing with a crisis we will not be intervening in a meaningful way. I heard this from somebody who had spent day and night thinking about this for many months before she spoke with me.

She is seeking to identify a contribution she can make in order to help her understand what happened and to address the problem itself at the same time.

In terms of voluntary and involuntary admissions, I would like the admissions policy to be specified when people present at accident and emergency departments because that has given rise to difficulties in a number of instances about which I will speak to the Minister separately.

I welcome the fact that we are having this debate. One of the positive developments in society as a whole in recent years has been an increase in discussion and openness about people's mental health difficulties. We are a long way from the stigma relating to mental health being fully removed but important progress has been made. The reality is that having mental health difficulties is entirely normal. One in four members of the population will experience a mental health difficulty at some stage and close to 50% of people in Ireland have had direct experience themselves or with friends and family.

When it comes to assessing the role of the Government in developments in mental health, the score card is much more negative. The reality is that austerity has been devastating in terms of mental health. Living with unemployment, low income and precarious housing is extremely damaging to people's mental health, and it is seen in the tragic rise in suicides. The figures from the National Suicide Research Foundation are shocking. By the end of 2012, the rate of male suicide was 57% higher than it might have been had the economic recession not happened. It stated that there were 476 additional male suicides on top of what "would have been expected" as a result of the collapse of the Celtic tiger. Unfortunately, the rate of death by suicide is twice as high for those who are unemployed than for those who are at work.

The impact of austerity is giving rise to mental health difficulties. We had the cuts in funding imposed under the previous Government, and continued by this Government, with the result that spending fell from approximately 13% to approximately 6% of the total health budget. We have a promise now that will improve but the reality is that it is still entirely inadequate in terms of what we need. Mental health services were among the hardest hit, with the recruitment ban representing a 10% loss in staffing levels despite the fact that the Minister's A Vision for Change estimates that we need 1,800 new staff. The comparisons with other European countries are devastating in terms of the levels of spending as a percentage of total health spending.

Does the Minister wish to respond?

I will not make a contribution because I do not think we will be coming back to this matter another day.

There are other speakers; Deputy Fleming was listed.

It is not that. I was not going to make much of a contribution anyway because what I find most offensive is that everyone who came into the House to speak got up and left afterwards. If they are so interested in mental health, the least they could do is sit down and listen to the debate.

The Minister of State has often done the same.